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Krakauer M, Gómez AM, Almeda-Valdes P, Manrique H, Ruiz Morosini ML, Godoy Jorquera G, Nunes Salles JE, Sanhueza Costa D, de Azeredo Siqueira R, Faradji RN, Rincón Ramírez A, Ré M, Fériz Bonelo K, Proietti A, Lavalle-González FJ. Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system. Diabetol Metab Syndr 2024; 16:106. [PMID: 38769575 PMCID: PMC11103952 DOI: 10.1186/s13098-024-01343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM. METHODS An executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American. RESULTS The number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM. CONCLUSION Continuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.
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Affiliation(s)
| | - Ana M Gómez
- Pontifical Javeriana University, Bogotá, Colombia
| | - Paloma Almeda-Valdes
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | - Matías Ré
- CINME Metabolic Research Center, Buenos Aires, Argentina
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Zhang Y, Li T, Yue CY, Liu Y. Associations of serum D-dimer and glycosylated hemoglobin levels with third-trimester fetal growth restriction in gestational diabetes mellitus. World J Diabetes 2024; 15:914-922. [PMID: 38766442 PMCID: PMC11099364 DOI: 10.4239/wjd.v15.i5.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/24/2024] [Accepted: 03/15/2024] [Indexed: 05/10/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a special type of diabetes that commonly occurs in women during pregnancy and involves impaired glucose tolerance and abnormal glucose metabolism; GDM is diagnosed for the first time during pregnancy and can affect fetal growth and development. AIM To investigate the associations of serum D-dimer (D-D) and glycosylated hemoglobin (HbA1c) levels with third-trimester fetal growth restriction (FGR) in GDM patients. METHODS The clinical data of 164 pregnant women who were diagnosed with GDM and delivered at the Obstetrics and Gynecology Hospital of Fudan University from January 2021 to January 2023 were analyzed retrospectively. Among these women, 63 whose fetuses had FGR were included in the FGR group, and 101 women whose fetuses had normal body weights were included in the normal body weight group (normal group). Fasting venous blood samples were collected from the elbow at 28-30 wk gestation and 1-3 d before delivery to measure serum D-D and HbA1c levels for comparative analysis. The diagnostic value of serum D-D and HbA1c levels for FGR was evaluated by receiver operating characteristic analysis, and the influencing factors of third-trimester FGR in GDM patients were analyzed by logistic regression. RESULTS Serum fasting blood glucose, fasting insulin, D-D and HbA1c levels were significantly greater in the FGR group than in the normal group, while the homeostasis model assessment of insulin resistance values were lower (P < 0.05). Regarding the diagnosis of FGR based on serum D-D and HbA1c levels, the areas under the curves (AUCs) were 0.826 and 0.848, the cutoff values were 3.04 mg/L and 5.80%, the sensitivities were 81.0% and 79.4%, and the specificities were 88.1% and 87.1%, respectively. The AUC of serum D-D plus HbA1c levels for diagnosing FGR was 0.928, and the sensitivity and specificity were 84.1% and 91.1%, respectively. High D-D and HbA1c levels were risk factors for third-trimester FGR in GDM patients (P < 0.05). CONCLUSION D-D and HbA1c levels can indicate the occurrence of FGR in GDM patients in the third trimester of pregnancy to some extent, and their combination can be used as an important index for the early prediction of FGR.
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Affiliation(s)
- Ying Zhang
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Teng Li
- Department of Interventional Radiology, The People’s Hospital of Weifang City, Weifang 261041, Shandong Province, China
| | - Chao-Yan Yue
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Yun Liu
- Department of Hematology, The People’s Hospital of Weifang City, Weifang 261041, Shandong Province, China
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Seckiner S, Bas M, Simsir IY, Ozgur S, Akcay Y, Aslan CG, Kucukerdonmez O, Cetinkalp S. Effects of Dietary Carbohydrate Concentration and Glycemic Index on Blood Glucose Variability and Free Fatty Acids in Individuals with Type 1 Diabetes. Nutrients 2024; 16:1383. [PMID: 38732629 PMCID: PMC11085728 DOI: 10.3390/nu16091383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
Monitoring glycemic control status is the cornerstone of diabetes management. This study aimed to reveal whether moderate-carbohydrate (CHO) diets increase the risk of free fatty acid (FFA) levels, and it presents the short-term effects of four different diet models on blood sugar, glycemic variability (GV), and FFA levels. This crossover study included 17 patients with type 1 diabetes mellitus to identify the effects of four diets with different CHO contents and glycemic index (GI) on GV and plasma FFA levels. Diet 1 (D1) contained 40% CHO with a low GI, diet 2 (D2) contained 40% CHO with a high GI, diet 3 (D3) contained 60% CHO with a low GI, and diet 4 (D4) contained 60% CHO with a high GI. Interventions were performed with sensor monitoring in four-day periods and completed in four weeks. No statistical difference was observed among the groups in terms of blood glucose area under the curve (p = 0.78), mean blood glucose levels (p = 0.28), GV (p = 0.59), and time in range (p = 0.567). FFA and total triglyceride levels were higher in the D1 group (p < 0.014 and p = 0.002, respectively). Different diets may increase the risk of cardiovascular diseases by affecting GI, FFA, and blood glucose levels.
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Affiliation(s)
- Selda Seckiner
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İstanbul Beykent University, Istanbul 34520, Turkey
- Institute of Health Sciences, Acibadem Mehmet Ali Aydınlar University, Istanbul 34450, Turkey
| | - Murat Bas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem Mehmet Ali Aydınlar University, Istanbul 34450, Turkey;
| | - Ilgin Yildirim Simsir
- Division of Endocrinology and Metabolism Disorders, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir 35100, Turkey; (I.Y.S.); (S.C.)
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, Izmir 35100, Turkey;
| | - Yasemin Akcay
- Department of Medical Biochemistry, Faculty of Medicine, Ege University, Izmir 35100, Turkey;
| | - Cigdem Gozde Aslan
- Department of Medical Biochemistry, Faculty of Medicine, Biruni University, Istanbul 34010, Turkey;
| | - Ozge Kucukerdonmez
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ege University, Izmir 35100, Turkey;
| | - Sevki Cetinkalp
- Division of Endocrinology and Metabolism Disorders, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir 35100, Turkey; (I.Y.S.); (S.C.)
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Chen C, Zhou Y, Xu JY, Song HY, Yin XW, Gu ZJ. Effect of peer support interventions in patients with type 2 diabetes: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 122:108172. [PMID: 38320444 DOI: 10.1016/j.pec.2024.108172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE This study aims to assess the effectiveness of a peer support intervention on the quality of life (QOL), self-management, self-efficacy, glycated hemoglobin (HbA1c), and depression in patients with type 2 diabetes mellitus (T2DM). METHODS A systematic review was conducted by searching 10 databases, namely PubMed, The Cochrane Library, Embase, Medline, CINHAL, Web of Science, Sinomed, CNKI, WanFang Data, and VIP for articles published from January 1974 to April 2023. RESULTS A total of 12 studies were included. A narrative synthesis of the results showed that peer support significantly improved QOL, self-management, self-efficacy, and HbA1c control in patients with T2DM, but had no significant effect on depression. CONCLUSION Peer support is an effective intervention for individuals with T2DM. Future research should focus on more rigorously designed and larger-sample studies. PRACTICE IMPLICATIONS Peer support proves to be effective for managing patients with T2DM. Current peer support interventions can provide valuable ideas that can guide the direction of future research.
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Affiliation(s)
- Chen Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yuan Zhou
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jia-Yi Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hai-Yan Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xu-Wen Yin
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ze-Juan Gu
- School of Nursing, Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Romero-Rosales JA, Aragones DG, Escribano-Serrano J, Borrachero MG, Doña AM, Macías López FJ, Santos Mata MA, Jiménez IN, Casamitjana Zamora MJ, Serrano H, Belmonte-Beitia J, Durán MR, Calvo GF. Integrated modeling of labile and glycated hemoglobin with glucose for enhanced diabetes detection and short-term monitoring. iScience 2024; 27:109369. [PMID: 38500833 PMCID: PMC10946329 DOI: 10.1016/j.isci.2024.109369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024] Open
Abstract
Metabolic biomarkers, particularly glycated hemoglobin and fasting plasma glucose, are pivotal in the diagnosis and control of diabetes mellitus. Despite their importance, they exhibit limitations in assessing short-term glucose variations. In this study, we propose labile hemoglobin as an additional biomarker, providing insightful perspectives into these fluctuations. By utilizing datasets from 40,652 retrospective general participants and conducting glucose tolerance tests on 60 prospective pediatric subjects, we explored the relationship between plasma glucose and labile hemoglobin. A mathematical model was developed to encapsulate short-term glucose kinetics in the pediatric group. Applying dimensionality reduction techniques, we successfully identified participant subclusters, facilitating the differentiation between diabetic and non-diabetic individuals. Intriguingly, by integrating labile hemoglobin measurements with plasma glucose values, we were able to predict the likelihood of diabetes in pediatric subjects, underscoring the potential of labile hemoglobin as a significant glycemic biomarker for diabetes research.
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Affiliation(s)
- José Antonio Romero-Rosales
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
| | - David G. Aragones
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
| | | | | | - Alfredo Michán Doña
- UGC Internal Medicine, University Hospital of Jerez and Department of Medicine, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | | | - Hélia Serrano
- Department of Mathematics, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Juan Belmonte-Beitia
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
| | - María Rosa Durán
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Hospital Universitario Puerta del Mar, Cádiz, Spain
- Department of Mathematics, University of Cádiz, Puerto Real, Cádiz, Spain
| | - Gabriel F. Calvo
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
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Li X, Shi Y, Wei D, Gong Y, Yan X, Cai S. Knowledge, attitude, and practice toward weight management among diabetic patients in Qidong City, Jiangsu Province. BMC Public Health 2024; 24:922. [PMID: 38553699 PMCID: PMC10979591 DOI: 10.1186/s12889-024-18392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Weight management is an effective prevention and treatment strategy for diabetes mellitus. This study aimed to assess the knowledge, attitude, and practice (KAP) of diabetic patients towards weight management. METHODS Diabetic patients treated at Qidong City, Jiangsu Province, between January 2023 and June 2023 were included in this cross-sectional study. A self-designed questionnaire was used to collect their demographic characteristics and KAP toward weight management. Structural equation modeling (SEM) was employed to examine the inter-relationships among KAP scores. RESULTS Among a total of 503 valid questionnaires that were collected, 55.07% were filled out by men and 54.67% by those aged < 60 years. The mean scores for knowledge, attitude, and practice were 8.03 ± 3.525 (possible range: 0-13), 31.88 ± 3.524 (possible range: 10-50), and 22.24 ± 3.318 (possible range: 9-45), respectively. Pearson's correlation analysis revealed the knowledge was positively associated with attitude (r = 0.295, P < 0.001) and practice (r = 0.131, P < 0.001), and attitude was positively associated with practice (r = 0.140, P = 0.002). SEM demonstrated positive associations between knowledge and attitude (β = 0.28, P < 0.001), and attitude and practice (β = 0.09, P = 0.019). Moreover, older age was negatively associated with knowledge (β=-0.04, P = 0.001), while higher education (β = 1.220, P < 0.001), increased monthly income (β = 0.779, P < 0.001), diagnosis of fatty liver (β = 1.03, P = 0.002), and screening for excess visceral fat (β = 1.11, P = 0.002) were positively associated with knowledge. CONCLUSION Diabetic patients showed moderate knowledge, neutral attitudes, and inappropriate practices toward weight management. Knowledge was positively associated with attitude and practice. These findings provided valuable directions for healthcare interventions targeting improved KAP status of weight management among diabetic patients.
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Affiliation(s)
- Xiaofeng Li
- Department of Endocrinology, Metabolic Managament Center, Qidong People's Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, 226200, Qidong, China.
| | - Yu Shi
- Department of Endocrinology, Metabolic Managament Center, Qidong People's Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, 226200, Qidong, China
| | - Dongqin Wei
- Department of Endocrinology, Metabolic Managament Center, Qidong People's Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, 226200, Qidong, China
| | - Yan Gong
- Department of Endocrinology, Metabolic Managament Center, Qidong People's Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, 226200, Qidong, China
| | - Xinyi Yan
- Department of Endocrinology, Metabolic Managament Center, Qidong People's Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, 226200, Qidong, China
| | - Shengnan Cai
- Department of Endocrinology, Metabolic Managament Center, Qidong People's Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, 226200, Qidong, China
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Dimitri Guy Rohner, Lukas Burget, Christoph Henzen, Stefan Fischli. Impact on diabetes control and patient-reported outcomes of a newer implantable continuous glucose monitoring system (Eversense® CGM System): a single-centre retro- and prospective observational study. Swiss Med Wkly 2024; 154:3366. [PMID: 38579290 DOI: 10.57187/s.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
AIMS OF THE STUDY The Eversense® CGM System is the first and only continuous glucose monitoring system (CGMS) that uses a fully subcutaneous implanted sensor. This study aimed to evaluate effectiveness, safety and patient-reported outcomes in patients using the Eversense® CGM System in a realistic clinical setting, assessed at a single Swiss diabetes centre (Luzerner Kantonsspital) with prolonged follow-up. METHODS This was a prospective and retrospective observational study that included patients with type 1 diabetes mellitus in whom at least one Eversense® glucose sensor was implanted between 2017 and 2022. The primary endpoint was the change in HbA1c levels from the baseline (before implantation of the sensor) to 6 ± 2 and 12 ± 2 months and the last follow-up (newest available value) after implantation. The secondary outcome measures were the number of premature sensor breakdowns, adverse events related to the implantation procedure (infection, bleeding, difficulties with implantation or explantation) and patient-related outcomes (assessed with a questionnaire). RESULTS A total of 33 patients participated in this study. The median follow-up time was 50 (IQR 22.3-58.5) months. In total, 178 sensor implantations were performed. Valid HbA1c results were available for 26 participants. Compared to the baseline values, HbA1c levels at 6 and 12 months and the last follow-up changed by -0.25%, -0.45 and -0.2 (p = 0.278, 0.308 and 0.296, respectively). We recorded 16 (9%) premature sensor breakdowns, all occurring between 2019 and 2020. Apart from one late-onset infection and four complicated sensor removals, no major complications were assessed. The results of the questionnaire showed a subjective improvement in hypoglycaemia rates, a better perception of hypoglycaemia and the impression of better diabetes management. Common issues with the device reported by the patients were technical errors (connection problems) and problems with the removal procedure. CONCLUSIONS The use of the Eversense® CGM System resulted in changes in HbA1c of between -0.2% and -0.45%. The rate of premature sensor breakdown was low. Major complications following sensor implantation or removal were absent, apart from one case of infection and four cases of complicated removal. Patient-reported outcomes with the Eversense® CGM System showed a subjective positive impact on hypoglycaemia rates, greater confidence in managing hypoglycaemia and diabetes in general, and easy handling of the transmitter and mobile app. Technical issues must be considered but are nowadays, with the use of the newest sensor generation, very rare.
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Affiliation(s)
- Dimitri Guy Rohner
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Lukas Burget
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Christoph Henzen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Fischli
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
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Mukherjee S, Yadav P, Ray SK, Jadhav AA, Wakode SL. Clinical Risk Assessment and Comparison of Bias between Laboratory Methods for Estimation of HbA1c for Glycated Hemoglobin in Hyperglycemic Patients. Curr Diabetes Rev 2024; 20:e261023222764. [PMID: 37921160 DOI: 10.2174/0115733998257140231011102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. OBJECTIVES To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs. HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the Clinical biochemistry laboratory. METHODS The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). RESULTS There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. CONCLUSION The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.
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Affiliation(s)
- Sukhes Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Prasant Yadav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Suman Kumar Ray
- Independent Researcher, Bhopal, Madhya Pradesh, 462020, India
| | - Ashish A Jadhav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Santosh L Wakode
- Department of Physiology. All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
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Mukherjee S, Ray SK, Jadhav AA, Wakode SL. Multi-level Analysis of HbA1c in Diagnosis and Prognosis of Diabetic Patients. Curr Diabetes Rev 2024; 20:e251023222697. [PMID: 37921158 DOI: 10.2174/0115733998262501231015051317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D), a multifaceted metabolic disorder, may cause health tribulations and changes in biochemical blood markers. Other research has examined the relationships between several biomarkers and the risk of T2D. Few studies have examined the relationships between these biomarkers and potential changes to the network of biomarkers associated with diabetes. METHOD Glycated hemoglobin, or HbA1c, is used to evaluate and track the blood glucose history throughout the previous two to three months of testing. The ability to reflect the cumulative glycemic history of the previous two to three months makes HbA1c an essential biomarker of long-term glycemic control. HbA1c offers a trustworthy indicator of chronic hyperglycemia and strongly correlates with the likelihood of long-term consequences from diabetes. RESULT Additionally, elevated HbA1c has been recognized as a stand-alone risk factor for patients with and without diabetes developing coronary heart disease and stroke. One HbA1c test offers a wealth of information that makes it a reliable biomarker for the diagnosis and prognosis of diabetes. A clinical examination may be required to establish the connection between diabetes, prediabetes, biochemical blood indicators, age, and body mass index (BMI). CONCLUSION We observed that diabetes, BMI, age, HbA1c, cholesterol, triglycerides, LDL, VLDL, and HDL were all linked using multivariate analysis.
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Affiliation(s)
- Sukhes Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Suman Kumar Ray
- Independent Researcher, Bhopal, Madhya Pradesh, 462020, India
| | - Ashish A Jadhav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Santosh L Wakode
- Department of Physiology All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
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Sakane N, Hirota Y, Yamamoto A, Miura J, Takaike H, Hoshina S, Toyoda M, Saito N, Hosoda K, Matsubara M, Tone A, Kawashima S, Sawaki H, Matsuda T, Domichi M, Suganuma A, Sakane S, Murata T. Association of scan frequency with CGM-derived metrics and influential factors in adults with type 1 diabetes mellitus. Diabetol Int 2024; 15:109-116. [PMID: 38264231 PMCID: PMC10800315 DOI: 10.1007/s13340-023-00655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/27/2023] [Indexed: 01/25/2024]
Abstract
Introduction This study aimed to investigate the association between scan frequency and intermittently scanned continuous glucose monitoring (isCGM) metrics and to clarify the factors affecting scan frequency in adults with type 1 diabetes mellitus (T1D). Methods We enrolled adults with T1D who used FreeStyle® Libre. Scan and self-monitoring of blood glucose (SMBG) frequency and CGM metrics from the past 90-day glucose data were collected. The receiver operating characteristic curve was plotted to obtain the optimal cutoff values of scan frequency for the target values of time in range (TIR), time above range (TAR), and time below range (TBR). Results The study was conducted on 211 adults with T1D (mean age, 50.9 ± 15.2 years; male, 40.8%; diabetes duration, 16.4 ± 11.9 years; duration of CGM use, 2.1 ± 1.0 years; and mean HbA1c, 7.6 ± 0.9%). The average scan frequency was 10.5 ± 3.3 scan/day. Scan frequency was positively correlated with TIR and negatively correlated with TAR, although it was not significantly correlated with TBR. Scan frequency was positively correlated with the hypoglycemia fear survey-behavior score, while it was negatively correlated with some glycemic variability metrics. Adult patients with T1D and good exercise habits had a higher scan frequency than those without exercise habits. The AUC for > 70% of the TIR was 0.653, with an optimal cutoff of 11 scan/day. Conclusions In real-world conditions, frequent scans were linked to improved CGM metrics, including increased TIR, reduced TAR, and some glycemic variability metrics. Exercise habits and hypoglycemia fear-related behavior might affect scan frequency. Our findings could help healthcare professionals use isCGM to support adults with T1D.Clinical Trial Registry No. UMIN000039376.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine Hyogo, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017 Japan
| | - Akane Yamamoto
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine Hyogo, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017 Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Sari Hoshina
- Division of Diabetology and Metabolism, Department of Internal Medicine Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1143 Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1143 Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565 Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565 Japan
- Department of General Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511 Japan
| | - Satoshi Kawashima
- Kanda Naika Clinic, 5-21-3 Hannan-cho, Abeno-ku, Osaka-shi, Osaka, 545-0021 Japan
| | - Hideaki Sawaki
- Sawaki Internal Medicine And Diabetes Clinic, 1-1-501A Konyamachi, Takatsuki-shi, Osaka, 569-0804 Japan
| | - Tomokazu Matsuda
- Matsuda Diabetes Clinic, 78-7 Ohtsukadai, Nishi-ku, Kobe City, Hyogo, 651-2135 Japan
| | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
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Lazar S, Ionita I, Reurean-Pintilei D, Timar B. How to Measure Glycemic Variability? A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:61. [PMID: 38256322 PMCID: PMC10818970 DOI: 10.3390/medicina60010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Optimal glycemic control without the presence of diabetes-related complications is the primary goal for adequate diabetes management. Recent studies have shown that hemoglobin A1c level cannot fully evaluate diabetes management as glycemic fluctuations are demonstrated to have a major impact on the occurrence of diabetes-related micro- and macroangiopathic comorbidities. The use of continuous glycemic monitoring systems allowed the quantification of glycemic fluctuations, providing valuable information about the patients' glycemic control through various indicators that evaluate the magnitude of glycemic fluctuations in different time intervals. This review highlights the significance of glycemic variability by describing and providing a better understanding of common and alternative indicators available for use in clinical practice.
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Affiliation(s)
- Sandra Lazar
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital Timisoara, 300041 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
| | - Ioana Ionita
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital Timisoara, 300041 Timisoara, Romania
| | - Delia Reurean-Pintilei
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases, Consultmed Medical Centre, 700544 Iasi, Romania
| | - Bogdan Timar
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
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12
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Elsheikh E, Aljohani SS, Alshaikhmubarak MM, Alhawl MA, Alsubaie AW, Alsultan N, Sharif AF, Ibrahim Ali S. Implications of Iron Deficiency Anaemia on Glycemic Dynamics in Diabetes Mellitus: A Critical Risk Factor in Cardiovascular Disease. Cureus 2023; 15:e49414. [PMID: 38149144 PMCID: PMC10750114 DOI: 10.7759/cureus.49414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a highly prevalent comorbidity in patients with diabetes, with rates estimated between 13% and 47% across studies. Iron deficiency anemia may potentially influence hemoglobin A1c (HbA1c) values, which are routinely measured to monitor long-term glycemic control in diabetes. Some evidence suggests that HbA1c may be lower in diabetics with IDA due to increased red blood cell turnover. However, current evidence elucidating the effects of IDA on HbA1c and diabetes outcomes remains inconsistent and inconclusive. OBJECTIVE This cross-sectional study aimed to evaluate the relationship between IDA, HbA1c levels, and glycemic dynamics in patients with diabetes mellitus. METHODS The study sample included 143 adult patients diagnosed with diabetes, recruited from outpatient clinics in Saudi Arabia. Iron deficiency anemia was identified through serum ferritin <100 ng/mL, transferrin saturation <20%, and hematologic parameters. The HbA1c levels were measured using standardized laboratory methods. Daily glucose profiles were obtained by continuous glucose monitoring (CGM) in a subset of patients to assess glycemic dynamics. RESULTS The prevalence of IDA was 39.9% among the diabetic cohort. Patients with IDA had a numerically higher mean HbA1c of 7.2% compared to 6.8% in non-anemic diabetics, suggesting a potential effect of IDA on HbA1c. Those with IDA also spent more time in hyperglycemic ranges, along with greater glucose variability based on CGM data. Iron deficiency measures, including low ferritin and high red cell distribution width (RDW), showed weak positive correlations with HbA1c levels. CONCLUSION Iron deficiency anemia is highly prevalent among Saudi diabetic patients and is potentially associated with inaccurate HbA1c values and poor short-term glycemic control. However, larger controlled studies are warranted to conclusively investigate mechanisms linking IDA to alterations in HbA1c and glycemic dynamics. Optimized screening and treatment of IDA may lead to more accurate diabetes monitoring and improved outcomes.
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Affiliation(s)
- Eman Elsheikh
- Cardiology, College of Medicine, Tanta University Hospital, Tanta, EGY
- Internal Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Sereen S Aljohani
- Diabetes and Endocrinology, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | | | - Meshari A Alhawl
- Dermatology, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Alhanouf W Alsubaie
- Diabetes and Endocrinology, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Norah Alsultan
- Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Asmaa F Sharif
- Clinical Medical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, SAU
- Forensic Medicine and Clinical Toxicology, College of Medicine, Tanta University Hospital, Tanta, EGY
| | - Sayed Ibrahim Ali
- Family and Community Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
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13
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Sokolov V, Yakovleva T, Penland RC, Boulton DW, Tang W. Effectiveness of dapagliflozin as an insulin adjunct in type 1 diabetes: a semi-mechanistic exposure-response model. Front Pharmacol 2023; 14:1229255. [PMID: 37954838 PMCID: PMC10634426 DOI: 10.3389/fphar.2023.1229255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction: Dapagliflozin-induced improvement of glycemic control in patients with inadequately controlled type 1 diabetes (T1D) is complicated by the delicate balance between blood glucose and exogenous insulin. In this work, we developed a semi-mechanistic population exposure-response model using pooled patient-level data to characterize the joint effect of dapagliflozin and insulin on average daily glucose concentrations and glycated hemoglobin (HbA1c) levels in patients with T1D. Methods: A non-linear mixed-effects model was developed in Monolix (Lixoft, France) and R software (R Project, www.r-project.org) using pooled patient-level data from phase 2 and phase 3 trials (NCT01498185, NCT02460978, NCT02268214). Results: Because of the apparent lack of association between bolus insulin dose and glucose concentrations measured by continuous glucose monitoring the model was able to capture the quantitative link between basal, but not bolus, insulin dose and plasma glucose. Even so, this association remained flat, with a 50% decrease in the basal insulin dose from pretreatment level, resulting in ∼5% increase in glucose exposure. Therefore, dapagliflozin efficacy was not significantly affected by the insulin dose adjustment, with 24-week HbA1c reduction on 10-mg dapagliflozin treatment changing from -0.5 [95% CI: -0.55, -0.45] to -0.42 [95%CI: -0.48, -0.36] after adjustment. At the same time, the analysis revealed ∼2-fold steeper slope of glucose-HbA1c relationship in dapagliflozin-treated patients vs. control group, suggesting the presence of additional dapagliflozin treatment-related benefits, not explained by the dapagliflozin-mediated ∼4% increase in plasma hemoglobin levels. Finally, the efficacy of 5 and 10-mg doses, represented by the mean HbA1c reduction at week 24 of dapagliflozin treatment, was shown to be notably greater than the 1- and 2.5-mg doses. Discussion: This research is an attempt to deconvolute and reconstruct dapagliflozin-HbA1c dose-response relationship in T1D by accounting for the drug's action on both daily insulin dose and plasma glucose on a subject-level. While the model is able to adequately capture the observed data, it also revealed that the variability in CGM is poorly approximated by the variability in insulin dose alone. Furthermore, the slope of CGM/HbA1c relationship may differ depending on the population and treatment scenarios. As such, a deeper dive into the physiological mechanisms is required to better quantify the intricate network of glycemic response under dapagliflozin treatment.
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Affiliation(s)
- Victor Sokolov
- M&S Decisions LLC, Moscow, Russia
- STU “Sirius”, Sochi, Russia
| | | | - Robert C. Penland
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, MA, United States
| | - David W. Boulton
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD, United States
| | - Weifeng Tang
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD, United States
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14
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Chen S, Zhu Y, Jin S, Zhao D, Guo J, Chen L, Huang Y. Association of glycemic control with hypertension in patients with diabetes: a population-based longitudinal study. BMC Cardiovasc Disord 2023; 23:501. [PMID: 37817110 PMCID: PMC10566157 DOI: 10.1186/s12872-023-03478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Diabetes increases the risk of hypertension morbidity, but whether this association is varied with glycemic control remains unknown. We aimed to examine the association of glycemic control with hypertension among individuals with diabetes. METHODS Data was from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. Participants were categorized as having adequate glycemic control (HbA1c < 7%) and inadequate glycemic uncontrol (HbA1c ≥ 7%) by combining blood glucose tests and physician's diagnoses in 2011. Incident hypertension was ascertained through self-reported physician diagnoses from 2011 to 2018. Cox proportional hazards regression models were used to examine the effect of glycemic control on hypertension. RESULTS Among 436 participants with diabetes in this study, 102 met the glycemic control standard, and 334 were insufficient glycemic control. During 7 years of follow-up, 141 individuals developed hypertension. Compared with adequate glycemic control, the hazard ratio of inadequate glycemic control on hypertension was 1.54 (95% CI, 1.07-2.21) in the multivariate model. Additionally, the influence of glycemic control on hypertension varied based on educational attainment and the presence of depressive symptoms (P for interaction < 0.05). CONCLUSIONS Insufficient glycemic control was associated with a higher risk of hypertension among individuals with diabetes. Notably, the effect of glycemic control on hypertension was more pronounced among those with lower educational attainment and those exhibiting depressive symptoms. These findings underscore the significance of vigilant glycemic monitoring, educational background considerations, and mental health assessments in managing diabetic individuals.
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Affiliation(s)
- Shengliang Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Yi Zhu
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Sihui Jin
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Dongbao Zhao
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Jianwei Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Lijin Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Yixiang Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China.
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15
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Sakane N, Hirota Y, Yamamoto A, Miura J, Takaike H, Hoshina S, Toyoda M, Saito N, Hosoda K, Matsubara M, Tone A, Kawashima S, Sawaki H, Matsuda T, Domichi M, Suganuma A, Sakane S, Murata T. To Use or Not to Use a Self-monitoring of Blood Glucose System? Real-world Flash Glucose Monitoring Patterns Using a Cluster Analysis of the FGM-Japan Study. Intern Med 2023; 62:2607-2615. [PMID: 36631091 PMCID: PMC10569920 DOI: 10.2169/internalmedicine.0639-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023] Open
Abstract
Objective This study investigated self-monitoring of blood glucose (SMBG) adherence and flash glucose monitoring patterns using a cluster analysis in Japanese type 1 diabetes (T1D) patients with intermittently scanned continuous glucose monitoring (isCGM). Methods We measured SMBG adherence and performed a data-driven cluster analysis using a hierarchical clustering in T1D patients from Japan using the FreeStyle Libre system. Clusters were based on three variables (testing glucose frequency and referred Libre data for hyperglycemia or hypoglycemia). Patients We enrolled 209 participants. Inclusion criteria were patients with T1D, duration of isCGM use ≥3 months, age ≥20 years old, and regular attendance at the collaborating center. Results The rate of good adherence to SMBG recommended by a doctor was 85.0%. We identified three clusters: cluster 1 (low SMBG test frequency but high reference to Libre data, 17.7%), cluster 2 (high SMBG test frequency but low reference to Libre data, 34.0%), and cluster 3 (high SMBG test frequency and high reference to Libra data, 48.3%). Compared with other clusters, individuals in cluster 1 were younger, those in cluster 2 had a shorter Libre duration, and individuals in cluster 3 had lower time-in-range, higher severe diabetic distress, and high intake of snacks and sweetened beverages. There were no marked differences in the incidence of diabetic complications and rate of wearing the Libre sensor among the clusters. Conclusion We stratified the patients into three subgroups with varied clinical characteristics and CGM metrics. This new substratification might help tailor diabetes management of patients with T1D using isCGM.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Akane Yamamoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Junnosuke Miura
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Japan
| | - Hiroko Takaike
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Japan
| | - Sari Hoshina
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Japan
- Department of General Medicine, Nara Medical University, Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | | | | | | | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Japan
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16
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Bragagna L, Polak C, Schütz L, Maqboul L, Klammer C, Feldbauer R, Draxler A, Clodi M, Wagner KH. Effect of Repeated Bolus and Continuous Glucose Infusion on DNA Damage and Oxidative Stress Biomarkers in Healthy Male Volunteers. Int J Mol Sci 2023; 24:13608. [PMID: 37686414 PMCID: PMC10487933 DOI: 10.3390/ijms241713608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Glucose variability (GV), which describes fluctuations in blood glucose levels within the day, is a phenomenon that is increasingly becoming the target of scientific attention when it comes to increased risk of coronary heart disease. Effects of GV may contribute to the development of metabolic syndrome and type 2 diabetes. Hyperglycemia can lead to oxidative stress resulting in molecular damage due to accumulation of reactive oxygen species (ROS). To discover more about the immediate effects of GV, continuous vs. bolus intravenous glucose administration was applied to 10 healthy men aged 21-30 years over a time frame of 48 h. Whole blood and plasma were analyzed for DNA damage using a comet assay with 3 different treatments (lysis buffer, H2O2, and the lesion-specific enzyme formamidopyrimidine DNA glycosylase (FPG)) as well as for the oxidative stress markers protein carbonyls (PC), unconjugated bilirubin (UCB), and ferric reducing antioxidant power (FRAP). A significant time effect was found in the three DNA damage treatments as well as in PC and UCB possibly due to circadian changes on oxidative stress, but no intervention group effect was observed for any of the markers. In conclusion, bolus vs. continuous glucose administration had no significant acute effect on DNA damage and markers of oxidative stress in healthy men.
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Affiliation(s)
- Laura Bragagna
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria; (L.B.); (L.M.); (A.D.)
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, 1090 Vienna, Austria;
| | - Christina Polak
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria; (L.B.); (L.M.); (A.D.)
| | - Lisa Schütz
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria; (L.B.); (L.M.); (A.D.)
| | - Lina Maqboul
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria; (L.B.); (L.M.); (A.D.)
| | - Carmen Klammer
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, 1090 Vienna, Austria;
- Department of Internal Medicine, St. John of God Hospital Linz, 4020 Linz, Austria; (R.F.); (M.C.)
- ICMR–Institute for Cardiovascular and Metabolic Research, Johannes Kepler University Linz (JKU Linz), 4040 Linz, Austria
| | - Roland Feldbauer
- Department of Internal Medicine, St. John of God Hospital Linz, 4020 Linz, Austria; (R.F.); (M.C.)
| | - Agnes Draxler
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria; (L.B.); (L.M.); (A.D.)
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, 1090 Vienna, Austria;
| | - Martin Clodi
- Department of Internal Medicine, St. John of God Hospital Linz, 4020 Linz, Austria; (R.F.); (M.C.)
- ICMR–Institute for Cardiovascular and Metabolic Research, Johannes Kepler University Linz (JKU Linz), 4040 Linz, Austria
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria; (L.B.); (L.M.); (A.D.)
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Lee GW, Jung DM, Jung WC, Lee KB. Effect of diabetes mellitus on the outcomes of total ankle arthroplasty: is controlled diabetes mellitus a risk factor? J Orthop Surg Res 2023; 18:636. [PMID: 37644589 PMCID: PMC10463683 DOI: 10.1186/s13018-023-04110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND It is still uncertain whether diabetes mellitus (DM) is a risk factor for poor outcomes and increased complications after total ankle arthroplasty (TAA). The objective of this study was to compare clinical outcomes and complication rates of TAA in patients with and without DM. METHODS This study enrolled patients with symptomatic end-stage ankle osteoarthritis with a minimum follow-up period of 24 months after TAA. A total of 252 patients (266 ankles) were classified into two groups according to the presence of DM: (1) DM group (59 patients, 67 ankles) and (2) non-DM group (193 patients, 199 ankles). We defined controlled diabetes as (1) HbA1c level < 7.0%, or (2) fasting glucose level < 130 mg/dL with HbA1c level ≥ 7.0% for hospitalization period. Clinical outcomes data (Ankle Osteoarthritis Scale, American Orthopedic Foot and Ankle Society ankle-hindfoot score, Short Form-36 Physical Component Summary score, and visual analog scale for pain) were compared preoperatively and at the final follow-up between the two groups. Complications following TAA were also compared between the two groups. RESULTS All clinical variables had improved in both groups by the final follow-up (mean follow-up = 77.8 months). There was no significant difference in any clinical variable between the two groups at the final follow-up (P > 0.05). Of the 266 ankles, 73 ankles (19 in the DM group, 54 in the non-DM group) developed periprosthetic osteolysis. Although the DM group showed a higher prevalence of aseptic loosening or subsidence, the difference between the two groups was not statistically significant (P = 0.236). CONCLUSIONS In the intermediate-term follow-up, TAA in patients with controlled DM showed clinical outcomes and complication rates comparable to patients without DM. Our results suggest that TAA can be done safely in diabetic patients if the DM is controlled in the perioperative period. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Dong-Min Jung
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Woo-Chul Jung
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea.
- Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea.
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18
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Azcoitia P, Rodríguez-Castellano R, Saavedra P, Alberiche MP, Marrero D, Wägner AM, Ojeda A, Boronat M. Age and Red Blood Cell Parameters Mainly Explain the Differences Between HbA1c and Glycemic Management Indicator Among Patients With Type 1 Diabetes Using Intermittent Continuous Glucose Monitoring. J Diabetes Sci Technol 2023:19322968231191544. [PMID: 37568271 DOI: 10.1177/19322968231191544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) is the gold standard to assess glycemic control in patients with diabetes. Glucose management indicator (GMI), a metric generated by continuous glucose monitoring (CGM), has been proposed as an alternative to HbA1c, but the two values may differ, complicating clinical decision-making. This study aimed to identify the factors that may explain the discrepancy between them. METHODS Subjects were patients with type 1 diabetes, with one or more HbA1c measurements after starting the use of the Freestyle Libre 2 intermittent CGM, who shared their data with the center on the Libreview platform. The 14-day glucometric reports were retrieved, with the end date coinciding with the date of each HbA1c measurement, and those with sensor use ≥70% were selected. Clinical data prior to the start of CGM use, glucometric data from each report, and other simultaneous laboratory measurements with HbA1c were collected. RESULTS A total of 646 HbA1c values and their corresponding glucometric reports were obtained from 339 patients. The absolute difference between HbA1c and GMI was <0.3% in only 38.7% of cases. Univariate analysis showed that the HbA1c-GMI value was associated with age, diabetes duration, estimated glomerular filtration rate, mean corpuscular volume (MCV), red cell distribution width (RDW), and time with glucose between 180 and 250 mg/dL. In a multilevel model, only age and RDW, positively, and MCV, negatively, were correlated to HbA1c-GMI. CONCLUSION The difference between HbA1c and GMI is clinically relevant in a high percentage of cases. Age and easily accessible hematological parameters (MCV and RDW) can help to interpret these differences.
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Affiliation(s)
- Pablo Azcoitia
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Raquel Rodríguez-Castellano
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - María P Alberiche
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
- University Institute of Biomedical and Healthcare Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Dunia Marrero
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ana M Wägner
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
- University Institute of Biomedical and Healthcare Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio Ojeda
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Mauro Boronat
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
- University Institute of Biomedical and Healthcare Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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19
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Friedman JG, Coyne K, Aleppo G, Szmuilowicz ED. Beyond A1C: exploring continuous glucose monitoring metrics in managing diabetes. Endocr Connect 2023; 12:e230085. [PMID: 37071558 PMCID: PMC10305570 DOI: 10.1530/ec-23-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/19/2023]
Abstract
Hemoglobin A1c (HbA1c) has long been considered a cornerstone of diabetes mellitus (DM) management, as both an indicator of average glycemia and a predictor of long-term complications among people with DM. However, HbA1c is subject to non-glycemic influences which confound interpretation and as a measure of average glycemia does not provide information regarding glucose trends or about the occurrence of hypoglycemia and/or hyperglycemia episodes. As such, solitary use of HbA1c, without accompanying glucose data, does not confer actionable information that can be harnessed to guide targeted therapy in many patients with DM. While conventional capillary blood glucose monitoring (BGM) sheds light on momentary glucose levels, in practical use the inherent infrequency of measurement precludes elucidation of glycemic trends or reliable detection of hypoglycemia or hyperglycemia episodes. In contrast, continuous glucose monitoring (CGM) data reveal glucose trends and potentially undetected hypo- and hyperglycemia patterns that can occur between discrete BGM measurements. The use of CGM has grown significantly over the past decades as an ever-expanding body of literature demonstrates a multitude of clinical benefits for people with DM. Continually improving CGM accuracy and ease of use have further fueled the widespread adoption of CGM. Furthermore, percent time in range correlates well with HbA1c, is accepted as a validated indicator of glycemia, and is associated with the risk of several DM complications. We explore the benefits and limitations of CGM use, the use of CGM in clinical practice, and the application of CGM to advanced diabetes technologies.
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Affiliation(s)
- Jared G Friedman
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Kasey Coyne
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Emily D Szmuilowicz
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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20
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De Block C, Cheng AYY, Christensen TB, Patted URH, Ginovker A. Healthcare Professionals' Knowledge of and Attitudes Towards the Use of Time in Range in Diabetes Management: Online Survey Across Seven Countries. Diabetes Ther 2023:10.1007/s13300-023-01429-x. [PMID: 37332055 PMCID: PMC10299986 DOI: 10.1007/s13300-023-01429-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION Time in range (TIR) is a metric of glycaemic target management derived from continuous glucose monitoring (CGM) data. This study aimed to understand knowledge of and attitudes towards use of TIR among healthcare professionals (HCPs), and gain insights into benefits and barriers to its use in clinical practice. METHODS An online survey was disseminated across seven countries. Participants were sampled from online HCP panels and were aware of TIR (defined as amount of time in, below, and above target range). Participants were HCPs classified as specialists (SP), generalists (GP), or allied HCPs (AP; diabetes nurse specialists, diabetes educators, general nurses, nurse practitioners/physician assistants). RESULTS Respondents included 741 SP, 671 GP and 307 AP. Most HCPs (approximately 90%) agreed TIR is likely/somewhat likely to become the standard of diabetes management. Perceived benefits of TIR included helping to optimise medication regimen (SP, 71%; GP, 73%; AP, 74%), giving HCPs the knowledge and insights to make informed clinical decisions (SP, 66%; GP, 61%; AP, 72%), and empowering people with diabetes with information to successfully manage their diabetes (SP, 69%; GP, 77%; AP, 78%). Barriers to wider adoption included limited CGM access (SP, 65%; GP, 74%; AP, 69%) and lack of HCP training/education (SP, 45%; GP, 59%; AP, 51%). Most participants considered integration of TIR into clinical guidelines, recognition of TIR by regulators as a primary clinical endpoint, and recognition of TIR by payers as a parameter for diabetes treatment evaluation as key factors for increased use. CONCLUSIONS Overall, HCPs agreed on the benefits of using TIR for diabetes management. Besides raising awareness among HCPs and people with diabetes, more training and healthcare system updates are needed to facilitate increased TIR use. In addition, integration into clinical guidelines and recognition by regulators and payers are needed.
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Affiliation(s)
- Christophe De Block
- Laboratory of Experimental Medicine and Paediatrics, Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- University Hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | - Alice Y Y Cheng
- Trillium Health Partners and Unity Health, University of Toronto, Toronto, ON, Canada
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21
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Sun R, Duan Y, Zhang Y, Feng L, Ding B, Yan R, Ma J, Su X. Time in Range Estimation in Patients with Type 2 Diabetes is Improved by Incorporating Fasting and Postprandial Glucose Levels. Diabetes Ther 2023:10.1007/s13300-023-01432-2. [PMID: 37328714 PMCID: PMC10299970 DOI: 10.1007/s13300-023-01432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Time in range (TIR) as assessed by continuous glucose monitoring (CGM) measures an individual's glucose fluctuations within set limits in a time period and is increasingly used together with HbA1c in patients with diabetes. HbA1c indicates the average glucose concentration but provides no information on glucose fluctuation. However, before CGM becomes available for patients with type 2 diabetes (T2D) worldwide, especially in developing nations, fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) are still the common biomarkers used for monitoring diabetes conditions. We investigated the importance of FPG and PPG to glucose fluctuation in patients with T2D. We used machine learning to provide a new estimate of TIR based on the HbA1c, together with FPG and PPG. METHODS This study included 399 patients with T2D. (1) Univariate and (2) multivariate linear regression models and (3) random forest regression models were developed to predict the TIR. Subgroup analysis was performed in the newly diagnosed T2D population to explore and optimize the prediction model for patients with different disease history. RESULTS Regression analysis suggests that FPG was strongly linked to minimum glucose, while PPG was strongly correlated with maximum glucose. After FPG and PPG were incorporated into the multivariate linear regression model, the prediction performance of TIR was improved compared with the univariate correlation between HbA1c and TIR, and the correlation coefficient (95% CI) increased from 0.62 (0.59, 0.65) to 0.73 (0.72, 0.75) (p < 0.001). The random forest model significantly outperformed the linear model (p < 0.001) in predicting TIR through FPG, PPG and HbA1c, with a stronger correlation coefficient 0.79 (0.79, 0.80). CONCLUSIONS The results offered a comprehensive understanding of glucose fluctuations through FPG and PPG compared to HbA1c alone. Our novel TIR prediction model based on random forest regression with FPG, PPG, and HbA1c provides a better prediction performance than the univariate model with solely HbA1c. The results indicate a nonlinear relationship between TIR and glycaemic parameters. Our results suggest that machine learning may have the potential to be used in developing better models for understanding patients' disease status and providing necessary interventions for glycaemic control.
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Affiliation(s)
- Rui Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yanli Duan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yumei Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rengna Yan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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22
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Kim R, Jayanti RP, Lee H, Kim HK, Kang J, Park IN, Kim J, Oh JY, Kim HW, Lee H, Ghim JL, Ahn S, Long NP, Cho YS, Shin JG. Development of a population pharmacokinetic model of pyrazinamide to guide personalized therapy: impacts of geriatric and diabetes mellitus on clearance. Front Pharmacol 2023; 14:1116226. [PMID: 37305528 PMCID: PMC10250603 DOI: 10.3389/fphar.2023.1116226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/19/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives: This study was performed to develop a population pharmacokinetic model of pyrazinamide for Korean tuberculosis (TB) patients and to explore and identify the influence of demographic and clinical factors, especially geriatric diabetes mellitus (DM), on the pharmacokinetics (PK) of pyrazinamide (PZA). Methods: PZA concentrations at random post-dose points, demographic characteristics, and clinical information were collected in a multicenter prospective TB cohort study from 18 hospitals in Korea. Data obtained from 610 TB patients were divided into training and test datasets at a 4:1 ratio. A population PK model was developed using a nonlinear mixed-effects method. Results: A one-compartment model with allometric scaling for body size effect adequately described the PK of PZA. Geriatric patients with DM (age >70 years) were identified as a significant covariate, increasing the apparent clearance of PZA by 30% (geriatric patients with DM: 5.73 L/h; others: 4.50 L/h), thereby decreasing the area under the concentration-time curve from 0 to 24 h by a similar degree compared with other patients (geriatric patients with DM: 99.87 μg h/mL; others: 132.3 μg h/mL). Our model was externally evaluated using the test set and provided better predictive performance compared with the previously published model. Conclusion: The established population PK model sufficiently described the PK of PZA in Korean TB patients. Our model will be useful in therapeutic drug monitoring to provide dose optimization of PZA, particularly for geriatric patients with DM and TB.
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Affiliation(s)
- Ryunha Kim
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
| | - Rannissa Puspita Jayanti
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
| | - Hongyeul Lee
- Division of Pulmonary, Critical Care Medicine, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Hyun-Kuk Kim
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea
| | - I-Nae Park
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jehun Kim
- Pulmonary Division, Department of IM, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Jee Youn Oh
- Division of Pulmonology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Heayon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Lyul Ghim
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
| | - Sangzin Ahn
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
| | - Nguyen Phuoc Long
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
| | - Yong-Soon Cho
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
| | - Jae-Gook Shin
- Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan, Republic of Korea
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
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Twigg S, Lim S, Yoo SH, Chen L, Bao Y, Kong A, Yeoh E, Chan SP, Robles J, Mohan V, Cohen N, McGill M, Ji L. Asia-Pacific Perspectives on the Role of Continuous Glucose Monitoring in Optimizing Diabetes Management. J Diabetes Sci Technol 2023:19322968231176533. [PMID: 37232515 DOI: 10.1177/19322968231176533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes.
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Affiliation(s)
- Stephen Twigg
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, South Korea
| | - Seung-Hyun Yoo
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Liming Chen
- Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine, Affiliated Sixth People's Hospital, Shanghai, China
| | - Alice Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ester Yeoh
- Diabetes Centre, Admiralty Medical Centre and Division of Endocrinology, Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Siew Pheng Chan
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Jeremyjones Robles
- Section of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Chong Hua Hospital, Cebu, Philippines
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Neale Cohen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Margaret McGill
- Central Clinical School Faculty of Medicine and Health, Diabetes Centre, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Linong Ji
- Peking University Diabetes Center, Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
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24
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Cho SH, Kim S, Lee YB, Jin SM, Hur KY, Kim G, Kim JH. Impact of continuous glucose monitoring on glycemic control and its derived metrics in type 1 diabetes: a longitudinal study. Front Endocrinol (Lausanne) 2023; 14:1165471. [PMID: 37255973 PMCID: PMC10225713 DOI: 10.3389/fendo.2023.1165471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023] Open
Abstract
Aim We explored the effectiveness of continuous glucose monitoring for 1 year on glycated A1c reduction in adults with type 1 diabetes mellitus. Methods We included type 1 diabetes mellitus adults who were either new continuous glucose monitoring users (N = 155) or non-users who were under standard care (N = 384). Glycated A1c was measured at baseline and 3, 6, 9, and 12 months. Individuals with (N = 155) or without continuous glucose monitoring use (N = 310) were matched 1:2 by propensity score. We used the linear mixed models to identify the quantitative reduction in repeated measures of glycated A1c. Results The change in glycated A1c from baseline to 12 months was -0.5% ± 1.0% for the continuous glucose monitoring user group (N = 155, P < 0.001) and -0.01% ± 1.0% for the non-user group (N = 310, P = 0.816), with a significant difference between the two groups (P = 0.003). Changes in glycated A1c were significant at 3, 6, 9, and 12 months compared with those at baseline in patients using continuous glucose monitoring (P < 0.001), and the changes differed significantly between the groups (P < 0.001). A linear mixed model showed an adjusted treatment group difference in mean reduction in glycated A1c of -0.11% (95% confidence interval, -0.16 to -0.06) each three months. In the continuous glucose monitoring user group, those who achieved more than 70% of time in range significantly increased from 3 months (37.4%) to 12 months (48.2%) (P < 0.001). Conclusion In this longitudinal study of type 1 diabetes mellitus adults, the use of continuous glucose monitoring for 1 year showed a significant reduction in glycated A1c in real-world practice.
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Affiliation(s)
- So Hyun Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seohyun Kim
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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An enzyme-free Ti 3C 2/Ni/Sm-LDH-based screen-printed-electrode for real-time sweat detection of glucose. Anal Chim Acta 2023; 1250:340981. [PMID: 36898808 DOI: 10.1016/j.aca.2023.340981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Here, we report the fabrication of an enzyme-free glucose sensor benefiting from nickel-samarium nanoparticles-decorated MXene layered double hydroxide (MXene/Ni/Sm-LDH). The electrochemical response of the MXene/Ni/Sm-LDH to glucose was studied via cyclic voltammetry (CV). The fabricated electrode has high electrocatalytic activity for glucose oxidation. The voltametric response of the MXene/Ni/Sm-LDH electrode to glucose was investigated by differential pulse voltammetry (DPV) that demonstrated an extended linear range of from 0.001 to 0.1 mM and 0.25-7.5 mM with a detection limit down to 0.24 μM (S/N = 3) and a sensitivity at 1673.54 μA mM-1 cm-2 1519.09 μA mM-1 cm-2 in concentrations of 0.01 mM and 1 mM respectively as well as good repeatability, high stability and applicability for the real sample analysis. Moreover, the as-fabricated sensor was applied to glucose detection in human sweat and showed promising results.
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Chmayssem A, Nadolska M, Tubbs E, Sadowska K, Vadgma P, Shitanda I, Tsujimura S, Lattach Y, Peacock M, Tingry S, Marinesco S, Mailley P, Lablanche S, Benhamou PY, Zebda A. Insight into continuous glucose monitoring: from medical basics to commercialized devices. Mikrochim Acta 2023; 190:177. [PMID: 37022500 DOI: 10.1007/s00604-023-05743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
According to the latest statistics, more than 537 million people around the world struggle with diabetes and its adverse consequences. As well as acute risks of hypo- or hyper- glycemia, long-term vascular complications may occur, including coronary heart disease or stroke, as well as diabetic nephropathy leading to end-stage disease, neuropathy or retinopathy. Therefore, there is an urgent need to improve diabetes management to reduce the risk of complications but also to improve patient's quality life. The impact of continuous glucose monitoring (CGM) is well recognized, in this regard. The current review aims at introducing the basic principles of glucose sensing, including electrochemical and optical detection, summarizing CGM technology, its requirements, advantages, and disadvantages. The role of CGM systems in the clinical diagnostics/personal testing, difficulties in their utilization, and recommendations are also discussed. In the end, challenges and prospects in future CGM systems are discussed and non-invasive, wearable glucose biosensors are introduced. Though the scope of this review is CGMs and provides information about medical issues and analytical principles, consideration of broader use will be critical in future if the right systems are to be selected for effective diabetes management.
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Affiliation(s)
- Ayman Chmayssem
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France
| | - Małgorzata Nadolska
- Institute of Nanotechnology and Materials Engineering, Faculty of Applied Physics and Mathematics, Gdansk University of Technology, 80-233, Gdansk, Poland
| | - Emily Tubbs
- Univ. Grenoble Alpes, CEA, INSERM, IRIG, 38000, Grenoble, Biomics, France
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
| | - Kamila Sadowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4, 02-109, Warsaw, Poland
| | - Pankaj Vadgma
- School of Engineering and Materials Science, Queen Mary University of London, Mile End, London, E1 4NS, UK
| | - Isao Shitanda
- Department of Pure and Applied Chemistry, Faculty of Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
- Research Institute for Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
| | - Seiya Tsujimura
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan
- Division of Material Science, Faculty of Pure and Applied Science, University of Tsukuba, 1-1-1, Tennodai, Ibaraki, Tsukuba, 305-5358, Japan
| | | | - Martin Peacock
- Zimmer and Peacock, Nedre Vei 8, Bldg 24, 3187, Horten, Norway
| | - Sophie Tingry
- Institut Européen Des Membranes, UMR 5635, IEM, Université Montpellier, ENSCM, CNRS, Montpellier, France
| | - Stéphane Marinesco
- Plate-Forme Technologique BELIV, Lyon Neuroscience Research Center, UMR5292, Inserm U1028, CNRS, Univ. Claude-Bernard-Lyon I, 69675, Lyon 08, France
| | - Pascal Mailley
- Univ. Grenoble Alpes, CEA, LETI, 38000, Grenoble, DTBS, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, LBFA and BEeSy, INSERM, U1055, F-38000, Grenoble, France
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Pierre Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Univ. Grenoble Alpes, Pôle DigiDune, Grenoble, France
| | - Abdelkader Zebda
- UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, INSERM, TIMC, VetAgro Sup, 38000, Grenoble, France.
- Japanese-French lAaboratory for Semiconductor physics and Technology (J-F AST)-CNRS-Université Grenoble Alpes-Grenoble, INP-University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8573, Japan.
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27
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Keshet A, Reicher L, Bar N, Segal E. Wearable and digital devices to monitor and treat metabolic diseases. Nat Metab 2023; 5:563-571. [PMID: 37100995 DOI: 10.1038/s42255-023-00778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/07/2023] [Indexed: 04/28/2023]
Abstract
Cardiometabolic diseases are a major public-health concern owing to their increasing prevalence worldwide. These diseases are characterized by a high degree of interindividual variability with regards to symptoms, severity, complications and treatment responsiveness. Recent technological advances, and the growing availability of wearable and digital devices, are now making it feasible to profile individuals in ever-increasing depth. Such technologies are able to profile multiple health-related outcomes, including molecular, clinical and lifestyle changes. Nowadays, wearable devices allowing for continuous and longitudinal health screening outside the clinic can be used to monitor health and metabolic status from healthy individuals to patients at different stages of disease. Here we present an overview of the wearable and digital devices that are most relevant for cardiometabolic-disease-related readouts, and how the information collected from such devices could help deepen our understanding of metabolic diseases, improve their diagnosis, identify early disease markers and contribute to individualization of treatment and prevention plans.
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Affiliation(s)
- Ayya Keshet
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Lee Reicher
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University (affiliated with Sackler Faculty of Medicine), Tel Aviv, Israel
| | - Noam Bar
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel.
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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Sakane N, Hirota Y, Yamamoto A, Miura J, Takaike H, Hoshina S, Toyoda M, Saito N, Hosoda K, Matsubara M, Tone A, Kawashima S, Sawaki H, Matsuda T, Domichi M, Suganuma A, Sakane S, Murata T. Factors associated with hemoglobin glycation index in adults with type 1 diabetes mellitus: The FGM-Japan study. J Diabetes Investig 2023; 14:582-590. [PMID: 36789495 PMCID: PMC10034957 DOI: 10.1111/jdi.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 02/16/2023] Open
Abstract
AIMS/INTRODUCTION The discrepancy between HbA1c and glucose exposure may have significant clinical implications; however, the association between the hemoglobin glycation index (HGI) and clinical parameters in type 1 diabetes remains controversial. This study aimed to find the factors associated with HGI (laboratory HbA1c - predicted HbA1c derived from the continuous glucose monitoring [CGM]). MATERIALS AND METHODS We conducted a cross-sectional study of adults with type 1 diabetes (n = 211, age 50.9 ± 15.2 years old, female sex = 59.2%, duration of CGM use = 2.1 ± 1.0 years). All subjects wore the CGM for 90 days before HbA1c measurement. Data derived from the FreeStyle Libre sensor were used to calculate the glucose management indicator (GMI) and glycemic variability (GV) parameters. HGI was defined as the difference between the GMI and the laboratory HbA1c levels. The participants were divided into three groups according to the HGI tertile (low, moderate, and high). Multivariate regression analyses were performed. RESULTS The female sex ratio, HbA1c, and % coefficient of variation (%CV) significantly increased over the HGI tertile, while eGFR and Hb decreased over the HGI tertile. In multivariate analysis, the factors associated with HGI were %CV and eGFR, after adjusting for HbA1c level and sex (R2 = 0.44). CONCLUSIONS This study demonstrated that HGI is associated with female sex, eGFR, and some glycemic variability indices, independently of HbA1c. Minimizing glycemic fluctuations might reduce HGI. This information provides diabetic health professionals and patients with personalized diabetes management for adults with type 1 diabetes.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Akane Yamamoto
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sari Hoshina
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of General Medicine, Nara Medical University, Nara, Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Hideaki Sawaki
- Sawaki Internal Medicine and Diabetes Clinic, Osaka, Japan
| | | | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Tuohy E, Gallagher P, Rawdon C, Murphy N, Swallow V, Lambert V. Adolescent perspectives on negotiating self-management responsibilities for type 1 diabetes with their parents. PATIENT EDUCATION AND COUNSELING 2023; 109:107629. [PMID: 36641999 DOI: 10.1016/j.pec.2023.107629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The overall purpose of this study was to explore adolescent perspectives on communicating about self-management of type 1 diabetes (T1D) and negotiating responsibilities for self-management with parents. METHODS Semi-structured interviews were conducted with 28 adolescents aged 11-17 years living with T1D. Interviews were audio-recorded, transcribed verbatim and thematically analysed. RESULTS Two themes and five subthemes were identified. The first theme, 'changing levels of involvement in self-management' describes the division of responsibility for self-management within the family and adolescents collaborating and sharing responsibilities with parents for self-management. The second theme, 'talking about self-management with parents' describes changes in patterns of parent-adolescent communication about T1D over time, adolescents' seeking parental feedback and advice and the factors that contribute to the promotion of self-management communication between adolescents and parents. CONCLUSION This study identified that how adolescents perceive communication with their parents contributes to negotiation of responsibilities for self-management during adolescence. The findings provide a nuanced understanding of adolescent perspectives on communication with parents about T1D self-management and how parent-adolescent communication can be framed in ways that promote positive adolescent engagement with T1D self-management. PRACTICE IMPLICATIONS Targeting parent-adolescent communication strategies may result in more optimal sharing of responsibilities and improved self-management.
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Affiliation(s)
- Ella Tuohy
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Caroline Rawdon
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Nuala Murphy
- Diabetes and Endocrine Unit, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Veronica Swallow
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.
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Noakes TD, Prins PJ, Volek JS, D’Agostino DP, Koutnik AP. Low carbohydrate high fat ketogenic diets on the exercise crossover point and glucose homeostasis. Front Physiol 2023; 14:1150265. [PMID: 37057184 PMCID: PMC10086139 DOI: 10.3389/fphys.2023.1150265] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
In exercise science, the crossover effect denotes that fat oxidation is the primary fuel at rest and during low-intensity exercise with a shift towards an increased reliance on carbohydrate oxidation at moderate to high exercise intensities. This model makes four predictions: First, >50% of energy comes from carbohydrate oxidation at ≥60% of maximum oxygen consumption (VO2max), termed the crossover point. Second, each individual has a maximum fat oxidation capacity (FATMAX) at an exercise intensity lower than the crossover point. FATMAX values are typically 0.3–0.6 g/min. Third, fat oxidation is minimized during exercise ≥85%VO2max, making carbohydrates the predominant energetic substrate during high-intensity exercise, especially at >85%VO2max. Fourth, high-carbohydrate low-fat (HCLF) diets will produce superior exercise performances via maximizing pre-exercise storage of this predominant exercise substrate. In a series of recent publications evaluating the metabolic and performance effects of low-carbohydrate high-fat (LCHF/ketogenic) diet adaptations during exercise of different intensities, we provide findings that challenge this model and these four predictions. First, we show that adaptation to the LCHF diet shifts the crossover point to a higher %VO2max (>80%VO2max) than previously reported. Second, substantially higher FATMAX values (>1.5 g/min) can be measured in athletes adapted to the LCHF diet. Third, endurance athletes exercising at >85%VO2max, whilst performing 6 × 800 m running intervals, measured the highest rates of fat oxidation yet reported in humans. Peak fat oxidation rates measured at 86.4 ± 6.2%VO2max were 1.58 ± 0.33 g/min with 30% of subjects achieving >1.85 g/min. These studies challenge the prevailing doctrine that carbohydrates are the predominant oxidized fuel during high-intensity exercise. We recently found that 30% of middle-aged competitive athletes presented with pre-diabetic glycemic values while on an HCLF diet, which was reversed on LCHF. We speculate that these rapid changes between diet, insulin, glucose homeostasis, and fat oxidation might be linked by diet-induced changes in mitochondrial function and insulin action. Together, we demonstrate evidence that challenges the current crossover concept and demonstrate evidence that a LCHF diet may also reverse features of pre-diabetes and future metabolic disease risk, demonstrating the impact of dietary choice has extended beyond physical performance even in athletic populations.
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Affiliation(s)
- T. D. Noakes
- Department of Medical and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - P. J. Prins
- Department of Exercise Science, Grove City College, Grove City, PA, United States
| | - J. S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - D. P. D’Agostino
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, United States
- Human Healthspan, Resilience and Performance, Institute of Human and Machine Cognition, Pensacola, FL, United States
| | - A. P. Koutnik
- Human Healthspan, Resilience and Performance, Institute of Human and Machine Cognition, Pensacola, FL, United States
- *Correspondence: A. P. Koutnik,
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Caccavale LJ, LaRose JG, Mazzeo SE, Bean MK. Development and Implementation of a Pilot Transition Preparation Intervention for Young Adults With Type 1 Diabetes in an Integrated Healthcare Setting. J Pediatr Psychol 2023; 48:228-240. [PMID: 36367835 PMCID: PMC10027053 DOI: 10.1093/jpepsy/jsac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a multisystem transition preparation intervention, SHIFT, for young adults (YAs) with type 1 diabetes (T1D). METHODS A single-arm, clinic-based pilot was conducted with 25 YAs with T1D (M age = 18.9 ± 1.0 years; 80% female), their parents (n = 25), and their providers (n = 10). Young adults and parents participated in a 6-month intervention designed to enhance transition readiness and independent diabetes management. Providers viewed a video module highlighting their role preparing YAs for transition and received individualized reports of YA's goals and transition readiness. Intervention feasibility (i.e., recruitment, retention, and engagement) and acceptability (e.g., program satisfaction) were assessed. Assessments of transition readiness, diabetes engagement, hemoglobin A1c (HbA1c), and related psychosocial variables were conducted at baseline, post-intervention (6 m), and follow-up (9 m). Paired t-tests examined 0-6 m and 0-9 m changes in study constructs. RESULTS SHIFT was feasible, evidenced by recruitment (100% of sample recruited in 4 m), retention (100% at 6 m), and YA session attendance (100%). Program satisfaction was high for YAs, parents, and providers (9.12 ± 1.40, 8.79 ± 1.56, 8.20 ± 1.30, respectively, [out of 10]). Significant improvements (with effect sizes ranging from small to medium) were observed in parent and YA-reported transition readiness at 6 and 9 m (ps<.05) and diabetes engagement at 9 m (ps<.05). Although based on limited data due to COVID-19-related disruptions, a potential reduction in HbA1c was also observed. CONCLUSION Findings support the feasibility, acceptability, and preliminary efficacy of SHIFT (although limited by the single arm design and homogeneous sample), and suggest a larger randomized controlled trial is warranted.
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Affiliation(s)
- Laura Jean Caccavale
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Melanie K Bean
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
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Goldenberg RM, Aroda VR, Billings LK, Donatsky AM, Frederiksen M, Klonoff DC, Kalyanam B, Bergenstal RM. Correlation Between Time in Range and HbA1c in People with Type 2 Diabetes on Basal Insulin: Post Hoc Analysis of the SWITCH PRO Study. Diabetes Ther 2023; 14:915-924. [PMID: 36905485 PMCID: PMC10126196 DOI: 10.1007/s13300-023-01389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION Use of continuous glucose monitoring (CGM) in people with diabetes may provide a more complete picture of glycemic control than glycated hemoglobin (HbA1c) measurements, which do not capture day-to-day fluctuations in blood glucose levels. The randomized, crossover, phase IV SWITCH PRO study assessed time in range (TIR), derived from CGM, following treatment with insulin degludec or insulin glargine U100 in patients with type 2 diabetes at risk for hypoglycemia. This post hoc analysis evaluated the relationship between TIR and HbA1c, following treatment intensification during the SWITCH PRO study. METHODS Correlation between absolute values for TIR (assessed over 2-week intervals) and HbA1c, at baseline and at the end of maintenance period 1 (M1; week 18) or maintenance period 2 (M2; week 36), were assessed by linear regression and using the Spearman correlation coefficient (rs). These methods were also used to assess correlation between change in TIR and change in HbA1c from baseline to the end of M1, both in the full cohort and in subgroups stratified by baseline median HbA1c (≥ 7.5% [≥ 58.5 mmol/mol] or < 7.5% [< 58.5 mmol/mol]). RESULTS A total of 419 participants were included in the analysis. A moderate inverse linear correlation was observed between TIR and HbA1c at baseline (rs -0.54), becoming stronger following treatment intensification during maintenance periods M1 (weeks 17-18: rs -0.59) and M2 (weeks 35-36: rs -0.60). Changes in TIR and HbA1c from baseline to end of M1 were also linearly inversely correlated in the full cohort (rs -0.40) and the subgroup with baseline HbA1c ≥ 7.5% (rs -0.43). This was less apparent in the subgroup with baseline HbA1c < 7.5% (rs -0.17) (p-interaction = 0.07). CONCLUSION Results from this post hoc analysis of data from SWITCH PRO, one of the first large interventional clinical studies to use TIR as the primary outcome, further support TIR as a valid clinical indicator of glycemic control. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03687827.
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Affiliation(s)
- Ronald M Goldenberg
- LMC Diabetes & Endocrinology, 5-1600 Steeles Ave. West, Concord, ON, L4K 4M2, Canada.
| | - Vanita R Aroda
- Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Liana K Billings
- NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | | | | | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | | | - Richard M Bergenstal
- International Diabetes Center and HealthPartners Institute, Minneapolis, MN, USA
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Prins PJ, Noakes TD, Buga A, D’Agostino DP, Volek JS, Buxton JD, Heckman K, Jones DW, Tobias NE, Grose HM, Jenkins AK, Jancay KT, Koutnik AP. Low and high carbohydrate isocaloric diets on performance, fat oxidation, glucose and cardiometabolic health in middle age males. Front Nutr 2023; 10:1084021. [PMID: 36845048 PMCID: PMC9946985 DOI: 10.3389/fnut.2023.1084021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
High carbohydrate, low fat (HCLF) diets have been the predominant nutrition strategy for athletic performance, but recent evidence following multi-week habituation has challenged the superiority of HCLF over low carbohydrate, high fat (LCHF) diets, along with growing interest in the potential health and disease implications of dietary choice. Highly trained competitive middle-aged athletes underwent two 31-day isocaloric diets (HCLF or LCHF) in a randomized, counterbalanced, and crossover design while controlling calories and training load. Performance, body composition, substrate oxidation, cardiometabolic, and 31-day minute-by-minute glucose (CGM) biomarkers were assessed. We demonstrated: (i) equivalent high-intensity performance (@∼85%VO2max), fasting insulin, hsCRP, and HbA1c without significant body composition changes across groups; (ii) record high peak fat oxidation rates (LCHF:1.58 ± 0.33g/min @ 86.40 ± 6.24%VO2max; 30% subjects > 1.85 g/min); (iii) higher total, LDL, and HDL cholesterol on LCHF; (iv) reduced glucose mean/median and variability on LCHF. We also found that the 31-day mean glucose on HCLF predicted 31-day glucose reductions on LCHF, and the 31-day glucose reduction on LCHF predicted LCHF peak fat oxidation rates. Interestingly, 30% of athletes had 31-day mean, median and fasting glucose > 100 mg/dL on HCLF (range: 111.68-115.19 mg/dL; consistent with pre-diabetes), also had the largest glycemic and fat oxidation response to carbohydrate restriction. These results: (i) challenge whether higher carbohydrate intake is superior for athletic performance, even during shorter-duration, higher-intensity exercise; (ii) demonstrate that lower carbohydrate intake may be a therapeutic strategy to independently improve glycemic control, particularly in those at risk for diabetes; (iii) demonstrate a unique relationship between continuous glycemic parameters and systemic metabolism.
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Affiliation(s)
- Philip J. Prins
- Department of Exercise Science, Grove City College, Grove City, PA, United States,*Correspondence: Philip J. Prins,
| | - Timothy D. Noakes
- Department of Medical and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Alex Buga
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Dominic P. D’Agostino
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, United States
| | - Jeff S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Jeffrey D. Buxton
- Department of Exercise Science, Grove City College, Grove City, PA, United States
| | - Kara Heckman
- Nebraska Methodist Health System, Omaha, NE, United States
| | - Dalton W. Jones
- Department of Exercise Science, Grove City College, Grove City, PA, United States
| | - Naomi E. Tobias
- Department of Exercise Science, Grove City College, Grove City, PA, United States
| | - Holly M. Grose
- Department of Exercise Science, Grove City College, Grove City, PA, United States
| | - Anna K. Jenkins
- Department of Exercise Science, Grove City College, Grove City, PA, United States
| | - Kelli T. Jancay
- Department of Exercise Science, Grove City College, Grove City, PA, United States
| | - Andrew P. Koutnik
- Human Healthspan, Resilience, and Performance, Institute for Human and Machine Cognition, Pensacola, FL, United States,Andrew P. Koutnik,
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Sugimoto T, Tokuda H, Miura H, Kawashima S, Ando T, Kuroda Y, Matsumoto N, Fujita K, Uchida K, Kishino Y, Sakurai T. Cross-sectional association of metrics derived from continuous glucose monitoring with cognitive performance in older adults with type 2 diabetes. Diabetes Obes Metab 2023; 25:222-228. [PMID: 36082514 DOI: 10.1111/dom.14866] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
AIM To examine the association between continuous glucose monitoring (CGM)-derived metrics and cognitive performance in older adults with type 2 diabetes (T2D). MATERIALS AND METHODS A total of 100 outpatients with T2D aged 70 years or older were analysed. Participants underwent CGM for 14 days. As CGM-derived metrics, mean sensor glucose (SG), glucose coefficient of variation (CV), time in range (TIR; 70-180 mg/dl), time above range (TAR; > 180 mg/dl) and time below range (TBR; < 70 mg/dl), were calculated. Participants underwent cognitive tests, including the Japanese version of the Montreal Cognitive Assessment (MoCA-J), a delayed word-recall test from the Alzheimer's Disease Assessment Scale-cognitive subscale, a digit symbol substitution test, a letter word fluency test, a trail-making test (TMT) and digit span test (DSP). RESULTS In multiple regression analyses adjusted for confounders, a higher mean SG was associated with a lower performance in MoCA-J and TMT part B (TMT-B) (P < .05). A higher TAR was associated with a lower performance in TMT-B and DSP-backward (P < .05). By contrast, a higher TIR was associated with better function in TMT-B and DSP-backward (P < .05). Furthermore, CV and TBR were not associated with any cognitive function. CONCLUSION Hyperglycaemia metrics and TIR derived from CGM are associated with cognitive functions, especially with executive function and working memory, in older adults with T2D.
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Affiliation(s)
- Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Haruhiko Tokuda
- Department of Clinical Laboratory, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Metabolic Research, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Endocrinology and Metabolism, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hisayuki Miura
- Department of Endocrinology and Metabolism, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Home Care and Regional Liaison Promotion, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shuji Kawashima
- Department of Endocrinology and Metabolism, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takafumi Ando
- Human-Centered Mobility Research Center, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Yujiro Kuroda
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nanae Matsumoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kosuke Fujita
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Yoshinobu Kishino
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
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Peter A, Tajudheen N, Ramamoorthy S. Antidiabetic effect of Borassus flabellifer L. extracts on streptozotocin-induced diabetic rats. BIOMEDICAL AND BIOTECHNOLOGY RESEARCH JOURNAL (BBRJ) 2023. [DOI: 10.4103/bbrj.bbrj_4_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Feldbauer R, Heinzl MW, Klammer C, Resl M, Pohlhammer J, Rosenberger K, Almesberger V, Obendorf F, Schinagl L, Wagner T, Egger M, Dieplinger B, Clodi M. Effect of repeated bolus and continuous glucose infusion on a panel of circulating biomarkers in healthy volunteers. PLoS One 2022; 17:e0279308. [PMID: 36574434 PMCID: PMC9794098 DOI: 10.1371/journal.pone.0279308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 12/29/2022] Open
Abstract
HYPOTHESIS Glycaemic variability (GV) refers to fluctuations in the blood glucose level and may contribute to complications in patients suffering from Diabetes. Several studies show negative effects of GV on the cardiovascular system, however there is still a lack of conclusive evidence. Using an explorative cardiovascular panel, it is possible to simultaneously measure the effects on proteins relevant for cardiovascular processes. The aim of this study was to investigate the effects of rapid glucose excursions on cardiovascular and metabolic parameters in healthy individuals. METHODS An explorative single-blinded cross-over study was performed in ten healthy men. Subjects received 3 times 20 grams of glucose i.v. over 5 minutes or 60 grams of glucose continuously over 3 hours. Blood was taken for repeated measurements of the cardiovascular panel over the following 6 hours and again after 24 and 48 hours. RESULTS We observed a significant elevation of 7 cardiovascular biomarkers (BMP6, SLAMF7, LOX-1, ADAMTS13, IL-1RA, IL-4RA, PTX3) at t = 360min after rapid glucose infusion compared to a continuous glucose infusion. CONCLUSIONS Intraday GV seems to have acute effects on cardiovascular proteins in healthy test persons. Rapid glucose administration compared to continuous administration showed significant changes in BMP6, SLAMF7, ADAMTS13, IL1RA, PTX3, IL-4RA and LOX-1. CLINICAL TRIAL REGISTRATION NCT04488848.
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Affiliation(s)
- Roland Feldbauer
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
| | - Matthias Wolfgang Heinzl
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
- ICMR–Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
| | - Carmen Klammer
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
- ICMR–Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
| | - Michael Resl
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
- ICMR–Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
| | - Johannes Pohlhammer
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
| | | | - Verena Almesberger
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
| | - Florian Obendorf
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
| | - Lukas Schinagl
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
| | - Thomas Wagner
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
| | - Margot Egger
- Department of Laboratory Medicine, Ordensklinikum Linz, Linz, Austria
| | | | - Martin Clodi
- Department of Internal Medicine, St. John of God Hospital Linz, Linz, Austria
- ICMR–Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
- * E-mail:
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Mehta A, Bansal R, Kaur S. Correlation of oxidative stress with vitamin D and glycated hemoglobin in patients with type 2 diabetes mellitus. Proc AMIA Symp 2022; 36:34-37. [PMID: 36578601 PMCID: PMC9762810 DOI: 10.1080/08998280.2022.2134724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) has a heavy disease burden and is one of the leading causes of death worldwide. It is considered to be evolving from a complex and multifactorial metabolic disorder to an inflammatory condition. The strong link between hyperglycemia and oxidative stress has long been established. Oxidative stress leads to the generation of inflammatory mediators and reactive oxygen species, which results in an inflammatory state, which plays a key role in the pathogenesis of diabetic complications. Vitamin D is also known to affect insulin sensitivity. We aimed to correlate the levels of glycated hemoglobin (HbA1c) and vitamin D with oxidative stress. This cross-sectional study included 100 patients with T2DM. Oxidative stress was estimated by lipid peroxidation assay for activity of malondialdehyde (MDA), as well as superoxide dismutase (SOD) levels. HbA1c was estimated using ion-exchange chromatography. Vitamin D was estimated using enzyme-linked immunosorbent assay. The data were analyzed using a t test. The results showed that as the duration of T2DM increased, the levels of SOD and MDA also increased. No significant correlation was found between SOD and MDA with HbA1c (P = 0.995 and 0.195) and vitamin D (P = 0.874 and 0.051), respectively.
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Affiliation(s)
- Aryan Mehta
- Department of Biochemistry, Government Medical College, Amritsar, Punjab, India
| | - Radha Bansal
- Department of Biochemistry, Government Medical College, Amritsar, Punjab, India
| | - Sukhraj Kaur
- Department of Biochemistry, Government Medical College, Amritsar, Punjab, India,Corresponding author: Sukhraj Kaur, PhD, MSc, Department of Biochemistry, Government Medical College, Amritsar, Circular Road Amritsar, Punjab143001, India (e-mail: )
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Teo WZ, See JY, Ramazanu S, Chan JCY, Wu XV. Effect of lactic acid fermented foods on glycemic control in diabetic adults: a systemic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2022; 64:2863-2878. [PMID: 36178255 DOI: 10.1080/10408398.2022.2128032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Lactic acid bacteria (LAB) fermented foods are reported to have potential in managing glycemic control. This systematic review aimed to evaluate the effectiveness of LAB-fermented foods on improving glycemic control in adults with prediabetics or type 2 diabetes mellitus (T2DM). Randomized controlled trials (RCTs) on LAB fermentation-related foods were searched on PubMed, Cochrane, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Sixteen RCTs were included, and the results concluded LAB-fermented food had significant effects in HbA1c (Z = 6.24, MD = -0.05, CI: -0.07 to -0.04, p ≤ 0.00001), fasting plasma glucose (Z = 2.50, MD = -0.16, CI: -0.29 to -0.04, p = 0.01) and fasting serum insulin (Z = 2.51, MD = -0.20, CI: -0.35 to -0.04, p = 0.01). There were significant effects on lipid profile, inflammatory markers, and body mass index in secondary analyses. Subgroup analysis suggests LAB-fermented consumption with a longer duration, younger age group and adults with T2DM, had a larger effect size. Clinicians could offer LAB-fermented food as dietary recommendations for prediabetic and diabetic adults. Larger trials are warranted to verify LAB-fermented food benefits on glycemic control. Systematic Review Registration: PROSPERO Registration No. CRD42022295220.
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Affiliation(s)
- Wei Zhou Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Yang See
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - James Chun Yip Chan
- PBTK and Exposomics Platform, Singapore Institute of Food and Biotechnology Innovation (SIFBI), Skin Omics Platform Lead, A*STAR Skin Research Labs (A*SRL), Singapore, Singapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore, Singapore
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Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction. DISEASE MARKERS 2022; 2022:2191294. [PMID: 36193498 PMCID: PMC9525741 DOI: 10.1155/2022/2191294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022]
Abstract
Objective This study was to investigate the correlation between glycated haemoglobin (HbA1c) level, cardiac function, and prognosis in patients with diabetes mellitus combined with myocardial infarction. Methods Ninety-three patients with type 2 diabetes mellitus combined with acute myocardial infarction who were hospitalized and treated in our hospital from January 2021 to June 2021 were recruited for prospective analysis and equally divided into group A (HbA1c < 6.5%), group B (6.5% ≤ HbA1c ≤ 8.5%), and group C (HbA1c > 8.5%) using the random number table method, with 31 patients in each group. General data of patients were collected on admission and blood glucose and cardiac function indexes were measured; the incidence of myocardial infarction and death during the follow-up period was recorded at 6 months after discharge. Results There was a significant difference in blood glucose (FBG) and HbA1c levels at fasting between the three groups (P < 0.05). There were statistically significant differences in plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP) and uric acid (UA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and cardiac function classification of the New York Heart Association (NYHA) among the three groups (P < 0.05). By statistical analysis, the HbA1c level was positively correlated with FBG, NT-proBNP, UA, LVEDD, LVESD, and NYHA grades but negatively correlated with LVEF (P < 0.05). The incidence rate of myocardial infarction and mortality was significantly higher in group C than in groups A and B (P < 0.05). Conclusion HbA1c level in patients with diabetes mellitus combined with myocardial infarction is closely related to the degree of cardiac function damage. Glycated haemoglobin levels are associated with the development of cardiac insufficiency in patients with acute myocardial infarction; glycated haemoglobin is also an independent predictor of major adverse cardiovascular events. Reasonable and effective blood glucose control is of great significance to the prognosis of patients.
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Glycemic Variability in Type 1 Diabetes Mellitus Pregnancies—Novel Parameters in Predicting Large-for-Gestational-Age Neonates: A Prospective Cohort Study. Biomedicines 2022; 10:biomedicines10092175. [PMID: 36140278 PMCID: PMC9495939 DOI: 10.3390/biomedicines10092175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Pregnancies with type 1 diabetes mellitus (T1DM) have a high incidence of large-for-gestational-age neonates (LGA) despite optimal glycemic control. In recent years, glycemic variability (GV) has emerged as a possible risk factor for LGA, but the results of the conducted studies are unclear. This study analyzed the association between GV and LGA development in pregnancies with T1DM. This was a prospective cohort study of patients with T1DM who used continuous glucose monitoring (CGM) during pregnancy. Patients were followed from the first trimester to birth. GV parameters were calculated for every trimester using the EasyGV calculator. The main outcomes were LGA or no-LGA. Logistic regression analysis was used to assess the association between GV parameters and LGA. In total, 66 patients were included. The incidence of LGA was 36%. The analysis extracted several GV parameters that were significantly associated with the risk of LGA. The J-index was the only significant parameter in every trimester of pregnancy (odds ratios with confidence intervals were 1.33 (1.02, 1.73), 3.18 (1.12, 9.07), and 1.37 (1.03, 1.82), respectively. Increased GV is a risk factor for development of LGA. The J-index is a possible novel GV parameter that may be assessed in all three trimesters of pregnancy together with glycated hemoglobin and time-in-range.
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Zhou W, Yang T, Xu W, Huang Y, Ran L, Yan Y, Mi J, Lu L, Sun Y, Zeng X, Cao Y. The polysaccharides from the fruits of Lycium barbarum L. confer anti-diabetic effect by regulating gut microbiota and intestinal barrier. Carbohydr Polym 2022; 291:119626. [DOI: 10.1016/j.carbpol.2022.119626] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 12/20/2022]
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Weinstein JM, Kahkoska AR. Association of Continuous Glucose Monitoring Use and Hemoglobin A1c Levels Across the Lifespan Among Individuals With Type 1 Diabetes in the US. JAMA Netw Open 2022; 5:e2223942. [PMID: 35895064 PMCID: PMC9331081 DOI: 10.1001/jamanetworkopen.2022.23942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This cross-sectional study investigates age, probability of continuous glucose monitoring use, and their association with glycemic control across the lifespan among US individuals with type 1 diabetes.
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Affiliation(s)
- Joshua M. Weinstein
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina, Chapel Hill
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Awan AM, Majeed W, Muhammad F, Faisal MN. Acacia jacquemontii ethyl acetate extract reduces hyperglycemia and pro-inflammatory markers while increasing endogenous antioxidant potential in alloxan-induced diabetic rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:52605-52617. [PMID: 35262888 DOI: 10.1007/s11356-022-19493-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
Acacia jacquemontii possess has numerous traditional therapeutic uses. The rationale of this study was to investigate the role of Acacia jacquemontii ethyl acetate extract (AJEAE) in the downregulation of hyperglycemia. The current study was performed in two parts, in vitro, through characterization (high-performance liquid chromatography), estimation of total phenolic content, total flavonoid content, antioxidant (2,2-diphenyl-1-picrylhydrazylassay), and α-amylase inhibitory activities of the studied extract, and in vivo using Wistar rats in which animals were divided into five groups NC, DC, GL, AJEAE 250 mg/kg, and AJEAE 500 mg/kg. The effects of AJEAE on fasting plasma glucose, plasma insulin, HOMA-IR, oral glucose tolerance test, glycated hemoglobin (HBA1c), lipid profile, inflammatory cytokines (Interleukin-6, tumor necrosis factor-alpha), and oxidative stress markers (lipid peroxidation, nitic oxide, superoxide dismutase, catalase, glutathione peroxidase) were evaluated. Our findings confirmed the presence of quercetin, kaempferol, gallic acid, vanillic acid, syringic acid, M-coumaric acid, sinapic acid, chlorogenic acid, cinnamic acid, and ferulic acid in AJEAE. Total flavonoid and phenolic contents in AJEAE were 83.83 mg GAE/g and 77.06 mg QE/g, respectively. Significant inhibition of DPPH (69.470%/1 mg/ml) and α-amylase (71.8%/1 mg/ml) activities were exhibited by AJEAE. Alloxan-injected rats showed marked hyperglycemia and hypoinsulinemia, and increased inflammatory marker levels as compared to normal control (p < 0.001). Additionally, raised levels of triglyceride (139.7 ± 2.771), total cholesterol (198.7 ± 1.856), very low-density lipoprotein (33.43 ± 0.2728), low-density lipoprotein (155.5 ± 2.754), lipid peroxidation, and nitric oxide (p < 0.001) and decreased levels of high-density lipoprotein (17.20 ± 0.1732), superoxide dismutase, catalase, and glutathione peroxidase were observed in diabetic rats (p < 0.001). AJEAE significantly (p < 0.05) improved the aforementioned parameters and the protective efficacy was comparable to glibenclamide. Histopathological findings also evidenced the anti-hyperglycemic properties of AJEAE through regeneration of pancreatic β cells. Conclusively, our findings demonstrated the antihyperglycemic, antihyperlipidemic, antioxidant, anti-inflammatory, and pancreatic beta β cell regenerative properties of AJEAE against alloxan-induced diabetes.
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Affiliation(s)
- Ambreen Mehmood Awan
- Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan
| | - Wafa Majeed
- Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan.
- Department of Pharmacy, University of Agriculture, Faisalabad, Pakistan.
| | - Faqir Muhammad
- Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Naeem Faisal
- Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan
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Migała M, Chałubińska-Fendler J, Zielińska M. 1,5-Anhydroglucitol as a Marker of Acute Hyperglycemia in Cardiovascular Events. Rev Diabet Stud 2022; 18:68-75. [PMID: 35831937 PMCID: PMC10044046 DOI: 10.1900/rds.2022.18.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
1,5-anhydroglucitol (1,5-AG) is a biomarker of acute hyperglycemia in diabetology and also in cardiodiabetology. It is used to monitor fluctuating glucose levels. 1,5-AG is a monosaccharide that is biochemically similar to D-glucose and originates from the nutrition. The presence of
1,5-AG in blood and tissue is nearly constant due to reabsorption in the renal proximal tubule. In acute hyperglycemia, renal reabsorption is inhibited by glucose and 1,5- AG is excreted in the urine, while its serum level decreases rapidly. 1,5-AG reflects glucose excursions over 1-3 days
to 2 weeks. In this regard, low levels of serum 1,5-AG can be a clinical marker of short- term glycemic derangements such as postprandial hyperglycemia, which is an important risk factor for the pathogenesis of coronary artery disease (CAD) as low levels of 1,5-AG reflect severe plaque calcification
in CAD and correlate with high-density lipoprotein cholesterol (HDL-C) levels. For these reasons, 1,5-AG may also be a marker for atherosclerosis; in fact an even better marker than HbA1c or fructosamine which are normally used. 1,5-AG may also be a predictor of cardiovascular disease, left
ventricular dysfunction after acute coronary syndrome (ACS), and mortality after ACS. This articles reviews the current knowledge on 1,5-AG related to its use as predictor for cardiovascular events.
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Affiliation(s)
- Marta Migała
- Department of Intensive Cardiac Therapy. Medical University of Lodz. Lodz. Poland
| | | | - Marzenna Zielińska
- Department of Intensive Cardiac Therapy. Medical University of Lodz. Lodz. Poland
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Fasting blood glucose-to-glycated hemoglobin ratio and all-cause mortality among Chinese in-hospital patients with acute stroke: a 12-month follow-up study. BMC Geriatr 2022; 22:508. [PMID: 35725369 PMCID: PMC9210760 DOI: 10.1186/s12877-022-03203-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Stroke is a leading cause of death and functional impairment in older people. To assess the prospective association between fasting blood glucose-to-glycated hemoglobin ratio and all-cause mortality and poor prognosis in stroke patients. METHODS A total of 971 Chinese inpatients with acute stroke (mean age of 65.7) were consecutively enrolled in the prospective clinical study and followed up for 12 months after discharge. Stress hyperglycemia was measured using the ratio of fasting blood glucose (FBG, mmol/L)/glycated hemoglobin (HbA1c, %). The primary outcome was all-cause mortality, and secondary outcomes were poor prognosis defined as infectious complications, a National Institutes of Health Stroke Scale (NIHSS) score ≥ 6, a Barthel Index score ≤ 60, or a modified Rankin Scale (mRS) score of 3-6, presented as multivariate-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) across the quartiles of the FBG/HbA1c ratio. RESULTS There were 35 (4.1%) all-cause deaths at 3 months and 85 (11.4%) at 12 months. The inpatients with the highest quartile of the FBG/HbA1c ratio had a higher risk of all-cause death at 3 months (adjusted OR: 5.16, 95% CI: 1.03-25.74) and at 12 months (adjusted OR: 2.59, 95% CI: 1.14-5.89)) and a higher risk of infectious complications (adjusted OR 2.37, 95% CI 1.27-4.43) and dysfunction (adjusted OR 1.79, 95% CI 1.06-3.01) during hospitalization than inpatients with the lowest quartile. CONCLUSIONS Stress hyperglycemia, measured by the FBG/HbA1c ratio, was associated with an increased risk of adverse outcomes, including all-cause death, infectious complications, and dysfunction after stroke.
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Farhan HA, Bukhari K, Grewal N, Devarasetty S, Munir K. Use of continuous glucose monitor as a motivational device for lifestyle modifications to improve glycaemic control in patients with type 2 diabetes treated with non-insulin therapies. BMJ Case Rep 2022; 15:e248579. [PMID: 35672060 PMCID: PMC9174837 DOI: 10.1136/bcr-2021-248579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/04/2022] Open
Abstract
The efficacy of continuous glucose monitors (CGM) to improve glycaemic control in individuals on intensive insulin therapy (basal and prandial) has been well established in several studies; however, there is limited evidence on its usage and efficacy in patients with type 2 diabetes (T2D) who are on non-insulin therapies. Lifestyle modifications and glucose monitoring are essential components of the management of T2D. We report a case that demonstrates the impact of CGM use as an effective tool for patient education and motivation to implement and adhere to lifestyle modifications in improving glycaemic control in a patient with long-standing poorly controlled T2D who was on oral glucose-lowering medications. CGM use is associated with high level of patient satisfaction which can improve quality of life and has the potential to reduce long-term complications related to poor glycaemic control. These observations emphasise the need to broaden the use of CGM in this patient population.
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Affiliation(s)
- Hisham Ahmed Farhan
- Endocrinology, Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Khulood Bukhari
- Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA
| | - Navneet Grewal
- Medicine, American University of Antigua College of Medicine, Saint Johns, Antigua and Barbuda
| | - Sranita Devarasetty
- Department of Medicine, American University of Antigua, Osborne, Antigua and Barbuda
| | - Kashif Munir
- Department of Medicine, Division of Endocrinology, University of Maryland Medical Center, Baltimore, Maryland, USA
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Omar SM, Musa IR, Abdelbagi O, Sharif ME, Adam I. The association between glycosylated haemoglobin and newly diagnosed hypertension in a non-diabetic Sudanese population: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:208. [PMID: 35538423 PMCID: PMC9088041 DOI: 10.1186/s12872-022-02649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glycosylated haemoglobin (HbA1c) is considered reliable for diagnosing and monitoring diabetes mellitus (DM). It also indicates cardiovascular complications related to DM. However, only a few studies have been conducted on this topic. METHODS We conducted a cross-sectional study to investigate the association between newly diagnosed hypertension and HbA1c among non-diabetic Sudanese adults. The sociodemographic characteristics of the participants in the sample were gathered using a questionnaire, and HbA1c was measured using an Ichroma machine. RESULTS Three hundred and eighty-four healthy participants were enrolled in this study. The median (interquartile range [IQR]) age was 56.0 (14.0) years, and 72.1% of the participants were female. The median (IQR) body mass index (BMI) was 31.2 (8.7) kg/m2. One hundred and fifteen (29.9%) participants presented newly diagnosed hypertension. The results of the multivariate analysis showed that age (adjusted odd ratio [AOR] = 1.03; 95% confidence interval [CI] = 1.01‒1.05); BMI (AOR = 1.09; 95% CI = 1.05‒1.14); HbA1c levels (AOR = 2.18; 95% CI = 1.29‒3.67) was positively associated with newly diagnosed hypertension. For an HbA1c level of 5.0% or more, the sensitivity and specificity of newly diagnosed hypertension were 91.3% and 28.2%, respectively (area under the curve = 0.61; 95% CI = 0.55-0.67; P ˂ 0.001). Participants who presented HbA1c levels of 5.0% or more were found to be at higher risk for newly diagnosed hypertension (AOR = 2.53; 95% CI = 1.14‒5.61). CONCLUSION The results of this study indicated a high prevalence of newly diagnosed hypertension, and HbA1c levels were positively associated with newly diagnosed hypertension.
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Affiliation(s)
- Saeed M Omar
- Faculty of Medicine, Gadarif University, Gadarif, Sudan.
| | - Imad R Musa
- Department of Medicine, Royal Commission Hospital in Al Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | - Omer Abdelbagi
- Department of Pathology, AL Qunfudhah Faculty of Medicine, Umm Al-Qura University, Al Qunfudhah, Saudi Arabia
| | - Manal E Sharif
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Gouveri E, Papanas N. The Emerging Role of Continuous Glucose Monitoring in the Management of Diabetic Peripheral Neuropathy: A Narrative Review. Diabetes Ther 2022; 13:931-952. [PMID: 35394566 PMCID: PMC9076783 DOI: 10.1007/s13300-022-01257-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
The aim of this narrative review is to present data on the role of continuous glucose monitoring (CGM) in the management of peripheral diabetic neuropathy (DPN) among individuals with type 1 and type 2 diabetes mellitus. Adequate glycaemic control is crucial to prevent the development or progression of DPN. CGM systems are valuable tools for improving glycaemic control and reducing glycaemic variability (GV). Chronic hyperglycaemia is known to be a risk factor for the development of diabetic microvascular complications, including DPN. In addition, there is now evidence that GV, evaluated by mean amplitude of glycaemic excursions, may be a novel factor in the pathogenesis of diabetic complications. Increased GV appears to be an independent risk factor for DPN and correlates with painful neuropathy. Similarly, time-in-range correlates positively with peripheral nerve function and negatively with sudomotor dysfunction. However, relevant studies are rather limited in scope, and the vast majority are cross-sectional and use different methodologies for the assessment of DPN. Therefore, the causal relationship between CGM-derived data and the development of DPN cannot be firmly established at the present time. It also remains to be elucidated whether CGM measures can be considered the new therapeutic targets for DPN management.
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Affiliation(s)
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68132, Alexandroupolis, Greece.
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Zhan Z, Li Y, Zhao Y, Zhang H, Wang Z, Fu B, Li WJ. A Review of Electrochemical Sensors for the Detection of Glycated Hemoglobin. BIOSENSORS 2022; 12:bios12040221. [PMID: 35448281 PMCID: PMC9024622 DOI: 10.3390/bios12040221] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 05/17/2023]
Abstract
Glycated hemoglobin (HbA1c) is the gold standard for measuring glucose levels in the diagnosis of diabetes due to the excellent stability and reliability of this biomarker. HbA1c is a stable glycated protein formed by the reaction of glucose with hemoglobin (Hb) in red blood cells, which reflects average glucose levels over a period of two to three months without suffering from the disturbance of the outside environment. A number of simple, high-efficiency, and sensitive electrochemical sensors have been developed for the detection of HbA1c. This review aims to highlight current methods and trends in electrochemistry for HbA1c monitoring. The target analytes of electrochemical HbA1c sensors are usually HbA1c or fructosyl valine/fructosyl valine histidine (FV/FVH, the hydrolyzed product of HbA1c). When HbA1c is the target analyte, a sensor works to selectively bind to specific HbA1c regions and then determines the concentration of HbA1c through the quantitative transformation of weak electrical signals such as current, potential, and impedance. When FV/FVH is the target analyte, a sensor is used to indirectly determine HbA1c by detecting FV/FVH when it is hydrolyzed by fructosyl amino acid oxidase (FAO), fructosyl peptide oxidase (FPOX), or a molecularly imprinted catalyst (MIC). Then, a current proportional to the concentration of HbA1c can be produced. In this paper, we review a variety of representative electrochemical HbA1c sensors developed in recent years and elaborate on their operational principles, performance, and promising future clinical applications.
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Affiliation(s)
- Zhikun Zhan
- School of Computer and Communication Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China;
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; (Y.L.); (Z.W.); (B.F.)
| | - Yang Li
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; (Y.L.); (Z.W.); (B.F.)
| | - Yuliang Zhao
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao 066004, China
- Correspondence: (Y.Z.); (W.J.L.)
| | - Hongyu Zhang
- Department of Mechanical Engineering, City University of Hong Kong, Kowloon, Hong Kong 999077, China;
| | - Zhen Wang
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; (Y.L.); (Z.W.); (B.F.)
| | - Boya Fu
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; (Y.L.); (Z.W.); (B.F.)
| | - Wen Jung Li
- Department of Mechanical Engineering, City University of Hong Kong, Kowloon, Hong Kong 999077, China;
- Correspondence: (Y.Z.); (W.J.L.)
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Song Q, Dai M, Zhao Y, Lin T, Huang L, Yue J. Association between stress hyperglycemia ratio and delirium in older hospitalized patients: a cohort study. BMC Geriatr 2022; 22:277. [PMID: 35369877 PMCID: PMC8978391 DOI: 10.1186/s12877-022-02935-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background It remains unclear whether stress hyperglycemia is associated with delirium. We performed this cohort study to determine the association between stress hyperglycemia and delirium. Methods We consecutively enrolled patients aged ≥70 years who were admitted to the Geriatric Department of West China Hospital between March 2016 and July 2017. Stress hyperglycemia ratio (SHR) was calculated as fasting blood glucose divided by estimated average glucose derived from glycosylated hemoglobin (HbA1c) and was classified into three tertiles. Delirium was screened within 24 h of admission and three times daily thereafter, using the confusion assessment method. The Cox proportional hazards models were used to assess the association of SHR with delirium. Results Among 487 included patients (mean age 83.0 years, 72.0% male), 50 (10.3%) patients experienced delirium during hospitalization. Compared to the second tertile, both the lowest and the highest SHR tertiles were independently associated with delirium (hazard ratio [HR] 3.71, 95% confidence interval [CI] 1.45-9.51; and HR 2.97, 95% CI 1.29-6.81, respectively). Similar results were found after further adjusting for statin comedication. Multiple-adjusted restricted cubic splines revealed a nonlinear relationship between SHR and delirium (Pnonlinearity=0.04). Adding SHR to conventional risk factors improved the risk prediction of delirium (net reclassification index 0.39, P=0.01; integrated discrimination improvement 0.07, P=0.03). Subgroup analyses indicated that the relationship between SHR and delirium was more apparent in patients with HbA1c <6.5%, with significantly higher HR in the first (3.65, 95% CI 1.11-11.97) and third (3.13, 95% CI 1.13-8.72) SHR tertiles compared to the second tertile, while there was no significant association between SHR and delirium in those with HbA1c ≥6.5%. Conclusions Both lower and higher SHR were associated with increased risk of delirium but only in patients with HbA1c <6.5%. Admission SHR may serve as a promising predictor of delirium, and incorporating this biomarker into prediction algorithms might have potential clinical utility in aiding delirium risk stratification, especially in those with HbA1c <6.5%. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02935-6.
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Affiliation(s)
- Quhong Song
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Miao Dai
- Jiujiang First People's Hospital, Jiujiang, China
| | - Yanli Zhao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Huang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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