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Ngaage LM, Osadebey EN, Tullie ST, Elegbede A, Rada EM, Spanakis EK, Goldberg N, Slezak S, Rasko YM. An Update on Measures of Preoperative Glycemic Control. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2240. [PMID: 31333965 PMCID: PMC6571350 DOI: 10.1097/gox.0000000000002240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 12/16/2022]
Abstract
Glycemic control represents a modifiable preoperative risk factor in surgery. Traditionally, hemoglobin A1c (HbA1c) and plasma glucose are utilized as measures of glycemic control. However, studies show mixed results regarding the ability of these conventional measures to predict adverse surgical outcomes. This may be explained by the time window captured by HbA1c and serum glucose: long-term and immediate glycemic control, respectively. Fructosamine, glycosylated albumin, and 1,5-anhydroglucitol constitute alternative metrics of glycemic control that are of growing interest but are underutilized in the field of surgery. These nontraditional measures reflect the temporal variations in glycemia over the preceding days to weeks. Therefore, they may more accurately reflect glycemic control within the time window that most significantly affects surgical outcomes. Additionally, these alternative measures are predictive of negative outcomes, even in the nondiabetic population and in patients with chronic renal disease and anemia, for whom HbA1c performs poorly. Adopting these newer metrics of glycemia may enhance the value of preoperative evaluation, such that the effectiveness of any preoperative glycemic control interventions can be assessed, and adverse outcomes associated with hyperglycemia better predicted. The goal of this review is to provide an update on the preoperative management of glycemia and to describe alternative metrics that may improve our ability to predict and control for the negative outcomes associated with poor glycemic control.
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Affiliation(s)
- Ledibabari M. Ngaage
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | | | - Sebastian T.E. Tullie
- East Kent NHS Foundation Trust, South Thames Foundation School, London, United Kingdom
| | - Adekunle Elegbede
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, University of Maryland Medical Center, Baltimore, Md
| | - Erin M. Rada
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Elias K. Spanakis
- Division of Diabetes and Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, Md
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Md
| | - Nelson Goldberg
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Sheri Slezak
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Yvonne M. Rasko
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
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Cheng L, Logan CM, Dewhurst RJ, Hodge S, Zhou H, Edwards GR. Effects of feed intake and genetics on tissue nitrogen-15 enrichment and feed conversion efficiency in sheep. J Anim Sci 2015; 93:5849-55. [PMID: 26641195 DOI: 10.2527/jas.2015-9638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study investigated the effects of sheep genetics and feed intake on nitrogen isotopic fractionation (ΔN) and feed conversion efficiency (FCE; live weight gain/DMI), using a 2 × 2 factorial design, with 2 levels of genetic merit for growth (high vs. low) and 2 levels of feed intake (110 vs. 170% of ME for maintenance [MEm]). No effect of genetic merit was detected for live weight gain ( = 0.64), FCE ( = 0.46), plasma urea nitrogen ( = 0.52), plasma glucose ( = 0.78), and ΔN of wool ( = 0.45), blood ( = 0.09), and plasma ( = 0.51). Sheep receiving 170% of MEm had 175% higher live weight gain ( < 0.001) and 77% higher FCE ( < 0.001) than sheep receiving 110% of MEm. There was no difference among treatments at the beginning of the study for either blood or plasma ∆N, but the treatment groups started to diverge in blood and plasma ∆N at 21 and 7 d, respectively. Blood, plasma, and wool samples were enriched in N compared with feed. There was a higher blood, plasma, and wool ∆N for the low feed intake group than the high feed intake group ( < 0.001 in all cases). Across the 4 treatment groups, higher FCE in sheep was associated with lower ∆N for plasma, blood, and wool. Overall, the results are consistent with the potential of ∆N as a rapid, low-cost biomarker of FCE in sheep, despite there being no effects of genetic treatment on FCE and ∆N.
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011; 34:e61-99. [PMID: 21617108 PMCID: PMC3114322 DOI: 10.2337/dc11-9998] [Citation(s) in RCA: 320] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (HbA(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA.
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2011; 57:e1-e47. [PMID: 21617152 DOI: 10.1373/clinchem.2010.161596] [Citation(s) in RCA: 308] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (Hb A(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892-1508, USA.
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Bergren DR, Rendell MS. Depressed ventilatory reflexes after capsaicin challenge in streptozotocin-treated rats. Life Sci 2004; 75:2103-16. [PMID: 15312754 DOI: 10.1016/j.lfs.2004.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Accepted: 04/09/2004] [Indexed: 11/29/2022]
Abstract
Diabetic sensory neuropathy is an affliction that decreases sensory perception in a number of organ systems. Although little is known of its pulmonary effects certain diabetic patients have reduced airway reactivity to cold air and elevated cough threshold to irritant inhalation, reflexes reported to be mediated by pulmonary C-fibers. Therefore we studied the effects the selective C-fiber activator capsaicin (0.01% aerosol, 30 s) on variables of ventilation using a whole-body plethysmograph in age-matched rats treated with streptozotocin (STZ) or its vehicle at 6 and 12 weeks after treatment. Body weight increased and plasma glucose and glycosylated hemoglobin were stable in vehicle-treated rats. In STZ-treated rats body weight decreased and plasma glucose and glycosylated hemoglobin increased. Capsaicin challenge decreased tidal volume, respiratory rate and therefore minute ventilation in non-treated and vehicle-treated rats. However capsaicin challenge increased tidal volume thereby altering minute ventilation in STZ-treated rats. Specific airway resistance increased in both groups after capsaicin challenge. Changes in ventilation in response to capsaicin challenge in STZ-treated rats may involve C-fiber sensory neuropathy.
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Affiliation(s)
- Dale R Bergren
- Department of Biomedical Sciences, School of Medicine Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
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Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM, Sacks DB. Tests of glycemia in diabetes. Diabetes Care 2004; 27:1761-73. [PMID: 15220264 DOI: 10.2337/diacare.27.7.1761] [Citation(s) in RCA: 411] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David E Goldstein
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO 65212, USA
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Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2002. [DOI: 10.1093/clinchem/48.3.436] [Citation(s) in RCA: 603] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractBackground: Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially.Approach: An expert committee drafted evidence-based recommendations for the use of laboratory analysis in patients with diabetes. An external panel of experts reviewed a draft of the guidelines, which were modified in response to the reviewers’ suggestions. A revised draft was posted on the Internet and was presented at the AACC Annual Meeting in July, 2000. The recommendations were modified again in response to oral and written comments. The guidelines were reviewed by the Professional Practice Committee of the American Diabetes Association.Content: Measurement of plasma glucose remains the sole diagnostic criterion for diabetes. Monitoring of glycemic control is performed by the patients, who measure their own plasma or blood glucose with meters, and by laboratory analysis of glycated hemoglobin. The potential roles of noninvasive glucose monitoring, genetic testing, autoantibodies, microalbumin, proinsulin, C-peptide, and other analytes are addressed.Summary: The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are of minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Thorn 530, 75 Francis St., Boston, MA 02115
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, PO Box 800214, Charlottesville, VA 22908
| | - David E Goldstein
- Department of Child Health, University of Missouri School of Medicine, 1 Hospital Dr., Columbia, MO 65212
| | - Noel K Maclaren
- Weill Medical College of Cornell University, 1300 York Ave., Suite LC-623, New York, NY 10021
| | - Jay M McDonald
- Department of Pathology, University of Alabama at Birmingham, 701 S. 19th St., Birmingham, AL 35294
- Veterans Administration Medical Center, Birmingham, AL 35233
| | - Marian Parrott
- American Diabetes Association, 1701 Beauregard St., Alexandria, VA 22311
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Rendell MS, Kelly ST, Finney D, Luu T, Kahler K, McIntyre SF, Terando JV. Decreased skin blood flow early in the course of streptozotocin-induced diabetes mellitus in the rat. Diabetologia 1993; 36:907-11. [PMID: 8243868 DOI: 10.1007/bf02374471] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have previously used laser Doppler technology to demonstrate that skin blood flow is reduced in Type 1 (insulin-dependent) diabetic patients. The possibility of using the skin as an extremely accessible indicator of diabetic microvascular disease is attractive. The streptozotocin diabetic rat is an appealing potential animal model. We performed measurements of skin blood flow in two rat species, nine Sprague Dawley (SD) rats and nine Wistar Kyoto (WKY) rats, observing early changes following the inception of diabetes. Four of the SD rats and five of the WKY rats were made diabetic, the rest serving as controls. There were no significant differences in skin blood flow between the two rat strains. As in man, there appear to be rat skin sites with primarily nutritive capillary supply and those with arteriovenous anastomotic predominance. The back and base of tail, both hair-covered areas, demonstrated low flow characteristics, consistent with nutritive perfusion. In contrast, the plantar surface of the paw behaved similarly to the finger or toe pulps in man, sites of arteriovenous perfusion, with high basal flow and a marked increment with thermal stimulation. In diabetic rats of both species, there was significantly lower flow at the back and base of tail than in non-diabetic animals. The differences were of the order of 30-40%. As a function of time, the decrease in blood flow at the base of tail parallelled the increase in glycohaemoglobin levels in the diabetic rats. In contrast, blood flow at the plantar surface of the paw was unchanged throughout the 3-month post-streptozotocin observation period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Lee PD, Sherman LD, O'Day MR, Rognerud CL, Ou CN. Comparisons of home blood glucose testing and glycated protein measurements. Diabetes Res Clin Pract 1992; 16:53-62. [PMID: 1576932 DOI: 10.1016/0168-8227(92)90135-e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We examined the relationships between 4 glycated protein assays and home blood glucose monitoring (HBGM) in 26 children with poorly-controlled insulin-dependent diabetes mellitus (IDDM) during a period of improved management. At 2 week intervals for 6 visits (12 weeks in total), HBGM records were collected and a blood sample was obtained for measurement of glycated proteins and glucose. Assays included glycated hemoglobin (GHb) and glycated serum proteins (GP) by boronate affinity chromatography, hemoglobin A1C by PolyCAT A high performance liquid chromatography (HAC) and fructosamine (FA). All 4 glycated protein levels declined significantly over the 12 week period. Significant correlations between the glycated proteins and HBGM were observed over 2 week intervals. None of the 4 assays were affected by the glucose level in the sample. Changes in mean HBGM readings over 2 week intervals were correlated with both FA and GP with wide prediction intervals. Over cumulative 2 week intervals, which may more accurately reflect longitudinal trends, all 4 glycated proteins were correlated with mean HBGM readings. At each cumulative interval, GHb and GP showed the largest variation with MBG, while FA showed the least variation with MBG. Our data indicate that of the 4 assays tested, FA has limited clinical values as compared to other glycated protein assays, whereas assays based on boronate affinity chromatography (GHb and GP) provide the most useful clinical indicators of short-term changes in glycemic control. The clinical utility of a new HPLC method for determination of glycated hemoglobins is also demonstrated.
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Affiliation(s)
- P D Lee
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Lester E. The clinical value of glycated haemoglobin and glycated plasma proteins. Ann Clin Biochem 1989; 26 ( Pt 3):213-9. [PMID: 2669613 DOI: 10.1177/000456328902600301] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- E Lester
- Chemical Pathology Department and Diabetic Unit, North Middlesex Hospital, London, UK
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