Time in range correlates glycated albumin measured immediately after 2 weeks of continuous glucose monitoring

AIMS

Time in range (TIR), an index of glycemic control and also blood glucose fluctuation, obtained from continuous glucose monitoring (CGM), has been increasing its importance along with the spread of CGM in recent years. For a while, glycated albumin (GA) has been also used as a glycemic control index during about 2-weeks in routine clinical practice. It has not yet been confirmed under optimal condition whether TIR and GA correlates. Clarification of the correlation between TIR and GA, which was measured immediately after 2-weeks of CGM, might be a finding that further supports the utility of TIR.

METHODS

GA was measured at the conclusion of 2-week CGM in 71 diabetes outpatients at our hospital, and the correlation between GA and indices such as TIR obtained from CGM was statistically analyzed.

RESULTS

It was found that TIR and time above range (TAR) were significantly correlated with GA. Upon performing multiple regression analysis, TIR, TAR and BMI. indicated a significant regression coefficient with respect to GA.

CONCLUSIONS

These findings further support the utility of TIR as a marker of glycemic control that it might also be correlated with GA, and also suggest a relation between GA and blood glucose fluctuation.

Clinical factors associated with the symptoms of constipation in patients with diabetes mellitus: A multicenter study

BACKGROUND AND AIM

Changes in treatment protocols for patients with diabetes mellitus (DM) may influence the functions of the digestive tract. This study examined possible clinical factors associated with the symptoms of constipation in patients with DM.

METHODS

This was a multicenter study. Participants were consecutive Japanese patients undergoing treatment for type 1 or type 2 DM. Constipation was evaluated using the gastrointestinal symptom rating scale. Diabetic neuropathy was evaluated by the presence or absence of peripheral neuropathy of the lower limbs.

RESULTS

Of 419 participants, 258 were men and 161 women (ratio: 1.6:1), with a mean age of 63.6 ± 12.5 years. In multivariate analysis, symptoms of constipation were significantly associated with age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.01-1.04, P = 0.032), lower mental component summary (OR = 3.31, 95% CI: 1.69-6.48, P < 0.001), diabetic retinopathy (OR = 1.99, 95% CI: 1.14-3.45, P = 0.015), and diabetic neuropathy (OR = 1.86, 95% CI: 1.10-3.16, P = 0.021). In patients with peripheral neuropathy of the lower limbs, regardless of the presence of other complications (diabetic nephropathy and diabetic retinopathy), the prevalence of symptoms of constipation was twice that of patients without peripheral neuropathy (40.0-49.1% vs 22.0%). Diabetic drugs were not associated with symptoms of constipation.

CONCLUSIONS

Diabetic neuropathy, defined as peripheral neuropathy of the lower limbs, was significantly associated with symptoms of constipation. Peripheral neuropathy of the lower limbs is not a direct risk factor for constipation but may be a useful criterion when assessing whether constipation is associated with DM.

Double-blind randomized clinical trial of the effects of ezetimibe on postprandial hyperlipidaemia and hyperglycaemia

AIM

Ezetimibe selectively blocks intestinal cholesterol absorption by inhibiting Niemann-Pick C1-like 1 (NPC1L1) and reducing LDL cholesterol (LDL-C). In animals, ezetimibe reversed diet-induced obesity, liver steatosis, and insulin resistance. In humans, its potential effects on liver steatosis and insulin resistance have been suggested. We investigated the effects of ezetimibe on postprandial hyperlipidaemia and hyperglycaemia in obese subjects with dyslipidaemia in a double-blind randomized crossover trial.

METHODS

Twenty obese men with hypertriglyceridaemia were assigned randomly to an ezetimibe- or a placebo-precedence-treated group. Subjects in the ezetimibe group were treated with ezetimibe (10 mg/day) for the first 4 weeks, followed by a 4-week interval and then treated with placebo for another 4 weeks. The placebo group received these treatments in reverse order. Subjects were requested to fast for at least 12 hours and then received a standard meal. Blood samples were collected at 0, 30, 60, 120, 240, 360 and 480 minutes after the meal on Days 0, 28, 56 and 84 and were used to measure the lipid and glucose metabolism markers.

RESULTS

Ezetimibe significantly decreased the postprandial serum triglyceride excursion (p=0.01) and fasting serum LDL-C, remnant-like particles(RLP) and ApoB48 levels (p<0.05). Postprandial glucose excursion, serum insulin levels, serum glucose-dependent insulinotropic polypeptide (GIP) and active glucagon-like peptide-1 (GLP-1) were not significantly affected by ezetimibe treatment.

CONCLUSION

Ezetimibe restored the postprandial dysregulation of lipid but did not affect glucose metabolism in a double-blind randomized crossover trial.

Ultrasound biomicroscopic diagnosis of cyclitic membranes

PURPOSE

To evaluate the utility of ultrasound biomicroscopy in imaging cyclitic membranes.

METHODS

Patients with hypotony and suspected or known cyclitic membrane underwent ultrasound biomicroscopic examination. Histopathology of cyclitic membrane was correlated with ultrasound biomicroscopy in three cases.

RESULTS

Six eyes of six patients were enrolled. Mean patient age was 62.2 +/- 18.4 (SD) years. The mean intraocular pressure in the affected eye was 4.3 +/- 3.4 mmHg. Three eyes were pseudophakic and three eyes were aphakic. All eyes had undergone two or more previous intraocular surgeries. Ultrasound biomicroscopy imaged the cyclitic membrane in all six eyes. Histopathology revealed fibroproliferative cyclitic membranes with associated inflammatory cells.

CONCLUSION

Ultrasound biomicroscopy is useful in detecting the presence of those cyclitic membranes that may not be identified on clinical examination.

Inadvertent corneal indentation can cause artifactitious widening of the iridocorneal angle on ultrasound biomicroscopy

A 70-year-old Asian female with narrow angles underwent ultrasound biomicroscopy (UBM) darkroom provocative testing. The angle was narrow under light conditions and occluded in the dark, except for the inferior quadrant where the angle was wide and the iris concave. This was reproducible in four quadrants with the use of a small UBM eye cup but not the large one. A small eye cup can indent the cornea, resulting in artifactitious angle widenening. Care must be taken when using the small eye cup not to press on the cornea.

[Evaluation of the Swedish interactive thresholding algorithm, a new thresholding algorithm, of the Humphrey Field Analyzer in glaucoma patients]

The Swedish interactive thresholding algorithm (SITA) is a new thresholding algorithm that aims to obtain the visual fields of the same quality in a shorter examination time than the conventional up-and-down method. We investigated the correlation between the threshold values obtained by SITA and the conventional thresholding algorithm in 30 glaucoma patients. The results of two types of SITA, i.e., SITA accurate and SITA fast, showed a significant correlation with those of the conventional method (r = 0.855, p < 0.0001 and r = 0.833, p < 0.0001, respectively). There was no statistical relation between the mean deviation (MD) of the conventional method and the difference between MD values of the conventional method, and SITA accurate and SITA fast. The examination time of SITA accurate and SITA fast was 50% and 31% shorter, respectively, than that of the conventional method. The difference in threshold of each test point in the conventional and SITA methods was minor except in one with a deep relative defect. These results indicate that SITA can be useful for detecting glaucomatous visual field defects in a shorter time.

[Evaluation of the Swedish Interactive Thresholding Algorithm, a new thresholding algorithm, of the Humphrey field analyzer in normal subjects]

The Swedish Interactive Thresholding Algorithm (SITA) is a new thresholding algorithm that aims to obtain the same quality of visual fields in a shorter examination time than with the conventional up-and-down method. We investigated the correlation between thresholds measured with the SITA algorithm and those with the conventional up-and-down method in 47 eyes of 47 normal subjects. In each test point, thresholds with the SITA accurate and with the SITA fast showed significant correlation with those of the conventional method (r = 0.693, p < 0.0001 and r = 0.689, p < 0.0001, respectively). The mean deviation (MD) in the conventional method and the difference between MD values of the conventional method and SITA accurate and SITA fast were significantly correlated (r = -0.442, p < 0.006 and r = -0.509, p < 0.00092, respectively). The examination times of the SITA accurate and SITA fast were 48% and 27% of the conventional method. Although the new thresholding algorithm enables us to perform perimetric examination with relatively high accuracy, further investigations should be conducted before we apply it to glaucoma cases.

The effects of the beta-adrenergic-blocking agents, timolol and carteolol, on plasma lipids and lipoproteins in Japanese glaucoma patients

PURPOSE

To determine whether two topical beta-blockers, timolol and carteolol, differently affect plasma lipids and lipoproteins in normolipidemic Japanese patients with glaucoma.

PATIENTS AND METHODS

Thirty-three normolipidemic patients with primary open-angle glaucoma or ocular hypertension were randomly allocated to and completed 16 weeks of bilateral treatment with 0.5% timolol, 1.0% carteolol, or 2.0% carteolol twice daily in a three-center, prospective study. Patients using any drugs affecting plasma lipids or with a history of beta-blocker use of hyperlipoproteinemia were excluded. Fasting blood lipids and lipoproteins, including total cholesterol, high-density lipoprotein cholesterol, triglyceride, and apoproteins, were measured three times before therapy was initiated. These measurements were repeated every 4 weeks during the treatment period.

RESULTS

The level of high-density lipoprotein cholesterol significantly decreased in the timolol treatment group but did not change in the carteolol treatment groups. The ratio of total cholesterol minus high-density lipoprotein cholesterol to high-density lipoprotein cholesterol increased in the timolol treatment group.

CONCLUSIONS

Topical beta-blockers do affect plasma lipids in Japanese patients with glaucoma. The effects of timolol are greater than those of carteolol.

Evaluation of the effect of aging on the retinal nerve fiber layer thickness using scanning laser polarimetry

PURPOSE

The scanning laser polarimeter is a new diagnostic scanning laser instrument that uses the polarizing properties of the retinal nerve fiber layer to measure its thickness in vivo. We first ascertained the measurement reproducibility of this instrument and then evaluated the effects of aging on the retinal nerve fiber layer.

METHODS

We performed three consecutive measurements in six glaucomatous and six age-matched normal healthy eyes to evaluate the instrumentation. The mean thickness of the peripapillary retinal nerve fiber layer within the rings 1. 0, 1. 5, and 2. 0 disk diameters from the center of the optic nerve head was calculated. We then evaluated aging effects on the retinal nerve fiber layer thickness in 75 eyes of 75 normal volunteers 20-66 years of age.

RESULTS

The mean coefficients of variation of the measurements of the 1. 0, 1. 5, and 2. 0 disk diameters were 3. 64, 3. 59, and 4. 10, respectively, for the normal subjects, and 10. 20, 5. 65, 6. 08, respectively, for the patients with glaucoma. We found a significant, inverse linear correlation between age and the retinal nerve fiber layer thickness when measured along the 1. 5 disk diameter ring (R = 0. 16, p = 0. 0004). Significant decreases with aging also were observed in the nasal (R = 0. 17, p = 0. 0003) and inferior (R = 0. 09, p = 0. 0091) retinal nerve fiber layer thickness.

CONCLUSIONS

Our results indicate that scanning laser polarimetry is sufficiently reliable to assess the retinal nerve fiber layer thickness in vivo. The retinal nerve fiber layer thickness decreases with age in the normal healthy eye.