Glucose values from the same continuous glucose monitoring sensor significantly differ among readers with different generations of algorithm

Continuous glucose monitoring (CGM) values obtained from CGM systems using the same sensor but with different internal algorithms (the first- and third-generation FreeStyle Libre (1st-gen-libre and 3rd-gen-libre, respectively)) were compared. We used 19,819 paired and simultaneously measured CGM values of 13 patients with diabetes. The average CGM value was significantly higher (P < 0.0001) and the time below range (CGM value < 70 mg/dL) was significantly lower (P < 0.0001) with the 3rd-gen-libre than with the 1st-gen-libre. There was a significant correlation (P < 0.0001) between the CGM values of the 3rd-gen-libre (y-axis, mg/dL) and 1st-gen-libre (x-axis, mg/dL) using the following formula: y = 0.9728x + 10.024. On assessing the association between glycated hemoglobin (HbA1c (%), y-axis) and the average CGM values (x-axis, mg/dL) by applying the obtained equation to previously reported 1st-gen-libre data and converting it to 3rd-gen-libre data, we obtained the equation y = 0.02628x + 3.233, indicating that the glucose management indicator reported in the West may be underestimated compared with the laboratory-measured HbA1c in the Japanese population. Glucose values from the same sensor were found to be significantly different between readers with different algorithms, and the calculation of CGM-related indices may need to be individualized for each device.

Glycemic Excursion and Insulin Action Revealed in a Rare Case of Type 1 Diabetes Complicated with Short Bowel Syndrome

We herein report a 52-year-old woman with a rare combination of short bowel syndrome due to massive resection of the small intestine and complete loss of endogenous insulin due to type 1 diabetes. To provide nutritional support, she was treated with total parenteral nutrition with co-administration of insulin, requiring careful matching of insulin and glucose levels. This case report provides insights on glycemic excursion and insulin action in type 1 diabetes, even when both insulin and glucose are administered directly into circulation, and the usual obstacles caused by subcutaneous injection of insulin and oral intake of nutrients are eliminated.

Associations between genetic loci related to lean mass and body composition in type 2 diabetes

Aim

Several genetic loci related to lean mass have been identified in healthy individuals by genome‐wide association studies; however, the contribution of these loci to body composition in type 2 diabetes remains to be investigated. Here, we aimed to clarify the genetic determinants of body composition in individuals with type 2 diabetes.

Methods

A total of 176 Japanese outpatients (70 women and 106 men) with type 2 diabetes were studied using a cross‐sectional design. Body composition was measured using bioimpedance analysis with a commercially available device (InBody770). Single‐nucleotide polymorphisms in IRS1 (rs2943656), HSD17B11 (rs9991501), VCAN (rs2287926), ADAMTSL3 (rs4842924) and FTO (rs9936385) were evaluated by genotyping. The contributions of single‐nucleotide polymorphisms to body composition were examined, considering known clinical determinants.

Results

Sex, body composition and age were identified as clinical predictors. IRS1 rs2934656 was identified as an independent predictor of skeletal muscle mass (β = 0.11, P = 0.026), and ADAMTSL3 rs4842924 was an independent predictor of body fat mass (β = 0.15, P = 0.0095) and appendicular lean mass (β = −0.13, P = 0.017).

Conclusions

The findings clarified the contribution of genetic factors – IRS1 and ADAMTSL3 – to interindividual variation in body composition, independent of clinical factors, in type 2 diabetes patients. These data will contribute to the establishment of effective methods for the prediction, prevention, and intervention of sarcopenia and frailty in diabetes patients. Geriatr Gerontol Int 2021; 21: 932–938.

Clinical and genetic determinants of urinary glucose excretion in patients with diabetes mellitus

AIMS/INTRODUCTION

Glucosuria is a representative symptom in diabetes patients with poor glycemic control and in those treated with sodium-glucose cotransporter 2 inhibitors. Renal threshold levels of glucose excretion are known to vary among individuals, but factors contributing to glucosuria are not well characterized. The present study aimed to clarify clinical and genetic determinants of glucosuria in individuals with diabetes mellitus.

MATERIALS AND METHODS

The 24-h urinary glucose excretion was measured in 135 hospitalized patients on admission, with continuous measurement for five consecutive days in 75 patients. Genetic and clinical factors contributing to glucosuria were studied. As a genetic factor, SLC5A2 polymorphism was genotyped. A total of 476 participants (266 participants with type 2 diabetes and 210 healthy controls) were additionally genotyped for the association study of SLC5A2 with type 2 diabetes. A meta-analysis was carried out with the present study and previous association studies.

RESULTS

Multiple regression analysis showed that the independent variables of average blood glucose (β = 0.41, P = 1.4 × 10-7 ), estimated glomerular filtration rate (β = 0.28, P = 6.0 × 10-5 ), sex (β = 0.28, P = 5.7 × 10-5 ) and SLC5A2 rs9934336 polymorphism (β = 0.17, P = 0.02) were significantly correlated with urinary glucose excretion. The frequency of the A allele of rs9934336 tended to be lower in participants with type 2 diabetes than in controls (odds ratio 0.78, 95% confidence interval 0.53-1.13, not significant), and meta-analysis showed a significant association between the A allele and type 2 diabetes (summary odds ratio for minor allele [A] 0.86, 95% confidence interval 0.78-0.94, P < 0.002).

CONCLUSIONS

Blood glucose, estimated glomerular filtration rate, sex and SLC5A2 polymorphism were independent determinants of glucosuria in diabetes mellitus.

Flash glucose monitoring in type 1 diabetes: A comparison with self-monitoring blood glucose

AIMS/INTRODUCTION

A flash glucose monitoring (FGM) system has become available. To clarify the relationship between FGM and self-monitoring blood glucose (SMBG) values, we compared the two values after simultaneous measurement in Japanese patients with type 1 diabetes, under daily life settings.

MATERIALS AND METHODS

A total of 20 outpatients with type 1 diabetes were analyzed. When FGM and SMBG were carried out simultaneously (within ±3 min), the values were adopted and each FGM value was matched and compared with the corresponding SMBG value. In addition, we analyzed other cases of simultaneity defined as "within ±2 min," "within ±1 min" and "at the exact same time."

RESULTS

The percentage of SMBG and FGM values in the clinically acceptable zone A + B in Clarke and consensus error grid analyses were 97.9 and 99.2%, respectively. Deming regression (x-axis: FGM values, y-axis: SMBG values) determined a slope of 0.9128 (95% confidence interval 0.9008-0.9247) and an intercept of +15.94 mg/dL (95% confidence interval 14.05-17.84). FGM values were lower than SMBG values in the lower glucose range, and higher in the higher glucose range. The shorter the time lag between measurements, the higher the rate of concordance between FGM and SMBG values.

CONCLUSIONS

The results of this study provided evidence on the reliability of FGM in Japanese patients with type 1 diabetes in home conditions. Based on the results, if an abnormal glucose value is detected by FGM, SBMG should then be used to confirm the result.

Insulin deficiency with and without glucagon: A comparative study between total pancreatectomy and type 1 diabetes

AIMS/INTRODUCTION

Patients with a total pancreatectomy and type 1 diabetes are similar in regard to absolute insulin deficiency, but different in regard to glucagon, providing a unique opportunity to study the contribution of glucagon to glucose metabolism in an insulin-dependent state. The aim of the present study was to investigate the contribution of glucagon to glucose homeostasis in complete insulin deficiency in vivo.

METHODS

A total of 38 individuals with a complete lack of endogenous insulin (fasting C-peptide <0.0066 nmol/L) and whose glycemic control was optimized with an insulin pump during hospitalization were retrospectively studied. The basal insulin requirement, time-to-time adjustment of the basal insulin infusion rate, prandial insulin requirement and fasting plasma glucagon were compared between patients with a total pancreatectomy (n = 10) and those with type 1 diabetes (n = 28) after achievement of optimal glycemic control.

RESULTS

Total daily insulin (P = 0.03) and basal insulin (P = 0.000006), but not prandial insulin requirements, were significantly lower in total pancreatectomy patients than in type 1 diabetes patients. The basal percentage (basal insulin/total daily insulin) was also significantly lower in total pancreatectomy patients than in type 1 diabetes patients (15.8 ± 7.8 vs 32.9 ± 10.1%, P = 0.00003). An increase in the insulin infusion rate early in the morning was not necessary in most patients with a pancreatectomy. The fasting plasma glucagon concentration was significantly lower in total pancreatectomy patients than in type 1 diabetes patients (P = 0.00007), and was positively correlated with the basal insulin requirement (P = 0.038).

CONCLUSIONS

The difference in insulin requirements between total pancreatectomy and type 1 diabetes patients suggests a contribution of glucagon to the basal insulin requirement and dawn phenomenon.

Effects of dosage and dosing frequency on the efficacy and safety of high-dose metformin in Japanese patients with type 2 diabetes mellitus

AIMS/INTRODUCTION

Differences in the efficacy and safety of antidiabetic drugs among different ethnic groups are well documented. Metformin is widely used in the treatment of type 2 diabetes in Western countries, but high doses of metformin have been approved only recently for clinical use in Japan. The aim of the present study was to investigate the effects of dosage and dosing frequency on the efficacy and safety of high-dose metformin in Japanese patients.

MATERIALS AND METHODS

A total of 71 Japanese patients with type 2 diabetes were prospectively studied for the effects of dosage and dosing frequency on the efficacy and safety of metformin during hospitalization. Dose effects were studied in 27 patients treated with 0, 500, 1,000, 1,500 and 2,250 mg/day of metformin. The effect of dosing frequency was compared in 56 patients with 1,500 mg/day of metformin administered either two or three times per day.

RESULTS

Significant dose-dependent improvement in daily profiles of blood glucose was observed with metformin dosages up to 1,500 mg/day, with a trend towards further improvement observed at 2,250 mg/day. The efficacy of 1,500 mg of metformin was comparable when the drug was administered either two or three times per day. The most frequently reported side-effects were gastrointestinal symptoms, which were not affected by the dosage or dosing frequency of metformin.

CONCLUSIONS

These results show that the efficacy of high-dose metformin is dose-dependent in Japanese patients. The efficacy and safety of metformin were similar when the drug was administered either two or three times per day.

[Dermal anesthesia: comparison of the analgesic effects of 2% and 10% lidocaine gel patch]

The analgesic effects of aqueous gel containing 2% or 10% lidocaine with 3% glycyrrhetinic acid mono 3-0 hemiphthalate sodium as an absorption promoter were compared in two volunteer groups of 12 persons each. A round sponge (25 mm in diameter and 1mm in thickness) filled with approximately 0.3g of either gel was applied on the volar surface of the forearm and kept covered with an adhesive plastic film (Tegaderm) for two hours. The analgesic effect was assessed every 30 min by pin-prick method at five places under the coverage for two hours, and after the gel was wiped away. The result from each place was scored 0 (no pain) or 1 (needle pain). The mean pain scores at 1 hr and 1.5 hr in the 10% group were 1.0 and 0.7, and significantly lower than 2.2 and 1.3 of the 2% group (P less than 0.05). Two hour application of the gel, five volunteers in the 2% group and eight volunteers in the 10% group produced a pain score under 1.0. In these subjects, a 26 gauge needle was stuck into the skin for further pain analysis. Four of the 5 subjects in the 2% group and 7 of the 8 subjects in the 10% group did not complain of any pain. Transient local redness under the coverage was observed in 3 subjects in each group. They were all known to be sensitive to alcoholic beverages. No other side effects were found. The plasma concentration of lidocaine was lower than 0.01 microgram.ml-1 at all times.

[Dermal patch anesthesia to prevent pain from dermal puncture--10% lidocaine aqueous gel with 3% glycyrrhetinic acid 3-0 hemiphthalate disodium]

The clinical efficacies of 10% lidocaine aqueous gel with and without 3% glycyrrhetinic acid 3-0 hemiphthalate disodium (GAHPh) applied as a skin patch for reduction of pain from venous cannulation were evaluated in a double blind study. Twenty-four adult patients, who were scheduled for surgery under general anesthesia, gave informed consent to participate in this study. The patients were allocated randomly into two groups: one for a dermal patch GAHPh (GAHPh group) and the other for a dermal patch without GAHPh (plain group). Approximately 0.3g of either gel with or without GAHPh, soaked in a round sponge (25mm in diameter, 1mm in thickness), was applied over the selected vein on the arm and was covered with an adhesive plastic film (Tegaderm). Pain score was graded by the number of painful spots out of the 5 tests in the treated skin area. In patients with a pain score under 1, venous cannulation was carried out without an intradermal injection of a local anesthetic and pain associated with the cannulation procedure was graded by patients on a scale of 5, where 0 = no pain, 1 = little pain, 2 = moderate pain, 3 = painful, 4 = very painful. The mean application time periods were 59.3 min for the GAHPh group and 60.3 min for the plain group. Transient local redness was observed in 8 patients after removal of the gels; 3 in the GAHPh group and 5 in the plain group. The mean pain score (1.3 +/- 1.5) in the GAHPh group, was significantly lower than that (2.5 +/- 1.7) in the plain group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental replacement of vena cava with expanded polytetrafluoroethylene graft

Expanded polytetrafluoroethylene (Gore Tex) grafts were used for the replacement of the superior or inferior vena cava in dogs. When examined 2 weeks to 18 months after the replacement, the overall patency rate was 82%. If neither deformation nor narrowing of the graft on examination by cavagram had occurred within 14 days after implantation, the patency of the grafts remained unchanged. Ninety days after implantation, the formation of pseudointima was almost complete. However, since the grafts were not firmly anchored, superficial desquamation in their mid-portion continued for long periods. A composite graft made up of Gore Tex and noncrimped Dacron was studied in order to know the reason why high patency of the Gore Tex graft was obtained. The pseudointima of the Gore Tex graft gradually increased in thickness for 60 min, after which no further increase was observed. The pseudointima in the Dacron graft thickened markedly as time progressed and additional layers of blood cells accumulated on it. Although the ultimate fate of Gore Tex graft has not yet been determined, experimental trials indicate its suitability for patients requiring replacement of the vena cava.

Modification and morphology of human umbilical cord vein as canine arterial bypass grafts

Human umbilical cord veins treated with various concentrations of glutaraldehyde (GA) and ethanol (ET) were used to replace short segments of the infrarenal abdominal artery in 40 dogs. The patency rates were 62.5% (5/8) in Group I; tanned with 1% GA for 24 hours and preserved in the same solution 87.5% (7/8) in Group II; tanned with 1% GA for 24 hours and preserved in 50% ethanol, 100% (8/8) in Group III; tanned in the same manner as Group II, but preserved in 70% ET; 87.5% (7/8) in Group IV; tanned with 0.5% GA for 24 hours and preserved in 50% ET, and 87.5% (7/8) in Group V; tanned as in Group IV but preserved in 70% ET when examined 14 days to 6 months after implantation. Angiographically, most of the anastomotic lines gradually contracted with the lapse of time because of excessive proliferation of connective tissue into the intraluminal surfaces, although the structural integrity of the graft was well preserved. Microscopically, the irregular fibrin membrane covering the entire inner surface of the graft became smoother and thinner with the lapse of time. The pannus increased gradually both in thickness and width. Scanning electron-micrography of the graft revealed that no endothelial cells were found more than 5 mm from the suture lines even 6 months after implantation. Antigenicity of the graft using a complement-dependent cytotoxicity test was effectively suppressed with glutaraldehyde regardless of whether its concentration was 0.5% or 1.0%. Although human umbilical cord vein tanned with 0.5% glutaraldehyde and preserved in 50% ethanol until used was considered to be useful as an arterial substitute, final conclusion could not be drawn since six grafts followed for six months, the longest follow-up, were stenotic.

Expanded polytetrafluoroethylene grafts for small artery replacement

Twenty vascular grafts of expanded polytetrafluoroethylene with a 1.5 mm. internal diameter and a 4.0 cm. length, were placed in the femoral arteries of dogs. The animals, divided into two groups, with and without pluronic F 68, were sacrificed two weeks after surgery. The patency rate was 33.3% (2/6) and 21.5% (3/14), which was not statistically significant. One factor contributing to the occlusion of the grafts were excessive proliferation of granulation tissue due to early formation of the thrombus. Histological findings showed that the pseudointima was almost complete, although it was only about 0.114 mm. thick at the anastomotic line.

End-to-side anastomosis of the mesenteric vein to the inferior vena cava in the treatment of glycogen storage disease: case report

A 2-year-old boy with Type I glycogen storage disease received an end-to-side anastomosis of the mesenteric vein to the inferior vena cava with marked improvement in his biochemical factors and nutritional status and with shrinkage of the liver. The efficacy and simplicity of this technique and its lack of complications, as evidenced by follow-up studies over a 4 year period, suggest that its further use is warranted.

Hemodynamic effects of beta-adrenergic blockade with pindolol, oxprenolol, propranolol and bufetolol hydrochloride in essential hypertension

Hemodynamic studies (using (131)I-labeled albumin [RISA]) Were performed before and 5 and 42 weeks after the oral administration of pindolol (av. 30 mg/day), oxprenolol (av. 216 mg/day), propranolol (av. 75 mg/day) or bufetolol hydrochloride (av. 30 mg/day) in 40 patients with essential hypertension. Responders to the antihypertensive actions of short-term (5 weeks) pindolol or bufetolol showed a reduction in total peripheral resistance (pindolol, from av. 2622 to 2022 dyne-sec-cm-5-m2; befetolol, from av. 3301 to 2620, p less than 0.05), without significant changes in cardiac index, while hypotensive actions of propranolol or oxprenolol appeared to be due mainly to a decrease in cardiac output (propranolol, from av. 4.03 to 2.99 L/min/m2; oxprenolol, from av. 3.97 to 3.29 L/min/m2), although the decrease in cardiac output was not significant. In long-term (42 weeks) oxprenolol therapy, antihypertensive effects seemed to be related to reduced cardiac output and a readaptation of peripheral resistance to chronic reduction of cardiac output was not always observed. Circulation time was determined in 9 patients with oxprenolol therapy and 8 with pindolol therapy by the measurement of the arrival time in the cerebral hemisphere of the intravenously injected radioisotope. The patients with oxprenolol therapy showed significant prolongation in circulation time (short-term administration, av. 6.6 to 8.4 sec; long-term administration av. 6.6 to 9.2 sec, p less than 0.05), while no prolongation was observed in pindolol therapy. These results suggest that hemodynamic responses to beta-blocking agents are not uniform and that the antihypertensive actions of beta-blockers depend on the effects on both cardiac output and peripheral vascular resistance.