scholarly journals Συγκριτική μελέτη δύο σχημάτων ινσουλινοθεραπείας σε ασθενείς με σακχαρώδη διαβήτη τύπου 2 με την χρήση αισθητήρων γλυκόζης

2021 ◽  
Author(s):  
Χαράλαμπος Μαργαριτίδης

ΣΚΟΠΟΣ: Η συγκριτική μελέτη δύο σχημάτων ινσουλινοθεραπείας (μίγμα ανθρώπινης ινσουλίνης 30/70-PIΗ και μίγμα ανάλογου-PAI, και συγκεκριμένα διφασική ινσουλίνη Aspart 30/70-Biasp30) με τη χρήση αισθητήρων γλυκόζης, και εκτίμηση της συσχέτισης της γλυκοζυλιωμένης αιμοσφαιρίνης (HbA1c), της γλυκοζυλιωμένης αλβουμίνης(GA) και της φρουκτοζαμίνης(FA) με τα δεδομένα της συνεχούς καταγραφής(CGM). ΑΣΘΕΝΕΙΣ-ΜΕΘΟΔΟΙ: Μια cross-over μελέτη σε 36 καλά ρυθμισμένα άτομα με Σακχαρώδη Διαβήτη τύπου 2 (ΣΔτ2), οι οποίοι υποβλήθηκαν σε 7ήμερη CGM με το PHI και στη συνέχεια με το Biasp30. ΑΠΟΤΕΛΕΣΜΑΤΑ: Το Biasp30 πέτυχε χαμηλότερη μέση τιμή γλυκόζης (Average Blood Glucose- ABG) για το διάστημα 23:00-03:00 (PHI: 135.08± 28.94mg/dl, Biasp30: 117.75± 21.24 mg/dl, p<0.001) και το διάστημα 00:00-06:00 (PHI: 120.42 ±23.13mg/dl, Biasp30: 111.17± 14.74, p=0.008, περισσότερο χρόνο σε επίπεδα γλυκόζης κάτω από το όριο των 70mg/dl (Time Below Range-TBR) για το διάστημα 23:00-03:00 (PHI: 58.75 ± 99.49min, Biasp30: 179.17 ± 249.30min,p=0.003). Το PHI πέτυχε χαμηλότερη ABG πριν το πρωινό (PHI: 111.75± 23.9 mg/dl, Biasp30: 128.25± 35.9mg/dl, p=0.013). Δεν υπήρξαν διαφορές μεταξύ των δύο ομάδων στην ABG για το συνολικό διάστημα του 24ώρου (PHI: 140.08± 20.71mg/dl, Biasp30:138.08± 17.93mg/dl,p=0.502), στο χρόνο εντός του στόχου (Time In Range -TIR-% του συνολικού χρόνου καταγραφής) (PHI: 75.92± 12.42%, Biasp30:74.17± 15.90%, p=0.534) και στο συνολικό TBR (% of the total CGM time) (PHI: 4.17± 3.55%, Biasp30: 5.5± 3.40%, p=0.063),και στο TBR για το διάστημα 00:00-06:00 period (PHI: 8.45 ± 8.81%, Biasp30: 12.08 ± 16.13%, p=0.253). Οι συνολικές μονάδες ινσουλίνης ήταν περισσότερες με το Biasp30(PHI: 47.92± 12.18 IU, Biasp30:49.58± 14.12 IU, p=0.001). HbA1c, GA and FA εμφάνισαν στατιστικά σημαντική συσχέτιση με την ABG (GA: r=0.512, p=0.011, FA: r=0.555, p=0.005, HbA1c: r=0.642, p=0.001).ΣΥΜΠΕΡΑΣΜΑΤΑ: Σε καλά ρυθμισμένους ασθενείς με ΣΔτ2 τα PIA και αποτελούν ισάξιες επιλογές με τα PHI. Από τους διάφορους δείκτες γλυκαιμικής μεταβλητότητας η HbA1c παρουσιάζει την ισχυρότερη συσχέτιση με την ABG.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mikhail Kosiborod ◽  
Silvio Inzucchi ◽  
Harlan M Krumholz ◽  
Lan Xiao ◽  
Phillip G Jones ◽  
...  

Background: Elevated blood glucose (BG) on admission is associated with higher mortality risk in patients (pts) hospitalized with AMI. However, the prognostic value of average BG, which reflects overall glycemic exposure much better than admission BG, is unknown. Furthermore, the nature of the relationship between average BG and mortality has not been determined. Methods: We evaluated a cohort of 16,871 AMI pts hospitalized from January 2000-December 2005, using Cerner Corporation’s Health Facts® database from 40 hospitals, which contains demographics, clinical and comprehensive laboratory data. Logistic regression models evaluated the nature of the relationship between mean BG during the entire AMI hospitalization and in-hospital mortality, after adjusting for multiple patient factors and confounders. Similar analyses were performed in subgroups of pts with and without diabetes (DM). Results: A J-shaped relationship was observed between mean BG and in-hospital mortality, which persisted after multivariable adjustment (Figure ). Mortality increased with each 10 mg/dL incremental rise in mean BG over >120 mg/dL, and with incremental decline in mean BG <80 mg/dL. The slope of these relationships was much steeper in pts without DM. Conclusions: Average BG during the entire AMI hospitalization is a powerful independent predictor of in-hospital mortality. Both persistent hyper- and hypoglycemia are associated with adverse prognosis. Whether strategies directed at optimizing BG control will improve survival remains to be established. Association Between Mean BG and In-Hospital Mortality After Multivariable Adjustment (Reference: Mean BG 100 to <110)


2021 ◽  
pp. 54-57
Author(s):  
Kali Shankar Das ◽  
Athokpam Poireiton ◽  
Niladri Sekhar Mandal ◽  
Samim Ahmed

OBJECTIVE: Retinopathy of prematurity (ROP) is a severe morbidity that can lead to blindness in premature babies. Neonatal hyperglycemia has been related to the growth of ROP in a variety of studies. However, there aren't many observational trials to show whether hyperglycemia is linked to ROP in the absence of other comorbidities. The aim of this research was to see if hyperglycemia in premature babies is linked to ROP in a different way. STUDY DESIGN: Premature infants (<1500 g or⩽ 32 weeks gestational age) were enrolled in a prospective longitudinal cohort study. All demographic, clinical and laboratory data were collected. Bedside whole-blood glucose concentration was measured every 8 hours daily for rst 7 , days of live. For any glucose reading <50 or>150 mg dl 1 serum sample was sent to the laboratory for conrmation. Hyperglycemia was dened as any blood glucose level⩾ 150 mg dl − 1. ROP patients were compared with non-ROP patients in a bivariate analysis. Variables signicantly associated with ROP were studied in a logistic regression model. RESULT:Atotal of 100 patients were enrolled with gestational age <32weeks and birth weight <1500g. Forty-eight patients (48%) were identied with hyperglycemia. On eye examination, 30 cases (30%) had ROP (19 with stage 1, 10 with stage 2 and 1 with stage 3). There were more cases of ROPin the hyperglycemia group compared with the euglycemia group (45.83% vs 15.38%, P = 0.007). Patients who developed ROP had signicantly higher maximum and average glucose concentrations when compared with non-ROP patients. Multiple factors have been associated with ROP on bivariate analysis, including gestational age, exposure to oxygen, respiratory support and poor weight gain. However, in a logistic regression model including all signicant variables, average blood glucose in the rst week of life was the factor independently associated with ROPwith an odds ratio of: 1.77 (95% condence interval: 1.08 to 2.86), P= 0.024 CONCLUSION: In a prospective cohort study of premature infants, elevated average blood glucose concentrations in the rst week of life is an independent risk factor associated with the development of ROP.


2020 ◽  
Author(s):  
Yifat Fundoiano-Hershcovitz ◽  
Abigail Hirsch ◽  
Sharon Dar ◽  
Eitan Feniger ◽  
Pavel Goldstein

BACKGROUND The use of remote data capture for monitoring blood glucose and supporting digital apps is becoming the norm in diabetes care. One common goal of such apps is to increase user awareness and engagement with their day-to-day health-related behaviors (digital engagement) in order to improve diabetes outcomes. However, we lack a deep understanding of the complicated association between digital engagement and diabetes outcomes. OBJECTIVE This study investigated the association between digital engagement (operationalized as tagging of behaviors alongside glucose measurements) and the monthly average blood glucose level in persons with type 2 diabetes during the first year of managing their diabetes with a digital chronic disease management platform. We hypothesize that during the first 6 months, blood glucose levels will drop faster and further in patients with increased digital engagement and that difference in outcomes will persist for the remainder of the year. Finally, we hypothesize that disaggregated between- and within-person variabilities in digital engagement will predict individual-level changes in blood glucose levels. METHODS This retrospective real-world analysis followed 998 people with type 2 diabetes who regularly tracked their blood glucose levels with the Dario digital therapeutics platform for chronic diseases. Subjects included “nontaggers” (users who rarely or never used app features to notice and track mealtime, food, exercise, mood, and location, n=585) and “taggers” (users who used these features, n=413) representing increased digital engagement. Within- and between-person variabilities in tagging behavior were disaggregated to reveal the association between tagging behavior and blood glucose levels. The associations between an individual’s tagging behavior in a given month and the monthly average blood glucose level in the following month were analyzed for quasicausal effects. A generalized mixed piecewise statistical framework was applied throughout. RESULTS Analysis revealed significant improvement in the monthly average blood glucose level during the first 6 months (<i>t</i>=−10.01, <i>P</i>&lt;.001), which was maintained during the following 6 months (<i>t</i>=−1.54, <i>P</i>=.12). Moreover, taggers demonstrated a significantly steeper improvement in the initial period relative to nontaggers (<i>t</i>=2.15, <i>P</i>=.03). Additional findings included a within-user quasicausal nonlinear link between tagging behavior and glucose control improvement with a 1-month lag. More specifically, increased tagging behavior in any given month resulted in a 43% improvement in glucose levels in the next month up to a person-specific average in tagging intensity (<i>t</i>=−11.02, <i>P</i>&lt;.001). Above that within-person mean level of digital engagement, glucose levels remained stable but did not show additional improvement with increased tagging (<i>t</i>=0.82, <i>P</i>=.41). When assessed alongside within-person effects, between-person changes in tagging behavior were not associated with changes in monthly average glucose levels (<i>t</i>=1.30, <i>P</i>=.20). CONCLUSIONS This study sheds light on the source of the association between user engagement with a diabetes tracking app and the clinical condition, highlighting the importance of within-person changes versus between-person differences. Our findings underscore the need for and provide a basis for a personalized approach to digital health.


2019 ◽  
Vol 97 (10) ◽  
pp. 4199-4207
Author(s):  
Tiana G Owens ◽  
Madeline Barnes ◽  
Vanessa M Gargano ◽  
Louise Julien ◽  
Wilfredo D Mansilla ◽  
...  

Abstract Soaking hay and steaming hay are strategies that are used to reduce respirable dust particles for horses but may result in variable nutrient losses, including nonstructural carbohydrates (NSC) and minerals. Since these losses have not been quantified in Canadian hay yet, the first aim of this study was to identify nutrient losses from first-cut timothy-alfalfa hay grown in southern Ontario, Canada, after soaking for 30 min or steaming for 60 min. It is uncertain whether horses prefer hay when it is dry, soaked, or steamed. To address this, 13 Standardbred racehorses were offered 2 of these hays side by side for 30 min on 6 consecutive occasions until all possible combinations had been offered. Quantity of hay eaten was determined and horses were video recorded during feedings to assess time spent eating and investigating hay. Additionally, consumption of feeds with differing NSC levels has been observed to influence glycemic response in horses; however, this has not been measured in horses consuming steamed hay before and the results from soaked hay studies have been inconclusive. As such, the final aim of this study was to examine acute glycemic response in horses after being fed dry, soaked, and steamed hays. Blood glucose was measured every 30 min from 9 Standardbred racehorses for 6 h following a meal of 0.5% of their body weight of treatment hay on a dry matter basis (DMB). Soaked, but not steamed, hay had lower concentrations of soluble protein, NSC, and potassium in contrast to the same dry hay (P < 0.05). Peak glucose, average blood glucose, total area under the curve, and time to peak did not differ among treatments (P > 0.05). We conclude that acute glycemic response of racehorses was not influenced by soaking or steaming hay. Horses also consumed less soaked hay (DMB) than dry or steamed hay (P < 0.05) and spent less time eating soaked hay than dry or steamed hay (P < 0.05).


Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Tao Yuan ◽  
Hongyu He ◽  
Yuepeng Liu ◽  
Jianwei Wang ◽  
Xin Kang ◽  
...  

Abstract Background Blood glucose levels that are too high or too low after traumatic brain injury (TBI) negatively affect patient prognosis. This study aimed to demonstrate the relationship between blood glucose levels and the Glasgow Outcome Score (GOS) in TBI patients. Methods This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. Information on the disease, laboratory examination, insulin therapy, and surgery for patients with TBI was collected as candidate variables according to clinical importance. Additionally, data on 5-year and 6-month GOS were collected as primary and secondary outcomes, respectively. For multivariate analysis, a generalized additive model (GAM) was used to investigate relationships between blood glucose levels and GOS. The results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We further applied a two- piecewise linear regression model to examine the threshold effect of blood glucose level and GOS. Results A total of 182 patients were included in the final analysis. Multivariate GAM analysis revealed that a bell-shaped relationship existed between average blood glucose level and 5-year GOS score or 6-month GOS score. The inflection points of the average blood glucose level were 8.81 (95% CI: 7.43–9.48) mmol/L considering 5-year GOS as the outcome and were 8.88 (95% CI 7.43−9.74) mmol/L considering 6-month GOS score as the outcome. The same analysis revealed that there was also a bell relationship between average blood glucose levels and the favorable outcome group (GOS score ≥ 4) at 5 years or 6 months. Conclusion In a population of patients with traumatic brain injury, blood glucose levels were associated with the GOS. There was also a threshold effect between blood glucose levels and the GOS. A blood glucose level that is either too high or too low conveys a poor prognosis. Trial registration ClinicalTrials.gov NCT02161055. Registered on 11 June 2014.


2018 ◽  
Vol 5 (3) ◽  
pp. 1092 ◽  
Author(s):  
Rameshwar Ninama ◽  
Chakshu Chaudhry ◽  
Rameshwar Lal Suman ◽  
Suresh Goyal ◽  
Ramprakash Prakash Bairwa ◽  
...  

Background: Diarrhea is the major cause of death in children below five years of age. Hypoglycemia has been a potential fatal complication of infectious diarrhea in both well-nourished and poorly nourished children. But prevalence of hypoglycemia in diarrheal dehydration is not exactly known. This study was done to evaluate the glycemic status in children having acute diarrhea with dehydration and specifically associated with severe acute malnutrition (SAM).Methods: This descriptive cross-sectional study was conducted during July 2017 to December 2017 at Bal Chikitsalaya Udaipur, Rajasthan, India. Blood glucose levels were assessed in 150 children of acute diarrhea with dehydration, comprising of 100 SAM and 50 Non SAM children.Results: Average blood glucose of SAM children was 89 mg/dl and of non-SAM, it was 120 mg/dl. Average blood glucose was low in SAM as compared to non-SAM in both some dehydration (116.08±21.26) and severe dehydration (66.69±19.80) as well as with or without ORS intake. Overall 18 (12%) of children had hypoglycemia and all were in severe dehydration and not taking ORS. Blood glucose levels were statistically low in severe dehydration and those who were not taking ORS at the time of hospitalization (p = 0.001). In severe dehydration 25% of children had hypoglycemia means every fourth child had low blood glucose <54 mg/dl.Conclusions: Overall prevalence of hypoglycemia is 12% in diarrheal dehydration and 20% in SAM with dehydration. Twenty five percent of severe dehydration children had hypoglycemia, and all have not started ORS. None of the child started ORS developed hypoglycaemia.


1980 ◽  
Vol 26 (12) ◽  
pp. 1683-1687 ◽  
Author(s):  
C V Subramaniam ◽  
B Radhakrishnamurthy ◽  
G S Berenson

Abstract We evaluated glycosylation of hemoglobin (HbA + HbA1) in 25 control subjects and in 133 diabetic patients who were in various stages of blood glucose control, by measuring ketoamine-linked hexoses in hemoglobin. These hexoses were converted by digestion with 10 mol/L acetic acid for 16 h at 100 +/- 5 degrees C to 5-hydroxymethylfurfuraldehyde, which was quantitated by reaction with 2-thiobarbituric acid. Glycosylation of hemoglobin was expressed as micromoles of hydroxymethylfurfuraldehyde per gram of globin protein (the "HMF index"). A mean HMF index of 1.67 (SD = 0.23) was obtained for controls; that for diabetic patients was 2.93 (SD 0.95). The index correlated well (r = 0.83, p &lt; 0.001) with average blood glucose concentration as measured during the preceding 16 weeks, over a wide range of glucose values (1 to 6 g/L). It correlated even better (r = 0.92, p &lt; 0.001) when corrected for variations in hemoglobin concentration. Thus measurement of ketoamine-linked hexoses of hemoglobin or HMF index provides an independent and useful alternative to the currently used methods that measure only HbA1 or HbA1c.


2020 ◽  
Vol 9 (11) ◽  
pp. 3635
Author(s):  
Rajat Kapoor ◽  
Lava R. Timsina ◽  
Nupur Gupta ◽  
Harleen Kaur ◽  
Arianna J. Vidger ◽  
...  

Beta cell dysfunction is suggested in patients with COVID-19 infections. Poor glycemic control in ICU is associated with poor patient outcomes. This is a single center, retrospective analysis of 562 patients in an intensive care unit from 1 March to 30 April 2020. We review the time in range (70–150 mg/dL) spent by critically ill COVID-19 patients and non-COVID-19 patients, along with the daily insulin use. Ninety-three in the COVID-19 cohort and 469 in the non-COVID-19 cohort were compared for percentage of blood glucose TIR (70–150 mg/dL) and average daily insulin use. The COVID-19 cohort spent significantly less TIR (70–150 mg/dL) compared to the non-COVID-19 cohort (44.4% vs. 68.5%). Daily average insulin use in the COVID-19 cohort was higher (8.37 units versus 6.17 units). ICU COVID-19 patients spent less time in range (70–150 mg/dL) and required higher daily insulin dose. A higher requirement for ventilator and days on ventilator was associated with a lower TIR. Mortality was lower for COVID-19 patients who achieved a higher TIR.


2020 ◽  
Author(s):  
Helleputte Simon ◽  
De Backer Tine ◽  
Calders Patrick ◽  
Pauwels Bart ◽  
Shadid Samyah ◽  
...  

OBJECTIVE: In type 1 diabetes mellitus (T1DM) management, CGM-derived parameters can provide additional insights, with the concept of time in range (TIR) and other parameters reflecting glycaemic control and variability (GV) being put forward. This study aimed to examine the added and interpretative value of the CGM-derived indices TIR and coefficient of variation (CV%) in T1DM patients stratified according to their level of glycaemic control by means of HbA1c. METHODS: T1DM patients with a minimum disease duration of 10 years and without known macrovascular disease were enrolled. Patients were equipped with a blinded CGM device (Dexcom G4) for seven days. TIR (70–180 mg/dl), time in hypoglycaemia (total: <70 mg/dl; level 2: <54 mg/dl) and hyperglycaemia (total: >180 mg/dl; level 2: >250 mg/dl) were determined, and CV% (=standard deviation(SD)/mean blood glucose(MBG)) was used as parameter for GV. Pearson and Spearman correlations, and regression analysis was used to examine associations. RESULTS: 95 patients (age: 45±10 years; HbAc1: 7.7±0.8%) were included (MBG: 159±31 mg/dl; TIR 55.8±14.9%; CV%: 43.5±7.8%) and labeled as having good (HbA1c ≤7%; n=20), moderate (7–8%; n=44) or poor (>8%; n=31) glycaemic control. HbA1c was significantly associated with MBG (rs=0.48, p<0.001) and time spent in hyperglycaemia (total: rs=0.52; level 2: r=0.46; p<0.001), but not with time in hypoglycaemia and CV%, even after analysis in HbA1c subgroups. Similarly, TIR was negatively associated with HbA1c (r=−0.53; p<0.001), MBG (rs=−0.81; p<0.001) and time in hyperglycaemia (total: rs=−0.90; level 2: rs=−0.84; p<0.001), but not with time in hypoglycaemia. Subgroup analyses, however, showed that TIR did associate with shorter time in level 2 hypoglycaemia in those patients with good (rs=−0.60; p=0.007) and moderate (rs=−0.25; p=0.047) glycaemic control. In contrast, CV% was strongly positively associated with time in hypoglycaemia (total: rs=0.78; level 2: rs=0.76; p<0.001), but not with TIR or time in hyperglycaemia in the entire cohort, although subgroup analyses showed that TIR was negatively associated with CV% in patients with good glycaemic control (r=−0.81, p<0.001) and positively in patients with poor glycaemic control (r=0.47; p<0.01). CONCLUSION: This study demonstrates that CGM-derived metrics TIR and CV% relate with clinically important situations, TIR being strongly dependent on hyperglycaemia and CV% being reflective of hypoglycaemic risk. However, the interpretation and applicability of TIR and CV%, and their relationship, depends on the level of glycaemic control of the individual patient, with CV% generally adding less clinically relevant information in those with poor control. This illustrates the need for further research and evaluation of composite measures of glycaemic control in T1DM. Abbreviations: T1DM = Type 1 diabetes mellitus; CGM = Continuous glucose monitoring; TIR = Time in range; TAR = Time above range; TBR = Time below range; GV = Glycaemic variability; CV% = Coefficient of variation; MBG = Mean blood glucose.


2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Monica Andrade Lima Gabbay ◽  
Melanie Rodacki ◽  
Luis Eduardo Calliari ◽  
Andre Gustavo Daher Vianna ◽  
Marcio Krakauer ◽  
...  

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