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Glucose Values (glucose + value)
Kinds of Glucose Values Selected AbstractsNo apparent impact of increased post-operative blood glucose levels on clinical outcome in kidney transplant recipientsCLINICAL TRANSPLANTATION, Issue 2 2009Tijs J. Van Den Berg Abstract:, Background:, Our objective is to evaluate whether hyperglycemia in the first 48 h after renal transplantation is independently associated with rejection, post-operative infection and post-transplant diabetes mellitus (PTDM) in a retrospective cohort study. Methods:, Patients who received a renal transplant in our hospital in 2003 or 2004 were included. Glucose values until 48 h after surgery were retrieved from laboratory reports. Biopsy proven acute rejection, culture proven infections and PTDM were scored until four months after transplantation. Data were analyzed using univariate analysis and logistic multivariate analysis. Results:, At least one post-operative glucose value could be retrieved for 150/151 patients. Rejection occurred in 46/150 (30.5%), infection in 47/150 (31.1%) and PTDM in 19/150 (12.6%) patients. When corrected for other risk factors, no relation was found between post-operative glucose levels and rejection (weak inverse relation, OR = 0.82; 95% CI = 0.65,1.03; p = 0.09), post-operative glucose and infections (OR = 0.98; 95% CI = 0.80,1.21; p = 0.84) and post-operative glucose and PTDM (OR = 0.93; 95% CI = 0.70,1.23; p = 0.63). Conclusion:, Increased post-operative blood glucose levels after renal transplantation were not found to be a risk factor for graft rejection. Also, post-operative glucose levels were not found to be associated with PTDM and post-operative infections. [source] Nocturnal hypoglycaemia in Type 1 diabetic patients, assessed with continuous glucose monitoring: frequency, duration and associationsDIABETIC MEDICINE, Issue 5 2007I. M. E. Wentholt Abstract Aims, We quantified the occurrence and duration of nocturnal hypoglycaemia in individuals with Type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) or multiple-injection therapy (MIT) using a continuous subcutaneous glucose sensor. Methods, A microdialysis sensor was worn at home by 24 patients on CSII (mean HbA1c 7.8 ± 0.9%) and 33 patients on MIT (HbA1c 8.7 ± 1.3%) for 48 h. Occurrence and duration of nocturnal hypoglycaemia were assessed and using multivariate regression analysis, the association between HbA1c, diabetes duration, treatment type (CSII vs. MIT), fasting and bedtime blood glucose values, total daily insulin dose and mean nocturnal glucose concentrations, and hypoglycaemia occurrence and duration was investigated. Results, Nocturnal hypoglycaemia , 3.9 mmol/l occurred in 33.3% of both the CSII- (8/24) and MIT-treated patients (11/33). Mean (± sd; median, interquartile range) duration of hypoglycaemia , 3.9 mmol/l was 78 (± 76; 57, 23,120) min per night for the CSII- and 98 (± 80; 81, 32,158) min per night for the MIT-treated group. Multivariate regression analysis showed that bedtime glucose value had the strongest association with the occurrence (P = 0.026) and duration (P = 0.032) of nocturnal hypoglycaemia. Conclusions, Microdialysis continuous glucose monitoring has enabled more precise quantification of nocturnal hypoglycaemia occurrence and duration in Type 1 diabetic patients. Occurrence and duration of nocturnal hypoglycaemia were mainly associated with bedtime glucose value. [source] Therapeutic Yield and Outcomes of a Community Teaching Hospital Code Stroke ProtocolACADEMIC EMERGENCY MEDICINE, Issue 4 2004Andrew W. Asimos MD Objectives: To describe the experience of a community teaching hospital emergency department (ED) Code Stroke Protocol (CSP) for identifying acute ischemic stroke (AIS) patients and treating them with tissue plasminogen activator (tPA) and to compare outcome measures with those achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial. Methods: This study was a retrospective review from a hospital CSP registry. Results: Over a 56-month period, CSP activation occurred 255 times, with 24% (n= 60) of patients treated with intravenous (IV) tPA. The most common reasons for thrombolytic therapy exclusion were mild or rapidly improving symptoms in 37% (n= 64), intracerebral hemorrhage (ICH) in 23% (n= 39), and unconfirmed symptom onset time for 14% (n= 24) of patients. Within 36 hours of IV tPA treatment, 10% (NINDS = 6%) of patients (n= 6) sustained a symptomatic ICH (SICH). Three months after IV tPA treatment, 60% of patients had achieved an excellent neurologic outcome, based on a Barthel Index of ,95 (NINDS = 52%), while mortality measured 12% (NINDS = 17%). Among IV tPA-treated patients, those developing SICH were significantly older and had a significantly higher mean initial glucose value. Treatment protocol violations occurred in 32% of IV tPA-treated patients but were not significantly associated with SICH (Fisher's exact test). Conclusions: Over the study period, the CSP yielded approximately one IV tPA-treated patient for every four screened and, despite prevalent protocol violations, attained three-month functional outcomes equal to those achieved in the NINDS trial. For community teaching hospitals, ED-directed CSPs are a feasible and effective means to screen AIS patients for treatment with thrombolysis. [source] Aging per se does not influence postprandial glucose levels in type 2 diabetesGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2005Yumiko Magata Background: It is well known that postprandial glucose increases with aging in non-diabetic subjects. The question we addressed is whether elderly type 2 diabetic patients with definite fasting hyperglycemia (, 126 mg/dL) also display increased postprandial hyperglycemia relative to their younger counterparts. Methods: Diurnal plasma glucose profiles were measured in 162 overt type 2 diabetic patients treated by diet alone (diet group) or with sulfonylureas as monotherapy (SU group). Plasma glucose concentrations were measured at 08.00 hours (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00 and 08.00 hours the next morning. The postprandial glucose area under the curve (AUC) from 08.00 to 24.00 hours was calculated above the baseline level equal to the 08.00-hours plasma glucose value, and the relationships with clinical variables, including age, were assessed. Results: There were no differences in diurnal plasma glucose profiles between the middle-aged (< 65 years) and elderly (, 65 years) groups either the diet group or the SU group. Univariate analysis showed that the postprandial glucose area under the curve was related to the 08:00-hours plasma glucose value (R = 0.583, P < 0.001) in the diet alone group and to the duration of diabetes (R = 0.220, P < 0.05), SU dose (R = 0.330, P = 0.001) and urine CPR (R = ,0.229, P < 0.05) in the SU group. In multivariate analysis, postprandial glucose area under the curve was only related to 08.00 hours plasma glucose value in the diet group (R2 of the model = 0.340, P < 0.001) and to the SU dose in SU group (R2 of the model = 0.145, P < 0.001). Conclusion: These results suggest that aging, per se, does not influence postprandial glucose levels in overt type 2 diabetic patients. [source] Seizures, ataxia, developmental delay and the general paediatrician: Glucose transporter 1 deficiency syndromeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2006David J Coman Aim Glucose transporter 1 deficiency syndrome (GLUT1-DS) is an important condition for the general paediatrician's differential armamentarium. We describe a case series of eight patients in order to raise awareness of this treatable neurometabolic condition. The diagnosis of GLUT1-DS is suggested by a decreased absolute cerebrospinal fluid (CSF) glucose value (<2.2 mmol/L) or lowered CSF: plasma glucose ratio (<0.4). Methods This is a review of eight Queensland patients with GLUT1-DS. The clinical presentation, clinical course, laboratory investigations and treatment outcomes are discussed. Results The clinical features noted in our patient cohort include combinations of ataxia, developmental delay and a severe seizure disorder that is refractory to anticonvulsant medications. Seizures are the most common clinical manifestation and may be exacerbated by phenobarbitone. The paired CSF: plasma glucose results ranged from 0.2 to 0.39 (normal <0.6) with an average of 0.33. 3-O-Methyl-D-Glucose uptake and GLUT1 Genotyping analysis have been performed on five patients thus far. Rapid and impressive seizure control was observed in 100% of our patients once the ketogenic diet was instituted, with half of the cohort being able to wean completely from anticonvulsants. Conclusion Children presenting with a clinical phenotype consisting of a refractory seizure disorder, ataxia and developmental delay should prompt the consideration of Glucose transporter 1 deficiency syndrome. While the diagnostic test of lumbar puncture is an invasive manoeuvre, the diagnosis provides a viable treatment option, the ketogenic diet. GLUT1-DS displays clinical heterogeneity, but the value of early diagnosis and treatment is demonstrated by our patient cohort. [source] Low-fat vs. high-fat bedtime snacks in children and adolescents with type 1 diabetesPEDIATRIC DIABETES, Issue 4pt1 2008Darrell Wilson Objective:, The purpose of this study was to determine whether, in a group of children with type 1 diabetes using insulin pump, a prebedtime snack with a relatively high fat content provides greater protection from nocturnal hypoglycemia than a snack containing the same amount of carbohydrate and protein but a lower fat content. Research design and methods:, Ten subjects, aged 6 to <18 yr, in a trial evaluating the Abbott Navigator glucose sensor, agreed to this ancillary study. On 12 or more separate nights, each subject was randomized by a Web site to a carbohydrate,low-fat (30 g CHO, 2.5 g protein, and 1.3 g fat; 138 kcal) snack or a carbohydrate,high-fat (30 g CHO, 2 g protein, and 20 g fat; 320 kcal) snack. Subjects used their usual evening snack algorithm to determine the size (in 15-g carbohydrate increments) and insulin dosage. Results:, Average glucose on 128 valid study nights before snack was similar in both groups. The proportion of nights with hypoglycemia (a sensor or meter glucose value ,70 mg/dL) was similar in both groups (19% high fat vs. 20% low fat), as was the proportion of nights with hyperglycemia (a glucose ,200 mg/dL and at least 50 mg/dL above baseline, 35% high fat vs. 30% low fat). Conclusions:, There were no statistical differences between the high- and low-fat snacks on the frequency of hyperglycemia or hypoglycemia. This study highlights the feasibility of web-based research in patients' home environment. [source] No apparent impact of increased post-operative blood glucose levels on clinical outcome in kidney transplant recipientsCLINICAL TRANSPLANTATION, Issue 2 2009Tijs J. Van Den Berg Abstract:, Background:, Our objective is to evaluate whether hyperglycemia in the first 48 h after renal transplantation is independently associated with rejection, post-operative infection and post-transplant diabetes mellitus (PTDM) in a retrospective cohort study. Methods:, Patients who received a renal transplant in our hospital in 2003 or 2004 were included. Glucose values until 48 h after surgery were retrieved from laboratory reports. Biopsy proven acute rejection, culture proven infections and PTDM were scored until four months after transplantation. Data were analyzed using univariate analysis and logistic multivariate analysis. Results:, At least one post-operative glucose value could be retrieved for 150/151 patients. Rejection occurred in 46/150 (30.5%), infection in 47/150 (31.1%) and PTDM in 19/150 (12.6%) patients. When corrected for other risk factors, no relation was found between post-operative glucose levels and rejection (weak inverse relation, OR = 0.82; 95% CI = 0.65,1.03; p = 0.09), post-operative glucose and infections (OR = 0.98; 95% CI = 0.80,1.21; p = 0.84) and post-operative glucose and PTDM (OR = 0.93; 95% CI = 0.70,1.23; p = 0.63). Conclusion:, Increased post-operative blood glucose levels after renal transplantation were not found to be a risk factor for graft rejection. Also, post-operative glucose levels were not found to be associated with PTDM and post-operative infections. [source] The usage of a simplified self-titration dosing guideline (303 Algorithm) for insulin detemir in patients with type 2 diabetes , results of the randomized, controlled PREDICTIVEÔ 303 studyDIABETES OBESITY & METABOLISM, Issue 6 2007L. Meneghini The Predictable Results and Experience in Diabetes through Intensification and Control to Target: An International Variability Evaluation 303 (PREDICTIVEÔ 303) Study (n = 5604) evaluated the effectiveness of insulin detemir, a long-acting basal insulin analogue, using a simplified patient self-adjusted dosing algorithm (303 Algorithm group) compared with standard-of-care physician-driven adjustments (Standard-of-care group) in a predominantly primary care setting, over a period of 6 months. Insulin detemir was to be started once-daily as add-on therapy to any other glucose-lowering regimens or as a replacement of prestudy basal insulin in patients with type 2 diabetes. Investigator sites rather than individual patients were randomized to either the 303 Algorithm group or the Standard-of-care group. Patients from the 303 Algorithm group sites were instructed to adjust their insulin detemir dose every 3 days based on the mean of three ,adjusted' fasting plasma glucose (aFPG) values (capillary blood glucose calibrated to equivalent plasma glucose values) using a simple algorithm: mean aFPG < 80 mg/dl (<4.4 mmol/l), reduce dose by 3 U; aFPG between 80 and 110 mg/dl (4.4,6.1 mmol/l), no change; and aFPG > 110 mg/dl (>1.1 mmol/l), increase dose by 3 U. The insulin detemir dose for patients in the Standard-of-care group was adjusted by the investigator according to the standard of care. Mean A1C decreased from 8.5% at baseline to 7.9% at 26 weeks for the 303 Algorithm group and from 8.5 to 8.0% for the Standard-of-care group (p = 0.0106 for difference in A1C reduction between the two groups). Mean FPG values decreased from 175 mg/dl (9.7 mmol/l) at baseline to 141 mg/dl (7.8 mmol/l) for the 303 Algorithm group and decreased from 174 mg/dl (9.7 mmol/l) to 152 mg/dl (8.4 mmol/l) for the Standard-of-care group (p < 0.0001 for difference in FPG reduction between the two groups). Mean body weight remained the same at 26 weeks in both groups (change from baseline 0.1 and ,0.2 kg for the 303 Algorithm group and the Standard-of-care group respectively). At 26 weeks, 91% of the patients in the 303 Algorithm group and 85% of the patients in the Standard-of-care group remained on once-daily insulin detemir administration. The rates of overall hypoglycaemia (events/patient/year) decreased significantly from baseline in both groups [from 9.05 to 6.44 for the 303 Algorithm group (p = 0.0039) and from 9.53 to 4.95 for the Standard-of-care group (p < 0.0001)]. Major hypoglycaemic events were rare in both groups (0.26 events/patient/year for the 303 Algorithm group and 0.20 events/patient/year for the Standard-of-care group; p = 0.2395). In conclusion, patients in the 303 Algorithm group achieved comparable glycaemic control with higher rate of hypoglycaemia as compared with patients in the Standard-of-care group, possibly because of more aggressive insulin dose adjustments. The vast majority of the patients in both groups were effectively treated with once-daily insulin detemir therapy. The use of insulin detemir in this predominantly primary care setting achieved significant improvements in glycaemic control with minimal risk of hypoglycaemia and no weight gain. [source] What predicts the occurrence of the metabolic syndrome in a population-based cohort of adult healthy subjects?DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2009S. Bo Abstract Background Metabolic syndrome (MS), the concurrence of hyperglycaemia, dyslipidaemia, hypertension and visceral obesity, increases cardiovascular risk and mortality. Predictors of MS were previously evaluated in patients without the full syndrome, but with some of its traits. This might confound the resulting associations. Methods The relationship between baseline variables and MS development was evaluated in healthy middle-aged subjects without any MS component at baseline, over a 4.5-year follow-up. Results From a population-based cohort of 1658 subjects, 241 individuals showed no MS components and 201 (83.4%) of them participated in a follow-up screening. At baseline, patients who developed the MS (n = 28/201; 13.9%) showed significantly higher Homeostasis Model Assessment-Insulin Resistance score (HOMA-IR) and C-reactive protein (CRP) values, and lower exercise level than subjects who did not. In a multiple logistic regression analysis, after multiple adjustments, the only baseline variable significantly (p < 0.01) associated with the MS was CRP (OR = 4.05; 95% CI 2.23,7.38; p < 0.001). Results did not change after adjusting for weight gain. The area under the receiver-operating curve was 0.83 for CRP after multiple adjustments. The optimal cut-off point of baseline CRP values was 2.1 mg/L, with 86% (95% CI 81,90) sensitivity and 75% (69,81) specificity in predicting the MS. Baseline CRP resulted associated with after-study glucose values in a multiple regression model (, = 0.14; 0.08,0.20; p < 0.001). Conclusions Higher baseline CRP values confer a significant increased risk of developing the MS in healthy subjects, independently of weight gain. Copyright © 2009 John Wiley & Sons, Ltd. [source] The relationship of postprandial glucose to HbA1cDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S2 2004Rüdiger Landgraf Abstract The gold standard for the assessment of the overall glycemic control is the determination of HbA1c. There are, however, insufficient data to determine reliably the relative contribution of fasting and postprandial plasma glucose to HbA1c. Increasing evidence suggests that excessive excursions of postprandial glucose might be important for the development of micro- and macroangiopathic complications. With respect to the treatment options, one important question to be answered is whether premeal, postmeal or fasting plasma glucose, alone or in combination, will be necessary in adjusting the therapy to achieve optimal HbA1c levels while minimizing hypoglycemia. HbA1c is difficult to predict from fasting plasma glucose. There are indications that there is a shift in the relative contribution from postprandial glucose at good to fair HbA1c levels (<7.3% to <9.2%) to fasting plasma glucose at high HbA1c (>9.3%). There is also a better correlation of afternoon and evening plasma glucose with HbA1c than with prebreakfast and prelunch plasma glucose values. Since the definition on how to define postprandial glucose is still a matter of debate and since postprandial glucose depends on the premeal blood glucose level and, on the time of the meal, its size and composition and the therapeutic strategy, the data so far available are inconclusive and the best correlation of HbA1c is with the area under the glucose profiles. Continuous glucose monitoring under daily life conditions will be the key to definitely unravel the relationship among HbA1c and fasting, premeal, postprandial and postabsorptive plasma glucose. Copyright © 2004 John Wiley & Sons, Ltd. [source] Postprandial hyperglycaemia in type 2 diabetes: pathophysiological aspects, teleological notions and flags for clinical practiceDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S2 2004Eleni I. Boutati Abstract Type 2 diabetes subjects carry an excess risk for micro- and macrovascular disease and a higher cardiovascular morbidity and mortality rate. The beneficial impact of tight glycaemic control,evidenced by the integrated marker of fasting glucose and postprandial glucose values, the HbA1c,for the prevention of microvascular complications is definitely confirmed. Over the past few years, several studies have identified postprandial hyperglycaemia as a better predictor of cardiovascular or even of all-cause mortality, as well as an independent risk factor for atherosclerosis. The continuous glucose monitoring could offer a rationale means for the detection of postprandial hyperglycaemia and ultimately for its effective management. Advances in technology keep a promise for a reliable, convenient and closer to the idea of the artificial endocrine pancreas glucose sensor. Subcutaneous glucose levels charted by one of the new sensors were found to be well correlated with venous glucose measurements. Intervention for a healthy lifestyle is frequently hampered by patients' poor compliance. The availability of diverse antidiabetic agents provides options for targeting the glycaemic goal and a choice more fitted to the particularized pathophysiology of each individual subject. Drugs targeting postprandial glycaemia may prove to represent the ,sine qua non' for the ,return' of postprandial glucose values at a ,non-deleterious' threshold, either as monotherapy for the early stages of the disease or as combination therapy later in the progression of diabetes. Copyright © 2004 John Wiley & Sons, Ltd. [source] Maternal blood glucose in diabetic pregnancies and cognitive performance in offspring in young adulthood: a Danish cohort studyDIABETIC MEDICINE, Issue 7 2010G. L. Nielsen Diabet. Med. 27, 786,790 (2010) Abstract Aims, Maternal diabetes is a known risk factor for perinatal complications, but there are little data on consequences for long-term intellectual outcome in offspring. We assess cognitive performance in military conscripts according to maternal blood glucose levels during pregnancy. Methods, We identified a cohort of 60 Danish male offspring of insulin-treated diabetic mothers born between 1976 and 1984 and followed this cohort to military conscription. From medical records, we extracted data on all available values of maternal blood glucose categorized as fasting and non-fasting and by day in pregnancy, together with maternal White class, smoking habits and socio-economic status. The main outcome was cognitive performance at conscription measured with a validated intelligence test. The association between maternal blood glucose level and cognitive performance was assessed by multivariate linear regression and a fitted fractional polynomial. Results, Median fasting blood glucose values in the second half of pregnancy was negatively associated with cognitive scores at conscription [adjusted coefficient ,1.7; 95% confidence interval (CI) ,3.0; ,0.4]. Restriction to only first-born sibling slightly strengthened the association (coefficient ,1.9; 95% CI ,3.3; ,0.5), but after exclusion of two pregnancies with the blood glucose > 10 mmol/l the association became insignificant (coefficient ,0.6; 95% CI ,2.6; 1.4). Conclusions, Maternal blood glucose level during diabetic pregnancy is negatively associated with cognitive performance in offspring at military conscription. In pregnancies with fasting blood glucose levels below 10 mmol/l, the association is weak and considered to be without clinical relevance. [source] Continuous Subcutaneous Glucose Monitoring System in diabetic mothers during labour and postnatal glucose adaptation of their infantsDIABETIC MEDICINE, Issue 4 2008E. Stenninger Abstract Aims To assess a new technique for continuous monitoring of glucose concentration during labour in diabetic mothers. A second objective was to study maternal glucose levels in relation to postnatal glucose adaptation and the need for intravenous (IV) glucose treatment in the newborn infant. Methods Fifteen pregnant women with insulin-treated diabetes mellitus participated in this prospective pilot study. To measure their glucose control during labour we used the Continuous Subcutaneous Glucose Monitoring System (CGMS; Medtronic, Minneapolis, MN, USA) to calculate the mean glucose concentration and the area under the curve (AUC) in the last 120 min before delivery. All infants of these women were transferred to the neonatal care unit for early oral feeding and blood glucose measurements up to 14 h after delivery. Infants received IV glucose if blood glucose values were repeatedly < 2.2 mmol/l. Results All women coped well with the CGMS monitoring. AUC 0,120 min before delivery, mean glucose concentration 0,120 min before delivery and cord plasma insulin level were all significantly associated with the need for IV glucose in the newborn children. Conclusions In this study we found an association between maternal glucose concentrations during labour and postnatal glucose adaptation and need for IV glucose treatment in the infants. Online monitoring of glucose levels during delivery might help us to achieve maternal normoglycaemia and further reduce the risk of postnatal hypoglycaemia in the offspring. [source] Nocturnal hypoglycaemia in Type 1 diabetic patients, assessed with continuous glucose monitoring: frequency, duration and associationsDIABETIC MEDICINE, Issue 5 2007I. M. E. Wentholt Abstract Aims, We quantified the occurrence and duration of nocturnal hypoglycaemia in individuals with Type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) or multiple-injection therapy (MIT) using a continuous subcutaneous glucose sensor. Methods, A microdialysis sensor was worn at home by 24 patients on CSII (mean HbA1c 7.8 ± 0.9%) and 33 patients on MIT (HbA1c 8.7 ± 1.3%) for 48 h. Occurrence and duration of nocturnal hypoglycaemia were assessed and using multivariate regression analysis, the association between HbA1c, diabetes duration, treatment type (CSII vs. MIT), fasting and bedtime blood glucose values, total daily insulin dose and mean nocturnal glucose concentrations, and hypoglycaemia occurrence and duration was investigated. Results, Nocturnal hypoglycaemia , 3.9 mmol/l occurred in 33.3% of both the CSII- (8/24) and MIT-treated patients (11/33). Mean (± sd; median, interquartile range) duration of hypoglycaemia , 3.9 mmol/l was 78 (± 76; 57, 23,120) min per night for the CSII- and 98 (± 80; 81, 32,158) min per night for the MIT-treated group. Multivariate regression analysis showed that bedtime glucose value had the strongest association with the occurrence (P = 0.026) and duration (P = 0.032) of nocturnal hypoglycaemia. Conclusions, Microdialysis continuous glucose monitoring has enabled more precise quantification of nocturnal hypoglycaemia occurrence and duration in Type 1 diabetic patients. Occurrence and duration of nocturnal hypoglycaemia were mainly associated with bedtime glucose value. [source] Rosiglitazone improves insulin sensitivity, glucose tolerance and ambulatory blood pressure in subjects with impaired glucose toleranceDIABETIC MEDICINE, Issue 5 2004S. M. A. Bennett Abstract Aims To determine the effects of rosiglitazone on insulin sensitivity, glucose tolerance and ambulatory blood pressure when administered to subjects with persistent impaired glucose tolerance (IGT). Methods Eighteen subjects with persistent IGT were randomized to receive rosiglitazone 4 mg twice daily or matching placebo for 12 weeks. Evaluation at baseline and at the end of treatment included measurement of whole body insulin sensitivity during a euglycaemic hyperinsulinaemic clamp and deriving an insulin sensitivity index. Changes in glucose and insulin concentration were determined after oral glucose tolerance test (OGTT) and mixed meal tolerance tests, and 24-h ambulatory blood pressure was monitored. Results Rosiglitazone significantly improved the insulin sensitivity index by 2.26 µg/kg per min per pmol/l relative to placebo (P = 0.0003). Four of nine subjects receiving rosiglitazone reverted to normal glucose tolerance and 5/9 remained IGT, although four of these had improved 2-h glucose values. In the placebo group, 1/9 subjects progressed to Type 2 diabetes and 8/9 remained IGT. Following OGTT and meal tolerance test, glucose and insulin area under curve were reduced over 3 and 4 h, respectively. Compared with placebo, ambulatory blood pressure decreased significantly in the rosiglitazone group by 10 mmHg systolic (P = 0.0066) and 8 mmHg diastolic (P = 0.0126). Conclusions Consistent with its effects in patients with Type 2 diabetes, rosiglitazone substantially improved whole body insulin sensitivity and the glycaemic and insulinaemic responses to an OGTT and meal tolerance test in subjects with persistent IGT. Furthermore, rosiglitazone reduced systolic and diastolic ambulatory blood pressure in these subjects. [source] Post-prandial glucose excursions following four methods of bolus insulin administration in subjects with Type 1 diabetesDIABETIC MEDICINE, Issue 4 2002H. P. Chase Abstract Aims To determine if one method of short-acting insulin bolus administration is superior to other methods in managing a meal high in carbohydrates, calories and fat. Methods Nine subjects receiving continuous subcutaneous insulin infusion using insulin lispro (Humalog®) agreed to consume the same meal high in carbohydrates, calories and fat on four occasions 1 week apart. They received the same dose of bolus insulin on each of the four occasions randomly assigned and beginning 10 min prior to the meal as either a single bolus, two separate boluses of one-half the same total dose (the second after 90 min), the entire bolus given as a square-wave (over 2 h) or a dual-wave (70% as a bolus and 30% as a square-wave over 2 h). Blood glucose levels were measured at ,60 and ,30 min and at zero time, and then every half-hour for 6 h using the Hemacue® in the out-patient clinic. Results Changes in blood glucose values from fasting were the lowest after 90 and 120 min (P < 0.01) when the dual wave was administered. When the dual or square-wave methods of insulin administration were used, subjects had significantly lower glucose levels after 4 h in comparison with when the single or double boluses were used (P = 0.04). Conclusions We conclude that the dual wave provided the most effective method of insulin administration for this meal. The dual- and square-wave therapies resulted in lower glucose levels 4 h after the meal in comparison with the single and double-bolus treatments. [source] Modulation of glycosphingolipid metabolism significantly improves hepatic insulin sensitivity and reverses hepatic steatosis in mice,HEPATOLOGY, Issue 5 2009Nora Bijl Nonalcoholic fatty liver disease (NAFLD) is associated with obesity, insulin resistance, and type 2 diabetes. The hyperinsulinemia that occurs as a consequence of insulin resistance is thought to be an important contributor to the development of fatty liver. We have shown that the iminosugar N-(5'-adamantane-1'-yl-methoxy)-pentyl-1-deoxynojirimycin (AMP-DNM), an inhibitor of the enzyme glucosylceramide synthase, is a potent enhancer of insulin signaling in rodent models for insulin resistance and type 2 diabetes. The present study was designed to assess the impact of AMP-DNM on insulin levels, liver triglyceride synthesis, and gene expression profile. Treatment of ob/ob mice with AMP-DNM restored insulin signaling in the liver, corrected blood glucose values to levels found in lean mice, and decreased insulin concentration. The expression of sterol regulatory element-binding protein 1c target genes involved in fatty acid synthesis normalized. AMP-DNM treatment significantly reduced liver to body weight ratio and reversed hepatic steatosis, comprising fat as well as inflammatory markers. In addition, AMP-DNM treatment corrected to a large extent the gene expression profile of ob/ob mice livers toward the profile of lean mice. Conclusion: Pharmacological lowering of glycosphingolipids with the iminosugar AMP-DNM is a promising approach to restore insulin signaling and improve glucose homeostasis as well as hepatic steatosis. (HEPATOLOGY 2009.) [source] Hyperglycemia as a Predictor of In-Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub-Intensive Care UnitJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2008Intissar Sleiman MD OBJECTIVES: To investigate the association between hyperglycemia and in-hospital and 45-day mortality in acutely ill elderly patients. DESIGN: Retrospective cohort. SETTING: Hospital medical patients admitted to a sub-intensive care unit (sub-ICU) for elderly patients, which is a level of care between ordinary wards and intensive care. PARTICIPANTS: One thousand two hundred twenty-nine patients (mean age 79.6±8.4) admitted to the sub-ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty-two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C). MEASUREMENTS: Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In-hospital mortality was the primary outcome, and 45-day mortality was the secondary outcome. RESULTS: Total in-hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in-hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6,4.8). Forty-five-day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM. CONCLUSION: In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL. [source] Abdominal Obesity Is Associated With Potassium Depletion and Changes in Glucose Homeostasis During Diuretic TherapyJOURNAL OF CLINICAL HYPERTENSION, Issue 6 2008Lydia Sebba Souza Mariosa MD The activation of the renin-angiotensin system (RAS) is an important mechanism that contributes to hypertension in obese individuals. Thiazide diuretics also activate the RAS in response to volume contraction and can lead to a decrease in serum potassium values and glucose metabolism abnormalities. To evaluate the impact of abdominal obesity on potassium depletion and glucose homeostasis in hypertensive patients receiving thiazide therapy, the authors studied 329 hypertensive patients without known diabetes or impaired renal function. Patients were stratified into 2 major groups according to whether they used thiazide diuretic therapy, and each group was further divided in 2 subgroups according to the presence of abdominal obesity. The authors demonstrated that obese patients receiving diuretic therapy had lower plasma potassium levels and higher glucose values compared with nonobese patients receiving diuretic therapy. In conclusion, abdominal obesity predisposes to potassium depletion during diuretic therapy in association with effects on glucose homeostasis. [source] Spontaneous pancreatic islet amyloidosis in 40 baboonsJOURNAL OF MEDICAL PRIMATOLOGY, Issue 2 2002G.B. Hubbard Spontaneous amyloidosis occurs in many nonhuman primate species but remains difficult to diagnose and treat. Nonhuman primates continue to offer promise as animal models in which to study amyloidosis in humans. Amyloidosis was not diagnosed clinically but was found histologically in four male and 36 female baboons. The baboons averaged 18 years of age at death (range, 7,28 years). Clinical signs, if present, were hyperglycemia and cachexia. Blood glucose values were elevated in 12 of 30 baboons with available clinical pathology data. Four baboons had been clinically diagnosed as diabetic and three were treated with insulin. Amyloid was found in the islets of Langerhans of the pancreas in 40 baboons; 35 baboons had amyloid only in the islets of Langerhans. Amyloid was found in nonislet tissue of baboons as follows: five, nonislet pancreas; four, intestine and adrenal; three, kidney; two, prostate and spleen; and one each, lymph node, liver, gall bladder, stomach, tongue, urinary bladder, and salivary gland. Sections of paraffin-embedded tissues were evaluated for amyloid with hematoxylin and eosin (HE) and congo red (CR) staining, and using immunohistochemistry for human islet amyloid polypeptide (IAPP), calcitonin gene-related peptide (CGRP), glucagon, pancreatic polypeptide (PP), somatostatin (SS), and porcine insulin. Islet amyloid was positive with HE in 40 baboons, with CR in 39 baboons, and with IAPP and CGRP in 35 baboons. IAPP and CGRP only stained islet amyloid. PP, SS, glucagon, and porcine insulin did not stain amyloid. Islet amyloidosis in the baboon appears to be difficult to diagnose clinically, age-related, and similar to islet amyloidosis in other species. The baboon may be a good model for the study of islet amyloidosis in humans. [source] Accuracy and reliability of continuous blood glucose monitor in post-surgical patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009K. YAMASHITA Background: The STG-22Ô is the only continuous blood glucose monitoring system currently available. The aim of this study is to determine the accuracy and reliability of the STG-22Ô for continuously monitoring blood glucose level in post-surgical patients. Methods: Fifty patients scheduled for routine surgery were studied in surgical intensive care unit (ICU) of a university hospital. After admission to the ICU, the STG-22Ô was connected to the patients. An attending physician obtained blood samples from a radial arterial catheter. Blood glucose level was measured using the ABLÔ800FLEX immediately after blood collection at 0, 4, 8, and 16 h post-admission to the ICU (total of 200 blood glucose values). Results: The correlation coefficient (R2) was 0.96. In the Clarke error grid, 100% of the paired measurements were in the clinically acceptable zone A and B. The Bland and Altman analysis showed that bias±limits of agreement (percent error) were 0.04(0.7)±0.35(6.3) mmol (mg/dl) (7%), ,0.11(,2)±1.22(22) (15%) and ,0.33(,6)±1.28(23) (10%) in hypoglycemia (<70(3.89) mmol (mg/dl), normoglycemia (3.89(70),10(180) mmol (mg/dl), and hyperglycemia (>10(180) mmol (mg/dl), respectively. Conclusions: The STG-22Ô can be used for measuring blood glucose level continuously and measurement results are consistent with intermittent measurement (percentage error within 15%). Therefore, the STG-22Ô is a useful device for monitoring in blood glucose level in the ICU for 16 h. [source] Evaluation of a continuous glucose monitoring system in diabetic dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 10 2003L. J. Davison The generation of a blood glucose curve is important for assessing the response to insulin therapy in diabetic dogs. Disadvantages of this technique include patient discomfort and the potential for missing transient hypo- or hyperglycaemic episodes. The aim of the current study was to evaluate a continuous glucose monitoring system (CGMS) for use in diabetic dogs. Interstitial fluid glucose concentrations were recorded in 10 diabetic dogs, every five minutes for up to 48 hours, using a subcutaneous sensor attached to the CGMS device. Blood glucose concentrations were measured simultaneously using a glucometer. The correlation between interstitial fluid and blood glucose values was 0·81 (P<0·01). The largest discrepancies between the two sets of data were seen during the one- to three-hour period following feeding, suggesting that postprandial hyperglycaemia might not be reflected in the interstitial fluid. The authors conclude that the CGMS is a potentially valuable tool in the management of canine diabetic patients. [source] Use of the DirecNet Applied Treatment Algorithm (DATA) for diabetes management with a real-time continuous glucose monitor (the FreeStyle Navigator)PEDIATRIC DIABETES, Issue 2 2008Diabetes Research In Children Network (DirecNet) Study Group Background:, There are no published guidelines for use of real-time continuous glucose monitoring data by a patient; we therefore developed the DirecNet Applied Treatment Algorithm (DATA). The DATA provides algorithms for making diabetes management decisions using glucose values: (i) in real time which include the direction and rate of change of glucose levels, and (ii) retrospectively based on downloaded sensor data. Objective:, To evaluate the use and effectiveness of the DATA in children with diabetes using a real-time continuous glucose sensor (the FreeStyle Navigator). Subjects:, Thirty children and adolescents (mean ± standard deviation age = 11.2 ± 4.1 yr) receiving insulin pump therapy. Methods:, Subjects were instructed on use of the DATA and were asked to download their Navigator weekly to review glucose patterns. An Algorithm Satisfaction Questionnaire was completed at 3, 7, and 13 wk. Results:, At 13 wk, all of the subjects and all but one parent thought that the DATA gave good, clear directions for insulin dosing, and thought the guidelines improved their postprandial glucose levels. In responding to alarms, 86% of patients used the DATA at least 50% of the time at 3 wk, and 59% reported doing so at 13 wk. Similar results were seen in using the DATA to adjust premeal bolus doses of insulin. Conclusions:, These results show the feasibility of implementing the DATA when real-time continuous glucose monitoring is initiated and support its use in future clinical trials of real-time continuous glucose monitoring. [source] Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnanciesPEDIATRIC DIABETES, Issue 1 2008Erin J Keely In utero hyperglycemia has been associated with insulin resistance (IR) in children; however, there are limited data in low-risk populations. The purpose of this study was to describe the prevalence of metabolic markers of IR in a primarily Caucasian cohort of gestational diabetes mellitus (GDM) offspring aged 7,11 yr (mean 9.1) and to correlate offspring with maternal indexes. Sixty-eight children were recruited through a follow-up study of women who participated in a randomized controlled trial of minimal intervention vs. tight glycemic control for GDM. All participants had a fasting plasma glucose (FPG), insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-chol), triglyceride (TG) level, and a 2-h oral glucose tolerance test. We calculated homeostasis model assessment (HOMA) and recorded body mass index and waist circumference (WC). Criteria for metabolic syndrome for children included: FPG > 6.0 mmol/L, HDL-chol < 1.03 mmol/L, TG > 1.24 mmol/L, WC > 90% for age and gender, and 2-h glucose > 7.8 mmol/L. Among these children, 45 (66%), 17 (25%), 5 (7%), and 1 (1.5%) had zero, one, two, or three metabolic markers of IR, respectively. Hypertriglyceridemia (21%) was most prevalent, with no child having an elevated FPG. WC (p = 0.018) and TG (p = 0.005) were strong predictors of IR in the offspring after adjustment for age, gender, birthweight, family history, and maternal IR. Maternal and offspring HDL-chol, TG, WC, and HOMA but not fasting or 2-h glucose levels were significantly correlated. We conclude that metabolic markers of IR in children exposed to GDM may be present in the absence of abnormal fasting or 2-h glucose values. Screening strategies that focus on glucose levels may need to be reconsidered to institute early intervention with lifestyle changes for children at risk. [source] Assessment of glycemic control by continuous glucose monitoring system in 50 children with type 1 diabetes starting on insulin pump therapyPEDIATRIC DIABETES, Issue 3 2004Dorothee Deiss Abstract:, Objective:, To report experience with a continuous glucose monitoring system (CGMS) and to identify factors influencing glycemic control in a large cohort of children and adolescents with type 1 diabetes and change to insulin pump therapy via continuous subcutaneous insulin infusion (CSII). Research design and methods:, In 50 patients [21 boys, 29 girls; median age 12.6 yr (range: 1.3,16.4 yr); diabetes duration 5.0 yr (0.2,13.3)], hemoglobin A1c (HbA1c) and ambulatory CGMS were performed before and 6 wk after starting CSII. Average glucose concentration per 24 h, during day and night time as well as number of excursions, duration, and area under the curve (AUC) of glucose values above 180 mg/dL and below 60 mg/dL were calculated from CGMS data. Simultaneously, metabolic control was documented by standardized self-monitoring of blood glucose (SMBG). Results:, In the total cohort, HbA1c improved from 8.1 ± 1.2% at baseline to 7.7 ± 0.9% after 6 wk of CSII (p < 0.001). This effect was more distinct in boys (8.0 ± 1.4 vs. 7.5 ± 1.1%, p = 0.007) than in girls (8.1 ± 1.1 vs. 7.8 ± 0.7%, p = 0.039) as well as in patients with poor glycemic control (HbA1c > 8.0%) at baseline (8.9 ± 0.6 vs. 8.1 ± 0.8%, p < 0.001) and in those older than 12 yr (8.2 ± 1.2 vs. 7.7 ± 1.0%, p < 0.001). At 6 wk of CSII, the values of glucose average per 24 h, AUC and time above 180 mg/dL, particularly during the day, improved. HbA1c was correlated with AUC above 180 mg/dL (r = 0.742, p < 0.001) and CGMS average glucose per 24 h (r = 0.628, p = 0.002), but to a lesser extent with SMBG values (r = 0.418, p = 0.054). Conclusion:, With the change to CSII, HbA1c improved significantly after 6 wk of therapy. CGMS usage provided additional information about glycemic control in these patients. [source] A comparison of physiological variables in aged and young women during and following submaximal exerciseAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 6 2009Michael R. Deschenes Previously, we have examined how aging affects the physiological responses of men to endurance exercise. In the present investigation, we aimed to extend our assessment of the influence of aging on exercise-induced responses by focusing on women. Ten young (20.3 ± 0.3 years; mean ± SE) and 10 aged (75.5 ± 1.2 years) women performed 30 min of cycling at 60,65% of their predetermined peak oxygen uptake. Data for respiratory exchange ratio (RER), heart rate, blood pressure, rectal temperature, and plasma metabolites were collected before exercise, at the 15th and 30th min of exercise, and at 5 and 15 min postexercise. A two-way, repeated measures ANOVA with main effects of age and time was conducted on each variable. Our findings showed that age affected exercise-induced responses of each variable quantified. Although RER, heart rate, temperature, and lactate were significantly (P < 0.05) higher among young women, blood pressure and glucose values were greater among aged women. Moreover, unlike previous results noted among men where age-related differences primarily occurred during postexercise recovery, in women the effect of aging was detected during exercise itself. The data presented here indicate that aging impacts physiological responses of women to prolonged endurance exercise even when relative intensity (% of peak oxygen uptake) is held constant. Combined with our earlier study on men, these findings suggest that gender interacts with aging to determine whether age-related differences are manifested during exercise itself, or during postexercise recovery. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc. [source] Tevaluation of transgenic event CBH 351 (StarLink) corn in pigANIMAL SCIENCE JOURNAL, Issue 1 2010Chisato YONEMOCHI ABSTRACT This study examined the influence of transgenic event CBH (StarLinkÔ; SL)-derived hybrid corn on growth, health and physiological functions of pigs, as well as the possibility of transferring the cry9C gene or Cry9C protein to the blood, liver or muscles, in comparison with pigs fed a diet with non-transgenic (isogenic) corn (non-SL). The diet for the SL group was composed of 70% SL corn, and the diet for the non-SL group was composed of 70% non-SL corn. Forty pigs approximately 3 months in age were used in the current experiment. After the pigs were acclimatized to their environment for 7 days, they were fed piglet diets for 7 weeks, and afterwards fed growing-finishing diets until the end of the experiment. There were no significant differences in bodyweight gain, feed intake or feed conversion ratio between the pigs fed SL diet and those of non-SL diet. No abnormalities were observed in the health conditions of either the SL or the non-SL group. Moreover, no significant differences were observed between the two groups in hematological values, histopathological examination and necropsy findings. Although the serum biochemical values within each group were normal, the blood urea nitrogen values of the SL group showed a tendency to be slightly higher than those of the non-SL group. Also, the blood glucose values of the SL group were significantly lower than those of the non-SL group. However, the cause of the significant differences in the blood glucose values between the two groups is unknown. The PCR and ELISA did not detect the cry9C gene and Cry9C protein in the blood, liver or muscles of the pigs at the end of the experiment. [source] Eugenol as an efficacious anaesthetic for tambaqui, Colossoma macropomum (Cuvier)AQUACULTURE RESEARCH, Issue 11 2005Rodrigo Roubach Abstract Anaesthetics are important in fish culture to reduce handling stress and mortality. Eugenol is a promising anaesthetic because of its low cost, efficacy, safety margin for fish and lack of toxicity to humans. The goal of this study was to establish a protocol using eugenol as a fish anaesthetic for tambaqui Colossoma macropomum (Cuvier), and provide information for regulating authorities on establishing safety dosage protocols for its use. Juvenile and sub-adult tambaqui were first individually exposed to doses of 35, 50, 65, 85, 100 or 135 mg L,1 eugenol for 10 min. A second experiment examined the effect of the duration of exposure to eugenol on the time required for recovery and survival of tambaqui. A eugenol dose of 65 mg L,1 was adequate to induce fish of both sizes into a surgical anaesthetic state, and recovery time was similar for dosages up to 100 mg L,1. Exposure to the ideal dose (65 mg L,1) for up to 30 min did not cause fish mortality. Fish blood glucose values were similar for all the tested eugenol doses as well as with the benzocaine control. The results show that eugenol is an efficient and safe anaesthetic for tambaqui. [source] Neonatal blood glucose concentrations in caesarean and vaginally delivered term infantsACTA PAEDIATRICA, Issue 10 2010Ronella Marom Abstract Background:, Little is known about the glucose concentrations at and after birth of infants delivered by caesarean section (CS), when compared with infants born vaginally (VD). Aim:, To compare venous cord blood glucose concentrations of term infants born after elective CS to infants born by VD. We studied the null hypothesis that mode of delivery does not affect neonatal blood glucose values. Methods:, We compared cord blood glucose concentrations in healthy term infants born after VD (n = 16) or by elective CS (n = 21). Glucose concentrations were obtained immediately at birth from the umbilical cord. Kruskal,Wallis was used to compare glucose concentrations and demographic variables between the groups. Results:, Gestational age was 39.6 ± 0.8 weeks in VD group vs. 38.7 ± 0.9 weeks in CS group, and birthweight was 3359 ± 494 vs. 3500 ± 528 g. Cord blood glucose concentration was higher in VD (81.3 ± 16.9 mg/dL) than CS infants (70.3 ± 9.7 mg/dL, p = 0.039). The change in blood glucose concentration over the first 2-h of life differed significantly between the two groups, being an increase in CS versus a decrease in VD infants (,3.5 ± 15.2 vs. ,15.4 ± 24.6 mg/dL, p = 0.013). Conclusions:, Glucose concentrations in VD infants are higher than in infants born by elective CS without labour. [source] | ||||||||||||||||||||||||||||