BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients wi...BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.展开更多
Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high B...Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL), and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL) might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.展开更多
In this work, children’s persistent hyperglycemia has been revised using the available literature to support the proposed reasoning. Based on this study, we have shown that the human glycemic management system must b...In this work, children’s persistent hyperglycemia has been revised using the available literature to support the proposed reasoning. Based on this study, we have shown that the human glycemic management system must be seen as coupled and integrated by four subsystems, namely, production system, consumption system, distribution system, control system, and also it should be seen as coupled to external noxious factors/stressors, if not we show that the glycemic homeostasis analysis might be defective and might induce, in many cases, a misdiagnosis of the causes of the persistent hyperglycemia under consideration. Also, in this work, some considerations were presented to show that anomalies in the cerebral glycemic control through the glucose sensor neurons might be a possible cause/origin of some of the glycemic abnormalities and dysfunctions (however, not only the known related hypoglycemia but also hyperglycemia) that occur in childhood. Finally, it is shown that persistent novel external noxious factors of modernity or noxious factors already known, but amplified by modernity, such as persistent stress, media induced fears, and phobias, environmental pollution, and electromagnetic pollution, can and should also be considered as possible precursors for the development of anomalies in the juvenile homeostatic glycemic system that might well be, if intense and persistent, the driver of the worldwide observed T1DM epidemic events.展开更多
Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically sea...Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. Results: Twenty-six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95%CI 0.58, 0.99). However, in terms of overall mortality and long-term neurological severity outcome, it didn't show differences with ORs of 0.93 (95%CI 0.79, 1.10) and 1.15 (95%CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay with OR of 0.51 (95%CI 0.42, 0.62) and WMD of -2.37 (95%CI -2.99, -1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95%CI 4.83, 8.07) and 2.73 (95%CI 2.56, 2.91) using two methods. Conclusion: In critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.展开更多
Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO...Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO), have been formulated to blunt postprandial hyperglycemia. The objective of this research was to evaluate the effectiveness of these products on postprandial glycemic and hormonal responses based on comparisons of GTSN with differing carbohydrate quantities or types. Methods: In two randomized, double-blind, crossover studies, participants (mean age 61 years) with type 2 diabetes consumed GTSN in a meal tolerance test. In the CHO Quantity Study, a standard nutritional beverage (STD) was compared to a low carbohydrate nutritional beverage with tapioca dextrin (GTSN-TDX) and a balanced carbohydrate nutritional beverage containing a blend of the slowly-digesting carbohydrates maltodextrin and sucromalt (GTSN-SDC). In the CHO Type Study, the GTSN beverages had similar carbohydrate quantities but varied in carbohydrate composition with GTSN-SDC compared to a formula with tapioca starch and fructose (GTSN-TS&F), and one with isomaltulose and resistant starch (GTSN-I&RS). Postprandial (0-240 min) concentrations of blood glucose, insulin (CHO Quantity Study only) and glucagon-like-peptide (GLP)-1 (CHO Quantity Study only) were measured. Results: Despite having substantially different carbohydrate quantities, the GTSN blunted the glucose positive area under the curve (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 min tended to be lower for GTSN-SDC (1477 ± 460) than GTSN-TS&F (2203 ± 412;p = 0.062) and GTSN-I&RS (2190 ± 412;p = 0.076). No differences were observed between GTSN-TS&F and GTSN-I&RS. Conclusions: These results demonstrate the effectiveness of several GTSN products and suggest that both CHO quantity and type play important roles in postprandial glycemic response in men and women with type 2 diabetes. Furthermore, GTSN products containing slow-digesting carbohydrates can blunt postmeal glucose and insulin concentration despite delivering greater total grams of CHO, which provides a dietary benefit for people with diabetes.展开更多
Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circu...Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circumference (NC) is an anthropometric measure that has been used to evaluate the overweight and accumulation of subcutaneous fat in the upper body, regardless of age. It is also a useful tool to predict insulin resistance and other risk factors. This research aimed to study the relationship between the NC and glycemia in adolescents and, thus, to analyze the applicability of this anthropometric measure in the screening of glycemic alterations in this group. Methods: The study population consisted of 600 adolescents aged 10 to 19 years. Data on sex, birth date, NC, fasting blood glucose and stage of sexual maturation was collected. Results: The evolution of sexual maturation generated a significant difference in the NC in both sexes, but not affected glycemia. Thus, the association between NC and glycemia was investigated according to this parameter. Among the pre-pubertal adolescents, the NC was significantly higher among those who had glycemia within borderline values, and the opposite occurred among pubertal adolescents. Among post-pubertal adolescents, NC was similar between the two groups. A negative correlation was found in all adolescents, as well as among those who were in the pubertal and post-pubertal stages of sexual maturation. Differently, adolescents in the pre-pubertal stage showed a positive correlation between the NC and the biochemical parameters. Conclusion: This study showed that the relationship between the NC and glycemia varies according to the stage of sexual maturation. As this maturation factor is rarely considered in the glycemic alteration screening, the use of the NC in this age group is not safe and requires further investigations.展开更多
Neoplasms of the digestive system are uncommon in dogs, and may be of epithelial, neuroendocrine, hematopoietic and mesenchymal origin. The leiomyosarcoma is a tumor of mesenchymal origin of smooth, malignant, slow-gr...Neoplasms of the digestive system are uncommon in dogs, and may be of epithelial, neuroendocrine, hematopoietic and mesenchymal origin. The leiomyosarcoma is a tumor of mesenchymal origin of smooth, malignant, slow-growing muscles. Paraneoplastic syndromes can affect different systems, being the most commonly found: hypercalcemia, hypoglycemia, cachexia and anemia. There are rare cases of mesenchymal tumors of the gastrointestinal tract in dogs that result in hypoglycaemia with clinical signs. The objective of this study is to report a case of gastric leiomyosarcoma associated with clinical hypoglycemia. The patient had neurological signs such as ataxia and seizures associated with hypoglycemia, which did not recur after surgical excision of the tumor. The definitive diagnosis was based on the histopathological and immunohistochemical examination of the tumor.展开更多
Through investigating the effect of mild hypothermia on activity of nitric oxide snythase (NOS) in cortical neurons and glycemia levels of neonatal rats with hypoxic ischemic brain damage (HIBD). We studied the mecha...Through investigating the effect of mild hypothermia on activity of nitric oxide snythase (NOS) in cortical neurons and glycemia levels of neonatal rats with hypoxic ischemic brain damage (HIBD). We studied the mechanism of protecting hypoxic ischemic neurons of mild hypothermia. We established neonatal rat HIBD models, used NOS immunohistochemistry and glycemia determination by micromethod. The number of cortical NOS positive neurons after hypoxic ischemia was significantly decreased as compared with controls. The glycemia levels was significantly increased than that controls. No significant difference was found in number of cortical NOS positive neurons and glycemia levels between 31℃ and 34℃ mild hypothemia. The results imply that hypothermia can decrease overproduction of NO through inhibiting the increase of the activity of NOS, and increase the glycemia levels, thus protect the hypoxic ischemic neurons.展开更多
Background: Exercise has positive impacts on metabolic health, whereas sleep loss has potentially negative impacts. This systematic literature review investigates whether acute and short-term exercise interventions ca...Background: Exercise has positive impacts on metabolic health, whereas sleep loss has potentially negative impacts. This systematic literature review investigates whether acute and short-term exercise interventions can mitigate negative effects of experimentally-induced sleep loss on metabolic markers in humans.Methods: A systematic search(PubMed/Medline, Web of Science, Scopus, Embase, SPORTDiscus, and Cochrane) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was conducted up to June 2024 for studies that compared glucose and insulin concentrations, insulin sensitivity, skeletal muscle gene expression, and other molecular markers following an acute or short-term(<14 days) exercise intervention during experimentally-induced sleep loss in adult humans. Articles were considered for inclusion and assessed for eligibility using the Population, Intervention, Comparison, Outcomes, and Study design(PICOS) framework, and critically appraised with the Cochrane Risk of Bias 2.0 tool.Results: Of the identified records, 4026 records were screened, with 12 studies meeting all the inclusion criteria and including 177 participants.Sleep intervention varied from a single night of total sleep deprivation to 5 consecutive nights of 4-h sleep opportunity(e.g., early or late sleep restriction), while exercise intervention varied in terms of model(walking/running, cycling, and resistance exercise), volume(e.g., minute to hour), and intensity(e.g., maximum efforts to low-intensity exercise). Most studies indicated a negative effect of insufficient sleep on glucose and insulin concentration as well as mitochondrial adaptations, whereas exercise had a positive impact, mitigating the negative effects on the aforementioned parameters.Conclusion: Exercise is likely to be effective as a therapeutic intervention for mitigating the negative effects of sleep loss on metabolic markers,at least in short-term intervention studies.展开更多
Objective Recaticimab(SHR-1209)significantly reduces low-density lipoprotein cholesterol levels.However,its effect on glucose metabolism remains unclear.This study aimed to evaluate its effect on glycemic parameters i...Objective Recaticimab(SHR-1209)significantly reduces low-density lipoprotein cholesterol levels.However,its effect on glucose metabolism remains unclear.This study aimed to evaluate its effect on glycemic parameters in a Chinese population.Methods Recaticimab versus placebo was administered in a 5:1 ratio to 110 hyperlipidemia patients who were followed up for 24 weeks.Glycated hemoglobin(HbA1c)levels were measured at baseline every 12 weeks.Fasting plasma glucose(FPG)levels were measured at baseline at week 1,3,5,8,12,16,20,and 24.Repeated-measures mixed-effects models were used to determine the longitudinal association between reacticimab and FPG and HbA1c levels.Results Among the 81 participants with normal glucose metabolism,HbA1c levels significantly decreased(F=4.568,P=0.036).In the 29 participants with abnormal glucose metabolism,a significant time effect was observed for FPG levels(F=2.492,P=0.016).For participants with normal and abnormal glucose metabolism,no significant group×time interaction effects on FPG or HbA1c levels were identified.Conclusion Recaticimab showed no adverse glycemic effects in participants with normal or abnormal glucose metabolism,indicating its safety in patients with or without diabetes.展开更多
BACKGROUND Continuous glucose monitoring(CGM)metrics,such as time in range(TIR)and glycemic risk index(GRI),have been linked to various diabetes-related complications,including diabetic foot(DF).AIM To investigate the...BACKGROUND Continuous glucose monitoring(CGM)metrics,such as time in range(TIR)and glycemic risk index(GRI),have been linked to various diabetes-related complications,including diabetic foot(DF).AIM To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus(T2DM).METHODS A total of 591 individuals with T2DM(297 with DF and 294 without DF)were enrolled.Relevant clinical data,complications,comorbidities,hematological parameters,and 72-hour CGM data were collected.Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF.RESULTS Individuals with DF exhibited higher mean blood glucose(MBG)levels and increased proportions of time above range(TAR),TAR level 1,and TAR level 2,but lower TIR(all P<0.001).Patients with DF had significantly lower rates of achieving target ranges for TIR,TAR,and TAR level 2 than those without DF(all P<0.05).Logistic regression analysis revealed that GRI,MBG,and TAR level 1 were positively associated with DF risk,while TIR was inversely correlated(all P<0.05).Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels(P<0.05).Additionally,achieving TAR was influenced by fasting plasma glucose,body mass index,diabetes duration,and antidiabetic medication use.CONCLUSION CGM metrics,particularly TIR and GRI,are significantly associated with the risk of DF in T2DM,emphasizing the importance of improved glucose control.展开更多
Diabetes has emerged as a worldwide epidemic chronicdisease with rapidly increasing prevalence.In 2011,the global prevalence of diabetes among adults was 6.4%,affecting 366 million adults and will rise to 552 milliona...Diabetes has emerged as a worldwide epidemic chronicdisease with rapidly increasing prevalence.In 2011,the global prevalence of diabetes among adults was 6.4%,affecting 366 million adults and will rise to 552 millionadults by 2030.1 According to the latest epidemiologicaldata in a nationally representative sample of 98 658展开更多
The glycemia-sensitive neuron in lateral hypothalamic area (LHA) is one of the important central neural events involved in the feeding control. Electrophysio-logical studies have demonstrated that gastrointestinal vag...The glycemia-sensitive neuron in lateral hypothalamic area (LHA) is one of the important central neural events involved in the feeding control. Electrophysio-logical studies have demonstrated that gastrointestinal vagal afferent inputs could convey the meal-related information of gastrointestinal tract to the hypothalamus. In this study, we examined whether the gastric vagal afferent inputs could reach the glycemia-sensitive neurons of the LHA by using in vivo extracellular recording technique in the rat. The results showed that stimulation of gastric vagal nerves elicited two types of the LHA neurons responses: the phasic response (93/116, 80.2%) and the change in cells firing pattern (23/116, 19.8%). Within the 93 cells that responded to the gastric vagal stimulation with a phasic response, 67 (72.0%) showed an inhibition in the cells firing rate, 26 (27.4%) were excited. Of the 23 cells that showed a change in the firing pattern, 13 responded to the gastric vagal stimulation with a long-lasting increase or decrease in firing rate, the remaining 10 cells turned their discrete spiking to the burst discharging. In addition, of 101 LHA neurons including the two types of responsive neurons, 73 (72.3%) were identified to be glyce-mia-sensitive neurons. These results demonstrated that the gastric vagal afferent inputs could reach the LHA and pre-dominantly reach those glycemia-sensitive neurons in the LHA. Presumably, the modulation of glycemia-sensitive neurons of LHA by the gastric vagal afferent inputs may play an important role in the short-term regulation of feed-ing behavior.展开更多
Cardiovascular diseases are serious pathologies that affect an increasing number of people. Several preventive measures are generally used, including supplementing of oils in foods. Our objective was to compare the ef...Cardiovascular diseases are serious pathologies that affect an increasing number of people. Several preventive measures are generally used, including supplementing of oils in foods. Our objective was to compare the effects of Tetracarpidum conophorum oil (TC) and corn oil (CO) on serum lipid profiles of normal male rats. 42 Wistar rats were divided into 7 groups. Diets included TC oil (groups TC5, TC10 and TC20) and corn oil (groups CO5, CO10 and CO20) in proportions of 5%, 10% and 20%, with a control group (T). After 5 weeks of feeding, several parameters were measured during and after the study, including body weight, food intake and organ weights (kidney, liver and fat). Lipid profiles (total cholesterol, TG, HDL and LDL), glucose and protein levels were measured in the serum. The increase in body mass was inversely proportional to the amount of oil in the food. The decrease in body mass and adiposomatic index of group TC10 was significant (p < 0.05) compared with the other groups. The lowest glycaemia (64.17 ± 5.14 mg/dl) was noted with the diet containing 20% TC oil. A significant reduction in total cholesterol, LDL fraction and blood triglycerides was observed in the groups supplemented with TC and corn oils compared to controls. Results were also more beneficial for the TC10 group. HDL-cholesterol levels were significantly higher (p < 0.05) in the oil-supplemented groups than in the control group. Castelli’s risk indices decrease significantly (p < 0.05) with increasing oil content for TC. The oils had no impact on blood protein contents. One can conclude that a diet containing 10% crude oil from TC kernels could prevent or alleviate cardiovascular diseases and glycemia.展开更多
目的分析血糖和血钙对主动脉根部扩张性疾病发生、发展的影响。方法回顾性分析2011年1月—2021年10月于新疆医科大学第一附属医院心外科行手术治疗主动脉根部扩大患者的临床资料。根据是否伴有急性主动脉夹层(Stanford A型)将患者分为两...目的分析血糖和血钙对主动脉根部扩张性疾病发生、发展的影响。方法回顾性分析2011年1月—2021年10月于新疆医科大学第一附属医院心外科行手术治疗主动脉根部扩大患者的临床资料。根据是否伴有急性主动脉夹层(Stanford A型)将患者分为两组,并应用倾向性评分法对其进行匹配。采用单因素和多因素logistic回归模型分析患者入院24 h内的血糖和血钙对主动脉根部扩张的影响,并绘制其受试者工作特征(receiver operating characteristic,ROC)曲线。结果成功匹配184对患者,其中男297例[平均年龄(48.76±9.62)岁]、女71例[平均年龄(49.97±10.97)岁]。民族、高血压史、主动脉根部直径、血钙以及血糖在两组患者中差异具有统计学意义(P<0.05)。多因素logistic回归分析结果表明,年龄<40岁(OR=4.106,P=0.010)、汉族(OR=2.863,P<0.001)、主动脉根部直径<45 mm(OR=5.063,P<0.001)、高血压(OR=2.736,P=0.001)、高血糖(OR=4.426,P<0.001)以及低血钙(OR=5.375,P<0.001)是主动脉根部扩张性疾病伴夹层的独立危险因素。ROC曲线分析提示,血糖曲线下面积(area under the curve,AUC)为0.742、血钙AUC为0.737,均对主动脉根部扩张伴夹层有一定的预测价值。结论高血糖和低血钙是主动脉根部扩张性疾病发生、发展的危险因素,某种程度上可用作筛选主动脉根部扩张性疾病高危患者的指标。展开更多
基金Supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project,No.2023ZD0508201the National Key R and D Program of China,No.2022YFC2010100+3 种基金the National Natural Science Foundation of China,No.82070812the Natural Science Foundation of Hunan Province,No.2024JJ9049,No.2023JJ30762 and No.2021JC0003Sinocare Diabetes Foundation,No.2020SD08the National Clinical Research Center for Metabolic Diseases Clinical Diagnosis and Treatment Capacity Enhancement Program,No.2023ZLNL003.
文摘BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.
文摘Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL), and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL) might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.
文摘In this work, children’s persistent hyperglycemia has been revised using the available literature to support the proposed reasoning. Based on this study, we have shown that the human glycemic management system must be seen as coupled and integrated by four subsystems, namely, production system, consumption system, distribution system, control system, and also it should be seen as coupled to external noxious factors/stressors, if not we show that the glycemic homeostasis analysis might be defective and might induce, in many cases, a misdiagnosis of the causes of the persistent hyperglycemia under consideration. Also, in this work, some considerations were presented to show that anomalies in the cerebral glycemic control through the glucose sensor neurons might be a possible cause/origin of some of the glycemic abnormalities and dysfunctions (however, not only the known related hypoglycemia but also hyperglycemia) that occur in childhood. Finally, it is shown that persistent novel external noxious factors of modernity or noxious factors already known, but amplified by modernity, such as persistent stress, media induced fears, and phobias, environmental pollution, and electromagnetic pollution, can and should also be considered as possible precursors for the development of anomalies in the juvenile homeostatic glycemic system that might well be, if intense and persistent, the driver of the worldwide observed T1DM epidemic events.
文摘Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. Results: Twenty-six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95%CI 0.58, 0.99). However, in terms of overall mortality and long-term neurological severity outcome, it didn't show differences with ORs of 0.93 (95%CI 0.79, 1.10) and 1.15 (95%CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay with OR of 0.51 (95%CI 0.42, 0.62) and WMD of -2.37 (95%CI -2.99, -1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95%CI 4.83, 8.07) and 2.73 (95%CI 2.56, 2.91) using two methods. Conclusion: In critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.
文摘Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO), have been formulated to blunt postprandial hyperglycemia. The objective of this research was to evaluate the effectiveness of these products on postprandial glycemic and hormonal responses based on comparisons of GTSN with differing carbohydrate quantities or types. Methods: In two randomized, double-blind, crossover studies, participants (mean age 61 years) with type 2 diabetes consumed GTSN in a meal tolerance test. In the CHO Quantity Study, a standard nutritional beverage (STD) was compared to a low carbohydrate nutritional beverage with tapioca dextrin (GTSN-TDX) and a balanced carbohydrate nutritional beverage containing a blend of the slowly-digesting carbohydrates maltodextrin and sucromalt (GTSN-SDC). In the CHO Type Study, the GTSN beverages had similar carbohydrate quantities but varied in carbohydrate composition with GTSN-SDC compared to a formula with tapioca starch and fructose (GTSN-TS&F), and one with isomaltulose and resistant starch (GTSN-I&RS). Postprandial (0-240 min) concentrations of blood glucose, insulin (CHO Quantity Study only) and glucagon-like-peptide (GLP)-1 (CHO Quantity Study only) were measured. Results: Despite having substantially different carbohydrate quantities, the GTSN blunted the glucose positive area under the curve (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 min tended to be lower for GTSN-SDC (1477 ± 460) than GTSN-TS&F (2203 ± 412;p = 0.062) and GTSN-I&RS (2190 ± 412;p = 0.076). No differences were observed between GTSN-TS&F and GTSN-I&RS. Conclusions: These results demonstrate the effectiveness of several GTSN products and suggest that both CHO quantity and type play important roles in postprandial glycemic response in men and women with type 2 diabetes. Furthermore, GTSN products containing slow-digesting carbohydrates can blunt postmeal glucose and insulin concentration despite delivering greater total grams of CHO, which provides a dietary benefit for people with diabetes.
文摘Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circumference (NC) is an anthropometric measure that has been used to evaluate the overweight and accumulation of subcutaneous fat in the upper body, regardless of age. It is also a useful tool to predict insulin resistance and other risk factors. This research aimed to study the relationship between the NC and glycemia in adolescents and, thus, to analyze the applicability of this anthropometric measure in the screening of glycemic alterations in this group. Methods: The study population consisted of 600 adolescents aged 10 to 19 years. Data on sex, birth date, NC, fasting blood glucose and stage of sexual maturation was collected. Results: The evolution of sexual maturation generated a significant difference in the NC in both sexes, but not affected glycemia. Thus, the association between NC and glycemia was investigated according to this parameter. Among the pre-pubertal adolescents, the NC was significantly higher among those who had glycemia within borderline values, and the opposite occurred among pubertal adolescents. Among post-pubertal adolescents, NC was similar between the two groups. A negative correlation was found in all adolescents, as well as among those who were in the pubertal and post-pubertal stages of sexual maturation. Differently, adolescents in the pre-pubertal stage showed a positive correlation between the NC and the biochemical parameters. Conclusion: This study showed that the relationship between the NC and glycemia varies according to the stage of sexual maturation. As this maturation factor is rarely considered in the glycemic alteration screening, the use of the NC in this age group is not safe and requires further investigations.
文摘Neoplasms of the digestive system are uncommon in dogs, and may be of epithelial, neuroendocrine, hematopoietic and mesenchymal origin. The leiomyosarcoma is a tumor of mesenchymal origin of smooth, malignant, slow-growing muscles. Paraneoplastic syndromes can affect different systems, being the most commonly found: hypercalcemia, hypoglycemia, cachexia and anemia. There are rare cases of mesenchymal tumors of the gastrointestinal tract in dogs that result in hypoglycaemia with clinical signs. The objective of this study is to report a case of gastric leiomyosarcoma associated with clinical hypoglycemia. The patient had neurological signs such as ataxia and seizures associated with hypoglycemia, which did not recur after surgical excision of the tumor. The definitive diagnosis was based on the histopathological and immunohistochemical examination of the tumor.
文摘Through investigating the effect of mild hypothermia on activity of nitric oxide snythase (NOS) in cortical neurons and glycemia levels of neonatal rats with hypoxic ischemic brain damage (HIBD). We studied the mechanism of protecting hypoxic ischemic neurons of mild hypothermia. We established neonatal rat HIBD models, used NOS immunohistochemistry and glycemia determination by micromethod. The number of cortical NOS positive neurons after hypoxic ischemia was significantly decreased as compared with controls. The glycemia levels was significantly increased than that controls. No significant difference was found in number of cortical NOS positive neurons and glycemia levels between 31℃ and 34℃ mild hypothemia. The results imply that hypothermia can decrease overproduction of NO through inhibiting the increase of the activity of NOS, and increase the glycemia levels, thus protect the hypoxic ischemic neurons.
文摘Background: Exercise has positive impacts on metabolic health, whereas sleep loss has potentially negative impacts. This systematic literature review investigates whether acute and short-term exercise interventions can mitigate negative effects of experimentally-induced sleep loss on metabolic markers in humans.Methods: A systematic search(PubMed/Medline, Web of Science, Scopus, Embase, SPORTDiscus, and Cochrane) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was conducted up to June 2024 for studies that compared glucose and insulin concentrations, insulin sensitivity, skeletal muscle gene expression, and other molecular markers following an acute or short-term(<14 days) exercise intervention during experimentally-induced sleep loss in adult humans. Articles were considered for inclusion and assessed for eligibility using the Population, Intervention, Comparison, Outcomes, and Study design(PICOS) framework, and critically appraised with the Cochrane Risk of Bias 2.0 tool.Results: Of the identified records, 4026 records were screened, with 12 studies meeting all the inclusion criteria and including 177 participants.Sleep intervention varied from a single night of total sleep deprivation to 5 consecutive nights of 4-h sleep opportunity(e.g., early or late sleep restriction), while exercise intervention varied in terms of model(walking/running, cycling, and resistance exercise), volume(e.g., minute to hour), and intensity(e.g., maximum efforts to low-intensity exercise). Most studies indicated a negative effect of insufficient sleep on glucose and insulin concentration as well as mitochondrial adaptations, whereas exercise had a positive impact, mitigating the negative effects on the aforementioned parameters.Conclusion: Exercise is likely to be effective as a therapeutic intervention for mitigating the negative effects of sleep loss on metabolic markers,at least in short-term intervention studies.
基金funded by Jiangsu Hengrui Pharmaceutical Co.,Ltd.(formerly,Jiangsu Hengrui Medicine Co.,Ltd.).
文摘Objective Recaticimab(SHR-1209)significantly reduces low-density lipoprotein cholesterol levels.However,its effect on glucose metabolism remains unclear.This study aimed to evaluate its effect on glycemic parameters in a Chinese population.Methods Recaticimab versus placebo was administered in a 5:1 ratio to 110 hyperlipidemia patients who were followed up for 24 weeks.Glycated hemoglobin(HbA1c)levels were measured at baseline every 12 weeks.Fasting plasma glucose(FPG)levels were measured at baseline at week 1,3,5,8,12,16,20,and 24.Repeated-measures mixed-effects models were used to determine the longitudinal association between reacticimab and FPG and HbA1c levels.Results Among the 81 participants with normal glucose metabolism,HbA1c levels significantly decreased(F=4.568,P=0.036).In the 29 participants with abnormal glucose metabolism,a significant time effect was observed for FPG levels(F=2.492,P=0.016).For participants with normal and abnormal glucose metabolism,no significant group×time interaction effects on FPG or HbA1c levels were identified.Conclusion Recaticimab showed no adverse glycemic effects in participants with normal or abnormal glucose metabolism,indicating its safety in patients with or without diabetes.
基金Supported by Yunnan Province Academician(Expert)Workstation Project,No.202305AF150097the Basic Research Program of Yunnan Province(Kunming Medical University Joint Special Project),No.202101AY070001-276+3 种基金the National Natural Science Foundation of China,No.82160159the Key Project Program of Yunnan Province(Kunming Medical University Joint Special Project),No.202301AY070001-013the Major Science and Technology Project of Yunnan Province,No.202202AA100004the Double First-class University Construction Project of Yunnan University,No.CY22624106.
文摘BACKGROUND Continuous glucose monitoring(CGM)metrics,such as time in range(TIR)and glycemic risk index(GRI),have been linked to various diabetes-related complications,including diabetic foot(DF).AIM To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus(T2DM).METHODS A total of 591 individuals with T2DM(297 with DF and 294 without DF)were enrolled.Relevant clinical data,complications,comorbidities,hematological parameters,and 72-hour CGM data were collected.Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF.RESULTS Individuals with DF exhibited higher mean blood glucose(MBG)levels and increased proportions of time above range(TAR),TAR level 1,and TAR level 2,but lower TIR(all P<0.001).Patients with DF had significantly lower rates of achieving target ranges for TIR,TAR,and TAR level 2 than those without DF(all P<0.05).Logistic regression analysis revealed that GRI,MBG,and TAR level 1 were positively associated with DF risk,while TIR was inversely correlated(all P<0.05).Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels(P<0.05).Additionally,achieving TAR was influenced by fasting plasma glucose,body mass index,diabetes duration,and antidiabetic medication use.CONCLUSION CGM metrics,particularly TIR and GRI,are significantly associated with the risk of DF in T2DM,emphasizing the importance of improved glucose control.
基金The study was supported by a grant from the National Natural Science Foundation of China （No. 81370823）.
文摘Diabetes has emerged as a worldwide epidemic chronicdisease with rapidly increasing prevalence.In 2011,the global prevalence of diabetes among adults was 6.4%,affecting 366 million adults and will rise to 552 millionadults by 2030.1 According to the latest epidemiologicaldata in a nationally representative sample of 98 658
文摘The glycemia-sensitive neuron in lateral hypothalamic area (LHA) is one of the important central neural events involved in the feeding control. Electrophysio-logical studies have demonstrated that gastrointestinal vagal afferent inputs could convey the meal-related information of gastrointestinal tract to the hypothalamus. In this study, we examined whether the gastric vagal afferent inputs could reach the glycemia-sensitive neurons of the LHA by using in vivo extracellular recording technique in the rat. The results showed that stimulation of gastric vagal nerves elicited two types of the LHA neurons responses: the phasic response (93/116, 80.2%) and the change in cells firing pattern (23/116, 19.8%). Within the 93 cells that responded to the gastric vagal stimulation with a phasic response, 67 (72.0%) showed an inhibition in the cells firing rate, 26 (27.4%) were excited. Of the 23 cells that showed a change in the firing pattern, 13 responded to the gastric vagal stimulation with a long-lasting increase or decrease in firing rate, the remaining 10 cells turned their discrete spiking to the burst discharging. In addition, of 101 LHA neurons including the two types of responsive neurons, 73 (72.3%) were identified to be glyce-mia-sensitive neurons. These results demonstrated that the gastric vagal afferent inputs could reach the LHA and pre-dominantly reach those glycemia-sensitive neurons in the LHA. Presumably, the modulation of glycemia-sensitive neurons of LHA by the gastric vagal afferent inputs may play an important role in the short-term regulation of feed-ing behavior.
文摘Cardiovascular diseases are serious pathologies that affect an increasing number of people. Several preventive measures are generally used, including supplementing of oils in foods. Our objective was to compare the effects of Tetracarpidum conophorum oil (TC) and corn oil (CO) on serum lipid profiles of normal male rats. 42 Wistar rats were divided into 7 groups. Diets included TC oil (groups TC5, TC10 and TC20) and corn oil (groups CO5, CO10 and CO20) in proportions of 5%, 10% and 20%, with a control group (T). After 5 weeks of feeding, several parameters were measured during and after the study, including body weight, food intake and organ weights (kidney, liver and fat). Lipid profiles (total cholesterol, TG, HDL and LDL), glucose and protein levels were measured in the serum. The increase in body mass was inversely proportional to the amount of oil in the food. The decrease in body mass and adiposomatic index of group TC10 was significant (p < 0.05) compared with the other groups. The lowest glycaemia (64.17 ± 5.14 mg/dl) was noted with the diet containing 20% TC oil. A significant reduction in total cholesterol, LDL fraction and blood triglycerides was observed in the groups supplemented with TC and corn oils compared to controls. Results were also more beneficial for the TC10 group. HDL-cholesterol levels were significantly higher (p < 0.05) in the oil-supplemented groups than in the control group. Castelli’s risk indices decrease significantly (p < 0.05) with increasing oil content for TC. The oils had no impact on blood protein contents. One can conclude that a diet containing 10% crude oil from TC kernels could prevent or alleviate cardiovascular diseases and glycemia.
文摘目的分析血糖和血钙对主动脉根部扩张性疾病发生、发展的影响。方法回顾性分析2011年1月—2021年10月于新疆医科大学第一附属医院心外科行手术治疗主动脉根部扩大患者的临床资料。根据是否伴有急性主动脉夹层(Stanford A型)将患者分为两组,并应用倾向性评分法对其进行匹配。采用单因素和多因素logistic回归模型分析患者入院24 h内的血糖和血钙对主动脉根部扩张的影响,并绘制其受试者工作特征(receiver operating characteristic,ROC)曲线。结果成功匹配184对患者,其中男297例[平均年龄(48.76±9.62)岁]、女71例[平均年龄(49.97±10.97)岁]。民族、高血压史、主动脉根部直径、血钙以及血糖在两组患者中差异具有统计学意义(P<0.05)。多因素logistic回归分析结果表明,年龄<40岁(OR=4.106,P=0.010)、汉族(OR=2.863,P<0.001)、主动脉根部直径<45 mm(OR=5.063,P<0.001)、高血压(OR=2.736,P=0.001)、高血糖(OR=4.426,P<0.001)以及低血钙(OR=5.375,P<0.001)是主动脉根部扩张性疾病伴夹层的独立危险因素。ROC曲线分析提示,血糖曲线下面积(area under the curve,AUC)为0.742、血钙AUC为0.737,均对主动脉根部扩张伴夹层有一定的预测价值。结论高血糖和低血钙是主动脉根部扩张性疾病发生、发展的危险因素,某种程度上可用作筛选主动脉根部扩张性疾病高危患者的指标。
