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Glycemic Variablity

Débora Lopes Souto, Joana Rodrigues Dantas, Marcus Miranda Dos Santos Oliveira, Eliane Lopes Rosado, Ronir Raggio Luiz, Lenita Zajdenverg, Melanie Rodacki
OBJECTIVE: The aim of this study was to compare the effects of a sucrose-free diet with a sucrose-added diet on glucose variability in patients with type 1 diabetes. METHODS: This was a two-way crossover design study in which patients with type 1 diabetes were monitored by blinded continuous glucose monitoring and were selected to receive a sucrose-free diet (<30 g/d), followed by a sucrose-added diet (>80 g/d) for 2 d each. Intra-day glucose variability was assessed by the mean amplitude of glycemic excursions (MAGE), the M-value, J-index, glycemic risk assessment in diabetes equation (GRADE), and continuous overlapping net glycemic action (CONGA1-3 )...
June 8, 2018: Nutrition
Peter Michael Rodgers-Fischl
The Framingham Studies revealed diabetes mellitus (DM) predisposed subjects to a 2-8 fold increase in risk in developing heart failure (HF). Much less information is available about the reverse issue; namely is there an increased risk of developing DM in patients with HF.  We sought to determine if reversal/partial reversal of HF through aortic valve replacement would improve glycemic control in patients with DM at our institution.             Methods: Electronic medical records of 57 consecutive diabetic patients who underwent aortic valve replacement (AVR) at a medium sized academic medical center from May 2005 through May 2015 and had glycated hemoglobin (HbA1C) measuredbefore and after the procedure were retrospectively analyzed...
July 12, 2018: Heart Surgery Forum
Jin J Zhou, Dawn C Schwenke, Gideon Bahn, Peter Reaven
OBJECTIVE: There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veteran Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA1c ) over time with the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control. RESEARCH DESIGN AND METHODS: During the VADT, fasting glucose and HbA1c were measured every 3 months for up to 84 months in 1,791 individuals...
August 6, 2018: Diabetes Care
Olga Simó-Servat, Alejandra Planas, Andreea Ciudin, Rafael Simó, Cristina Hernández
There are substantial differences in the onset and severity of diabetes complications that are not fully explained by HbA1c levels and other risk factors. HbA1c is the gold standard for assessing metabolic control, but has limited value to identify patients at risk of developing diabetic complications. The main disadvantage of HbA1c is that it does not provide information about glycemic variability and does not reflect long-term exposure to hyperglycemia. One of the main pathogenetic mechanisms of diabetic complications is the generation and accumulation of advanced glycation end-products (AGEs)...
August 1, 2018: Endocrinología, Diabetes y Nutrición
Gabriela Mahelková, Marie Ceská Burdová, Šárka Malá, Lucie Hoskovcová, Dagmar Dotrelová, Katerina Štechová
Purpose: Neuropathies are among the most common long-term complications of diabetes mellitus (DM) and good glycemic control is essential in prevention of this complication. DM patients with similar mean glucose levels or HbA1c levels often exhibit differences in glucose variability. We tested for possible associations between parameters of glycemia compensation and corneal sub-basal nerve fiber status. Methods: The study included 20 patients with DM type 1 treated using an intensified insulin regimen...
August 1, 2018: Investigative Ophthalmology & Visual Science
Ayla Karimova, Yalçin Hacioğlu, Nurten Bahtiyar, Mutlu Niyazoğlu, Fahri Akbaş, Erkan Yilmaz, Turgut Ulutin, Ilhan Onaran
The present study examined the presence and frequency of the 4,977‑base pair mitochondrial (mt)DNA (mtDNA4977) deletion in blood platelets, and whether increased mtDNA4977 deletion was associated with abnormal mitochondrial and platelet function in type 2 diabetes mellitus. A total of 66 patients with type 2 diabetes mellitus and 23 healthy subjects were included in the present study. Patients were divided into three subgroups according to glycemic control, and the presence or absence of chronic diabetic complications: i) Good glycemic control [glycated hemoglobin (HbA1c) <7] without complications; ii) poor glycemic control (HbA1c ≥7) without complications; and iii) poor glycemic control (HbA1c ≥7) with complications...
July 31, 2018: Molecular Medicine Reports
A-M L Wegeberg, C Brock, B Brock, A D Farmer, A R Hobson, J R Semler, S M Scott
BACKGROUND: Gastrointestinal (GI) symptoms, such as nausea and bloating, are common in people with type 1 diabetes (T1DM). Autonomic dysfunction can lead to changes in the GI secreto-motor function which can be associated with GI symptom development. We hypothesized that regional pH profiles in T1DM differs from health and would be associated with objective physiological/clinical markers. METHODS: Forty-seven T1DM with confirmed diabetic sensory peripheral neuropathy and 41 healthy age-matched subjects underwent standardized wireless motility capsule testing...
July 30, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Elena Toschi, Lawrence Fisher, Howard Wolpert, Michael Love, Timothy Dunn, Gary Hayter
BACKGROUND: The goal of this uncontrolled pilot study was to assess the feasibility of a self-care management mobile app, called Sugar Sleuth, which incorporates the FreeStyle Libre™ glucose sensor, to help clinicians and people with type 1 diabetes (PWD) identify and mitigate self-care behaviors that contribute to glucose variability. METHODS: PWDs with a baseline A1c between 7.5 and 9.0% used the mobile app for 14 weeks. The app prompted the PWD to enter the suspected cause of detected glycemic excursions, and to record food and insulin information...
July 31, 2018: Journal of Diabetes Science and Technology
Giulia Mancini, Maria Giulia Berioli, Elisa Santi, Francesco Rogari, Giada Toni, Giorgia Tascini, Roberta Crispoldi, Giulia Ceccarini, Susanna Esposito
In people with type 1 diabetes mellitus (T1DM), obtaining good glycemic control is essential to reduce the risk of acute and chronic complications. Frequent glucose monitoring allows the adjustment of insulin therapy to improve metabolic control with near-normal blood glucose concentrations. The recent development of innovative technological devices for the management of T1DM provides new opportunities for patients and health care professionals to improve glycemic control and quality of life. Currently, in addition to traditional self-monitoring of blood glucose (SMBG) through a glucometer, there are new strategies to measure glucose levels, including the detection of interstitial glucose through Continuous Glucose Monitoring (iCGM) or Flash Glucose Monitoring (FGM)...
July 29, 2018: Nutrients
Gleiciane G Avelar, Wilcelly Machado-Silva, Adriane D Henriques, Jeeser A Almeida, Aparecido P Ferreira, Ciro J Brito, Lucy Gomes, Clayton F Moraes, Otávio T Nóbrega
Nitric oxide (NOx) availability in biological systems is associated with either favorable or unfavorable outcomes. In this sense, several studies bring about evidence that unbalanced NOx production may be underlying to the pathophysiology of vascular disorders. Our study investigated the possible association of clinical, biochemical and inflammatory variables with total circulating levels of NOx in elderly patients devoid of major inflammatory conditions. Clinical (demographics, lifestyle, anthropometry, pressoric traits) and biochemical characteristics (lipemic, glycemic and hormonal profiles) were assessed from 168 geriatrics outpatients eligible for primary care for age-related disorders...
2018: International Journal of Molecular Epidemiology and Genetics
Edith Pascale Mofo Mato, Magellan Guewo-Fokeng, M Faadiel Essop, Peter Mark Oroma Owira
BACKGROUND: Metformin is one of the most commonly used drugs for type 2 diabetes mellitus (T2DM). Despite its efficacy and safety, metformin is frequently associated with highly variable glycemic responses, which is hypothesized to be the result of genetic variations in its transport by organic cation transporters (OCTs). This systematic review aims to highlight and summarize the overall effects of OCT1 polymorphisms on therapeutic responses to metformin and to evaluate their potential role in terms of interethnic differences with metformin responses...
July 25, 2018: Systematic Reviews
Raymond Y Lo, Shu-Ching Chen, Ya-Ling Yang, Yi-Hsuan Wang, Hsin-Dean Chen, Jer-Chuan Li, Du-An Wu
We aim to test whether the association between glucose control and cognitive function still holds true in elderly patients with diabetes mellitus (DM) and Alzheimer disease (AD) under health-care case management. We enrolled 100 patients with DM (mean age: 74.6 years; male: 49%) and 102 patients with AD (mean age: 77.9 years; male: 41.2%) consecutively from the Diabetes Shared Care Program and the memory clinic. These patients were followed up every 3 months with scheduled examinations. Most patients with AD were at early stage and DM was a common comorbidity (n = 42)...
July 24, 2018: Journal of Geriatric Psychiatry and Neurology
Heather Hall, Dalia Perelman, Alessandra Breschi, Patricia Limcaoco, Ryan Kellogg, Tracey McLaughlin, Michael Snyder
Diabetes is an increasing problem worldwide; almost 30 million people, nearly 10% of the population, in the United States are diagnosed with diabetes. Another 84 million are prediabetic, and without intervention, up to 70% of these individuals may progress to type 2 diabetes. Current methods for quantifying blood glucose dysregulation in diabetes and prediabetes are limited by reliance on single-time-point measurements or on average measures of overall glycemia and neglect glucose dynamics. We have used continuous glucose monitoring (CGM) to evaluate the frequency with which individuals demonstrate elevations in postprandial glucose, the types of patterns, and how patterns vary between individuals given an identical nutrient challenge...
July 2018: PLoS Biology
Anna R Kahkoska, Nicholas F Brazeau, Kyle A Lynch, M Sue Kirkman, Joseph Largay, Laura A Young, John B Buse
Introduction: Type 2 diabetes is a significant problem among uninsured patients. Shared medical appointments (SMA) have been shown to improve outcomes in type 2 diabetes. We hypothesized that the SMA model could be adapted for a non-profit clinic in North Carolina that serves uninsured patients with diabetes that have incomes at/below 150% of the federal poverty line. Research Design and Methods: We implemented and sustained a patient-driven, student-led SMA model that incorporated the monthly rotations of students, physician assistant, and undergraduate students as well as pharmacy residents and an endocrinologist who collectively provide diabetes care at the free clinic...
2018: Journal of medical education and training
Brandon L Pierce, Peter Kraft, Chenan Zhang
Purpose of review: In this paper, we summarize prior studies that have used Mendelian Randomization (MR) methods to study the effects of exposures, lifestyle factors, physical traits, and/or biomarkers on cancer risk in humans. Many such risk factors have been associated with cancer risk in observational studies, and the MR approach can be used to provide evidence as to whether these associations represent causal relationships. MR methods require a risk factor of interest to have known genetic determinants that can be used as proxies for the risk factor (i...
June 2018: Current Epidemiology Reports
Rachel T McGrath, Sarah J Glastras, Samantha L Hocking, Gregory R Fulcher
Despite significant reductions in serious adverse perinatal outcomes for women with type 1 diabetes in pregnancy, the opposite effect has been observed for fetal overgrowth and associated complications, such as neonatal hypoglycemia, shoulder dystocia, and admission to the neonatal intensive care unit. In addition, infants born large for gestational age (LGA) have an increased lifetime risk of obesity, diabetes, and chronic disease. Although exposure to hyperglycemia plays an important role, women who seemingly achieve adequate glycemic control in pregnancy continue to experience a greater risk of excess fetal growth, leading to LGA neonates and macrosomia...
August 2018: Diabetes Care
Annunziata Nusca, Dario Tuccinardi, Marzia Albano, Camilla Cavallaro, Elisabetta Ricottini, Silvia Manfrini, Paolo Pozzilli, Germano Di Sciascio
Diabetes mellitus represents a major risk factor for the development of coronary artery disease and other vascular complications. Glycated haemoglobin, fructosamine, and fasting blood glucose levels are partial parameters to exhaustively describe patient dysglycemic status. Thus, recently the new concept of glycemic variability has emerged, including information about two major aspects: the magnitude of blood glucose excursions (from nadir to peak, thus lower and higher spikes) and the time intervals in which these fluctuations occur...
July 20, 2018: Diabetes/metabolism Research and Reviews
Yuan Shao, Weiwei Heng, Shanshan Li, Yun Xu, Gang Hu
BACKGROUND: Glycemic control is essential for managing acute stroke. This study evaluated the impact of a diabetes-specific formula (DSF) on glycemic control in severe acute ischemic stroke patients. METHODS: A randomized, prospective controlled trial was conducted in Nanjing Drum Tower Hospital. Acute ischemic stroke patients who scored > 10 on the National Institutes of Health Stroke Scale as well as had swallowing problems were randomized to group A, which received a diabetes-specific enteral formula, and group B, which received a standard formula...
July 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Jennifer Blackwood
BACKGROUND AND PURPOSE: Cognitive impairments have been reported in older adults with type 2 diabetes (T2DM), which subsequently increases the risk of falling. However, the relationship between specific cognitive processes and falls has not been reported. Therefore, the purpose of this study was to describe the contribution of cognitive function on falls in older adults with T2DM and to describe any differences by age group. METHODS: A cross-sectional analysis was conducted of 1171 older adult respondents with T2DM from the 2010 wave of the Health and Retirement Study...
July 11, 2018: Journal of Geriatric Physical Therapy
Juan Chen, Hai Jian Guo, Shan-Hu Qiu, Wei Li, Xiao-Hang Wang, Min Cai, Bei Wang, Xiao-Ning Li, Zi-Lin Sun
Background: Although fasting plasma glucose (FPG) has been highly recommended as the sole test for diabetes screening, the efficacy of FPG alone for diabetes screening is potentially limited due to its low sensitivity. The aim of this study was to improve the efficacy of FPG for diabetes screening using urinary glucose (UG). Methods: This study was initiated on November 12, 2015, and ended on June 28, 2016. A representative sample of individuals aged between 18 and 65 years, with no history of diabetes, from 6 cities in Jiangsu Province participated in this study...
July 20, 2018: Chinese Medical Journal
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