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Glycaemic variability

A K J Gradel, T Porsgaard, J Lykkesfeldt, T Seested, S Gram-Nielsen, N R Kristensen, H H F Refsgaard
Variability in the effect of subcutaneously administered insulin represents a major challenge in insulin therapy where precise dosing is required in order to achieve targeted glucose levels. Since this variability is largely influenced by the absorption of insulin, a deeper understanding of the factors affecting the absorption of insulin from the subcutaneous tissue is necessary in order to improve glycaemic control and the long-term prognosis in people with diabetes. These factors can be related to either the insulin preparation, the injection site/patient, or the injection technique...
2018: Journal of Diabetes Research
Antonio Ceriello, Louis Monnier, David Owens
Glycaemic variability is an integral component of glucose homoeostasis. Although it has not yet been definitively confirmed as an independent risk factor for diabetes complications, glycaemic variability can represent the presence of excess glycaemic excursions and, consequently, the risk of hyperglycaemia or hypoglycaemia. Glycaemic variability is currently defined by a large and increasing number of metrics, representing either short-term (within-day and between-day variability) or long-term glycaemic variability, which is usually based on serial measurements of HbA1c or other measures of glycaemia over a longer period of time...
August 13, 2018: Lancet Diabetes & Endocrinology
Silvia Giatti, Silvia Diviccaro, Roberto Cosimo Melcangi
Diabetes mellitus is a metabolic disease where improper glycaemic control may induce severe complications in different organs. In this review, we will discuss alterations occurring in peripheral and central nervous system of patients with type 1 (i.e., insulin dependent diabetes mellitus,) or type 2 diabetes (i.e., non-insulin dependent diabetes mellitus), as well as related experimental models. A particular focus will be on the role exerted by neuroactive steroids (i.e., important regulators of nervous functions) in the nervous damage induced by diabetes...
August 14, 2018: Cellular and Molecular Neurobiology
Christina Bächle, Anna Peneva, Werner Maier, Katty Castillo, Anna Stahl-Pehe, Oliver Kuß, Rolf Holle, Julia M Hermann, Reinhard W Holl, Joachim Rosenbauer
PURPOSE: To analyse the association of area-level deprivation (German Index of Multiple Deprivation, GIMD 2010) with health- and disease-related quality of life (QoL) and glycaemic control (HbA1c) jointly with individual-level socioeconomic status (SES) in young patients with preschool-onset type 1 diabetes. METHODS: A total of 425 male and 414 female patients aged 11-21 years from a Germany-wide population-based survey completed the generic KINDL-R, the DISABKIDS chronic-generic module (DCGM-12), and the DISABKIDS diabetes-specific module with impact and treatment scales (QoL indicators; range 0-100 with higher scores representing better QoL)...
August 11, 2018: Quality of Life Research
Annika Rosengren, Jon Edqvist, Araz Rawshani, Naveed Sattar, Stefan Franzén, Martin Adiels, Ann-Marie Svensson, Marcus Lind, Soffia Gudbjörnsdottir
AIMS/HYPOTHESIS: Type 2 diabetes is an established risk factor for heart failure, but age-specific data are sparse. We aimed to determine excess risk of heart failure, based on age, glycaemic control and kidney function in comparison with age- and sex-matched control individuals from the general population. METHODS: Individuals with type 2 diabetes registered in the Swedish National Diabetes Registry 1998-2012 (n = 266,305) were compared with age-, sex- and county-matched control individuals without diabetes (n = 1,323,504), and followed over a median of 5...
August 9, 2018: Diabetologia
Valentina Guarnotta, Giulia Di Bella, Giuseppe Pillitteri, Alessandro Ciresi, Carla Giordano
Background: Cardiovascular disease is a frequent complication of type 1 diabetes (T1D). We evaluated the effectiveness of switching from glargine to degludec in reducing the cardiovascular risk factors, the Framingham risk score (FRS) and visceral adiposity index (VAI) in patients with T1D and autoimmune polyglandular syndrome (APS). Methods: We selected 66 T1D outpatients who had been on stable treatment with glargine for at least 5 years. Among them, 30 patients maintained glargine (group A), while 36 were switched to degludec (group B) for 12 months...
2018: Frontiers in Endocrinology
N Shohat, C Foltz, C Restrepo, K Goswami, T Tan, J Parvizi
Aims: The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery. Patients and Methods: This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study...
August 2018: Bone & Joint Journal
Marzena Dworacka, Saule Iskakova, Anna Wesołowska, Gulmira Zharmakhanova, Agnieszka Stelmaszyk, Bartosz A Frycz, Paweł P Jagodziński, Grzegorz Dworacki
AIM: Over the last few years, studies have indicated that fluctuant hyperglycemia is very likely to increase the risk of cardiovascular complications of diabetes. Statins are widely used in diabetes for the prevention of cardiovascular complications, but it is still not clear whether simvastatin could also prevent glycaemic variability - induced aberrant angiogenesis which plays a significant role in the development of atherosclerosis. METHODS: Wistar rats were divided into four groups: (1) simvastatin-treated (20 mg/kg for 8 consecutive weeks) type 2 diabetes rat model with daily glucose excursions, (2) placebo-treated type 2 diabetes rat model with daily glucose excursions, (3) placebo-treated stable well-controlled type 2 diabetes rat model and (4) placebo-treated non-diabetic rats...
July 26, 2018: Diabetes Research and Clinical Practice
B M Bonora, A Avogaro, G P Fadini
BACKGROUND: Good glycaemic control during pregnancy is key to reduce maternal and foetal complications. Insulin degludec, an ultralong acting analogue with a "peakless" and stable pharmacokinetic profile, has the potential advantage of reducing hypoglycaemia and glucose variability compared to other basal insulins. Therefore, degludec could be a reasonable therapeutic option for pregnant women with type 1 diabetes (T1D). However, degludec is not licensed for use during pregnancy owing to the lack of safety data...
July 24, 2018: Journal of Endocrinological Investigation
Hannah Tamara Field, Nicholas Woodier, Jenny Clayton, Piotr Plichta, Kuok Shern Teo
Variable rate intravenous insulin infusions (VRIII) are used to maintain stable blood glucose in hospitalised patients with diabetes who are unable to eat or have a severe illness where good glycaemic control is paramount. With VRIII it is important to prescribe an adequate substrate to avoid hypoglycaemia and maintain electrolyte balance. Traditionally the substrate would have been varied to achieve this; current guidelines advise varying the infusion rate rather than the type of substrate. The local hospital Trust updated their VRIII prescription chart to reflect the Joint British Diabetes Societies' suggestions for inpatient care in October 2014...
2018: BMJ Open Quality
Rafaella Cristhine Pordeus Luna, Mayara Karla Dos Santos Nunes, Mussara Gomes Cavalcante Alves Monteiro, Cássia Surama Oliveira da Silva, Rayner Anderson Ferreira do Nascimento, Raquel Patrícia Ataíde Lima, Flávia Cristina Fernandes Pimenta, Naila Francis Paulo de Oliveira, Darlene Camati Persuhn, Aléssio Tony Cavalcanti de Almeida, Alcides da Silva Diniz, Cristina Wide Pissetti, Rodrigo Pinheiro Toledo Vianna, Flavia Emília Leite de Lima Ferreira, Maria da Conceição Rodrigues Gonçalves, Maria José de Carvalho Costa
Background: Excess weight is a strong risk factor for the development of dysglycaemia. It has been suggested that changes in the metabolism microRNAs, small non-coding RNAs that regulate gene expression, could precede late glycaemic changes. Vitamin E in turn may exert important functions in methylation and gene expression processes. This study aimed to determine the effect of α-tocopherol on glycaemic variables and miR-9-1 and miR-9-3 promoter DNA methylation in overweight women. Methods: A randomized, double-blind, exploratory, placebo-controlled study was conducted in overweight and obese adult women ( n  = 44) who ingested synthetic vitamin E (all-rac-α-tocopherol), natural source vitamin E (RRR-rac-α-tocopherol) or placebo capsules and were followed up for a period of 8 weeks...
2018: Nutrition & Metabolism
David G Bruce, Wendy A Davis, Timothy Me Davis
AIMS: To investigate whether tight glycaemic control achieved with metformin, insulin or sulphonylurea-based pharmacotherapy increases all-cause mortality in older people with type 2 diabetes. MATERIALS AND METHODS: A prospective cohort study of individuals with known diabetes recruited between 2008 and 2011 and followed until 2016. The impact of baseline glycated haemoglobin (HbA1c) on mortality hazards was investigated in participants aged ≥75 years. Proportional hazards models for time to death were constructed from the baseline clinical assessment then the variables of interest (HbA1c, treatment category and their interactions) were entered...
July 13, 2018: Diabetes, Obesity & Metabolism
Anjana Radhakutty, Morton G Burt
Glucocorticoids are frequently prescribed to patients with a wide range of inflammatory and autoimmune diseases. The semi-synthetic glucocorticoid prednisolone is most commonly prescribed and in two main patterns. Prednisolone is prescribed short-term at medium-high doses to treat an acute inflammatory illness or long-term at lower doses to attenuate chronic inflammatory disease progression. In hospitalized patients with acute prednisolone-induced hyperglycaemia there is a distinct circadian pattern of glucose elevation, which occurs predominantly in the afternoon and evening...
July 10, 2018: European Journal of Endocrinology
Lauren L O'Mahoney, Jamie Matu, Oliver J Price, Karen M Birch, Ramzi A Ajjan, Diane Farrar, Robyn Tapp, Daniel J West, Kevin Deighton, Matthew D Campbell
BACKGROUND: Randomized controlled trials (RCTs) suggest that supplementation with omega-3 polyunsaturated fatty acids (n-3PUFAs) may favourably modify cardiometabolic biomarkers in type 2 diabetes (T2DM). Previous meta-analyses are limited by insufficient sample sizes and omission of meta-regression techniques, and a large number of RCTs have subsequently been published since the last comprehensive meta-analysis. Updated information regarding the impact of dosage, duration or an interaction between these two factors is therefore warranted...
July 7, 2018: Cardiovascular Diabetology
Sridevi A Naaraayan, Poovazhagi Varadharajan, Raghavan Velayutham Dhakshayani, Rema Chandramohan, Senthil Senniappan
Flash glucose monitoring using Free Style Libre Pro (FSLP) was undertaken among fifteen diabetic children. Data revealed high glycaemic variability, Time in Target Range (TIR) to be 27% and 12% of time in hypoglycaemia. Sensor insertion and retention were problematic in 33%. Though user friendly, sensors may need an additional adhesive plaster for retention.
June 15, 2018: Indian Pediatrics
Paolo Pozzilli, Silvia Pieralice
Autoimmune diabetes is a heterogeneous disease which can arise at any age. Subjects with adult-onset autoimmune diabetes who do not necessitate insulin-therapy for at least 6 months after diagnosis are demarcated as having latent autoimmune diabetes in adults (LADA). This condition is more heterogeneous than young-onset autoimmune diabetes and shares clinical and metabolic characteristics with both type 2 and type 1 diabetes. Patients with LADA are considered by having highly variable β-cell destruction, different degrees of insulin resistance and heterogeneous titre and pattern of islet autoantibody, suggesting different pathophysiological pathways partially explaining the heterogeneous phenotypes of LADA...
June 2018: Endocrinology and Metabolism
Sean D Sullivan, Timothy S Bailey, Ronan Roussel, Fang Liz Zhou, Zsolt Bosnyak, Ronald Preblick, Jukka Westerbacka, Rishab A Gupta, Lawrence Blonde
AIMS: To compare clinical outcomes in patients with type 2 diabetes (T2D) switching from insulin glargine 100 units/mL (Gla-100) or insulin detemir (IDet) to insulin glargine 300 units/mL (Gla-300) or insulin degludec (IDeg). MATERIALS AND METHODS: We conducted a retrospective, observational study of electronic medical records for Gla-300/IDeg adult switchers (March 1, 2015 to January 31, 2017) with active records for 12-month baseline (glycated haemoglobin [HbA1c] used a 6-month baseline period) and 6-month follow-up periods...
June 25, 2018: Diabetes, Obesity & Metabolism
M A Rodriguez-Calero, E Barceló Llodrá, M Cruces Cuberos, I Blanco-Mavillard, M A Pérez Axartell
AIM: To assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. METHOD: Prospective "pre-post" quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention)...
June 20, 2018: Enfermería Intensiva
R Perera, N Oliver, E Wilmot, C Marriott
Since the introduction of real-time continuous glucose monitoring (CGM) systems more than 15 years ago and, more recently, flash glucose monitoring (Flash-GM), clinical studies have observed reductions in HbA1c , independent of insulin delivery method, with decreasing time spent in hypoglycaemia [1] and reduction in glycaemic variability [2]. CGM can improve quality of life and reduce diabetes-related distress [3], including fear of hypoglycaemia [4,5]. Despite these benefits, CGM has yet to be fully implemented as part of the standard of care for people living with Type 1 diabetes in England, and there is considerable variation in how it is funded through local payer organizations...
June 22, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
S Misra, N Vedovato, E Cliff, E De Franco, A T Hattersley, F M Ashcroft, N S Oliver
BACKGROUND: Permanent neonatal diabetes caused by mutations in the KCNJ11 gene may be managed with high-dose sulfonylureas. Complete transfer to sulfonylureas is not successful in all cases and can result in insulin monotherapy. In such cases, the outcomes of combining sulfonylureas with insulin have not been fully explored. We present the case of a woman with diabetes due to a KCNJ11 mutation, in whom combination therapy led to clinically meaningful improvements. CASE: A 22-year-old woman was found to have a KCNJ11 mutation (G334V) following diagnosis with diabetes at 3 weeks...
June 13, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
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