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Glycaemic variability

Yassmin Mansela Musthaffa, Vikas Goyal, Margaret-Anne Harris, Nitin Kapur, Juliane Leger, Mark Harris
Background Congenital central hypoventilation syndrome (CCHS) is a rare disorder of autonomic control. A hypoglycaemic seizure in a 4-year-old girl with CCHS led to a more detailed examination of glycaemic control in a cohort of children with CCHS. Methods We conducted an observational cohort study of glucose homeostasis in seven children (3 months to 12 years) with genetically confirmed CCHS using a combination of continuous glucose monitoring (CGM), fasting studies and oral glucose tolerance test (OGTT). CGM was used to compare the effect of diazoxide and dietary intervention in the index patient...
November 17, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
Siwaporn Hiranput, S Haris Ahmed, Deborah Macaulay, Shazli Azmi
Optimal glycaemic control pre-conception and throughout pregnancy is paramount to achieve the best outcomes and to minimise the risk of complications for the mother and baby. Current long-acting insulin analogues that have been approved by the National Institute for Health and Care Excellence in the UK for use in pregnancy include glargine and detemir. In many patients, these treatments have limitations because of their pharmacokinetic properties thus not enabling optimal glycaemic control. Efforts at rapidly achieving the recommended blood glucose targets with these analogues can be associated with recurrent and/or disabling hypoglycaemia...
November 15, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
A J Ahola, V Harjutsalo, C Forsblom, M Saraheimo, P-H Groop
AIMS: To study the association between dietary intake and glycaemia in Type 1 diabetes. METHODS: Data on energy and nutrient intakes, and the mean and coefficient of variation of self-monitored blood glucose measurements were obtained from records completed by 1000 adults with Type 1 diabetes. Associations between these measures of glycaemia and dietary intake were investigated using generalized linear regression, with and without macronutrient substitution. RESULTS: In the first set of analyses, fibre intake was associated with lower mean self-monitored blood glucose values (β = -0...
November 13, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Kent W Stewart, J Geoffrey Chase, Christopher G Pretty, Geoffrey M Shaw
BACKGROUND AND OBJECTIVE: Hyperglycaemia is commonplace in the adult intensive care unit (ICU), and has been associated with increased morbidity and mortality. Effective glycaemic control (GC) can reduce morbidity and mortality, but has proven difficult. STAR is a model-based GC protocol that uniquely maintains normoglycaemia by changing both insulin and nutrition interventions, and has been proven effective in controlling blood glucose (BG) in the ICU. However, most ICU GC protocols only change insulin interventions, making the variable nutrition aspect of STAR less clinically desirable...
November 2018: Computer Methods and Programs in Biomedicine
Lyvia Biagi, Arthur Bertachi, Marga Giménez, Ignacio Conget, Jorge Bondia, Josep Antoni Martín-Fernández, Josep Vehí
The aim of this study was to apply a methodology based on compositional data analysis (CoDA) to categorise glucose profiles obtained from continuous glucose monitoring systems. The methodology proposed considers complete daily glucose profiles obtained from six patients with type 1 diabetes (T1D) who had their glucose monitored for eight weeks. The glucose profiles were distributed into the time spent in six different ranges. The time in one day is finite and limited to 24 h, and the times spent in each of these different ranges are co-dependent and carry only relative information; therefore, CoDA is applied to these profiles...
October 31, 2018: Statistical Methods in Medical Research
Leon Campbell, Tessa Pepper, Kate Shipman
Identification of the correlation between HbA1c and diabetic complications has yielded one of the most clinically useful biomarkers. HbA1c has revolutionised the diagnosis and monitoring of diabetes mellitus. However, with widespread adoption of HbA1c has come increasing recognition that non-glycaemic variables can also affect HbA1c, with varying clinical significance. Furthermore, the identification of a discrepancy between predicted and measured HbA1c in some individuals, the so-called 'glycation gap', may be clinically significant...
October 25, 2018: Journal of Clinical Pathology
Anne Meike Boels, Guy Rutten, Nicolaas Zuithoff, Ardine de Wit, Rimke Vos
BACKGROUND: Health care providers aim to stimulate self-management in type 2 diabetes (T2DM) patients. However, they have a limited number of patient contacts to do this. With the growing number of T2DM patients, innovative and cost-effective interventions to promote self-management are needed. We aim to evaluate the effectiveness of diabetes self-management education via a smartphone app in T2DM patients on insulin therapy. METHODS: Non-blinded two-arm multi-centre randomised controlled superiority trial with parallel-groups and equal randomisation ('TRIGGER study')...
October 22, 2018: BMC Endocrine Disorders
Nesreen Aldawi, Gassan Darwiche, Salah Abusnana, Murtada Elbagir, Targ Elgzyri
There are no studies evaluating the glucose variability in different periods of Ramadan fasting in patients with type 2 diabetes using continuous glucose monitoring (CGM). This study examined the effect of Ramadan fasting on interstitial glucose (IG) variability in early,- late-, and post-Ramadan compared to pre-Ramadan days in non-insulin-treated type 2 diabetes patients. Participants had a CGM system connected 2 or 3 days before Ramadan start, which was removed on the third or fourth day of Ramadan. CGM performance continued for a total of 6 days...
December 2019: Libyan Journal of Medicine
Hérica Cristina Alves de Vasconcelos, José Claudio Garcia Lira Neto, Márcio Flávio Moura de Araújo, Gerdane Celene Nunes Carvalho, Carla Regina de Souza Teixeira, Roberto Wagner Júnior Freire de Freitas, Marta Maria Coelho Damasceno
BACKGROUND: People with diabetes have a high risk of developing micro and macrovascular complications that increase treatment costs and shorten life expectancy. Telecoaching programmes can improve short-term control of diabetes and reduce disease burden. AIMS: To analyse the effect of a health telecoaching programme in the control of type 2 diabetes. METHODS: A pragmatic clinical trial was carried out. Thirty-one patients with type 2 diabetes were divided into control and intervention groups...
October 18, 2018: British Journal of Nursing: BJN
Bruce A Griffin, Celia G Walker, Susan A Jebb, Carmel Moore, Gary S Frost, Louise Goff, Tom A B Sanders, Fiona Lewis, Margaret Griffin, Rachel Gitau, Julie A Lovegrove
We examined the impact of APOE genotype on plasma lipids and glucose in a secondary analysis of data from a five-arm, randomised controlled, parallel dietary intervention trial ('RISCK' study), to investigate the impact of replacing saturated fatty acids (SFA) with either monounsaturated fat (MUFA) or carbohydrate of high or low glycaemic index (GI) on CVD risk factors and insulin sensitivity. We tested the impact of APOE genotype (carriage of E2 and E4 alleles versus E3/E3), determined retrospectively, on plasma lipids, lipoproteins and glucose homeostasis at baseline ( n = 469), and on the change in these variables after 24 weeks of dietary intervention ( n = 389)...
October 17, 2018: Nutrients
Gareth A Wallis, Javier T Gonzalez
The objective of this review paper is to evaluate the impact of undertaking aerobic exercise in the overnight-fasted v. fed-state, in the context of optimising the health benefits of regular physical activity. Conducting a single bout of aerobic exercise in the overnight-fasted v. fed-state can differentially modulate the aspects of metabolism and energy balance behaviours. This includes, but is not limited to, increased utilisation of fat as a fuel source, improved plasma lipid profiles, enhanced activation of molecular signalling pathways related to fuel metabolism in skeletal muscle and adipose tissue, and reductions in energy intake over the course of a day...
October 18, 2018: Proceedings of the Nutrition Society
Luca Boeri, Paolo Capogrosso, Eugenio Ventimiglia, Filippo Pederzoli, Nicola Frego, Walter Cazzaniga, Francesco Chierigo, Massimo Alfano, Lorenzo Piemonti, Paola Viganò, Marina Pontillo, Emanuele Montanari, Francesco Montorsi, Andrea Salonia
OBJECTIVE: To study the prevalence and the risk associated with prediabetes (PreDM) in primary infertile men. PATIENTS AND METHODS: Data from 744 infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every man. Semen analysis was based on 2010 World Health Organization (WHO) reference criteria. PreDM was defined according to the clinical criteria detailed by the American Diabetes Association (Diabetes Care 2014; 37 (Suppl...
October 16, 2018: BJU International
Sanjay Kalra
This opinion piece describes a cricket-based analogy, the Glycaemic Sixer, for diabetes care. The hexad lists six glycaemic parameters which must be targeted to achieve optimal cardiovascular outcomes. All six parameters, i.e., fasting glucose, post prandial glucose, glycosylated haemoglobin, avoidance of hypoglycaemia, avoidance of nocturnal hypoglycaemia, and minimization of glycaemic variability, are associated with cardiovascular outcomes. Hence, equal attention must be paid to all these while planning strategies and choosing drugs for diabetes management...
October 2018: JPMA. the Journal of the Pakistan Medical Association
Rocío Fernández-Méndez, Sancho Rodríguez-Villar, Pablo F Méndez, Richard Windle, Gary George Adams
RATIONALE, AIMS, AND OBJECTIVES: The practice of glycaemic control of critically ill patients admitted to intensive care units (ICUs) is guided by clinical management protocols, designed locally by the ICUs. These protocols differ significantly in their aims and methods. The aim of this study was to develop a standardized methodology for the systematic and objective analysis and comparison of protocols for glycaemic control implemented in any ICU. METHOD: The protocols for glycaemic control implemented in seven ICUs of a UK-based ICU network were analysed using techniques of inductive content analysis, through an open coding process and the framework method...
October 11, 2018: Journal of Evaluation in Clinical Practice
Jingyi Lu, Xiaojing Ma, Lei Zhang, Yifei Mo, Lingwen Ying, Wei Lu, Wei Zhu, Yuqian Bao, Jian Zhou
OBJECTIVE: The relationship between glycaemic variability (GV) and diabetic complications has gained much interest and remains under debate. Moreover, the association of GV with diabetic complications has not been examined in latent autoimmune diabetes of the adult (LADA). Therefore, we evaluated the relationships among several metrics of GV with diabetic retinopathy (DR) in patients with LADA and type 2 diabetes (T2DM). METHODS: A total of 192 patients with LADA and 2927 patients with T2DM were enrolled...
October 10, 2018: Journal of Diabetes Investigation
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...
October 1, 2018: European Journal of Endocrinology
F Carbone, G Adami, L Liberale, A Bonaventura, M Bertolotto, G Andraghetti, N Scopinaro, G B Camerini, F S Papadia, R Cordera, F Dallegri, F Montecucco
AIM: Bariatric surgery has been shown to effectively improve glycaemic control in morbidly obese subjects. However, the molecular bases of this association are still elusive and may act independently of weight loss. Here, our retrospective study has investigated the inflammatory molecule osteopontin (OPN) as a potential predictor of type 2 diabetes mellitus (T2DM) remission. METHODS: Baseline serum levels of OPN were analyzed in 41 T2DM patients who underwent bariatric surgery...
September 27, 2018: Diabetes & Metabolism
A C Paing, K A McMillan, A F Kirk, A Collier, A Hewitt, S F M Chastin
AIM: To explore the dose-response between frequency of interruption of sedentary time and basal glucose (fasting glucose, the dawn phenomenon and night-time glucose) in Type 2 diabetes. METHODS: In a randomized three-treatment, two-period balanced incomplete block trial, 12 people with Type 2 diabetes (age, 60.0 ± 3.2 years; BMI, 30.2 ± 1.4 kg/m2 ) completed two of three conditions: sitting for 7 h interrupted every 60 min (Condition 1), 30 min (Condition 2), and 15 min (Condition 3) by 3-min light-intensity walking breaks...
September 28, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Lise L Kurtzhals, Sidse K Nørgaard, Anna L Secher, Vibeke L Nichum, Helle Ronneby, Ann Tabor, H David McIntyre, Peter Damm, Elisabeth Reinhardt Mathiesen
AIMS/HYPOTHESIS: We aimed to investigate the impact of maternal gestational weight gain (GWG) during dietary treatment on fetal growth in pregnancies complicated by gestational diabetes (GDM). METHODS: This was a retrospective cohort study of 382 women consecutively diagnosed with GDM before 34 weeks' gestation with live singleton births in our centre (Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark) between 2011 and 2017. The women were stratified into three groups according to restricted (53%), appropriate (16%) and excessive (31%) weekly GWG during dietary treatment (using the Institute of Medicine guidelines) to estimate compliance with an energy-restricted 'diabetes diet' (6000 kJ/day [1434 kcal/day], with approximately 50% of energy intake coming from carbohydrates with a low glycaemic index, and a carbohydrate intake of 175 g/day)...
December 2018: Diabetologia
Sonya Chelvanayagam, Janet James
Diabulimia has become a common term used to describe a condition when a person with type 1 diabetes has an eating disorder. The individual may omit or restrict their insulin dose to lose/control weight. Evidence suggests that as many as 20% of women with type 1 diabetes may have this condition. The serious acute and long-term complications of hyperglycaemia are well documented. Detection of this condition is challenging and health professionals need to be vigilant in assessing reasons for variable glycaemic control and weight changes...
September 20, 2018: British Journal of Nursing: BJN
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