Intermittently Scanned Continuous Glucose Monitoring Performance in Patients With Liver Cirrhosis.

AIM: To evaluate the use of intermittently scanned continuous glucose monitoring (isCGM) in patients with liver cirrhosis (LC). METHODS: Observational study including 30 outpatients with LC (Child-Pugh B/C): 10 without diabetes (DM) (G1), 10 with newly diagnosed DM by oral glucose tolerance test (G2), and 10 with a previous DM diagnosis (G3). isCGM (FreeStyle Libre Pro) was used for 56 days (four sensors/patient). Blood tests were performed at baseline and after 28 and 56 days. RESULTS: No differences were found in the baseline characteristics, except for higher age in G3. There were significant differences between G1, G2 and G3 in glucose management indicator (GMI) (5.28 ± 0.17, 6.03 ± 0.59, 6.86 ± 1.08%, P < .001), HbA1c (4.82 ± 0.39, 5.34 ± 1.26, 6.97 ± 1.47%, P < .001), average glucose (82.79 ± 7.06, 113.39 ± 24.32, 149.14 ± 45.31mg/dL, P < .001), time in range (TIR) (70.89 ± 9.76, 80.2 ± 13.55, 57.96 ± 17.96%, P = .006), and glucose variability (26.1 ± 5.0, 28.21 ± 5.39, 35.31 ± 6.85%, P = .004). There was discordance between GMI and HbA1c when all groups were considered together, with a mean difference of 0.35% (95% SD 0.17, 0.63). In G1, the mean difference was 0.46% (95% SD 0.19, 0.73) and in G2 0.69% (95% SD 0.45, 1.33). GMI and HbA1c were concordant in G3, with a mean difference of -0.10 % (95% SD [-0.59, 0.38]). CONCLUSION: Disagreements were found between the GMI and HbA1c levels in patients with LC. isCGM was able to detect abnormalities in glycemic control that would not be detected by monitoring with HbA1c, suggesting that isCGM can be useful in assessing glycemic control in patients with LC.

Flash glucose monitoring system in special situations

ABSTRACT The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.

Flash glucose monitoring system in special situations.

The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.

Effects of Bariatric Surgery in Male Obesity-Associated Hypogonadism.

INTRODUCTION: The prevalence of obesity has grown exponentially over the last several decades. Research has linked male obesity to changes in the gonadal axis, which can induce functional hypogonadism. Bariatric surgery provides sustained weight loss and metabolic improvement. This was a retrospective cohort study to evaluate the male gonadal axis and metabolic profiles of obese individuals during the bariatric pre- and post-operative periods while comparing them to a normal body mass index (BMI) group. METHODS: Twenty-nine obese men, who underwent bariatric surgery between 2012 and 2016 at the Federal University of Santa Catarina Hospital and a control group (CG) of 29 age-matched men with normal BMI, were analyzed. Bariatric pre- and 6-month post-operative data were compared with the CG. RESULTS: The study group (G1) presented an average age, weight, and BMI of 42.8 ± 9.5 years, 155.2 ± 25.8 kg, and 50.6 ± 7.1 kg/m2, respectively. The pre-operative total testosterone (TT) G1 values were different from the CG (229.5 ± 96.4 versus 461.5 ± 170.8 ng/dL, p < 0.01). Bariatric surgery promoted a statistically significant improvement in weight, TT, and metabolic profiles in surgical patients. CONCLUSION: Functional hypogonadism is prevalent in obese men, and we must be aware of this diagnosis. Although studies defining the best diagnostic parameters and indication of adequate hormone replacement therapy are lacking, an increase in TT levels during the first 6 months after bariatric surgery was identified in our study. Previous studies have shown that gonadal function can normalize after metabolic improvement.

Avaliação dos diferentes esquemas de insulinoterapia prescritos aos pacientes hiperglicêmicos do Hospital Governador Celso Ramos, Florianópolis, SC, Brasil / Evaluation of different insulin therapies schemes prescribed to hyperglycemicpatients at Governador Celso Ramos Hospital, Florianópolis, SC, Brazil

Este trabalho tem como objetivo identificar e caracterizaros pacientes hiperglicêmicos hospitalizados deacordo com dados demográficos, setor de internação,esquemas de insulinoterapia, glicemia de jejum, médiaglicêmica, tempo de internação e presença de hipoglicemia.Trata-se de um estudo transversal em que foramanalisados 63 prontuários de pacientes hiperglicêmicosdo Hospital Governador Celso Ramos, de Florianópolis,Santa Catarina. A análise descritiva foi realizadapor meio do programa estatístico SPSS 19.0 e as comparaçõesutilizaram o Teste Z e Teste T de Student. Entreos 63 pacientes recrutados para o estudo, 52 (82,5%)estavam em tratamento somente com esquema SlidingScale Insulin (SSI) e 11 (17,4%) com esquema basal--bolus (B-B). No grupo SSI, 25 (48,1%) apresentavamdiagnóstico prévio de Diabetes Mellitus (DM), contra10 (90,9%) dos pacientes do grupo B-B (p =0,02). Nogrupo SSI, 6 (11,5%) apresentaram hipoglicemia, bemcomo 6 (54,5%) dos pacientes do grupo B-B (p<0,01).A média da glicemia de jejum encontrada no grupo SSIfoi de 137,8mg/dL, enquanto o grupo B-B mostrou umamédia de 183,1mg/dL (p =0,04). A grande maioria dospacientes hospitalizados foram tratados com esquemade insulina SSI e um número significativo não apresentavadiagnóstico prévio de DM. O número reduzido depacientes em esquema basal-bolus dificultou a análisecomparativa entre os grupos.

The objectives of this work is to identify and tocharacterize hyperglycemic patients according todemographic data and inpatient sector, as well as toevaluate insulin therapy regimens according to fastingglucose, mean glycemic index, length of hospital stayand the presence of hypoglycemia. It is a cross-sectionalstudy in which 63 handbooks of hyperglycemicpatients from Hospital Governador Celso Ramos ofFlorianópolis/Brazil were analyzed. A descriptiveanalysis was carried out through SPSS 19.0 statisticalsoftware and comparisons through Student?s Z-Test andT-Test. Among the 63 patients recruited for the study,52 (82.5%) were treated with Sliding Scale Insulin (SSI)and 11 (17.4%) with basal-bolus (B-B). In SSI group, 25patients (48.1%) presented a previous diagnosis ofdiabetes while the same diagnosis was presented in10 (90.9%) of B-B group (p =0.02). Among SSI group, 6(11.5%) presented hypoglycemia detection as well as 6(54.5%) from B-B group (p<0.01). The average amountof venous glucose found in SSI group was 137.8mg/dlwhereas B-B group displayed an average of 183.1mg/dl (p =0.04). The great majority of inpatients weretreated with an insulin regimen according to capillaryblood glucose and a significant number of them had notpresented a previous diagnosis of DM. The small amountof patients in basal-bolus hampered a comparativeanalysis between the groups.