Utilidad de la prueba de tolerancia de comida mixta con Nutrial I para la evaluación de la función de las células beta en diabetes tipo 1 / Usefulness of the tolerance test of mixed food with Nutrial I for the assessment of beta cells function in diabetes type 1

RESUMEN Introducción: La prueba de tolerancia de comida mixta es considerada la prueba de oro para la medición de la producción de insulina endógena en pacientes con diabetes tipo 1. Objetivo: Determinar la utilidad de la prueba de tolerancia de comida mixta con Nutrial I para evaluar la función de las células ß en diabéticos tipo 1 de diagnóstico reciente y la relación de esa función con algunas características clínicas y bioquímicas. Métodos: Se estudiaron variables bioquímicas como la glucemia, hemoglobina glucosilada (HbA1c), péptido C y fracciones lipídicas. La prueba de tolerancia de comida mixta con Nutrial I se aplicó a 18 sujetos con diabetes tipo 1 de diagnóstico reciente y a 8 voluntarios con edades comprendidas entre 19 y 35 años. El consumo del suplemento Nutrial I se calculó según el peso del paciente. Se obtuvieron muestras para glucemia y péptido C a los -10, 0, 30, 60, 90 y 120 minutos. Resultados: Se observaron concentraciones elevadas de glucemia y disminuidas de péptido C durante la prueba de tolerancia de comida mixta en los diabéticos tipo 1 de diagnóstico reciente, en comparación con los voluntarios, así como, diferencias en las áreas bajo la curva de péptido C (AUC-pc) (p= 0,001). En los diabéticos tipo 1 de diagnóstico reciente se evidenció una correlación negativa entre el AUC-pc con los niveles de glucemia en ayunas (r= -0,747; p ( 0,0001) y la HbA1c (r= -0,535; p= 0,022). Por el contrario, se encontró una correlación positiva entre el AUC-pc y el péptido C en ayunas (r= 0,722; p= 0,001). El AUC-pc después de la prueba de tolerancia de comida mixta es mayor en los sujetos con glucemia en ayunas si GA < 7 mmol/L con respecto a los sujetos con glucemia en ayunas ( 7 mmol/L (p= 0,012). Conclusiones: El empleo del Nutrial I en la prueba de tolerancia de comida mixta fue útil en la evaluación de la función de las células β en diabéticos tipo 1 de diagnóstico reciente. Los valores bajos de glucemia en ayunas durante esta prueba son marcadores indirectos de una función residual de células ( más conservada en los diabéticos tipo 1 de diagnóstico reciente(AU)

ABSTRACT Introduction: The tolerance test of mixed food is considered the gold standard for the measurement of endogenous insulin production in patients with diabetes type 1. Objective: To determine the usefulness of the tolerance test of mixed food with Nutrial I to assess the ß-cells function in patients with diabetes type 1 of recent diagnosis and the relation of this function with some clinical and biochemical characteristics. Methods: There were studied biochemical variables as the blood glucose, glycosylated haemoglobin (HbA1c), C-peptide and lipid fractions. The tolerance test of mixed food with Nutrial I was applied to 18 individuals with diabetes type 1 of recent diagnosis and in 8 volunteers aged between 19 and 35 years old. The consumption of Nutrial I supplement was calculated according to the weight of the patient. Samples were obtained for blood glucose and C-peptide at -10, 0, 30, 60, 90 and 120 minutes. Results: There were observed high concentrations of glycemia and decreased amounts of C-peptide during the tolerance test of mixed food in recently diagnosed type 1 diabetics in comparison with the volunteers, as well as differences in areas under the curve of C-peptide (AUC-pc) (p= 0.001). In the recently diagnosed type 1 diabetics was evident a negative correlation between the AUC-pc with fasting plasma glucose levels (r= -0,747; p(0.0001) and HbA1c (r= -0,535; p= 0.022). On the contrary, it was found a positive correlation between the AUC-pc and fasting C-peptide (r = 0.722; p = 0.001). The AUC-pc after the tolerance test of mixed food was greater in subjects with fasting blood glucose < 7 mmol/L with respect to the subjects with fasting blood glucose ( 7 mmol/L (p= 0.012). Conclusions: The use of Nutrial I in the tolerance test of mixed food was useful in the assessment of the role of the β-cells in patients with recently diagnosed diabetes type 1. Low values of fasting blood glucose during this test are indirect markers of a residual function of (cells more preserved in type 1 diabetics of recent diagnosis(AU)

Assessment of glucose kinetics with real-time continuous glucose monitoring during labor.

AIM: Changes in glucose levels during labor have not been sufficiently investigated in pregnant women. Using real-time continuous glucose monitoring, we aimed to assess glucose kinetics during labor among pregnant women with gestational diabetes mellitus (PwGDM), and those with normal glucose tolerance (PwNGT). METHODS: Japanese PwGDM and PwNGT who had planned a transvaginal delivery at Okayama University Hospital were enrolled. The correlation between changes in glucose levels during labor among the PwGDM and PwNGT groups at four time periods was assessed: (i) active phase of 1st stage of labor; (ii) 2nd stage of labor; (iii) postpartum 0-12 h; and (iv) postpartum 12-48 h. RESULTS: In total, 18 and 22 PwGDM and PwNGT, respectively, were enrolled. During labor, both groups had similar changes in glucose levels over time, which peaked during period 3. The main effect of glucose level changes was the labor period (P < 0.001), not the presence of gestational diabetes mellitus. Furthermore, differences in glucose levels in the PwGDM group were observed between periods 1 and 2 (P = 0.037), 1 and 3 (P = 0.024), 3 and 4 (P = 0.005); differences in glucose levels in the PwNGT group were observed between periods 3 and 4 (P = 0.024). CONCLUSION: During labor, both PwGDM and PwNGT groups showed similar changes in glucose levels over time. During delivery, the PwGDM who regularly measured their own glucose levels could be managed using the same nutritional management methods as those for PwNGT.

Assessment of a Personalized Approach to Predicting Postprandial Glycemic Responses to Food Among Individuals Without Diabetes.

Importance: Emerging evidence suggests that postprandial glycemic responses (PPGRs) to food may be influenced by and predicted according to characteristics unique to each individual, including anthropometric and microbiome variables. Interindividual diversity in PPGRs to food requires a personalized approach for the maintenance of healthy glycemic levels. Objectives: To describe and predict the glycemic responses of individuals to a diverse array of foods using a model that considers the physiology and microbiome of the individual in addition to the characteristics of the foods consumed. Design, Setting, and Participants: This cohort study using a personalized predictive model enrolled 327 individuals without diabetes from October 11, 2016, to December 13, 2017, in Minnesota and Florida to be part of a study lasting 6 days. The study measured anthropometric variables, described the gut microbial composition, and assessed blood glucose levels every 5 minutes using a continuous glucose monitor. Participants logged their food and activity information for the duration of the study. A predictive model of individualized PPGRs to a diverse array of foods was trained and applied. Main Outcomes and Measures: Glycemic responses to food consumed over 6 days for each participant. The predictive model of personalized PPGRs considered individual features, including the microbiome, in addition to the features of the foods consumed. Results: Postprandial response to the same foods varied across 327 individuals (mean [SD] age, 45 [12] years; 78.0% female). A model predicting each individual's responses to food that considers several individual factors in addition to food features had better overall performance (R = 0.62) than current standard-of-care approaches using nutritional content alone (R = 0.34 for calories and R = 0.40 for carbohydrates) to control postprandial glycemic levels. Conclusions and Relevance: Across the cohort of adults without diabetes who were examined, a personalized predictive model that considers unique features of the individual, such as clinical characteristics, physiological variables, and the microbiome, in addition to nutrient content was more predictive than current dietary approaches that focus only on the calorie or carbohydrate content of foods. Providing individuals with tools to manage their glycemic responses to food based on personalized predictions of their PPGRs may allow them to maintain their blood glucose levels within limits associated with good health.

Assessment of serum lactate levels, blood glucose values and blood gas values in sheep, newborn lambs and placenta / Avaliação da concentração de lactato sérico, glicemia e hemogasometria de ovelhas, cordeiros recém-nascidos e placenta

Newborn animals, in the fetal-to-neonatal transition, usually face several challenges in their first 24 hours, including issues with acid-base balance, glycemic levels and oxygenation. Difficulties to overcome such issues have caused several deaths among newborns. Therefore, studies have been carried out in order to evaluate them. The main purpose of this study is to evaluate the correlation between the serum lactate level in the mother, in the placenta and in the newborn. Moreover, the study measured the lactate level, blood glucose level and blood gas level in the first 24 hours. Tests were carried out right after birth, and at 4, 8, 12 and 24 hours after. Lactate levels were quite similar to the placental levels (p=0.991) which, in turn, were significantly different from the mother's (p=0.011). Results showed that, shortly after birth, the production of lactate in the placenta is part of the issue. Along the first 24 hours, the study observed a reduction of the levels of lactate in newborns; the levels were closer to the normal index levels for the species. Regarding the blood gas test results, we observed mild metabolic acidosis at birth; acid-base balance was completely stable at the end of the period.(AU)

Os principais desafios da transição fetal-neonatal são a estabilização do equilíbrio ácido-básico, glicemia e oxigenação ao longo das primeiras 24 horas de vida. Falhas nesse sistema são a maior causa de morte nesse período e os estudos de viabilidade neonatal tem se concentrado nas avaliações destas variáveis. O objetivo do presente estudo foi avaliar a comparação da lactatemia materna, placentária e neonatal ao nascimento e, ainda, observar o comportamento do lactato, glicemia e hemogasometria nas primeiras 24 horas de vida do neonato ovino. Para tanto, as avaliações foram realizadas ao nascimento, 4, 8, 12 e 24 horas após. A lactatemia neonatal se mostrou próxima à placentária (p=0,991) e significativamente diferente da materna (p=0,011), o que sugere uma influência da produção de lactato pela placenta na lactatemia neonatal ao nascimento. Ao longo das 24 horas de vida foi possível observar a depuração de lactato pelo organismo do neonato, aproximando assim dos valores de referência para a espécie. Na hemogasometria foi possível observar discreta acidose metabólica, com normalização já nas primeiras 4 horas e estabilização completa do equilíbrio ácido-básico ao final das 24 horas de vida.(AU)

The application of simple metrics in the assessment of glycaemic variability.

The assessment of glycaemic variability (GV) remains a subject of debate with many indices proposed to represent either short- (acute glucose fluctuations) or long-term GV (variations of HbA1c). For the assessment of short-term within-day GV, the coefficient of variation for glucose (%CV) defined as the standard deviation adjusted on the 24-h mean glucose concentration is easy to perform and with a threshold of 36%, recently adopted by the international consensus on use of continuous glucose monitoring, separating stable from labile glycaemic states. More complex metrics such as the Low Blood Glucose Index (LBGI) or High Blood Glucose Index (HBGI) allow the risk of hypo or hyperglycaemic episodes, respectively to be assessed although in clinical practice its application is limited due to the need for more complex computation. This also applies to other indices of short-term intraday GV including the mean amplitude of glycemic excursions (MAGE), Shlichtkrull's M-value and CONGA. GV is important clinically as exaggerated glucose fluctuations are associated with an enhanced risk of adverse cardiovascular outcomes due primarily to hypoglycaemia. In contrast, there is at present no compelling evidence that elevated short-term GV is an independent risk factor of microvascular complications of diabetes. Concerning long-term GV there are numerous studies supporting its association with an enhanced risk of cardiovascular events. However, this association raises the question as to whether the impact of long-term variability is not simply the consequence of repeated exposure to short-term GV or ambient chronic hyperglycaemia. The renewed emphasis on glucose monitoring with the introduction of continuous glucose monitoring technologies can benefit from the introduction and application of simple metrics for describing GV along with supporting recommendations.

Homeostatic Model Assessment for Insulin Resistance (HOMA-IR): A Better Marker for Evaluating Insulin Resistance Than Fasting Insulin in Women with Polycystic Ovarian Syndrome.

OBJECTIVE: To assess the utility of HOMA-IR in assessing insulin resistance in patients with polycystic ovary syndrome (PCOS) and compare it with fasting insulin for assessing insulin resistance (IR). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2009 to September 2012. METHODOLOGY: Medical chart review of all women diagnosed with PCOS was performed. Of the 400 PCOS women reviewed, 91 met the inclusion criteria. Insulin resistance was assessed by calculating HOMA-IR using the formula (fasting glucose x fasting insulin)/405, taking normal value <2 in adults and hyperinsulinemia based on fasting insulin levels ≥12 µIU/ml. RESULTS: A total of 91 premenopausal women diagnosed with PCOS were included. Mean age was 30 ±5.5 years. Mean HOMA-IR of women was 3.1 ±1.7, respectively with IR in 69% (n=63) women, while hyperinsulinemia was present in 60% (n=55) women (fasting Insulin 18.5 ±5.8 µIU/ml). Hyperandrogenism was present in 53.8% (n=49), whereas 38.5% (n=35) women had primary infertility or subfertility, while 65.9% (n=60) had menstrual irregularities; and higher frequencies were observed in women with IR. Eight subjects with IR and endocrine abnormalities were missed by fasting insulin. CONCLUSION: Insulin resistance is common in PCOS and it is likely a pathogenic factor for development of PCOS. HOMAIR model performed better than hyperinsulinemia alone for diagnosing IR.

Development of dietary soluble fibres by enzymatic synthesis and assessment of their digestibility in in vitro, animal and randomised clinical trial models.

The aim was to develop novel fibres by enzymatic synthesis, to determine their total dietary fibre by AOAC method 2009.01 and to estimate their potential digestibility and assess their digestibility in vivo using glycaemic and insulinaemic responses as markers in mice and randomised clinical trial models. We found that fibre candidates to which α-(1,2) branching was added were resistant to digestion in the mouse model, depending on the amount of branching. These results show that in vivo models are needed to reliably assess the digestibility of α-glycosidic-linked oligomeric dietary fibre candidates, possibly due to absence of brush border α-glucosidase activity in the current in vitro assessment. α-(1,3)-linked and α-(1,6)-linked glucose oligomers were completely digested in humans and mice. In conclusion, it is possible to develop dietary soluble fibres by enzymatic synthesis. Adding α-(1,2) branching increases their resistance to digestion in vivo and can thus improve their suitability as potential fibre candidates. Clinical Trial Registry: ClinicalTrials.gov, NCT02701270.

A comparison of cardiometabolic risk factors in households in rural Uganda with and without a resident with type 2 diabetes, 2012-2013.

INTRODUCTION: Few studies have examined the health consequences of living in a household with a person who has been diagnosed with type 2 diabetes (T2D). We assessed the association of sharing a household with a person with diagnosed T2D and risk factors for cardio-metabolic diseases in Uganda, a low-income country. METHODS: Ninety households with 437 residents in southwestern Uganda were studied from December 2012 through March 2013. Forty-five of the households had a member with diagnosed T2D (hereafter "diabetic household"), and 45 households had no member with diagnosed T2D (hereafter "nondiabetic household"). We compared glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), hypertension, anthropometry, aerobic capacity, physical activity, nutrition, smoking, and diabetes-related knowledge of people without diagnosed T2D living in diabetic and nondiabetic households. RESULTS: People living in diabetic households had a significantly higher level of diabetes-related knowledge, lower levels of FPG (5.6 mmol/L vs 6.0 mmol/L), and fewer smoked (1.3% vs 12.9%) than residents of nondiabetic households. HbA1c was significantly lower in people aged 30 years or younger (5.2% vs 5.4%) and in males (5.2% vs 5.4%) living in diabetic households compared to residents of nondiabetic households. No differences were found between the 2 types of households in overweight and obesity, upper-arm fat area, intake of staple foods or cooking oil, or physical activity. CONCLUSIONS: Sharing a household with a person with T2D may have unexpected benefits on the risk factor profile for cardio-metabolic diseases, probably because of improved health behaviors and a closer connection with the health care system. Thus, future studies should consider the household for interventions targeting primary and secondary prevention of T2D.

A Bayesian network for modelling blood glucose concentration and exercise in type 1 diabetes.

This article presents a new statistical approach to analysing the effects of everyday physical activity on blood glucose concentration in people with type 1 diabetes. A physiologically based model of blood glucose dynamics is developed to cope with frequently sampled data on food, insulin and habitual physical activity; the model is then converted to a Bayesian network to account for measurement error and variability in the physiological processes. A simulation study is conducted to determine the feasibility of using Markov chain Monte Carlo methods for simultaneous estimation of all model parameters and prediction of blood glucose concentration. Although there are problems with parameter identification in a minority of cases, most parameters can be estimated without bias. Predictive performance is unaffected by parameter misspecification and is insensitive to misleading prior distributions. This article highlights important practical and theoretical issues not previously addressed in the quest for an artificial pancreas as treatment for type 1 diabetes. The proposed methods represent a new paradigm for analysis of deterministic mathematical models of blood glucose concentration.

Longitudinal assessment of neuroanatomical and cognitive differences in young children with type 1 diabetes: association with hyperglycemia.

Significant regional differences in gray and white matter volume and subtle cognitive differences between young diabetic and nondiabetic children have been observed. Here, we assessed whether these differences change over time and the relation with dysglycemia. Children ages 4 to <10 years with (n = 144) and without (n = 72) type 1 diabetes (T1D) had high-resolution structural MRI and comprehensive neurocognitive tests at baseline and 18 months and continuous glucose monitoring and HbA1c performed quarterly for 18 months. There were no differences in cognitive and executive function scores between groups at 18 months. However, children with diabetes had slower total gray and white matter growth than control subjects. Gray matter regions (left precuneus, right temporal, frontal, and parietal lobes and right medial-frontal cortex) showed lesser growth in diabetes, as did white matter areas (splenium of the corpus callosum, bilateral superior-parietal lobe, bilateral anterior forceps, and inferior-frontal fasciculus). These changes were associated with higher cumulative hyperglycemia and glucose variability but not with hypoglycemia. Young children with T1D have significant differences in total and regional gray and white matter growth in brain regions involved in complex sensorimotor processing and cognition compared with age-matched control subjects over 18 months, suggesting that chronic hyperglycemia may be detrimental to the developing brain.

Associations between physical activity and cardiometabolic risk factors assessed in a Southern California health care system, 2010-2012.

INTRODUCTION: Risk factors associated with many chronic diseases can be improved through regular physical activity. This study investigated whether cross-sectional associations between physical activity, assessed by the Exercise Vital Sign (EVS), and cardiometabolic risk factors can be detected in clinical settings. METHODS: We used electronic records from Kaiser Permanente Southern California members (N = 622,897) to examine the association of EVS category with blood pressure, fasting glucose, random glucose, and glycosylated hemoglobin. Adults aged 18 years or older with at least 3 EVS measures between April 2010 and December 2012, without comorbid conditions, and not taking antihypertension or glucose-lowering medications were included. We compared consistently inactive (EVS = 0 min/wk for every measure) with consistently active (EVS ≥150 min/wk) and irregularly active (EVS 1-149 min/wk or not meeting the consistently active or inactive criteria) patients. Separate linear regression analyses were conducted controlling for age, sex, race/ethnicity, body mass index, and smoking status. RESULTS: Consistently active women had lower systolic (-4.60 mm Hg; 95% confidence interval [CI], -4.70 to -4.44) and diastolic (-3.28 mm Hg; 95% CI, -3.40 to -3.17) blood pressure than inactive women. Active men had lower diastolic blood pressure than inactive men. Consistently active patients (women, -5.27 mg/dL [95% CI, -5.56 to -4.97]; men, -1.45 mg/dL [95% CI, -1.75 to -1.16] and irregularly active patients (women, -4.57 mg/dL [95% CI, -4.80 to -4.34]; men, -0.42 mg/dL [95% CI, -0.66 to -0.19]) had lower fasting glucose than consistently inactive patients. Consistently active and irregularly active men and women also had favorable random glucose and HbA1c compared with consistently inactive patients. CONCLUSION: Routine clinical physical activity assessment may give health care providers additional information about their patients' cardiometabolic risk factors.

Does homeostasis model assessment of insulin resistance have a predictive value for post-coronary artery bypass grafting surgery outcomes?

OBJECTIVE: This study aims to investigate whether pre-operative Homeostasis Model Assessment Insulin Resistance (HOMA-IR) value is a predictor in non-diabetic coronary artery bypass grafting patients in combination with hemoglobin A1c, fasting blood glucose and insulin levels. METHODS: Eighty one patients who were admitted to Cardiovascular Surgery Clinic at our hospital between August 2012 and January 2013 with a coronary artery bypass grafting indication were included. Patients were non-diabetic with <6.3% hemoglobin A1c and were divided into two groups including treatment and control groups according to normal insulin resistance (HOMA-IR<2.5, Group A; n=41) and high insulin resistance (HOMA-IR>2.5, Group B; n=40), respectively. Pre-operative fasting blood glucose and insulin were measured and serum chemistry tests were performed. The Homeostasis Model Assessment Insulin Resistance values were calculated. Statistical analysis was performed. RESULTS: There was a statistically significant difference in fasting blood glucose and HOMA-IR values between the groups. Cross-clamping time, and cardiopulmonary bypass time were longer in Group B, compared to Group A (P=0.043 and P=0.031, respectively). Logistic regression analysis revealed that hemoglobin A1c was not a reliable determinant factor alone for pre-operative glucometabolic evaluation of non-diabetic patients. The risk factors of fasting blood glucose and cardiopulmonary bypass time were more associated with high Homeostasis Model Assessment Insulin Resistance levels. CONCLUSION: Our study results suggest that preoperative screening of non-diabetic patients with Homeostasis Model Assessment Insulin Resistance may improve both follow-up visit schedule and short-term outcomes, and may be useful in risk stratification of the high-risk population for impending health problems.

Bariatric surgery and microvascular complications of type 2 diabetes mellitus.

Metabolic dysregulation is the defining characteristic of type 2 diabetes mellitus (T2DM) and can give rise to microvascular complications, specifically retinopathy, nephropathy and neuropathy. Pharmacological targeting of risk factors for microvascular complications can yield therapeutic gains, particularly in relation to retinopathy and nephropathy. Bariatric surgery is superior to intensified pharmacotherapy in relation to glycaemic control and can remediate dyslipidaemia and hypertension. Consequently, evidence of the effect of bariatric surgery on microvascular complications is now emerging in the literature. Examination of the recent published evidence base (covering the period 2011-2014) on the effects of bariatric surgery on microvascular complications reveals further evidence supportive of the efficacy of bariatric surgery in preventing the incidence and progression of albuminuria and arresting renal functional decline. Data on retinopathy are more ambivalent potentially representing the potential in some cases for a degree of surgery associated reactive hypoglycaemia to detract from the benefits of amelioration of hyperglycaemia. A significant gap in the literature remains in relation to the effects of surgery on diabetic neuropathy. Overall, there is a pressing need for prospective randomised controlled trials examining long-term microvascular outcomes following bariatric surgery in patients with T2DM.

Does Homeostasis Model Assessment of Insulin Resistance have a predictive value for post-coronary artery bypass grafting surgery outcomes? / O Modelo de Avaliação da Homeostase da Resistência à Insulina tem valor preditivo para os resultados após a cirurgia de revascularização miocárdica?

Objective: This study aims to investigate whether pre-operative Homeostasis Model Assessment Insulin Resistance (HOMA-IR) value is a predictor in non-diabetic coronary artery bypass grafting patients in combination with hemoglobin A1c, fasting blood glucose and insulin levels. Methods: Eighty one patients who were admitted to Cardiovascular Surgery Clinic at our hospital between August 2012 and January 2013 with a coronary artery bypass grafting indication were included. Patients were non-diabetic with <6.3% hemoglobin A1c and were divided into two groups including treatment and control groups according to normal insulin resistance (HOMA-IR<2.5, Group A; n=41) and high insulin resistance (HOMA-IR>2.5, Group B; n=40), respectively. Pre-operative fasting blood glucose and insulin were measured and serum chemistry tests were performed. The Homeostasis Model Assessment Insulin Resistance values were calculated. Statistical analysis was performed. Results: There was a statistically significant difference in fasting blood glucose and HOMA-IR values between the groups. Cross-clamping time, and cardiopulmonary bypass time were longer in Group B, compared to Group A (P=0.043 and P=0.031, respectively). Logistic regression analysis revealed that hemoglobin A1c was not a reliable determinant factor alone for pre-operative glucometabolic evaluation of non-diabetic patients. The risk factors of fasting blood glucose and cardiopulmonary bypass time were more associated with high Homeostasis Model Assessment Insulin Resistance levels. Conclusion: Our study results suggest that preoperative screening of non-diabetic patients with Homeostasis Model Assessment Insulin Resistance may improve both follow-up visit schedule and short-term outcomes, and may be useful in risk stratification of the high-risk population for impending health problems. .

Objetivo: Este estudo tem como objetivo investigar se a resistência de valor do Modelo de Avaliação da Homeostase da Resistência à Insulina (Homeostasis Model Assessment Insulin Resistance - HOMA-IR) no pré-operatório é um preditor de revascularização do miocárdio para pacientes não diabéticos em combinação com a hemoglobina A1c, glicemia em jejum e insulina. Métodos: Oitenta e um pacientes que foram internados no serviço de Cirurgia Cardiovascular em nosso hospital entre agosto de 2012 e janeiro de 2013, com indicação para cirurgia de revascularização do miocárdio indicação foram incluídos. Os pacientes não diabéticos com <6,3% de hemoglobina A1c foram divididos em dois grupos, incluindo os grupos de tratamento e controle de acordo com a resistência à insulina normal (HOMA-IR <2,5, Grupo A, n=41) e alta resistência à insulina (HOMA-IR> 2,5, Grupo B, n=40), respectivamente. Glicemia de jejum pré-operatório e insulina foram medidas e testes de química do soro foram realizados. Os valores de HOMA-IR foram calculados. A análise estatística foi realizada. Resultados: Houve diferença estatisticamente significativa em jejum de valores de glicose no sangue e HOMA-IR entre os grupos. Tempo de pinçamento e tempo de circulação extracorpórea foi maior no grupo B, em relação ao Grupo A (P=0,043 e P=0,031, respectivamente). A análise de regressão logística revelou que hemoglobina A1c não foi um fator determinante para a avaliação confiável sozinho glicometabólico pré-operatória de pacientes não diabéticos. Os fatores de risco de glicemia de jejum e tempo de circulação extracorpórea foram associados com altos níveis do HOMA-IR. Conclusão: ...

Impact of a 12-week, pharmacist-directed walking program in an established employee preventive care clinic.

PURPOSE: The impact on physical activity and health of a 12-week, pharmacist-directed walking program incorporated into an employee health and wellness clinic was evaluated. METHODS: Clinic participants were eligible for study inclusion if they or their spouse was a current or retired employee of Ohio Northern University. Participants received a pedometer, a calendar with specific daily walking goals for the 12-week period, and maps with walking routes. Participants also met with a pharmacist and a student pharmacist for point-of-care tests measuring lipid and fasting glucose concentrations and blood pressure. Participants reported to weekly pedometer checks where steps were recorded and medications were reassessed by the pharmacist or student pharmacist. As an incentive to meet the walking goals, the participants received a raffle ticket each week their goal had been achieved. After 12 weeks, participants reported for a final appointment when all baseline variables were reassessed by a team of health care professionals. RESULTS: A total of 144 participants were screened at baseline and included in the study, 65 of whom completed the program. At baseline, there were 240 abnormal laboratory test values found in participants with no prior history of dyslipidemia, hyperglycemia, or hypertension. After 12 weeks, significant changes in high-density-lipoprotein (HDL) cholesterol concentrations (p = 0.0012), fasting blood glucose concentrations (p = 0.0017), and blood pressure (p = 0.021) were noted. CONCLUSION: A pharmacist-directed walking program that included clinical assessments, walking goals, and weekly pedometer checks was an effective approach to increase employee activity levels, identify previously unknown health conditions, lower blood glucose concentrations and blood pressure values, and increase HDL cholesterol concentrations.

Financial incentives for home-based health monitoring: a randomized controlled trial.

BACKGROUND: Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases, but daily engagement rates among these patients may be low. OBJECTIVE: To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes. DESIGN: Randomized, controlled trial. (Clinicaltrials.gov Identifier: NCT01282957). PARTICIPANTS: Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5% recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System. INTERVENTIONS: Twelve weeks of daily home-monitoring of blood glucose, blood pressure, and weight (control group; n = 28); a lottery incentive with expected daily value of $2.80 (n = 26) for daily monitoring; and a lottery incentive with expected daily value of $1.40 (n = 21) for daily monitoring. MAIN MEASURES: Daily use of three home-monitoring devices during the three-month intervention (primary outcome) and during the three-month follow-up period and change in A1c over the intervention period (secondary outcomes). KEY RESULTS: Incentive arm participants used devices on a higher proportion of days relative to control (81% low incentive vs. 58%, P = 0.007; 77% high incentive vs. 58%, P = 0.02) during the three-month intervention period. There was no difference in adherence between the two incentive arms (P = 0.58). When incentives were removed, adherence in the high incentive arm declined while remaining relatively high in the low incentive arm. In month 6, the low incentive arm had an adherence rate of 62% compared to 35% in the high incentive arm (P = 0.015) and 27% in the control group (P = 0.002). CONCLUSIONS: A daily lottery incentive worth $1.40 per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive.

Hunger games: fluctuations in blood glucose levels influence support for social welfare.

Social-welfare policies are a modern instantiation of a phenomenon that has pervaded human evolutionary history: resource sharing. Ancestrally, food was a key shared resource in situations of temporary hunger. If evolved human psychology continues to shape how individuals think about current, evolutionarily novel conditions, this invites the prediction that attitudes regarding welfare politics are influenced by short-term fluctuations in hunger. Using blood glucose levels as a physiological indicator of hunger, we tested this prediction in a study in which participants were randomly assigned to conditions in which they consumed soft drinks containing either carbohydrates or an artificial sweetener. Analyses showed that participants with experimentally induced low blood glucose levels expressed stronger support for social welfare. Using an incentivized measure of actual sharing behavior (the dictator game), we further demonstrated that this increased support for social welfare does not translate into genuinely increased sharing motivations. Rather, we suggest that it is "cheap talk" aimed at increasing the sharing efforts of other individuals.

Genetic ablation of myelin protein zero-like 3 in mice increases energy expenditure, improves glycemic control, and reduces hepatic lipid synthesis.

Obesity continues to be a global health problem, and thus it is imperative that new pathways regulating energy balance be identified. Recently, it was reported: (Hayashi K, Cao T, Passmore H, Jourdan-Le Saux C, Fogelgren B, Khan S, Hornstra I, Kim Y, Hayashi M, Csiszar K. J Invest Dermatol 123: 864-871, 2004) that mice carrying a missense mutation in myelin protein zero-like 3 (Mpzl3rc) have reduced body weight. To determine how Mpzl3 controls energy balance in vivo, we generated mice deficient in myelin protein zero-like 3 (Mpzl3-KO). Interestingly, KO mice were hyperphagic yet had reduced body weight and fat mass. Moreover, KO mice were highly resistant to body weight and fat mass gain after exposure to a high-fat, energy-dense diet. These effects on body weight and adiposity were driven, in part, by a pronounced increase in whole body energy expenditure levels in KO mice. KO mice also had reduced blood glucose levels during an intraperitoneal glucose challenge and significant reductions in circulating insulin levels suggesting an increase in insulin sensitivity. In addition, there was an overall increase in oxidative capacity and contractile force in skeletal muscle isolated from KO mice. Hepatic triglyceride levels were reduced by 92% in livers of KO mice, in part due to a reduction in de novo lipid synthesis. Interestingly, Mpzl3 mRNA expression in liver was increased in diet-induced obese mice. Moreover, KO mice exhibited an increase in insulin-stimulated Akt signaling in the liver, further demonstrating that Mpzl3 can regulate insulin sensitivity in this tissue. We have determined that Mpzl3 has a novel physiological role in controlling body weight regulation, energy expenditure, glycemic control, and hepatic triglyceride synthesis in mice.

Sun-dried raisins are a cost-effective alternative to Sports Jelly Beans in prolonged cycling.

The purpose of this study was to examine the effects of a natural carbohydrate (CHO) source in the form of sun-dried raisins (SDRs) vs. Sports Jelly Beans™ (SJBs) on endurance performance in trained cyclists and triathletes. Ten healthy men (18-33 years) completed 1 water-only acclimatization exercise trial and 2 randomized exercise trials administered in a crossover fashion. Each trial consisted of a 120-minute constant-intensity glycogen depletion period followed by a 10-km time trial (TT). During each experimental trial, participants consumed isocaloric amounts of SDRs or SJBs in 20-minute intervals. Measurements included time to complete 10-km TT, power output during 10-km TT, blood glucose levels and respiratory exchange ratio during glycogen depletion period, rate of perceived exertion (RPE), 'flow' questionnaire responses, and a hedonic (i.e., pleasantness) sensory acceptance test. There were no significant differences in endurance performance for TT time (SDRs vs. SJBs, 17.3 ± 0.4 vs. 17.3 ± 0.4 seconds) or power (229.3 ± 13.0 vs. 232.0 ± 13.6 W), resting blood glucose levels (5.8 ± 04 mmol·L(-1) for SDRs and 5.4 ± 0.2 mmol·L(-1) for SJBs), RPE, or flow experiences between SDR and SJB trials. However, the mean sensory acceptance scores were significantly higher for the SDRs compared to the SJBs (50.7 ± 1.7 vs. 44.3 ± 2.7). Consuming SDRs or SJBs during 120 minutes of intense cycling results in similar subsequent TT performances and are equally effective in maintaining blood glucose levels during exercise. Therefore, SDRs are a natural, pleasant, cost-effective CHO alternative to commercial SJBs that can be used during moderate- to high-intensity endurance exercise.