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1.
Diabetes Care ; 47(2): 267-271, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38085705

RESUMEN

OBJECTIVE: Patients with diabetes and end-stage kidney disease (ESKD) may experience "burnt-out diabetes," defined as having an HbA1c value <6.5% without antidiabetic therapy for >6 months. We aim to assess glycemic control by continuous glucose monitoring (Dexcom G6 CGM) metrics and glycemic markers in ESKD patients on hemodialysis with burnt-out diabetes. RESEARCH DESIGN AND METHODS: In this pilot prospective study, glycemic control was assessed by continuous glucose monitoring (CGM), HbA1c measures, and glycated albumin and fructosamine measurements in patients with burnt-out diabetes (n = 20) and without a history of diabetes (n = 20). RESULTS: Patients with burnt-out diabetes had higher CGM-measured daily glucose levels, lower percent time in the range 70-180 mg/dL, higher percent time above range (>250 mg/dL), and longer duration of hyperglycemia >180 mg/dL (hours/day) compared with patients without diabetes (all P < 0.01). HbA1c and fructosamine levels were similar; however, patients with burnt-out diabetes had higher levels of glycated albumin than did patients without diabetes. CONCLUSIONS: The use of CGM demonstrated that patients with burnt-out diabetes have significant undiagnosed hyperglycemia. CGM and glycated albumin provide better assessment of glycemic control than do values of HbA1c and fructosamine in patients with ESKD.


Asunto(s)
Diabetes Mellitus , Hiperglucemia , Fallo Renal Crónico , Humanos , Hemoglobina Glucada , Glucemia , Fructosamina , Automonitorización de la Glucosa Sanguínea , Monitoreo Continuo de Glucosa , Estudios Prospectivos , Control Glucémico , Albúmina Sérica Glicada , Productos Finales de Glicación Avanzada , Diabetes Mellitus/diagnóstico , Albúmina Sérica/análisis , Hiperglucemia/diagnóstico , Fallo Renal Crónico/terapia
2.
Nat Commun ; 14(1): 4201, 2023 07 14.
Artículo en Inglés | MEDLINE | ID: mdl-37452024

RESUMEN

While immunologic correlates of COVID-19 have been widely reported, their associations with post-acute sequelae of COVID-19 (PASC) remain less clear. Due to the wide array of PASC presentations, understanding if specific disease features associate with discrete immune processes and therapeutic opportunities is important. Here we profile patients in the recovery phase of COVID-19 via proteomics screening and machine learning to find signatures of ongoing antiviral B cell development, immune-mediated fibrosis, and markers of cell death in PASC patients but not in controls with uncomplicated recovery. Plasma and immune cell profiling further allow the stratification of PASC into inflammatory and non-inflammatory types. Inflammatory PASC, identifiable through a refined set of 12 blood markers, displays evidence of ongoing neutrophil activity, B cell memory alterations, and building autoreactivity more than a year post COVID-19. Our work thus helps refine PASC categorization to aid in both therapeutic targeting and epidemiological investigation of PASC.


Asunto(s)
COVID-19 , Neutrófilos , Humanos , Síndrome Post Agudo de COVID-19 , Inflamación , Antivirales , Progresión de la Enfermedad
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