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1.
Front Endocrinol (Lausanne) ; 11: 571037, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33071977

RESUMEN

Background: Diabetes has been found to increase severity and mortality under the current pandemic of coronavirus disease of 2019 (COVID-19). Up to date, the clinical characteristics of diabetes patients with COVID-19 and the risk factors for poor clinical outcomes are not clearly understood. Methods: The study was retrospectively carried out on enrolled diabetes patients with laboratory confirmed COVID-19 infection from a designated medical center for COVID-19 from January 25th, 2020 to February 14th, 2020 in Wuhan, China. The medical record was collected and reviewed. Univariate and multivariate analyses were performed to assess the risk factors associated with the severe events which were defined as a composite endpoint of admission to intensive care unit, the use of mechanical ventilation, or death. Results: A total of 52 diabetes patients with COVID-19 were finally included in the study. 21 (40.4%) patients had developed severe events in 27.50 (IQR 12.25-35.75) days follow-up, 15 (28.8%) patients experienced life-threatening complications and 8 patients died with a recorded mortality rate of 15.4%. Only 13 patients (41.9%) were in optimal glycemic control with HbA1c value of <7.0%. In addition to general clinical characteristics of COVID-19, the severe events diabetes patients showed higher counts of white blood cells and neutrophil, lower lymphocytes (40, 76.9%), high levels of hs-CRP, erythrocyte sedimentation rate (ESR) and procalcitonin (PCT) as compared to the non-severe diabetes patients. Mild higher level of cardiac troponin I (cTNI) (32.0 pg/ml; IQR 16.80-55.00) and D-dimer (1.70 µg/L, IQR 0.70-2.40) were found in diabetes patients with severe events as compared to the non-severe patients (cTNI:20.00 pg/ml, IQR5.38-30.00, p = 0.019; D-dimer: 0.70 µg/L, IQR 0.30-2.40, p = 0.037). After adjusting age and sex, increased level of cTNI was found to significantly associate with the incidence of severe events (HR: 1.007; 95% CI: 1.000-1.013; p = 0.048), Furthermore, using of α-glucosidase inhibitors was found to be the potential protectant for severe events (HR: 0.227; 95% CI: 0.057-0.904; p = 0.035). Conclusion: Diabetes patients with COVID-19 showed poor clinical outcomes. Vigorous monitoring of cTNI should be recommended for the diabetes patients with COVID-19. Usage of α-glucosidase inhibitors could be a potential protectant for the diabetes patients with COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Neumonía Viral/mortalidad , Índice de Severidad de la Enfermedad , Anciano , Glucemia/análisis , China/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
2.
Medicine (Baltimore) ; 99(43): e22215, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120730

RESUMEN

The Increasing prevalence of type 2 diabetes mellitus (T2DM) has been observed in younger adults. Insulin resistance [IR], decreased first-, second-phase insulin secretion, and glucose effectiveness (GE) (IR, first phase insulin secretion [FPIS], second phase insulin secretion [SPIS], and GE), denoted as diabetes factors (DF), are core for developing T2DM. A body of evidence has shown that inflammation contributes to the development of diabetes. In the present study, our goals were first, evaluate the relationships between white blood cell (WBC) count and, second, examine the relative tightness between the 4 DFs to WBC count. Thus, the pathophysiology of T2DM in Chinese young men could be more understood.21112 non-obese males between 18 to 27 years old were recruited (mean age: 24.3 ±â€Š0.017), including 1745 subjects with metabolic syndrome. DFs were calculated by the published equations by our groups as follows:The association between DFs and WBC count was analyzed using a simple correlation. The r-values of the simple correlation are regarded as the tightness of the relationships.Higher WBC, FPIS, SPIS, IR, age, BMI, blood pressure, FPG, TG, Cholesterol, low-density lipoprotein cholesterol and lower HDL-C and GE were observed in subjects with metabolic syndrome. A similar trend was seen across the quartiles of WBC levels. Among the 4 DFs, GE has the highest r-value (r = -0.093, P < .001), followed by IR (r = 0.067, P < .001), SPIS (r = 0.029, P < .001) and FPIS (r = 0.027, P < .001).Elevated WBC count is significantly associated with all the 4 DFs and the relative order of the tightness, from the highest to the lowest, are GE, IR, SPIS, and FPIS in Chinese young men.


Asunto(s)
Glucemia/análisis , Resistencia a la Insulina/fisiología , Secreción de Insulina/fisiología , Recuento de Leucocitos , Síndrome Metabólico/sangre , Adolescente , Adulto , Grupo de Ascendencia Continental Asiática , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , HDL-Colesterol , LDL-Colesterol , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Ayuno , Humanos , Masculino , Síndrome Metabólico/fisiopatología , Taiwán , Adulto Joven
3.
PLoS One ; 15(10): e0239720, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33017436

RESUMEN

BACKGROUND: Women with hyperglycaemia first detected in pregnancy (HFDP), including those with gestational diabetes mellitus (GDM), should undergo a glucose evaluation 4-12 weeks after delivery. Globally, suboptimal postpartum return rates limit the opportunity to intervene in women with sustained hyperglycaemia and pragmatic solutions should be sought to bridge this gap. OBJECTIVE: To assess the utility of postpartum in-hospital glucose evaluation to predict the outcome of the oral glucose tolerance test (OGTT) performed 4-12 weeks after delivery. METHODS: The study was performed prospectively at Tygerberg Hospital, Cape Town, South Africa. Women with HFDP, classified as GDM based on the modified National Institute for Health and Care Excellence criteria, who delivered between November 2018 and June 2019 were included in the study. Fasting plasma glucose (FPG) was performed 24-72 hours after delivery (t1) in the postnatal ward, provided glucose lowering medication was discontinued at delivery. An OGTT 4-12 weeks postpartum (t2) was scheduled for the total cohort. We compared glucose values and glucose categories at t1 and t2 and evaluated antenatal characteristics of women who returned, compared to the group that was lost to follow-up. RESULTS: In-hospital post-delivery glucose assessment (t1) was performed in 115 women. Glucose levels were significantly lower at t1 compared to antenatal diagnostic values (t0) and assessment at t2. Of the fourteen women with hyperglycaemia at t2, none had abnormal fasting glucose concentrations at t1. Women with HFDP who fulfilled criteria for overt diabetes at t0, all (24/115) had normal fasting glucose levels at t1 except for IFG in one (1/24). The antenatal characteristics of women with HFDP who returned at t2, were similar to the women who did not return. CONCLUSION: Based on this study, in-hospital fasting glucose 24-72 hours postpartum cannot replace the OGTT 4-12 weeks postpartum. Pragmatic solutions for low postpartum return rates in women with HFDP should be pursued.


Asunto(s)
Glucemia/análisis , Glucosa/metabolismo , Hiperglucemia/fisiopatología , Adulto , Estudios de Cohortes , Diabetes Mellitus Tipo 2/sangre , Diabetes Gestacional/sangre , Ayuno/sangre , Ayuno/fisiología , Femenino , Intolerancia a la Glucosa/sangre , Prueba de Tolerancia a la Glucosa , Humanos , Periodo Posparto/sangre , Embarazo , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Sudáfrica
4.
J Diabetes Sci Technol ; 14(6): 1065-1073, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33063556

RESUMEN

BACKGROUND: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). METHODS: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. RESULTS: CGM devices were placed on 11 patients: Medtronic (n = 6) and Dexcom G6 (n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of -17.76 mg/dL (Medtronic) and -1.94 mg/dL (Dexcom), with wide 95% limits of agreement. CONCLUSIONS: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.


Asunto(s)
Glucemia/análisis , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/terapia , Enfermedad Crítica/terapia , Monitoreo Fisiológico/instrumentación , Neumonía Viral/sangre , Neumonía Viral/terapia , Adulto , Anciano , Betacoronavirus/fisiología , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea/instrumentación , Automonitorización de la Glucosa Sanguínea/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Enfermedad Crítica/epidemiología , Enfermedad Crítica/mortalidad , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Diabetes Mellitus/terapia , Estudios de Factibilidad , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/mortalidad , Hiperglucemia/terapia , Insulina/administración & dosificación , Sistemas de Infusión de Insulina , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Pandemias , Proyectos Piloto , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Sistemas de Atención de Punto , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos
5.
Front Endocrinol (Lausanne) ; 11: 574541, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33123093

RESUMEN

Background: Diabetes mellitus is considered a common comorbidity of COVID-19, which has a wide spectrum of clinical manifestations ranging from asymptomatic infection to severe respiratory symptoms and even death. However, the impact of COVID-19 on blood glucose has not been fully understood. This meta-analysis aimed to summarize available data on the association between glycemic parameters and severity of COVID-19. Methods: PubMed, EMBASE, and Cochrane Library were searched from December 1, 2019 to May 15, 2020. Observational studies investigating blood glucose or glycated hemoglobin A1c (HbA1c) according to the severity of COVID-19 were considered for inclusion. Two independent researchers extracted data from eligible studies using a standardized data extraction sheet and then proceeded to cross check the results. Data were pooled using a fixed- or random-effects model to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Results: Three studies reported blood glucose and HbA1c according to the severity of COVID-19 and were included in this meta-analysis. The combined results showed that severe COVID-19 was associated with higher blood glucose (WMD 2.21, 95% CI: 1.30-3.13, P < 0.001). In addition, HbA1c was slightly higher in patients with severe COVID-19 than those with mild COVID-19, yet this difference did not reach significance (WMD 0.29, 95% CI: -0.59 to 1.16, P = 0.52). Conclusions: This meta-analysis provides evidence that severe COVID-19 is associated with increased blood glucose. This highlights the need to effectively monitor blood glucose to improve prognosis in patients infected with COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Glucemia/análisis , Infecciones por Coronavirus/complicaciones , Hemoglobina A Glucada/análisis , Hiperglucemia/epidemiología , Neumonía Viral/complicaciones , Humanos , Hiperglucemia/metabolismo , Hiperglucemia/virología , Pandemias
6.
Diabetologia ; 63(12): 2548-2558, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33029657

RESUMEN

AIMS/HYPOTHESIS: The aim of the study was to characterise the humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with diabetes. Demonstrating the ability to mount an appropriate antibody response in the presence of hyperglycaemia is relevant for the comprehension of mechanisms related to the observed worse clinical outcome of coronavirus disease 2019 (COVID-19) pneumonia in patients with diabetes and for the development of any future vaccination campaign to prevent SARS-CoV-2 infection. METHODS: Using a highly specific and sensitive measurement of antibodies by fluid-phase luciferase immunoprecipitation assays, we characterised the IgG, IgM and IgA response against multiple antigens of SARS-CoV-2 in a cohort of 509 patients with documented diagnosis of COVID-19, prospectively followed at our institution. We analysed clinical outcomes and antibody titres according to the presence of hyperglycaemia, i.e., either diagnosed or undiagnosed diabetes, at the time of, or during, hospitalisation. RESULTS: Among patients with confirmed COVID-19, 139 (27.3%) had diabetes: 90 (17.7%) had diabetes diagnosed prior to the hospital admission (comorbid diabetes) while 49 (9.6%) had diabetes diagnosed at the time of admission (newly diagnosed). Diabetes was associated with increased levels of inflammatory biomarkers and hypercoagulopathy, as well as leucocytosis and neutrophilia. Diabetes was independently associated with risk of death (HR 2.32 [95% CI 1.44, 3.75], p = 0.001), even after adjustment for age, sex and other relevant comorbidities. Moreover, a strong association between higher glucose levels and risk of death was documented irrespective of diabetes diagnosis (HR 1.14 × 1.1 mmol/l [95% CI 1.08, 1.21], p < 0.001). The humoral response against SARS-CoV-2 in patients with diabetes was present and superimposable, as for timing and antibody titres, to that of non-diabetic patients, with marginal differences, and was not influenced by glucose levels. Of the measured antibody responses, positivity for IgG against the SARS-CoV-2 spike receptor-binding domain (RBD) was predictive of survival rate, both in the presence or absence of diabetes. CONCLUSIONS/INTERPRETATION: The observed increased severity and mortality risk of COVID-19 pneumonia in patients with hyperglycaemia was not the result of an impaired humoral response against SARS-CoV-2. RBD IgG positivity was associated with a remarkable protective effect, allowing for a cautious optimism about the efficacy of future vaccines against SARs-COV-2 in people with diabetes. Graphical abstract.


Asunto(s)
Formación de Anticuerpos , Antígenos Virales/inmunología , Infecciones por Coronavirus/inmunología , Diabetes Mellitus/inmunología , Neumonía Viral/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/química , Anticuerpos Antivirales/inmunología , Anticuerpos Antivirales/aislamiento & purificación , Biomarcadores/análisis , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/inmunología , Glucemia/análisis , Estudios de Cohortes , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Inmunidad Humoral , Inmunoglobulina G/análisis , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Factores de Riesgo , Análisis de Supervivencia
7.
Aquat Toxicol ; 228: 105644, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33053460

RESUMEN

Nowadays, depletion of oxygen or hypoxia has become a real concerning problem worldwide in freshwater, marine, and estuarine ecosystems and very often co-occurs with xenobiotics. Even though the acute and severe hypoxia is heavily studied in environment and laboratory studies, the in situ combined effects of these stressors on freshwater lake organisms are poorly understood. The current study sought to understand how the combined effects of moderate hypoxia, pesticides and PCBs affect the biochemistry, physiology and organ morphology of Carassius carassius, residing in the Lake Seferani, Dumrea region (Elbasan, Albania), a natural karst freshwater system declared as Nature Monument situated in central Albania. Crucian carp is used as a model organism, because of its residency and ecological relevance to the Lake, as well as for its amenability for the environmental toxicology studies. For this purpose, blood, liver and kidney samples of fish were processed for hematological, biochemical and histopathological analysis. We found a significant increase of blood glucose (GLU), cortisol levels, hematocrit (PCV) and hemoglobin (Hb) which clearly indicate the presence of stress in fish. Based on the histopathological evaluation and organ index results, liver and kidney organs displayed moderate-to-heavy histological-architecture changes. Our results provide a strong evidence that both, hypoxia and the presence of pesticides and PCB congeners found in Seferani Lake, put a heavy load on C. carassius energy metabolism and endocrine system, leading to an elevation of the biochemical and physiological parameters (hemoglobin level, hematocrit, glucose and cortisol), as well as the histopathological alterations. Additionally, in the presence of moderate hypoxia, the toxic effects of pesticides and PCBs on C. carassius are exacerbated. Further studies are needed to evaluate possible effects of pesticide and PCBs toxicity in human health, since crucian carp has an economic value for the population of the zone and it is used often as food sustenance. Elucidation of these kinds of responses can better improve our understanding of response of highly tolerant species, like Carassius carassius, to multiple stressors interactions, helping us to better predict and manage the consequences of the exposure of the freshwater biota to complex stressors in an environment that changes rapidly.


Asunto(s)
Carpas/metabolismo , Ecosistema , Hipoxia/patología , Lagos , Plaguicidas/toxicidad , Bifenilos Policlorados/toxicidad , Albania , Animales , Glucemia/análisis , Geografía , Hematócrito , Hidrocortisona/sangre , Especificidad de Órganos/efectos de los fármacos , Contaminantes Químicos del Agua/toxicidad , Calidad del Agua
8.
Acta Diabetol ; 57(12): 1511-1517, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33026497

RESUMEN

AIMS: Billions of people have been under lockdown in an attempt to prevent COVID-19 spread. Lifestyle changes during lockdown could lead to deterioration of glycemic control in type 1 diabetes (T1D). We aimed to assess the impact of COVID-19 lockdown on the glycemic control of pediatric patients with T1D. METHODS: This observational real-life study from the AWeSoMe Group assessed continuous glucose monitoring (CGM) metrics of 102 T1D patients (52.9% males, mean age 11.2 ± 3.8 years, mean diabetes duration 4.2 ± 3.8 years) who used  Dexcom G5. The data were accessed without any interface between patients, caregivers, and the diabetes team. Study variables from CGM metrics were: mean glucose level, time-in-range (TIR, 70-180 mg/dL; 3.9-10 mmol/L), hypoglycemia (< 54 mg/dL; < 3 mmol/L), hyperglycemia (> 250 mg/dL; > 13.3 mmol/L), coefficient of variation (CV), and time CGM active before and during lockdown. Delta-variable = lockdown variable minus before-lockdown variable. RESULTS: The mean TIR was 60.9 ± 14.3% before lockdown, with no significant change during lockdown (delta-TIR was 0.9 ± 7.9%). TIR during lockdown was significantly correlated with TIR before lockdown (r = 0.855, P < 0.001). Patients with improved TIR (delta-TIR > 3%) were significantly older than patients with stable or worse TIR (P = 0.028). Children aged < 10 years had a significantly higher CV before lockdown and during lockdown than children aged ≥ 10 years (P = 0.02 and P = 0.005, respectively). Among children aged < 10 years, a multiple linear regression model revealed associations of age and lower socioeconomic cluster with delta-TIR (F = 4.416, P = 0.019) and with delta-mean glucose (F = 4.459, P = 0.018). CONCLUSIONS: CGM metrics in pediatric patients with T1D were relatively stable during a nationwide lockdown. Intervention plans should focus on younger patients with lower socioeconomic position.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/métodos , Glucemia/análisis , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus Tipo 1/metabolismo , Neumonía Viral/epidemiología , Adolescente , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea/instrumentación , Niño , Diabetes Mellitus Tipo 1/diagnóstico , Femenino , Humanos , Estudios Longitudinales , Masculino , Pandemias
9.
PLoS One ; 15(10): e0239317, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33027299

RESUMEN

The present study demonstrated a noninvasive preocular sensor system for the concurrent monitoring of diabetes and one of its prevalent complications, dry eye syndrome (DES), using tear fluids. Two distinct sensors, i.e., the glucose and DES sensors, were prepared and encased together in a single housing unit to produce the sensor system, and the tip was designed to be in contact with the eye surface noninvasively to collect and deliver tear fluid to the sensors. The glucose sensor was modified from a commercially available electrochemical sensor to allow for the measurement of glucose concentrations, even in a small amount of collected tear fluid. The DES sensor was equipped with a microchannel spaced with two parallel electrodes to determine the amount of collected tear fluid. In vivo experimental results revealed that with the collected tear fluid of about 0.6-1.0 µl, the sensor system estimated the blood glucose concentrations with acceptable accuracy compared with that of the glucometer in clinical use. The DES condition in animals was diagnosed with high sensitivity (91.7%) and specificity (83.3%).


Asunto(s)
Técnicas Biosensibles/métodos , Glucemia/análisis , Síndromes de Ojo Seco/diagnóstico , Lágrimas/química , Animales , Área Bajo la Curva , Técnicas Biosensibles/instrumentación , Electrodos , Masculino , Curva ROC , Conejos
10.
Cochrane Database Syst Rev ; 10: CD004730, 2020 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-33075159

RESUMEN

BACKGROUND: The Cystic Fibrosis Foundation recommends both short-term and long-acting insulin therapy when cystic fibrosis-related diabetes (CFRD) has been diagnosed. Diagnosis is based on: an elevated fasting blood glucose level greater than 6.94 mmol/L (125 mg/dL); or oral glucose tolerance tests greater than 11.11 mmol/L (200 mg/dL) at two hours; or symptomatic diabetes for random glucose levels greater than 11.11 mmol/L (200 mg/dL); or glycated hemoglobin levels of at least 6.5%. This is an update of a previously published review. OBJECTIVES: To establish the effectiveness of insulin and oral agents for managing diabetes in people with cystic fibrosis in relation to blood sugar levels, lung function and weight management. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also handsearched abstracts from pulmonary symposia and the North American Cystic Fibrosis Conferences. Date of most recent register search: 10 September 2020. We searched online trials registries; date of most recent searches: 21 March 2020. SELECTION CRITERIA: Randomized controlled trials comparing all methods of pharmacological diabetes therapy in people with diagnosed CFRD. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed the risk of bias in the included studies. Authors also used GRADE to assess the quality of the evidence. MAIN RESULTS: The searches identified 29 trials (45 references). Four included trials provide results: one short-term single-center cross-over trial (seven adults) comparing insulin with oral repaglinide and no medication in adults with CFRD and normal fasting glucose; one long-term multicenter trial (61 adults with CFRD) comparing insulin with oral repaglinide and placebo; one long-term multicenter trial (67 adults) comparing insulin with oral repaglinide; and one 12-week single-center cross-over trial (20 adults) comparing the long-acting insulin glargine to short-term neutral protamine Hagedorn insulin. Two ongoing trials of newly approved incretin mimics have been noted for possible future inclusion. Downgrading of the quality of the evidence was mainly due to risks of bias across all domains, but particularly due to concerns surrounding allocation concealment and selective reporting. There were also some concerns due to imprecision from small sample sizes and low event rates. Finally, there may be some bias due to the amounts of insulin and repaglinide given not being comparable. Data from one trial comparing insulin to placebo (39 participants) did not show any difference between groups for the primary outcomes of blood glucose levels (very low-quality evidence), lung function (low-quality evidence) or nutritional status (low-quality evidence). Similarly, no differences between groups were seen for the secondary outcomes of number of hypoglycemic episodes (low-quality evidence), secondary infection complications or quality of life (QoL). These results were mirrored in the narrative reports for the second trial in this comparison (seven participants). Data from the one-year trial comparing repaglinide to placebo (38 participants), showed no differences between groups for the primary outcomes of blood glucose levels (very low-quality evidence), lung function (low-quality evidence) and nutritional status (low-quality evidence). Also, no differences were seen between groups for the secondary outcomes of number of hypoglycemic episodes (low-quality evidence), secondary infection complications or QoL. These findings were mirrored in the narrative reports for the second trial (n = 7) in this comparison. Three trials compared insulin to repaglinide (119 participants). Data from one trial (n = 67) showed no difference in blood glucose levels at either 12 months (high-quality evidence) or 24 months; narrative reports from one trial (45 participants) reported no difference between groups, but the second trial (7 participants) reported a beneficial effect of insulin over repaglinide. Two trials (112 participants) found no difference between insulin and repaglinide in lung function or nutritional status (moderate-quality evidence). Two trials (56 participants) reported no difference in the number of hypoglycemic episodes (low-quality evidence). One trial (45 participants) reported no difference between groups in secondary infections and cystic fibrosis QoL. The single trial comparing glargine to neutral protamine Hagedorn insulin did not report directly on the review's primary outcomes, but did report no differences between groups in post-prandial glucose values and weight; neither group reported infectious complications. There was no difference in episodes of hypoglycemia (very low-quality evidence) and while there was no difference reported in QoL, all participants opted to continue treatment with glargine after the trial was completed. Mortality was not reported by any trial in any comparison, but death was not given as a reason for withdrawal in any trial. AUTHORS' CONCLUSIONS: This review has not found any conclusive evidence that any agent has a distinct advantage over another in controlling hyperglycemia or the clinical outcomes associated with CFRD. Given the treatment burden already experienced by people with cystic fibrosis, oral therapy may be a viable treatment option. While some cystic fibrosis centers use oral medications to help control diabetes, the Cystic Fibrosis Foundation (USA) clinical practice guidelines support the use of insulin therapy and this remains the most widely-used treatment method. Randomized controlled trials specifically related to controlling diabetes and its impact on the course of pulmonary disease process in cystic fibrosis continue to be a high priority. Specifically, investigators should evaluate adherence to different therapies and also whether there is benefit in using additional hypoglycemic agents as well as the newly approved incretin mimics. Agents that potentiate insulin action, especially agents with additional anti-inflammatory potential should also be further investigated as adjuvant therapy to insulin.


Asunto(s)
Fibrosis Quística/complicaciones , Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Administración Oral , Sesgo , Glucemia/análisis , Carbamatos/administración & dosificación , Fibrosis Quística/sangre , Diabetes Mellitus/sangre , Diabetes Mellitus/etiología , Ayuno/sangre , Humanos , Hiperglucemia/tratamiento farmacológico , Insulina Glargina/administración & dosificación , Insulina Isófana/administración & dosificación , Piperidinas/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
Nat Commun ; 11(1): 4933, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004787

RESUMEN

The influence of seasons on biological processes is poorly understood. In order to identify biological seasonal patterns based on diverse molecular data, rather than calendar dates, we performed a deep longitudinal multiomics profiling of 105 individuals over 4 years. Here, we report more than 1000 seasonal variations in omics analytes and clinical measures. The different molecules group into two major seasonal patterns which correlate with peaks in late spring and late fall/early winter in California. The two patterns are enriched for molecules involved in human biological processes such as inflammation, immunity, cardiovascular health, as well as neurological and psychiatric conditions. Lastly, we identify molecules and microbes that demonstrate different seasonal patterns in insulin sensitive and insulin resistant individuals. The results of our study have important implications in healthcare and highlight the value of considering seasonality when assessing population wide health risk and management.


Asunto(s)
Exposición a Riesgos Ambientales , Resistencia a la Insulina/fisiología , Redes y Vías Metabólicas/fisiología , Microbiota/fisiología , Estaciones del Año , Adulto , Anciano , Glucemia/análisis , Glucemia/metabolismo , California , Análisis por Conglomerados , Femenino , Estado de Salud , Humanos , Insulina/metabolismo , Estudios Longitudinales , Masculino , Metabolómica , Persona de Mediana Edad , RNA-Seq
12.
Nat Commun ; 11(1): 5162, 2020 10 14.
Artículo en Inglés | MEDLINE | ID: mdl-33056984

RESUMEN

Bioactive natural C-glycosides are rare and chemical C-glycosylation faces challenges while enzymatic C-glycosylation catalyzed by C-glycosyltransferases provides an alternative way. However, only a small number of C-glycosyltransferases have been found, and most of the discovered C-glycosyltransferases prefer to glycosylate phenols with an acyl side chain. Here, a promiscuous C-glycosyltransferase, AbCGT, which is capable of C-glycosylating scaffolds lacking acyl groups, is identified from Aloe barbadensis. Based on the substrate promiscuity of AbCGT, 16 C-glycosides with inhibitory activity against sodium-dependent glucose transporters 2 are chemo-enzymatically synthesized. The C-glycoside 46a shows hypoglycemic activity in diabetic mice and is biosynthesized with a cumulative yield on the 3.95 g L‒1 scale. In addition, the key residues involved in the catalytic selectivity of AbCGT are explored. These findings suggest that AbCGT is a powerful tool in the synthesis of lead compounds for drug discovery and an example for engineering the catalytic selectivity of C-glycosyltransferases.


Asunto(s)
Aloe/enzimología , Glicósidos/biosíntesis , Glicosiltransferasas/metabolismo , Proteínas de Plantas/metabolismo , Inhibidores del Cotransportador de Sodio-Glucosa 2/metabolismo , Aloxano/toxicidad , Aloe/genética , Animales , Biocatálisis , Glucemia/análisis , Glucemia/efectos de los fármacos , Clonación Molecular , Diabetes Mellitus Experimental/sangre , Diabetes Mellitus Experimental/inducido químicamente , Diabetes Mellitus Experimental/tratamiento farmacológico , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/inducido químicamente , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Descubrimiento de Drogas/métodos , Femenino , Glicósidos/farmacología , Glicósidos/uso terapéutico , Glicosilación , Glicosiltransferasas/genética , Glicosiltransferasas/aislamiento & purificación , Humanos , Masculino , Ratones , Proteínas de Plantas/genética , Proteínas de Plantas/aislamiento & purificación , Proteínas Recombinantes/genética , Proteínas Recombinantes/aislamiento & purificación , Proteínas Recombinantes/metabolismo , Transportador 2 de Sodio-Glucosa/metabolismo , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Especificidad por Sustrato
13.
Medicine (Baltimore) ; 99(40): e22249, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019400

RESUMEN

BACKGROUND: To comprehensively evaluate the treatment efficacy and safety of silymarin for patients with glucose/lipid metabolic dysfunction using a meta-analysis. METHODS: A systematic literature search in PubMed, EMBASE and Cochrane Library databases was performed up to October 1, 2019. STATA 13.0 software was used to estimate pooled standardized mean difference (SMD) and 95% confidence interval (95% CI). RESULTS: Sixteen studies involving 1358 patients were identified. Overall meta-analysis showed that compared with control, silymarin significantly reduced levels of fasting blood glucose (SMD: -1.27, 95% CI = [-1.78, -0.76]; P < .001), homeostatic model assessment for insulin resistance (SMD: -0.41, 95% CI = [-0.70, -0.12]; P = .005), hemoglobin A1c (SMD: -1.88, 95% CI = [-2.57, -1.20]; P < .001), total cholesterol (SMD: -1.13, 95% CI = [-1.82, -0.77]; P < .001), triglyceride (SMD: -0.37, 95% CI = [-0.69, -0.05]; P = .025), low-density lipoprotein-cholesterol (SMD: -1.30, 95% CI = [-1.93, -0.67]; P < .001), C-reactive protein (SMD: -0.63, 95% CI = [-1.01, -0.27]; P = .001), and increased high-density lipoprotein-cholesterol (SMD: 0.17, 95% CI = [0.05, 0.29]; P = .005), but had no impacts on function indicators of liver and kidney (alanine transaminase, aspartate aminotransferase, creatinine phosphokinase, creatinine) and the complication rate. Subgroup analyses indicated that insulin (which was negative in overall analysis) was significantly decreased in patients undergoing silymarin monotherapy (SMD: -2.03, 95% CI = [-3.03, -1.04]; P = .044) for more than 3 months (SMD: -0.01, 95% CI = [-0.25, -0.24]; P = .035). CONCLUSION: Supplementation of silymarin may be effective and safe for the management of diabetes mellitus and hyperlipidemia.


Asunto(s)
Antioxidantes/uso terapéutico , Enfermedades Metabólicas/tratamiento farmacológico , Silimarina/uso terapéutico , Antioxidantes/administración & dosificación , Antioxidantes/efectos adversos , Biomarcadores Farmacológicos , Glucemia/análisis , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Hemoglobina A Glucada , Humanos , Resistencia a la Insulina/fisiología , Pruebas de Función Renal , Lípidos/sangre , Pruebas de Función Hepática , Silimarina/administración & dosificación , Silimarina/efectos adversos
14.
Medicine (Baltimore) ; 99(40): e22337, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019410

RESUMEN

At present, glycated hemoglobin (HbA1c) and glycated albumin (GA) are used to evaluate glycemic control in diabetic patients, but they cannot reflect insulin deficiency and/or insulin resistance.We investigated the feasibility of using estimated average glucose to fasting plasma glucose ratio (eAG/fPG ratio) to estimate insulin resistance in young adult diabetes. A total of 387 patients with type 2 diabetes were included and were stratified into 2 groups based on median values of the glycemic index ratio: the GA/A1c ratio <2.09 (n = 91) and ≥2.09 (n = 296); the eAG/fPG ratio <1.69 (n = 155) and ≥1.69 (n = 232). HbA1c, GA, fructosamine, insulin, and C-peptide levels were measured. The ratio of GA to HbA1c was calculated, and the homeostasis model assessment of ß-cell function and insulin resistance were determined. The homeostasis model assessment of insulin resistance level was significantly associated with the eAG/fPG ratio, but not with the ratio of GA to HbA1c, GA, HbA1c, and fructosamine levels. The ratio of estimated average glucose to fasting plasma glucose level correlates with insulin resistance in young adult diabetes.


Asunto(s)
Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Ayuno/metabolismo , Resistencia a la Insulina/fisiología , Adolescente , Adulto , Péptido C/sangre , Niño , Femenino , Fructosamina/sangre , Hemoglobina A Glucada/análisis , Índice Glucémico , Humanos , Insulina/sangre , Masculino , Albúmina Sérica/análisis , Adulto Joven
15.
Arch Pathol Lab Med ; 144(10): 1204-1208, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33002153

RESUMEN

CONTEXT.­: Glycemic control requires accurate blood glucose testing. The extent of hematocrit interference is difficult to assess to assure quality patient care. OBJECTIVE.­: To predict the effect of patient hematocrit on the performance of a glucose meter and its corresponding impact on insulin-dosing error. DESIGN.­: Multilevel mixed regression was conducted to assess the extent that patient hematocrit influences Roche Accu-Chek Inform II glucose meters, using the Radiometer ABL 837 as a reference method collected during validation of 35 new meters. Regression coefficients of fixed effects for reference glucose, hematocrit, an interaction term, and random error were applied to 4 months of patient reference method results extracted from the laboratory information system. A hospital inpatient insulin dose algorithm was used to determine the frequency of insulin dose error between reference glucose and meter glucose results. RESULTS.­: Fixed effects regression for method and hematocrit predicted biases to glucose meter results that met the "95% within ±12%" for the US Food and Drug Administration goal, but combinations of fixed and random effects exceeded that target in emergency and hospital inpatient units. Insulin dose errors were predicted from the meter results. Twenty-eight percent of intensive care unit, 20.8% of hospital inpatient, and 17.7% of emergency department results were predicted to trigger a ±1 insulin dose error by fixed and random effects. CONCLUSIONS.­: The current extent of hematocrit interference on glucose meter performance is anticipated to cause insulin error by 1-dose category, which is likely associated with low patient risk.


Asunto(s)
Glucemia/análisis , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Errores Médicos , Algoritmos , Hematócrito , Humanos , Medición de Riesgo , Estados Unidos
16.
J Diabetes Sci Technol ; 14(6): 1035-1064, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32985262

RESUMEN

This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.


Asunto(s)
Glucemia/análisis , Equipos y Suministros , Hospitalización , Sistemas de Infusión de Insulina , Insulina/administración & dosificación , Monitoreo Fisiológico/instrumentación , Adulto , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea/instrumentación , Automonitorización de la Glucosa Sanguínea/métodos , Automonitorización de la Glucosa Sanguínea/normas , Niño , Consenso , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/terapia , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Cálculo de Dosificación de Drogas , Equipos y Suministros/normas , Femenino , Hospitales/normas , Humanos , Sistemas de Infusión de Insulina/normas , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/normas , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Embarazo
17.
PLoS One ; 15(9): e0238522, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32946478

RESUMEN

The effects of feeding frequency on postprandial response of circulating appetite-regulating hormones, insulin, glucose and amino acids, and on physical activity, energy expenditure, and respiratory quotient were studied in healthy adult cats. Two experiments were designed as a 2 x 3 replicated incomplete Latin square design. Eight cats, with an average body weight (BW) of 4.34 kg ± 0.04 and body condition score (BCS) of 5.4 ± 1.4 (9 point scale), were fed isocaloric amounts of a commercial adult maintenance canned cat food either once (0800 h) or four times daily (0800 h, 1130 h, 1500 h, 1830 h). Study 1 consisted of three 21-d periods. On day 14, two fasted and 11 postprandial blood samples were collected over 24 hours to measure plasma concentrations of ghrelin, GLP-1, GIP, leptin, PYY, insulin and amino acids, and whole blood glucose. Physical activity was monitored from day 15 to 21 of each period. In Study 2 indirect calorimetry was performed on the last day of each period. Body weight was measured weekly and feed intake recorded daily in both experiments. No effect of feeding regimen on BW was detected. Cats eating four times daily had lesser plasma concentrations of GIP and GLP-1 (P<0.05) and tended to have lesser plasma PYY concentrations (P<0.1). Plasma leptin and whole blood glucose concentrations did not differ between regimens (P>0.1). Cats fed once daily had a greater postprandial plasma amino acid response, and greater plasma ghrelin and insulin concentrations (P<0.05). Physical activity was greater in cats fed four times (P<0.05), though energy expenditure was similar between treatments at fasting and in postprandial phases. Finally, cats eating one meal had a lower fasting respiratory quotient (P<0.05). Overall, these data indicate that feeding once a day may be a beneficial feeding management strategy for indoor cats to promote satiation and lean body mass.


Asunto(s)
Aminoácidos/metabolismo , Regulación del Apetito , Gatos/fisiología , Conducta Alimentaria , Hormonas/metabolismo , Aminoácidos/sangre , Alimentación Animal/análisis , Animales , Apetito , Glucemia/análisis , Glucemia/metabolismo , Gatos/sangre , Metabolismo Energético , Femenino , Ghrelina/sangre , Ghrelina/metabolismo , Hormonas/sangre , Insulina/sangre , Insulina/metabolismo , Masculino , Fotoperiodo , Condicionamiento Físico Animal , Respiración
18.
Nat Med ; 26(9): 1380-1384, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32908282

RESUMEN

Despite the increasing adoption of insulin pumps and continuous glucose monitoring devices, most people with type 1 diabetes do not achieve their glycemic goals1. This could be related to a lack of expertise or inadequate time for clinicians to analyze complex sensor-augmented pump data. We tested whether frequent insulin dose adjustments guided by an automated artificial intelligence-based decision support system (AI-DSS) is as effective and safe as those guided by physicians in controlling glucose levels. ADVICE4U was a six-month, multicenter, multinational, parallel, randomized controlled, non-inferiority trial in 108 participants with type 1 diabetes, aged 10-21 years and using insulin pump therapy (ClinicalTrials.gov no. NCT03003806). Participants were randomized 1:1 to receive remote insulin dose adjustment every three weeks guided by either an AI-DSS, (AI-DSS arm, n = 54) or by physicians (physician arm, n = 54). The results for the primary efficacy measure-the percentage of time spent within the target glucose range (70-180 mg dl-1 (3.9-10.0 mmol l-1))-in the AI-DSS arm were statistically non-inferior to those in the physician arm (50.2 ± 11.1% versus 51.6 ± 11.3%, respectively, P < 1 × 10-7). The percentage of readings below 54 mg dl-1 (<3.0 mmol l-1) within the AI-DSS arm was statistically non-inferior to that in the physician arm (1.3 ± 1.4% versus 1.0 ± 0.9%, respectively, P < 0.0001). Three severe adverse events related to diabetes (two severe hypoglycemia, one diabetic ketoacidosis) were reported in the physician arm and none in the AI-DSS arm. In conclusion, use of an automated decision support tool for optimizing insulin pump settings was non-inferior to intensive insulin titration provided by physicians from specialized academic diabetes centers.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/instrumentación , Automonitorización de la Glucosa Sanguínea/métodos , Glucemia/análisis , Sistemas de Apoyo a Decisiones Clínicas/instrumentación , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Insulina/uso terapéutico , Adolescente , Inteligencia Artificial , Niño , Humanos , Insulina/administración & dosificación , Sistemas de Infusión de Insulina , Resultado del Tratamiento , Adulto Joven
19.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 36(3): 193-196, 2020 May.
Artículo en Chino | MEDLINE | ID: mdl-32981270

RESUMEN

Objective: To investigate the protective effect of spermine (Sp) on diabetic cardiomyopathy (DCM) and high glucose-induced cardiac fibroblasts (CFs), and to explore its mechanism.Methods: ①Animal experiments: 24 male Wistar rats were randomly divided into control group, type 1 diabetes group (TID) and spermine group (TID+Sp, each group n=8). TID rats were induced by streptozocin (STZ, 60 mg/kg), and TID+Sp rat were pretreated with spermine (Sp, 5 mg/(kg·d)) for 2 weeks before STZ injection. After 12 weeks of modeling, blood glucose, insulin levels, ejection fraction (EF) and shortening fraction (FS) were measured, and Masson staining and Sirius red staining were performed in the rat cardiac tissues. ②Cell experiments: primary CFs were extracted from newborn (1-3 d) Wistar rat hearts, and were randomly divided into control group, high-glucose group (HG) and HG+Sp group (n=6 per group). HG group was treated with 40 mmol/L glucose, and the HG+Sp group was pretreated with 5 µmol/L Sp for 30 min before HG treatment. The cell viability of CFs was detected by CCK8, the content of collagen in culture medium was analyzed by ELISA, and protein expressions of cell cycle related proteins (PCNA, CyclinD1 and P27) were detected by Western blot. Results: Compared with control group, the blood glucose and collagen content were increased, and the insulin level and heart function were decreased in the T1D group. Meanwhile, HG induced an increasing of the cell viability, the collagen content in the medium and the expressions of PCNA and CyclinD1, while the expression of P27 was down-regulated. Spermine could reduce the above changes, manifested as improving the cardiac function, regulating the expression of cyclin and reducing the level of myocardial fibrosis. Conclusion: Spermine can alleviate myocardial fibrosis in diabetic cardiomyopathy, which mechanism is related to the regulation of cell cycle.


Asunto(s)
Ciclo Celular , Complicaciones de la Diabetes , Cardiomiopatías Diabéticas , Fibrosis , Espermina , Animales , Glucemia/análisis , Glucemia/efectos de los fármacos , Ciclo Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Complicaciones de la Diabetes/inducido químicamente , Complicaciones de la Diabetes/tratamiento farmacológico , Cardiomiopatías Diabéticas/inducido químicamente , Cardiomiopatías Diabéticas/complicaciones , Cardiomiopatías Diabéticas/tratamiento farmacológico , Fibroblastos/efectos de los fármacos , Fibrosis/tratamiento farmacológico , Fibrosis/etiología , Glucosa/toxicidad , Corazón/efectos de los fármacos , Masculino , Distribución Aleatoria , Ratas , Ratas Wistar , Espermina/farmacología , Espermina/uso terapéutico
20.
PLoS One ; 15(9): e0239091, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32915897

RESUMEN

INTRODUCTION: To investigate the glycaemic response, macronutrient intake and insulin management in people with type 1 diabetes (T1D) compared to healthy individuals around a running competition. MATERIAL AND METHODS: This was a single-centre, prospective, controlled observational study performed in individuals with T1D and healthy people. 24 people (12 T1D) were included in this study (age: T1D 41±12 vs. healthy 38±6 years, females: 3 vs. 6, BMI: 25.53.0 vs. 22.9±2.8 kg/m2). Both groups received an intermittently scanned continuous glucose monitoring (isCGM; FreeStyle Libre 1, Abbott, USA) system to assess glycaemia 24 hours before, during and 24 hours after a running competition. During this period, participants recorded their food intake and insulin administration. Data were analysed via ANOVA and mixed model analyses with post-hoc testing (p≤0.05). RESULTS: For overall glycaemic ranges in comparison of groups, significant differences were found for time in range (T1D 63±21% vs. healthy 89±13%, p = 0.001), time above range (TAR) 1 (T1D 21±15% vs. healthy 0±0%, p<0.001) and TAR 2 (T1D 8 [0-16%] vs. healthy 0±0%, p<0.001). When glycaemic variability was assessed, people with T1D had a higher glycaemic variability compared to healthy individuals (p<0.0001). Basal insulin dose was significantly reduced when compared against the regular pre-study basal insulin dose (pre-study 22±6 vs. pre-competition day 11±9 (-50±41%), p = 0.02; competition day 15±5 (-32± 1%)). CONCLUSION: People with T1D have impaired glucose responses around a running competition compared to healthy individuals. However, basal insulin dose reductions were sufficient to prevent further dysglycaemia. CLINICAL TRIAL ID: drks.de; DRKS00019886.


Asunto(s)
Glucemia/fisiología , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Ingestión de Alimentos/fisiología , Insulina/administración & dosificación , Carrera/fisiología , Adolescente , Adulto , Anciano , Glucemia/análisis , Glucemia/efectos de los fármacos , Automonitorización de la Glucosa Sanguínea/estadística & datos numéricos , Estudios de Casos y Controles , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/fisiopatología , Relación Dosis-Respuesta a Droga , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
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