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1.
Medicine (Baltimore) ; 100(4): e24510, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530277

RESUMEN

ABSTRACT: The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear.To explore the risk factors predictive of 72-hours mortality in patients with extremely high RPG under heterogenos pathophysiological conditions.Retrospective, single-center, case-controlled cross-sectional study.University teaching hospital.Adults over age 18 were selected from the medical records of patients at the Saitama Medical Center, Japan, from 2004 to 2013.Extremely high RPG (≥500 mg/dl).Mortality at 72 hours following the RPG test, regardless of hospitalization or in an outpatient setting. Multivariate logistic regression analysis was performed with adjustment for age, sex, body mass index (BMI), and RPG level. The final prediction model was built using the logistic regression model with a higher C-statistic, specificity, and sensitivity.A total of 351 patients with RPG ≥500 mg/dl were identified within the 10-year period. The 72-hours mortality rate was 16/351 (4.6%). The C-statistics of the 72-hours mortality prediction model with serum albumin (ALB) and creatine kinase (CK) was 0.856. The probability of 72-hours mortality was calculated as follows: 1/[1 + exp (-5.142 + 0.901log (CK) -1.087 (ALB) + 0.293 (presence (1) or absence (0) of metastatic solid tumor)]. The sensitivity and specificity of this model was 75.5%.The independent risk factors associated with 72-hours mortality in patients with RPG ≥500 mg/dl are hypoalbuminemia, elevated CK, and presence of a metastatic solid tumour. Further research is needed to understand the mechanisms and possible interventions to prevent mortality associated with extremely high RPG.


Asunto(s)
Glucemia/análisis , Creatina Quinasa/sangre , Hiperglucemia/mortalidad , Hipoalbuminemia/sangre , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Comorbilidad , Estudios Transversales , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/etiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
2.
Lancet Diabetes Endocrinol ; 9(3): 174-188, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33515493

RESUMEN

Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.


Asunto(s)
/terapia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Manejo de la Enfermedad , Hospitalización/tendencias , Hiperglucemia/terapia , Glucemia/efectos de los fármacos , Glucemia/metabolismo , /epidemiología , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Humanos , Hiperglucemia/sangre , Hiperglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación
3.
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
4.
J Diabetes Res ; 2020: 3918723, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33062712

RESUMEN

People with diabetes have higher risks of various infections. Therefore, these diabetic patients might be at increased risk of COVID-19 and have a poorer prognosis. Up until now, little is known about critical role in the pathogenesis. This study aims to investigate the clinical characteristics of COVID-19 patients with diabetes and secondary hyperglycemia, as well as to explore the purported mechanisms. 80 confirmed COVID-19 subjects were classified into the euglycemia group, secondary hyperglycemia group, and diabetes group. Severity of COVID-19 was defined based on the diagnostic and treatment guideline for SARS-CoV-2 issued by Chinese National Health Committee. According to the severity of the disease, patients of the mild type and common type were registered as mild cases (patients with minimal symptoms and negative CT findings), while patients of the severe type and critical type were enrolled as severe cases (patients with positive CT findings and different extent of clinical manifestations). Patients in the diabetes group were older than those in the euglycemia group, and most of them were male. In the diabetes group, the proportion of severe cases was 57.14%, which was significantly higher than those in the other two groups, and 32% of the COVID-19 patients diagnosed as severe cases were with diabetes. The CD4+ cell counts in the diabetes group were lower than those in the other two groups, while the levels of LDH and hs-CRP were higher. Compared with the euglycemia group, the CD3+ cell counts and the CD4+/CD8+ ratio were decreased, whereas the levels of IL-6 were increased in the secondary hyperglycemia group and diabetes group, with the diversities in the diabetes group being especially more significant. The Spearman correlation analysis revealed that the presence of diabetes was positively correlated with age, hs-CRP, LDH, IL-6, CD8+ cells, and severity of COVID-19 and negatively correlated with CD3+ cell counts, CD4+ cell counts, and CD4+/CD8+ ratio. Compared with the other two groups, the diabetes group exhibited more diverse and multifocal features in CT imagings. Diabetes is a risk factor for influence of the progression and prognosis of COVID-19 due to ongoing inflammation and impaired immune response.


Asunto(s)
Betacoronavirus/patogenicidad , Glucemia/metabolismo , Infecciones por Coronavirus/virología , Diabetes Mellitus Tipo 2/inmunología , Hiperglucemia/inmunología , Neumonía Viral/virología , Adulto , Anciano , Betacoronavirus/inmunología , Biomarcadores/sangre , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/inmunología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Progresión de la Enfermedad , Femenino , Interacciones Huésped-Patógeno , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Estudios Retrospectivos , Factores de Riesgo
5.
Diabetes Res Clin Pract ; 168: 108381, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32853687

RESUMEN

AIMS: Coronavirus disease 2019 (COVID-19) has become a recognized worldwide pandemic. Researchers now know that mortality from COVID-19 can be reduced through early prevention measures. This retrospective, multi-centered study of 293 COVID-19 patients without diabetes explores the association between fasting blood glucose (FBG) levels and the risk of COVID-19 disease progression, with the goal of providing clinical evidence for glycemic targets in patients. METHODS: The multivariate stepwise binary logistic regression analysis was used to test the dose-response effects of FBG levels on the risk of severe and critical condition in COVID-19 patients. RESULTS: FBG levels were plotted in quintiles with set at <4.74, 4.74-5.21, 5.21-5.78, 5.78-7.05, and ≧7.05 mmol/L. The constituent ratio of severe or critical cases in each FBG quintile was 20.7%, 1.7%, 13.8%, 27.1%, and 67.2%, respectively (P < 0.0001). When the second quintile was used as the reference, the adjusted odds ratios (AORs) (95%CI) for the risk of severe/critical condition in COVID-19 was 25.33 (2.77, 231.64), 1.00 (Reference), 3.13 (0.33, 29.67), 10.59 (1.23, 91.24), 38.93 (4.36, 347.48) per FBG quintile respectively (P < 0.001). CONCLUSIONS: We provide evidence of J-shaped associations between FBG and risk of severe and critical condition in non-diabetes patients with COVID-19, with nadir at 4.74-5.78 mmol/L.


Asunto(s)
Glucemia/análisis , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/patología , Ayuno/sangre , Neumonía Viral/sangre , Neumonía Viral/patología , Adulto , Anciano , Betacoronavirus/fisiología , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Progresión de la Enfermedad , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/complicaciones , Hiperglucemia/diagnóstico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
6.
Pediatrics ; 146(3)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32778539

RESUMEN

BACKGROUND: The optimal approach to screening and diagnosis of prediabetes and diabetes in youth is uncertain. METHODS: We conducted a cross-sectional analysis of 14 119 youth aged 10 to 19 years in the 1999-2016 NHANES. First, we examined the performance of American Diabetes Association risk-based screening criteria. Second, we evaluated the performance of current clinical definitions of prediabetes and diabetes based on hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), either HbA1c or FPG, or both HbA1c and FPG (confirmatory definition) to identify youth at high cardiometabolic risk. RESULTS: Overall, 25.5% of US youth (10.6 million in 2016) were eligible for screening. Sensitivity and specificity of the screening criteria for detecting any hyperglycemia were low for both HbA1c ≥5.7% (sensitivity = 55.5%, specificity = 76.3%) and FPG ≥100 mg/dL (sensitivity = 35.8%, specificity = 77.1%). Confirmed undiagnosed diabetes (HbA1c ≥6.5% and FPG ≥126 mg/dL) was rare, <0.5% of youth. Most (>85%) cases of diabetes were diagnosed. Associations with cardiometabolic risk were consistently stronger and more specific for HbA1c-defined hyperglycemia (specificity = 98.6%; sensitivity = 4.0%) than FPG-defined hyperglycemia (specificity = 90.1%; sensitivity = 19.4%). CONCLUSIONS: One-quarter of US youth are eligible for screening for diabetes and prediabetes; however, few will test positive, especially for diabetes. Most cases of diabetes in US youth are diagnosed. Regardless of screening eligibility, we found that HbA1c is a specific and useful nonfasting test to identify high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular risk in adulthood.


Asunto(s)
Glucemia/análisis , Diabetes Mellitus/diagnóstico , Ayuno/sangre , Hemoglobina A Glucada/análisis , Estado Prediabético/diagnóstico , Adolescente , Niño , Estudios Transversales , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etnología , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/etnología , Tamizaje Masivo/estadística & datos numéricos , Síndrome Metabólico/diagnóstico , Encuestas Nutricionales , Obesidad Pediátrica/epidemiología , Guías de Práctica Clínica como Asunto , Estado Prediabético/sangre , Estado Prediabético/epidemiología , Estado Prediabético/etnología , Prevalencia , Sensibilidad y Especificidad , Estados Unidos/epidemiología , Adulto Joven
7.
Niger J Clin Pract ; 23(8): 1087-1094, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32788486

RESUMEN

Background: Maternal hyperglycemia first diagnosed in pregnancy, previously referred to as gestational diabetes mellitus is associated with health consequences for both the mother and her fetus/baby, not only in the short term but also in the long term. Early screening helps to identify women with overt diabetes or those with early onset GDM. Aims: The aim of this study was to determine the diagnostic performance of two screening tests (Random plasma glucose, Random capillary glucose) in relation to 75g Oral glucose tolerance test (OGTT) done before 24 weeks gestation. Methods: This prospective longitudinal cohort study was carried out between 1st February, 2017 and 31st July, 2017, at two teaching hospitals in Nigeria. Two hundred and eighty one (281) pregnant women who met the inclusion criteria were selected and screened with both random plasma glucose (RPG) and random capillary glucose (RCG) before 24 weeks of pregnancy. They were then made to undergo 75g OGTT a week later. The diagnostic performance of the screening tests were determined. Results: A total of 270 women had 75g OG. Conclusion: Random plasma glucose and Random capillary glucose performed poorly compared to 75g-OGTT in detecting hyperglycemia in early pregnancy.


Asunto(s)
Glucemia/análisis , Diabetes Gestacional/sangre , Diabetes Gestacional/diagnóstico , Prueba de Tolerancia a la Glucosa/métodos , Hiperglucemia/diagnóstico , Tamizaje Masivo/métodos , Adulto , Femenino , Humanos , Hiperglucemia/sangre , Estudios Longitudinales , Nigeria/epidemiología , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Mujeres Embarazadas , Prevalencia , Estudios Prospectivos , Reproducibilidad de los Resultados
8.
Nutr Metab Cardiovasc Dis ; 30(9): 1452-1464, 2020 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-32600955

RESUMEN

BACKGROUND AND AIMS: The influence of metabolic syndrome (MetS) on mortality may be influenced by age- and gender-related changes affecting the impact of individual MetS components. We investigated gender differences in the association between MetS components and mortality in community-dwelling older adults. METHODS AND RESULTS: Prospective studies were identified through a systematic literature review up to June 2019. Random-effect meta-analyses were run to estimate the pooled relative risk (RR) and 95% confidence intervals (95% CI) of all-cause and cardiovascular (CV) mortality associated with the presence of MetS components (abdominal obesity, high triglycerides, low HDL cholesterol, high fasting glycemia, and high blood pressure) in older men and women. Meta-analyses considering all-cause (103,859 individuals, 48,830 men, 55,029 women; 10 studies) and CV mortality (94,965 individuals, 44,699 men, 50,266 women; 8 studies) did not reveal any significant association for abdominal obesity and high triglycerides in either gender. Low HDL was associated with increased all-cause (RR = 1.16, 95% CI: 1.02-1.32) and CV mortality (RR = 1.34, 95% CI: 1.03-1.74) among women, while weaker results were found for men. High fasting glycemia was associated with higher all-cause mortality in older women (RR = 1.35, 95% CI: 1.22-1.50) more than in older men (RR = 1.21, 95% CI: 1.13-1.30), and CV mortality only in the former (RR = 1.36, 95% CI: 1.04-1.78). Elevated blood pressure was associated with increased all-cause mortality (RR = 1.16, 95% CI: 1.03-1.32) and showed marginal significant results for CV death only among women. CONCLUSIONS: The impact of MetS components on mortality in older people present some gender differences, with low HDL cholesterol, hyperglycemia, and elevated blood pressure being more strongly associated to all-cause and CV mortality in women.


Asunto(s)
Dislipidemias/mortalidad , Disparidades en el Estado de Salud , Hiperglucemia/mortalidad , Hipertensión/mortalidad , Síndrome Metabólico/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Glucemia/metabolismo , Presión Sanguínea , Causas de Muerte , Dislipidemias/sangre , Dislipidemias/diagnóstico , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Lípidos/sangre , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/fisiopatología , Pronóstico , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo
9.
Cardiovasc Diabetol ; 19(1): 101, 2020 07 04.
Artículo en Inglés | MEDLINE | ID: mdl-32622355

RESUMEN

BACKGROUND: Left ventricular systolic dysfunction (LVSD) occurs frequently after acute ST-segment elevation myocardial infarction (STEMI). The predisposing factors and underlying mechanism of post-infarct LVSD are not fully understood. The present study mainly investigated the correlation between glycaemic gap, a novel index of stress-induced hyperglycaemia (SIH), and post-infarct LVSD. METHODS: A total of 274 first STEMI patients were enrolled in this cross-sectional study. Transthoracic echocardiography was performed within 48 h after admission and at 6 months after discharge to obtain left ventricular ejection fraction (LVEF). The change in LVEF was calculated as LVEF at 6 months after discharge minus baseline LVEF. Additionally, post-infarct LVSD was defined as LVEF ≤ 50%. Most importantly, glycaemic gap was calculated as admission blood glucose (ABG) minus the estimated average glucose over the previous 3 months. RESULTS: In patients without diabetes mellitus (DM), multivariate linear regression analysis revealed that both glycaemic gap (Beta = - 1.214, 95% CI - 1.886 to - 0.541, p < 0.001) and ABG (Beta = - 1.124, 95% CI - 1.795 to - 0.453, p = 0.001) were associated with change in LVEF. In DM patients, only glycaemic gap was still associated with change in LVEF, although this association was not observed in univariate linear regression analysis. Regarding the association between SIH and post-infarct LVSD, multivariate logistic regression analysis revealed that both glycaemic gap (OR = 1.490, 95% CI 1.043 to 2.129, p = 0.028) and ABG (OR = 1.600, 95% CI 1.148 to 2.229, p = 0.005) were associated with an increased risk of having post-infarct LVSD in non-DM patients. However, after multivariate adjustment in DM patients, only glycaemic gap (OR = 1.399, 95% CI 1.021 to 1.919, p = 0.037) remained associated with an increased risk of having post-infarct LVSD. Furthermore, the predictive value of glycaemic gap for post-infarct LVSD was not inferior to ABG in non-DM patients (p = 0.499), and only glycaemic gap, instead of ABG, could significantly predict post-infarct LVSD in DM patients (AUC = 0.688, 95% CI 0.591 to 0.774, p = 0.002). CONCLUSIONS: Glycaemic gap was strongly associated with a change in LVEF and an increased risk of having post-infarct LVSD in patients following STEMI. In STEMI patients with DM, glycaemic gap could provide more valuable information than ABG in identifying patients at high risk of developing post-infarct LVSD.


Asunto(s)
Glucemia/metabolismo , Hiperglucemia/complicaciones , Infarto del Miocardio con Elevación del ST/complicaciones , Volumen Sistólico , Disfunción Ventricular Izquierda/etiología , Función Ventricular Izquierda , Adulto , Anciano , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Masculino , Persona de Mediana Edad , Admisión del Paciente , Pronóstico , Medición de Riesgo , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/fisiopatología , Factores de Tiempo , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología
10.
Curr Opin Endocrinol Diabetes Obes ; 27(4): 215-224, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32618633

RESUMEN

PURPOSE OF REVIEW: Emerging data have suggested that ß-cell dysfunction may exacerbate the development and progression of type 1 diabetes (T1D). In this review, we highlight clinical and preclinical studies suggesting a role for ß-cell dysfunction during the evolution of T1D and suggest agents that may promote ß-cell health in T1D. RECENT FINDINGS: Metabolic abnormalities exist years before development of hyperglycemia and exhibit a reproducible pattern reflecting progressive deterioration of ß-cell function and increases in ß-cell stress and death. Preclinical studies indicate that T1D may be prevented by modification of pathways impacting intrinsic ß-cell stress and antigen presentation. Recent findings suggest that differences in metabolic phenotypes and ß-cell stress may reflect differing endotypes of T1D. Multiple pathways representing potential drug targets have been identified, but most remain to be tested in human populations with preclinical disease. SUMMARY: This cumulative body of work shows clear evidence that ß-cell stress, dysfunction, and death are harbingers of impending T1D and likely contribute to progression of disease and insulin deficiency. Treatment with agents targeting ß-cell health could augment interventions with immunomodulatory therapies but will need to be tested in intervention studies with endpoints carefully designed to capture changes in ß-cell function and health.


Asunto(s)
Diabetes Mellitus Tipo 1/etiología , Diabetes Mellitus Tipo 1/patología , Diabetes Mellitus Tipo 1/fisiopatología , Células Secretoras de Insulina/fisiología , Diabetes Mellitus Tipo 1/metabolismo , Progresión de la Enfermedad , Humanos , Hiperglucemia/sangre , Hiperglucemia/complicaciones , Hiperglucemia/patología , Hiperglucemia/fisiopatología , Insulina/deficiencia , Insulina/metabolismo , Células Secretoras de Insulina/metabolismo , Células Secretoras de Insulina/patología
11.
Lancet Diabetes Endocrinol ; 8(9): 782-792, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32687793

RESUMEN

Since the initial COVID-19 outbreak in China, much attention has focused on people with diabetes because of poor prognosis in those with the infection. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk, but limitations to their use and potential interactions with COVID-19 treatments should be carefully assessed. Finally, severe acute respiratory syndrome coronavirus 2 infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through direct negative effects on ß-cell function. These effects on ß-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with unknown history of diabetes, and potentially new-onset diabetes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Infecciones por Coronavirus/sangre , Diabetes Mellitus Tipo 2/sangre , Humanos , Hiperglucemia/sangre , Hiperglucemia/epidemiología , Hiperglucemia/terapia , Hipertensión/sangre , Hipertensión/epidemiología , Hipertensión/terapia , Obesidad/sangre , Obesidad/epidemiología , Obesidad/terapia , Pandemias , Neumonía Viral/sangre , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
12.
J Pediatr ; 223: 42-50.e2, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32711750

RESUMEN

OBJECTIVE: To determine whether neonatal hyperglycemia is associated with retinopathy of prematurity (ROP), visual outcomes, and ocular growth at 7 years of age. STUDY DESIGN: Children born preterm (<30 weeks of gestational age) at a tertiary hospital in Auckland, New Zealand, who developed neonatal hyperglycemia (2 blood glucose concentrations ≥153 mg/dL [8.5 mmol/L] 4 hours apart) were matched with children who were not hyperglycemic (matching criteria: sex, gestational age, birth weight, age, socioeconomic status, and multiple birth) and assessed at 7 years of corrected age. The primary outcome, favorable overall visual outcome (visual acuity ≤0.3 logarithm of the minimum angle of resolution, no strabismus, stereoacuity ≤240 arcsec, not requiring spectacles) was compared between groups using generalized matching criteria-adjusted linear regression models. RESULTS: Assessments were performed on 57 children with neonatal hyperglycemia (hyperglycemia group) and 54 matched children without hyperglycemia (control group). There were no differences in overall favorable visual outcome (OR 0.95, 95% CI 0.42-2.13, P = .90) or severe ROP incidence (OR 2.20, 95% CI 0.63-7.63, P = .21) between groups. Children with hyperglycemia had poorer binocular distance visual acuity (mean difference 0.08, 95% CI 0.03-0.14 logarithm of the minimum angle of resolution, P < .01), more strabismus (OR 6.22, 95% CI 1.31-29.45, P = .02), and thicker crystalline lens (mean difference 0.14, 95% CI 0.04-0.24 mm, P < .01). Maximum blood glucose concentration was greater in the ROP-treated group compared with the ROP-not treated and no ROP groups after adjusting for sex, gestational age, and birth weight z score (P = .02). CONCLUSIONS: Neonatal hyperglycemia was not associated with overall visual outcomes at 7 years of age. However, there were between-group differences for specific outcome measures relating to interocular lens growth and binocular vision. Further follow-up is required to determine implications on long-term visual outcome.


Asunto(s)
Hiperglucemia/epidemiología , Retinopatía de la Prematuridad/epidemiología , Agudeza Visual , Glucemia/metabolismo , Causalidad , Niño , Estudios Transversales , Femenino , Humanos , Hiperglucemia/sangre , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro , Recién Nacido de muy Bajo Peso , Masculino , Retinopatía de la Prematuridad/sangre , Factores de Riesgo
13.
J Vis Exp ; (159)2020 05 22.
Artículo en Inglés | MEDLINE | ID: mdl-32510516

RESUMEN

The insulin tolerance test is commonly used in metabolic studies to assess whole body insulin sensitivity in rodents. It is a relatively simple test that involves measurement of blood glucose levels over time following a single intraperitoneal injection of insulin. Given that it is performed in the conscious state and blood is often collected via a tail snip, it has the potential to elicit a stress response from animals due to anxiety associated with handling and blood collection. As such, a stress-induced rise in blood glucose can occur, making it difficult to detect and interpret the primary endpoint measure, namely an insulin-mediated reduction in blood glucose. This has been seen in many mouse strains, and is quite common in diabetic db/db mice, where glucose levels can increase, rather than decrease, after insulin administration. Here, we describe a method of acclimating mice to handling, injections and blood sampling prior to performing the insulin tolerance test. We find that this lowers stress-induced hyperglycemia and results in data that more accurately reflects whole body insulin sensitivity.


Asunto(s)
Aclimatación , Artefactos , Hiperglucemia/metabolismo , Hiperglucemia/psicología , Resistencia a la Insulina , Estrés Psicológico/complicaciones , Estrés Psicológico/fisiopatología , Animales , Glucemia/metabolismo , Hiperglucemia/sangre , Hiperglucemia/complicaciones , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Endogámicos
14.
Acta Diabetol ; 57(10): 1245-1253, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32488499

RESUMEN

AIMS: To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND). METHODS: In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA-during follow-up according to the most recent episode-or ND. RESULTS: At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression. CONCLUSIONS: HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.


Asunto(s)
Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Cetoacidosis Diabética/epidemiología , Hiperglucemia/epidemiología , Coma Hiperglucémico Hiperosmolar no Cetósico/epidemiología , Adolescente , Adulto , Anciano , Austria/epidemiología , Niño , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Cetoacidosis Diabética/sangre , Cetoacidosis Diabética/complicaciones , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Hiperglucemia/sangre , Hiperglucemia/complicaciones , Coma Hiperglucémico Hiperosmolar no Cetósico/sangre , Coma Hiperglucémico Hiperosmolar no Cetósico/complicaciones , Luxemburgo/epidemiología , Masculino , Persona de Mediana Edad , Sistema de Registros , Suiza/epidemiología , Adulto Joven
15.
J Diabetes Sci Technol ; 14(4): 822-832, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32536205

RESUMEN

Continuous glucose monitoring (CGM) has become a widely used tool in the ambulatory setting for monitoring glucose levels, as well as detecting uncontrolled hyperglycemia, hypoglycemia, and glycemic variability. The accuracy of some CGM systems has recently improved to the point of manufacture with factory calibration and Food and Drug Administration clearance for nonadjunctive use to dose insulin. In this commentary, we analyze the answers to six questions about what is needed to bring CGM into the hospital as a reliable, safe, and effective tool. The evidence to date indicates that CGM offers promise as an effective tool for monitoring hospitalized patients. During the current coronavirus disease 2019 crisis, we hope to provide guidance to healthcare professionals, who are seeking to reduce exposure to SARS-Cov-2, as well as preserve invaluable personal protective equipment. In this commentary, we address who, what, where, when, why, and how CGM can be adopted for inpatient use.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/métodos , Infecciones por Coronavirus/epidemiología , Complicaciones de la Diabetes/terapia , Hiperglucemia/complicaciones , Hiperglucemia/diagnóstico , Neumonía Viral/epidemiología , Betacoronavirus , Glucemia/análisis , Calibración , Control de Enfermedades Transmisibles , Diabetes Mellitus/sangre , Diabetes Mellitus/terapia , Registros Electrónicos de Salud , Hospitalización , Hospitales , Humanos , Hiperglucemia/sangre , Pacientes Internos , Sistemas de Infusión de Insulina , Monitoreo Ambulatorio , Pandemias , Estados Unidos , United States Food and Drug Administration
16.
Diabetes Obes Metab ; 22(8): 1443-1454, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32406594

RESUMEN

AIM: To explore whether coronavirus disease 2019 (COVID-19) patients with diabetes and secondary hyperglycaemia have different clinical characteristics and prognoses than those without significantly abnormal glucose metabolism. MATERIALS AND METHODS: We retrospectively analysed 166 COVID-19 patients at Tongji Hospital (Wuhan) from 8 February to 21 March 2020. Clinical characteristics and outcomes (as of 4 April 2020) were compared among control (group 1), secondary hyperglycaemia (group 2: no diabetes history, fasting plasma glucose levels of ≥7.0 mmol/L once and HbA1c values <6.5%) and patients with diabetes (group 3). RESULTS: Compared with group 1, groups 2 and 3 had higher rates of leukocytosis, neutrophilia, lymphocytopenia, eosinopenia and levels of hypersensitive C-reactive protein, ferritin and d-dimer (P < .05 for all). Group 2 patients had higher levels of lactate dehydrogenase, prevalence of liver dysfunction and increased interleukin-8 (IL-8) than those in group 1, and a higher prevalence of increased IL-8 was found in group 2 than in group 3 (P < .05 for all). The proportions of critical patients in groups 2 and 3 were significantly higher compared with group 1 (38.1%, 32.8% vs. 9.5%, P < .05 for both). Groups 2 and 3 had significantly longer hospital stays than group 1, which was nearly 1 week longer. The composite outcomes risks were 5.47 (1.56-19.82) and 2.61 (0.86-7.88) times greater in groups 2 and 3 than in group 1. CONCLUSIONS: Hyperglycaemia in both diabetes and secondary hyperglycaemia patients with COVID-19 may indicate poor prognoses. There were differences between patients with secondary hyperglycaemia and those with diabetes. We recommend that clinicians pay more attention to the blood glucose status of COVID-19 patients, even those not diagnosed with diabetes before admission.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/sangre , Diabetes Mellitus/virología , Hiperglucemia/virología , Neumonía Viral/sangre , Adulto , Anciano , Glucemia/análisis , China/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/sangre , Diabetes Mellitus/mortalidad , Femenino , Hemoglobina A Glucada/análisis , Hospitalización/estadística & datos numéricos , Humanos , Hiperglucemia/sangre , Hiperglucemia/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Pronóstico , Estudios Retrospectivos
17.
Diabetes Res Clin Pract ; 164: 108185, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32360710

RESUMEN

Diabetes emerged as major risk factor for severe acute respiratory syndrome (SARS) and adverse outcome in patients with the coronavirus disease 2019 (COVID-19). Nevertheless, the role of admission hyperglycemia in patients with COVID-19 has not been well-explored, yet. With this retrospective analysis, we report for the first time that hyperglycemia on day-1 is the best predictor of radiographic imaging of SARS-CoV2, regardless of the past medical history of diabetes. Admission hyperglycemia should not be overlooked, but adequately treated to improve the outcomes of COVID-19 patients with our without diabetes.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico por imagen , Hiperglucemia/sangre , Hiperglucemia/virología , Neumonía Viral/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/terapia , Estudios Retrospectivos , Factores de Riesgo
18.
Am J Med Sci ; 359(5): 266-270, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32359533

RESUMEN

BACKGROUND: Cross-sectional surveys report a higher prevalence of diagnosed type 2 diabetes mellitus (T2DM) in African Americans (AA) than European Americans (EA). We studied 5-year glycemic excursions among AA and EA in the Pathobiology of Prediabetes in A Biracial Cohort study, to assess ethnic disparities. MATERIALS AND METHODS: Pathobiology of Prediabetes in A Biracial Cohort followed normoglycemic offspring of parents with T2DM for 5 years, with serial assessments of oral glucose tolerance test , anthropometry, body fat, insulin sensitivity and beta-cell function. The primary outcome was progression to prediabetes (impaired fasting glucose and/or impaired glucose tolerance). We further analyzed 5-year changes in fasting (FPG) and 2-hour plasma glucose (2hrPG). RESULTS: One hundred and one (52 AA, 49 EA) out of 343 subjects developed prediabetes during follow-up. The change in FPG ranged from -24 mg/dl to +38 mg/dl. The FPG remained stable (± 5 mg/dl from baseline) in 50% of EA and 46.8% of AA and the 2hrPG remained stable (± 25 mg/dl from baseline) in 73.7% of EA and 71.0 % of AA during follow-up. The proportions with change in FPG of 5mg/dl to >25 mg/dl and 2hrPG of 25 mg/dl to >50 mg/dl were similar in EA and AA offspring, as were the 10th - 90th percentiles of the distribution of 5-year changes in FPG and 2hrPG. CONCLUSIONS: During 5 years of follow-up, black and white offspring of parents with T2DM exhibited remarkable phenotypic concordance of glycemic trajectories. Thus, parental history of T2DM may be a stronger factor than race/ethnicity in the prediction of longitudinal glycemic trends.


Asunto(s)
Diabetes Mellitus Tipo 2/etnología , Estado Prediabético/etnología , Adulto , Afroamericanos , Antropometría , Glucemia/análisis , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/sangre , Grupo de Ascendencia Continental Europea , Salud de la Familia , Femenino , Estudios de Seguimiento , Intolerancia a la Glucosa/diagnóstico , Prueba de Tolerancia a la Glucosa , Hemoglobina A Glucada/análisis , Disparidades en Atención de Salud , Humanos , Hiperglucemia/sangre , Insulina/sangre , Resistencia a la Insulina , Células Secretoras de Insulina/citología , Masculino , Persona de Mediana Edad , Padres , Fenotipo , Estado Prediabético/sangre , Prevalencia , Resultado del Tratamiento , Estados Unidos/epidemiología
19.
Diabetes Res Clin Pract ; 165: 108234, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32450103

RESUMEN

AIM: To observe the effect of keeping flexible glycemic targets during fasting and tighter targets during non-fasting hours in insulin-treated people with type 2 diabetes during Ramadan. METHODS: This prospective study was conducted at Baqai Institute of Diabetology and Endocrinology in 2014. People with T2DM on split mixed insulin therapy were recruited. The pre-Ramadan education given and insulin doses were adjusted before Ramadan. 24-hour telephonic helpline service was provided to achieve pre-determined glycemic targets and minimize complications. RESULTS: A total of 54 people with T2DM with a mean age of 54.65 ± 9.32 years were recruited. Mean glucose levels achieved were 183.50 ± 30.91 mg/dl and 179.20 ± 36.27 mg/dl during the day and night respectively. Mean HbA1c (p-value < 0.0001) and serum creatinine (p-value 0.0010) significantly improved at the end of Ramadan. 0.6% episodes of hypoglycemia including one major hypoglycemia while 30% of episodes of hyperglycemia were recorded. No hospitalization needed. CONCLUSION: By keeping flexible glycemic targets during the day and tighter targets during the night, safe fasting was feasible with significant improvement in overall glycemic control without significant major complications.


Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Ayuno/sangre , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Islamismo , Adulto , Insulinas Bifásicas/uso terapéutico , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea , Creatinina/análisis , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Vacaciones y Feriados , Humanos , Hiperglucemia/sangre , Hipoglucemia/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos
20.
Cell Metab ; 31(6): 1068-1077.e3, 2020 06 02.
Artículo en Inglés | MEDLINE | ID: mdl-32369736

RESUMEN

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.


Asunto(s)
Glucemia/análisis , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus Tipo 2/sangre , Índice Glucémico/fisiología , Hiperglucemia/sangre , Neumonía Viral/mortalidad , Anciano , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/patología , Diabetes Mellitus Tipo 2/complicaciones , Susceptibilidad a Enfermedades/patología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hiperglucemia/complicaciones , Hipoglucemiantes/uso terapéutico , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/complicaciones , Insuficiencia Multiorgánica/mortalidad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/patología , Estudios Retrospectivos
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