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1.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 647-653, dic. 2019. tab, graf
Artículo en Inglés | IBECS | ID: ibc-184792

RESUMEN

Introduction: Several sweeteners are introduced to replace sucrose in the human diet. However, they had their own limitations and concerns, particularly in terms of their taste and their long-term health consequences. This study examined the effect of a new mixture of sugars and sugar alcohol on the postprandial blood glucose levels and its possible gastrointestinal (GI) adverse reactions in human adults. Methods: In this double-blind three-way randomized clinical trial, adults (21 with type 2 diabetes and 20 healthy) received 300 ml of three beverages containing 50 g glucose, sucrose, and lacritose (a mixture of lactose, fructose, sucrose, and erythritol) when they were in the fasted state in a random order. Postprandial serum glucose was checked every 30min up to 2 h and the gastrointestinal reactions were collected. Results: The mean serum glucose was significantly lower in all time points after ingestion of the lacritose for participants with type 2 diabetes compared to glucose and sucrose (P < 0.05). The blood glucose levels were significantly lower in the 30th and 60th min for healthy subjects (P < 0.05). Adverse GI reactions were not significant between the test beverages. Conclusions: The ingestion of a 50 g dose of lacritose containing lactose, fructose, sucrose, and erythritol, led to an improved blood glucose levels without any significant adverse effect compared to the same amount of glucose and sucrose. Studying the long-term effects of lacritose on appetite, metabolic markers and adverse reactions is recommended. The trial was registered in Iranian registry of clinical trials: IRCT2015050912571N2


Introducción: Se han utilizado varios edulcorantes para sustituir a la sacarosa en la dieta humana. Sin embargo, tenían sus propias limitaciones y problemas, sobre todo por su sabor y sus consecuencias a largo plazo para la salud. En este estudio se explora el efecto de una nueva muestra de azúcares y alcohol de azúcar en los niveles de glucemia posprandial y las posibles reacciones adversas digestivas a ella en adultos humanos. Métodos: En este ensayo clínico doble ciego aleatorizado de tres vías, adultos (21 con diabetes tipo 2 y 20 sanos) recibieron 300ml de tres bebidas que contenían 50 g de glucosa, sacarosa y lacritosa (una mezcla de lactosa, fructosa, sacarosa y eritritol) en orden aleatorio en ayunas. Se comprobó la glucose sérica posprandial cada 30 minutos hasta las dos horas y se recogieron las reacciones digestivas. Resultados: Los valores medios de glucosa en suero eran significativamente menores en todos los puntos temporales tras la ingesta de lacritosa que tras la de glucosa y sacarosa en los participantes con diabetes tipo 2 (P < 0,05). Los niveles de glucemia eran significativamente menores a los 30 y 60 minutos en los sujetos sanos (P < 0,05). No había diferencias significativas en las reacciones digestivas adversas entre las bebidas estudiadas. Conclusiones: La ingesta de una dosis de 50 g de lacritosa que contiene lactosa, fructosa, sacarosa y eritritol, mejoró los niveles de glucemia sin efectos adversos importantes comparada con la misma cantidad de glucosa y sacarosa. Se recomienda estudiar los efectos a largo plazo de la lacritosa en el apetito, los marcadores metabólicos y las reacciones adversas. El ensayo se inscribió en el registro de ensayos clínicos de Irán: IRCT2015050912571N2


Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Glucemia/análisis , Sacarosa/sangre , Hiperglucemia/sangre , Hiperglucemia/inducido químicamente , Alcoholes del Azúcar/análisis , Sacarosa/efectos adversos , Índice Glucémico , Hiperglucemia/complicaciones , Método Doble Ciego , Alcoholes del Azúcar/efectos adversos , Alcoholes del Azúcar/sangre , Antropometría
2.
Orv Hetil ; 160(45): 1784-1790, 2019 Nov.
Artículo en Húngaro | MEDLINE | ID: mdl-31680540

RESUMEN

Introduction: It is known that lactate concentration is increased in diabetic ketoacidosis (DKA), however, the pathophysiology and kinetics of lactate changes are still unclear. Normally, L-lactate is the major form in the human body. According to previous data, also D- and L-lactate might be increased in hyperglycaemic disorders. Aim: We aimed to describe the kinetics and mechanisms of lactate concentration changes in ketoacidosis and newly diagnosed diabetes. Method: We performed a prospective study, including 5-18-year-old children with ketoacidosis (DKA, n = 13) and with newly diagnosed type 1 diabetes without ketoacidosis (T1DM, n = 6). We performed routine blood gas analysis 0-12-24-48 hours after admission, which also measured L-lactate levels. We also determined total venous serum lactate level by gas chromatography-mass spectrometry. Results: Initial plasma lactate concentration was increased in ketoacidosis as compared to the newly diagnosed diabetes group (p<0.05). After 12 h of rehydration, lactate levels were greatly reduced in ketoacidotic patients but after 24-48 h it was repeatedly increased (all p<0.01). In the 0-12 h phase, total serum lactate level was higher than L-lactate level, referring to D-lactate production. Conclusion: We described two L-lactate peaks in ketoacidosis. In the first 12 hours anaerobic glycolysis seems to have major role in hyperlactataemia. We assume that stimulated aerobic glycolysis leads to the second lactate peak. However, D-lactate is not routinely measured, it may contribute to the initial hyperlactataemia in both groups and is comparable to L-lactate production in ketoacidosis. Orv Hetil. 2019; 160(45): 1784-1790.


Asunto(s)
Diabetes Mellitus Tipo 1/diagnóstico , Ácido Láctico/sangre , Análisis de los Gases de la Sangre , Niño , Preescolar , Diabetes Mellitus Tipo 1/sangre , Cetoacidosis Diabética/sangre , Cetoacidosis Diabética/diagnóstico , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Hiperglucemia/sangre , Masculino , Estudios Prospectivos
3.
BMJ ; 367: l5887, 2019 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690574

RESUMEN

Diabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients' goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.


Asunto(s)
Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Calidad de Vida , Glucemia/análisis , Glucemia/efectos de los fármacos , Complicaciones de la Diabetes/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Hiperglucemia/sangre , Hiperglucemia/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Incidencia , Metaanálisis como Asunto , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Guías de Práctica Clínica como Asunto , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
4.
Zhonghua Wai Ke Za Zhi ; 57(10): 31-37, 2019 Oct 01.
Artículo en Chino | MEDLINE | ID: mdl-31510730

RESUMEN

Objective: To examine the association of hyperglycemia and postoperative complications in non-diabetic patients underwent pancreaticoduodenectomy(PD). Methods: The clinical data of 209 non-diabetic patients who underwent PD from January 2012 to June 2018 at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University and met the inclusion criteria were retrospectively analyzed. According to the diagnostic criteria of postoperative hyperglycemia, the patients were divided into postoperative hyperglycemia group (167 cases, 79.9%) and control group(42 cases, 20.1%). The propensity score matching(PSM) method was used to eliminate the difference between groups(caliper value=0.02; 38 cases in control group including 30 males and 8 females with age of 59.0 years;38 cases in postoperative hyperglycemia group including 32 males and 6 females with age of 61.0 years;37 cases of pancreatic head carcinoma,30 cases of periampullary carcinoma and 9 cases of benign diseases). A comparative analysis was applied for preoperative data, surgical related indicators and postoperative complication rates.The receiver operating characteristic(ROC) curve was used to calculate the area under the curve(AUC) of blood glucose values on postoperative day 1,3 and 5(POD1, POD3, POD5), to determine the high-risk blood glucose cutoff value of complications and to evaluate its sensitivity and specificity for the prediction of postoperative complications. Results: Univariate analysis showed that the differences in gender, body mass index, preoperative blood glucose, and serum urea nitrogen levels were statistically significant before PSM.There was no significant difference in the preoperative data between the two groups after PSM. Compared with the control group, the incidence of postoperative pancreatic fistula (31.6% vs. 5.3%), abdominal infection(29.0% vs. 7.9%) and Clavien-Dindo Ⅲ-Ⅴ complications(31.6% vs.7.9%) were statistically different(χ(2)=7.092,P=0.008; χ(2)=4.290,P=0.038; χ(2)=5.316,P=0.021), respectively. According to the AUC on POD3,the blood glucose value ≥8.860 mmol/L was an independent risk factor for pancreatic fistula with sensitivity of 58.3% and specificity of 76.9%,the blood glucose value ≥9.130 mmol/L was an independent risk factor for abdominal infection with sensitivity of 54.5% and specificity of 81.5% and the blood glucose value ≥7.685 mmol/L was independent risk factor of Clavien-Dindo Ⅲ-Ⅴ complications with sensitivity of 75.0% and specificity of 57.7%. Conclusions: Postoperative hyperglycemia in non-diabetic patients is associated with postoperative pancreatic fistula, abdominal infection, and Clavien-Dindo Ⅲ-Ⅴ complications.According to the early postoperative blood glucose value,the occurrence of postoperative pancreatic fistula, abdominal infection and Clavien-Dindo Ⅲ- Ⅴ complications can be effectively predicted.


Asunto(s)
Hiperglucemia/complicaciones , Pancreaticoduodenectomía/efectos adversos , Femenino , Humanos , Hiperglucemia/sangre , Infecciones Intraabdominales/etiología , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/cirugía , Fístula Pancreática/etiología , Complicaciones Posoperatorias/clasificación , Valor Predictivo de las Pruebas , Estudios Retrospectivos
5.
Transplant Proc ; 51(7): 2228-2231, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474289

RESUMEN

BACKGROUND: The aim of this study is to investigate the frequency and risk factors of new-onset diabetes after donation in kidney donors without diabetes. METHODS: Living donors of kidney transplants between 1998 and 2016 were evaluated. To detect the blood glucose profile of the donors, preoperative fasting glucose (pro-G), nephrectomy evening glucose (nG), and postoperative day 1 fasting glucose (post-G) values were measured. RESULTS: A total of 195 cases were included in the study. The mean follow-up time in months ± SD (range) was 56 ± 45 (12-215). Of these, 28 (14.3%) donors developed diabetes. The pro-G (103 ± 7.6 vs 93 ± 9.0), nG (208 ± 122 vs 163 ± 67) and post-G (121 ± 25 vs 111 ± 21) values of the donors with new-onset diabetes were higher. Nineteen donors (9.7%) had normal pro-G, nG, and post-G values (group A). However, there were 153 (78.5%) cases with at least 1 abnormal value (group B) and 25 (12.8%) cases that had abnormal values in all (pro-G, nG, and post-G) measurements (group C). The incidence of new-onset diabetes was 0 (0%) in group A, 11% in group B, and 48% in group C (P < .001). In multiple regression analysis, pro-G (Exp[B], 1.08; 95% CI, 1.04-1.13; P < .001) and basal glomerular filtration rate (Exp[B], 0.96; 95% CI, 0.94-0.99; P < .01) independently associated with new-onset diabetes. CONCLUSIONS: In kidney donors without a history of diabetes, the development of diabetes after donor nephrectomy is an important problem. Pre- and postoperative blood glucose levels provide important information to predict these cases.


Asunto(s)
Diabetes Mellitus/etiología , Hiperglucemia/etiología , Complicaciones Intraoperatorias/etiología , Donadores Vivos , Nefrectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Recolección de Tejidos y Órganos/efectos adversos , Adulto , Glucemia/análisis , Diabetes Mellitus/sangre , Ayuno/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Hiperglucemia/sangre , Complicaciones Intraoperatorias/sangre , Riñón/cirugía , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Factores de Riesgo
6.
Med Arch ; 73(3): 144-148, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31402800

RESUMEN

Introduction: Previous research found that diabetes mellitus capable to aggravate osteoarthritis disease. In brief, the hyperglycemia condition in diabetes mellitus has an impact on protein glycation of all joint components, including molecule, such as perlecan. The protein expression of perlecan reflects the presence amount of perlecan in the matrix of articular cartilage. However, the impact of hyperglycemia on articular perlecan has not been explained. Moreover, the role of perlecan as a mechanotransducer for chondrocytes in type 1 Diabetes mellitus remains unclear. Aim: This research aims to analyze the effect of hyperglycemia in type 1 Diabetes mellitus to the mRNA level and protein expression of perlecan. Methods: Thirty-five adult male rats were divided into seven groups, such as three groups of rat model with anterior cruciate ligament transection (ACLT) at right knee (ACLT1, ACLT2, ACLT3); three groups of rats with ACLT at right knee which followed by Streptozotocin injection for diabetic mice model (DM1, DM2, DM3); and control group (N). Rat sacrificed at the third week, fourth week, and sixth week after two months of maintenance. The mRNA level and protein expression were analyzed by using PCR and Western blot. All of data was analyzed by ANOVA. Results: Protein expression of perlecan in ACLT mice with diabetes mellitus (DM1, DM2, DM3 group) was gradually decreased according to the increased hyperglycemia duration. Whilst, protein expression of perlecan within ACLT mice without diabetes mellitus (ACLT1, ACLT2, ACLT3 group) was increased. The similar result also demonstrated by the mRNA level of perlecan. Group of DM1, DM2, DM3 exhibited decreased mRNA level of perlecan over the hyperglycemia duration. While, ACLT1, ACLT2, and ACLT3 group had a gradually increased of perlecan mRNA level. Conclusion: Hyperglycemia on osteoarthritic condition decreased mRNA level and protein expression of perlecan which increased the severity of osteoarthritis disease.


Asunto(s)
Diabetes Mellitus Experimental/sangre , Diabetes Mellitus Tipo 1/sangre , Proteoglicanos de Heparán Sulfato/genética , Proteoglicanos de Heparán Sulfato/metabolismo , Hiperglucemia/sangre , Osteoartritis/metabolismo , Animales , Glucemia , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Tipo 1/complicaciones , Modelos Animales de Enfermedad , Hiperglucemia/etiología , Masculino , Osteoartritis/complicaciones , Osteoartritis/genética , ARN Mensajero/metabolismo , Ratas
7.
Diabetes Metab Syndr ; 13(4): 2775-2784, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31405707

RESUMEN

Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy and can lead to significant perinatal mortalities as well as long term risk of comorbidities for both mother and her offspring. This systematic review aimed to explore whether combined diet and exercise interventions are associated with improved glycemic control and/or improved maternal and newborn outcomes in women with GDM when compared to dietary interventions. A search on combined diet and exercise interventions during pregnancy in women with GDM was performed in 3 electronic databases: PubMed (NCBI), ScienceDierct, and the Cochrane Library. Evaluated outcomes were fasting blood glucose levels, postprandial blood glucose levels, glycated hemoglobin percentages, total weight gain during pregnancy, proportion of caesarean delivery, proportion of patients needing insulin, neonatal birth weight, proportion of macrosomia, neonatal hypoglycemia, and preterm birth. This systematic review identified eight randomized, controlled trials involving 592 pregnant women and 350 infants. The risk of bias of the included trials ranged from high to low. The combined diet and exercise interventions reduced fasting and postprandial blood glucose levels when compared to dietary interventions. No significant differences were reported in the selected trials regarding total weight gain during pregnancy, cesarean section, neonatal birth weight, macrosomia, neonatal hypoglycemia, and preterm birth between diet plus exercise and diet groups. The combination of diet and exercise interventions help to control postprandial blood glucose concentration in women diagnosed with GDM, but did not change either maternal or newborn outcomes. REGISTRATION: PROSPERO CRD42018109896.


Asunto(s)
Diabetes Gestacional/terapia , Dieta , Ejercicio , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Glucemia/análisis , Diabetes Gestacional/diagnóstico , Femenino , Humanos , Hiperglucemia/sangre , Hipoglucemia/sangre , Recién Nacido , Embarazo , Pronóstico
8.
Nutrients ; 11(8)2019 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-31382699

RESUMEN

Little is known about the association between dietary patterns and hyperglycemia incidence among Korean adults. Hence, we aimed to prospectively investigate the major dietary patterns associated with hyperglycemia among middle-aged and older Korean adults. In total, 55,457 adults (18,292 men and 37,165 women) aged 40 to 79 years, who were previously enrolled in the Health Examinee Study of the Korean Genome and Epidemiology Study and had no history of type 2 diabetes mellitus (T2DM) or cancer at baseline, were included. Dietary patterns were identified by a factor analysis based on dietary data, which were assessed at baseline using a validated food-frequency questionnaire. Participants were classified as having hyperglycemia if fasting blood glucose levels were ≥126 mg/dL or physician diagnosed T2DM during follow-up. Multivariable Cox proportional hazard models were used to examine the associations between each dietary pattern and future hyperglycemia risk after adjusting for potential confounders. After a mean follow-up of 4.9 years, 2574 new cases of hyperglycemia were identified. Using a factor analysis, four distinct dietary patterns were identified: "prudent;" "fatty fish, meat, and flour-based food;" "coffee and sweets;" and "whole grain (men)" or "white rice (women)." The "prudent" pattern was inversely associated with hyperglycemia risk only in women (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.63-0.89; p for trend = 0.0003). Conversely, women in the highest quintile of the "fatty fish, meat, and flour-based food" pattern showed an increased risk of hyperglycemia (HR, 1.22; 95% CI, 1.03-1.44; p for trend = 0.0210) compared with those in the lowest quintile. The "coffee and sweets" and "white rice" patterns were not associated with hyperglycemia risk in women. The dietary patterns observed in men had no associations with hyperglycemia incidence. Our findings suggest that a diet rich in vegetables, mushrooms, seaweeds, fruits, and soy products and low in fatty fish and high-fat meat may potentially play a protective role in T2DM development with sex differences in middle-aged and older Korean adults.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/epidemiología , Dieta/efectos adversos , Conducta Alimentaria , Hiperglucemia/epidemiología , Adulto , Factores de Edad , Anciano , Biomarcadores/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevención & control , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/prevención & control , Incidencia , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Valor Nutritivo , Estudios Prospectivos , Factores Protectores , República de Corea/epidemiología , Medición de Riesgo , Factores de Riesgo , Factores Sexuales
9.
J Med Case Rep ; 13(1): 258, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31366392

RESUMEN

BACKGROUND: Neonatal diabetes mellitus with hyperglycemia during the first 6 months of life is a rare disorder that can occur in all races and societies. CASE PRESENTATION: In this study, we introduced an Iranian (Persian) 65-day-old patient with neonatal diabetes mellitus with novel homozygous mutation in the pancreatic and duodenal homeobox 1, PDX1, gene, which is also known as IPF1 gene, located in exon 2. This case was a newborn boy born in Vali-Asr Hospital, Tehran; he was diagnosed as having hyperglycemia on 28th day. Genetic analysis detected a homozygous mutation on PDX1 gene on chromosome 13. It is a novel homozygous mutation in the PDX1 gene (NM_000209.3), p.Phe167Val. This mutation was confirmed by Sanger sequencing. There was no evidence of agenesis of the pancreas. CONCLUSIONS: We reported a case of neonatal diabetes mellitus due to novel homozygous mutation in the PDX1 gene without exocrine pancreas manifestations.


Asunto(s)
Diabetes Mellitus/genética , Proteínas de Homeodominio , Hiperglucemia/genética , Transactivadores , Diabetes Mellitus/sangre , Diabetes Mellitus/tratamiento farmacológico , Humanos , Hiperglucemia/sangre , Hiperglucemia/tratamiento farmacológico , Lactante , Recién Nacido , Enfermedades del Recién Nacido , Insulina/administración & dosificación , Irán , Masculino , Mutación
10.
Nat Commun ; 10(1): 3545, 2019 08 07.
Artículo en Inglés | MEDLINE | ID: mdl-31391467

RESUMEN

Tens of millions suffer from insulin deficiency (ID); a defect leading to severe metabolic imbalance and death. The only means for management of ID is insulin therapy; yet, this approach is sub-optimal and causes life-threatening hypoglycemia. Hence, ID represents a great medical and societal challenge. Here we report that S100A9, also known as Calgranulin B or Myeloid-Related Protein 14 (MRP14), is a leptin-induced circulating cue exerting beneficial anti-diabetic action. In murine models of ID, enhanced expression of S100A9 alone (i.e. without administered insulin and/or leptin) slightly improves hyperglycemia, and normalizes key metabolic defects (e.g. hyperketonemia, hypertriglyceridemia, and increased hepatic fatty acid oxidation; FAO), and extends lifespan by at least a factor of two. Mechanistically, we report that Toll-Like Receptor 4 (TLR4) is required, at least in part, for the metabolic-improving and pro-survival effects of S100A9. Thus, our data identify the S100A9/TLR4 axis as a putative target for ID care.


Asunto(s)
Calgranulina B/metabolismo , Diabetes Mellitus Experimental/metabolismo , Hiperglucemia/metabolismo , Longevidad/fisiología , Receptor Toll-Like 4/metabolismo , Animales , Diabetes Mellitus Experimental/sangre , Diabetes Mellitus Experimental/etiología , Toxina Diftérica/toxicidad , Ácidos Grasos/metabolismo , Humanos , Hiperglucemia/sangre , Hiperglucemia/etiología , Insulina/deficiencia , Leptina/administración & dosificación , Hígado/metabolismo , Masculino , Ratones , Ratones Noqueados , Oxidación-Reducción , Transducción de Señal/efectos de los fármacos , Transducción de Señal/fisiología , Estreptozocina/toxicidad , Receptor Toll-Like 4/genética
11.
Sensors (Basel) ; 19(14)2019 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-31323886

RESUMEN

In the daily management of type 1 diabetes (T1D), determining the correct insulin dose to be injected at meal-time is fundamental to achieve optimal glycemic control. Wearable sensors, such as continuous glucose monitoring (CGM) devices, are instrumental to achieve this purpose. In this paper, we show how CGM data, together with commonly recorded inputs (carbohydrate intake and bolus insulin), can be used to develop an algorithm that allows classifying, at meal-time, the post-prandial glycemic status (i.e., blood glucose concentration being too low, too high, or within target range). Such an outcome can then be used to improve the efficacy of insulin therapy by reducing or increasing the corresponding meal bolus dose. A state-of-the-art T1D simulation environment, including intraday variability and a behavioral model, was used to generate a rich in silico dataset corresponding to 100 subjects over a two-month scenario. Then, an extreme gradient-boosted tree (XGB) algorithm was employed to classify the post-prandial glycemic status. Finally, we demonstrate how the XGB algorithm outcome can be exploited to improve glycemic control in T1D through real-time adjustment of the meal insulin bolus. The proposed XGB algorithm obtained good accuracy at classifying post-prandial glycemic status (AUROC = 0.84 [0.78, 0.87]). Consequently, when used to adjust, in real-time, meal insulin boluses obtained with a bolus calculator, the proposed approach improves glycemic control when compared to the baseline bolus calculator. In particular, percentage time in target [70, 180] mg/dL was improved from 61.98 (± 13.89) to 67.00 (± 11.54; p < 0.01) without increasing hypoglycemia.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hiperglucemia/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Algoritmos , Glucemia/efectos de los fármacos , Automonitorización de la Glucosa Sanguínea , Simulación por Computador , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/patología , Relación Dosis-Respuesta a Droga , Humanos , Hiperglucemia/sangre , Hiperglucemia/patología , Sistemas de Infusión de Insulina , Periodo Posprandial , Prueba de Estudio Conceptual
12.
Clin Lab ; 65(7)2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31307169

RESUMEN

BACKGROUND: The current study aims to explore the changes of serum miR-587 level in patients with metabolic syndrome (MS) and analyze its clinical diagnostic value. METHODS: The serum levels of miR-587 in 50 patients with hyperglycemia, 50 patients with hyperlipidemia, and 50 healthy controls were detected by RT-qPCR. The diagnostic value of serum miR-587 was detected by ROC analy-sis and correlation analysis in MS. Dual luciferase reporter assay was carried out to determine the possible target gene of miR-587. RESULTS: The results of RT-qPCR showed that the relative content of serum miR-587 in patients with hyperglyce-mia and hyperlipidemia was 0.45 ± 0.30, 0.41 ± 0.30, compared with 1 ± 0.87 in healthy people. The area under ROC curve (AUC) of serum miR-587 in hyperglycemic patients was 0.830 (95% CI = 0.716 - 0.863, p < 0.001), with the sensitivity of 68.6% and specificity of 89.3%. The AUC of serum miR-587 in hyperlipidemia patients was 0.790 (95% CI = 0.759 - 0.851, p < 0.001), with the sensitivity of 78% and specificity of 89.7%. Correlation analysis showed that serum miR-587 level was negatively correlated with fasting blood glucose (FBG) (r = -0.291, p < 0.05), and negatively correlated with total cholesterol (TC) (r = -0.243, p < 0.01). Furthermore, dual luciferase reporter assay showed that PTEN was the target gene of miR-587. CONCLUSIONS: In summary the decreased expression of miR-587 in serum is a potential diagnostic marker and in-dependent risk factor in patients with MS.


Asunto(s)
Biomarcadores/sangre , Regulación de la Expresión Génica , Síndrome Metabólico/sangre , Síndrome Metabólico/diagnóstico , MicroARNs/sangre , Glucemia/metabolismo , Colesterol/sangre , Ayuno/sangre , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/genética , Hiperlipidemias/sangre , Hiperlipidemias/diagnóstico , Hiperlipidemias/genética , Masculino , Síndrome Metabólico/genética , MicroARNs/genética , Persona de Mediana Edad , Curva ROC
13.
Nutrients ; 11(7)2019 06 29.
Artículo en Inglés | MEDLINE | ID: mdl-31261967

RESUMEN

Background: The effect of dietary fat intake on the metabolic syndrome (MetS) and in turn on cardiovascular disease (CVD) remains unclear in individuals at high CVD risk. Objective: To assess the association between fat intake and MetS components in an adult Mediterranean population at high CVD risk. Design: Baseline assessment of nutritional adequacy in participants (n = 6560, men and women, 55-75 years old, with overweight/obesity and MetS) in the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial. Methods: Assessment of fat intake (total fat, monounsatured fatty acids: MUFA, polyunsaturated fatty acids: PUFA, saturated fatty acids: SFA, trans-fatty acids: trans-FA, linoleic acid, α-linolenic acid, and ω-3 FA) using a validated food frequency questionnaire, and diet quality using 17-item Mediterranean dietary questionnaire and fat quality index (FQI). Results: Participants in the highest quintile of total dietary fat intake showed lower intake of energy, carbohydrates, protein and fiber, but higher intake of PUFA, MUFA, SFA, TFA, LA, ALA and ω-3 FA. Differences in MetS components were found according to fat intake. Odds (5th vs. 1st quintile): hyperglycemia: 1.3-1.6 times higher for total fat, MUFA, SFA and ω-3 FA intake; low high-density lipoprotein cholesterol (HDL-c): 1.2 higher for LA; hypertriglyceridemia: 0.7 lower for SFA and ω-3 FA intake. Conclusions: Dietary fats played different role on MetS components of high CVD risk patients. Dietary fat intake was associated with higher risk of hyperglycemia.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Grasas de la Dieta/efectos adversos , Dislipidemias/epidemiología , Hiperglucemia/epidemiología , Síndrome Metabólico/epidemiología , Anciano , Biomarcadores/sangre , Glucemia/análisis , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Estudios Transversales , Dieta Mediterránea , Grasas de la Dieta/administración & dosificación , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/dietoterapia , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/dietoterapia , Lípidos/sangre , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/dietoterapia , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Resultado del Tratamiento
14.
Diabetes Res Clin Pract ; 154: 75-81, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31271810

RESUMEN

AIMS: To evaluate the impact of a prepregnancy care (PPC) programme, beyond HbA1c, on hypoglycaemia awareness and glycaemic variability (GV). METHODS: Prospective pilot study. We selected women with Type 1 diabetes who initiated a PPC programme with normal hypoglycaemia awareness (n = 24). Hypoglycaemia awareness, hypoglycaemic events and GV derived from masked-continuous glucose monitoring were evaluated in the first visit and within 2 weeks after pregnancy confirmation. RESULTS: The duration was 16.5 ±â€¯13.0 months. HbA1c significantly decreased (-0.8 ±â€¯0.7; p < 0.001). The Clarke score increased (0[0-1] vs. 1[0-2] points, p = 0.164), 2 out of 24 were reclassified as having impaired awareness of hypoglycaemia and 2 presented severe hypoglycaemia. GV decreased: standard deviation (p = 0.008), coefficient of variation (p = 0.021), mean amplitude of glycaemic excursions (p = 0.007), average daily risk range (p < 0.001), J-index (p = 0.010), high blood glucose index (HBGI) (p = 0.004), continuous overall net glycaemic action (CONGA) (p = 0.018), mean of daily differences (p = 0.045) and glycaemic risk assessment diabetes equation (p = 0.012). Final HbA1c was associated with baseline J-index, CONGA and HBGI (ß = 0.535, ß = 0.466, ß = 0.534, respectively; p < 0.05). CONCLUSIONS: A PPC programme improved HbA1c as well as GV with no significant impact on hypoglycaemia awareness. Moreover, GV could help to identify women less likely to achieve glycaemic targets. Larger studies are needed to confirm these results.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/normas , Glucemia/análisis , Diabetes Mellitus Tipo 1/sangre , Conocimientos, Actitudes y Práctica en Salud , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Atención Preconceptiva/métodos , Adulto , Automonitorización de la Glucosa Sanguínea/métodos , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hiperglucemia/sangre , Hiperglucemia/inducido químicamente , Hiperglucemia/diagnóstico , Hipoglucemia/sangre , Hipoglucemia/inducido químicamente , Hipoglucemia/diagnóstico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Proyectos Piloto , Pronóstico , Estudios Prospectivos
15.
Intern Med ; 58(19): 2825-2830, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31243198

RESUMEN

A 77-year-old-man with renal cell carcinoma who was undergoing nivolumab treatment visited our department due to hyperglycemia; his plasma glucose level was 379 mg/dL. Although his serum C-peptide immunoreactivity (CPR) level was preserved (5.92 ng/mL), we suspected an onset of fulminant type 1 diabetes mellitus (FT1DM) and immediately started insulin therapy. His CPR levels gradually decreased and were depleted within 1 week. We later discovered that the patient's casual CPR level had been abnormally high (11.78 ng/mL) 2 weeks before his admission. Hence, the possibility of FT1DM in hyperglycemic patients undergoing nivolumab treatment should not be excluded, even with a preserved CPR level.


Asunto(s)
Glucemia/metabolismo , Péptido C/sangre , Diabetes Mellitus Tipo 1/inducido químicamente , Hiperglucemia/diagnóstico , Nivolumab/efectos adversos , Anciano , Anticuerpos Monoclonales/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Antineoplásicos Inmunológicos/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Diabetes Mellitus Tipo 1/sangre , Humanos , Hiperglucemia/sangre , Hiperglucemia/inducido químicamente , Insulina/sangre , Neoplasias Renales/tratamiento farmacológico , Masculino , Nivolumab/uso terapéutico
16.
Nutrients ; 11(6)2019 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-31234301

RESUMEN

Overnutrition during critical windows of development plays a significant role in life-long metabolic disease risk. Early exposure to excessive nutrition may result in altered programming leading to increased susceptibility to obesity, inflammation, and metabolic complications. This study investigated the programming effects of high-fat diet (HFD) exposure during the lactation period on offspring adiposity and inflammation. Female C57Bl/6J dams were fed a normal diet or a 60% HFD during lactation. Offspring were weaned onto a normal diet until 12 weeks of age when half were re-challenged with HFD for 12 weeks. Metabolic testing was performed throughout adulthood. At 24 weeks, adipose depots were isolated and evaluated for macrophage profiling and inflammatory gene expression. Males exposed to HFD during lactation had insulin resistance and glucose intolerance as adults. After re-introduction to HFD, males had increased weight gain and worsened insulin resistance and hyperglycemia. There was increased infiltration of pro-inflammatory CD11c+ adipose tissue macrophages, and bone marrow was primed to produce granulocytes and macrophages. Bone density was lower due to enhanced marrow adiposity. This study demonstrates that maternal HFD exposure during the lactational window programs offspring adiposity, inflammation, and impaired glucose homeostasis.


Asunto(s)
Tejido Adiposo/fisiopatología , Adiposidad , Médula Ósea/fisiopatología , Dieta Alta en Grasa/efectos adversos , Hiperglucemia/etiología , Inflamación/etiología , Lactancia , Exposición Materna/efectos adversos , Fenómenos Fisiologicos Nutricionales Maternos , Obesidad/etiología , Tejido Adiposo/metabolismo , Factores de Edad , Animales , Biomarcadores/sangre , Glucemia/metabolismo , Médula Ósea/metabolismo , Femenino , Hiperglucemia/sangre , Hiperglucemia/fisiopatología , Inflamación/sangre , Inflamación/fisiopatología , Mediadores de Inflamación/sangre , Resistencia a la Insulina , Masculino , Ratones Endogámicos C57BL , Células Mieloides/metabolismo , Estado Nutricional , Obesidad/sangre , Obesidad/fisiopatología , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Aumento de Peso
17.
Clin Lab ; 65(6)2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-31232032

RESUMEN

BACKGROUND: The current study mainly evaluated whether peripheral blood miR-937 could be a biomarker to differentiate patients with metabolic disorders and healthy controls. METHODS: The peripheral blood was collected with patients with hyperglycemia, hyperlipidemia and healthy control. The relative peripheral blood miR-937 level in patients with metabolic disorders and healthy individuals were evaluated by real-time PCR. Receiver operating characteristic curve (ROC) analysis and Spearman's correlation coefficient were applied to evaluate whether miR-937 could be a potential biomarker for metabolic disorders. Dual luciferase reporter assay was performed to identify the possible target genes of miR-937. RESULTS: First, miR-937 was significantly increased (8.02 ± 8.27) in the peripheral blood of hyperglycemia patients. The level of miR-937 of patients with hyperlipidemia (13.7 ± 14.72) was also enhanced obviously compared with healthy controls (1 ± 1.35). ROC analysis showed that the peripheral blood levels of miR-937 could screen patients with hyperglycemia or hyperlipidemia from healthy controls. Furthermore, peripheral blood miR-937 level posi-tively correlated with serum glucose level (r = 0.556, p < 0.01) as well as total serum TG/TC levels (r = 0.455, p < 0.01). Dual luciferase reporter assay indicated that miR-937 suppressed the relative luciferase activity of pmir-GLO-AMPKα-3'UTR. CONCLUSIONS: The upregulation of circulating miR-937 level may cause a metabolism disorder by suppressing the expression of AMPKα. miR-937 could be a potential biomarker to differentiate patients with metabolism syndrome from healthy controls.


Asunto(s)
Proteínas Quinasas Activadas por AMP/genética , Biomarcadores/metabolismo , Enfermedades Metabólicas/genética , MicroARNs/genética , Regiones no Traducidas 3'/genética , Biomarcadores/sangre , Femenino , Regulación de la Expresión Génica , Células HEK293 , Células Hep G2 , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Hiperglucemia/genética , Hiperlipidemias/sangre , Hiperlipidemias/diagnóstico , Hiperlipidemias/genética , Masculino , Enfermedades Metabólicas/sangre , Enfermedades Metabólicas/diagnóstico , MicroARNs/sangre , Persona de Mediana Edad , Curva ROC
18.
Indian J Med Res ; 149(3): 384-388, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-31249204

RESUMEN

Background & objectives: Diabetes mellitus (DM) is an important risk factor for tuberculosis and has received increasing emphasis. However, the reverse association of tuberculosis impacting blood sugar levels has not been well studied. The present study was conducted to evaluate the prevalence of hyperglycemia in patients with tuberculosis and assess its resolution following successful treatment of tuberculosis. Methods: In this prospective study, a total of 582 patients with tuberculosis were evaluated for hyperglycaemia [DM or impaired glucose tolerance (IGT)] with random blood sugar (RBS) and all patients with RBS >100 mg/dl were subjected to a 75 g oral glucose tolerance test (OGTT). All patients received thrice weekly intermittent Directly Observed Treatment Short Course (DOTS) for tuberculosis. Patients with hyperglycaemia were re-evaluated at the end of anti-tuberculosis treatment with an OGTT and glycated hemoglobin (HbA1c) levels to assess for glycaemic status. Results: In the present study, 41 of the 582 patients were found to have DM [7%, 95% confidence interval (CI) (5.2, 9.4)] while 26 patients were found to have IGT [4.5%, 95% CI (3, 6.5)]. Three patients were lost to follow up. Of the 26 patients with IGT, 17 [65.4%, 95% CI (46.1, 80.7)] reverted to euglycaemic status following successful treatment of tuberculosis, while the blood sugar levels improved in all patients with DM following treatment of tuberculosis. Interpretation & conclusions: Our study results show that tuberculosis adversely impacts glycaemic status with improvement in blood sugar levels at the end of successful treatment of tuberculosis. Longitudinal studies with large sample size are required to confirm these findings.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Hiperglucemia/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Glucemia , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Intolerancia a la Glucosa , Prueba de Tolerancia a la Glucosa , Humanos , Hiperglucemia/sangre , Hiperglucemia/complicaciones , Masculino , Persona de Mediana Edad , Factores de Riesgo , Tuberculosis/sangre , Tuberculosis/complicaciones , Adulto Joven
19.
Diabetes Res Clin Pract ; 154: 43-51, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31226281

RESUMEN

INTRODUCTION: Controlling postprandial glycemia (PPG) is important to achieve optimal glycemic control, but few studies have evaluated how often is measured and evaluated. OBJECTIVES: To evaluate how often patients on insulin therapy measure PPG and modify insulin doses accordantly. As secondary objectives, we evaluated the factors conditioning elevated PPG and associated issues. MATERIAL AND METHODS: Cross-sectional observational study based on a web-based survey from an unselected sample of adult insulin-treated patients. A p-value of < 0.05 was significant. RESULTS: 1251 patients (68% women, 38.9 ±â€¯13 years [mean ±â€¯SD], body mass index (BMI) 24.2 ±â€¯4.2 kg/m2, diabetes duration 17.4 ±â€¯12.8 years, insulin dose 38 ±â€¯18 IU) participated, 1104 with autoinmmune disease (AD) and 147 with non-autoinmmune diabetes (NAD). 59% of patients had HbA1c ≤ 7%, 92.7% of patients with AD and 55.8% with NAD were attended by specialists (p < 0.001). People with AD did more often blood glucose monitoring (BGM) (p < 0.0001) and used continuous glucose monitoring systems (CGMS) (p < 0.0001). 90.1% with AD and 68.0% with NAD received instructions on measuring PPG (p < 0.001), and more with AD received specific training to change the treatment (87% vs. 61.2%, p < 0.0001) and were more proactive. However, more with NAD discussed their postprandial glucose levels with their healthcare team during clinical visits (92.5% vs. 74.1%, p < 0.0001). Regarding bolus administration, 88.6% with AD and 68.7% with NAD injected the insulin bolus before meals (p < 0.001). CONCLUSIONS: Patients with AD determine PPG more frequently. Diabetes type, follow-up setting, number of injections and CGMS use were the most important predictive factors for PPG measurement. Diabetes education programs should address how to best monitor PPG and appropriate corrective actions.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/normas , Glucemia/análisis , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Hiperglucemia/prevención & control , Insulina/normas , Insulina/uso terapéutico , Periodo Posprandial , Adulto , Estudios Transversales , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hiperglucemia/sangre , Hipoglucemiantes/normas , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , España/epidemiología , Encuestas y Cuestionarios
20.
Diabetes Res Clin Pract ; 152: 1-8, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31078665

RESUMEN

AIMS: It is known that autonomic nerve activity (ANA) affects glucose metabolism by regulating the secretion of insulin and glucagon. Sympathetic nerve stimulation results in increased blood glucose levels. ANA also showed a circadian variation, and sympathetic nerve activity was minimal at night and began to rise at arousal. Therefore, a drastic alteration in ANA around wake-up would be associated with glycemic variability (GV) known risk factor for cardiovascular disease. We investigated the relation between ANA around wake-up and either morning or daily GV. METHODS: We simultaneously performed Holter ECG and continuous glucose monitoring system in 41 patients with type 2 diabetes (T2D). ANA was assessed by heart rate variability (HRV) analysis. Delta (Δ) wake-up was defined as the difference between the maximum and minimum value during 1 h before and after wake-up time, before breakfast. RESULTS: Δ of low frequency/high frequency (LF/HF) around wake-up time (Δ LF/HF wake-up) was positively associated with Δ glucose wake-up, standard deviation (SD) glucose wake-up, the mean amplitude of glucose excursions (MAGE24h), and SD glucose24h after adjustment for age, sex, BMI, the duration of diabetes, and the prevalence of diabetic polyneuropathy (ß = 0.47, p = 0.011, ß = 0.48, p = 0.009, ß = 0.54, p = 0.002 and ß = 0.41, p = 0.0025, respectively). No association was found between Δ LF/HFwake-up and either mean blood glucose for 24 h, or HbA1c as parameters of chronic hyperglycemia. CONCLUSIONS: In T2D, the fluctuation in fasting sympathetic nerve activity around wake-up was positively associated with not only morning but also daily GV.


Asunto(s)
Nivel de Alerta/fisiología , Glucemia/metabolismo , Ritmo Circadiano/fisiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Frecuencia Cardíaca/fisiología , Sistema Nervioso Simpático/fisiopatología , Anciano , Automonitorización de la Glucosa Sanguínea , Estudios de Cohortes , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/patología , Angiopatías Diabéticas/complicaciones , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/metabolismo , Angiopatías Diabéticas/fisiopatología , Neuropatías Diabéticas/sangre , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/fisiopatología , Progresión de la Enfermedad , Electrocardiografía , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/complicaciones , Hiperglucemia/fisiopatología , Insulina/metabolismo , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Factores de Riesgo , Sistema Nervioso Simpático/metabolismo
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