Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study).

INTRODUCTION: Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers. OBJECTIVE: The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment. METHODS: The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR). RESULTS: There was a strong positive correlation between fructosamine and HbA1c (n = 318, r = 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r = 0.61, p < 0.001) or using glucocorticoids (n = 96, r = 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r = 0.66, p < 0.001), hypoproteinemia (n = 54, r = 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m2 (n = 189, r = 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r = 0.54, p = 0.001) and with reduced eGFR (n = 67, r = 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r = 0.49, p < 0.001; n = 111, r = 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m2 or with anemia. CONCLUSIONS: Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy.

Estimated average blood glucose level based on fructosamine level.

Objective: To define the mathematical relationship between fructosamine levels and average glucose values. Subjects and methods: The study comprised laboratory data of 1,227 patients with type 1 or 2 diabetes mellitus. Fructosamine levels measured at the end of a 3-week period were compared against the average blood glucose levels of the previous 3 weeks. Average glucose levels were determined by the weighted average of the daily fasting capillary glucose results performed during the study period, and the plasma glucose measured in the same sample collected for fructosamine measurement. Results: In total, 9,450 glucose measurements were performed. Linear regression analysis between fructosamine levels and average glucose levels showed that for each 1.0 µmol/L increase in fructosamine level there was a 0.5 mg/dL increase in average glucose level, as estimated by the equation Mean glucose level = (0.5157 × Fructosamine) - 20. The coefficient of determination (r2 = 0.353492, p < 0.006881) allowed the calculation of the estimated average glucose based on fructosamine level. Conclusion: Our study demonstrated a linear correlation between fructosamine level and mean blood glucose level, suggesting that fructosamine levels can be a proxy for the average glucose level in assessing the metabolic control of patients with diabetes.

Effects of Astragalus membranaceus, Peumus boldus and Curcuma longa extracts in diabetic rats / Efeitos de extratos de Astragalus membranaceus, Peumus boldus e Curcuma longa em ratos com diabetes induzida

Objectives: the aim of this study was to evaluate the effects of the association of dry extracts of Astragalus membranaceus, Peumus boldus and Curcuma longa in rats with induced diabetes. Methods: After the induction of type 2 diabetes by intraperitoneal streptozotocin, male Wistar rats were randomly assigned to groups (n=6) and treated for 20 days. The extracts were suspended in water and administered through orogastric gavage once daily as described: Group I: healthy control (saline); group II: received Astragalus membranaceus, Peumus boldus and Curcuma longa (400 mg/kg/day of each dry extract); group III: received Astragalus membranaceus, Peumus boldus, Curcuma longa (400 mg/kg/day of each dry extract) and glibenclamide (15 mg/kg/day). Fasting glucose, glucose tolerance, alanine aminotransferase, aspartate aminotransferase and fructosamine were evaluated. Results: Fasting blood glucose and glucose tolerance for groups II and III were influenced by treatments (p<0.05). The extracts did not significantly influence the efficacy of glibenclamide. Conclusion: The results found in this study allow us to consider that it is not possible to conclude that the compounds evaluated are not effective in DM in rats, due to variables such as total treatment period, doses, size of pancreatic injury caused by streptozotocin, and diet profile may have influenced the results. The studied compounds have potential for application in diabetes and further studies should be carried out to adjust the treatment.

Objetivos: avaliar os efeitos da associação de extratos secos de Astragalus membranaceus, Peumus boldus e Curcuma longa em ratos com diabetes induzida. Métodos: Após a indução de diabetes tipo 2 (DM) por estreptozotocina intraperitoneal, ratos Wistar machos foram distribuídos aleatoriamente em grupos (n=6) e tratados por 20 dias. Os extratos foram suspensos em água e administrados por gavagem orogástrica uma vez ao dia conforme descrito: Grupo I: controle saudável (solução salina); grupo II: recebeu Astragalus membranaceus, Peumus boldus e Curcuma longa (400 mg/kg/dia de cada extrato seco); grupo III: receberam Astragalus membranaceus, Peumus boldus, Curcuma longa (400 mg/kg/dia de cada extrato seco) e glibenclamida (15 mg/kg/dia). A glicemia de jejum, tolerância à glicose, alanina aminotransferase, aspartato aminotransferase e frutosamina foram avaliados. Resultados: A glicemia de jejum e a tolerância à glicose para os grupos II e III foram influenciadas pelos tratamentos (p<0,05). Os extratos não influenciaram significativamente na eficácia da glibenclamida. Conclusão: Os resultados encontrados neste estudo permitem considerar que não é possível concluir que os compostos avaliados não são eficazes no DM em ratos, devido às variáveis como tempo total de tratamento, doses e tamanho da lesão pancreática causada por estreptozotocina, além do perfil da dieta, que podem ter influenciado os resultados. Os compostos estudados têm potencial para aplicação em diabetes e mais estudos devem ser realizados para adequar o tratamento.

Relación entre los niveles basales de fructosamina y glucosa en adultos mayores / Relationship between basal levels of fructosamine and glucose in older adults

INTRODUCCIÓN: los cambios fisiológicos a los que están expuestos los adultos mayores, son muchas veces factores negativos en su calidad de vida, sobre todo en aquellos que se encuentran en residencias geriátricas, existen parámetros como la glicemia y hemoglobina glucosilada que podrían ser útiles en el control metabólico. OBJETIVO: relacionar los niveles basales de Fructosamina y Glucosa en adultos mayores institucionalizados en residencias geriátricas del municipio de Tiquipaya, septiembre 2019. METODOLOGÍA: estudio no experimental, observacional, prospectivo, transversal, con enfoque de análisis positivista cuantitativo, con un universo de 97 adultos mayores de 65 años, con una muestra de 79 que cumplen con los criterios de inclusión y exclusión, con un 4,77% de error máximo aceptable. RESULTADOS: el 71% (n=56) de los pacientes fueron mujeres. Los ancianos predominaron como grupo etario. Se evidenció que no hay una buena concordancia entre los niveles basales de Glicemia y Fructosamina, mediante el cálculo estadístico del índice de Kappa que fue de 0,023; Test de Wilcoxon 0.081; Test correlación Pearson r=0.281. Los niveles basales de Fructosamina tienen una sensibilidad y especificidad altas del 82,14% (L.I. 62,42% -L.S. 93,23%) y 56.92% (L.I. 47,95% - L.S. 65,48%), respectivamente. CONCLUSIONES: no existe relación entre los niveles basales de Glucosa y la Fructosamina puesto que son parámetros de evaluación metabólica en diferente tiempo y una no remplaza la otra, por lo tanto, se debería implementar adicionalmente a la Glucosa la determinación de la Fructosamina para monitorizar a los pacientes adultos a mediano plazo.

INTRODUCTION: the physiological changes to which older adults are exposed; are many times negative factors in their quality of life, especially in those who are in geriatric residences. Glycemia and glycosylated hemoglobin are useful as metabolic control parameters. OBJECTIVE: to relate the basal levels of Fructosamine and Glucose in institutionalized older adults in geriatric residences in the municipality of Tiquipaya, September 2019. METHODOLOGY: non-experimental, observational, prospective, cross-sectional study, with a quantitative positivist analysis approach, with a universe of 97 adults over 65 years of age, with a sample of 79 that met the inclusion and exclusion criteria, with a maximum acceptable error of 4.77%. RESULTS: 71% (n=56) of the patients were female. The elderly dominated as an age group. It was evidenced that there is not a good agreement between basal levels of Glycemia and Fructosamine, through the statistical calculation of the Kappa index which was 0.023; Wilcoxon test 0.081; Pearson correlation test r= 0.281. The basal levels of Fructosamine have a high sensitivity and specificity of 82.14% (L.I. 62.42% - L.S. 93.23%) and 56.92% (L.I.47.95% - L.S. 65.48%), respectively. CONCLUSIONS: there is no relationship between basal levels of Glucose and Fructosamine since they are parameters of metabolic evaluation in different time and one does not replace the other, therefore, the determination of Fructosamine should be implemented in addition to Glucose to monitor adult patients in the medium term.

Protective effect of flavonoids from Passiflora edulis Sims on diabetic complications in rats.

OBJECTIVES: This study was carried out to evaluate the effects of flavonoids present in leaves of Passiflora edulis fruit on complications induced by diabetes in rats. METHODS: The extract of P. edulis leaf was obtained by 70% ethanol maceration. From the dry extract, the fractions were obtained by consecutive liquid-liquid partition with hexane, ethyl acetate and n-butanol. The content of isoorientin of ethyl acetate and n-butanol fractions was determined by ultra-performance liquid chromatography coupled with electrospray and triple quadrupole ionization (TQD) analysis in tandem mass spectrometry (UPLC-ESI-Tq-MS). Only Fr-BuOH was used to treat diabetic or not Wistar rats. Biochemical parameters, platelet aggregation and production of reactive species were evaluated. KEY FINDINGS: The UPLC-ESI-Tq-MS analysis revealed the presence of several flavonoids, among which we identified five possible flavonoids c-heterosides (luteolin-7-O-pyranosyl-3-O-glucoside, apigenin-6-8-di-C-glycoside, apigenin-6-C-arabinoside-8-C-glycoside, isoorientin, isovitexin). The diabetic rats (treated intraperitoneally with alloxan, 150 mg/kg) treated with Fr-BuOH (20 mg/kg/day for 90 days) presented improvement in blood glucose, serum levels of fructosamine, lipid profile and urea. Furthermore, the Fr-BuOH reduced both platelet aggregation and the production of oxidant species in diabetic animals. CONCLUSIONS: These results suggested that flavonoid C-glycosides present in the Fr-BuOH may be beneficial for the diabetic state, preventing complications induced by diabetes.

Changes in metabolic and physiological biomarkers in Mangalarga Marchador horses with induced obesity.

This study aimed to characterize and correlate physiological and metabolic changes in horses fed a hypercaloric diet (HD). Nine mature horses with a mean initial body condition score of 2.9 ± 1 (scale, 1-9) were fed a high-calorie diet for 5 months. Fasting blood samples were collected before the study and biweekly for the duration of the project to determine the concentrations of cholesterol (CHOL), very low (VLDL), low (LDL) and high-density (HDL) lipoproteins, triglycerides, non-esterified fatty acids, and fructosamine. A low-dose oral glucose tolerance test (LGTT) was conducted before, 75 and 150 days after HD introduction. Mean arterial blood pressure was measured monthly. Following HD introduction, CHOL, LDL, HDL, and fructosamine blood concentrations increased (P < 0.001). These four variables were also positively and significantly correlated with the blood insulin response to LGTT. These findings confirm the occurrence of hypercholesterolemia concomitantly with insulin dysregulation development in horses exposed to HD.

Curcumin, Alone or in Combination with Aminoguanidine, Increases Antioxidant Defenses and Glycation Product Detoxification in Streptozotocin-Diabetic Rats: A Therapeutic Strategy to Mitigate Glycoxidative Stress.

Both oxidative stress and the exacerbated generation of advanced glycation end products (AGEs) have crucial roles in the onset and progression of diabetic complications. Curcumin has antioxidant and antidiabetic properties; its combination with compounds capable of preventing the advanced glycation events, such as aminoguanidine, is an interesting therapeutic option to counteract diabetic complications. This study is aimed at investigating the effects of treatments with curcumin or aminoguanidine, alone or in combination, on metabolic alterations in streptozotocin-diabetic rats; the focus was mainly on the potential of these bioactive compounds to oppose the glycoxidative stress. Curcumin (90 mg/kg) or aminoguanidine (50 and 100 mg/kg), alone or in combination, slightly decreased glycemia and the biomarkers of early protein glycation, but markedly decreased AGE levels (biomarkers of advanced glycation) and oxidative damage biomarkers in the plasma, liver, and kidney of diabetic rats. Some novel insights about the in vivo effects of these bioactive compounds are centered on the triggering of cytoprotective machinery. The treatments with curcumin and/or aminoguanidine increased the activities of the antioxidant enzymes (paraoxonase 1, superoxide dismutase, and catalase) and the levels of AGE detoxification system components (AGE-R1 receptor and glyoxalase 1). In addition, combination therapy between curcumin and aminoguanidine effectively prevented dyslipidemia in diabetic rats. These findings demonstrate the combination of curcumin (natural antioxidant) and aminoguanidine (prototype therapeutic agent with anti-AGE activity) as a potential complementary therapeutic option for use with antihyperglycemic agents, which may aggregate beneficial effects against diabetic complications.

Effects of pea with barley and less-processed maize on glycaemic control in diabetic dogs.

The source of starch may interfere with glycaemic control in dogs, but few studies have evaluated these aspects in diabetic dogs. This study compared the effects of two isonutrient diets with different starch sources, peas and barley (PB) v. maize (Mi), on diabetic dogs. The Mi diet was processed in order to generate a lower starch gelatinisation index. In all, fifteen adult diabetic dogs without other conditions were included. The animals were fed two dry extruded rations with moderate levels of fat and starch and high levels of protein and fibre using a random, double-blind cross-over design. Glycaemic curves over 48 h were developed via continuous glucose monitoring after 60 d on each diet and with the same neutral protamine Hagedorn (NPH) insulin dosage. The following were compared: fasting, mean, maximum and minimum blood glucose, maximum and minimum glycaemia difference, glycaemic increment, area under the glycaemic curve, area under the glycaemic increment curve and serum fructosamine concentration. Paired t tests or Wilcoxon signed-rank tests were used to compare the amount of food and nutrients ingested and the dietary effects on glycaemic variables between the diets. Dogs fed the PB diet presented a lower average mean interstitial glucose (P=0·01), longer mean hypoglycaemic time (P<0·01), shorter mean hyperglycaemic time (P<0·01) and smaller difference between maximum and minimum blood glucose levels (P=0·03). Thus, the processing applied to the Mi diet was not sufficient to achieve the same effects of PB on glycaemic control in diabetic dogs.

Hemoglobin A1c Accurately Predicts Continuous Glucose Monitoring-Derived Average Glucose in Youth and Young Adults With Cystic Fibrosis.

OBJECTIVE: In cystic fibrosis (CF), hemoglobin A1c (HbA1c) is thought to underestimate glycemia. However, few studies have directly assessed the relationship between HbA1c and average glucose in CF. We determined the relationships among glycemic markers-HbA1c, fructosamine (FA), glycated albumin (%GA), and 1,5-anhydroglucitol (1,5-AG)-and continuous glucose monitoring (CGM) in CF, hypothesizing that alternate markers would better predict average sensor glucose (ASG) than HbA1c. RESEARCH DESIGN AND METHODS: CF participants and a group of healthy control subjects (HCs), ages 6-25 years, wore CGM for up to 7 days. Pearson correlations assessed the relationships between CGM variables and HbA1c, FA, %GA, and 1,5-AG. The regression line between HbA1c and ASG was compared in CF versus HC. Linear regressions determined whether alternate markers predicted ASG after adjustment for HbA1c. RESULTS: CF (n = 93) and HC (n = 29) groups wore CGM for 5.2 ± 1 days. CF participants were 14 ± 3 years of age and 47% were male, with a BMI z score -0.1 ± 0.8 and no different from HCs in age, sex, or BMI. Mean HbA1c in CF was 5.7 ± 0.8% (39 ± 9 mmol/mol) vs. HC 5.1 ± 0.2% (32 ± 2 mmol/mol) (P < 0.0001). All glycemic markers correlated with ASG (P ≤ 0.01): HbA1c (r = 0.86), FA (r = 0.69), %GA (r = 0.83), and 1,5-AG (r = -0.26). The regression line between ASG and HbA1c did not differ in CF versus HC (P = 0.44). After adjustment for HbA1c, %GA continued to predict ASG (P = 0.0009) in CF. CONCLUSIONS: HbA1c does not underestimate ASG in CF as previously assumed. No alternate glycemic marker correlated more strongly with ASG than HbA1c. %GA shows strong correlation with ASG and added to the prediction of ASG beyond HbA1c. However, we are not advocating use of HbA1c for diabetes screening in CF based on these results. Further study will determine whether glycemic measures other than ASG differ among different types of diabetes for a given HbA1c.

Diabetes Mellitus em gato: relato de caso / Diabetes mellitus in cat: case report / Diabetes mellitus en felinos: relato de caso

Diabetes Mellitus é uma endocrinopatia bastante presente na clínica de felinos, ocorrendo devido a uma deficiência relativa ou absoluta de insulina ou a resistência da sua ação. A hiperglicemia persistente desencadeia uma sintomatologia sugestiva da doença que para seu correto diagnóstico deve ser associado aos exames laboratoriais, avaliando-se sempre a glicemia e a frutosamina sérica. Objetivou-se com este trabalho, relatar o caso de um felino macho com 11 anos de idade e sem raça definida, apresentando Diabetes Mellitus e tratado com insulina NPH a cada 12 horas. O sucesso do tratamento dependerá do comprometimento do proprietário durante toda a vida do animal, assim como na frequente monitoração clínica e laboratorial do paciente, realizada pelo veterinário.(AU)

Diabetes Mellitus is a very endocrinopathy present in clinical feline, occurring due to an absolute or relative insulin deficiency or resistance of its action. Persistent hyperglycemia triggers a suggestive symptoms of the disease for its correct diagnosis should be associated with laboratory tests, assessing always blood glucose and serum fructosamine. The objective of this study is to report the case of a male cat with 11-year-old mixed breed, with diabetes mellitus and treated with NPH insulin every 12 hours. Successful treatment depends on the owner's involvement during the entire life of the animal, as well as common laboratory and clinical patient monitoring, carried out by the veterinarian.(AU)

La diabetes mellitus es un regalo muy endocrinopatía en clínica felina, que se producen debido a una deficiencia de insulina absoluta o relativa o resistencia a su acción. La hiperglucemia persistente desencadena um sugestivo síntomas de la enfermedad para su diagnóstico correcto deben estar asociados con las pruebas de laboratorio, la evaluación siempre glucosa en sangre y la fructosamina sérica. El objetivo de este estudio es dar a conocer el caso de un gato macho con 11 anos de edad, de raza mixta, con la diabetes mellitus y tratados com insulina NPH cada 12 horas. El éxito dei tratamiento depende de la participación dei propietario durante toda la vida del animal, así como de laboratorio común y la monitorización clínica dei paciente, llevado a cabo por el veterinario.(AU)

Diabetes Mellitus em gato: relato de caso / Diabetes mellitus in cat: case report / Diabetes mellitus en felinos: relato de caso

Diabetes Mellitus é uma endocrinopatia bastante presente na clínica de felinos, ocorrendo devido a uma deficiência relativa ou absoluta de insulina ou a resistência da sua ação. A hiperglicemia persistente desencadeia uma sintomatologia sugestiva da doença que para seu correto diagnóstico deve ser associado aos exames laboratoriais, avaliando-se sempre a glicemia e a frutosamina sérica. Objetivou-se com este trabalho, relatar o caso de um felino macho com 11 anos de idade e sem raça definida, apresentando Diabetes Mellitus e tratado com insulina NPH a cada 12 horas. O sucesso do tratamento dependerá do comprometimento do proprietário durante toda a vida do animal, assim como na frequente monitoração clínica e laboratorial do paciente, realizada pelo veterinário.

Diabetes Mellitus is a very endocrinopathy present in clinical feline, occurring due to an absolute or relative insulin deficiency or resistance of its action. Persistent hyperglycemia triggers a suggestive symptoms of the disease for its correct diagnosis should be associated with laboratory tests, assessing always blood glucose and serum fructosamine. The objective of this study is to report the case of a male cat with 11-year-old mixed breed, with diabetes mellitus and treated with NPH insulin every 12 hours. Successful treatment depends on the owner's involvement during the entire life of the animal, as well as common laboratory and clinical patient monitoring, carried out by the veterinarian.

La diabetes mellitus es un regalo muy endocrinopatía en clínica felina, que se producen debido a una deficiencia de insulina absoluta o relativa o resistencia a su acción. La hiperglucemia persistente desencadena um sugestivo síntomas de la enfermedad para su diagnóstico correcto deben estar asociados con las pruebas de laboratorio, la evaluación siempre glucosa en sangre y la fructosamina sérica. El objetivo de este estudio es dar a conocer el caso de un gato macho con 11 anos de edad, de raza mixta, con la diabetes mellitus y tratados com insulina NPH cada 12 horas. El éxito dei tratamiento depende de la participación dei propietario durante toda la vida del animal, así como de laboratorio común y la monitorización clínica dei paciente, llevado a cabo por el veterinario.

Manejo del control glucémico: objetivos de tratamiento y métodos. Hemoglobina glicosilada A1C (HbA1c). Fructosamina. Automonitoreo glucémico. Glucosuria. Cetonuria / Management of glycemia monitoring: objectives of treatment and methods. Glycosilated hemoglobin A1c (HbA1c). Fructosamine. Self-blood glucose monitoring. Glycosuria. Ketonuria

En la medición estándar del control y el seguimiento en pacientes con diabetes, la hemoglobina glicosilada (HbA1C) presenta dificultades en la insuficiencia renal, en la cual puede no ser buen indicador del control glucémico. La fructosamina no es válida cuando la albumina es menor a 3 mg/dl, mientras que la glucosuria y la cetonuria no son herramientas de medición efectiva en enfermedad renal. El automonitoreo glucémico (AMG) individualizado es un método útil en todos los estadios renales y el de mayor valor en el control y seguimiento en insuficiencia renal avanzada y tratamientos renales sustitutivos

Low glycemic index diet reduces body fat and attenuates inflammatory and metabolic responses in patients with type 2 diabetes

ABSTRACT Objective The aim of this study was to verify the effects of glycemic index (GI) on body composition, and on inflammatory and metabolic markers concentrations in patients with type 2 diabetes. Subjects and methods In this randomized controlled parallel trial, twenty subjects (aged 42.4 ± 5.1 years, BMI 29.2 ± 4.8 kg.m-2) were allocated to low GI (LGI) (n = 10) or high GI (HGI) (n = 10) groups. Body composition, inflammatory and metabolic markers were assessed at baseline and after 30 days of intervention. Food intake was monitored during the study using three-day food records completed on two non-consecutive weekdays and on a weekend day. Results Body fat reduced after the LGI intervention compared with baseline (P = 0.043) and with the HGI group (P = 0.036). Serum fructosamine concentration (P = 0.031) and TNF-α mRNA expression (P = 0.05) increased in the HGI group. Serum non-esterified fatty acids were greater in the HGI than in the LGI group (P = 0.032). IL-6 mRNA expression tended to decrease after the consumption of the LGI diet compared to baseline (P = 0.06). Conclusion The LGI diet reduced body fat and prevented the negative metabolic and inflammatory responses induced by the HGI diet.

Low glycemic index diet reduces body fat and attenuates inflammatory and metabolic responses in patients with type 2 diabetes.

OBJECTIVE: The aim of this study was to verify the effects of glycemic index (GI) on body composition, and on inflammatory and metabolic markers concentrations in patients with type 2 diabetes. SUBJECTS AND METHODS: In this randomized controlled parallel trial, twenty subjects (aged 42.4 ± 5.1 years, BMI 29.2 ± 4.8 kg.m-2) were allocated to low GI (LGI) (n = 10) or high GI (HGI) (n = 10) groups. Body composition, inflammatory and metabolic markers were assessed at baseline and after 30 days of intervention. Food intake was monitored during the study using three-day food records completed on two non-consecutive weekdays and on a weekend day. RESULTS: Body fat reduced after the LGI intervention compared with baseline (P = 0.043) and with the HGI group (P = 0.036). Serum fructosamine concentration (P = 0.031) and TNF-α mRNA expression (P = 0.05) increased in the HGI group. Serum non-esterified fatty acids were greater in the HGI than in the LGI group (P = 0.032). IL-6 mRNA expression tended to decrease after the consumption of the LGI diet compared to baseline (P = 0.06). CONCLUSION: The LGI diet reduced body fat and prevented the negative metabolic and inflammatory responses induced by the HGI diet.

[Correlation of the Levels of Fructosamine and Glycated Hemoglobin with the Blood Glucose Profile in Pregnant Women with Diabetes Mellitus]. / Correlação das dosagens de frutosamina e de hemoglobina glicosilada com o perfil glicêmico em gestantes com diabetes mellitus.

OBJECTIVE: To evaluate the correlation of the levels of fructosamine and of glycated hemoglobin (HbA1c) with the frequency of blood glucose self-monitoring values out of the treatment target range in pregnant women with diabetes mellitus. METHODS: We performed an observational, retrospective, cross-sectional study, including all pregnant women with diabetes who attended prenatal care visits at a tertiary teaching hospital during the year of 2014 and who presented at least 20 days of blood glucose self-monitoring prior to assessment of serum levels of fructosamine and HbA1c. Capillary blood glucose values out of the treatment target range were considered "hypoglycemia" when lower than 70 mg/dL and "hyperglycemia" when above the glycemic therapeutic target. We evaluated the correlation of the levels of fructosamine and of HbA1c with the frequencies of hyperglycemia and hypoglycemia recorded in the glucometer device by performing Tau-b of Kendall correlation tests. Next, linear regression tests were performed between the levels of HbA1c and of fructosamine and the frequencies of hypoglycemia and hyperglycemia. RESULTS: We included 158 pregnant women, from whom 266 blood samples were obtained for assessing fructosamine and HbA1c levels. Measurements of fructosamine and of HbA1c presented, respectively, Kendall's τ coefficient of 0.29 (p < 0.001) and 0.50 (p < 0.001) regarding the frequency of hyperglycemia, and of 0.09 (p = 0.046) and 0.25 (p < 0.001) regarding the frequency of hypoglycemia. In the linear regression model, levels of fructosamine and of HbA1c respectively presented determination coefficients R2 = 0.265 (p < 0.001) and R2 = 0.513 (p < 0.001) for the prediction of hyperglycemia, and R2 = 0.033 (p = 0.003) and R2 = 0.059 (p < 0.001) for the prediction of hypoglycemia. CONCLUSION: Levels of fructosamine and of HbA1c presented a weak to moderate correlation with the frequencies of hyperglycemia and hypoglycemia at blood glucose self-monitoring and were not able to accurately translate the deviations from the glycemic goals in pregnant women with diabetes.

Correlação das dosagens de frutosamina e de hemoglobina glicosilada com o perfil glicêmico em gestantes com diabetes mellitus / Correlation of the Levels of Fructosamine and Glycated Hemoglobin with the Blood Glucose Profile in Pregnant Women with Diabetes Mellitus

Objetivo Avaliar se há correlação das dosagens de frutosamina e de hemoglobina glicosilada (HbA1c) com as frequências de desvios de glicemia capilar em gestantes com diabetes mellitus. Métodos estudo observacional, retrospectivo, de corte transversal, incluindo todas as gestantes comdiabetes que iniciaram o pré-natal emhospital terciário de ensino durante o ano de 2014 e que apresentavam pelo menos 20 dias de auto monitoramento glicêmico previamente às dosagens séricas de frutosamina e de HbA1c. Os desvios de glicemia capilar foram considerados "hipoglicemias" quando menores que 70mg/dL ou "hiperglicemias" quando acima do alvo glicêmico terapêutico para o horário. Foram testadas as correlações lineares par a par das dosagens de frutosamina e de HbA1c com as frequências de hipoglicemias e de hiperglicemias capilares pelo teste Tau-b de Kendall. Na sequência, foi avaliada a regressão linear entre as dosagens de HbA1c e de frutosamina e as frequências de hipoglicemias e de hiperglicemias. Resultados Foram incluídas 158 gestantes que contribuíram com 266 amostras para dosagem sérica de frutosamina e HbA1c. As dosagens de frutosamina e de HbA1c apresentaram, respectivamente, coeficientes τ de Kendall de 0,29 (p < 0,001) e 0,5 (p < 0,001) com a frequência de hiperglicemias, e de 0,09 (p = 0,04) e 0,25 (p < 0,001) com a frequência de hipoglicemias capilares. No modelo de regressão linear, as dosagens de frutosamina e de HbA1c apresentaram, respectivamente, coeficientes de determinação R2 = 0,26 (p < 0,001) e R2 = 0,51 (p < 0,001) para a predição de hiperglicemias, e R2 = 0,03 (p = 0,003) e R2 = 0,059 (p < 0,001) para a predição de hipoglicemias. Conclusão As dosagens de frutosamina e de HbA1c apresentam correlação fraca a moderada com as frequências de hiperglicemias e hipoglicemias capilares no auto monitoramento glicêmico e não são capazes de traduzir com precisão os desvios da meta glicêmica no tratamento de gestantes com diabetes.

Objective To evaluate the correlation of the levels of fructosamine and of glycated hemoglobin (HbA1c) with the frequency of blood glucose self-monitoring values out of the treatment target range in pregnant women with diabetes mellitus. Methods We performed an observational, retrospective, cross-sectional study, including all pregnant women with diabetes who attended prenatal care visits at a tertiary teaching hospital during the year of 2014 and who presented at least 20 days of blood glucose self-monitoring prior to assessment of serum levels of fructosamine and HbA1c. Capillary blood glucose values out of the treatment target range were considered "hypoglycemia" when lower than 70 mg/dL and "hyperglycemia" when above the glycemic therapeutic target. We evaluated the correlation of the levels of fructosamine and of HbA1c with the frequencies of hyperglycemia and hypoglycemia recorded in the glucometer device by performing Tau-b of Kendall correlation tests. Next, linear regression tests were performed between the levels of HbA1c and of fructosamine and the frequencies of hypoglycemia and hyperglycemia. Results We included 158 pregnant women, from whom 266 blood samples were obtained for assessing fructosamine and HbA1c levels. Measurements of fructosamine and of HbA1c presented, respectively, Kendall's τ coefficient of 0.29 (p < 0.001) and 0.50 (p < 0.001) regarding the frequency of hyperglycemia, and of 0.09 (p = 0.046) and 0.25 (p < 0.001) regarding the frequency of hypoglycemia. In the linear regression model, levels of fructosamine and of HbA1c respectively presented determination coefficients R2 = 0.265 (p < 0.001) and R2 = 0.513 (p < 0.001) for the prediction of hyperglycemia, and R2 = 0.033 (p = 0.003) and R2 = 0.059 (p < 0.001) for the prediction of hypoglycemia. Conclusion Levels of fructosamine and of HbA1c presented a weak to moderate correlation with the frequencies of hyperglycemia and hypoglycemia at blood glucose self-monitoring and were not able to accurately translate the deviations from the glycemic goals in pregnant women with diabetes.

Serum glucose, cholesterol, triglycerides and fructosamine in pregnant dogs / Concentração sérica de glicose, colesterol, triglicerídeos e frutosamina em cadelas gestantes

The aim of this study was to evaluate the occurrence of diabetes mellitus in pregnant dogs, as well as associated factors. They evaluated 20 pregnant dogs with varying ages, regardless of race and pregnancy. Serum glucose, cholesterol, triglycerides and fructosamine were performed with the patient fasted 12 hours, and abdominal ultrasound. The mean glucose, cholesterol and triglycerides were obtained 87,1mg/dL, 213,4mg/dL and 132,75mg/dL, respectively. Serum fructosamine was considered satisfactory in all pregnant women. Despite not having detected diabetes mellitus in the surveyed bitches diet and increased cholesterol and triglycerides in some pregnant women underscore the need for awareness of the owners of the factors associated with this disease by avoiding risk pregnant women and young dogs.(AU)

O objetivo desta pesquisa foi avaliar a ocorrência de diabetes mellitus em cadelas gestantes, bem como possíveis fatores associados. Foram avaliadas 20 cadelas gestantes, com idades variadas, independente de raça e período gestacional. Dosagem sérica de glicose, colesterol, triglicerídeos e frutosamina foram realizadas em pacientes em jejum de 12 horas, além de ultrassonografia abdominal. A média de glicose, colesterol e triglicerídeos obtidas foram de 87,1mg/dL, 213,4mg/dL e 132,75mg/dL, respectivamente. A concentração sérica de frutosamina foi considerada satisfatória em todas as gestantes. Apesar de não ter detectado a diabetes mellitus nas cadelas gestantes pesquisadas, a dieta e aumento de colesterol e triglicerídeos em algumas gestantes reforçam a necessidade de conscientização dos proprietários acerca dos fatores associados à esta enfermidade evitando risco as cadelas gestantes e filhotes.(AU)

Serum glucose, cholesterol, triglycerides and fructosamine in pregnant dogs / Concentração sérica de glicose, colesterol, triglicerídeos e frutosamina em cadelas gestantes

The aim of this study was to evaluate the occurrence of diabetes mellitus in pregnant dogs, as well as associated factors. They evaluated 20 pregnant dogs with varying ages, regardless of race and pregnancy. Serum glucose, cholesterol, triglycerides and fructosamine were performed with the patient fasted 12 hours, and abdominal ultrasound. The mean glucose, cholesterol and triglycerides were obtained 87,1mg/dL, 213,4mg/dL and 132,75mg/dL, respectively. Serum fructosamine was considered satisfactory in all pregnant women. Despite not having detected diabetes mellitus in the surveyed bitches diet and increased cholesterol and triglycerides in some pregnant women underscore the need for awareness of the owners of the factors associated with this disease by avoiding risk pregnant women and young dogs.

O objetivo desta pesquisa foi avaliar a ocorrência de diabetes mellitus em cadelas gestantes, bem como possíveis fatores associados. Foram avaliadas 20 cadelas gestantes, com idades variadas, independente de raça e período gestacional. Dosagem sérica de glicose, colesterol, triglicerídeos e frutosamina foram realizadas em pacientes em jejum de 12 horas, além de ultrassonografia abdominal. A média de glicose, colesterol e triglicerídeos obtidas foram de 87,1mg/dL, 213,4mg/dL e 132,75mg/dL, respectivamente. A concentração sérica de frutosamina foi considerada satisfatória em todas as gestantes. Apesar de não ter detectado a diabetes mellitus nas cadelas gestantes pesquisadas, a dieta e aumento de colesterol e triglicerídeos em algumas gestantes reforçam a necessidade de conscientização dos proprietários acerca dos fatores associados à esta enfermidade evitando risco as cadelas gestantes e filhotes.

Association between insulin resistance and risk of complications in children and adolescents with type 1 diabetes.

BACKGROUND: It has been hypothesized that insulin resistance may be involved in the development of type 1 diabetes complications and early diagnosis would be important for their prevention. Our aim was to study insulin resistance in our population of children with type 1 diabetes and to identify associated early risk factors for micro- and macrovascular complications. METHODS: A descriptive, cross-sectional study was conducted including 150 children with type 1 diabetes. Anthropometric, bioelectric impedance, carotid Doppler ultrasonography, electromyography, and conduction velocity studies were performed. Baseline plasma glucose, lipid profile, uric acid, plasma thyrotropin, glycosylated hemoglobin A1C, and microalbuminuria were assessed. More insulin-resistant patients were defined as those having an estimated glucose disposal rate (eGDR) value below the first quartile. RESULTS: Clinically manifest microvascular complications were not found in any of the patients. More insulin-resistant patients had a greater sub scapular fold thickness, a higher incidence of obesity (12% vs. 1.7% p 0.007), higher fructosamine levels (496 vs. 403 p<0.00019, and a higher incidence of altered lipid metabolism (70% vs. 39% p 0.0007). CONCLUSION: In the subgroup of patients with lower eGDR there were more children with lipid disorders, obesity, and worse diabetic control, which, if not corrected, may lead to development of micro- and macrovascular complications.

Hemoglobina glicada e frutosamina em cães com diabetes mellitus / Glycated hemoglobin and fructosamine in dogs with diabetes mellitus

Diabetes mellitus (DM) commonly occurs in dogs, and the laboratorial confirmation is carriedout by glycemia test. The diagnosis and monitoring in humans is made by glycated hemoglobinand fructosamine concentrations. The objective of this study was to diagnose DM in 19 dogs, byevaluating seric glucose, glycated hemoglobin and fructosamine concentrations. Six dogs with DMand treated with insulin were assisted during a twelve-month period, by means of the same bloodanalysis, until the death (three dogs) or glycemic control (three dogs). Glucose, glycated hemoglobinand fructosamine increased in all dogs with DM, and dogs that did not survive presented higherglycated hemoglobin and seric glucose values than those that survived at the last evaluation. Theresults showed the importance of evaluating glycated hemoglobin and fructosamine in dogs with DMto diagnose and control treatment effectiveness.(AU)

O Diabetes mellitus (DM) ocorre com frequência em cães, sendo a glicemia o teste laboratorialde confirmação. O diagnóstico e monitoramento em pessoas são realizados pelas concentrações dehemoglobina glicada e frutosamina. O objetivo deste estudo foi diagnosticar a DM em 19 cães, comavaliação das concentrações da glicose sérica, hemoglobina glicada e frutosamina. Seis cães comDM e em tratamento com insulina foram acompanhados por um período de doze meses, com asmesmas avaliações hematológicas, até o óbito (três cães) ou controle glicêmico (três cães). Observouseaumento dos valores de glicose, hemoglobina glicada e frutosamina em todos os cães com DM,e valores de hemoglobina glicada e glicose superiores nos animais não sobreviventes, na últimaavaliação realizada. Estes resultados apontam para a importância da avaliação de hemoglobina glicadae frutosamina em cães com diabetes e para diagnóstico e controle da efetividade do tratamento.(AU)