The Discrepancy Between Hemoglobin A1c and Glucose Management Indicators in 26 Patients Treated With Continuous Glucose Monitoring in an Internal Medicine Residency Clinic.

We conducted a retrospective observational cohort study between 2020 and 2023 in 26 patients with type 1 and type 2 diabetes mellitus (DM) who were using 3-4 injections per day of insulin and were monitored by continuous glucose monitoring (CGM). The goal of this retrospective observational cohort study is to compare these two metrics in an internal medicine community primary care residency clinic. We used CGM devices, Dexcom G6 and G7, and Freestyle Libre 3. The goal was to compare the patient's hemoglobin A1c (HbA1c) taken during their clinic visit by phlebotomy as a marker for diabetic control with an estimated HbA1c glucose management indicator (GMI) derived from the 30-day CGM readings. HbA1c is derived from the blood, while the GMI value is derived from the interstitial fluid. Both parameters were taken within 30 days of each other. GMI was taken in the last 30 days. We excluded patients with known anemia, chronic kidney disease, polycythemia, cirrhosis of the liver, or metabolic dysfunction associated with steatohepatitis (MASH) because disease states can affect the measured HbA1c. Also, pregnant and African American patients were excluded. We concluded the measured HbA1c was 0.34% (4 mmol/mol) higher than the CGM-derived GMI. The relationship between factors that affect glycemic control was discussed in the article, as well as the future utilization of them in improving diabetic control and management. As the use of CGM continues to grow, addressing differences between laboratory-measured HbA1c and CGM-derived GMI is critical.

Muscle Activity and Physiological Responses During Running in Water and on Dry Land at Submaximal and Maximal Efforts.

Masumoto, K, Mefferd, KC, Iyo, R, and Mercer, JA. Muscle activity and physiological responses during running in water and on dry land at submaximal and maximal efforts. J Strength Cond Res 32(7): 1960-1967, 2018-We investigated muscle activity, oxygen uptake, heart rate, and rating of perceived exertion during running in water and on dry land at submaximal and maximal efforts. Eleven recreational runners performed deep-water running (DWR) and treadmill running (TMR) graded exercise tests on separate days. On the third-test day, the subjects exercised at their 60, 80, and 100% of maximal oxygen uptake (V[Combining Dot Above]O2max) by matching specific stride frequencies or running speeds. V[Combining Dot Above]O2max, maximal heart rate (HRmax), and rating of perceived exertion at maximal effort (RPEmax) were measured. Furthermore, muscle activity from the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius were measured. V[Combining Dot Above]O2max (DWR: 48.9 ± 5.7 ml·kg·min; TMR: 59.2 ± 5.6 ml·kg·min; p < 0.001) and HRmax (DWR: 174.1 ± 9.6 beats·min; TMR: 191.2 ± 6.9 beats·min; p < 0.001) were each lower during DWR vs. TMR. In addition, RPEmax was not significantly different between DWR and TMR (DWR: 17.8 ± 1.9; TMR: 18.4 ± 1.3; p > 0.05). Furthermore, muscle activity from all tested muscles was not influenced by the interaction of mode and intensity (p > 0.05). Muscle activity from all tested muscles was different between modes (p < 0.05) and between intensities (p < 0.001). Specifically, muscle activity from the tested muscles during DWR was 29-69% lower than that of TMR at maximal effort. Athletes and coaches should consider that the exercise intensity during DWR can be overestimated, if exercise prescription was made according to the maximal responses during TMR.

A Novel Approach to Assessing Head Injury Severity in Pediatric Patient Falls.

INTRODUCTION: Pediatric patient falls with head-to-floor impact have the greatest potential for injury. METHODS: An objective measure of head injury severity, the Head Injury Criterion (HIC15), was calculated from anthropometric and biomechanical components of patient falls. A secondary aim was to compare HIC15 levels with the hospital's subjective assignment of level of harm (1-9 scale) used for regulatory reports. RESULTS: Adverse event reports yielded a sample of 49 falls from heights of 72.5 to 1793.0 cm by children ages 11 months through 17 years. Contact velocity from beginning to end was 2.81 to 6.16 ms. Mean acceleration was 19.5 to 95.3g. HIC15 levels of impact ranged from 26.4 to 1,330.0, and mean force upon contact was 2.0 to 9.8 N/kg body mass. Seven (14.3%) children's HIC15 levels exceeded age-specific thresholds, with no follow-up scheduled. Hospital-assigned levels of harm were not correlated with HIC15 levels (r = .23, R2 = .05, p = .12). DISCUSSION: A point-of-care computerized HIC15 algorithm would be useful for diagnostic and follow-up decisions.