Influence of Sargassum pallidum and the synergistic interaction mechanism of 6-gingerol and poricoic acid A on inhibiting ovalbumin glycation.

This study aimed to investigate the antiglycation capacity of Sargassum pallidum extract on ovalbumin (OVA) glycation, and the interaction mechanism of its active compounds, including 6-gingerol (6G) and poricoic acid A (PA). The results showed that Sargassum pallidum extract, PA and 6G had excellent suppression on the formation of fructosamine, 5-hydroxymethylfurfural (5-HMF), acrylamide and advanced glycation end products (AGEs), which was higher than aminoguanidine (AG). The combination of PA and 6G showed good synergistic effect on inhibiting the formation of AGEs. PA exhibited the strongest inhibition activity for protein glycation products, and the content of 5-HMF and acrylamide decreased from 277.44 and 10.60 µg mL-1 to 208.37 and 5.46 µg mL-1, respectively, at 30.08 × 10-5 M compared with the control group. 6G and PA quenched the fluorescence of OVA with a static mechanism, and enhanced the hydrophilic microenvironment of the tyrosine (Tyr) and tryptophan (Trp) residues. The binding of 6G and PA with OVA was spontaneous and driven by hydrogen bonds and van der Waals interactions. Molecular docking indicated that 6G and PA entered the hydrophobic cavity of OVA, and formed hydrogen bonds with Ser103, Leu101 and Thr 91. These findings suggested that Sargassum pallidum extract, PA and 6G have great potential as antiglycation inhibitors to treat diabetes complications in healthy food.

Markers of hyperglycemia in the vitreous humor. A systematic review and meta-analysis.

BACKGROUND: Vitreous humor has been extensively used in forensic practice to assess hyperglycemia after death. The results from different articles, for various hyperglycemia markers are highly variable, and a systematic analysis of the results from studies currently used in forensic practice as landmarks has not yet been performed. Therefore, we aimed to evaluate to usefulness and limits of using the values of vitreous glucose, lactic acid, beta-hydroxybutyrate, and 1,5 Anhydro-d-glucitol to detect postmortem hyperglycemia. MATERIALS AND METHODS: For this purpose, we performed a systematic review and a meta-analysis using the random-effects model to identify the threshold values and average differences for the markers mentioned above in the vitreous humor of diabetic versus nondiabetic subjects. RESULTS: We included eleven studies in the meta-analysis and found the following mean differences between the diabetic and nondiabetic groups: for glucose - 91.4 mg/dl, for lactate - 34.17 mg/dl, for the Traub formula - 111 mg/dl, for fructosamine - 0.71 mmol/L, for beta-hydroxybutyrate - 36.55 mg/dl and 1,5 Anhydro-d-glucitol - -15.2 mg/dl. We also gave practical recommendations, based on the range of values and 95% confidence intervals in normal subjects and controls to identify antemortem hyperglycemia and evaluated, whenever possible, threshold values for fatal diabetes. CONCLUSIONS: Glucose, Traub formula, fructosamine, and beta-hydroxy-butyrate can be used to detect postmortem hyperglycemia with some limitations; 1,5 Anhydro-d-glucitol can only be used to suggest the absence of a hyperglycemic status before death.

Improved Detection of Abnormal Glucose Tolerance in Africans: The Value of Combining Hemoglobin A1c With Glycated Albumin.

OBJECTIVE: In African-born Blacks living in America, we determined by BMI category 1) prevalence of abnormal glucose tolerance (Abnl-GT) and 2) diagnostic value and reproducibility of hemoglobin A1c (HbA1c), fructosamine, and glycated albumin (GA). RESEARCH DESIGN AND METHODS: Participants (n = 416; male, 66%; BMI 27.7 ± 4.5 kg/m2 [mean ± SD]) had an oral glucose tolerance test with HbA1c, GA, and fructosamine assayed. These glycemic markers were repeated 11 ± 7 days later. Abnl-GT diagnosis required 0 h ≥5.6 mmol/L (≥100 mg/dL) and/or 2 h ≥7.8 mmol/L (≥140 mg/dL). Thresholds for HbA1c, GA, and fructosamine were the values at the 75th percentile for the population (39 mmol/mol [5.7%], 14.2%, and 234 µmol/L, respectively). RESULTS: Abnl-GT prevalence in the nonobese was 34% versus 42% in the obese (P = 0.124). Reproducibility was excellent for HbA1c and GA (both κ ≥ 0.8), but moderate for fructosamine (κ = 0.6). Focusing on HbA1c and GA in the nonobese, we found as single tests the sensitivities of HbA1c and GA were 36% versus 37% (P = 0.529). Combining HbA1c and GA, sensitivity increased to 58% because GA identified 37% of Africans with Abnl-GT not detected by HbA1c (P value for both tests vs. HbA1c alone was <0.001). For the obese, sensitivities for HbA1c, GA, and the combined tests were 60%, 27%, and 67%, respectively. Combined test sensitivity did not differ from HbA1c alone (P = 0.25) because GA detected only 10% of obese Africans with Abnl-GT not detected by HbA1c. CONCLUSIONS: Adding GA to HbA1c improves detection of Abnl-GT in nonobese Africans.

Non-nutritive sweeteners are in concomitant with the formation of endogenous and exogenous advanced glycation end-products.

This study investigated the role of non-nutritive sweeteners in the formation of advanced glycation end-products (AGEs) and their reactive intermediates using endogenous and exogenous models. In the endogenous model, xylitol and sorbitol formed similar levels of reactive intermediates compared to sucralose. Protein-bound fluorescent AGEs, Nε-carboxymethyllysine (CML), and Nε-carboxyethyllysine (CEL) levels in the xylitol and sorbitol treatment were significantly higher compared to the sucralose treatment. In the exogenous model, sucralose treatment showed significantly higher glyoxal and fructosamine levels compared to xylitol and sorbitol, respectively. However, protein-bound fluorescent AGEs, CML, and CEL were lower in the sucralose treatment compared to other sugar treatments. The data suggest that the structure of sugar alcohols which are similar to reducing sugars may contribute to the formation of AGEs and their reactive intermediates in the endogenous model. The long-term effects of non-nutritive sweeteners consumption on AGEs formation and health implications should be verified with population studies.

A study of the physicochemical properties of rabbit glycated myofibrillary protein with high solubility in low ionic strength medium.

To analyze the physicochemical properties of rabbit glycated myofibrillary protein (GMP) with different solubility ((15.10 ± 0.76)%, (35.03 ± 1.01)%, (55.06 ± 1.25)%, and (75.07 ± 1.86)%) in low ionic strength medium, the changes in SDS-PAGE, foaming properties, emulsifying properties, gelling properties, rheological properties, and thermal stability under different pH conditions were determined. The results indicated that GMP with (75.07 ± 1.86)% solubility had better foaming and emulsifying properties than GMP with (35.03 ± 1.01)% solubility at pH 6.0 and pH 7.5 did; however, GMP with (75.07 ± 1.86)% solubility had lower gel strength and showed more cracks in gel networks. Furthermore, the storage modulus (G') of GMP increased as the solubility increased within the range of (15.10 ± 0.76)% to (35.03 ± 1.01)%, but decreased after the solubility reached (55.06 ± 1.25)%. Results also suggested that the glycation process can improve the thermal stability of myofibrillary protein; GMP with (75.07 ± 1.86)% solubility had the highest denaturation temperature. In conclusion, the physicochemical properties of rabbit GMP were affected by changes in solubility in low ionic strength medium; rabbit GMP with high solubility was more resistant to pH changes than native myofibrillary protein.

HbA1C as a marker of retrograde glycaemic control in diabetes patient with co-existed beta-thalassaemia: A case report and a literature review.

WHAT IS KNOWN AND OBJECTIVE: The HbA1C marker used in assessing diabetes control quality is not sufficient in diabetes patients with thalassaemia. CASE DESCRIPTION: A male diabetic patient with thalassaemia was hospitalized due to distal neuropathic pain, right toe trophic ulcer, unacceptable five-point glycaemic profile and recommended HbA1C value. After simultaneously initiated insulin therapy and management of ulcer by hyperbaric oxygen, the patient showed improved glycaemic control and ulcer healing, which led to the patient's discharge. WHAT IS NEW AND CONCLUSION: In thalassaemia and haemoglobinopathies, due to discrepancies in the five-point glycaemic profile and HbA1C values, it is necessary to measure HbA1C with a different method or to determine HbA1C and fructosamine simultaneously.

Comparative study of different glycating agents on human plasma and vascular cells.

Diabetic complications are associated with the glycation and formation of advanced glycation end products (AGEs) which leads to structural modifications of biomolecules further affecting cells. Carbonyl compounds such as methylglyoxal and glyceraldehyde-3-phosphate are highly reactive and form an elevated amount of AGEs as compared to glucose and fructose. The investigation of glycation modifications by different compounds may be important to assess the specific pattern of biomolecular and cellular modifications and compare their glycation potential. The present work aims to comprehensively and comparatively examine the effect of glycating agents (glucose, fructose, ribose, methylglyoxal, and glyceraldehyde) on plasma, erythrocytes, platelets, and blood DNA. Glycation of plasma, cells, and DNA was initiated by incubating them with glycating agents for 24-48 h at 37 °C. Negative control samples (without glycating agents) were maintained simultaneously. After treatment, plasma and DNA samples were dialyzed and cell lysate was prepared. Markers of glycation (fructosamine), structural modifications (free amino, ß-amyloid, absorption spectra), antioxidant indices (catalase activity, glutathione) and erythrocyte hemolysis were estimated. In the presence of glycating agents, there was a significant increase in the formation of fructosamine, structural modification markers and depletion in antioxidant indices. Overall results suggest that among all glycating agents; methylglyoxal and glyceraldehyde have more potency of glycation induced structural modifications in plasma and vascular cells. This indicates the specific glycation modifications in plasma and vascular cells by various glycating agents may be investigated further for controlling diabetic pathological changes.

Alterations of morphology and phosphorylated protein expression in the seminal vesicles of diabetic mice.

Although many studies reported the detrimental effects of type 1 and 2 diabetes mellitus (T1DM and T2DM) on testis, reproductive parameter changes in DM seminal vesicles have never been documented. This study aimed to examine the morphology, biochemical levels and tyrosine phosphorylation in seminal vesicles of T1DM and T2DM mice. Fifty-six male C57BL/6 mice were divided into four groups (n = 14/each): T1DM control, T1DM, T2DM control and T2DM. T1DM mice were daily injected of streptozotocin (STZ; 40 mg/kg BW) for 5 days. T2DM mice received high-fat diet for 14 days prior to STZ injection at a single dose (85 mg/kg BW). At the end of experiments (days 36 and 72), magnesium (MG) and fructosamine (FRA) levels, and phosphorylated protein expression in seminal vesicle were examined. The results showed that seminal and prostate weights and MG and FRA levels of T1DM animals were significantly increased as compared to T2DM mice. Some seminal histopathologies and decreased epithelial height were observed in both DM groups. Significantly, a 72-kDa phosphorylated protein expression was increased in DM seminal vesicle. We concluded that changes of biochemical components and phosphorylated proteins in seminal vesicle of T1DM and T2DM mice may be associated with low-quality seminal plasma.

Diabetes mellitus and laboratory medicine in sub-Saharan Africa: challenges and perspectives.

Diabetes mellitus is an increasing public health problem in sub-Saharan Africa with a substantial socioeconomic burden. Although laboratory medicine has been recognized as one of the six key public health functions, there are still gaps in strengthening of laboratory services in developing countries. In the last decades, a lot of progress has been made in the diagnostic field of infectious diseases, whereas the diagnosis of noncommunicable diseases is still insufficient and uneven. This article analyses the challenges encountered in diagnosing and monitoring of diabetes mellitus in sub-Saharan Africa and explores new alternative diagnostic tools.

Systematic review of the biological variation data for diabetes related analytes.

BACKGROUND: Objective interpretation of laboratory test results used to diagnose and monitor diabetes mellitus in part requires the application of biological variation data (BVD). The quality of published BVD has been questioned. The aim of this study was to quality assess publications reporting BVD for diabetes-related analytes using the Biological Variation Data Critical Appraisal Checklist (BIVAC); to assess whether published BVD are fit for purpose and whether the study design and population attributes influence BVD estimates and to undertake a meta-analysis of the BVD from BIVAC-assessed publications. METHODS: Publications reporting data for glucose, HbA1c, adiponectin, C-peptide, fructosamine, insulin like growth factor 1 (IGF-1), insulin like growth factor binding protein 3 (IGFBP-3), insulin, lactate and pyruvate were identified using a systematic literature search. These publications were assessed using the BIVAC, receiving grades A, B, C or D, where A is of highest quality. A meta-analysis of the BVD from the assessed studies utilised weightings based upon BIVAC grades and the width of the data confidence intervals to generate global BVD estimates. RESULTS: BIVAC assessment of 47 publications delivered 1 A, 3 B, 39C and 4 D gradings. Publications relating to adiponectin, C-peptide, IGF-1, IGFBP-3, lactate and pyruvate were all assessed as grade C. Meta-analysis enabled global BV estimates for all analytes except pyruvate, lactate and fructosamine. CONCLUSIONS: This study delivers updated and evidence-based BV estimates for diabetes-related analytes. There remains a need for delivery of new high-quality BV studies for several clinically important analytes.

Glucose, fructosamine, and insulin measurements in saliva of dogs: variations after an experimental glucose administration.

The aim of this study was to evaluate if glucose, fructosamine, and insulin levels can be measured in saliva of dogs and assess the changes in these compounds after an experimental glucose administration. Automated spectrophotometric assays for glucose and fructosamine and an ELISA assay for insulin measurements were validated in saliva of dogs, by evaluating precision, accuracy, and limits of detection. In addition, an intravenous glucose bolus was administrated to 10 beagles and fasting serum and saliva samples were obtained immediately before and 5, 10, 20, 30, and 45 min after glucose infusion. The results of the between-run imprecision gave mean CVs of 6.16, 9.40, and 3.10% for glucose, fructosamine, and insulin, respectively. Linearity under dilution showed coefficient of correlation of 0.999, 0.994, and 0.990 for glucose, fructosamine, and insulin, respectively. The LDs were 0.04 mg/dL, 4.08 µmol/L, and 0.02 µg/mL for glucose, fructosamine, and insulin, respectively. The glucose administration caused an increase in serum and salivary levels of glucose with a peak in salivary levels at 30 min and of insulin with a peak in salivary levels at 45 min, while fructosamine did not change. No correlations between serum and salivary concentrations were found for any compound. It is concluded that glucose, fructosamine, and insulin can be measured in saliva of dogs, and an experimental administration of glucose in this species can lead to increases in glucose and insulin in saliva.

Glucose Homeostasis Markers in Beta-Thalassemia.

BACKGROUND: Glycosylated hemoglobin (HbA1c) has been a well-recognized marker of glucose homeostasis among thalassemics. Recently some studies have proposed the role of fructosamine as a better marker as compared with HbA1c. Hence, the study was carried out to find out which marker holds promise among Indian beta-thalassemic children. METHODS: In this case-control study, 60 diagnosed cases of beta-thalassemia major and equal number of normal controls who were ≥8 years of age were enrolled. HbA1c, fructosamine, and fasting insulin levels were measured in all. Oral glucose tolerance test was done as a gold standard and the measured parameters were compared. RESULTS: HbA1c was significantly higher in cases (7.10% [±0.47%]) than in controls (5.15% [±0.19%]) (P<0.001). Thalassemics with abnormal glucose tolerance had higher HbA1c level (7.34% [±0.57%]) than those with normal glucose tolerance (7.05% [±0.43%]) (P=0.05). Insulin resistance was noticed among thalassemics with abnormal glucose tolerance as compared with their normal counterparts (P=0.04). No significant difference was found in fructosamine levels between cases (239.80 [±31.80] µmol/L) and controls (234.10 [±21.34] µmol/L) (P=0.25) or between thalassemics with abnormal glucose tolerance (243.92 [±21.94] µmol/L) and their normal counterparts (238.77 [±33.93] µmol/L) (P=0.62). CONCLUSIONS: The use of HbA1c as a diagnostic marker for diabetes in hemolytic anemias has to be done with caution as its baseline values are higher in them. Despite this finding, HbA1c continues to be a good marker for worsening glucose homeostasis in thalassemics as higher values were found in thalassemics with abnormal glucose tolerance compared with their normal counterparts. The present study did not find any relationship of fructosamine levels with impaired glucose tolerance in beta-thalassemia.

Protein glycation and aggregation inhibitory potency of biomolecules from black gram milled by-product.

BACKGROUND: Persistent hyperglycaemia causes increased advanced glycation end products (AGEs), which contribute to the pathogenesis of diabetic complication. Therefore, effect of black gram milled by-product (BGBP) extract on inhibition of AGE formation in a bovine serum albumin (BSA)/glucose system was investigated. RESULTS: BGBP extract had a total polyphenol content of 82 mg GAE g-1 and flavonoid content of 46 mg CE g-1 . Ferulic acid, protocatechuic acid, gallic acid, gentisic acid, isovitexin, vitexin and epicatechin were the major bioactives in the extract. BGBP extract exhibited an effective Fe2+ chelating activity. Size exclusion-high-performance liquid chromatographic studies indicated that upon BSA-AGE formation the BSA monomer content was 38%; however, in the presence of BGBP extract at 50 and 100 µg levels, the monomer content increased and it was found to be 48% and 73%, respectively. BGBP extract at 50 and 100 µg levels decreased the protein carbonyl and fructosamine contents, and quenched the fluorescence intensity of glycated BSA in a dose-dependent manner. Further, fluorescence and transmission electron microscopic studies confirmed the decrease in formation of AGEs by BGBP extract. CONCLUSION: As BGBP extract inhibited the formation of AGEs, the extract can be used as a nutraceutical or it can be incorporated into food products to obtain functional foods. © 2016 Society of Chemical Industry.

Diagnostic Accuracies of Glycated Hemoglobin, Fructosamine, and Homeostasis Model Assessment of Insulin Resistance in Predicting Impaired Fasting Glucose, Impaired Glucose Tolerance, or New Onset Diabetes After Transplantation.

BACKGROUND: New onset diabetes after transplantation (NODAT) is associated with a 3-fold greater risk of cardiovascular disease events, with early identification and treatment potentially attenuating this risk. The optimal screening test to identify those with NODAT remains unclear, and the aim of this study was to examine the diagnostic accuracies of 4 screening tests in identifying impaired fasting glucose, impaired glucose tolerance (IGT), and NODAT. METHODS: This is a single-center prospective cohort study of 83 nondiabetic kidney transplant recipients between 2008 and 2011. Oral glucose tolerance test was considered the gold standard in identifying IFG/IGT or NODAT. Diagnostic accuracies of random blood glucose, glycated hemoglobin (HBA1c), fructosamine, and Homeostasis Model Assessment-Insulin Resistance in predicting IFG/IGT or NODAT were assessed using the area under the receiver operating characteristic curve. RESULTS: Forty (48%) recipients had IFG/IGT or NODAT. Compared with HBA1c with adjusted area under the curve (AUC) of 0.88 (95% confidence interval [95% CI], 0.77-0.93), fructosamine was the most accurate test with adjusted AUC of 0.92 (95% CI, 0.83-0.96). The adjusted AUCs of random blood glucose and Homeostasis Model Assessment-Insulin Resistance in identifying IFG/IGT were between 0.81 and 0.85. Restricting to identifying IGT/NODAT using 2-hour oral glucose tolerance test (n = 66), fructosamine was the most accurate diagnostic test with adjusted AUC of 0.93 (95% CI, 0.84-0.99), but not statistically different to HBA1c with adjusted AUC of 0.88 (95% CI, 0.76-0.96). CONCLUSIONS: Although HBA1c is an acceptable and widely used screening test in detecting IFG/IGT or NODAT, fructosamine may be a more accurate diagnostic test but this needs to be further examined in larger cohorts.

Protective effects of cyanidin-3-rutinoside against monosaccharides-induced protein glycation and oxidation.

Cyanidin-3-rutinoside (C3R), a naturally occurring anthocyanin, is present in various fruits and vegetables as a colorant. C3R has been well characterized and demonstrated a number of biological activities attributed to its antioxidant properties. The present study compared the effectiveness of C3R against monosaccharide-induced protein glycation and oxidation in vitro using bovine serum albumin (BSA).The results demonstrated that C3R (0.125-1.00 mM) inhibited the formation of fluorescent AGEs in ribose-glycated BSA (2-52%), fructose-glycated BSA (81-93%), glucose-glycated BSA (30-74%) and galactose-glycated BSA (6-79%).Correspondingly, C3R (1.00 mM) decreased the level of N(ɛ)-(carboxymethyl) lysine (56-86%) in monosaccharide-induced glycation in BSA. C3R also reduced the level of fructosamine, ß-amyloid cross structure, protein carbonyl content as well as the depletion of thiol in BSA/monosaccharide system. In summary, C3R might offer a new promising antiglycation agent for the prevention of diabetic complications by inhibiting AGE formation and oxidation-dependent protein damage.

Ethnic/racial determinants of glycemic markers in a UK sample.

OBJECTIVE: To investigate possible causes for previously reported glycemia-independent South Asian-white differences in HbA1c. METHODS: Demographic and laboratory data on non-diabetic patients from primary care were analyzed. Linear regression models measured the association between race/ethnicity and three glycemic measures (HbA1c, fructosamine and fasting plasma glucose), adjusted for a range of hematological, biochemical and demographic factors. RESULTS: Nine hundred and forty-eight patients consisting of 711 white subjects (407 women) and 237 South Asian subjects (138 women) were studied. Unadjusted bivariate analysis showed that South Asians had higher HbA1c concentrations [41 (5.9 %) vs. 40 (5.8 %) mmol/mol (p = 0.011), coefficient 1.21, 95 % CI 0.27, 2.17 (p = 0.011)] similar fructosamine [228.4 vs. 226.7 mmol/L (p = 0.352), coefficient 3.93, 95 % CI 0.79, 7.08 (p = 0.014)] and fasting plasma glucose [5.1 vs. 5.2 mmol/L (p = 0.154), coefficient -0.09, 95 % CI -0.22, -0.04 (p = 0.156)] concentrations than whites. South Asians also had lower hemoglobin, ferritin and vitamin B12 concentrations than whites. After adjustment for independent variables, South Asian ethnicity was associated with higher HbA1c concentrations [0.89, 95 % CI 0.06-1.72 (p = 0.035)], higher fructosamine levels [3.93, 95 % CI 0.79, 7.08 (p = 0.014)] and lower fasting plasma glucose concentrations [-0.12, 95 % CI -0.26, -0.02 (p = 0.026)] compared to white race. CONCLUSIONS: The increased prevalence of hematological abnormalities in South Asians and their higher adjusted HbA1c and fructosamine but lower fasting glucose levels compared to white subjects suggest that ethnic differences in glycation markers may, in part, be due to a combination of erythrocyte factors and glycemia-independent glycation.

Estudio del control metabólico en pacientes diabéticos en hemodiálisis crónica: hemoglobina glicosilada, fructosamina y glicemias capilares / Study of metabolic control in diabetic patients on chronic hemodialysis: glycated hemoglobin, fructosamine and capillary glycemia

Background: In conditions that may change red blood cell survival, such as hemodialysis, the accuracy of A1c glycosylated hemoglobin (HbA1c) to assess metabolic control can be hampered. Other glycosylated proteins such as fructosamine, could accomplish the role of HbA1c. Aim: To assess if HbA1c is a good metabolic control parameter in diabetic patients on chronic hemodialysis. To compare fructosamine, HbA1c and serial capillary glucose levels in the same patients. Material and Methods: Patients on hemodialysis three times per week were studied. Twenty one subjects with diabetes mellitus and 10 non-diabetic patients were included (70 percent were male). During a period of 14 days, fasting and post prandial capillary glucose levels were measured. Venous glucose, HbA1c and fructosamine were measured at the onset and completion of the monitoring period. Results: Diabetic patients were older than their non-diabetic counterparts (65 and 47 years respectively, p < 0.04). In diabetic and non-diabetic patients respectively, capillary blood glucose levels were 161 +/- 22 and 104 +/- 51 mg/dl, HbA1c levels were 6.8 +/- 1.2 and 5.4 +/- 0.4 percent and fructosamine levels were 282.0 +/- 126.6 and 154.6 +/- 73 umol/L. In all patients there was a positive correlation between blood glucose, HbA1c (r = 0.78 p < 0.01) and fructosamine (r = 0.52, p 0.02). There was a positive correlation between mean capillary glucose, HbA1c (r = 0.77, p < 0.01) and fructosamine (r = 0.69, p < 0.02). Among diabetic patients, the correlation coefficients between mean capillary glucose levels, HbA1c and fructosamine levels were 0.67 (p < 0.01) and 0.51 (NS), respectively. Conclusions: Among diabetic patients on hemodialysis fructosamine levels are not a better indicator of metabolic control than HbA1c.

Glycosylated hemoglobin and albumin-corrected fructosamine are good indicators for glycemic control in peritoneal dialysis patients.

PURPOSE: Diabetes mellitus (DM) is the most common cause of end-stage renal disease and is an important risk factor for morbidity and mortality after dialysis. However, glycemic control among such patients is difficult to assess. The present study examined glycemic control parameters and observed glucose variation after refilling different kinds of fresh dialysate in peritoneal dialysis (PD) patients. METHODS: A total of 25 DM PD patients were recruited, and continuous glucose monitoring system (CGMS) was applied to measure interstitial fluid (ISF) glucose levels at 5-min intervals for 3 days. Patients filled out diet and PD fluid exchange diaries. The records measured with CGMS were analyzed and correlated with other glycemic control parameters such as fructosamine, albumin-corrected fructosamine (AlbF), glycosylated hemoglobin (HbA1c), and glycated albumin levels. RESULTS: There were significant correlations between mean ISF glucose and fructosamine (r = 0.45, P<0.05), AlbF (r = 0.54, P<0.01), and HbA1c (r = 0.51, P<0.01). The ISF glucose levels in glucose-containing dialysate increased from approximately 7-8 mg/dL within 1 hour of exchange in contrast to icodextrin dialysate which kept ISF glucose levels unchanged. CONCLUSION: HbA1c and AlbF significantly correlated with the mean ISF glucose levels, indicating that they are reliable indices of glycemic control in DM PD patients. Icodextrin dialysate seems to have a favorable glycemic control effect when compared to the other glucose-containing dialysates.

Postmortem chemistry update part I.

Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.