Association of cigarette and water-pipe smoking with increased visceral adiposity, glycemic intolerance and hematological derangement in Iraqi healthy smokers

Abstract The present study aims to investigate the impacts of cigarette smoking (CS) and water-pipe smoking (WPS) on the visceral adiposity index (VAI), hematological characteristics, and glycemic tolerance in Iraqi healthy smokers. A total of 528 healthy males from different locations of Baghdad city were allocated to three groups; nonsmokers (176), cigarette smokers (178), and WP smokers (174). Baseline characteristics, anthropometric and hematological markers and were reported. Glycemic control was evaluated using the glucose tolerance test. The evidence of elevated VAI, disrupted hematological markers, and impaired glucose tolerance was significantly (P<0.001) different compared with non-smokers and related to the duration of smoking. The impacts of WPS seem to be significantly greater than CS in certain parameters (hemoglobin, hematocrit, methemoglobin, and 2-hour glucose tolerance values). In conclusion, CS and WPS negatively impacted body fat distribution, glucose tolerance, and hematological markers. There is a positive association between the rate of smoking and obesity, glycemic intolerance in both groups

Statistical and spectral analysis of ECG signal towards achieving non-invasive blood glucose monitoring.

BACKGROUND: Globally, the cases of diabetes mellitus (diabetes) have increased in the past three decades, and it is recorded as one of the leading cause of death. This epidemic is a metabolic condition where the body cannot regulate blood glucose, thereby leading to abnormally high blood sugar. Genetic condition plays a significant role to determine a person susceptibility to the condition, a sedentary lifestyle and an unhealthy diet are behaviour that supports the current global epidemic. The complication that arises from diabetes includes loss of vision, peripheral neuropathy, cardiovascular complications and so on. Victims of this condition require constant monitoring of blood glucose which is done by the pricking of the finger. This procedure is painful, inconvenient and can lead to disease infection. Therefore, it is important to find a way to measure blood glucose non-invasively to minimize or eliminate the disadvantages encountered with the usual monitoring of blood glucose. METHOD: In this paper, we performed two experiments on 16 participants while electrocardiogram (ECG) data was continuously captured. In the first experiment, participants are required to consume 75 g of anhydrous glucose solution (oral glucose tolerance test) and the second experiment, no glucose solution was taken. We explored statistical and spectral analysis on HRV, HR, R-H, P-H, PRQ, QRS, QT, QTC and ST segments derived from ECG signal to investigate which segments should be considered for the possibility of achieving non-invasive blood glucose monitoring. In the statistical analysis, we examined the pattern of the data with the boxplot technique to reveal the change in the statistical properties of the data. Power spectral density estimation was adopted for the spectral analysis to show the frequency distribution of the data. RESULTS: HRV segment obtained a statistical score of 81% for decreasing pattern and HR segment have the same statistical score for increasing pattern among the participants in the first quartile, median and mean properties. While ST segment has a statistical score of 81% for decreasing pattern in the third quartile, QT segment has 81% for increasing pattern for the median. From a total change score of 6, ST, QT, PRQ, P-H, HR and HRV obtained 4, 5, 4, 5 and 6 respectively. For spectral analysis, HRV and HR segment scored 81 and 75% respectively. ST, QT, PRQ have 75, 62 and 68% respectively. CONCLUSIONS: The results obtained demonstrate that HR, HRV, PRQ, QT and ST segments under a normal, healthy condition are affected by glucose and should be considered for modelling a system to achieve the possibility of non-invasive blood glucose measurement with ECG.

Performance evaluation of a self-administered home oral glucose tolerance test kit in a controlled clinical research setting.

AIM: To evaluate the performance of the current, pre-production version of a novel home oral glucose tolerance test (Home OGTT) device when administered by trained research nurses, compared with a reference laboratory glucose analyser and a second laboratory analyser, incorporating a sample processing delay to simulate normal practice. METHODS: One hundred women (aged 19-48 years), with and without known glucose intolerance were recruited. Following an overnight fast, participants attended for a 75-g OGTT. A fasting capillary sample was applied to the Home OGTT device with a corresponding venous sample collected and measured immediately on the reference YSI 2300 stat plus analyser, and following a 1-h delay on the Randox Daytona Plus analyser. The sampling process was repeated 2 h after the oral glucose load. RESULTS: Some 97% of tested devices gave complete data for analysis. Good agreement was observed between the reference glucose analyser and the Home OGTT device, with the Home OGTT device displaying a small negative bias (-0.18 mmol/l, -1.75 to 1.39 mmol/mol; -1.0%, -26.4% to 24.5%; absolute and relative mean, 95% limits of agreement). When classified as normal glucose tolerant or glucose intolerant, the Home OGTT device showed 100% and 90% sensitivity, and 99% and 99% specificity using fasting plasma glucose and 2-h glucose respectively. Similar sensitivity (100% and 100%) and specificity (96% and 99%) for fasting plasma glucose and 2-h glucose were observed using the secondary analyser. CONCLUSIONS: The novel Home OGTT device was reliable and easy to use and showed excellent agreement with two separate laboratory analysers. The Home OGTT offers potential as an effective alternative for clinic-based OGTT testing.

A Glucose Sensing System Based on Transmission Measurements at Millimetre Waves using Micro strip Patch Antennas.

We present a sensing system operating at millimetre (mm) waves in transmission mode that can measure glucose level changes based on the complex permittivity changes across the signal path. The permittivity of a sample can change significantly as the concentration of one of its substances varies: for example, blood permittivity depends on the blood glucose levels. The proposed sensing system uses two facing microstrip patch antennas operating at 60 GHz, which are placed across interrogated samples. The measured transmission coefficient depends on the permittivity change along the signal path, which can be correlated to the change in concentration of a substance. Along with theoretical estimations, we experimentally demonstrate the sensing performance of the system using controlled laboratory samples, such as water-based glucose-loaded liquid samples. We also present results of successful glucose spike detection in humans during an in-vivo Intravenous Glucose Tolerance Test (IVGTT). The system could eventually be developed into a non-invasive glucose monitor for continuous monitoring of glucose levels for people living with diabetes, as it can detect as small as 1.33 mmol/l (0.025 wt%) glucose concentrations in the controlled water-based samples satisfactorily, which is well below the typical human glucose levels of 4 mmol/l.

Diabetes en urgencias: evaluación del control y tratamientos instaurados / Diabetes in emergency services: evaluation of monitoring and installed treatments

No disponible

Long-term blood glucose monitoring with implanted telemetry device in conscious and stress-free cynomolgus monkeys.

AIMS: Continuous blood glucose monitoring, especially long-term and remote, in diabetic patients or research is very challenging. Nonhuman primate (NHP) is an excellent model for metabolic research, because NHPs can naturally develop Type 2 diabetes mellitus (T2DM) similarly to humans. This study was to investigate blood glucose changes in conscious, moving-free cynomolgus monkeys (Macaca fascicularis) during circadian, meal, stress and drug exposure. MATERIALS AND METHODS: Blood glucose, body temperature and physical activities were continuously and simultaneously recorded by implanted HD-XG telemetry device for up to 10 weeks. RESULTS AND DISCUSSION: Blood glucose circadian changes in normoglycemic monkeys significantly differed from that in diabetic animals. Postprandial glucose increase was more obvious after afternoon feeding. Moving a monkey from its housing cage to monkey chair increased blood glucose by 30% in both normoglycemic and diabetic monkeys. Such increase in blood glucose declined to the pre-procedure level in 30 min in normoglycemic animals and >2 h in diabetic monkeys. Oral gavage procedure alone caused hyperglycemia in both normoglycemic and diabetic monkeys. Intravenous injection with the stress hormones, angiotensin II (2 µg/kg) or norepinephrine (0.4 µg/kg), also increased blood glucose level by 30%. The glucose levels measured by the telemetry system correlated significantly well with glucometer readings during glucose tolerance tests (ivGTT or oGTT), insulin tolerance test (ITT), graded glucose infusion (GGI) and clamp. CONCLUSION: Our data demonstrate that the real-time telemetry method is reliable for monitoring blood glucose remotely and continuously in conscious, stress-free, and moving-free NHPs with the advantages highly valuable to diabetes research and drug discovery.

[Accuracy of a continuous glucose monitoring system in detection of blood glucose during oral glucose tolerance test].

OBJECTIVE: To evaluate the accuracy of continuous glucose monitoring system (CGMS) during oral glucose tolerance test (OGTT) in the detection of blood glucose changes in glucose stress condition. METHODS: Forty-nine out-patients with fasting plasma glucose of 3.9-11.0 mmol/L underwent continuous blood glucose monitoring using CGMS for 3 days, and OGTT was conducted on the third day. The venous blood glucose was measured at 0, 30, 60, 90, and 120 min after oral glucose intake, and the accuracy of CGMS during OGTT was evaluated. RESULTS: The correlation indices between CGMS values and the venous blood glucose values during the entire OGTT and in phases of stable, rapidly rising and falling glucose levels were 0.928, 0.901, 0.924 and 0.902, respectively (P<0.001). Clarke error-grid analysis showed that more than 95% of the measured results fell into the A and B zones. CONCLUSION: CGMS values show good consistency with venous blood glucose values measured during OGTT. CGMS is accurate in detection of rapidly changing blood glucose during OGTT.

Screening for type 2 diabetes with random finger-prick glucose and bedside HbA1c in an Australian emergency department.

OBJECTIVE: To determine if screening for undiagnosed type 2 diabetes mellitus (T2DM) and pre-diabetes is feasible in an Australian ED; to estimate the prevalence of T2DM and pre-diabetes in the Australian ED population. METHODS: Prospective cross-sectional prevalence survey in the ED of St Vincent's Hospital, Melbourne, an adult, tertiary referral centre seeing approximately 40,000 patients annually. A convenience sample of adult patients was screened with finger-prick random blood glucose and glycosylated haemoglobin (HbA1c); those over 6.0 mmol/L and 6.0% were referred for oral glucose tolerance test (OGTT). Diagnoses of T2DM and pre-diabetes were made according to World Health Organization definitions. Those not attending for OGTT were contacted by phone, and interviewed about their reasons. RESULTS: Seven hundred and twenty-five patients were recruited; 135 (18.6%; 95% confidence intervals [CI] 15.9-21.6%) had known T2DM, leaving 590 screened, of whom 210 screened positive. Of the 192 referred for OGTT, 147 (77%) did not attend despite several telephone reminders. Of the 45 (23%) completing OGTT, pre-diabetes was present in eight (17.8%; 95% CI 9.0-31.6%) and T2DM in six (13.3%; 95% CI 5.9-26.6%). Many people interviewed (18/86, 21%) did not attend for OGTT on the advice of their doctors. CONCLUSIONS: This inner city tertiary ED has a high prevalence of T2DM, diagnosed and undiagnosed, with over a quarter of our population probably affected [corrected]. Although ED screening might have a high yield, opportunistic screening is not feasible, with difficulties in staff engagement and patient follow up for diagnostic testing. Future studies might consider finger-prick fasting blood glucose through a patient's general practitioner for diagnosis.

A new non-invasive technology to screen for dysglycaemia including diabetes.

OBJECTIVE: Assess the ability of a new device based on electrochemical principles using iontophoresis (the EZSCAN) to detect impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM). METHODS: Eligible Asian Indian subjects, n=212, had anthropometric and blood pressure measurements, followed by an OGTT, HbA1c, serum lipids tests and EZSCAN measurement. RESULTS: Biochemically, 24 subjects were diagnosed with DM, 30 with IGT, 57 subjects had normal glucose tolerance (NGT) with metabolic syndrome (MS) and 101 had NGT without MS. Fasting plasma glucose (FPG) and HbA1c levels were highest in the DM group (p<0.0001 for both). HDL-C levels were different (p=0.015). FPG at a cut-off level of 7.0 mmol/L had a low sensitivity to detect DM (29%) EZSCAN had a 75% sensitivity to detect DM, 70% for IGT and 84% for NGT with MS at threshold >50%. CONCLUSIONS: FPG had low sensitivity to detect DM in the study group. EZSCAN demonstrated good sensitivity to detect IGT and DM and also identified NGT with MS. The concept of measuring ion fluxes through the skin appears to be a powerful method for early detection of MS, IGT and DM.

Modelo mínimo / Minimal model

La resistencia a la insulina desempeña un papel fundamental en la fi siopatología de la diabetes tipo 2 y está estrechamente ligada a la obesidad, el síndrome metabólico y las enfermedades cardiovasculares. La medida de la resistencia a la insulina es de gran importancia para los estudios epidemiológicos, en la investigación clínica y básica, y para su utilización en la práctica clínica. En la actualidad disponemos de diversos métodos, de complejidad variable, para este propósito. El clamp euglucémico hiperinsulinémico (CEH) es el método de referencia para la medida de la resistencia a la insulina in vivo. Sin embargo, requiere mucho tiempo y un trabajo intensivo, es caro y precisa de personal entrenado para solucionar las dificultades técnicas. Un método menos complejo es el «modelo mínimo», que proporciona una medida indirecta de la sensibilidad/ resistencia a la insulina sobre la base de los resultados de la glucemia y la insulinemia obtenidos a partir de extracciones múltiples tras un test intravenoso de tolerancia a la glucosa (TTIVG). Estos datos, analizados con el programa MINMOD instalado en un ordenador personal, nos proporcionan el índice de sensibilidad a la insulina (Si), el índice de efectividad de la glucosa (Sg), e información sobre la función de la célula beta. En la actualidad se utiliza un TTIVG modificado con la administración de tolbutamida o insulina a los 20 minutos del bolo de glucosa. El análisis mediante el modelo mínimo del TTIVG modificado es bastante más sencillo que el CEH y resulta adecuado para estudios extensos de investigación clínica, así como para su utilización en la práctica clínica (AU)

Insulin resistance plays a major pathophysIological role in type 2 diabetes and is tightly associated with obesity, metabolic syndrome and cardiovascular diseases. Therefore, quantifying insulin resistance is of great importance for epidemiological studies, clinical and basic science investigations and eventual use in clinical practice. Several methods of varying complexity are currently employed for these purposes. The hyperinsulinemic euglycemic glucose clamp is currently the gold standard method for measuring insulin resistance in vivo. However, it is time consuming, labour intensive, expensive and requires an experienced operator to manage the technical diffi culties. A slightly less complex method is the minimal model, that provides an indirect measurement of metabolic insulin sensitivity/resistance on the basis of glucose and insulin data obtained during a frequently sampled intravenous glucose tolerance test (FSIVGTT). These data are then subjected to minimal model analysis using the computer program MINMOD to generate an index of insulin sensitivity, an index of glucose effectiveness and information about b-cell function. Currently, a modifi ed FSIVGTT is used where exogenous insulin or tolbutamide are infused beginning 20 minutes after the intravenous glucose bolus. The minimal model analysis of the modifi ed FSIVGTT is easier that the glucose clamp technique and is appropriate for large clinical investigations or routine clinical applications (AU)

Influence of acute and chronic administration of benzylamine on glucose tolerance in diabetic and obese mice fed on very high-fat diet

The combination of vanadate plus benzylamine has been reported to stimulateglucose transport in rodent adipocytes and to mimic other insulin actions in diversestudies. However, benzylamine alone activates glucose uptake in human fat cells andincreases glucose tolerance in rabbits. The aim of this work was to unravel the benzylamineantihyperglycemic action and to test whether its chronic oral administrationcould restore the defective glucose handling of mice rendered slightly obese anddiabetic by very high-fat diet (VHFD). When VHFD mice were i.p. injected withbenzylamine at 0.7 to 700 ìmol/kg before glucose tolerance test, they exhibitedreduced hyperglycemic response without alteration of insulin secretion. Whole bodyglucose turnover, as assessed by the glucose isotopic dilution technique, wasunchanged in mice perfused with benzylamine (total dose of 75 ìmol/kg). However,their in vivo glycogen synthesis rate was increased. Benzylamine appeared thereforeto directly facilitate glucose utilisation in peripheral tissues. When given chronicallyat 2000 or 4000 ìmol/kg/d in drinking water, benzylamine elicited a slightreduction of water consumption but did not change body weight or adiposity anddid not modify oxidative stress markers. Benzylamine treatment improved glucosa tolerance but failed to normalize the elevated glucose fasting plasma levels of VHFDmice. There was no influence of benzylamine ingestion on lipolytic activity, basal andinsulin-stimulated glucose uptake, and on inflammatory adipokine expression inadipocytes. The improvement of glucose tolerance and the lack of adverse effects onadipocyte metabolism, reported here in VHFD mice allow to consider orally givenbenzylamine as a potential antidiabetic strategy which deserves to be further studied in other diabetic models (AU)

No disponible

A minimal model for glycemia control in critically ill patients.

In this paper we propose a modified minimal model to be used for glycemia control in critically ill patients. For various reasons the Bergman minimal model is widely used to describe glucose and insulin dynamics. However, since this model is mostly valid in a rather restrictive setting, it might not be suitable to be used in a model predictive controller. Simulations show that the new model exhibits a similar glycemia behaviour but clinically more realistic insulin kinetics. Therefore it is potentially more suitable for glycemia control. The designed model is also estimated on a set of critically ill patients giving promising results.

AKA-Glucose: a program for kinetic and epidemiological analysis of frequently sampled intravenous glucose tolerance test data using database technology.

BACKGROUND: The Bergman Minimal Model enables estimation of two key indices of glucose/ insulin dynamics: glucose effectiveness and insulin sensitivity. METHODS AND RESULTS: In this paper we describe AKA-Glucose, a program that combines MINMOD Millennium (minimal model analysis software) with relational database technologies. AKA-Glucose enables the fitting of individual frequently sampled intravenous glucose tolerance test (FSIGT) data sets to the Minimal Model and the secure storage in a dedicated database (and retrieval from) of thousands of individual subjects' demographic data, their individual FSIGT data, and each subject's parameters and indices derived from minimal model analysis. AKA-Glucose also enables the population analysis of various strata or subpopulations within the database. AKA-Glucose has all of the capabilities of MINMOD Millennium, provides Minimal Model parameter estimates that are concordant with estimates from previous MINMOD software, and allows importation of data files from earlier versions of the MINMOD software. CONCLUSIONS: By combining FSIGT data fitting, population analysis, and relational database technologies, AKA-Glucose is the first minimal model software designed specifically for researchers confronted with minimal model and epidemiological analysis of large numbers of either human or animal FSIGT data sets.

Challenges of implementing point-of-care testing (POCT) glucose meters in a pediatric acute care setting.

OBJECTIVES: To investigate factors contributing to analytical bias in POCT glucose values generated by the NICU versus the core laboratory. METHODS: The LifeScan Flexx hospital system glucose meters (SureStep) were used in precision and comparison studies between the NICU and laboratory (ABL715 and Vitros 950). RESULTS: Analysis of 40 neonatal blood samples revealed a positive bias between the NICU glucose meters versus either the laboratory glucose meter or instrument (mean difference of 0.28 and 0.21 mmol/L, respectively). Linear regression analysis (R2 = 0.0584) of the difference in glucose results versus time elapsed between measurements indicated that the bias observed between the NICU and laboratory glucose meters was not due to in vitro glycolysis for samples transported on ice. Further analysis indicated that the bias appeared to be mostly operator driven, with different NICU operators exhibiting different mean biases. Increasing the amount of blood applied to the SureStep Pro test strip (e.g., 60 vs. 20 microL), led to higher values for glucose concentration for the same blood. Nearly 50% of all glucose values reported for the NICU were obtained by the SureStep Flexx glucose meters in a 3-month period following the introduction of POCT, yet the number of laboratory-reported glucose results for the same period increased by 21% as compared to the previous year. CONCLUSIONS: Operator error appears to be a source of bias present between the NICU and laboratory, and despite glucose meter utilization in the NICU, the number of glucose measurements by the central laboratory increased after POCT introduction.

Noninvasive glucose measurement by monitoring of scattering coefficient during oral glucose tolerance tests. Non-Invasive Task Force.

BACKGROUND: Continuous glucose monitoring by means of optical glucose sensors would allow patients with diabetes to check their metabolic control to their convenience. In an earlier study, we showed that noninvasive glucose monitoring is feasible for rapid changes in blood glucose by means of measuring the scattering coefficient of human skin. In this study, we investigated whether also slower changes in blood glucose, this time induced by an oral glucose load, can also be monitored by this approach. METHODS: Five healthy subjects and 13 patients with type 2 diabetes have been given a 75-g oral glucose load. Portable noninvasive systems were used to measure the skin tissue scattering coefficient. For this purpose, two optical sensor heads were attached directly to the skin of each volunteer. Light was applied to the skin and the reflected light intensity was registered. RESULTS: In 8 of 10 measurements, correlation of changes in scattering coefficient with changes in glycemia was acceptable. In 19 of 26 measurements (73%) of patients with type 2 diabetes the observed changes in the scattering coefficient also correlated in acceptable manner. The accordance between the simultaneous measurements of the two sensor heads was acceptable in 13 of 18 volunteers and patients studied. There were virtually no differences in the quality of the measurements between healthy volunteers and patients with diabetes. CONCLUSIONS: This study shows that also slow changes in blood glucose induced by an oral glucose load can be monitored by registration of scattering coefficient changes. It remains to be elucidated why this has not been possible in all experiments.

Evaluation of a simplified intravenous glucose tolerance test and a reflectance glucose meter for use in cats.

A simplified intravenous glucose tolerance test has been developed for use in domestic cats and the results compared with those obtained using the standard test. The simplified test used two cephalic catheters, implanted in unsedated, unanaesthetised cats three hours before the test. Blood samples were collected before and after intravenous administration of glucose (0.5 g/kg bodyweight). Blood glucose concentration was measured with a reflectance glucose meter and an automated chemistry analyser. There were no significant differences between the results derived from the two tests. Because the simplified glucose tolerance test is easier to perform, requires no anaesthesia, uses only cephalic catheters and can be done on an outpatient basis, it is more cost effective and more clinically applicable. There were no significant differences between the results of glucose measurements with the two machines and the simplified glucose tolerance test can therefore be carried out with the reflectance glucose meter.