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1.
Vet J ; 252: 105359, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31554585

RESUMO

Point-of-care glucometry is used commonly in clinical and research settings; however, accuracy and precision of this method are concerns. The objectives of this study were to determine the accuracy of glucometry in adult horses and the precision of duplicate measurements. Blood samples were collected from 62 horses into one plain syringe, one EDTA tube and three fluoride oxalate (FO) tubes. Immediately after collection, glucose concentrations in whole blood were determined, in duplicate, by glucometry from the syringe (plain whole blood [WB] group), EDTA tube (EDTA group) and one FO tube (FO group). One FO sample was used to measure plasma glucose concentration by a laboratory chemistry analyser (LAB group) ≤1 h after collection. The third FO tube was used to measure plasma glucose concentration by glucometry after 3 h storage (FO3hr group). Adequate precision was present for all groups (coefficient of variation: 0.7-3.5%) except WB (5.5-9.4%). Between groups, correlations were significant (P < 0.05; except for WB-EDTA), varied with group comparison, and tended to be lowest for comparisons involving WB. Mean bias was lowest for WB-LAB and greatest for FO-LAB and FO3hr-LAB; however, the limits of agreement were ≥4.65 mmol/L for WB-LAB and ≤2.75 mmol/L for most other comparisons. For the glucometer used, performance was influenced by sample type: WB was unsuitable, while FO or EDTA samples resulted in adequate precision and accuracy, provided under-estimation of glucose concentrations is accounted for by using method-specific reference ranges. Glucometer performance and optimal sample type(s) should be determined prior to use in horses.


Assuntos
Glicemia/metabolismo , Doenças dos Cavalos/diagnóstico , Cavalos/sangue , Hiperglicemia/veterinária , Sistemas Automatizados de Assistência Junto ao Leito , Animais , Feminino , Doenças dos Cavalos/sangue , Hiperglicemia/diagnóstico , Masculino , Valores de Referência , Reprodutibilidade dos Testes
2.
Nutrients ; 11(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31382699

RESUMO

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


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Dieta/efeitos adversos , Comportamento Alimentar , Hiperglicemia/epidemiologia , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Valor Nutritivo , Estudos Prospectivos , Fatores de Proteção , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Fatores Sexuais
3.
Sensors (Basel) ; 19(15)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366169

RESUMO

Diabetes is a very complex condition affecting millions of people around the world. Its occurrence, always accompanied by sustained hyperglycemia, leads to many medical complications that can be greatly mitigated when the disease is treated in its earliest stage. In this paper, a novel sensing approach for the early non-invasive detection and monitoring of sustained hyperglycemia is presented. The sensing principle is based on millimeter-wave transmission spectroscopy through the skin and subsequent statistical analysis of the amplitude data. A classifier based on functional principal components for sustained hyperglycemia prediction was validated on a sample of twelve mice, correctly classifying the condition in diabetic mice. Using the same classifier, sixteen mice with drug-induced diabetes were studied for two weeks. The proposed sensing approach was capable of assessing the glycemic states at different stages of induced diabetes, providing a clear transition from normoglycemia to hyperglycemia typically associated with diabetes. This is believed to be the first presentation of such evolution studies using non-invasive sensing. The results obtained indicate that gradual glycemic changes associated with diabetes can be accurately detected by non-invasively sensing the metabolism using a millimeter-wave spectral sensor, with an observed temporal resolution of around four days. This unprecedented detection speed and its non-invasive character could open new opportunities for the continuous control and monitoring of diabetics and the evaluation of response to treatments (including new therapies), enabling a much more appropriate control of the condition.


Assuntos
Glicemia/isolamento & purificação , Diabetes Mellitus Experimental/diagnóstico , Hiperglicemia/diagnóstico , Análise Espectral/métodos , Animais , Diabetes Mellitus Experimental/metabolismo , Humanos , Hiperglicemia/metabolismo , Camundongos
4.
Surgery ; 166(4): 655-662, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31351669

RESUMO

BACKGROUND: The relationship between preoperative hyperglycemia and complications after surgery is not well defined. We compared the relationship of preoperative versus postoperative hyperglycemia on clinical outcomes and assessed if preoperative hyperglycemia was a predictor for postoperative hyperglycemia in patients undergoing elective colorectal surgery. METHODS: We performed a retrospective review of an institutional database for patients who underwent elective colorectal resection between July 2015 and June 2017. Data regarding patient characteristics, history of diabetes, preoperative and postoperative hyperglycemic events, and postoperative complications were collected. Bivariate and multivariate logistic analyses were used to assess relationships. RESULTS: Of 755 surgical operations reviewed, preoperative hyperglycemia >180 mg/dL was not significantly associated with adverse outcomes in an adjusted model. Only postoperative hyperglycemia >180 mg/dL was significantly associated with complications, including acute kidney injury (odds ratio 2.58, P < 0.001), anastomotic leak (odds ratio 2.64, P = 0.01), arrhythmia (odds ratio 2.40, P = 0.009), and sepsis (odds ratio 3.86, P < 0.001). Preoperative hyperglycemia remained a significant predictor of postoperative hyperglycemia (odds ratio 4.91, P < 0.001). CONCLUSION: Postoperative hyperglycemia was more significantly associated with adverse clinical outcomes after elective colorectal surgery than was preoperative hyperglycemia. However, preoperative hyperglycemia was associated with postoperative hyperglycemia, suggesting that improved glycemic management preoperatively may help reduce hyperglycemic events after surgery.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Idoso , Estudos de Coortes , Neoplasias Colorretais/patologia , Bases de Dados Factuais , Intervalo Livre de Doença , Procedimentos Cirúrgicos Eletivos/mortalidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
5.
Diabetes Metab Syndr ; 13(2): 1241-1244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336471

RESUMO

AIMS: Visceral Adiposity Index (VAI) is suggested as a surrogate marker for visceral adipose tissue dysfunction. It is an empirical-mathematical model, sex-specific, based on metabolic and anthropometric parameters. Diabetes mellitus is growing in an expanding fashion globally. The aim of this study to study the association between VAI and glycemic control in women with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A total of 300 T2DM female aged (25-60 years) were enrolled in this cross-sectional study. Subjects were recruited from Baghdad medical city during the period from January 2017 to July 2018. Body mass index (BMI), waist circumference (WC), blood pressure was measured and fasting blood sample was analyzed for blood glucose, glycated hemoglobin(HbA1c), and lipid profile. VAI was calculated in addition to triglyceride-glucose (TyG) derived indices. Statistical analysis was done by SPSS version 23. The study was ethically approved. RESULTS: Patients with high VAI showed poor glycemic control, dyslipidemia, elevated TYG index, TYGWC and TYGBMI. The number of diabetics with poor glycemic control increased across the VAI quartiles. The area under the curve in ROC analysis demonstrated that VAI had a good predictive ability to identify the state of glycemic control as compared to other anthropometric measures (WC, BMI) or combined metabolic and anthropometric measures (TyGWC, TyGBMI). CONCLUSION: increased VAI adversely affects the glycemic control in women with T2DM.


Assuntos
Adiposidade , Biomarcadores/análise , Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/diagnóstico , Gordura Intra-Abdominal/fisiopatologia , Obesidade Abdominal/fisiopatologia , Adulto , Glicemia/análise , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/etiologia , Iraque/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Fatores de Risco , Circunferência da Cintura
6.
Pan Afr Med J ; 33: 7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303952

RESUMO

Sickle cell anaemia (SCA) and type 1 diabetes mellitus (type 1 DM) are chronic medical conditions whose co-existence is uncommon in childhood. Furthermore, complications of SCA such as mesenteric crisis typically present with abdominal pain, which is also common in children with diabetic ketoacidosis (DKA) and this may possess diagnostic challenge. Herewith in, we report a rare case of a nine-year-old child with homozygous sickle cell anaemia, who presented with features of mesenteric crisis and diabetic ketoacidosis. The DKA was diagnosed based on the presence of hyperglycaemia (32.2 mmol/L), ketonaemia (4.6 mmol/L) and acidosis (11.6 mmol/L). The fluids deficit was corrected over 24 hours, with improvement in the vaso-occlusive crises (VOC) without precipitating cerebral oedema.


Assuntos
Anemia Falciforme/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/diagnóstico , Criança , Cetoacidose Diabética/fisiopatologia , Cetoacidose Diabética/terapia , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Cetose/diagnóstico , Cetose/etiologia , Masculino
8.
Medicine (Baltimore) ; 98(28): e16255, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305406

RESUMO

RATIONALE: Hemichorea-hemiballism, a rare manifestation of non-ketotic hyperglycemia, characterized by involuntary arrhythmic motions involving one side of the body, results from focal lesions in the contralateral caudate nucleus and putamen. Hyperkinetic disorders can be complications of uncontrolled diabetes mellitus and should not be ignored. PATIENT CONCERNS: We present the case of a 39-year-old woman who presented to the emergency department with a 3-day history of left-sided hemichorea-hemiballism. She had type 2 diabetes mellitus with poor control and maintenance of regular hemodialysis. DIAGNOSES: The patient was diagnosed as hyperglycemia, normal ketone body and hemichorea-hemiballism based on laboratory examination, computed tomography (CT) scan, and brain magnetic resonance image (MRI). INTERVENTIONS: Intensive glycemic control via insulin injection was prescribed for correction of hyperglycemia. OUTCOMES: The unilateral involuntary movements subsided progressively over four weeks. The patient's hemichorea had completely resolved at the three-month follow-up. LESSONS: This unusual clinical presentation is often accompanied by severe hyperglycemia. Appropriate blood glycemic control is important. If physicians recognize and provide early treatment for this disease, it is usually treatable and has a good prognosis.


Assuntos
Coreia/complicações , Diabetes Mellitus Tipo 2/complicações , Discinesias/complicações , Hiperglicemia/complicações , Adulto , Coreia/diagnóstico , Coreia/tratamento farmacológico , Coreia/fisiopatologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Diagnóstico Diferencial , Discinesias/diagnóstico , Discinesias/tratamento farmacológico , Discinesias/fisiopatologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/tratamento farmacológico , Hiperglicemia/fisiopatologia
9.
Clin Lab ; 65(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31307169

RESUMO

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


Assuntos
Biomarcadores/sangue , Regulação da Expressão Gênica , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , MicroRNAs/sangue , Glicemia/metabolismo , Colesterol/sangue , Jejum/sangue , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/genética , Hiperlipidemias/sangue , Hiperlipidemias/diagnóstico , Hiperlipidemias/genética , Masculino , Síndrome Metabólica/genética , MicroRNAs/genética , Pessoa de Meia-Idade , Curva ROC
10.
Nutrients ; 11(7)2019 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261967

RESUMO

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


Assuntos
Doenças Cardiovasculares/epidemiologia , Gorduras na Dieta/efeitos adversos , Dislipidemias/epidemiologia , Hiperglicemia/epidemiologia , Síndrome Metabólica/epidemiologia , Idoso , Biomarcadores/sangue , Glicemia/análise , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Estudos Transversais , Dieta Mediterrânea , Gorduras na Dieta/administração & dosagem , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/dietoterapia , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/dietoterapia , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/dietoterapia , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento
11.
Diabetes Res Clin Pract ; 154: 75-81, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271810

RESUMO

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


Assuntos
Automonitorização da Glicemia/normas , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Conhecimentos, Atitudes e Prática em Saúde , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Cuidado Pré-Concepcional/métodos , Adulto , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/sangue , Hiperglicemia/induzido quimicamente , Hiperglicemia/diagnóstico , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Projetos Piloto , Prognóstico , Estudos Prospectivos
12.
Diabetes Res Clin Pract ; 154: 138-145, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31150723

RESUMO

AIM: To evaluate the predictive factors of glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS: Cross-sectional study at a referral service in Rio de Janeiro, Brazil. Sociodemographic, anthropometric, clinical, and dietary factors were evaluated. Food consumption was evaluated by 24 h dietary recall and the NOVA system was adopted for classifying the foods according to the extent and purpose of industrial processing. The predictive factors were evaluated by multivariate linear regression, adopting p < 0.05. RESULTS: One hundred and twenty children and adolescents participated, with a mean age of 11.74 years (±2.88) and HbA1c of 8.13% (±1.26). The mean diabetes duration was 6.68 years (±3.33) and the insulin used was 1.05 units per kilogram of ideal weight (IU/kg of ideal weight; ±0.46) About 80% (n = 96) used carbohydrate counting and it was verified that 24.27% (±17.89) of the participants' total calories came from ultraprocessed foods. For each year of diagnosis with T1DM and for each IU/kg of weight used, HbA1c increased by 0.087% (ß = 0.087, p = 0.007) and 0.651%, respectively (ß = 0.651; p = <0.001). Use of carbohydrate counting was associated with a 1.058% reduction in HbA1c (ß = -1.058; p = 0.001). CONCLUSION: Disease duration and insulin dose were directly reflected in HbA1c concentrations, while carbohydrate counting showed an inverse association.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hemoglobina A Glicada/análise , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Insulina/administração & dosagem , Encaminhamento e Consulta , Adolescente , Peso Corporal , Brasil/epidemiologia , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/fisiopatologia , Ingestão de Energia , Feminino , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Valor Preditivo dos Testes , Prevalência
13.
BMC Endocr Disord ; 19(1): 57, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170961

RESUMO

BACKGROUND: Although exercise seems to be beneficial for type 2 diabetes mellitus (T2DM) patients, there is limited research elucidating the optimal accessible indices of adiposity and insulin resistance for identifying elderly T2DM patients with poor glycemic control, which could be improved by performing regular exercise. METHODS: A community-based, cross-sectional study was conducted with 918 Chinese elderly individuals with T2DM in Zhejiang. Relevant risk factors for poor glycemic control, as determined using glycated haemoglobin A1c (HbA1c) > 7%, were explored using logistic regression analyses and included body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), the product of fasting triglycerides and glucose (TyG), visceral adiposity index (VAI), lipid accumulation product (LAP), TyG-BMI, and TyG-WC. Comparisons of the risk factors' ability to discriminate poor glycemic control as well as their optimal cutoff values were determined using receiver operating characteristic (ROC) analyses, and then the extent of poor glycemic control risk reduction through regular exercise was examined using multivariate logistic regression analyses. RESULTS: The overall poor glycemic control rate was 49.3%. The factors associated with poor glycemic control included FBG > 3.869, TyG > 8.73, TyG-BMI > 222.45, and TyG-WC > 713.48 in logistic regression analyses. The optimal cutoff points of FBG, TyG, TyG-WC, and TyG-BMI in discriminating poor glycemic control were 7.38, 9.22, 813.33, and 227.77, and their corresponding areas under the ROC curves were 0.864(0.840-0.886), 0.684(0.653-0.714), 0.604(0.571-0.635), and 0.574(0.541-0.606), respectively. Occasional and regular exercise reduced the odds ratios (95% confidence interval) of poor glycemic control to 0.187 (0.063-0.557) and 0.183 (0.059-0.571) for subjects with TyG-WC > 813.33 (p = 0.008), to 0.349 (0.156-0.782) and 0.284 (0.123-0.652) for subjects with TyG > 9.22 (p = 0.011), and to 0.390 (0.175-0.869) and 0.300(0.130-0.688) for subjects with TyG-BMI > 227.77 (p = 0.017), respectively, after adjusting for multiple confounding factors. CONCLUSION: Among elderly individuals with T2DM, poor glycemic control risk might be identified using indices calculated from FBG, TG, BMI, and WC measurements, which are indicative of adiposity and insulin resistance. TyG-WC seems to be an accessible and useful indicator to identify which elderly T2DM patients would benefit from performing regular exercise to achieve good glycemic control.


Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Vida Independente/estatística & dados numéricos , Resistência à Insulina , Obesidade Abdominal/complicações , Adiposidade , Idoso , Biomarcadores/análise , China/epidemiologia , Estudos Transversais , Terapia por Exercício , Feminino , Seguimentos , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Prognóstico , Curva ROC , Fatores de Risco
14.
Diabetes Res Clin Pract ; 154: 27-34, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31238060

RESUMO

AIMS: To evaluate the natural history of gastric emptying in type 2 diabetes. METHODS: 12 patients with type 2 diabetes (7 female; age 65.6 ±â€¯1.2 years; duration of known diabetes 22.9 ±â€¯1.5 years) were invited to return for repeat measurements of gastric emptying using the same dual-labelled solid and liquid meal, a mean of 14.0 ±â€¯0.5 years after their initial study. Blood glucose levels, glycated haemoglobin, upper gastrointestinal symptoms and autonomic nerve function at baseline and follow up were also compared. RESULTS: Gastric emptying of solids was more rapid at follow up than at baseline (period effect P < 0.05), while emptying of liquids was comparable at baseline and follow up (period effect P = 0.2). Gastric emptying of the solid component was abnormally slow (based on T100min) in 6 subjects at baseline and 1 subject at follow up. Liquid emptying was abnormally slow in 6 subjects at baseline, and 5 subjects at follow up. Two patients were insulin treated at baseline, and 6 at follow up. HbA1c was higher at follow up (P < 0.05); however, fasting blood glucose (P = 0.6), postprandial blood glucose excursions (P = 0.07), autonomic nerve function (P > 0.999), and total upper gastrointestinal symptom score (P = 0.1) did not differ. CONCLUSIONS: In patients with long-term type 2 diabetes, gastric emptying of solids and liquids does not usually become more delayed over time, and abnormally slow gastric emptying of solids may improve.


Assuntos
Complicações do Diabetes/etiologia , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/etiologia , Esvaziamento Gástrico , Gastroenteropatias/etiologia , Hiperglicemia/etiologia , Hipoglicemia/etiologia , Idoso , Glicemia/análise , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Neuropatias Diabéticas/diagnóstico , Feminino , Gastroenteropatias/diagnóstico , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/diagnóstico , Hipoglicemia/diagnóstico , Insulina/análise , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico
15.
Intern Med ; 58(19): 2825-2830, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243198

RESUMO

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


Assuntos
Glicemia/metabolismo , Peptídeo C/sangue , Diabetes Mellitus Tipo 1/induzido quimicamente , Hiperglicemia/diagnóstico , Nivolumabe/efeitos adversos , Idoso , Anticorpos Monoclonais/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Diabetes Mellitus Tipo 1/sangue , Humanos , Hiperglicemia/sangue , Hiperglicemia/induzido quimicamente , Insulina/sangue , Neoplasias Renais/tratamento farmacológico , Masculino , Nivolumabe/uso terapêutico
16.
Clin Lab ; 65(6)2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31232032

RESUMO

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


Assuntos
Proteínas Quinases Ativadas por AMP/genética , Biomarcadores/metabolismo , Doenças Metabólicas/genética , MicroRNAs/genética , Regiões 3' não Traduzidas/genética , Biomarcadores/sangue , Feminino , Regulação da Expressão Gênica , Células HEK293 , Células Hep G2 , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/genética , Hiperlipidemias/sangue , Hiperlipidemias/diagnóstico , Hiperlipidemias/genética , Masculino , Doenças Metabólicas/sangue , Doenças Metabólicas/diagnóstico , MicroRNAs/sangue , Pessoa de Meia-Idade , Curva ROC
17.
J Pediatr Endocrinol Metab ; 32(7): 785-789, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31251726

RESUMO

Background Cyclic Cushing's disease (CCD) is reported to occur in approximately 15% of patients with Cushing's disease (CD). CCD is a rare phenomenon in children. Case presentation A Portuguese female with well-controlled type 1 diabetes (T1DM) on an insulin pump developed transient uncontrolled blood sugar every morning. Increased basal and bolus insulin dosing was ineffective in lowering blood sugar and she began to miss school because of nausea, vomiting, fatigue, but no ketoacidosis. Therefore, other causes of sporadic hyperglycemia were explored. Multiple 6-h urinary free cortisol (UFC) samples revealed a spike in cortisol coincident with severe hyperglycemia. Pituitary magnetic resonance imaging (MRI) revealed a 3.5 mm microadenoma and inferior petrosal sinus sampling of adrenocorticotropic hormone (ACTH) after corticotropin releasing hormone (CRH) stimulation confirmed ACTH-dependent CD. Endoscopic endonasal tumor resection led to resolution of early morning hyperglycemia and symptoms. Discussion Our case illustrates an atypical presentation of CCD. There are no previous case reports of a pediatric patient with T1DM and CCD. Unexplained hyperglycemia in a patient with previous well-controlled T1DM should prompt assessment of other causes. CCD can be easily be missed if timed 6-h UFC measurements are not obtained.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Hiperglicemia/diagnóstico , Hipersecreção Hipofisária de ACTH/diagnóstico , Adolescente , Diagnóstico Diferencial , Feminino , Humanos , Hiperglicemia/etiologia , Hipersecreção Hipofisária de ACTH/etiologia , Prognóstico
18.
Zhonghua Er Ke Za Zhi ; 57(6): 440-444, 2019 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-31216801

RESUMO

Objective: To explore the gene mutation characteristics and detailed clinical presentations of hyperglycemia caused by GCK mutations in 10 patients. Methods: The clinical and follow-up data of 10 patients with hyperglycemia caused by mutation of GCK gene were reviewed. The patients were ascertained between January 1, 2014 and August 31, 2018 at the Department of Pediatrics, the First Affiliated Hospital of Zhejiang University and Ningbo Women & Children's Hospital. Clinical data were collected, including age, gender, main complaint, family history, fasting blood glucose, fasting blood insulin, 2-hour blood glucose, 2-hour blood insulin after oral glucose tolerance test, glycosylated hemoglobin, anti-glutamic acid decarboxylase antibody and body mass index. Mutations of GCK gene were detected by Sanger sequencing or high-throughput sequencing of diabetes-related genes in the patients and their family members. Results: There were ten patients, 8 of them were male, 2 were female.The ages at diagnosis varied between 4.7 to 12.3 years. The patients usually did not have obvious clinical symptoms of diabetes mellitus. Most of them were unexpectedly found to have hyperglycemia and with impaired glucose metabolism in three consecutive generations. The fasting blood glucose of patients was 6.8-7.7 mmol/L, 2-hour postprandial blood glucose was 7.8-11.6 mmol/L. Fasting blood insulin was 0.5-8.5 mU/L, glucose tolerance test results showed that 2 h postprondial blood insulin was 1.3-55.4 mU/L. The level of glycosylated hemoglobin was 6.1%-6.8%. Anti-glutamic acid decarboxylase antibody was negative in all patients. The GCK mutations identified in patients and one of their parents were located at exon5 (4 cases), exon9 (2 cases), exon2 (1 case), exon4 (1 case), exon6 (1 case) and exon7 (1 case). Conclusions: Most of the hyperglycemia patients caused by GCK mutations did not have typical clinical symptoms of diabetes. The fasting blood glucose was slightly elevated. Abnormal glucose tolerance test results were found in all 10 patients. Three consecutive generations of family had impaired glucose metabolism. GCK mutations located at exon 5 were common in 10 cases. There was no correlation between type of mutations and plasma glucose levels in domestic and international researches. When fasting glucose was found abnormal in clinic, a complete family history should be taken and the GCK gene should be sequenced to confirm the diagnosis in time.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/genética , Glucoquinase/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Hiperglicemia/genética , Glicemia , Criança , Pré-Escolar , Feminino , Marcadores Genéticos , Teste de Tolerância a Glucose , Humanos , Hiperglicemia/diagnóstico , Masculino , Mutação
19.
Zhonghua Nei Ke Za Zhi ; 58(5): 372-376, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31060146

RESUMO

Objective: To explore the influence of lifestyle intervention on long-term diabetes in subjects with impaired glucose tolerance (IGT) returned to normal glucose tolerance (NGT) within 6 years. Methods: A total of 577 subjects (aged 25-74 years old) with IGT in Daqing were enrolled and randomly assigned to control, and diet, exercise and diet plus exercise groups in a six-year intervention trial in 1986. Subjects who were non-diabetic at the end of the intervention were followed up for additional 14 years. Results: Among all the subjects, 41.38% of them who had returned to NGT from IGT within 6 years maintained NGT status after 20 years, and had a lower incidence of diabetes than subjects maintained IGT status (46.55% vs. 75.25%). Of note, in the intervention group, the percentage of participants developed diabetes in the NGT subjects was significantly lower than that in the IGT group (43.71% vs. 76.25%) after 20 years. There was high long-term risk for diabetes in the IGT subjects after the adjustment of age, sex and baseline glucose (HR=1.81, 95%CI 1.27-2.58, P=0.001), whereas in the non-intervention group, no significant difference could be viewed in long-term diabetic risk between subjects maintained IGT status and those returned to NGT (71.43% vs. 65.22%) after adjusting of the same confounders (HR=1.03, 95%CI 0.45-2.35, P=0.94). Conclusions: IGT subjects who had returned to NGT in early years had lower risk for future diabetes than those who remained IGT. However, this beneficial effect could only be viewed in the intervention group, but not in the non-intervention group.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Intolerância à Glucose/prevenção & controle , Insulina/metabolismo , Adulto , Idoso , Glicemia/análise , Diabetes Mellitus Tipo 2/diagnóstico , Exercício , Seguimentos , Intolerância à Glucose/complicações , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Pessoa de Meia-Idade , Comportamento de Redução do Risco
20.
PLoS One ; 14(5): e0216897, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31075132

RESUMO

OBJECTIVE: To estimate the risk of childhood obesity associated with the various criteria proposed for diagnosis of gestational diabetes (GDM), and the joint effects with maternal BMI. METHODS: Cohort study of 46,396 women delivering at the Kaiser Permanente Northern California health care delivery system in 1995-2004 and their offspring, followed through 5-7 years of age. Pregnancy hyperglycemia was categorized according to the screening and oral glucose tolerance test values proposed for the diagnosis of GDM by the International Association of the Diabetes and Pregnancy Study Group (IADPSG), Carpenter Coustan (CC), and the National Diabetes Data Group (NDDG). Childhood obesity was defined by the International Obesity Task Force's age and sex-specific BMI cut-offs. Poisson regression models estimated the risks of childhood obesity associated with each category of pregnancy glycemia compared to normal screening, and the joint effects of maternal BMI category and GDM by the CC and the IADPSG criteria. RESULTS: Compared with normal screening, increased risks of childhood obesity were observed for abnormal screening [RR (95% CI): 1.30 (1.22, 1.38)], 1+ abnormal values by the IADPSG or CC [1.47 (1.36, 1.59) and 1.48 (1.37, 1.59), respectively], and 2+ values by CC or NDDG [1.52 (1.39, 1.67) and 1.60 (1.43, 1.78), respectively]. Compared to obese women without GDM, obese women with GDM defined by the CC criteria had significantly increased risk of childhood obesity [1.20 (1.07, 1.34)], which was also observed for GDM by the IADSPG [1.18 (1.07, 1.30)], though GDM did not significantly increase the risk of childhood obesity among normal weight or overweight women. CONCLUSIONS: The risk of childhood obesity starts to increase at levels of pregnancy glycemia below those used to diagnose GDM and the effect of GDM on childhood obesity risk appears more pronounced in women with obesity. Interventions to reduce obesity and pregnancy hyperglycemia are warranted.


Assuntos
Glicemia/metabolismo , Bases de Dados Factuais , Diabetes Gestacional , Hiperglicemia , Obesidade Pediátrica , California , Criança , Pré-Escolar , Assistência à Saúde , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Obesidade Pediátrica/sangue , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/etiologia , Gravidez , Fatores de Risco
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