المؤلفون: Hjort, Anna, Iggman, David, Docent, 1981, Rosqvist, Fredrik, 1985

المصدر: Clinical Nutrition. 43(4):915-925

مصطلحات موضوعية: Atherosclerosis, Cardiovascular disease, Continuous glucose monitoring, Glycemic variability, Prediabetes, Type 2 diabetes

الوصف: Background & aims: Continuous glucose monitoring (CGM) provides data on short-term glycemic variability (GV). GV is associated with adverse outcomes in individuals with diabetes. Whether GV is associated with cardiometabolic risk in individuals without diabetes is unclear. We systematically reviewed the literature to assess whether GV is associated with cardiometabolic risk markers or outcomes in individuals without diabetes. Methods: Searches were performed in PubMed/Medline, Embase and Cochrane from inception through April 2022. Two researchers were involved in study selection, data extraction and quality assessment. Studies evaluating GV using CGM for >= 24 h were included. Studies in populations with acute and/or critical illness were excluded. Both narrative synthesis and meta -analyzes were performed, depending on outcome. Results: Seventy-one studies were included; the majority were cross-sectional. Multiple measures of GV are higher in individuals with compared to without prediabetes and GV appears to be inversely associated with beta cell function. In contrast, GV is not clearly associated with insulin sensitivity, fatty liver disease, adiposity, blood lipids, blood pressure or oxidative stress. However, GV may be positively associated with the degree of atherosclerosis and cardiovascular events in individuals with coronary disease. Conclusion: GV is elevated in prediabetes, potentially related to beta cell dysfunction, but less clearly associated with obesity or traditional risk factors. GV is associated with coronary atherosclerosis development and may predict cardiovascular events and type 2 diabetes. Prospective studies are warranted, investigating the predictive power of GV in relation to incident disease. GV may be an important risk measure also in individuals without diabetes. (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0Test/).

وصف الملف: electronic

الوصول الحر: https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-527717Test
https://doi.org/10.1016/j.clnu.2024.02.014Test
https://uu.diva-portal.org/smash/get/diva2:1856676/FULLTEXT01.pdfTest

المؤلفون: Nilsen, Inger, Cand. Scient, 1968, Sundbom, Magnus, Osterberg, Johanna, Laurenius, Anna, Andersson, Agneta, 1968, Hänni, Arvo

المصدر: Surgery for Obesity and Related Diseases. 20(1):10-16

مصطلحات موضوعية: Carbohydrate intake, Continuous glucose monitoring (CGM), Edinburgh hypoglycemia scale, Glycemic variability, Hypoglycemia, Interstitial glucose concentration, Low-energy diet, Open-ended food record, Roux-en-Y gastric bypass, Sleeve gastrectomy

الوصف: BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) lead to lower fasting glucose concentrations, but might cause higher glycemic variability (GV) and increased risk of hypoglycemia. However, it has been sparsely studied in patients without preoperative diabetes under normal living conditions.OBJECTIVES: To study 24-hour interstitial glucose (IG) concentrations, GV, the occurrence of hypoglycemia and dietary intake before and after laparoscopic RYGB and SG in females without diabetes.SETTING: Outpatient bariatric units at a community and a university hospital.METHODS: Continuous glucose monitoring and open-ended food recording over 4 days in 4 study periods: at baseline, during the preoperative low-energy diet (LED) regimen, and at 6 and 12 months postoperatively.RESULTS: Of 47 patients included at baseline, 83%, 81%, and 79% completed the remaining 3 study periods. The mean 24-hour IG concentration was similar during the preoperative LED regimen and after surgery and significantly lower compared to baseline in both surgical groups. GV was significantly increased 6 and 12 months after surgery compared to baseline. The self-reported carbohydrate intake was positively associated with GV after surgery. IG concentrations below 3.9 mmol/L were observed in 14/25 (56%) of RYGB- and 9/12 (75%) of SG-treated patients 12 months after surgery. About 70% of patients with low IG concentrations also reported hypoglycemic symptoms.CONCLUSIONS: The lower IG concentration in combination with the higher GV after surgery, might create a lower margin to hypoglycemia. This could help explain the increased occurrence of hypoglycemic episodes after RYGB and SG.

وصف الملف: electronic

الوصول الحر: https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-514540Test
https://doi.org/10.1016/j.soard.2023.07.008Test
https://uu.diva-portal.org/smash/get/diva2:1805708/FULLTEXT01.pdfTest

المؤلفون: Huang L, Wang Z, Pan Y, Zhou K, Zhong S

المصدر: Diabetes, Metabolic Syndrome and Obesity, Vol Volume 17, Pp 1973-1986 (2024)

مصطلحات موضوعية: diabetes mellitus, glycemic variability, vascular lesions of diabetes mellitus, glycemic variability parameters., Specialties of internal medicine, RC581-951

الوصف: Lining Huang,1 Zhaoxiang Wang,1 Ying Pan,1 Kaixin Zhou,2 Shao Zhong1 1Gusu School, Nanjing Medical University, the First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China; 2Guangzhou Laboratory, Guangzhou, 510005, People’s Republic of ChinaCorrespondence: Shao Zhong, Department of Endocrinology, Gusu School, Nanjing Medical University, the First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China, Tel +86 13328056828, Email drzhong@163.comObjective: Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by insulin resistance and progressively impaired insulin secretion resulting in dynamic fluctuations in glucose levels.High blood urea nitrogen (BUN) levels have been linked to decreased insulin sensitivity, suppressed insulin synthesis and increased risk of incident diabetes mellitus in humans as well as insulin use in patients with T2DM.This study characterize the association between BUN levels and short-term and long-term glycemic variability(GV) in the elderly patients with T2DM who were hospitalized.Methods: A total of 927 elderly patients with T2DM were included in the study. The short-term GV was quantified using parameters such as standard deviation (SD), coefficient of variation (CV), time in range (TIR), and mean amplitude of glycemic excursions (MAGE), based on multi-point fingertip blood glucose monitoring. The long-term GV was quantified using parameters such as SD, CV, variation independent of the mean (VIM), and average successive variability (ARV), based on fasting blood glucose(FPG). The relationship between BUN levels and short-term and long-term GV in elderly T2DM who were hospitalized was explored using methods such as Spearman correlation coefficient, linear regression analysis, logistic regression analysis, and interaction tests.Results: In elderly patients with T2DM were hospitalized, there is a significant correlation between BUN levels and both short-term and long-term GV. BUN is negatively correlated with the GV parameter TIR (r=− 0.12, P=0.000), and positively correlated with SD (r=0.12, P=0.000), CV (r=0.07, P=0.026), MAGE (r=0.11, P=0.001), FPG-SD (r=0.08, P=0.013), and FPG-CV (r=0.08, P=0.014).Furthermore, the association remains consistent across different age, gender, BMI, and haemoglobin A1c (HbA1c) subgroups (P interaction > 0.05).Conclusion: In elderly patients with T2DM were hospitalized, BUN levels were positively associated with GV.Therefore, monitoring BUN levels were beneficial in assessing the degree of GV.Keywords: diabetes mellitus, glycemic variability, vascular lesions of diabetes mellitus, glycemic variability parameters

وصف الملف: electronic resource

العلاقة: https://www.dovepress.com/correlation-between-blood-urea-nitrogen-and-short--and-long-term-glyce-peer-reviewed-fulltext-article-DMSOTest; https://doaj.org/toc/1178-7007Test

الوصول الحر: https://doaj.org/article/5d8e22b7fe4542d29be122295279f07fTest

المؤلفون: Juan Wang, Lu-lu Wang, Yan-min Yang, Hui-qiong Tan, Jun Zhu

المصدر: Cardiovascular Diabetology, Vol 23, Iss 1, Pp 1-10 (2024)

مصطلحات موضوعية: Glycemic variability, ST-segment elevation myocardial infarction, Diabetes mellitus, Outcomes, All-cause death, Major adverse cardiovascular events, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract Background Given the increasing attention to glycemic variability (GV) and its potential implications for cardiovascular outcomes. This study aimed to explore the impact of acute GV on short-term outcomes in Chinese patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled 7510 consecutive patients diagnosed with acute STEMI from 274 centers in China. GV was assessed using the coefficient of variation of blood glucose levels. Patients were categorized into three groups according to GV tertiles (GV1, GV2, and GV3). The primary outcome was 30-day all-cause death, and the secondary outcome was major adverse cardiovascular events (MACEs). Cox regression analyses were conducted to determine the independent correlation between GV and the outcomes. Results A total of 7136 patients with STEMI were included. During 30-days follow-up, there was a significant increase in the incidence of all-cause death and MACEs with higher GV tertiles. The 30-days mortality rates were 7.4% for GV1, 8.7% for GV2 and 9.4% for GV3 (p = 0.004), while the MACEs incidence rates was 11.3%, 13.8% and 15.8% for the GV1, GV2 and GV3 groups respectively (p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/4a2c5a08edfa429591450089ba030deeTest

المؤلفون: Salvatore Greco, Alessandro Salatiello, Francesco De Motoli, Antonio Giovine, Martina Veronese, Maria Grazia Cupido, Emma Pedarzani, Giorgia Valpiani, Angelina Passaro

المصدر: Cardiovascular Diabetology, Vol 23, Iss 1, Pp 1-17 (2024)

مصطلحات موضوعية: Type 2 diabetes mellitus, Glycemic variability, Glucose metabolism disorder, AdaBoost-FAS, Machine learning, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract Background Type 2 Diabetes Mellitus (T2DM) presents a significant healthcare challenge, with considerable economic ramifications. While blood glucose management and long-term metabolic target setting for home care and outpatient treatment follow established procedures, the approach for short-term targets during hospitalization varies due to a lack of clinical consensus. Our study aims to elucidate the impact of pre-hospitalization and intra-hospitalization glycemic indexes on in-hospital survival rates in individuals with T2DM, addressing this notable gap in the current literature. Methods In this pilot study involving 120 hospitalized diabetic patients, we used advanced machine learning and classical statistical methods to identify variables for predicting hospitalization outcomes. We first developed a 30-day mortality risk classifier leveraging AdaBoost-FAS, a state-of-the-art ensemble machine learning method for tabular data. We then analyzed the feature relevance to identify the key predictive variables among the glycemic and routine clinical variables the model bases its predictions on. Next, we conducted detailed statistical analyses to shed light on the relationship between such variables and mortality risk. Finally, based on such analyses, we introduced a novel index, the ratio of intra-hospital glycemic variability to pre-hospitalization glycemic mean, to better characterize and stratify the diabetic population. Results Our findings underscore the importance of personalized approaches to glycemic management during hospitalization. The introduced index, alongside advanced predictive modeling, provides valuable insights for optimizing patient care. In particular, together with in-hospital glycemic variability, it is able to discriminate between patients with higher and lower mortality rates, highlighting the importance of tightly controlling not only pre-hospital but also in-hospital glycemic levels. Conclusions Despite the pilot nature and modest sample size, this study marks the beginning of exploration into personalized glycemic control for hospitalized patients with T2DM. Pre-hospital blood glucose levels and related variables derived from it can serve as biomarkers for all-cause mortality during hospitalization.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/3c1f3c18e4904c598cc722c8475e0043Test

المؤلفون: Ying Xing, Min Wu, Hongping Liu, Penghui Li, Guoming Pang, Hui Zhao, Tiancai Wen

المصدر: Diabetology & Metabolic Syndrome, Vol 16, Iss 1, Pp 1-12 (2024)

مصطلحات موضوعية: Within-day glycemic variability, Glycemic fluctuations, Glycemic stability, Type 2 diabetes, Nutritional diseases. Deficiency diseases, RC620-627

الوصف: Abstract Aims Frequent and extensive within-day glycemic variability (GV) in blood glucose levels may increase the risk of hypoglycemia and long-term mortality in hospitalized patients with diabetes. We aimed to assess the amplitude and frequency of within-day GV in inpatients with type 2 diabetes and to explore the factors influencing within-day GV. Methods We conducted a single-center, retrospective observational study by analyzing hospital records and 10-day real-time continuous glucose monitoring data. Within-day GV was assessed using the coefficient of variation (%CV). The primary outcome was the amplitude and frequency of within-day GV. The frequency of within-day GV was assessed by the consecutive days (CD) of maintaining within the target %CV range after first reaching it (CD after first reaching the target) and the maximum consecutive days of maintaining within the target %CV range (Max-CD). The target %CV range was less than 24.4%. We evaluated the factors influencing within-day GV using COX regression and Poisson regression models. Results A total of 1050 cases were analyzed, of whom 86.57% reduced the amplitude of within-day GV before the sixth day of hospitalization. Of the 1050 hospitalized patients, 66.57% stayed within the target %CV range for less than two days after first reaching the target and 69.71% experienced a Max-CD of fewer than four days. Reducing the average postprandial glucose excursion (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.77–0.85; incidence rate ratios [IRR]: 0.72, 95% CI: 0.69–0.74) and the use of α-glucosidase inhibitors (IRR: 1.1, 95% CI: 1.01–1.18) and glucagon-like peptide-1 agonist (IRR: 1.30, 95% CI: 1.02–1.65) contributed to reducing the amplitude and decreasing the frequency of within-day GV. However, the use of insulin (HR: 0.64, 95% CI: 0.55–0.75; IRR: 0.86, 95% CI: 0.79–0.93) and glinide (HR: 0.47, 95% CI: 0.31–0.73; IRR: 0.84, 95% CI: 0.73–0.97) may lead to an increased frequency of within-day GV. Conclusions An increasing frequency of within-day GV was observed during the hospitalization in patients with type 2 diabetes, despite the effective reduction in the amplitude of within-day GV. Using medications designed to lower postprandial blood glucose could contribute to minimize the risk of frequent within-day GV.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1758-5996Test

الوصول الحر: https://doaj.org/article/d6521e359fad4b9b86a7d457908ebefcTest

المؤلفون: Hao-ming He, Shu-wen Zheng, Ying-ying Xie, Zhe Wang, Si-qi Jiao, Fu-rong Yang, Xue-xi Li, Jie Li, Yi-hong Sun

المصدر: Cardiovascular Diabetology, Vol 23, Iss 1, Pp 1-14 (2024)

مصطلحات موضوعية: Coronary artery disease, Glycemic variability, Stress hyperglycemia ratio, MIMIC-IV database, Mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Abstract Background Stress hyperglycemia and glycemic variability (GV) can reflect dramatic increases and acute fluctuations in blood glucose, which are associated with adverse cardiovascular events. This study aimed to explore whether the combined assessment of the stress hyperglycemia ratio (SHR) and GV provides additional information for prognostic prediction in patients with coronary artery disease (CAD) hospitalized in the intensive care unit (ICU). Methods Patients diagnosed with CAD from the Medical Information Mart for Intensive Care-IV database (version 2.2) between 2008 and 2019 were retrospectively included in the analysis. The primary endpoint was 1-year mortality, and the secondary endpoint was in-hospital mortality. Levels of SHR and GV were stratified into tertiles, with the highest tertile classified as high and the lower two tertiles classified as low. The associations of SHR, GV, and their combination with mortality were determined by logistic and Cox regression analyses. Results A total of 2789 patients were included, with a mean age of 69.6 years, and 30.1% were female. Overall, 138 (4.9%) patients died in the hospital, and 404 (14.5%) patients died at 1 year. The combination of SHR and GV was superior to SHR (in-hospital mortality: 0.710 vs. 0.689, p = 0.012; 1-year mortality: 0.644 vs. 0.615, p = 0.007) and GV (in-hospital mortality: 0.710 vs. 0.632, p = 0.004; 1-year mortality: 0.644 vs. 0.603, p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1475-2840Test

الوصول الحر: https://doaj.org/article/23cbbc08ef054a519f94b386fbe90d46Test

المؤلفون: Gordana Bukara-Radujkovic, Vesna Miljkovic

المصدر: Frontiers in Endocrinology, Vol 15 (2024)

مصطلحات موضوعية: glycemia risk index, glycemic variability, continuous glucose monitoring, pediatric diabetes, time in range, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: IntroductionFrom the introduction of continuous glucose monitoring (CGM) in treatments of type 1 diabetes, particularly its integration with insulin pumps, there has been a quest for new parameters that describe optimal glycemic control. As of the consensus reached in 2019, the ambulatory glucose profile (AGP) has become the standard, with time in range (TIR) emerging as a fundamental parameter for metabolic control assessment. However, with technological advancements, new parameters, such as the glycemia risk index (GRI), have been introduced and clinically utilized. Therefore, exploring the relationships between traditional and novel parameters to understand metabolic control comprehensively is imperative.Materials and methodsThis study was conducted at the Pediatric Clinic of the University Hospital of the Republic of Srpska Banja Luka between January and July 2023. The participants were randomly selected, with the inclusion criteria specifying an age greater than eight years and a diabetes type 1 duration exceeding two years. All participants were required to use a sensor-augmented insulin pump for the next three months (90 days), irrespective of prior use, with the suspend-before-low option activated.ResultsOf the 35 participants, 30 completed the study, 14 (46.7%) of whom were male. The mean age of the subjects was 14.90 ± 2.88 years, and the mean duration of diabetes was 7.83 ± 4.76 years. Over the 90-day period, HbA1c increased to an average of 7.31%. The analysis revealed significant effects of TIR (β=-0.771) and GRI (β=0.651) on HbA1c. Furthermore, GRI and TIR strongly correlated (β=-0.953).Discussion and conclusionNew parameters generated from the ambulatory glucose profile (AGP) can help clinicians create a complete picture of a patient’s metabolic control in relation to HbA1c levels. Additionally, the GRI is a mathematically tailored parameter that incorporates all components of the ambulatory glucose profile and demonstrates strong correlations with laboratory-measured HbA1c and TIR. The GRI potentially can become a valuable statistical parameter for evaluating and managing patients in routine clinical practice.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2024.1388245/fullTest; https://doaj.org/toc/1664-2392Test

الوصول الحر: https://doaj.org/article/65b2d6366ca7437c888e44530b9d17b4Test

المؤلفون: Weiping Wang, Lili Men, Yongbo Wang, Chunhong Shi, Huihui Yin, Han Li, Haicheng Zhou, Jianling Du

المصدر: Frontiers in Endocrinology, Vol 15 (2024)

مصطلحات موضوعية: needle-free injection, psychological insulin resistance, type 2 diabetes mellitus, insulin aspart 30, blood glucose control, glycemic variability, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Background and objectivePsychological insulin resistance (PIR), which refers to the reluctance of diabetic patients to use insulin, is a frequently encountered clinical issue. Needle-free injection (NFI) offers advantages in terms of expediting insulin absorption and mitigating adverse reactions related to injection. To evaluate the effects of subcutaneous injection of insulin aspart 30 with NFI on PIR and insulin dosage in patients with type 2 diabetes mellitus (T2DM).MethodsSixty-four patients with T2DM participated in this randomized, prospective, open, crossover study. Insulin aspart 30 was administered subcutaneously to each subject via QS-P NFI and Novo Pen 5 (NP) successively. The effects of NFI on PIR were analyzed. Differences in insulin dosage, glycemic variability, and injection safety were compared at similar levels of glycemic control.ResultsAfter the administration of NFI, the insulin treatment attitude scale score decreased (53.7 ± 7.3 vs. 58.9 ± 10.7, p

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2024.1379830/fullTest; https://doaj.org/toc/1664-2392Test

الوصول الحر: https://doaj.org/article/599b2427b58447ae8c364cc8fe0d9898Test

المؤلفون: Liyuan Ma, Jieying Liu, Mingqun Deng, Liyuan Zhou, Qian Zhang, Xinhua Xiao

المصدر: Diabetology & Metabolic Syndrome, Vol 16, Iss 1, Pp 1-12 (2024)

مصطلحات موضوعية: Type 1 diabetes, Time in range, Glycemic variability, Metabolomics, Nutritional diseases. Deficiency diseases, RC620-627

الوصف: Abstract Background Time in range (TIR), as an important glycemic variability (GV) index, is clearly associated with disease complications in type 1 diabetes (T1D). Metabolic dysregulation is also involved in the risks of T1D complications. However, the relationship between metabolites and TIR remains poorly understood. We used metabolomics to investigate metabolic profile changes in T1D patients with different TIR. Methods This study included 85 T1D patients and 81 healthy controls. GV indices, including TIR, were collected from continuous glucose monitoring system. The patients were compared within two subgroups: TIR-L (TIR 70%, n = 14). To screen for differentially abundant metabolites and metabolic pathways, serum and urine samples were obtained for untargeted metabolomics by ultra-performance liquid chromatography‒mass spectrometry. Correlation analysis was conducted with GV metrics and screened biomarkers. Results Metabolites were significantly altered in T1D and subgroups. Compared with healthy controls, T1D patients had higher serum levels of 5-hydroxy-L-tryptophan, 5-methoxyindoleacetate, 4-(2-aminophenyl)-2,4-dioxobutanoate, and 4-pyridoxic acid and higher urine levels of thromboxane B3 but lower urine levels of hypoxanthine. Compared with TIR-H group, The TIR-L subgroup had lower serum levels of 5-hydroxy-L-tryptophan and mevalonolactone and lower urine levels of thromboxane B3 and phenylbutyrylglutamine. Dysregulation of pathways, such as tryptophan, vitamin B6 and purine metabolism, may be involved in the mechanism of diabetic complications related to glycemic homeostasis. Mevalonolactone, hypoxanthine and phenylbutyrylglutamine showed close correlation with TIR. Conclusions We identified altered metabolic profiles in T1D individuals with different TIR. These findings provide new insights and merit further exploration of the underlying molecular pathways relating to diabetic complications.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1758-5996Test

الوصول الحر: https://doaj.org/article/f66f5ecd7c02483bacab46ab482061a6Test