-
1.
Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis.
Afghahi, H, Nasic, S, Peters, B, Rydell, H, Hadimeri, H, Svensson, J
PloS one. 2022;(1):e0262880
Abstract
BACKGROUND The large amount of glucose in the dialysate used in peritoneal dialysis (PD) likely affects the glycemic control. The aim of this study was to investigate the association between HbA1c variability, as a measure of long-term glycemic variability, and the risk of all-cause mortality in diabetic patients with PD. METHODS 325 patients with diabetes and ESRD were followed (2008-2018) in the Swedish Renal Registry. Patients were separated in seven groups according to level of HbA1c variability. The group with the lowest variability was denoted the reference. The ratio of the standard deviation (SD) to the mean of HbA1c, HbA1c (SD)/HbA1c (mean), i.e. the coefficient of variation (CV), was defined as HbA1c variability. Hazard ratios (HR) and 95% confidence intervals (CI) were examined using Cox regression analyses. RESULTS During follow-up, 170 (52%) deaths occurred. The highest mortality was among patients with the second highest HbA1c variability, CV≥2.83 [n = 44 of which 68% patients died]. In the multivariate analyses where lowest HbA1c variability (CV≤0.51) was used as the reference group, HbA1c CV 2.83-4.60 (HR 3.15, 95% CI 1.78-5.55; p<0.001) and CV> 4.6 (HR 2.48, 95% CI 1.21-5.11; p = 0.014) were associated with increased risk of death. CONCLUSION The high risk of all-cause mortality in patients with diabetes and PD increased significantly with elevated HbA1c variability, as measure of long-term glycemic control. This indicates that stable glycemia is associated with an improvement of survival; whereas more severe glycemic fluctuations, possibly caused by radical changes in dialysis regimes or peritonitis, are associated with a higher risk of mortality in diabetic patients with PD.
-
2.
Alternative pre-analytic sample handling techniques for glucose measurement in the absence of fluoride tubes in low resource settings.
Nakanga, WP, Balungi, P, Niwaha, AJ, Shields, BM, Hughes, P, Andrews, RC, Mc Donald, TJ, Nyirenda, MJ, Hattersley, AT
PloS one. 2022;(2):e0264432
Abstract
INTRODUCTION Sodium fluoride (NaF) tubes are the recommended tubes for glucose measurements, but these are expensive, have limited number of uses, and are not always available in low resource settings. Alternative sample handling techniques are thus needed. We compared glucose stability in samples collected in various tubes exposed to different pre-analytical conditions in Uganda. METHODS Random (non-fasted) blood samples were drawn from nine healthy participants into NaF, Ethylenediaminetetraacetic acid (EDTA), and plain serum tubes. The samples were kept un-centrifuged or centrifuged with plasma or serum pipetted into aliquots, placed in cool box with ice or at room temperature and were stored in a permanent freezer after 0, 2, 6, 12 and 24 hours post blood draw before glucose analysis. RESULTS Rapid decline in glucose concentrations was observed when compared to baseline in serum (declined to 64%) and EDTA-plasma (declined to 77%) after 6 hours when samples were un-centrifuged at room temperature whilst NaF-plasma was stable after 24 hours in the same condition. Un-centrifuged EDTA-plasma kept on ice was stable for up to 6 hours but serum was not stable (degraded to 92%) in the same conditions. Early centrifugation prevented glucose decline even at room temperature regardless of the primary tube used with serum, EDTA-plasma and NaF-plasma after 24 hours. CONCLUSION In low resource settings we recommend use of EDTA tubes placed in cool box with ice and analysed within 6 hours as an alternative to NaF tubes. Alternatively, immediate separation of blood with manual hand centrifuges will allow any tube to be used even in remote settings with no electricity.
-
3.
Precision Nutrition Model Predicts Glucose Control of Overweight Females Following the Consumption of Potatoes High in Resistant Starch.
Nolte Fong, JV, Miketinas, D, Moore, LW, Nguyen, DT, Graviss, EA, Ajami, N, Patterson, MA
Nutrients. 2022;(2)
Abstract
Individual glycemic responses following dietary intake result from complex physiological processes, and can be influenced by physical properties of foods, such as increased resistant starch (RS) from starch retrogradation. Predictive equations are needed to provide personalized dietary recommendations to reduce chronic disease development. Therefore, a precision nutrition model predicting the postprandial glucose response (PPGR) in overweight women following the consumption of potatoes was formulated. Thirty overweight women participated in this randomized crossover trial. Participants consumed 250 g of hot (9.2 g RS) or cold (13.7 g RS) potatoes on two separate occasions. Baseline characteristics included demographics, 10-day dietary records, body composition, and the relative abundance (RA) and α-diversity of gut microbiota. Elastic net regression using 5-fold cross-validation predicted PPGR after potato intake. Most participants (70%) had a favorable PPGR to the cold potato. The model explained 32.2% of the variance in PPGR with the equation: 547.65 × (0 [if cold, high-RS potato], ×1, if hot, low-RS potato]) + (BMI [kg/m2] × 40.66)-(insoluble fiber [g] × 49.35) + (Bacteroides [RA] × 8.69)-(Faecalibacterium [RA] × 73.49)-(Parabacteroides [RA] × 42.08) + (α-diversity × 110.87) + 292.52. This model improves the understanding of baseline characteristics that explain interpersonal variation in PPGR following potato intake and offers a tool to optimize dietary recommendations for a commonly consumed food.
-
4.
For a high fat, high protein breakfast, preprandial administration of 125% of the insulin dose improves postprandial glycaemic excursions in people with type 1 diabetes using multiple daily injections: A cross-over trial.
Smith, TA, Smart, CE, Howley, PP, Lopez, PE, King, BR
Diabetic medicine : a journal of the British Diabetic Association. 2021;(7):e14512
Abstract
AIM: To determine the glycaemic impact of an increased insulin dose, split insulin dose and regular insulin for a high fat, high protein breakfast in people with type 1 diabetes using multiple daily injections (≥4/day). METHODS In this cross-over trial, participants received the same high fat, high protein breakfast (carbohydrate:30 g, fat:40 g, protein:50 g) for 4 days. Four different insulin strategies were randomly allocated and tested; 100% of the insulin-to-carbohydrate ratio (ICR) given in a single dose using aspart insulin (100Asp), 125% ICR given in a single dose using aspart (125Asp) or regular insulin (125Reg) and 125% ICR given in a split dose using aspart insulin (100:25Asp). Insulin was given 0.25 hr pre-meal and for 100:25Asp, also 1 hr post-meal. Postprandial sensor glucose was measured for 5 hr. RESULTS In all, 24 children and adults were participated. The 5-hr incremental area under the curves for 100Asp, 125Asp, 125Reg and 100:25Asp were 620 mmol/L.min [95% CI: 451,788], 341 mmol/L.min [169,512], 675 mmol/L.min [504,847] and 434 mmol/L.min [259,608], respectively. The 5-hr incremental area under the curve for 125Asp was significantly lower than for 100Asp (p = 0.016) and for 125Reg (p = 0.002). There was one episode of hypoglycaemia in 125Reg. CONCLUSIONS For a high fat, high protein breakfast, giving 125% ICR preprandially, using aspart insulin significantly improved postprandial glycaemia without hypoglycaemia. There was no additional glycaemic benefit from giving insulin in a split dose (100:25%) or replacing aspart with regular insulin.
-
5.
Interactive associations of the INAFM2 rs67839313 variant and egg consumption with type 2 diabetes mellitus and fasting blood glucose in a Chinese population: A family-based study.
Wang, X, Wang, Z, Wu, J, Wang, M, Wang, J, Wu, T, Chen, D, Tang, X, Qin, X, Wu, Y, et al
Gene. 2021;:145357
Abstract
BACKGROUND INAFM2 rs67839313 was associated with type 2 diabetes (T2DM) in Japanese populations but not in other populations. We aimed to validate the association of rs67839313 with T2DM and explore interactive associations of INAFM2 rs67839313 and egg consumption with T2DM and fasting blood glucose (FBG) in a Chinese population. METHODS In total, 7175 participants (4202 T2DM cases) from 3980 families were included and categorized into two groups (<4 and ≥4 eggs/week) according to the median egg consumption. Multilevel logistic regression and linear regression models were performed to estimate the genetic associations of rs67839313 with T2DM and FBG, respectively. The crossproduct term between the variant and egg was included in the models for interaction analysis. RESULTS We found that rs67839313_T was associated with an increased risk of T2DM (1.22 [95% CI: 1.17-1.27], P < 0.001). Among individuals with the rs67839313_T genotype, those with egg consumption <4/week (1.37 [1.25-1.51]) had a higher T2DM risk than those with egg consumption ≥4/week (1.17 [1.11-1.23]). A significant interactive effect between rs67839313_T and egg consumption on T2DM risk was identified (P = 0.008). Moreover, among participants without T2DM, rs67839313_T was associated with FBG, with a 0.188 mmol/l increase and a 0.152 mmol/l decrease among those consuming <4 eggs/week and ≥4 eggs/week, respectively. The interaction between rs67839313_T and egg consumption was observed to be significantly associated with FBG (P = 0.003). CONCLUSIONS INAFM2 rs67839313_T was associated with increased T2DM risk and FBG levels in Chinese individuals, and consuming more eggs may eliminate the associated genetic risk. This finding has important implications for understanding the genetic pathogenesis of T2DM and for the precision nutrition management of T2DM.
-
6.
Black chokeberry Aronia melanocarpa extract reduces blood pressure, glycemia and lipid profile in patients with metabolic syndrome: a prospective controlled trial.
Tasic, N, Jakovljevic, VLJ, Mitrovic, M, Djindjic, B, Tasic, D, Dragisic, D, Citakovic, Z, Kovacevic, Z, Radoman, K, Zivkovic, V, et al
Molecular and cellular biochemistry. 2021;(7):2663-2673
Abstract
The aim of the study was to examine the effect of 4-week supplementation of Alixir 400 PROTECT® (Standardized Aronia L. Melanocarpa Extract Extract-SAE) on clinical and biochemical parameters in patients with confirmed metabolic syndrome (MetS). This study was designed as a prospective open-label clinical case-series study with 28 days of follow-up with cases selected and followed during the period from February 1, 2018 to November 2019. The study included 143 male and female patients with MetS who were subjected to SAE. SAE supplementation significantly altered SP, BP as well as HR values. After 2 weeks, CHOL levels significantly decreased in the fMetS-DM group compared to the baseline values in this group, while the LDL levels significantly decreased in the fMetS group. Triglycerides significantly decreased only after 4 weeks of SAE treatment in diabetic groups of patients (fMetS-DM and mMetS-DM) compared to the baseline, while in non-diabetic groups this marker was not significantly altered. Increased polyphenols or SAE consumption is correlated with a positive effect on body weight, total cholesterol, low and high-density lipoproteins, blood pressure and glycemia. Increasing consumption of polyphenol-rich foods could be a promising strategy to reduce cardiovascular risk.
-
7.
Association of Serum Alkaline Phosphatase with the TG/HDL Ratio and TyG Index in Korean Adults.
Son, DH, Ha, HS, Lee, YJ
Biomolecules. 2021;(6)
Abstract
Alkaline phosphatase (ALP) has long been considered a marker of hepatobiliary and bone disorders, but recent studies have shown that increased ALP activity is correlated with various cardio-metabolic diseases. Thus, we investigated the association of serum ALP level with surrogate markers of insulin resistance such as triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C ratio) and triglyceride and glucose (TyG) index in the general population. The study included 12,868 men and women aged 19 years and older. Participants were categorized into four groups based on serum ALP level (U/L) as follows: Q1: 55-190 U/L, Q2: 191-224 U/L, Q3: 225-265 U/L, and Q4: 266-923 U/L for men, Q1: 48-161 U/L, Q2: 162-198 U/L, Q3: 199-245 U/L, Q4: 246-790 U/L for women. The insulin resistance cut-off levels were defined corresponding to the 75th percentile of the TyG index and TG/HDL-C ratio in the current samples. Odds ratios (ORs) with 95% confidence intervals (CIs) of insulin resistance according to quartile of serum ALP level were calculated using weighted multivariate logistic regression analysis. Compared with Q1, the adjusted OR (95% CI) for insulin resistance of the Q4 serum ALP group was 1.517 (1.234-1.866) in men and 1.881 (1.399-2.528) in women using the TG/HDL-C ratio and 1.374 (1.093-1.728) in men and 2.047 (1.468-2.855) in women using the TyG index after adjusting for confounding variables. Serum ALP levels are independently and positively associated with surrogate markers of insulin resistance in Korean adults.
-
8.
Correlation between hyperglycemia and glycated albumin with retinopathy of prematurity.
Almeida, AC, Silva, GA, Santini, G, Brízido, M, Correia, M, Coelho, C, Borrego, LM
Scientific reports. 2021;(1):22321
Abstract
To determine the association between hyperglycemia, glycated albumin (GlyA) and retinopathy of prematurity (ROP). Prospective study of all infants under ROP screening from March 2017 to July 2019. All demographic, clinical and laboratory data were collected. Glucose was measured at birth and every 8 h for the first week and serum GlyA was evaluated at birth, 1st, 2nd and 4th weeks after birth. Reference range for GlyA was obtained. Univariate logistic regression was used to examine risk factors for ROP followed by multivariate regression. A total of 152 infants were included in the study. Median gestational age was 30 weeks and median birth weight 1240 g. Thirty-three infants (21.7%) had ROP. Hyperglycemia was present in 24 (72.7%) infants diagnosed with any ROP versus 6 (0.05%) in those without ROP. Median GlyA at birth, 1st, 2nd and 4th and respective reference ranges were 8.50% (6.00-12.65), 8.20% (5.32-11.67), 8.00% (5.32-10.00) and 7.90% (5.30-9.00) respectively. After multivariate logistic regression, hyperglycemia but not GlyA, remained a significant risk factor for ROP overpowering the other recognized risk factors (Exp (B) 28.062, 95% CI for Exp(B) 7.881-99.924 p < 0.001). In our cohort, hyperglycemia but not GlyA, remained a significant risk factor for ROP overpowering the other recognized risk factors.
-
9.
In children and young people with type 1 diabetes using Pump therapy, an additional 40% of the insulin dose for a high-fat, high-protein breakfast improves postprandial glycaemic excursions: A cross-over trial.
Smith, TA, Smart, CE, Fuery, MEJ, Howley, PP, Knight, BA, Harris, M, King, BR
Diabetic medicine : a journal of the British Diabetic Association. 2021;(7):e14511
Abstract
AIM: To determine the insulin requirement for a high-fat, high-protein breakfast to optimise postprandial glycaemic excursions in children and young people with type 1 diabetes using insulin pumps. METHODS In all, 27 participants aged 10-23 years, BMI <95th percentile (2-18 years) or BMI <30 kg/m2 (19-25 years) and HbA1c ≤64 mmol/mol (≤8.0%) consumed a high-fat, high-protein breakfast (carbohydrate: 30 g, fat: 40 g and protein: 50 g) for 4 days. In this cross-over trial, insulin was administered, based on the insulin-to-carbohydrate ratio (ICR) of 100% (control), 120%, 140% and 160%, in an order defined by a randomisation sequence and delivered in a combination bolus, 60% ¼ hr pre-meal and 40% over 3 hr. Postprandial sensor glucose was assessed for 6 hr. RESULTS Comparing 100% ICR, 140% ICR and 160% ICR resulted in significantly lower 6-hr areas under the glucose curves: mean (95%CI) (822 mmol/L.min [605,1039] and 567 [350,784] vs 1249 [1042,1457], p ≤ 0.001) and peak glucose excursions (4.0 mmol/L [3.0,4.9] and 2.7 [1.7,3.6] vs 6.0 [5.0,6.9],p < 0.001). Rates of hypoglycaemia for 100%-160% ICR were 7.7%, 7.7%, 12% and 19% respectively (p ≥ 0.139). With increasing insulin dose, a step-wise reduction in mean glucose excursion was observed from 1 to 6 hr (p = 0.008). CONCLUSIONS Incrementally increasing the insulin dose for a high-fat, high-protein breakfast resulted in a predictable, dose-dependent reduction in postprandial glycaemia: 140% ICR improved postprandial glycaemic excursions without a statistically significant increase in hypoglycaemia. These findings support a safe, practical method for insulin adjustment for high-fat, high-protein meals that can be readily implemented in practice to improve postprandial glycaemia.
-
10.
Pancreaticoduodenectomy model demonstrates a fundamental role of dysfunctional β cells in predicting diabetes.
Mezza, T, Ferraro, PM, Di Giuseppe, G, Moffa, S, Cefalo, CM, Cinti, F, Impronta, F, Capece, U, Quero, G, Pontecorvi, A, et al
The Journal of clinical investigation. 2021;(12)
-
-
Free full text
-
Abstract
BACKGROUNDThe appearance of hyperglycemia is due to insulin resistance, functional deficits in the secretion of insulin, and a reduction of β cell mass. There is a long-standing debate as to the relative contribution of these factors to clinically manifesting β cell dysfunction. The aim of this study was to verify the acute effect of one of these factors, the reduction of β cell mass, on the subsequent development of hyperglycemia.METHODSTo pursue this aim, nondiabetic patients, scheduled for identical pancreaticoduodenectomy surgery, underwent oral glucose tolerance tests (OGTT) and hyperglycemic clamp (HC) procedures, followed by arginine stimulation before and after surgery. Based on postsurgery OGTT, subjects were divided into 3 groups depending on glucose tolerance: normal glucose tolerance (post-NGT), impaired glucose tolerance (post-IGT), or having diabetes mellitus (post-DM).RESULTSAt baseline, the 3 groups showed similar fasting glucose and insulin levels; however, examining the various parameters, we found that reduced first-phase insulin secretion, reduced glucose sensitivity, and rate sensitivity were predictors of eventual postsurgery development of IGT and diabetes.CONCLUSIONDespite comparable functional mass and fasting glucose and insulin levels at baseline and the very same 50% mass reduction, only reduced first-phase insulin secretion and glucose sensitivity predicted the appearance of hyperglycemia. These functional alterations could be pivotal to the pathogenesis of type 2 diabetes (T2DM).TRIAL REGISTRATIONClinicalTrials.gov NCT02175459.FUNDINGUniversità Cattolica del Sacro Cuore; Italian Ministry of Education, University and Research; European Foundation for the Study of Diabetes.