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High Fasting Blood Glucose Level With Unknown Prior History of Diabetes Is Associated With High Risk of Severe Adverse COVID-19 Outcome.
Wang, W, Chai, Z, Cooper, ME, Zimmet, PZ, Guo, H, Ding, J, Yang, F, Chen, X, Lin, X, Zhang, K, et al
Frontiers in endocrinology. 2021;:791476
Abstract
BACKGROUND We aimed to understand how glycaemic levels among COVID-19 patients impact their disease progression and clinical complications. METHODS We enrolled 2,366 COVID-19 patients from Huoshenshan hospital in Wuhan. We stratified the COVID-19 patients into four subgroups by current fasting blood glucose (FBG) levels and their awareness of prior diabetic status, including patients with FBG<6.1mmol/L with no history of diabetes (group 1), patients with FBG<6.1mmol/L with a history of diabetes diagnosed (group 2), patients with FBG≥6.1mmol/L with no history of diabetes (group 3) and patients with FBG≥6.1mmol/L with a history of diabetes diagnosed (group 4). A multivariate cause-specific Cox proportional hazard model was used to assess the associations between FBG levels or prior diabetic status and clinical adversities in COVID-19 patients. RESULTS COVID-19 patients with higher FBG and unknown diabetes in the past (group 3) are more likely to progress to the severe or critical stage than patients in other groups (severe: 38.46% vs 23.46%-30.70%; critical 7.69% vs 0.61%-3.96%). These patients also have the highest abnormal level of inflammatory parameters, complications, and clinical adversities among all four groups (all p<0.05). On day 21 of hospitalisation, group 3 had a significantly higher risk of ICU admission [14.1% (9.6%-18.6%)] than group 4 [7.0% (3.7%-10.3%)], group 2 [4.0% (0.2%-7.8%)] and group 1 [2.1% (1.4%-2.8%)], (P<0.001). Compared with group 1 who had low FBG, group 3 demonstrated 5 times higher risk of ICU admission events during hospitalisation (HR=5.38, 3.46-8.35, P<0.001), while group 4, where the patients had high FBG and prior diabetes diagnosed, also showed a significantly higher risk (HR=1.99, 1.12-3.52, P=0.019), but to a much lesser extent than in group 3. CONCLUSION Our study shows that COVID-19 patients with current high FBG levels but unaware of pre-existing diabetes, or possibly new onset diabetes as a result of COVID-19 infection, have a higher risk of more severe adverse outcomes than those aware of prior diagnosis of diabetes and those with low current FBG levels.
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Quantitative efficacy of L-carnitine supplementation on glycemic control in type 2 diabetes mellitus patients.
Wang, DD, Mao, YZ, He, SM, Yang, Y, Chen, X
Expert review of clinical pharmacology. 2021;(7):919-926
Abstract
OBJECTIVES This study aimed to explore the quantitative efficacy of L-carnitine supplementation on glycemic control in type 2 diabetes mellitus patients using model-based meta-analysis (MBMA). METHODS Literatures were retrieved from the public database and data from these trials were extracted. The quantitative efficacy of L-carnitine on fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) in type 2 diabetes mellitus patients were evaluated by maximal effect (Emax) models with nonlinear mixed effects modeling (NONMEM). RESULTS In the model of FPG, Emax and treatment duration to reach half of the maximal effects (ET50) were -9.8% and 36.1 weeks, respectively. In the model of HbA1c, Emax and ET50 were -19.6% and 106 weeks, respectively. In addition, the durations for achieving 25%, 50%, 75%, 80%, and 90% Emax of L-carnitine on FPG were 13, 36.1, 118, 160, and 390 weeks, respectively. The durations for achieving 25%, 50%, 75%, 80%, and 90% Emax of L-carnitine on HbA1c were 38, 106, 334, 449, and 1058 weeks, respectively. CONCLUSIONS It was the first time to provide valuable quantitative information for efficacy of L-carnitine supplementation on glycemic control in type 2 diabetes mellitus patients.
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Acupuncture and related techniques for obesity and cardiovascular risk factors: a systematic review and meta-regression analysis.
Chen, J, Chen, D, Ren, Q, Zhu, W, Xu, S, Lu, L, Chen, X, Yan, D, Nie, H, Zhou, X
Acupuncture in medicine : journal of the British Medical Acupuncture Society. 2020;(4):227-234
Abstract
OBJECTIVE To assess how acupuncture and related techniques affect weight-related indicators and cardiovascular risk factors compared with non-acupuncture interventions in overweight and obese patients. METHODS We searched PubMed, Embase and CENTRAL up to 19 April 2018 and included relevant randomised controlled trials (RCTs). Weighted mean differences (WMDs) and 95% confidence intervals (CI) were pooled using the inverse variance method with random-effects model. Prespecified hypotheses were tested in meta-regression to investigate the source of heterogeneity. Statistical software packages used were RevMan 5.3.5 and Stata 14.0. RESULTS Thirty-three RCTs were included (n=2503 patients). Compared with non-acupuncture interventions, acupuncture produced a greater reduction in body weight (WMD -1.76 kg, 95% CI -2.22 to -1.30, I2=77%; moderate quality), body mass index (WMD -1.13 kg/m2, 95% CI -1.38 to -0.88, I2=85%; low quality) and waist circumference (WMD -2.42 cm, 95% CI -3.22 to -1.62, I2=75%; moderate quality). Acupuncture plus lifestyle intervention resulted in a greater reduction in body weight than acupuncture alone (MD -1.94 kg, 95% CI -3.17 to -0.70). Acupuncture also led to a greater reduction in total cholesterol (WMD -12.87 mg/dL, 95% CI -22.17 to -3.57, I2=87%; very low quality) and low-density lipoprotein cholesterol (WMD -13.52 mg/dL, 95% CI -21.47 to -5.58, I2=74%; low quality). The differences were not statistically significant for blood glucose or blood pressure. CONCLUSION In the short term, acupuncture and related techniques may produce a small but statistically significant degree of weight loss based on moderate- to low-quality evidence, and improve serum lipid parameters based on low- to very-low-quality evidence. Their effects on blood glucose and blood pressure remain uncertain.
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Fasting blood glucose level is a predictor of mortality in patients with COVID-19 independent of diabetes history.
Cai, Y, Shi, S, Yang, F, Yi, B, Chen, X, Li, J, Wen, Z
Diabetes research and clinical practice. 2020;:108437
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Abstract
AIM: No study elucidated the role of fasting blood glucose (FBG) level in the prognosis
of coronavirus disease 2019 (COVID-19). METHODS This cohort study was conducted in a single center at Renmin Hospital of Wuhan University, Wuhan, China. Clinical laboratory, and treatment data of inpatients with laboratory-confirmed COVID-19 were collected and analyzed. Outcomes of patients with and without pre-existing diabetes were compared. The associations of diabetes history and/or FBG levels with mortality were analyzed. Multivariate cox regression analysis on the risk factors associated with mortality in patients with COVID-19 was performed. RESULTS A total of 941 hospitalized patients with COVID-19 were enrolled in the study. There was a positive relationship between pre-existing diabetes and the mortality of patients who developed COVID-19 (21 of 123 [17.1%] vs 76 of 818 [9.3%]; P = 0.012). FBG ≥7.0 mmol/L was an independent risk factor for the mortality of COVID-19 regardless of the presence or not of a history of diabetes (hazard ratio, 2.20 [95% CI, 1.21-4.03]; P = 0.010). CONCLUSIONS We firstly showed FBG ≥7.0 mmol/L predicted worse outcome in hospitalized patients with COVID-19 independent of diabetes history. Our findings indicated screening FBG level is an effective method to evaluate the prognosis of patients with COVID-19.
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Effects of wine on blood pressure, glucose parameters, and lipid profile in type 2 diabetes mellitus: A meta-analysis of randomized interventional trials (PRISMA Compliant).
Ye, J, Chen, X, Bao, L
Medicine. 2019;(23):e15771
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Abstract
BACKGROUND Previous studies identified conflicting results about the effects of wine intake on glucose parameters and the risk of cardiovascular diseases in type 2 diabetes mellitus (T2DM). The present study further investigated the association between wine digestion and these outcomes in T2DM patients. MATERIAL AND METHODS A search of PubMed, Embase, and Scopus databases (up to November 2018) was performed for randomized interventional trials which evaluated the effect of wine on blood pressure (BP), glucose parameters and lipid profiles in T2DM people. We used a variety of tests: fixed and random effects models, Q Cochrane test and I index, Egger and Begg tests, forest plots, and sensitivity analysis in our study. RESULTS A total of 9 randomized interventional studies were included in this meta-analysis. Overall, significant association between wine intake with diastolic BP (weighted mean difference [WMD] = 0.10; 95% confidence interval [95% CI]: -0.01 to 0.20, P = .03 I = 13%) and total cholesterol (TC) (WMD = 0.16, 95% CI: 0.02-0.31, P = .03, I = 6%), whereas no noticeable differences in glucose parameters, systolic BP, low-density lipoprotein cholesterol (LDLC), triglyceride (TG) and high-density lipoprotein cholesterol (HDLC) were identified between wine and controls groups (fasting glucose [FG],WMD = -0.00, 95% CI: -0.58 to 0.58; fasting insulin [FI], -0.22, -2.09 to 1.65; HbAc1%, -0.16, -0.40 to 0.07; systolic blood pressure, 0.12, -0.05 to 0.28; LDLC, -0.02, -0.25 to 0.21; TG, -0.34, -1.31 to 0.64; HDLC, 0.22, -0.08 to 0.53]. CONCLUSION This meta-analysis revealed that moderate wine consumption among T2DM patients could reduce the level of diastolic blood pressure and TC, but not glucose parameters and other cardiovascular risk factors.
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Effect of Rice Processing towards Lower Rapidly Available Glucose (RAG) Favors Idli, a South Indian Fermented Food Suitable for Diabetic Patients.
Chelliah, R, Chandrashekar, S, Saravanakumar, K, Ramakrishnan, SR, Rubab, M, Daliri, EB, Barathikannan, K, Tyagi, A, Kwame Ofosu, F, Chen, X, et al
Nutrients. 2019;(7)
Abstract
The Asian food pattern primarily embraces rice and rice-based products, which mainly comprise 90% starch. Among these various food products, Idli is mostly prepared through fermentation. It has high palatability, and the rapid and highly digestible nature of the food product results in a higher post-glucose level in diabetic patients. A heat-treated Idli rice sample was prepared by roasting parboiled rice at the temperature range of 155 to 165 °C for 65 to 75 s. Idli/rice-based Dokala made from heat-treated rice is better when compared to untreated rice in terms of its microbiological profile and physiochemical properties. The proximate composition of heat-treated parboiled rice Idli/Rice Dokala showed slightly higher values than the untreated parboiled rice Idli/Rice Dokala, which reveals that it has marginally higher nutritive value. Determination of the Rapidly Available Glucose (RAG) and Slowly Available Glucose (SAG) values, SEM analysis, resistant starch analysis, microbial assay, and in vivo studies were performed to determine the glycemic index (GI) and glycemic load in normal and diabetic persons. Sensory analysis also proved that heat-treated Idli/Rice Dokala is superior to untreated based on the color, flavor, appearance, taste, and texture.
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Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis.
Huo, R, Du, T, Xu, Y, Xu, W, Chen, X, Sun, K, Yu, X
European journal of clinical nutrition. 2015;(11):1200-8
Abstract
BACKGROUND/OBJECTIVES Studies suggest that the Mediterranean-style diet (MSD) may improve glucose metabolism in patients with type 2 diabetes (T2D), but the results are inconsistent. We conducted a meta-analysis of randomized controlled trials (RCTs) to explore the effects of MSD on glycemic control, weight loss and cardiovascular risk factors in T2D patients. SUBJECTS/METHODS We performed searches of EMBASE, Cochrane Library and PubMed databases up to February 2014. We included RCTs that compared the MSD with control diets in patients with T2D. Effect size was estimated as mean difference with 95% confidence interval (CI) by using random effect models. RESULTS The meta-analysis included nine studies with 1178 patients. Compared with control diets, MSD led to greater reductions in hemoglobin A1c (mean difference, -0.30; 95% CI, -0.46 to -0.14), fasting plasma glucose (-0.72 mmol/l; CI, -1.24 to -0.21), fasting insulin (-0.55 μU/ml; CI, -0.81 to -0.29), body mass index (-0.29 kg/m(2); CI, -0.46 to -0.12) and body weight (-0.29 kg; CI, -0.55 to -0.04). Likewise, concentrations of total cholesterol and triglyceride were decreased (-0.14 mmol/l; CI, -0.19 to -0.09 and -0.29 mmol/l; CI, -0.47 to -0.10, respectively), and high-density lipoprotein was increased (0.06 mmol/l; CI, 0.02 to 0.10). In addition, MSD was associated with a decline of 1.45 mm Hg (CI, -1.97 to -0.94) for systolic blood pressure and 1.41 mm Hg (CI, -1.84 to -0.97) for diastolic blood pressure. CONCLUSIONS The present meta-analysis provides evidence that MSD improves outcomes of glycemic control, body weight and cardiovascular risk factors in T2D patients.
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A Linear Dose-Response Relationship between Fasting Plasma Glucose and Colorectal Cancer Risk: Systematic Review and Meta-analysis.
Shi, J, Xiong, L, Li, J, Cao, H, Jiang, W, Liu, B, Chen, X, Liu, C, Liu, K, Wang, G, et al
Scientific reports. 2015;:17591
Abstract
For many years, the question of whether hyperglycaemia, a manifestation of prediabetes, diabetes mellitus and metabolic syndrome, is a risk factor for colorectal cancer has been intensely studied. In fact, even after the conclusion of several prospective studies, the topic is still controversial. We conducted a systematic review and meta-analysis to investigate the dose-response relationship between blood glucose concentration and the incidence of colorectal cancer. A linear (P = 0.303 for non-linearity) dose-response relationship was observed between fasting plasma glucose (FPG) and colorectal cancer risk without significant heterogeneity. The relative risk (RR) for colorectal cancer per 20 mg/dL increase in FPG was 1.015 (95% CI: 1.012-1.019, P = 0.000). In subgroup analyses, the pooled RRs for colon cancer (CC) and rectal cancer (RC) studies were 1.035 (95% CI 1.008-1.062, P = 0.011) and 1.031 (95% CI: 0.189-5.628, P = 0.972), respectively; in the analysis comparing men and women, the pooled RRs were 1.016 (95% CI: 1.012-1.020, P = 0.000) and 1.011 (95% CI: 0.995-1.027, P = 0.164), respectively. Sensitivity analyses using two methods showed similar results. In conclusion, there is a significant linear dose-response relationship between FPG and the incidence risk of colorectal cancer. For people with diabetes or prediabetes, controlling blood glucose might be useful to prevent colorectal cancer.
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Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function.
Li, Y, Xu, W, Liao, Z, Yao, B, Chen, X, Huang, Z, Hu, G, Weng, J
Diabetes care. 2004;(11):2597-602
Abstract
OBJECTIVE To investigate whether long-term optimal glycemic control can be achieved without medication by transient continuous subcutaneous insulin infusion (CSII) and the possible mechanisms responsible for this remission. RESEARCH DESIGN AND METHODS Newly diagnosed type 2 diabetic patients (n = 138, fasting glucose >11.1mmol/l) were hospitalized and treated with CSII for 2 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, HbA(1c), lipid profiles, proinsulin, insulin, and C-peptide were measured before and after CSII. Patients were followed longitudinally on diet alone after withdrawal of insulin. RESULTS Optimal glycemic control was achieved within 6.3 +/- 3.9 days by CSII in 126 patients. The remission rates (percentages maintaining near euglycemia) at the third, sixth, twelfth, and twenty-fourth month were 72.6, 67.0, 47.1, and 42.3%, respectively. Patients who maintained glycemic control >12 months (remission group) had greater recovery of beta-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of beta-cell function (HOMA-B) and the area under the curve (AUC) of insulin during IVGTT were higher in the remission group (145.4 +/- 89.6 vs. 78.5 +/- 68.5, P = 0.002, and 1,423.4 +/- 523.2 vs. 1,159.5 +/- 476.8 pmol x l(-1) x min(-1), P = 0.044). Change in acute insulin response was also greater in the remission group than that in the nonremission group (621.8 +/- 430.4 vs. 387.3 +/- 428.8 pmol x l(-1) x min(-1), P = 0.033). CONCLUSIONS Short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. The improvement of beta-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.