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Elevated glucose level leads to rapid COVID-19 progression and high fatality.
Wang, W, Shen, M, Tao, Y, Fairley, CK, Zhong, Q, Li, Z, Chen, H, Ong, JJ, Zhang, D, Zhang, K, et al
BMC pulmonary medicine. 2021;(1):64
Abstract
OBJECTIVES We aimed to identify high-risk factors for disease progression and fatality for coronavirus disease 2019 (COVID-19) patients. METHODS We enrolled 2433 COVID-19 patients and used LASSO regression and multivariable cause-specific Cox proportional hazard models to identify the risk factors for disease progression and fatality. RESULTS The median time for progression from mild-to-moderate, moderate-to-severe, severe-to-critical, and critical-to-death were 3.0 (interquartile range: 1.8-5.5), 3.0 (1.0-7.0), 3.0 (1.0-8.0), and 6.5 (4.0-16.3) days, respectively. Among 1,758 mild or moderate patients at admission, 474 (27.0%) progressed to a severe or critical stage. Age above 60 years, elevated levels of blood glucose, respiratory rate, fever, chest tightness, c-reaction protein, lactate dehydrogenase, direct bilirubin, and low albumin and lymphocyte count were significant risk factors for progression. Of 675 severe or critical patients at admission, 41 (6.1%) died. Age above 74 years, elevated levels of blood glucose, fibrinogen and creatine kinase-MB, and low plateleta count were significant risk factors for fatality. Patients with elevated blood glucose level were 58% more likely to progress and 3.22 times more likely to die of COVID-19. CONCLUSIONS Older age, elevated glucose level, and clinical indicators related to systemic inflammatory responses and multiple organ failures, predict both the disease progression and the fatality of COVID-19 patients.
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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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Effects of branched-chain amino acids on glucose metabolism in obese, prediabetic men and women: a randomized, crossover study.
Woo, SL, Yang, J, Hsu, M, Yang, A, Zhang, L, Lee, RP, Gilbuena, I, Thames, G, Huang, J, Rasmussen, A, et al
The American journal of clinical nutrition. 2019;(6):1569-1577
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Abstract
BACKGROUND Recent studies have shown that circulating branched-chain amino acids (BCAAs) are elevated in obese, insulin-resistant individuals. However, it is not known if supplementation of additional BCAAs will further impair glucose metabolism. OBJECTIVES The aim of this pilot study was to determine the effects of BCAA supplementation on glucose metabolism in obese, prediabetic individuals. METHODS This is a randomized crossover study involving 12 obese individuals with prediabetes. Participants were randomly assigned to receive a daily supplement containing either 20 g BCAA or protein low in BCAAs for 4 wk with a 2-wk washout in between. At each visit, an oral-glucose-tolerance test (OGTT) was performed. Collected blood samples were used to measure glucose, insulin, and insulin resistance-associated biomarkers. RESULTS BCAA supplementation tended to decrease the plasma glucose area under the curve (AUC) measured by the OGTT (AUC percentage change from supplementation baseline, BCAA -3.3% ± 3%; low-BCAA: 10.0% ± 6%; P = 0.08). However, BCAA supplementation did not affect plasma insulin during OGTT challenge (BCAA: -3.9% ± 8%; low-BCAA: 14.8% ± 10%; P = 0.28). The plasma concentrations of nerve growth factor (BCAA: 4.0 ± 1 pg/mL; low-BCAA: 5.7 ± 1 pg/mL; P = 0.01) and monocyte chemoattractant protein-1 (BCAA: -0.4% ± 9%; low-BCAA: 29.0% ± 18%; P = 0.02) were significantly lowered by BCAA supplementation compared to low-BCAA control. Plasma interleukin 1β was significantly elevated by BCAA supplementation (BCAA: 231.4% ± 187%; low-BCAA: 20.6% ± 33%; P = 0.05). BCAA supplementation did not affect the circulating concentrations of the BCAAs leucine (BCAA: 9.0% ± 12%; low-BCAA: 9.2% ± 11%), valine (BCAA: 9.1% ± 11%; low-BCAA: 12.0% ± 13%), or isoleucine (BCAA: 2.5% ± 11%; low-BCAA: 7.3% ± 11%). CONCLUSIONS Our data suggest that BCAA supplementation did not impair glucose metabolism in obese, prediabetic subjects. Further studies are needed to confirm the results seen in the present study. This study was registered at clinicaltrials.gov as NCT03715010.
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[Effect of moderate exercise for 30 min at 30 min versus 60 min after dinner on glycemic control in patients with type 2 diabetes: a randomized, crossover, self-controlled study].
Li, Z, Hu, Y, Ma, J
Nan fang yi ke da xue xue bao = Journal of Southern Medical University. 2018;(10):1165-1170
Abstract
OBJECTIVE To compare the effectiveness of moderate exercise for 30 min at 30 min and 60 min after dinner on glycemic control in patients with type 2 diabetes. METHODS This randomized, crossover, self-controlled pilot study was conducted in 15 inactive patients with type 2 diabetes without serious complications or use of exogenous insulin. The participants completed two randomly ordered exercise protocols (brisk walking for 30 min at 30 min or 60 min after dinner on the exercise day) spaced 1 week apart. All the exercise was performed while maintaining a heart rate reserve of 40%. The interstitial glucose level was monitored using a continuous glucose monitor (CGM) for all the participants, who maintained a standardized diet with routine medications. The 2-h postprandial mean glucose, peak glucose, and glucose area under the curve (AUC) were measured. The mean amplitude of glycemic excursions (MAGE) and other plasma glucose fluctuation parameters in 12 h after dinner, including the mean blood glucose (MBG) and the coefficient variation (CV) of glucose, were also calculated. The incidence of nocturnal hypoglycemia was recorded in all the participants. RESULTS The participants had a mean age of 46±11 years with a mean BMI of 25.8±3.1 kg/m2 and a mean HbA1c of 7.7%. No significant differences were found between postprandial 30 min exercise group and postprandial 60 min exercise group in terms of 2-h postprandial mean glucose, peak glucose, glucose AUC, or in MBG, CV and MAGE during the 12-h period after dinner. No nocturnal hypoglycemia occurred in the participants after exercise at 30 or 60 min after dinner. However, significant reductions in the 2-h postprandial glucose levels were detected after exercise at 60 min after dinner as compared to exercise at 30 min. CONCLUSIONS The timing (30 min vs 60 min after dinner) of moderate exercises for 30 min does not produce significant difference in the improvement of postprandial hyperglycemia in type 2 diabetic patients, and both exercise protocols are safe without a potential risk of hypoglycemia. Nevertheless, exercise at 60 min after dinner can be more effective to lower 2-h postprandial glucose, while exercise at 30 min after dinner might be safer for patients with a high risk of hypoglycemia.
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Nuciferine and paeoniflorin can be quality markers of Tangzhiqing tablet, a Chinese traditional patent medicine, based on the qualitative, quantitative and dose-exposure-response analysis.
Li, Z, Liu, J, Zhang, D, Du, X, Han, L, Lv, C, Li, Y, Wang, R, Wang, B, Huang, Y
Phytomedicine : international journal of phytotherapy and phytopharmacology. 2018;:155-163
Abstract
BACKGROUND Diabetes is a chronic disease associated with significant morbidity and mortality. Tangzhiqing tablet (TZQ), a Chinese traditional patent medicine, has been in phase 2 clinical trial for the treatment of diabetes mellitus. However, the current quality evaluation of TZQ still remains rather obscure. PURPOSE The promising quality markers (Q-markers) of TZQ will be sought for its quality assessment and process control based on the qualitative, quantitative and dose-exposure-response analysis. METHODS The fingerprint analysis of TZQ was carried out through ultra high performance liquid chromatography- quadrupole time-of-flight/ mass spectrometry (UPLC-Q-TOF/MS) assay. Multicomponent quantitative analysis was implemented to the main ingredients of nuciferine, paeoniflorin, salvianolic acid B, hyperoside and rutin in TZQ by means of LC analysis. The dose-exposure-response relationship of TZQ was revealed by a placebo-controlled, 5-way crossover study in healthy Chinese subjects. The potential Q-markers in plasma were determined by a liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) method. The therapeutic effect of TZQ was expressed as the glucose-lowering profile. The exposure-response relevance was developed between the concentration of Q-markers and the glucose-lowering effect of TZQ. RESULTS 46 compounds were identified or tentatively characterized from TZQ. The contents of paeoniflorin, nuciferine, salvianolic acid B, hyperoside and rutin in TZQ were 6.40, 1.75, 1.70, 0.004, and 0.006 mg, respectively. However, salvianolic acid B, hyperoside and rutin could hardly be detected in human plasma under the current LC-MS/MS condition. The exposures of nuciferine and paeoniflorin (AUC0-3, Cmax) were dose-proportionality in human at the studied dosage ranges. The glucose-lowering effect appeared to increase proportionally with increasing TZQ dose in healthy volunteers. A clockwise hysteresis was displayed between the exposure of nuciferine and paeoniflorin and the glucose-lowering effect of TZQ. CONCLUSION Nuciferine and paeoniflorin were identified as the promising Q-markers of TZQ based on the fingerprint qualitative analysis, multicomponent quantitative analysis and dose-exposure-response analysis. The two Q-markers are meaningful to ensure the quality assessment and process control of TZQ.
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Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein.
Li, Z, Hong, K, Saltsman, P, DeShields, S, Bellman, M, Thames, G, Liu, Y, Wang, HJ, Elashoff, R, Heber, D
European journal of clinical nutrition. 2005;(3):411-8
Abstract
BACKGROUND Achieving significant weight loss and glycemic control in diabetic patients remains a challenging task. OBJECTIVE This study compared the effects of a soy-based meal replacement (MR) plan vs an individualized diet plan (IDP; as recommended by the American Diabetes Association) on weight loss and metabolic profile. DESIGN/SUBJECTS A total of 104 subjects were randomized prospectively to the two treatments for a total of 12 months. RESULTS In all, 77 of the 104 subjects completed the study. Percentage weight loss in MR group (4.57+/-0.81%) was significantly greater (P<0.05) than in IDP group (2.25+/-0.72%). Fasting plasma glucose was significantly reduced in MR group (126.4+/-4.9 mg/dl) compared with IDP group (152.5+/-6.6 mg/dl, P<0.0001) at 6 months but not at 12 months. Controlling for baseline levels, hemoglobin Alc level improved by 0.49+/-0.22% for those receiving MR when compared to IDP group (P<0.05). A greater number of subjects in MR group reduced their use of sulfonylureas (P<0.0001) and metformin (P<0.05) as compared to IDP group. High-sensitivity C-reactive protein (hs-CRP) decreased -26.3% (P = 0.019) in MR group compared to -7.06% (P = 0.338) in IDP group at 6 months. Similar changes were observed at 12 months with MR groups, with hs-CRP decreasing by -25.0% (P = 0.019) compared to -18.7% (P = 0.179) in IDP group. CONCLUSION This study demonstrates that MR is a viable strategy for weight reduction in diabetic patients, resulting in beneficial changes in measures of glycemic control and reduction of medications.