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1

Proof of concept for the role of glycemic control in the early detection of infections in diabetics  

Microsoft Academic Search

The relationship of infections and glycemic control in diabetes has been previously investigated but no solid findings have been described. Meanwhile, the detection of any infection at the early stages of disease progression, i.e. during the incubation period, is critical. In order to study this topic, we used the infection evidence and the daily glycemic control data of 248 type-2

Taxiarchis Botsis; Albert M. Lai; Walter Palmas; Justin B. Starren; Gunnar Hartvigsen; George Hripcsak

2012-01-01

2

Glycemic index, glycemic control and beyond.  

PubMed

It is currently estimated that over 370 million individuals have diabetes, making diabetes a major public health issue contributing significantly to global morbidity and mortality. The steep rise in diabetes prevalence over the past decades is attributable, in a large part, to lifestyle changes, with dietary habits and behaviour as significant contributors. Despite the relatively wide availability of antidiabetic medicine, it is lifestyle approaches that still remain the cornerstone of diabetes prevention and treatment. Glycemic index (GI) is a nutritional tool which represents the glycemic response to carbohydrate ingestion. In light of the major impact of nutrition on diabetes pathophysiology, with the rising need to combat the escalating diabetes epidemic, this review will focus on the role of GI in glycemic control, the primary target of diabetic treatment and beyond. The review will present the evidence relating GI and diabetes treatment and prevention, as well as weight loss, weight maintenance and cardiovascular disease risk factors. PMID:24040877

Derdemezis, Christos S; Lovegrove, Julie A

2014-01-01

3

Usefulness of glycated albumin for early detection of deterioration of glycemic control state after discharge from educational admission.  

PubMed

Glycated albumin (GA) reflects shorter term glycemic control state than HbA1c. This study evaluated whether GA is useful for early detection of deterioration of glycemic control state after discharge from educational admission. Among the patients with educational admission, this study included 21 diabetic patients who were followed for at least 10 weeks after discharge from educational admission. Deterioration was defined that GA after discharge increased by ?0.6% compared to the previous GA. Thirteen patients without deterioration up to 10 weeks after discharge were used as controls. In 8 patients with deterioration within 10 weeks after discharge, their HbA1c and GA at the time of admission and the decrease in HbA1c and GA during hospitalization were not significantly different from the control patients. At the time of deterioration, GA in the patients with deterioration increased significantly from 18.7 ± 2.7% to 21.0 ± 2.5%, whereas HbA1c decreased significantly from 9.1 ± 0.7% to 8.3 ± 0.6%. Subsequently, HbA1c increased significantly to 9.0 ± 0.8% together with GA. Thus, GA is useful for early detection of deterioration of glycemic control state after discharge from educational admission. PMID:23221004

Murai, Jun; Soga, Sumiko; Saito, Hiroshi; Koga, Masafumi

2013-01-01

4

Pharmacologic Factors Affecting Glycemic Control  

Microsoft Academic Search

Among many challenges to achieving and maintaining glycemic control, the impact of pharmacologic agents on glycemia is a significant,\\u000a but often overlooked factor. Numerous medications have been implicated in the development of drug-induced hyperglycemia and\\u000a type 2 diabetes mellitus. Of these, the atypical antipsychotics (for the management of depression and psychosis), the protease-inhibitor\\u000a anti retroviral agents (for the management of

Lillian F. Lien

5

Early Enhancements of Hepatic and Later of Peripheral Insulin Sensitivity Combined With Increased Postprandial Insulin Secretion Contribute to Improved Glycemic Control After Roux-en-Y Gastric Bypass.  

PubMed

Roux-en-Y gastric bypass (RYGB) improves glycemic control within days after surgery, and changes in insulin sensitivity and ?-cell function are likely to be involved. We studied 10 obese patients with type 2 diabetes (T2D) and 10 obese glucose-tolerant subjects before and 1 week, 3 months, and 1 year after RYGB. Participants were included after a preoperative diet-induced total weight loss of -9.2 ± 1.2%. Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic- euglycemic clamp combined with the glucose tracer technique, and ?-cell function was evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load. Within 1 week, RYGB reduced basal glucose production, improved basal hepatic insulin sensitivity, and increased insulin clearance, highlighting the liver as an important organ responsible for early effects on glucose metabolism after surgery. Insulin-mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year; this increase likely was related to the reduction in body weight. Insulin secretion increased after RYGB only in patients with T2D and only in response to oral glucose, underscoring the importance of the changed gut anatomy. PMID:24241533

Bojsen-Møller, Kirstine N; Dirksen, Carsten; Jørgensen, Nils B; Jacobsen, Siv H; Serup, Annette K; Albers, Peter H; Hansen, Dorte L; Worm, Dorte; Naver, Lars; Kristiansen, Viggo B; Wojtaszewski, Jørgen F P; Kiens, Bente; Holst, Jens J; Richter, Erik A; Madsbad, Sten

2014-05-01

6

Glycemic Goals in Diabetes: Trade-off Between Glycemic Control and Iatrogenic Hypoglycemia.  

PubMed

The selection of a glycemic goal in a person with diabetes is a compromise between the documented upside of glycemic control-the partial prevention or delay of microvascular complications-and the documented downside of glycemic control-the recurrent morbidity and potential mortality of iatrogenic hypoglycemia. The latter is not an issue if glycemic control is accomplished with drugs that do not cause hypoglycemia or with substantial weight loss. However, hypoglycemia becomes an issue if glycemic control is accomplished with a sulfonylurea, a glinide, or insulin, particularly in the setting of absolute endogenous insulin deficiency with loss of the normal decrease in circulating insulin and increase in glucagon secretion and attenuation of the sympathoadrenal response as plasma glucose concentrations fall. Then the selection of a glycemic goal should be linked to the risk of hypoglycemia. A reasonable individualized glycemic goal is the lowest A1C that does not cause severe hypoglycemia and preserves awareness of hypoglycemia, preferably with little or no symptomatic or even asymptomatic hypoglycemia, at a given stage in the evolution of the individual's diabetes. PMID:24962915

Cryer, Philip E

2014-07-01

7

Glycemic control in critically ill: A moving target  

PubMed Central

Glycemic control targets in intensive care units (ICUs) have three distinct domains. Firstly, excessive hyperglycemia needs to be avoided. The upper limit of this varies depending on the patient population studied and diabetic status of the patients. Surgical patients particularly cardiac surgery patients tend to benefit from a lower upper limit of glycemic control, which is not evident in medically ill patient. Patient with premorbid diabetic status tends to tolerate higher blood sugar level better than normoglycemics. Secondly, hypoglycemia is clearly detrimental in all groups of critically ill patient and all measures to avoid this catastrophe need to be a part of any glycemic control protocol. Thirdly, glycemic variability has increasingly been shown to be detrimental in this patient population. Glycemic control protocols need to take this into consideration and target to reduce any of the available metrics of glycemic variability. Newer technologies including continuous glucose monitoring techniques will help in titrating all these three domains within a desirable range.

Todi, Subhash

2014-01-01

8

Insulin glargine effectively achieves glycemic control and improves insulin resistance in patients with early type 2 diabetes that exhibit a high risk for cardiovascular disease  

PubMed Central

In the present study, the clinical efficacy and safety of administering insulin glargine to early type 2 diabetes (T2D) mellitus patients with a high risk for cardiovascular disease were assessed. A total of 42 early T2D patients at a high risk for cardiovascular disease were randomly divided into an insulin-glargine group and a standard-care group. The patients in the insulin-glargine group received oral antidiabetic agents plus glargine once a day via a subcutaneous injection. The patients in the standard-care group were administered oral antidiabetic agents according to the diabetic treatment guidelines. The median follow-up period was 6.4 years. Comparisons were made between the two groups with regard to levels of plasma glucose, glycosylated hemoglobin (HbA1c) and plasma lipids, the homeostasis model assessment-insulin secretion index (HOMA-?) and HOMA-insulin resistance index (HOMA-IR), as well as the incidence of hypoglycemia, adverse cardiovascular events and body mass index (BMI). The fasting plasma glucose level in the insulin-glargine group was significantly lower than that observed in the standard-care group. However, the levels of 2-h postprandial glucose, HbA1c and plasma lipids, as well as the BMI, were similar when comparing the two groups. Although the level of the HOMA-? did not differ between the two groups, the level of HOMA-IR in the insulin-glargine group was significantly lower than that observed in the standard-care group. During the follow-up period, the incidence of hypoglycemia in the insulin-glargine group was significantly higher when compared with the standard-care group, however, no significant difference in the incidence of adverse cardiovascular events was observed. Therefore, the results of the present study indicated that insulin glargine may effectively achieve glycemic control and improve insulin resistance without increasing the risk for cardiovascular events in early T2D patients that were considered to be at a high risk for cardiovascular disease.

LI, JILING; FENG, ZHENGPING; LI, QIFU; HE, YAN; ZHAO, CHANGHONG; HE, JUN

2014-01-01

9

Glycemic control indicators in patients with neonatal diabetes mellitus  

PubMed Central

Neonatal diabetes mellitus (NDM) is a type of diabetes mellitus caused by genetic abnormality which develops in insulin dependent state within 6 mo after birth. HbA1c is widely used in clinical practice for diabetes mellitus as the gold standard glycemic control indicator; however, fetal hemoglobin (HbF) is the main hemoglobin in neonates and so HbA1c cannot be used as a glycemic control indicator in NDM. Glycated albumin (GA), another glycemic control indicator, is not affected by HbF. We reported that GA can be used as a glycemic control indicator in NDM. However, it was later found that because of increased metabolism of albumin, GA shows an apparently lower level in relation to plasma glucose in NDM; measures to solve this problem were needed. In this review, we outlined the most recent findings concerning glycemic control indicators in neonates or NDM.

Suzuki, Shigeru; Koga, Masafumi

2014-01-01

10

Glycemic control in cardiac surgery: implementing an evidence-based insulin infusion protocol.  

PubMed

Background Acute hyperglycemia following cardiac surgery increases the risk of deep sternal wound infection, significant early morbidity, and mortality. Insulin infusion protocols that target tight glycemic control to treat hyperglycemia have been linked to hypoglycemia and increased mortality. Recently published studies examining glycemic control in critical illness and clinical practice guidelines from professional organizations support moderate glycemic control. Objectives To measure critical care nurses' knowledge of glycemic control in cardiac surgery before and after education. To evaluate the safety and effectiveness of an evidence-based insulin infusion protocol targeting moderate glycemic control in cardiac surgery patients. Methods This evidence-based practice change was implemented in the cardiovascular unit in a community teaching hospital. Nurses completed a self-developed questionnaire to measure knowledge of glycemic control. Blood glucose data, collected (retrospectively) from anesthesia end time through 11:59 PM on postoperative day 2, were compared from 2 months before to 2 months after the practice change. Results Nurses' knowledge (test scores) increased significantly after education (pretest mean = 53.10, SD = 11.75; posttest mean = 79.10, SD = 12.02; t54 = -8.18, P < .001). Mean blood glucose level after implementation was 148 mg/dL. The incidence of hypoglycemia, 2.09% before and 0.22% after the intervention, was significantly reduced ( $${\\hbox{ \\chi }}_{1}^{2}$$ [n = 29] = 13.9, P < .001). The percentage of blood glucose levels less than 180 mg/dL was 88.30%. Conclusions Increasing nurses' knowledge of glycemic control and implementing an insulin infusion protocol targeting moderate glycemic control were effective for treating acute hyperglycemia following cardiac surgery with decreased incidence of hypoglycemia. PMID:24786814

Hargraves, Joelle D

2014-05-01

11

Diabetes, Glycemic Control, and Risk of Tuberculosis  

PubMed Central

OBJECTIVE To examine the association between diabetes, glycemic control, and risk of tuberculosis (TB). RESEARCH DESIGN AND METHODS We conducted a population-based case-control study in Northern Denmark. Cases of active TB were all individuals with a first-time principal hospital diagnosis of TB between 1980 and 2008. Each case subject was matched with up to five population control subjects with similar age, sex, place and length of residence in Denmark, and country of emigration. We computed odds ratios (ORs) for a first-time TB diagnosis among people with and without diabetes using regression to control for other comorbidities, alcoholism, immunosuppressive medications, and socioeconomic markers. RESULTS We identified 2,950 patients, including 156 diabetic individuals (5.3%), with active TB, and 14,274 population control subjects, of which 539 had diabetes (3.8%). The adjusted OR for active TB among subjects with diabetes was 1.18 (95% CI 0.96–1.45) compared with nondiabetic individuals. We found a similar risk increase from diabetes in the 843 (29%) TB case subjects who were immigrants; adjusted OR = 1.23 (95% CI 0.78–1.93). In a subset with laboratory data, diabetic individuals with an HbA1c <7.0, 7–7.9, and ?8.0% had ORs of 0.91 (0.51–1.63), 1.05 (0.41–2.66), and 1.19 (CI 0.61–2.30), respectively, compared with individuals without diabetes. CONCLUSIONS In the low TB–burden country of Denmark, the TB risk increase associated with diabetes is substantially lower than previously suggested. We found no evidence for any association between TB and dysglycemia.

Leegaard, Anne; Riis, Anders; Kornum, Jette B.; Prahl, Julie B.; Thomsen, Vibeke ?; S?rensen, Henrik Toft; Horsburgh, C. Robert; Thomsen, Reimar W.

2011-01-01

12

Durability of glycemic control using U-500 insulin  

Microsoft Academic Search

Previous short-term studies evaluating U-500 insulin have reported improvements in glycemic control but with significant weight gain. This study was performed to examine the glycemic durability of U-500 insulin in highly insulin resistant subjects, and to determine if weight gain was continuous with use. Patients using U-500 insulin provided consent for chart reviews for up to 3 years prior to

Alexandria M. Dailey; Jennifer A. Gibert; Lisa R. Tannock

13

Use of the glycemic index for weight loss and glycemic control: a review of recent evidence.  

PubMed

This article summarizes current findings regarding the use of low-glycemic index (GI) diets for weight loss and type 2 diabetes control. Results from cross-sectional studies evaluating the association between dietary GI and body mass index had equivocal results, especially when dietary fiber was included in the model. Of five prospective cohort studies, two reported increased risk of type 2 diabetes diagnosis with higher dietary GI or glycemic load (GL). Risk of type 2 diabetes appeared to have a stronger association with carbohydrate intake or GL than with GI. Evidence from intervention studies using a low-GI approach for weight loss produced inconsistent results, especially for longer-term studies. In intervention studies with type 2 diabetes patients, consumption of a low-GI diet resulted in lower hemoglobin A1c concentrations in participants of shorter-term studies. Recent evidence adds to the controversy regarding the effectiveness of consuming low-GI diets for glycemic control and weight reduction. PMID:19793508

Vega-López, Sonia; Mayol-Kreiser, Sandra N

2009-10-01

14

Glycemic control in diabetic CAPD patients assessed by continuous glucose monitoring system (CGMS)  

Microsoft Academic Search

Glycemic control in diabetic CAPD patients assessed by continuous glucose monitoring system (CGMS).IntroductionFrom 20% to 40% of all patients commencing dialysis are diabetic. The quality of glycemic control is an important determinant of outcome. The aims of this study were to investigate the use of the continuous glucose monitoring system (CGMS) to assess overall 24-hour glycemic control and the effects

Jennifer Marshall; Peter Jennings; Adrian Scott; Richard J. Fluck; Christopher W. Mcintyre

2003-01-01

15

Clinical impact of glycated albumin as another glycemic control marker.  

PubMed

It is known that glycation among various proteins is increased in diabetic patients compared with non-diabetic subjects. Currently, among these glycated proteins, glycated hemoglobin (HbA(1C)) is used as the gold standard index of glycemic control in clinical practice for diabetes treatment. However, HbA(1C) does not accurately reflect the actual status of glycemic control in some conditions where plasma glucose changes during short term, and in patients who have diseases such as anemia and variant hemoglobin. In comparison, another index of glycemic control, glycated albumin (GA), more accurately reflects changes in plasma glucose during short term and also postprandial plasma glucose. Although GA is not influenced by disorders of hemoglobin metabolism, it is affected by disorders of albumin metabolism. This review summarizes diseases and pathological conditions where GA measurement is useful. These include the status of glycemic control changes during short term, diseases which cause postprandial hyperglycemia, iron deficiency anemia, pregnancy, chronic liver disease (liver cirrhosis), chronic renal failure (diabetic nephropathy), and variant hemoglobin. PMID:20724796

Koga, Masafumi; Kasayama, Soji

2010-01-01

16

Fathers' Involvement in Preadolescents' Diabetes Adherence and Glycemic Control*  

PubMed Central

Objective?To examine the relationship of paternal involvement in diabetes care with adherence and glycemic control.?Methods?One hundred and thirty-six mothers and fathers of preadolescents (aged 9–12 years) with type 1 diabetes reported on paternal involvement. Adherence was measured by interview and blood glucose meter downloads. Mothers’ and fathers’ ratings of paternal involvement in diabetes care were compared. We evaluated three structural equation models linking paternal involvement with adherence and glycemic control.?Results?Mothers and fathers reported similar amounts of paternal involvement, yet mothers rated paternal involvement as more helpful. The data supported a model indicating links between more paternal involvement and higher HbA1c and between lower adherence and higher HbA1c. Mediation and moderation models were not supported. Discussion?Although paternal involvement was not directly associated with treatment adherence, it was associated with poorer glycemic control. Some fathers may increase their involvement in response to suboptimal glycemic outcomes.

Rohan, Jennifer M.; Carle, Adam C.; Pendley, Jennifer Shroff; Delamater, Alan; Drotar, Dennis

2011-01-01

17

Diabetic nephropathy in adolescence: appearance during improved glycemic control.  

PubMed

Two girls, aged 15 and 14 years, with poorly controlled insulin-dependent diabetes (IDD) of 9 and 7 years duration, respectively, developed overt and persistent proteinuria shortly after rapid increases in insulin therapy and improved glycemic control. Renal biopsies showed diffuse diabetic glomerulosclerosis. Both patients maintained normal or increased creatinine clearances. Direct ophthalmoscopy and fluorescein retinal angiography demonstrated nonproliferative diabetic retinopathy in the first patient, which deteriorated after 6 weeks of strict metabolic control; the second patient had normal retinas. The appearance of clinical proteinuria during this brief period of good glycemic control suggests that the latter may have unmasked a preexisting condition. Possible pathophysiologic mechanisms initiating the proteinuria in these patients are reviewed. PMID:6340051

Ellis, D; Avner, E D; Transue, D; Yunis, E J; Drash, A L; Becker, D J

1983-05-01

18

Use of Insulin to Improve Glycemic Control in Diabetes Mellitus  

Microsoft Academic Search

Background  The restoration of normoglycemia ensures the control of diabetic symptoms and reduction in microangiopathic complications\\u000a in type 1 and type 2 diabetes. However, there is no conclusive evidence that intensive glycemic control alone will prevent\\u000a macrovascular disease, the commonest cause of morbidity and mortality in type 2 diabetes. As atherosclerosis is an inflammatory\\u000a condition, it is relevant that the two

Paresh Dandona; Ajay Chaudhuri; Husam Ghanim; Priya Mohanty

2008-01-01

19

Point of care testing to improve glycemic control  

Microsoft Academic Search

Purpose – The purpose of this paper is to pilot-test the feasibility and impact of protocol-driven point-of-care HbA1c testing on levels of glycemic control and on rates of diabetic regimen intensification in an urban community health center serving low-income patients. Design\\/methodology\\/approach – The paper suggests a primary care process re-design, using point of care finger-stick HbA1c testing under a standing

George Rust; Morna Gailor; Elvan Daniels; Barbara McMillan-Persaud; Harry Strothers; Robert Mayberry

2008-01-01

20

A Systematic Review of Exenatide in Glycemic Control  

Microsoft Academic Search

Background: Type II diabetes is characterized by hyperglycemia, insulin resistance or having impairment with insulin secretion. Patients are traditionally treated with oral medication and lifestyle modification before adding insulin to their treatment. Exenatide is an adjunct subcutaneous therapy to improve glycemic control and weight loss\\u000aMethod: The focus of this study was to review clinical trials of exetanide on diabetes

Alvaro Ramos

2010-01-01

21

Increasing serum osteocalcin after glycemic control in diabetic men.  

PubMed

The pathogenesis of diabetic osteopenia is unclear. The markers of bone metabolism may show some changes in diabetic patients. In this study, we investigated the effect of glycemic control on serum osteocalcin level and urinary hydroxyproline excretion and the relations of these markers to duration of diabetes, C-peptide status, and body mass index. Twenty-seven men with poorly controlled diabetes mellitus (DM) (HbA1 > 9%, fasting plasma glucose > 7.8 mmol/liter) between ages 25 and 60 years (means +/- SD 46.6 +/- 10.4) were included in the study. Duration of diabetes was 5.8 +/- 4.7 years, body mass index (BMI) was 25 +/- 3.5 kg/m2, and fasting C-peptide was 2.33 (1.05-3.21) micrograms/liter. None of the patients had a disease or were treated with drugs that would interfere with calcium or phosphate metabolism and/or bone structure. They were free from chronic diabetic complications. Of these patients, 11 were lost to follow-up before metabolic control was achieved. The remaining 16 patients obtained good glycemic control (HbA1 < 8.3%, fasting plasma glucose < 7.8 mmol/liter) and completed the study. Serum osteocalcin level and urinary hydroxyproline excretion were determined before and after glycemic control. Urinary hydroxyproline excretion was not significantly changed by glycemic control [17.8 (7.1-23.2) versus 18.1 (10.9-28.1) mg/m2 day, P > 0.05]. However, serum osteocalcin level was significantly elevated (5.04 +/- 1.43 versus 4.17 +/- 1.83 micrograms/liter, P = 0.04). We found no correlation among fasting plasma glucose, HbA1, and fasting serum C-peptide levels with urinary hydroxyproline excretion. There was also no correlation between serum osteocalcin and fasting plasma glucose or serum C-peptide, but HbA1 was negatively correlated with serum osteocalcin (P = 0.01). No correlation was found between DM duration and BMI in the patients with serum osteocalcin level and urinary hydroxyproline excretion. To eliminate the possible effect of exogenous insulin on bone metabolism, the correlation analysis between the markers and C-peptide was further repeated in oral agents-treated patients. Serum C-peptide was not correlated to serum osteocalcin or urinary hydroxyproline in this subgroup of patients. Knowing that serum osteocalcin is a marker of bone formation, we concluded that osteoblast function may improve by glycemic control in diabetic patients; this may be due to correction of metabolic abnormalities associated with insulinopenia. PMID:8581873

Sayinalp, S; Gedik, O; Koray, Z

1995-12-01

22

Glycemic Control in Pediatric Patients on Extracorporeal Membrane Oxygenation  

PubMed Central

OBJECTIVES To determine whether glycemic control has an effect on outcomes for pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy, while controlling for multiple factors. METHODS A single-center retrospective chart review was performed on 82 patients who required ECMO from January 1, 2008, to December 31, 2010. All glucose concentrations collected while patients were on ECMO were analyzed; multiple other factors that may have affected mortality were also recorded. Primary outcome was mortality, and secondary outcomes were length of time on ECMO and length of time until death or discharge from the hospital. RESULTS Of 82 patients, 53 patients survived ECMO (64.6%). Glucose control had no effect on survival of patients on ECMO (p=0.56), even when controlling for multiple factors (p=0.48). Similarly, statistical evaluation showed no differences for hospital mortality in relationship to controlled serum glucose (p=0.50). Patients with controlled glucose spent an average of 31.5% more time on ECMO than non-controlled patients (p=0.048). CONCLUSIONS In this study, glycemic control, defined as serum glucose concentration between 60 mg/dL and 250 mg/dL for >95% of the time on ECMO, had no statistically significant effect on mortality for patients on ECMO. Future studies could focus on tighter glucose control or specific dextrose/glucose protocols to evaluate whether improved glucose control would have an effect on morbidity and mortality.

Wierer, Kathryn L.; Pagryzinski, Rachel A.; Xiang, Qun

2013-01-01

23

Glycemic control in pediatric patients on extracorporeal membrane oxygenation.  

PubMed

OBJECTIVES To determine whether glycemic control has an effect on outcomes for pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy, while controlling for multiple factors. METHODS A single-center retrospective chart review was performed on 82 patients who required ECMO from January 1, 2008, to December 31, 2010. All glucose concentrations collected while patients were on ECMO were analyzed; multiple other factors that may have affected mortality were also recorded. Primary outcome was mortality, and secondary outcomes were length of time on ECMO and length of time until death or discharge from the hospital. RESULTS Of 82 patients, 53 patients survived ECMO (64.6%). Glucose control had no effect on survival of patients on ECMO (p=0.56), even when controlling for multiple factors (p=0.48). Similarly, statistical evaluation showed no differences for hospital mortality in relationship to controlled serum glucose (p=0.50). Patients with controlled glucose spent an average of 31.5% more time on ECMO than non-controlled patients (p=0.048). CONCLUSIONS In this study, glycemic control, defined as serum glucose concentration between 60 mg/dL and 250 mg/dL for >95% of the time on ECMO, had no statistically significant effect on mortality for patients on ECMO. Future studies could focus on tighter glucose control or specific dextrose/glucose protocols to evaluate whether improved glucose control would have an effect on morbidity and mortality. PMID:24052786

Wierer, Kathryn L; Pagryzinski, Rachel A; Xiang, Qun

2013-07-01

24

Glycemic Control for Postoperative Pediatric Cardiac Patients  

Microsoft Academic Search

This study aimed to determine the prevalence of hyperglycemia among pediatric postoperative cardiac patients, its impact on\\u000a outcomes, and whether hyperglycemia can be controlled effectively in this population. A retrospective chart review of 100\\u000a postoperative patients admitted to the authors’ pediatric cardiac intensive care unit (ICU) was conducted. Patients were evaluated\\u000a for incidence of hyperglycemia, defined as blood glucose (BG)

Catherine M. Preissig; Mark R. Rigby; Kevin O. Maher

2009-01-01

25

Creating a Perioperative Glycemic Control Program  

PubMed Central

Hyperglycemia in the surgical population is a recognized risk factor for postoperative complications; however, there is little literature to date regarding the management of hyperglycemia in the perioperative period. Here, we detail the strategies that our institutions have employed to identify and treat hyperglycemia in patients with diabetes who present for surgery. Our approach focuses on the recognition of hyperglycemia and metabolic abnormalities, control of glucose levels via insulin infusion when needed, monitoring for hypoglycemia and a comprehensive multidisciplinary approach that provides standardized recommendations for patients at all points in care as they transition from the preoperative clinic into the operating room, and then into the hospital.

Alexanian, Sara M.; McDonnell, Marie E.; Akhtar, Shamsuddin

2011-01-01

26

Adiposity and glycemic control in children exposed to perfluorinated compounds.  

PubMed

Objective: Our objective was to explore whether childhood exposure to perfluorinated and polyfluorinated compounds (PFCs), widely used stain- and grease-repellent chemicals, is associated with adiposity and markers of glycemic control. Materials and Methods: Body mass index, skinfold thickness, waist circumference, leptin, adiponectin, insulin, glucose, and triglyceride concentrations were assessed in 8- to 10-year-old children in 1997 in a subset of the European Youth Heart Study, Danish component. Plasma PFC concentrations were available from 499 children. Linear regression models were performed to determine the association between PFC exposure and indicators of adiposity and markers of glycemic control. Results: There was no association between PFC exposures and adiposity or markers of glycemic control in normal-weight children. Among overweight children, an increase of 10 ng perfluorooctane sulfonic acid/mL plasma was associated with 16.2% (95% confidence interval [CI], 5.2%-28.3%) higher insulin concentration, 12.0% (95% CI, 2.4%-22.4%) higher ?-cell activity, 17.6% (95% CI, 5.8%-30.8%) higher insulin resistance, and 8.6% (95% CI, 1.2%-16.5%) higher triglyceride concentrations, and an increase of 10 ng perfluorooctanoic acid/mL plasma was associated with 71.6% (95% CI, 2.4%-187.5%) higher insulin concentration, 67.5% (95% CI, 5.5%-166.0%) higher ?-cell function, 73.9% (95% CI, 0.2%-202.0%) higher insulin resistance, and 76.2% (95% CI, 22.8%-153.0%) higher triglyceride concentrations. Discussion: Increased PFC exposure in overweight 8- to 10-year-old children was associated with higher insulin and triglyceride concentrations. Chance findings may explain some of our results, and due to the cross-sectional design, reverse causation cannot be excluded. The findings therefore need to be confirmed in longitudinal studies. PMID:24606078

Timmermann, Clara Amalie G; Rossing, Laura I; Grøntved, Anders; Ried-Larsen, Mathias; Dalgård, Christine; Andersen, Lars B; Grandjean, Philippe; Nielsen, Flemming; Svendsen, Kira D; Scheike, Thomas; Jensen, Tina K

2014-04-01

27

Glycemic Control and Radiographic Manifestations of Tuberculosis in Diabetic Patients  

PubMed Central

Background Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB. Methods Consecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005–2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients’ diabetic status. Films with any discordant reading were read by a third reader. Results 1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46–1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%–9%, and 1.62 (95% CI 1.12–2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46–1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20–2.84) for A1C 7%–9%, and 3.71 (95% CI 2.64–5.22) for A1C>9%, relative to patients without DM. Conclusions Glycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM.

Chiang, Chen-Yuan; Lee, Jen-Jyh; Chien, Shun-Tien; Enarson, Donald A.; Chang, You-Cheng; Chen, Yi-Ting; Hu, Ting-Yu; Lin, Chih-Bin; Suk, Chi-Won; Tao, Jui-Ming; Bai, Kuan-Jen

2014-01-01

28

Glycemic Control during Coronary Artery Bypass Graft Surgery  

PubMed Central

Hyperglycemia, which occurs in the perioperative period during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of perioperative hyperglycemia during coronary artery bypass graft surgery and all cardiac surgical procedures has been the focus of intensive study in recent years. This report will paper the pathophysiology responsible for the detrimental effects of perioperative hyperglycemia during cardiac surgery, show how continuous insulin infusions in the perioperative period have improved outcomes, and discuss the results of trials designed to determine what level of a glycemic control is necessary to achieve optimal clinical outcomes.

Lazar, Harold L.

2012-01-01

29

Age and glycemic control among low-income Latinos.  

PubMed

Younger adult patients with diabetes often have poorer glycemic control (HbA1c) than older patients. It is not known if this relationship holds true in the Latino population. Objective was to explore the relationship between age and HbA1c in a Mexican American population and what plausible factors might mediate this relationship. We analyzed data from 387 patients with diabetes self-identified as Mexican American recruited as a part of a cross-sectional study of safety net patients in two cities. Patients completed questionnaires and their last HbA1c was extracted from the medical record. We conducted multivariate regression analyses and Baron and Kenny tests of mediation. Participants were young with mean age of 53 ± 12 years. Younger age was associated with a higher HbA1c and having a higher fat diet. High fat diet partially mediated the relationship between age and HbA1c (p < 0.001 to p < 0.01). Age's indirect effect on HbA1c through diet was significant (Sobel = -2.44, p = 0.01). Younger Mexican American patients had higher HbA1c compared to older patients. Having a diet high in fat partially explained this relationship. Future epidemiological studies are needed to understand the multifaceted relationship between age and glycemic control. PMID:22843322

Naranjo, Diana M; Jacobs, Elizabeth A; Fisher, Lawrence; Hessler, Danielle; Fernandez, Alicia

2013-10-01

30

Bodily Pain, Poor Physical Functioning, and Poor Glycemic Control in Adults With Diabetes  

Microsoft Academic Search

n the January issue of Diabetes Care, Krein et al. (1) reported that the pres- ence of chronic pain was associated with poor diabetes self-management. Their study was performed in a primarily male veteran population, and glycemic control was not addressed. We examined psychosocial factors associated with poor glycemic control in a largely female pop- ulation followed in an urban,

Jorgensen RS; Weinstock RS; Sprafkin RP; Lantinga LJ; Carnrike CL Jr

31

Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes  

Microsoft Academic Search

Objectives: To examine predictors of glycemic control and to assess how glycemic control affects the incidence of short-term adverse outcomes in a pediatric population with type 1 diabetes. Study design: Three hundred youth, aged 7 to 16 years, with type 1 diabetes who were receiving diabetes specialty care were followed up prospectively for 1 year. Treatment plans and frequency of

Bat-Sheva Levine; Barbara J. Anderson; Deborah A. Butler; Jeanne E. Antisdel; Julienne Brackett; Lori M. B. Laffel

2001-01-01

32

Diabetes in Primary Care: Prospective Associations between Depression, Nonadherence and Glycemic Control  

Microsoft Academic Search

Background: Findings are inconsistent regarding the degree to which depression may exert a negative impact on glycemic control in patients with type 2 diabetes. We therefore aimed to examine the longitudinal relationship between depression, behavioral factors, and glycemic control. Methods: In a prospective component of a nationally representative sample, 866 patients with type 2 diabetes aged ?18 years completed a

Jörg Dirmaier; Birgit Watzke; Uwe Koch; Holger Schulz; Hendrik Lehnert; Lars Pieper; Hans-Ulrich Wittchen

2010-01-01

33

Congestive Heart Failure and Diabetes: Balancing Glycemic Control with Heart Failure Improvement  

PubMed Central

Diabetes and congestive heart failure (HF) commonly coexist in the same patient, and the presence of diabetes in HF patients is associated with increased adverse events compared to patients without diabetes. Recent guidelines regarding glycemic control stress individualization of glycemic therapy based on patient comorbid conditions and potential adverse effects of medical therapy. This balance in glycemic control may be particularly relevant in patients with diabetes and HF. In this review, we address data regarding the influence that certain HF medications may have on glycemic control. Despite potential modest changes in glycemic control, clinical benefits of proven pharmacologic HF therapies extend to patients with diabetes and HF. In addition, we review potential benefits and challenges associated with commonly used glycemic medications in HF patients. Finally, recent data and controversies on optimal glycemic targets in HF patients are discussed. Given the large number of patients with diabetes and HF and the health burden of these conditions, much needed future work is necessary to define the optimal glycemic treatment in HF patients with diabetes.

Nasir, Saifullah; Aguilar, David

2012-01-01

34

Durability of glycemic control: a feature of the thiazolidinediones.  

PubMed

Type 2 diabetes is a rapidly growing disorder that affects millions of Americans. It usually results from a combination of insulin resistance and a beta-cell secretory defect leading to hyperglycemia and microvascular and macrovascular complications, including cardiovascular disease. With the increasing number of options available for the treatment of type 2 diabetes, it can be difficult to determine which medication to prescribe for each patient. Ideally, an agent that effectively lowers glucose concentrations while also minimizing disease progression should be chosen. The thiazolidinediones (TZDs), a relatively newer class of antidiabetic agents, have been shown to be efficacious in lowering glucose concentrations, maintaining glycemic control, and improving other cardiovascular risk factors. These include reduction of visceral adiposity, alteration of lipoprotein concentrations with a favorable distribution of cholesterol subfractions, and decreasing markers of inflammation and endothelial dysfunction. Overall, the TZDs appear to be a promising therapeutic option for consistent control of glucose levels and may slow the progression of type 2 diabetes. PMID:15117584

Serdy, Shanti; Abrahamson, Martin J

2004-04-01

35

Health Literacy, Diabetes Self-Care, and Glycemic Control in Adults with Type 2 Diabetes  

PubMed Central

Abstract Background Although limited health literacy is a barrier to disease management and has been associated with poor glycemic control, the mechanisms underlying the relationships between health literacy and diabetes outcomes are unknown. We examined the relationships between health literacy, determinants of diabetes self-care, and glycemic control in adults with type 2 diabetes. Methods Patients with diabetes were recruited from an outpatient primary care clinic. We collected information on demographics, health literacy, diabetes knowledge, diabetes fatalism, social support, and diabetes self-care, and hemoglobin A1c values were extracted from the medical record. Structural equation models tested the predicted pathways linking health literacy to diabetes self-care and glycemic control. Results No direct relationship was observed between health literacy and diabetes self-care or glycemic control. Health literacy had a direct effect on social support (r?=??0.20, P?glycemic control (r?=??0.01). More diabetes knowledge (r?=?0.22, P?glycemic control (r?=??0.20, P?glycemic control through its association with social support. This suggests that for patients with limited health literacy, enhancing social support would facilitate diabetes self-care and improved glycemic control.

Osborn, Chandra Y.; Bains, Sujeev S.

2010-01-01

36

Self-Efficacy Links Health Literacy and Numeracy to Glycemic Control  

Microsoft Academic Search

The mechanisms underlying the relationship between health literacy, numeracy, and glycemic control are unclear. We explored the role of diabetes self-efficacy in the predicted pathway linking health literacy and numeracy to glycemic control (A1C). Adults with type 1 or type 2 diabetes mellitus (N = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers.

Chandra Y. Osborn; Kerri Cavanaugh; Kenneth A. Wallston; Russell L. Rothman

2010-01-01

37

FACTORS ASSOCIATED WITH POOR GLYCEMIC CONTROL IN OLDER MEXICAN AMERICAN DIABETICS AGED 75 YEARS AND OLDER  

PubMed Central

Objective This study examines the prevalence and correlates of poor glycemic control in Mexican Americans aged 75 years and older with diabetes. Methods Data are from the 5th wave (2004–05) of the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE). A total of 2,069 Mexican Americans aged 75 and over were interviewed. Six hundred eighty nine subjects (33.5%) reported having been diagnosed with diabetes and 209 (30.3%) subjects agreed to a blood test of their HbA1c level. Results Of the 209 diabetic subjects with an HbA1c test, 73 (34.9%) had good glycemic control (HbA1c <7%) and 136 (65.1%) had poor glycemic control (HbA1c >7%). Bivariate analysis revealed that subjects with poor control had longer disease duration, had lower education, used the glucometer more frequently, and had more diabetes-complications when compared to those in the good glycemic control group. Multivariable logistic regression analysis found the following factors associated with poor glycemic control: < 8 years of education, foreign-born, smoking, obesity, longer disease duration, daily glucometer use, and having macro-complications. Discussion Prevalence of poor glycemic control is very high in this population with very high and rising prevalence of diabetes. Further studies are needed to explore the effect of these and other characteristics on glycemic control among older Mexican Americans and to develop appropriate interventions to improve diabetes outcomes and increase life-expectancy.

Otiniano, Max E.; Al Snih, Soham; Goodwin, James S.; Ray, Laura; Al Ghatrif, Majd; Markides, Kyriakos S.

2012-01-01

38

Motor Vehicle Crashes in Diabetic Patients with Tight Glycemic Control: A Population-based Case Control Analysis  

Microsoft Academic Search

Using a population-based case control analysis, Donald Redelmeier and colleagues found that tighter glycemic control, as measured by the HbA1c, is associated with an increased risk of a motor vehicle crash.

Donald A. Redelmeier; Anne B. Kenshole; Joel G. Ray

2009-01-01

39

Dietary glycemic index, glycemic load, and the risk of endometrial cancer: a case-control study and meta-analysis.  

PubMed

Carbohydrates and the dietary glycemic index (GI) influence insulin secretion and insulin-like growth factors, and may exert relevant effects on obesity and diabetes, both of which are important risk factors for endometrial cancer. We studied the association between dietary GI and glycemic load (GL) and endometrial cancer using data from an Italian case-control study. This included 454 women with histologically confirmed endometrial cancer and 908 controls admitted to the same hospitals for acute, non-neoplastic conditions. Multivariate odds ratios were obtained after allowance for major potential confounding factors, including noncarbohydrate energy intake. We updated a meta-analysis on this issue, including a recent US cohort study, which contributed about a quarter of all cases, besides our case-control study. In the case-control study, the odds ratios of endometrial cancer for the highest versus the lowest quintile were 1.03 [95% confidence interval (CI): 0.67-1.58] for GI and 1.01 (95% CI: 0.64-1.61) for GL. No heterogeneity was found across the strata of diabetes and other selected covariates. The summary risk estimate of endometrial cancer for the highest versus the lowest GI level, obtained from the meta-analysis, was 1.09 (95% CI: 0.92-1.29). The corresponding risk estimate for GL was 1.19 (95% CI: 1.06-1.34). The case-control study showed no association between dietary GI and GL and the risk of endometrial cancer overall and in the strata of relevant covariates, whereas the meta-analysis supported an increased risk for high GL, but not GI. PMID:22584216

Galeone, Carlotta; Augustin, Livia S A; Filomeno, Maria; Malerba, Stefano; Zucchetto, Antonella; Pelucchi, Claudio; Montella, Maurizio; Talamini, Renato; Franceschi, Silvia; La Vecchia, Carlo

2013-01-01

40

Impact of pancreatic cancer and subsequent resection on glycemic control in diabetic and nondiabetic patients.  

PubMed

The incidence of new onset or worsening diabetes is surprisingly low in patients after partial pancreatectomy for cancer, leading us to question what factors predict diminished glycemic control in those undergoing resection. All patients undergoing pancreatectomy for cancer at a large, rural university teaching hospital between 1996 and 2010 were identified. The incidence of new onset, or worsening, existing diabetes was determined based on pre and postoperative medication requirement. Univariate analysis was undertaken to identify factors that predict worsened glycemic control. One hundred and one (1 total, 79 Whipple, 21 distal) patients were identified, 41 per cent of which had preexisting diabetes. Nearly half of existing diabetics manifested an increased medication requirement prior to their cancer diagnosis. New onset diabetes occurred in 20 per cent of postoperative patients. Of established diabetics, 34 per cent had either improved glycemic control (9/41) or were cured (5/41) despite the reduction of islet cell mass that occurred with surgery. On univariate analysis, only prolonged hospitalization was associated with worsened glycemic control. Diminished glycemic control is a frequent presenting symptom of pancreatic cancer. Worsened or new onset diabetes is associated with length of stay, which can be influenced by a number of factors including complications and comorbidities. PMID:21944519

White, Michael A; Agle, Steven C; Fuhr, Hannah M; Mehaffey, James H; Waibel, Brett H; Zervos, Emmanuel E

2011-08-01

41

Plasma concentrations of asymmetric-dimethyl-arginine in type 2 diabetes associate with glycemic control and glomerular filtration rate but not with risk factors of vasculopathy  

Microsoft Academic Search

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase (NOS). Increased plasma levels of ADMA may indicate endothelial dysfunction and increased risk of angiopathy. The relation of ADMA to diabetes, glycemic control, and renal function, especially early diabetic hyperfiltration, remains unknown. We tried to evaluate whether there is an association between ADMA and glycosylated hemoglobin (GHbA1c) on the

Juha Laakso; Inkeri Ruokonen; Vappu Rantalaiho; Ole Wirta; Amos Pasternack; Reijo Laaksonen

2003-01-01

42

Organ failure and tight glycemic control in the SPRINT study  

PubMed Central

Introduction Intensive care unit mortality is strongly associated with organ failure rate and severity. The sequential organ failure assessment (SOFA) score is used to evaluate the impact of a successful tight glycemic control (TGC) intervention (SPRINT) on organ failure, morbidity, and thus mortality. Methods A retrospective analysis of 371 patients (3,356 days) on SPRINT (August 2005 - April 2007) and 413 retrospective patients (3,211 days) from two years prior, matched by Acute Physiology and Chronic Health Evaluation (APACHE) III. SOFA is calculated daily for each patient. The effect of the SPRINT TGC intervention is assessed by comparing the percentage of patients with SOFA ?5 each day and its trends over time and cohort/group. Organ-failure free days (all SOFA components ?2) and number of organ failures (SOFA components >2) are also compared. Cumulative time in 4.0 to 7.0 mmol/L band (cTIB) was evaluated daily to link tightness and consistency of TGC (cTIB ?0.5) to SOFA ?5 using conditional and joint probabilities. Results Admission and maximum SOFA scores were similar (P = 0.20; P = 0.76), with similar time to maximum (median: one day; IQR: [1,3] days; P = 0.99). Median length of stay was similar (4.1 days SPRINT and 3.8 days Pre-SPRINT; P = 0.94). The percentage of patients with SOFA ?5 is different over the first 14 days (P = 0.016), rising to approximately 75% for Pre-SPRINT and approximately 85% for SPRINT, with clear separation after two days. Organ-failure-free days were different (SPRINT = 41.6%; Pre-SPRINT = 36.5%; P < 0.0001) as were the percent of total possible organ failures (SPRINT = 16.0%; Pre-SPRINT = 19.0%; P < 0.0001). By Day 3 over 90% of SPRINT patients had cTIB ?0.5 (37% Pre-SPRINT) reaching 100% by Day 7 (50% Pre-SPRINT). Conditional and joint probabilities indicate tighter, more consistent TGC under SPRINT (cTIB ?0.5) increased the likelihood SOFA ?5. Conclusions SPRINT TGC resolved organ failure faster, and for more patients, from similar admission and maximum SOFA scores, than conventional control. These reductions mirror the reduced mortality with SPRINT. The cTIB ?0.5 metric provides a first benchmark linking TGC quality to organ failure. These results support other physiological and clinical results indicating the role tight, consistent TGC can play in reducing organ failure, morbidity and mortality, and should be validated on data from randomised trials.

2010-01-01

43

Erectile function in men with diabetes type 2: correlation with glycemic control  

Microsoft Academic Search

Men with diabetes have an increased risk for erectile dysfunction (ED) than those without diabetes. The diabetes control and complications trial clearly showed that better long-term control of blood glucose in diabetes type 1 is associated with decreased frequency and delayed the onset of microvascular complications. The aim of this study is to explore the role of glycemic control, and

H Awad; A Salem; A Gadalla; N Abou El Wafa; O A Mohamed

2010-01-01

44

Perioperative glycemic control: use of a hospital-wide protocol to safely improve hyperglycemia.  

PubMed

Perioperative hyperglycemia impairs immunity and contributes to increased susceptibility to infection, higher incidence of multiorgan dysfunction, and greater mortality. Strict glycemic control is associated with lower infection rates, decreased length of stay (LOS), and faster recovery. A protocol that standardized preoperative education, testing, and treatment of elevated blood glucose (BG) safely improved perioperative glycemic control. Preoperative average BG improved from 191 to 155 mg/dL (P=.016); postoperative average BG decreased from 189 to 168 mg/dL (P=.094). The percentage of patients presenting with BG greater than 180 mg/dL preoperatively and achieving BG less than 180 mg/DL postoperatively increased from 21% to 43% (P = .09). Even though some results were statistically non-significant, the data showed a trend toward improvement with the new protocol. Good perioperative glycemic control, without an increased risk of hypoglycemia, is achievable. PMID:21803272

Michaelian, Nancy; Joshi, Renu; Gillman, Ed; Kratz, Ronald; Helmuth, Amy; Zimmerman, Karen; Klahre, Denise; Warner, Sandy; McBride, Vickie; Bailey, M Judy; Houseal, Linda

2011-08-01

45

Template to improve glycemic control without reducing adiposity or dietary fat.  

PubMed

Drugs that improve chronic hyperglycemia independently of insulin signaling or reduction of adiposity or dietary fat intake may be highly desirable. Ad36, a human adenovirus, promotes glucose uptake in vitro independently of adiposity or proximal insulin signaling. We tested the ability of Ad36 to improve glycemic control in vivo and determined if the natural Ad36 infection in humans is associated with better glycemic control. C57BL/6J mice fed a chow diet or made diabetic with a high-fat (HF) diet were mock infected or infected with Ad36 or adenovirus Ad2 as a control for infection. Postinfection (pi), systemic glycemic control, hepatic lipid content, and cell signaling in tissues pertinent to glucose metabolism were determined. Next, sera of 1,507 adults and children were screened for Ad36 antibodies as an indicator of past natural infection. In chow-fed mice, Ad36 significantly improved glycemic control for 12 wk pi. In HF-fed mice, Ad36 improved glycemic control and hepatic steatosis up to 20 wk pi. In adipose tissue (AT), skeletal muscle (SM), and liver, Ad36 upregulated distal insulin signaling without recruiting the proximal insulin signaling. Cell signaling suggested that Ad36 increases AT and SM glucose uptake and reduces hepatic glucose release. In humans, Ad36 infection predicted better glycemic control and lower hepatic lipid content independently of age, sex, or adiposity. We conclude that Ad36 offers a novel tool to understand the pathways to improve hyperglycemia and hepatic steatosis independently of proximal insulin signaling, and despite a HF diet. This metabolic engineering by Ad36 appears relevant to humans for developing more practical and effective antidiabetic approaches. PMID:21266671

Krishnapuram, R; Dhurandhar, E J; Dubuisson, O; Kirk-Ballard, H; Bajpeyi, S; Butte, N; Sothern, M S; Larsen-Meyer, E; Chalew, S; Bennett, B; Gupta, A K; Greenway, F L; Johnson, W; Brashear, M; Reinhart, G; Rankinen, T; Bouchard, C; Cefalu, W T; Ye, J; Javier, R; Zuberi, A; Dhurandhar, N V

2011-05-01

46

Template to improve glycemic control without reducing adiposity or dietary fat  

PubMed Central

Drugs that improve chronic hyperglycemia independently of insulin signaling or reduction of adiposity or dietary fat intake may be highly desirable. Ad36, a human adenovirus, promotes glucose uptake in vitro independently of adiposity or proximal insulin signaling. We tested the ability of Ad36 to improve glycemic control in vivo and determined if the natural Ad36 infection in humans is associated with better glycemic control. C57BL/6J mice fed a chow diet or made diabetic with a high-fat (HF) diet were mock infected or infected with Ad36 or adenovirus Ad2 as a control for infection. Postinfection (pi), systemic glycemic control, hepatic lipid content, and cell signaling in tissues pertinent to glucose metabolism were determined. Next, sera of 1,507 adults and children were screened for Ad36 antibodies as an indicator of past natural infection. In chow-fed mice, Ad36 significantly improved glycemic control for 12 wk pi. In HF-fed mice, Ad36 improved glycemic control and hepatic steatosis up to 20 wk pi. In adipose tissue (AT), skeletal muscle (SM), and liver, Ad36 upregulated distal insulin signaling without recruiting the proximal insulin signaling. Cell signaling suggested that Ad36 increases AT and SM glucose uptake and reduces hepatic glucose release. In humans, Ad36 infection predicted better glycemic control and lower hepatic lipid content independently of age, sex, or adiposity. We conclude that Ad36 offers a novel tool to understand the pathways to improve hyperglycemia and hepatic steatosis independently of proximal insulin signaling, and despite a HF diet. This metabolic engineering by Ad36 appears relevant to humans for developing more practical and effective antidiabetic approaches.

Krishnapuram, R.; Dhurandhar, E. J.; Dubuisson, O.; Kirk-Ballard, H.; Bajpeyi, S.; Butte, N.; Sothern, M. S.; Larsen-Meyer, E.; Chalew, S.; Bennett, B.; Gupta, A. K.; Greenway, F. L.; Johnson, W.; Brashear, M.; Reinhart, G.; Rankinen, T.; Bouchard, C.; Cefalu, W. T.; Ye, J.; Javier, R.; Zuberi, A.

2011-01-01

47

Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes  

PubMed Central

OBJECTIVE To determine whether food insecurity—the inability to reliably afford safe and nutritious food—is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes. RESEARCH DESIGN AND METHODS We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control. RESULTS The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A1c ?8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07–2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control. CONCLUSIONS Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.

Seligman, Hilary K.; Jacobs, Elizabeth A.; Lopez, Andrea; Tschann, Jeanne; Fernandez, Alicia

2012-01-01

48

Patient perception of understanding health education and instructions has moderating effect on glycemic control  

PubMed Central

Background Whether health literacy is independently associated with processes or outcomes of diabetes-related care is controversial. We tried to demonstrate the interaction of health literacy and understanding of health education and instructions in achieving glycemic control. Methods Five hundred and one consecutive patients with type 2 diabetes mellitus (DM) in the outpatient clinic of the metabolism department were recruited into this pilot study. The demographic data were collected from patients’ self-reports. The clinical background information was collected through electronic medical records. A questionnaire derived from part of the Mandarin Health Literacy Scale was used to measure numeracy and functional health literacy of people with diabetes. Health literacy levels were categorized into inadequate, marginal and adequate. Patient self-ratings of their perceived understanding of the health education information and instructions provided by their case manager in the past were categorized into two subgroups: better and poor. Patients with an HbA1c level equal to or below 7% were considered to have good glycemic control. Multivariate logistic regression was used to find associated factors of health literacy and understanding of health education and instructions. GENMOD procedures were used to analyze repeated outcome measurements of glycemic control. Results Higher educational attainment and higher household income (odds ratios were 2.23 and 2.22, respectively) were significantly associated with patients who had adequate health literacy. Higher educational attainment and patients with a family history of DM (odds ratios were 4.99 and 1.85, respectively) were significantly associated with better understanding of health education and instructions. Adequate health literacy is not the only factor associated with good glycemic control. The effect of adequate health literacy in achieving good glycemic control might be masked by patients with better understanding of health education and instructions. Conclusions Our results revealed that not only were patients with adequate health literacy associated with good glycemic control but patients with marginal health literacy were also able to achieve good glycemic control. Adequate health literacy and better understanding of health education is highly correlated. The role of adequate health literacy on glycemic control could be suppressed if variables are over-controlled during analysis.

2014-01-01

49

Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes  

PubMed Central

Objective To investigate the way that family stress influences glycemic control among patients with diabetes who are younger than 18 years of age. Data sources PubMed and Scopus were searched for relevant studies published since 1990 using the following key words: diabetes type 1, glycemic control, family stress, family conflict, and family function. Study selection In total, 1478 papers were identified in the initial search. The final review included 6 cohort studies, 3 cross-sectional studies, and 1 qualitative review in which family stress was assessed using specific diabetes-related conflict measurement instruments, and glycemic control was evaluated by glycosylated hemoglobin measurement. Synthesis In most studies family stress was negatively correlated with patients' glycemic control. Family function was strongly related to patients' glycemic control, while family conflict was adversely associated with glycemic control. Families of low socioeconomic status, those of adolescents with diabetes, and those of single parents were more prone to diabetes-related stress and thus more susceptible to worse glycemic control. Conclusion Therapeutic psychological interventions and educational programs can help alleviate family diabetes-related stress and will likely improve glycemic control.

Tsiouli, Elina; Alexopoulos, Evangelos C.; Stefanaki, Charikleia; Darviri, Christina; Chrousos, George P.

2013-01-01

50

Effect of mosapride on glycemic control and gastric emptying in type 2 diabetes mellitus patients with gastropathy  

Microsoft Academic Search

Delay of gastric emptying is one of the factors responsible for unfavorable glycemic control. We investigated the possible effects of mosapride, a digestive tract prokinetic agent, on glycemic control in diabetic patients complicated with gastropathy. Enrolled were 36 type II diabetic patients presenting with mild digestive tract symptoms. They were given mosapride 15 mg per day for 6 months. Seventeen

Hideki Asakawa; Isao Hayashi; Takeshi Fukui; Katsuo Tokunaga

2003-01-01

51

Molecular variants and derivatives of insulin for improved glycemic control in diabetes.  

PubMed

Insulin is a historic molecule. It presents many first instances, such as the first protein to be fully sequenced, one of the first proteins to be crystallized in pure form, one among the early proteins whose structure was investigated using X-ray crystallography, the first protein to be chemically synthesized and the first Biotech drug. Therefore, the development of insulin in the early years is intricately intertwined with the progress in molecular and structural biology. In recent years, development of a range of insulin analogs has led to better control of glucose levels, thus preventing secondary complications and improving the quality of life in diabetic patients. Such analogs were obtained by modification of the native insulin sequence. They vary with regard to their pharmacokinetic profile, stability, tissue specificity and mode of administration. In addition, alterations involving incorporation of various chemical moieties in insulin and its co-crystallization with insoluble derivatives are used to modulate the time-action profile of the drug. This article traces the development of molecular variants and derivatives of insulin. It discusses future directions for further improvement in their properties to produce still better insulin therapeutics for tight glycemic control. PMID:16061274

Bhatnagar, Sonika; Srivastava, Deepa; Jayadev, M S K; Dubey, A K

2006-07-01

52

Association of Exercise Stages of Change with Glycemic Control in Individuals with Type 2 Diabetes.  

ERIC Educational Resources Information Center

Investigated the distribution of diabetic patients' stages of change to follow an exercise regimen, examining whether later stages of change were associated with better glycemic control. Data on participants from a primary care clinic (who were predominantly black, female, and indigent) indicated that over half of were in pre-contemplation,…

Natarajan, Sundar; Clyburn, Ernest B.; Brown, Ronald T.

2002-01-01

53

Association of serum copper levels and glycemic control in patients with type 2 diabetes.  

PubMed

It has been suggested that copper ion is involved in the pathogenesis of various diseases. The aim of this study is to examine the association of serum copper levels and glycemic control in patients with type 2 diabetes. We recruited a total of 132 patients with type 2 diabetes, and measured their serum copper levels by atomic absorption spectrometry. Serum copper levels were positively correlated with HbA1c levels (r=0.176, p=0 .044). In addition, after 3-month glycemic control, we evaluated whether the improvement of glycemic control influenced serum copper levels. As hemoglobin A1c (HbA1c) levels were decreased (from 8.7% to 6.8%, p<0.001), copper levels tended to be decreased (from 105.7 ?g/dL to 101.8 ?g/dL, p=0.069). In conclusion, it is likely that serum copper levels are associated with glycemic control in patients with type 2 diabetes. PMID:23197044

Naka, Toyoko; Kaneto, Hideaki; Katakami, Naoto; Matsuoka, Taka-Aki; Harada, Ayako; Yamasaki, Yoshimitsu; Matsuhisa, Munehide; Shimomura, Iichiro

2013-01-01

54

Prevalence of Asthma and Its Association With Glycemic Control Among Youth With Diabetes  

PubMed Central

OBJECTIVE: To estimate the prevalence of asthma among youth with types 1 and 2 diabetes and examine associations between asthma and glycemic control. METHODS: This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, which included youth diagnosed with type 1 (n = 1683) and type 2 (n = 311) diabetes from 2002 through 2005. Asthma status and medications were ascertained from medical records and self-administered questionnaires, and glycemic control was assessed from hemoglobin A1c measured at the study visit. RESULTS: Prevalence of asthma among all youth with diabetes was 10.9% (95% confidence interval [CI]: 9.6%–12.3%). The prevalence was 10.0% (95% CI: 8.6%–11.4%) among youth with type 1 and 16.1% (95% CI: 12.0%–20.2%) among youth with type 2 diabetes and differed according to race/ethnicity. Among youth with type 1 diabetes, those with asthma had higher mean A1c levels than those without asthma, after adjustment for age, gender, race/ethnicity, and BMI (7.77% vs 7.49%; P = .034). Youth with asthma were more likely to have poor glycemic control, particularly those with type 1 diabetes whose asthma was not treated with pharmacotherapy, although this association was attenuated by adjustment for race/ethnicity. CONCLUSIONS: Prevalence of asthma may be elevated among youth with diabetes relative to the general US population. Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated. Specific asthma medications may decrease systemic inflammation, which underlies the complex relationship between pulmonary function, BMI, and glycemic control among youth with diabetes.

Black, Mary Helen; Anderson, Andrea; Bell, Ronny A.; Dabelea, Dana; Pihoker, Catherine; Saydah, Sharon; Seid, Michael; Standiford, Debra A.; Waitzfelder, Beth; Marcovina, Santica M.

2011-01-01

55

Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis  

PubMed Central

Introduction Hyper- and hypoglycemia are strongly associated with adverse outcomes in critical care. Neurologically injured patients are a unique subgroup, where optimal glycemic targets may differ, such that the findings of clinical trials involving heterogeneous critically ill patients may not apply. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing intensive insulin therapy with conventional glycemic control among patients with traumatic brain injury, ischemic or hemorrhagic stroke, anoxic encephalopathy, central nervous system infections or spinal cord injury. Results Sixteen RCTs, involving 1248 neurocritical care patients, were included. Glycemic targets with intensive insulin ranged from 70-140 mg/dl (3.9-7.8 mmol/L), while conventional protocols aimed to keep glucose levels below 144-300 mg/dl (8.0-16.7 mmol/L). Tight glycemic control had no impact on mortality (RR 0.99; 95% CI 0.83-1.17; p = 0.88), but did result in fewer unfavorable neurological outcomes (RR 0.91; 95% CI 0.84-1.00; p = 0.04). However, improved outcomes were only observed when glucose levels in the conventional glycemic control group were permitted to be relatively high [threshold for insulin administration > 200 mg/dl (> 11.1 mmol/L)], but not with more intermediate glycemic targets [threshold for insulin administration 140-180 mg/dl (7.8-10.0 mmol/L)]. Hypoglycemia was far more common with intensive therapy (RR 3.10; 95% CI 1.54-6.23; p = 0.002), but there was a large degree of heterogeneity in the results of individual trials (Q = 47.9; p<0.0001; I2 = 75%). Mortality was non-significantly higher with intensive insulin in studies where the proportion of patients developing hypoglycemia was large (> 33%) (RR 1.17; 95% CI 0.79-1.75; p = 0.44). Conclusions Intensive insulin therapy significantly increases the risk of hypoglycemia and does not influence mortality among neurocritical care patients. Very loose glucose control is associated with worse neurological recovery and should be avoided. These results suggest that intermediate glycemic goals may be most appropriate.

2012-01-01

56

Hypertension, poor glycemic control, and microalbuminuria in Cuban Americans with type 2 diabetes  

PubMed Central

Purpose: To investigate to what degree the presence of hypertension (HTN) and poor glycemic control (GC) influences the likelihood of having microalbuminuria (MAU) among Cuban Americans with type 2 diabetes (T2D). Methods: A cross-sectional study conducted in Cuban Americans (n = 179) with T2D. Participants were recruited from a randomly generated mailing list purchased from Knowledge-Base Marketing, Inc. Blood pressure (BP) was measured twice and averaged using an adult size cuff. Glycosylated hemoglobin (A1c) levels were measured from whole blood samples with the Roche Tina-quant method. First morning urine samples were collected from each participant to determine MAU by a semiquantitative assay (ImmunoDip). Results: MAU was present in 26% of Cuban Americans with T2D. A significantly higher percentage of subjects with MA had HTN (P = 0.038) and elevated A1C (P = 0.002) than those with normoalbuminuria. Logistic regression analysis showed that after controlling for covariates, subjects with poor GC were 6.76 times more likely to have MAU if they had hypertension compared with those without hypertension (P = 0.004; 95% confidence interval [CI]: 1.83, 23.05). Conclusion: The clinical significance of these findings emphasizes the early detection of MAU in this Hispanic subgroup combined with BP and good GC, which are fundamentals in preventing and treating diabetes complications and improving individuals’ renal and cardiovascular outcomes.

Zarini, Gustavo G; Exebio, Joel C; Gundupalli, Deva; Nath, Subrata; Huffman, Fatma G

2011-01-01

57

Poor glycemic control in younger women attending Malaysian public primary care clinics: findings from adults diabetes control and management registry  

PubMed Central

Background Women of reproductive age are a group of particular concern as diabetes may affect their pregnancy outcome as well as long-term morbidity and mortality. This study aimed to compare the clinical profiles and glycemic control of reproductive and non-reproductive age women with type 2 diabetes (T2D) in primary care settings, and to determine the associated factors of poor glycemic control in the reproductive age group women. Methods This was a cross-sectional study using cases reported by public primary care clinics to the Adult Diabetes Control and Management registry from 1st January to 31st December 2009. All Malaysian women aged 18 years old and above and diagnosed with T2D for at least 1 year were included in the analysis. The target for glycemic control (HbA1c < 6.5%) is in accordance to the recommended national guidelines. Both univariate and multivariate approaches of logistic regression were applied to determine whether reproductive age women have an association with poor glycemic control. Results Data from a total of 30,427 women were analyzed and 21.8% (6,622) were of reproductive age. There were 12.5% of reproductive age women and 18.0% of non-reproductive age women that achieved glycemic control. Reproductive age group women were associated with poorer glycemic control (OR = 1.5, 95% CI = 1.2-1.8). The risk factors associated with poor glycemic control in the reproductive age women were being of Malay and Indian race, longer duration of diabetes, patients on anti-diabetic agents, and those who had not achieved the target total cholesterol and triglycerides. Conclusion Women with T2D have poor glycemic control, but being of reproductive age was associated with even poorer control. Health care providers need to pay more attention to this group of patients especially for those with risk factors. More aggressive therapeutic strategies to improve their cardiometabolic control and pregnancy outcome are warranted.

2013-01-01

58

Mobile Phone Diabetes Project Led To Improved Glycemic Control And Net Savings For Chicago Plan Participants  

PubMed Central

Even with the best health care available, patients with chronic illnesses typically spend no more than a few hours a year in a health care setting, while their outcomes are largely determined by their activities during the remaining 5,000 waking hours of the year. As a widely available, low-cost technology, mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self-care between visits. We examined the impact of a six-month mobile health (mHealth) demonstration project among adults with diabetes who belonged to an academic medical center’s employee health plan. In addition to pre-post improvements in glycemic control (p = 0.01) and patients’ satisfaction with overall care (p = 0.04), we observed a net cost savings of 8.8 percent. Those early results suggest that mHealth programs can support health care organizations’ pursuit of the triple aim of improving patients’ experiences with care, improving population health, and reducing the per capita cost of health care.

Nundy, Shantanu; Dick, Jonathan J.; Chou, Chia-Hung; Nocon, Robert S.; Chin, Marshall H.; Peek, Monica E.

2014-01-01

59

Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.  

PubMed

Even with the best health care available, patients with chronic illnesses typically spend no more than a few hours a year in a health care setting, while their outcomes are largely determined by their activities during the remaining 5,000 waking hours of the year. As a widely available, low-cost technology, mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self-care between visits. We examined the impact of a six-month mobile health (mHealth) demonstration project among adults with diabetes who belonged to an academic medical center's employee health plan. In addition to pre-post improvements in glycemic control (p=0.01) and patients' satisfaction with overall care (p=0.04), we observed a net cost savings of 8.8 percent. Those early results suggest that mHealth programs can support health care organizations' pursuit of the triple aim of improving patients' experiences with care, improving population health, and reducing the per capita cost of health care PMID:24493770

Nundy, Shantanu; Dick, Jonathan J; Chou, Chia-Hung; Nocon, Robert S; Chin, Marshall H; Peek, Monica E

2014-02-01

60

Is race related to glycemic control? An assessment of glycosylated hemoglobin in two South Carolina communities.  

PubMed

To consider the relationship between race and long-term glycemic control, as measured by glycosylated hemoglobin (GHb), we analyzed data from a community-based sample of 3175 adults in the South Carolina Cardiovascular Disease Prevention Project. A clinically meaningful difference for mean GHb levels (10.5 vs 8.4%, P < 0.001) was present between black people and white people reporting diabetes. Similarly, a significant association between race and GHb was present among people reporting "borderline diabetes" or no diabetes. Logistic regression confirmed this finding in all three diabetic categories, however, controlling for insulin use in the diabetic group reduced (P < 0.001) the association between GHb and race. These findings confirm that further improvements in glycemic control are necessary, especially for black patients and that black people not reporting diabetes have higher GHb levels compared to white people, possibly due to undiagnosed diabetes. PMID:7722552

Eberhardt, M S; Lackland, D T; Wheeler, F C; German, R R; Teutsch, S M

1994-10-01

61

Evaluation of a novel artificial pancreas: closed loop glycemic control system with continuous blood glucose monitoring.  

PubMed

A closed-loop glycemic control system using an artificial pancreas has been applied with many clinical benefits in Japan since 1987. To update this system incorporating user-friendly features, we developed a novel artificial pancreas (STG-55). The purpose of this study was to evaluate STG-55 for device usability, performance of blood glucose measurement, glycemic control characteristics in vivo in animal experiments, and evaluate its clinical feasibility. There are several features for usability improvement based on the design concepts, such as compactness, display monitor, batteries, guidance function, and reduction of the preparation time. All animal study data were compared with a clinically available artificial pancreas system in Japan (control device: STG-22). We examined correlations of both blood glucose levels between two groups (STG-55 vs. control) using Clarke's error grid analysis, and also compared mean glucose infusion rate (GIR) during glucose clamp. The results showed strong correlation in blood glucose concentrations (Pearson's product-moment correlation coefficient: 0.97; n?=?1636). Clarke's error grid analysis showed that 98.4% of the data fell in Zones A and B, which represent clinically accurate or benign errors, respectively. The difference in mean GIRs was less than 0.2?mg/kg/min, which was considered not significant. Clinical feasibility study demonstrated sufficient glycemic control maintaining target glucose range between 80 and 110 (mg/dL), and between 140 and 160 without any hypoglycemia. In conclusion, STG-55 was a clinically acceptable artificial pancreas with improved interface and usability. A closed-loop glycemic control system with STG-55 would be a useful tool for surgical and critical patients in intensive care units, as well as diabetic patients. PMID:23506242

Tsukamoto, Yuuki; Kinoshita, Yoshihiko; Kitagawa, Hiroyuki; Munekage, Masaya; Munekage, Eri; Takezaki, Yuka; Yatabe, Tomoaki; Yamashita, Koichi; Yamazaki, Rie; Okabayashi, Takehiro; Tarumi, Masatoshi; Kobayashi, Masaki; Mishina, Suguru; Hanazaki, Kazuhiro

2013-04-01

62

Glycemic Control Among Latinos with Type 2 Diabetes: The Role of Social-Environmental Support Resources  

PubMed Central

Objective Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources. Methods Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support resources for disease management influence hemoglobin A1c (HbA1c) levels in a sample of 208 Latinos with type 2 diabetes recruited from low-income serving community clinics in San Diego County. We hypothesized that the relationship between support resources for disease-management and HbA1c would be mediated by diabetes self-management and/or depression. Results Participants who perceived greater support resources for disease-management reported better diabetes self-management (? = .40, p < .001) and less depression (? = ?.19, p < .01). In turn, better diabetes self-management and less depression were associated with tighter glycemic control (HbA1c; ? = ?.17, p < .05 and ? = .15, p < .05, respectively). Once the indirect effects via diabetes self-management (95% CI [?.25; ?.03]) and depression (95% CI [?.14; ?.01]) were statistically controlled, the direct pathway from support resources to HbA1c was markedly reduced (p = .57). Conclusions These findings demonstrate the important connection that support resources for disease management can have with diabetes self-management, emotional well-being, and glycemic control among Latinos. Thus, programs targeting diabetes self-management and glycemic control in this population should consider culturally-relevant, multi-level influences on health outcomes.

Fortmann, Addie L.; Gallo, Linda C.; Philis-Tsimikas, Athena

2011-01-01

63

Glycemic Control, Complications, and Death in Older Diabetic Patients  

PubMed Central

OBJECTIVE To identify the range of glycemic levels associated with the lowest rates of complications and mortality in older diabetic patients. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study (2004–2008) of 71,092 patients with type 2 diabetes, aged ?60 years, enrolled in Kaiser Permanente Northern California. We specified Cox proportional hazards models to evaluate the relationships between baseline glycated hemoglobin (A1C) and subsequent outcomes (nonfatal complications [acute metabolic, microvascular, and cardiovascular events] and mortality). RESULTS The cohort (aged 71.0 ± 7.4 years [means ± SD]) had a mean A1C of 7.0 ± 1.2%. The risk of any nonfatal complication rose monotonically for levels of A1C >6.0% (e.g., adjusted hazard ratio 1.09 [95% CI 1.02–1.16] for A1C 6.0–6.9% and 1.86 [1.63–2.13] for A1C ?11.0%). Mortality had a U-shaped relationship with A1C. Compared with the risk with A1C <6.0%, mortality risk was lower for A1C levels between 6.0 and 9.0% (e.g., 0.83 [0.76–0.90] for A1C 7.0–7.9%) and higher at A1C ?11.0% (1.31 [1.09–1.57]). Risk of any end point (complication or death) became significantly higher at A1C ?8.0%. Patterns generally were consistent across age-groups (60–69, 70–79, and ?80 years). CONCLUSIONS Observed relationships between A1C and combined end points support setting a target of A1C <8.0% for older patients, with the caution that A1Cs <6.0% were associated with increased mortality risk. Additional research is needed to evaluate the low A1C–mortality relationship, as well as protocols for individualizing diabetes care.

Huang, Elbert S.; Liu, Jennifer Y.; Moffet, Howard H.; John, Priya M.; Karter, Andrew J.

2011-01-01

64

Glycemic Control after Total Pancreatectomy for Intraductal Papillary Mucinous Neoplasm: An Exploratory Study  

PubMed Central

Background. Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN) is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C) at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, P = 0.52), 12 months (7.3% versus 8.0%, P = 0.081), 18 months (7.7% and 7.6%, P = 0.64), and at 24 months (7.3% versus 7.8%, P = 0.10)). Seven TP patients (50%) experienced a hypoglycemic event compared to 65 type 1 DM patients (65%, P = 0.38). Limitations. Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.

Jamil, Laith H.; Chindris, Ana M.; Gill, Kanwar R. S.; Scimeca, Daniela; Stauffer, John A.; Heckman, Michael G.; Meek, Shon E.; Nguyen, Justin H.; Asbun, Horacio J.; Raimondo, Massimo; Woodward, Timothy A.; Wallace, Michael B.

2012-01-01

65

Perioperative glycemic control using an artificial endocrine pancreas in patients undergoing total pancreatectomy: tight glycemic control may be justified in order to avoid brittle diabetes.  

PubMed

I dedicate this paper to the late Prof. Yukihiko Nosé with all my heart. In 2001, under the direction of Prof. Nosé and Prof. Brunicardi at Baylor College of Medicine, we published a review article entitled "Artificial endocrine pancreas" in JACS. Subsequently, we reported that perioperative tight glycemic control (TGC) using an artificial pancreas (AP) with a closed-loop system could stably maintain near-normoglycemia in total-pancreatectomized dogs. Based on this experimental study in Houston, since 2006, we have introduced perioperative TGC using an AP into clinical use in Kochi. As of 2011, this novel TGC method has provided safe and stable blood glucose levels in more than 400 surgical patients. In this paper, we report new clinical findings regarding perioperative TGC using an AP in total-pancreatectomized patients. TGC using an AP enables us to achieve stable glycemic control not only without hypoglycemia and hyperglycemia but also with less variation in blood glucose concentration from the target blood glucose range, even in patients with the most serious form of diabetes, so-called "brittle diabetes", undergoing total pancreatectomy. To the best of our knowledge, this is the first clinical report of TGC using an AP in patients undergoing total pancreatic resection. PMID:23442241

Hanazaki, Kazuhiro; Yatabe, Tomoaki; Kobayashi, Masaki; Tsukamoto, Yuuki; Kinoshita, Yoshihiko; Munekage, Masaya; Kitagawa, Hiroyuki

2013-01-01

66

Explaining the family conflict-glycemic control link through psychological variables in adolescents with type 1 diabetes  

Microsoft Academic Search

To examine whether individual psychological variables mediate the family conflict-glycemic control relationship. During three\\u000a study visits spanning 9 months, 147 adolescents with type 1 diabetes completed questionnaires measuring anxiety and depressive\\u000a symptoms, and diabetes-specific worry. Caregivers similarly completed a measure of diabetes-specific family conflict. Blood\\u000a glucose monitoring frequency and glycemic control were also obtained during study visits. Separate mediation analyses revealed

Michele Herzer; Anthony Vesco; Lisa M. Ingerski; Lawrence M. Dolan; Korey K. Hood

67

Actions of insulin beyond glycemic control: A perspective on insulin detemir  

Microsoft Academic Search

The physiologic effects of insulin on carbohydrate metabolism in health in general and in diabetes are well known. Less understood,\\u000a but far more intriguing, are the extrapancreatic effects of insulin that go beyond glycemic control to help sense, integrate,\\u000a and maintain energy balance. Virtually every organ, including the brain, is a target for insulin action. When exogenous insulin\\u000a is administered

Joseph Tibaldi

2007-01-01

68

Patient complexity in quality comparisons for glycemic control: An observational study  

Microsoft Academic Search

BACKGROUND: Patient complexity is not incorporated into quality of care comparisons for glycemic control. We developed a method to adjust hemoglobin A1c levels for patient characteristics that reflect complexity, and examined the effect of using adjusted A1c values on quality comparisons. METHODS: This cross-sectional observational study used 1999 national VA (US Department of Veterans Affairs) pharmacy, inpatient and outpatient utilization,

Monika M Safford; Michael Brimacombe; Quanwu Zhang; Mangala Rajan; Minge Xie; Wesley Thompson; John Kolassa; Miriam Maney; Leonard Pogach

2009-01-01

69

Glycemic Control Among Latinos With Type 2 Diabetes: The Role of Social-Environmental Support Resources  

Microsoft Academic Search

Objective: Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources. Methods: Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support

Addie L. Fortmann; Linda C. Gallo; Athena Philis-Tsimikas

2011-01-01

70

Diabetic nephropathy: new approaches for improving glycemic control and reducing risk.  

PubMed

Nephropathy is a common consequence of diabetes, with a high prevalence in patients with type 1 (15%-25%) and type 2 diabetes mellitus (T2DM; 30%-40%). Nephropathy is associated with a poor prognosis and high economic burden. The risk of developing nephropathy increases with the duration of diabetes, and early diagnosis and treatment of risk factors for nephropathy (e.g., tight control of glycemia and hypertension) can reduce the development and progression of diabetic nephropathy. Advances in our understanding of the mechanisms of renal complications associated with diabetes and the etiology of nephropathy have identified additional risk factors for nephropathy, and novel therapeutic options are being explored. This review discusses the pathophysiology of diabetic nephropathy and common risk factors. Furthermore, we discuss emerging treatments for T2DM that could potentially slow or prevent the progression of diabetic nephropathy. The use of incretin-based therapies, such as the dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) analogs, is growing in patients with T2DM, due to their efficacy and tolerability profiles. As renal safety is a key factor when choosing treatment options to manage patients with T2DM, drugs that are suitable for use in patients with varying degrees of renal impairment without a requirement for dose adjustment, such as the DPP-4 inhibitor linagliptin, are of particular use. The ongoing advances in T2DM therapy may allow optimization of glycemic control in a wide range of patients, thereby helping to reduce the increasing morbidity and mortality associated with diabetic nephropathy. PMID:23807645

Schernthaner, Guntram; Schernthaner, Gerit Holger

2013-01-01

71

Effect of glycemic control on soluble RAGE and oxidative stress in type 2 diabetic patients  

PubMed Central

Background The interaction of advanced glycation end products (AGEs) and its receptor (RAGE) has played an important role in the pathogenesis of diabetes and its complications. A soluble form of RAGE (sRAGE) has been reported as a decoy receptor for AGEs. Oxidative stress is demonstrated in pathological condition such as atherosclerosis and diabetes mellitus. It has been suggested to be involved in the pathogenesis of both macro- and microvascular complications. This study was designed to evaluate the effect of glycemic control on sRAGE and oxidative stress markers in type 2 diabetic patients. Methods Seventy patients with type 2 diabetes and 20 healthy subjects were recruited into the study. Blood glutathione (GSH) and plasma total nitric oxide (NOx) levels were measured using commercially available colorimetric kits, blood superoxide dismutase (SOD) activity was measured by the method of Marklund and Marklund, and plasma C-peptide, oxidized LDL (ox-LDL), sRAGE, and VCAM-1 levels were measured using competitive ELISA kits. Results Plasma sRAGE levels were significantly lower (p?controlled diabetic patients compared with healthy control. Blood GSH levels were significantly lower in diabetic patients compared with healthy control (p?control. Plasma levels of sRAGE were negatively associated with circulating VCAM-1 levels in diabetic patients. Conclusion Poor glycemic control decreases plasma sRAGE and increases VCAM-1 levels while good glycemic control improves these abnormalities which provides benefit to diabetic patients.

2013-01-01

72

Lipoprotein (a) in type 2 diabetes mellitus: Relation to LDL:HDL ratio and glycemic control  

PubMed Central

BACKGROUND: Increased lipoprotein (a) [Lp (a)] concentrations are predictive of coronary artery disease (CAD). Type 2 diabetes mellitus also leads to dyslipidemia, like elevated triglyceride levels and low HDL levels, which are known risk factors for CAD. This study was designed to investigate the levels of Lp (a) in type 2 diabetic patients and their association with LDL: HDL ratio and glycemic control. MATERIALS AND METHODS: The study included 60 patients of type 2 diabetes and 50 age and sex matched controls. The Lp(a) levels in the diabetic group were compared with the control group and the relationship between the Lp(a) levels and LDL: HDL ratio was evaluated. Diabetic group was further divided into three subgroups according to levels of glycated hemoglobin. Lp(a) levels and glycated hemoglobin in controlled and uncontrolled diabetes mellitus were also compared to find out any correlation between them. Statistical analysis was done using the students ‘t’ test and Chi square test. RESULTS: Lp(a) levels were found to be significantly increased in the diabetic group as compared to the control group (P< 0.001). LDL: HDL ratio was also increased in the diabetic group as compared to the control group. Lp(a) levels showed no association with LDL: HDL ratio and degree of glycemic control in these patients. CONCLUSIONS: The results of the present study suggest that Lp(a) levels are increased in type 2 diabetic patients. The elevated Lp(a) levels do not reflect the glycemic status and are also independent of increase in LDL:HDL ratio suggesting different metabolic pathways and the genetic connection for LDL and Lp(a).

Singla, Seema; Kaur, Kiranjeet; Kaur, Gurdeep; Kaur, Habir; Kaur, Jasbinder; Jaswal, Shivani

2009-01-01

73

Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes  

Microsoft Academic Search

Depression and low self-efficacy are both associated with worse glycemic control in adults with diabetes, but the relationship\\u000a between these variables is poorly understood. We conducted a cross-sectional study examining associations between depressive\\u000a symptoms, self-efficacy, and glycemic control among men (n = 64) and women (n = 98) with type 2 diabetes to see if self-efficacy mediates the relationship between depression and glycemic control.

Andrea CherringtonKenneth; Kenneth A. Wallston; Russell L. Rothman

2010-01-01

74

Endothelial Progenitor Cells Are Related to Glycemic Control in Children With Type 1 Diabetes Over Time  

PubMed Central

OBJECTIVE The risk of cardiovascular death before the age of 40 is 20-fold higher in patients with type 1 diabetes mellitus (T1DM). Endothelial progenitor cells (EPCs) predict cardiovascular morbidity and mortality in patients without diabetes. We hypothesized that EPCs are modified in children with T1DM and are related to characteristics of T1DM such as glycemic control. RESEARCH DESIGN AND METHODS Children (n = 190; 156 T1DM subjects and 34 control subjects) were included in an observational cohort study and matched for age and sex. EPCs were enumerated by flow cytometry at the beginning (cross-sectional) and 1 year later (longitudinal). To analyze changes of variables during the observation, ? values were calculated. RESULTS EPCs were significantly reduced in T1DM children versus control subjects (609 ± 359 vs. 1,165 ± 484, P < 0.001). Multivariate regression modeling revealed that glycated hemoglobin A1c (HbA1c) was the strongest independent predictor of EPCs (? = ?0.355, P < 0.001). Overall glycemic control at the beginning and end of study did not differ (7.8 ± 1.2 vs. 7.8 ± 1.2 relative %, P = NS), but we observed individual HbA1c changes of ?4.30/+3.10 relative %. The strongest EPC increase was observed in the patients with the most favorable HbA1c lowering during the 1-year follow-up. Accordingly, the strongest EPC decrease was demonstrated in the patients with the strongest HbA1c worsening during the time period. CONCLUSIONS This is the first prospective study demonstrating diminished EPCs in children with T1DM. The association of better glycemic control with an increase in EPC numbers within 1 year suggests that a reduction of the high cardiovascular disease burden might be mediated likewise.

Hortenhuber, Thomas; Rami-Mehar, Birgit; Satler, Miriam; Nagl, Katrin; Hobaus, Clemens; Hollerl, Florian; Koppensteiner, Renate; Schernthaner, Guntram; Schober, Edith; Schernthaner, Gerit-Holger

2013-01-01

75

Glibenclamide or metformin combined with honey improves glycemic control in streptozotocin-induced diabetic rats.  

PubMed

Diabetes mellitus is associated with deterioration of glycemic control and progressive metabolic derangements. This study investigated the effect of honey as an adjunct to glibenclamide or metformin on glycemic control in streptozotocin-induced diabetic rats. Diabetes was induced in rats by streptozotocin. The diabetic rats were randomized into six groups and administered distilled water, honey, glibenclamide, glibenclamide and honey, metformin or metformin and honey. The animals were treated orally once daily for four weeks. The diabetic control rats showed hypoinsulinemia (0.27 ± 0.01 ng/ml), hyperglycemia (22.4 ± 1.0 mmol/L) and increased fructosamine (360.0 ± 15.6 µmol/L). Honey significantly increased insulin (0.41 ± 0.06 ng/ml), decreased hyperglycemia (12.3 ± 3.1 mmol/L) and fructosamine (304.5 ± 10.1 µmol/L). Although glibenclamide or metformin alone significantly (p < 0.05) reduced hyperglycemia, glibenclamide or metformin combined with honey produced significantly much lower blood glucose (8.8 ± 2.9 or 9.9 ± 3.3 mmol/L, respectively) compared to glibenclamide or metformin alone (13.9 ± 3.4 or 13.2 ± 2.9 mmol/L, respectively). Similarly, glibenclamide or metformin combined with honey produced significantly (p < 0.05) lower fructosamine levels (301.3 ± 19.5 or 285.8 ± 22.6 µmol/L, respectively) whereas glibenclamide or metformin alone did not decrease fructosamine (330.0 ± 29.9 or 314.6 ± 17.9 µmol/L, respectively). Besides, these drugs or their combination with honey increased insulin levels. Glibenclamide or metformin combined with honey also significantly reduced the elevated levels of creatinine, bilirubin, triglycerides, and VLDL cholesterol. These results indicate that combination of glibenclamide or metformin with honey improves glycemic control, and provides additional metabolic benefits, not achieved with either glibenclamide or metformin alone. PMID:21448302

Erejuwa, Omotayo Owomofoyon; Sulaiman, Siti Amrah; Wahab, Mohd Suhaimi Ab; Sirajudeen, Kuttulebbai Nainamohammed Salam; Salleh, Md Salzihan Md; Gurtu, Sunil

2011-01-01

76

Second-line agents for glycemic control for type 2 diabetes: are newer agents better?  

PubMed

OBJECTIVE While metformin is generally accepted as the first-line agent in treatment of type 2 diabetes, there are insufficient evidence and extensive debate about the best second-line agent. We aimed to assess the benefits and harms of four commonly used antihyperglycemia treatment regimens considering clinical effectiveness, quality of life, and cost. RESEARCH DESIGN AND METHODS We developed and validated a new population-based glycemic control Markov model that simulates natural variation in HbA1c progression. The model was calibrated using a U.S. data set of privately insured individuals diagnosed with type 2 diabetes. We compared treatment intensification of metformin monotherapy with sulfonylurea, dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, or insulin. Outcome measures included life-years (LYs), quality-adjusted life-years (QALYs), mean time to insulin dependence, and expected medication cost per QALY from diagnosis to first diabetes complication (ischemic heart disease, myocardial infarction, congestive heart failure, stroke, blindness, renal failure, amputation) or death. RESULTS According to our model, all regimens resulted in similar LYs and QALYs regardless of glycemic control goal, but the regimen with sulfonylurea incurred significantly lower cost per QALY and resulted in the longest time to insulin dependence. An HbA1c goal of 7% (53 mmol/mol) produced higher QALYs compared with a goal of 8% (64 mmol/mol) for all regimens. CONCLUSIONS Use of sulfonylurea as second-line therapy for type 2 diabetes generated glycemic control and QALYs comparable with those associated with other agents but at lower cost. A model that incorporates HbA1c and diabetes complications can serve as a useful clinical decision tool for selection of treatment options. PMID:24574345

Zhang, Yuanhui; McCoy, Rozalina G; Mason, Jennifer E; Smith, Steven A; Shah, Nilay D; Denton, Brian T

2014-05-01

77

The combination of colesevelam with sitagliptin enhances glycemic control in diabetic ZDF rat model.  

PubMed

Bile acid sequestrants have been shown to reduce glucose levels in patients with type 2 diabetes. We previously reported that the bile acid sequestrant colesevelam HCl (Welchol) (COL) induced the release of glucagon-like peptide (GLP)-1 and improved glycemic control in insulin-resistant rats. In the present study, we tested whether adding sitagliptin (Januvia) (SIT), which prolongs bioactive GLP-1 half life, to COL would further enhance glycemic control. Male Zucker diabetic fatty (ZDF) rats were assigned to four groups: diabetic model without treatment (the model), the model treated with 2% COL or 0.4% (120 mg/day) SIT alone, or with the combination (COL+SIT). After 4 wk of treatment, the glucose area under the curve (AUC) was reduced more in the COL+SIT than the COL although both groups showed decreased glucose AUC with increased AUC of bioactive GLP-1 (GLP-1A) compared with the model group. The above changes were not observed after 8 wk. Increasing the SIT dose by 50% (180 mg SIT/day) in the diet reduced the glucose AUC in the COL+SIT group even after 8 wk but still not in the SIT alone group compared with the model. It was noteworthy that, after 8 wk, insulin levels in the SIT group declined to levels similar to the model. Histological examination of the pancreatic ?-cell islets showed that islet sizes were larger, proliferation enhanced, and cell apoptosis reduced in the COL+SIT but not the SIT alone group compared with the model. We hypothesize that the combination of COL with SIT extends the half life of COL-induced GLP-1A and benefits preservation of the islets that delay the development of diabetes and improve glycemic control. This study suggests that the combined therapy (COL+SIT) is more effective than either drug alone for reducing glucose levels in diabetes. PMID:22281473

Shang, Quan; Liu, Matthew K; Saumoy, Monica; Holst, Jens Juul; Salen, Gerald; Xu, Guorong

2012-04-15

78

From Caregiver Psychological Distress to Adolescent Glycemic Control: The Mediating Role of Perceived Burden around Diabetes Management  

PubMed Central

Objective?To examine whether perceived caregiver burden around diabetes management mediated the relationship between caregivers’ psychological distress and adolescents’ glycemic control.?Methods?Across three visits spanning 9 months, caregivers of 147 adolescents with type 1 diabetes completed measures of anxiety and depressive symptoms and a measure of perceived burden specific to diabetes management. Adolescents’ glycemic control was also measured.?Results?Perceived burden mediated the relationship between caregiver depressive symptoms and adolescents’ glycemic control. The overall model was significant, F(10,132) = 5.0, p < .001, R2 = 0.27. Fifty percent of the relationship was explained by diabetes-specific burden. The relationship between caregiver anxiety symptoms and adolescent glycemic control was partially mediated by diabetes-specific burden, F(10,133) = 5.7, p < .001, R2 = 0.30, explaining 26% of this relationship.?Discussion?A variable linking caregiver psychological distress to adolescent glycemic control is perceived caregiver burden around diabetes management. Implications for clinical practice include targeting caregiver psychological functioning and reducing global and diabetes-specific distress.

Cunningham, Natoshia Raishevich; Vesco, Anthony T.; Dolan, Lawrence M.

2011-01-01

79

Tight glycemic control and computerized decision-support systems: a systematic review  

Microsoft Academic Search

Objective  To identify and summarize characteristics of computerized decision-support systems (CDSS) for tight glycemic control (TGC)\\u000a and to review their effects on the quality of the TGC process in critically ill patients.\\u000a \\u000a \\u000a \\u000a Methods  We searched Medline (1950–2008) and included studies on critically ill adult patients that reported original data from a clinical\\u000a trial or observational study with a main objective of evaluating

Saeid Eslami; Ameen Abu-Hanna; Evert de Jonge; Nicolette F. de Keizer

2009-01-01

80

Effects of chromium picolinate on glycemic control and kidney of the obese Zucker rat  

PubMed Central

Background Chromium picolinate (Cr(pic)3) is advocated as adjuvant therapy for impaired glycemic control, despite concerns for DNA damage. Potential toxicity of Cr(pic)3 should be greater for the kidney that accumulates chromium. Therefore, we tested the hypothesis that Cr(pic)3 treatment of obese Zucker rats (OZR) exacerbates renal abnormalities associated with dysglycemia. Methods Male OZR were treated with diets lacking or containing 5 and 10 mg/kg of chromium, as Cr(pic)3, for 20 weeks; lean Zucker rats (LZR) served as controls. Glycemic and renal effects of Cr(pic)3 were determined in the context of indices of oxidative stress and inflammation. Results The OZR displayed increased fasting plasma glucose and insulin in association with enlarged pancreatic islets exhibiting collagen and periodic acid Schiff-positive deposits compared to LZR; Cr(pic)3 treatment did not affect these parameters. The OZR, irrespective of Cr(pic)3, excreted more albumin than LZR. Also, other indices of renal function or histopathology were not affected by Cr(pic)3 treatment. Urinary excretion of 8-hydroxydeoxyguanosine (8-OHdG), an index of oxidative DNA damage, was greater in the OZR than LZR; dietary Cr(pic)3 treatment attenuated 8-OHdG excretion. However, immunostaining of kidney for 8-OHdG revealed similar staining pattern and intensity, despite significant renal accumulation of chromium in Cr(pic)3-treated groups. Finally, increased renal nitrotyrosine and cyclooxygenase-2 levels and urinary excretion of monocyte chemoattractant protein-1 of OZR were partially reversed by Cr(pic)3 treatment. Conclusion Dietary Cr(pic)3 treatment of OZR does not beneficially influence glycemic status or increase the risk for oxidative DNA damage; rather, the treatment attenuates indices of oxidative stress and inflammation.

2009-01-01

81

Diet, Inflammation, and Glycemic Control in Type 2 Diabetes: An Integrative Review of the Literature  

PubMed Central

Type 2 diabetes (T2D) is a growing national health problem affecting 35% of adults ?20 years of age in the United States. Recently, diabetes has been categorized as an inflammatory disease, sharing many of the adverse outcomes as those reported from cardiovascular disease. Medical nutrition therapy is recommended for the treatment of diabetes; however, these recommendations have not been updated to target the inflammatory component, which can be affected by diet and lifestyle. To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D, we conducted an integrative review of the literature. A comprehensive search of the PubMed, CINAHL, Scopus, and Web of Science databases from January 2000 to May 2012 yielded 786 articles. The final 16 studies met the selection criteria including randomized control trials, quasiexperimental, or cross-sectional studies that compared varying diets and measured inflammatory markers. The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers. The Mediterranean diet demonstrated the most clinically significant reduction in glycosylated hemoglobin (HbA1c). Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking. Continued research is warranted.

Nowlin, Sarah Y.; Hammer, Marilyn J.; D'Eramo Melkus, Gail

2012-01-01

82

Mother-father informant discrepancies regarding diabetes management: Associations with diabetes-specific family conflict and glycemic control  

PubMed Central

Objective To examine the relationship of mother-father informant discrepancies regarding diabetes management to diabetes-specific family conflict and glycemic control. Methods 136 mothers and fathers of youth with type 1 diabetes reported on the youth's diabetes management, diabetes-specific family conflict, and amount of paternal involvement in diabetes care. Glycosylated hemoglobin A1c (HbA1c) was used to measure glycemic control. Results As hypothesized, mother-father discrepancies regarding diabetes management were positively associated with frequency of diabetes-specific family conflict. Contrary to hypotheses, mother-father discrepancies regarding diabetes management predicted poorer glycemic control for youth with less involved fathers only. Conclusions Results highlight the importance of caregivers being consistent about pediatric illness management and support the idea that informant discrepancies represent an important window into the functioning of the family system.

Sood, Erica D.; Pendley, Jennifer Shroff; Delamater, Alan; Rohan, Jennifer M.; Pulgaron, Elizabeth; Drotar, Dennis

2014-01-01

83

Higher glycemic index and glycemic load diet is associated with increased risk of esophageal squamous cell carcinoma: a case-control study.  

PubMed

Several studies have indicated the association between intake of foods high in dietary glycemic index (GI) and glycemic load (GL) with an increased risk of digestive tract cancers. We hypothesized that GI and GL may be associated with risk of esophageal squamous cell carcinoma (ESCC) in a high-risk population in Iran. In total, we interviewed 47 cases with incident of ESCC and 96 frequency-matched hospital controls, then calculated the average dietary GI and GL via a validated food frequency questionnaire. Dietary GL was calculated as a function of GI, carbohydrate content, and frequency of intake of certain foods. Dietary GI and GL levels were significantly higher among the ESCC cases compared with the controls (P < .05). After adjustment for potential confounders, those in the highest tertile of dietary GI had 2.95 times higher risk of ESCC compared with those in the lowest (95% confidence interval, 1.68-3.35; P for trend = .002). In addition, being in the highest tertile of dietary GL was positively associated with an ESCC risk (odds ratio, 3.49; 95% confidence interval, 2.98-4.41; P for trend = .001). Findings of the present study indicate that diets with high GI and GL might have potentially unfavorable effects on ESCC risk and suggest a possible role for excess circulating insulin and related insulin-like growth factor 1 in esophageal cancer development. PMID:24034571

Eslamian, Ghazaleh; Jessri, Mahsa; Hajizadeh, Bahareh; Ibiebele, Torukiri I; Rashidkhani, Bahram

2013-09-01

84

Intervention with Delivery of Diabetic Meals Improves Glycemic Control in Patients with Type 2 Diabetes Mellitus  

PubMed Central

The aim of this study was to investigate the effects of a diabetic meal delivery system on glycemic control over a 12 month period in patients with type 2 diabetes. A total of 77 patients with type 2 diabetes were assigned randomly into three dietary intervention groups: group M, diabetic meal delivery; group D, individual dietary counseling; and group C, conventional dietary education. In group M, HbA1c levels decreased significantly from 8.2 ± 1.2% to 7.4 ± 0.8% after 12 months (p<0.05), while in group D, HbA1c levels decreased significantly throughout the entire 12 month period, from 8.5 ± 1.7% at baseline to 7.4 ± 1.1% at the endpoint. Similarly, fasting blood glucose (FBG) levels decreased significantly between 1 and 12 months in group M (p<0.05), and decreased significantly during the entire 12 month period in group D (p<0.01). There were no significant changes in either HbA1c or FBG levels in group C. This study provides evidence that intervention with delivery of diabetic meals to patients with type 2 diabetes can be equally effective for achieving glycemic control as individual dietary counselling by a dietitian. Diabetic meal delivery can therefore be used successfully to provide diabetes education to outpatients.

Imai, Saeko; Kozai, Hana; Matsuda, Mikuko; Hasegawa, Goji; Obayashi, Hiroshi; Togawa, Chikako; Yamamura, Toyomi; Watanabe, Kanji; Miyatani, Syuichi; Yoshikawa, Toshikazu; Kajiyama, Shizuo

2008-01-01

85

Initiating basal insulin therapy in type 2 diabetes: practical steps to optimize glycemic control.  

PubMed

Primary care practitioners are increasingly responsible for the management of the escalating numbers of patients with type 2 diabetes. The majority of these patients will require insulin replacement therapy as their disease progresses, because glycemic control is often unsustainable using oral antidiabetic drugs. This review explains the practicalities of initiating and optimizing basal insulin in clinical practice, emphasizing the need for regular glycated hemoglobin (A1c) monitoring to allow timely initiation of insulin when the A1c target is not met. The importance of patient education in overcoming barriers to insulin is discussed, as well as the choice of available basal insulins and the necessity to optimize basal insulin dosage by self-titration. The traditional view of insulin therapy as a last resort is challenged with the modern basal insulin analogues (insulin detemir and insulin glargine), which offer simple and effective glycemic control with a reduced risk of hypoglycemia compared with older insulin formulations such as neutral protamine Hagedorn. PMID:23953076

Philis-Tsimikas, Athena

2013-09-01

86

Everolimus dramatically improves glycemic control in unresectable metastatic insulinoma: a case report.  

PubMed

Hypoglycemia poses a significant management challenge in patients with unresectable metastatic insulinoma. A 57-year-old woman with pancreatic neuroendocrine tumor with multiple liver metastases was referred to our institution. During the clinical course of pancreatic neuroendocrine tumor, she had experienced palpitations, cold sweats and faintness between meals that indicated her tumors had attained the characteristics of an insulinoma, and her quality of life was impacted by frequent hypoglycemic episodes which could not be prevented by conventional therapies. Shortly after the approval of everolimus for pancreatic neuroendocrine tumor in Japan, we began oral administration at 10 mg per day, which produced a rapid and substantial improvement in glycemic control. The serum insulin level decreased dramatically despite the tumor size remaining stable on computed tomography evaluation. Despite a dose reduction of everolimus to 5 mg per day in response to the adverse reaction of interstitial pneumonitis and a subsequent moderate increase in the serum insulin level, the patient has maintained normoglycemia for a year. Everolimus might represent the treatment of choice for unresectable insulinoma in terms of not only tumor stabilization but also glycemic control. PMID:24367043

Asayama, Masako; Yamada-Murano, Toko; Hara, Hiroki; Ooki, Akira; Kurosumi, Masafumi; Yamaguchi, Kensei

2014-02-01

87

The acute effects of glycemic control on axonal excitability in human diabetics.  

PubMed

In diabetic nerves, the activation of the polyol pathway and a resulting decrease in Na(+)-K(+) ATPase activity lead to intra-axonal Na(+) accumulation and a smaller Na(+) gradient across the axolemma than normal. To investigate whether glycemic control is associated with acutely reversible changes in axonal excitability and Na(+) conductance, we measured the multiple excitability indices (strength-duration time constant, rheobase, refractoriness, and refractory period) of the median motor axons of 21 diabetic patients before and after intensive insulin treatment. Within 4 weeks after treatment was begun, there was a significant improvement in nerve conduction velocities, associated with increased strength-duration time constant, decreased rheobase, increased refractoriness, and prolonged refractory periods. Assuming that the strength-duration time constant partly reflects persistent Na(+) conductance, and that refractoriness/refractory periods depend on inactivation of transient Na(+) channels caused by prior depolarization (the influx of Na(+)), the patterns of changes in these indices may reflect a reduced trans-axonal Na(+) gradient during hyperglycemia and its restoration by glycemic control in diabetic patients. Measurement of the excitability indices could provide new insights into the pathophysiology of human diabetic neuropathy. PMID:15455400

Kitano, Yukiko; Kuwabara, Satoshi; Misawa, Sonoko; Ogawara, Kazue; Kanai, Kazuaki; Kikkawa, Yuriko; Yagui, Kazuo; Hattori, Takamichi

2004-10-01

88

Association of Helicobacter pylori Infection with Glycemic Control in Patients with Diabetes: A Meta-Analysis  

PubMed Central

Objective. To assess the association between Helicobacter pylori (HP) infection and glycemic control in patients with diabetes through a meta-analytic approach. Research Design and Methods. Electronic literature searches were conducted for cross-sectional studies that examined the hemoglobin A1c (A1C) level by whether patients with diabetes were or were not carriers of HP. Mean differences in A1C between groups with and without HP infection were pooled with a random-effects model. Results. Thirteen eligible studies were included in this meta-analysis. Overall, the HP carriers did not have significantly higher A1C levels compared with HP noncarriers (mean difference (95% CI), 0.19% (?0.18 to 0.46), P = 0.16). When the analysis was limited to studies targeting patients with type 1 diabetes, there was also no significant difference in A1C (0.69% (?0.31 to 1.68), P = 0.18). Conclusions. There was insufficient evidence that HP infection worsened glycemic control in patients with diabetes.

Horikawa, Chika; Kodama, Satoru; Fujihara, Kazuya; Yachi, Yoko; Tanaka, Shiro; Suzuki, Akiko; Hanyu, Osamu; Shimano, Hitoshi; Sone, Hirohito

2014-01-01

89

Quality of Clinical Practice Guidelines for Glycemic Control in Type 2 Diabetes Mellitus  

PubMed Central

Background Several studies have reported that clinical practice guidelines (CPGs) in a variety of clinical areas are of modest or variable quality. The objective of this study was to evaluate the quality of an international cohort of CPGs that provide recommendations on pharmaceutical management of glycemic control in patients with type 2 diabetes mellitus (DM2). Methods and Findings We searched the National Guideline Clearinghouse (NGC) on February 15th and June 4th, 2012 for CPGs meeting inclusion criteria. Two independent assessors rated the quality of each CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Twenty-four guidelines were evaluated, and most had high scores for clarity and presentation. However, scope and purpose, stakeholder involvement, rigor of development, and applicability domains varied considerably. The majority of guidelines scored low on editorial independence, and only seven CPGs were based on an underlying systematic review of the evidence. Conclusions The overall quality of CPGs for glycemic control in DM2 is moderate, but there is substantial variability among quality domains within and across guidelines. Guideline users need to be aware of this variability and carefully appraise and select the guidelines that they apply to patient care.

Holmer, Haley K.; Ogden, Lauren A.; Burda, Brittany U.; Norris, Susan L.

2013-01-01

90

Glycemic Control in the Burn Intensive Care Unit: Focus on the Role of Anemia in Glucose Measurement  

PubMed Central

Glycemic control with intensive insulin therapy (IIT) has received widespread adoption secondary to findings of improved clinical outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred benefits from IIT, our findings of poor outcomes associated with glycemic variability, advantages from preserved diurnal variation of glucose and insulin, and impacts of glucometer error and hematocrit correction factor are discussed. We conclude with direction for further study and the need for a reliable continuous glucose monitoring system. Such efforts will further the endeavor for achieving adequate glycemic control in order to assess the efficacy of target ranges and use of IIT.

Mann, Elizabeth A.; Mora, Alejandra G.; Pidcoke, Heather F.; Wolf, Steven E.; Wade, Charles E.

2009-01-01

91

Lifestyle and glycemic control in Japanese adults receiving diabetes treatment: an analysis of the 2009 Japan Society of Ningen Dock database.  

PubMed

We investigated the level of glycemic control in 7020 patients treated with diabetes medications. We found that the overall mean HbA1c was 7.3% (56 mmol/mol). Over half had HbA1c levels ?7.0% (53 mmol/mol) and poorer glycemic control was associated with unhealthy lifestyle habits. PMID:24598264

Takahashi, Eiko; Moriyama, Kengo; Yamakado, Minoru

2014-05-01

92

Interaction Between Poor Glycemic Control and 9p21 Locus on Risk of Coronary Artery Disease in Type 2 Diabetes  

PubMed Central

Context A common allele on chromosome 9p21 has been repeatedly associated with increased risk of coronary artery disease (CAD) in the general population. However, the magnitude of this effect in the population with diabetes has not been well characterized. Objective To examine the association of the 9p21 variant with CAD in individuals with type 2 diabetes and evaluate its interaction with poor glycemic control. Design, Setting, and Participants 1. Case-control study of 734 type 2 diabetic patients (322 with angiographically-diagnosed CAD and 412 with no evidence of CAD) who were recruited in 2001–2006 at the Joslin Clinic/Beth Israel Deaconess Medical Center, 2. Independent cohort study of 475 type 2 diabetic patients from the Joslin Clinic whose survival status was monitored from their recruitment in 1993–1996 until December 31, 2004. Study subjects were genotyped for a representative SNP at 9p21 (rs2383206) and characterized for their long-term glycemic control by averaging multiple hemoglobin A1c (HbA1c) measurements taken in the years before study entry. Main Outcome Measures Case-control study: association between SNP rs2383206 and CAD defined as angiographically documented stenosis greater than 50% in a major coronary artery or a main branch thereof. Cohort study: cumulative 10-year mortality. Results Individuals homozygous for the risk allele were significantly more frequent in case than control subjects (42.3 vs. 28.9%, p=0.0002). This association was unaffected by adjustment for cardiovascular risk factors, but the effect of the risk genotype was significantly magnified (adjusted p for interaction = 0.048) in the presence of poor glycemic control (worst tertile of the distribution of HbA1c at examination). Relative to the CAD risk for patients with neither a 9p21 risk allele nor poor glycemic control, the CAD risk for subjects having two risk alleles but not poor glycemic control was increased two-fold (OR=1.99, 1.17–3.41), whereas the risk for study subjects with the same genotype and with poor glycemic control was increased four-fold (OR=4.27, 2.26–8.01). The interaction was stronger (adjusted p=0.005) when a measure of long-term glycemic control (7-year average rather than most recent HbA1c) was used, with ORs of 7.83 (3.49–17.6) for subjects having two risk alleles and a history of poor glycemia and 1.54 (0.72–3.30) for subjects with the same genotype but without this exposure. A similar interaction between 9p21 variant and poor glycemic control was observed with respect to cumulative 10-year mortality in the cohort study (43.6% in patients with two risk alleles and poor glycemic control, 23.1% in those with only the two risk alleles, 30.0% in those with only poor glycemic control, and 31.6% in those with neither factor, p for interaction=0.036). Conclusions In this study population, the CAD risk associated with the 9p21 variant was increased in the presence of poor glycemic control in type 2 diabetes.

Doria, Alessandro; Wojcik, Joanna; Xu, Rui; Gervino, Ernest V.; Hauser, Thomas H.; Johnstone, Michael T.; Nolan, David; Hu, Frank B.; Warram, James H.

2009-01-01

93

The amylin analog pramlintide improves glycemic control and reduces postprandial glucagon concentrations in patients with type 1 diabetes mellitus  

Microsoft Academic Search

To explore further the effects of the human amylin analog pramlintide on overall glycemic control and postprandial responses of circulating glucose, glucagon, and metabolic intermediates in type 1 diabetes mellitus, 14 male type 1 diabetic patients were examined in a double-blind, placebo-controlled, crossover study. Pramlintide (30 ?g four times daily) or placebo were administered for 4 weeks, after which a

Birgit Nyholm; Lotte Ørskov; Karen Y. Hove; Claus H. Gravholt; Niels Møller; K. George; M. M. Alberti; Chris Moyses; Orville Kolterman; Ole Schmitz

1999-01-01

94

Short-Term Effects of Improved Glycemic Control on Cognitive Function in Patients with Type 2 Diabetes  

Microsoft Academic Search

Background: According to numerous studies, type 2 diabetes is associated with mild cognitive dysfunction, and there is some evidence suggesting favorable effects of improved metabolic control on the mental capability of elderly diabetic patients. Objective: To compare patients with type 2 diabetes to normal controls with respect to cognitive performance and to investigate the consequences of glycemic adjustment. Methods: 53

W. Hewer; M. Mussell; F. Rist; B. Kulzer; K. Bergis

2003-01-01

95

Glycemic control of type 2 diabetic patients after short-term zinc supplementation.  

PubMed

This study was carried out to determine whether a short-term zinc supplementation contributes to beneficial changes in glycemic control among type 2 diabetic patients. Seventy-six diabetic subjects and 72 normal adults participated in this study. Subjects were divided into supplemented and control groups. Forty-four diabetic patients and 34 normal subjects were supplemented with 50 mg zinc daily as zinc gluconate for 4 weeks. Zinc status was assessed from fasting plasma levels and urinary excretion. The effects of zinc supplementation on fasting blood glucose, HbA(1c), insulin, and C-peptide were measured at the beginning of the study and after 4 weeks of supplementation. The changes in glycemic control indicators were compared between diabetic groups, classified by baseline HbA(1c) levels, and by diabetic duration. At baseline, the incidence of marginal zinc deficiency in the diabetic group, as determined by plasma zinc level, was approximately twice as high as in the normal adult group. The changes of HbA(1c) concentration, and fasting blood glucose following supplementation were not statistically significant in diabetic subjects. In normal subjects, a significant decrease of HbA(1c) occurred only in the zinc supplemented group. No significant changes were observed for serum insulin and C-peptide in diabetic as well as normal subjects. However, when the changes were compared by baseline HbA(1c) level, we found that diabetic subjects with HbA(1c) >/= 7.5% showed significantly improved levels of HbA(1c) and fasting glucose after Zn supplementation. While such improvement in fasting blood glucose was significant among diabetics with shorter diabetic duration, significant levels of increase in serum insulin and C-peptide were observed in zinc supplemented subjects with longer diabetic duration. Fasting blood glucose was significantly decreased, whereas serum insulin and C-peptide were increased in diabetics with marginal zinc status. Therefore, we suggest that Zn supplementation for a short-term period may improve glycemic control in diabetic patients with higher HbA(1c) levels and marginal zinc status. PMID:20016731

Oh, Hyun-Mee; Yoon, Jin-Sook

2008-01-01

96

Glycemic control of type 2 diabetic patients after short-term zinc supplementation  

PubMed Central

This study was carried out to determine whether a short-term zinc supplementation contributes to beneficial changes in glycemic control among type 2 diabetic patients. Seventy-six diabetic subjects and 72 normal adults participated in this study. Subjects were divided into supplemented and control groups. Forty-four diabetic patients and 34 normal subjects were supplemented with 50 mg zinc daily as zinc gluconate for 4 weeks. Zinc status was assessed from fasting plasma levels and urinary excretion. The effects of zinc supplementation on fasting blood glucose, HbA1c, insulin, and C-peptide were measured at the beginning of the study and after 4 weeks of supplementation. The changes in glycemic control indicators were compared between diabetic groups, classified by baseline HbA1c levels, and by diabetic duration. At baseline, the incidence of marginal zinc deficiency in the diabetic group, as determined by plasma zinc level, was approximately twice as high as in the normal adult group. The changes of HbA1c concentration, and fasting blood glucose following supplementation were not statistically significant in diabetic subjects. In normal subjects, a significant decrease of HbA1c occurred only in the zinc supplemented group. No significant changes were observed for serum insulin and C-peptide in diabetic as well as normal subjects. However, when the changes were compared by baseline HbA1c level, we found that diabetic subjects with HbA1c ? 7.5% showed significantly improved levels of HbA1c and fasting glucose after Zn supplementation. While such improvement in fasting blood glucose was significant among diabetics with shorter diabetic duration, significant levels of increase in serum insulin and C-peptide were observed in zinc supplemented subjects with longer diabetic duration. Fasting blood glucose was significantly decreased, whereas serum insulin and C-peptide were increased in diabetics with marginal zinc status. Therefore, we suggest that Zn supplementation for a short-term period may improve glycemic control in diabetic patients with higher HbA1c levels and marginal zinc status.

Oh, Hyun-Mee

2008-01-01

97

Determinants of Glycemic control in Youth with Type 2 diabetes at randomization in the TODAY study  

PubMed Central

Objective To investigate insulin sensitivity and secretion indices and determinants of glycemic control in youth with recent-onset type 2 diabetes at randomization in the TODAY study, the largest study of youth with type 2 diabetes to date. Research Design and Methods We examined estimates of insulin sensitivity [1/fasting insulin (1/IF), fasting glucose/insulin (GF/IF), 1/fasting C-peptide (1/CF), GF/CF], ?-cell function [insulinogenic index (?I30/?G30), and ?C30/?G30], and disposition index (DI) in the TODAY cohort of 704 youth (14.0±2.0 yr; diabetes duration 7.8±5.8 mo; 64.9% female; 41.1% Hispanic, 31.5% Black, 19.6% White, 6.1% American Indian, and 1.7% Asian) according to HbA1c quartiles at study randomization. The randomization visit followed a run-in period (median 71 days) during which glycemic control (HbA1c? 8% for at least 2 months) was achieved with metformin alone. These measures were also examined in relation to screening HbA1c levels prior to run-in. Results Insulin secretion indices declined with increasing HbA1c quartiles, at randomization and screening, (at randomization: ?C30/?G30: 0.11±0.09, 0.10±0.19, 0.07±0.06, and 0.03±0.03 ng/ml per mg/dl, p<0.0001; DI: 0.03±0.03, 0.03±0.05, 0.02±0.02, and 0.01±0.01 mg/dl?1, p<0.0001) with no significant difference in insulin sensitivity. There were no significant differences in estimates of insulin sensitivity or secretion between genders or across the different racial groups. At randomization and screening, HbA1C correlated with DI (r=?0.3, p<0.001), with ?C30/?G30, but not with insulin sensitivity estimates. Conclusions In youth with recent-onset type 2 diabetes treated with metformin, glycemic control, as measured by HbA1c, appears to be associated with residual ?-cell function, and not insulin sensitivity.

2011-01-01

98

Postpregnancy Glycemic Control and Weight Changes in Type 1 Diabetic Women  

PubMed Central

OBJECTIVE Pregnancy in type 1 diabetes requires excellent glycemic control. Most pregnant type 1 diabetic women achieve normoglycemia; however, there is scarce data on their postdelivery characteristics. We aimed to examine postpregnancy glycemic control and weight changes in type 1 diabetes. RESEARCH DESIGN AND METHODS We identified and followed (median 20 months) 254 women with singleton pregnancies receiving postdelivery medical care at a single institution. RESULTS Study subjects were 28.3 ± 4.7 years of age (mean ± SD), with a diabetes duration of 12.0 ± 7.7 years. Mean A1C before conception was 6.9 ± 1.4%, and preconception weight and BMI were 64.4 ± 10.0 kg and 23.9 ± 3.3 kg/m2, respectively. Mean A1C decreased during pregnancy, reaching 5.7 ± 0.8% in the third trimester. We observed a mean weight gain of 14.4 ± 6.5 kg during pregnancy. Within 6 months after delivery, A1C increased by 0.8% (P < 0.0001) compared with the last trimester, and body weight and BMI were 4.4 kg and 2.5 kg/m2 higher (P < 0.0001) compared with the preconception baseline. A1C further deteriorated by 0.8% until the end of follow-up. For women in the “pregnancy planning” program (n = 117), A1C >12 months after delivery was worse compared with before conception (7.1 vs. 6.5%, P = 0.0018), whereas in women with unplanned pregnancies, it was similar to the pregestational levels (7.3 vs.7.4%, P = 0.59). Weight and BMI in the entire study group did not return to prepregnancy levels and were 2.5 kg (P = 0.0079) and 0.9 kg/m2 higher (P = 0.0058). CONCLUSIONS In this clinical observation, type 1 diabetic women showed postpregnancy deterioration in glycemic control and were unable to return to prepregnancy weight. Type 1 diabetic women seem to require special attention after delivery to meet therapeutic targets.

Cyganek, Katarzyna; Hebda-Szydlo, Alicja; Skupien, Jan; Janas, Izabela; Walczyk, Joanna; Lipowska, Anna; Borys, Sebastian; Malecki, Maciej T.

2013-01-01

99

A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes  

PubMed Central

BACKGROUND Despite the increasing prevalence of type 2 diabetes in youth, there are few data to guide treatment. We compared the efficacy of three treatment regimens to achieve durable glycemic control in children and adolescents with recent-onset type 2 diabetes. METHODS Eligible patients 10 to 17 years of age were treated with metformin (at a dose of 1000 mg twice daily) to attain a glycated hemoglobin level of less than 8% and were randomly assigned to continued treatment with metformin alone or to metformin combined with rosiglitazone (4 mg twice a day) or a lifestyle-intervention program focusing on weight loss through eating and activity behaviors. The primary outcome was loss of glycemic control, defined as a glycated hemoglobin level of at least 8% for 6 months or sustained metabolic decompensation requiring insulin. RESULTS Of the 699 randomly assigned participants (mean duration of diagnosed type 2 diabetes, 7.8 months), 319 (45.6%) reached the primary outcome over an average follow-up of 3.86 years. Rates of failure were 51.7% (120 of 232 participants), 38.6% (90 of 233), and 46.6% (109 of 234) for metformin alone, metformin plus rosiglitazone, and metformin plus lifestyle intervention, respectively. Metformin plus rosiglitazone was superior to metformin alone (P = 0.006); metformin plus lifestyle intervention was intermediate but not significantly different from metformin alone or metformin plus rosiglitazone. Prespecified analyses according to sex and race or ethnic group showed differences in sustained effectiveness, with metformin alone least effective in non-Hispanic black participants and metformin plus rosiglitazone most effective in girls. Serious adverse events were reported in 19.2% of participants. CONCLUSIONS Monotherapy with metformin was associated with durable glycemic control in approximately half of children and adolescents with type 2 diabetes. The addition of rosiglitazone, but not an intensive lifestyle intervention, was superior to metformin alone. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; TODAY ClinicalTrials.gov number, NCT00081328.)

2012-01-01

100

Impact of psychological stress caused by the Great East Japan Earthquake on glycemic control in patients with diabetes.  

PubMed

We examined the relationship between psychological stress and the worsening of glycemic control in diabetic patients at the time of the Great East Japan Earthquake. HbA1c levels in diabetic patients before and after the disaster were evaluated with the General Health Questionnaire (GHQ) and other questions including those on changes in diet, exercise, psychological stress and drug intake in 320 consecutive diabetic patients who had been followed in a diabetes clinic. Logistic regression analysis revealed that the total GHQ scores (odds ratio [OR] 1.03 [95% confidence interval 1.01-1.06]; p<0.01) and interruption of drug intake (OR 4.48 [1.57-12.7]; p=0.01) were independently associated with worsening of glycemic control defined as an increase in the HbA1c level equal to or greater than 0.5%. Among the scores on the GHQ, those for somatic symptoms (OR 1.18 [1.01-1.38]; p=0.03) and sleep disturbances or anxiety (OR 1.26 [1.08-1.46]; p<0.01) were independently associated with glycemic control. These results suggest that psychological stress during a disaster has independent effects on worsening of glycemic control. PMID:22851189

Fujihara, K; Saito, A; Heianza, Y; Gibo, H; Suzuki, H; Shimano, H; Saito, K; Kodama, S; Yamada, N; Sone, H

2012-10-01

101

The Relationship Between Alcohol Consumption and Glycemic Control Among Patients with Diabetes: The Kaiser Permanente Northern California Diabetes Registry  

PubMed Central

BACKGROUND Alcohol consumption is a common behavior. Little is known about the relationship between alcohol consumption and glycemic control among people with diabetes. OBJECTIVE To evaluate the association between alcohol consumption and glycemic control. DESIGN Survey follow-up study, 1994–1997, among Kaiser Permanente Northern California members. PATIENTS 38,564 adult diabetes patients. MEASUREMENTS Self-reported alcohol consumption, and hemoglobin A1C (A1C), assessed within 1 year of survey date. Linear regression of A1C by alcohol consumption was performed, adjusted for sociodemographic variables, clinical variables, and diabetes disease severity. Least squares means estimates were derived. RESULTS In multivariate-adjusted models, A1C values were 8.88 (lifetime abstainers), 8.79 (former drinkers), 8.90 (<0.1 drink/day), 8.71 (0.1–0.9 drink/day), 8.51 (1–1.9 drinks/day), 8.39 (2–2.9 drinks/day), and 8.47 (?3 drinks/day). Alcohol consumption was linearly (p?glycemic control among diabetes patients. This supports current clinical guidelines for moderate levels of alcohol consumption among diabetes patients. As glycemic control affects incidence of complications of diabetes, the lower A1C levels associated with moderate alcohol consumption may translate into lower risk for complications.

Karter, Andrew J.; Warton, E. Margaret; Doan, Jennifer U.; Weisner, Constance M.

2008-01-01

102

Relationship between Postoperative Infectious Complications and Glycemic Control for Diabetic Patients in an Orthopedic Hospital in Kuwait  

Microsoft Academic Search

Objective: To study the relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait. Subjects and Methods: Patients who underwent surgical orthopedic procedures between 2006 and 2007 were identified to provide demographic and clinical informations including age, gender, type of surgery, length of operation, HbA1c values, nature of specimens and species of the

S. M. Lamloum; L. A. Mobasher; A. H. Karar; L. Basiony; T. H. Abdallah; A. I. Al-Saleh; N. A. Al-Shamali

2009-01-01

103

Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial  

PubMed Central

Background Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. Methods We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ?18 years and whose last measured HbA1c was ?7.5% (?58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. Results Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants’ diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. Conclusions Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. Trial registration Clinicaltrials.gov Identifier: NCT01221090.

2014-01-01

104

Blood Glucose Monitoring is Associated with Better Glycemic Control in Type 2 Diabetes: A Database Study  

Microsoft Academic Search

BACKGROUND  The value of self-monitoring blood glucose (SMBG) in type 2 diabetes is controversial.\\u000a \\u000a \\u000a \\u000a OBJECTIVE  To determine SMBG testing rates are positively associated with glycemic control in veterans on oral hypoglycemic agents (OHA).\\u000a \\u000a \\u000a \\u000a DESIGN  Observational database study.\\u000a \\u000a \\u000a \\u000a SUBJECTS  Southwestern Healthcare Network veterans taking OHA in 2002 and followed through the end of 2004.\\u000a \\u000a \\u000a \\u000a MEASUREMENTS  OHA and glucose test strip (GTS) prescriptions were derived from pharmacy

Glen H. Murata; William C. Duckworth; Jayendra H. Shah; Christopher S. Wendel; M. Jane Mohler; Richard M. Hoffman

2009-01-01

105

Glycemic control and surgery-optimizing outcomes for the patient with diabetes.  

PubMed

Diabetes mellitus (DM) has reached epidemic proportions globally, and its incidence continues to rise. Considering the increasing number of patients diagnosed with diabetes and the associated complications, such as cardiovascular and renal disease, the complexity of care for this population can be very challenging. In addition, specific postoperative complications, such as delayed wound healing, infections, and cardiac dysrhythmias, are more likely to occur in the presence of perioperative hyperglycemia. Recognition of the presence of diabetes and implementation of a diabetic management protocol will optimize patient outcomes by providing guidelines for avoiding such complications. Although comparative studies of the current published protocols are limited, there is agreement that health care facilities must have a protocol in place that considers the individual's health history, planned surgery, and glycemic control to guide management of diabetes. PMID:19962105

Ead, Heather

2009-12-01

106

Glycemic control in diabetic dialysis patients and the burnt-out diabetes phenomenon.  

PubMed

Diabetes mellitus (DM) is the most common cause of end-stage kidney disease and a major risk of morbidity and mortality. It is not clear whether medical management of DM has any significant beneficial effect on clinical outcomes at the end-stage of diabetic nephropathy with full-blown micro- and macro-angiopathic complications. Both loss of kidney function and dialysis treatment interfere with glucose homeostasis and confound glycemic control. Given the unique nature of uremic milieu and dialysis therapy related alterations, there have been some debates about reliance on the conventional measures of glycemic control, in particular the clinical relevance of hemoglobin A1c and its recommended target range of <7 % in diabetic dialysis patients. Moreover, a so-called burnt-out diabetes phenomenon has been described, in that many diabetic dialysis patients experience frequent hypoglycemic episodes prompting cessation of their anti-diabetic therapies transiently or even permanently. By reviewing the recent literature we argue that the use of A1c for management of diabetic dialysis patients should be encouraged if appropriate target ranges specific for these patients (e.g. 6 to 8 %) are used. We also argue that "burnt-out diabetes" is a true biologic phenomenon and highly prevalent in dialysis patients with established history and end-stage diabetic nephropathy and explore the role of protein-energy wasting to this end. Similarly, the J- or U-shaped associations between A1c or blood glucose concentrations and mortality are likely biologically plausible phenomena that should be taken into consideration in the management of diabetic dialysis patients to avoid hypoglycemia and its fatal consequences in diabetic dialysis patients. PMID:22638938

Park, Jongha; Lertdumrongluk, Paungpaga; Molnar, Miklos Z; Kovesdy, Csaba P; Kalantar-Zadeh, Kamyar

2012-08-01

107

Salsalate improves glycemic control in patients with newly diagnosed type 2 diabetes.  

PubMed

Chronic inflammation contributes to insulin resistance and type 2 diabetes mellitus (T2DM). We investigated whether treatment with salsalate, an anti-inflammatory medication, improves glycemia in a group of newly diagnosed drug-naïve patients with T2DM. The study was a randomized, double-blind, placebo-controlled trial. Diagnosis of T2DM was made within 2 months of enrollment, and participants had not received any anti-glycemic agent. Sixty adults were randomized to receive salsalate (3 g/day) or placebo for 12 weeks. Fasting plasma glucose and insulin, glucose 2 h after 75 g oral glucose, HbA1C, lipid profile, HOMA-IR, and HOMA-B were determined before and after treatment. Salsalate reduced fasting glucose from 6.3 ± 0.2 mmol/l to 5.4 ± 0.2 mmol/l (P < 0.01) and TG from 1.9 ± 0.2 mmol/l to 1.5 ± 0.2 mmol/l (P < 0.03). Fasting insulin levels were increased in the salsalate group from 18.8 ± 1.6 to 21.6 ± 3.9, while they decreased in the placebo group. HbA1c rose in the placebo group from 6.2% ± 0.2 to 7.9% ± 1.1 mmol/mol, but decreased in the intervention group from 6.1% ± 0.5 to 5.6% ± 0.2 mmol/mol (P < 0.04 for between-group comparison). HOMA-IR did not change but HOMA-B increased ~1.7-fold (P = 0.06) in the salsalate group. The results show that salsalate is effective in improving glycemic control in newly diagnosed naïve patients with T2DM. The optimal duration of treatment with salsalate and sustainability of its effect requires further study (IRCT138709011465N1). PMID:21938543

Faghihimani, Elham; Aminorroaya, Ashraf; Rezvanian, Hassan; Adibi, Peyman; Ismail-Beigi, Faramarz; Amini, Masoud

2013-08-01

108

Closed-Loop Insulin Therapy Improves Glycemic Control in Children Aged <7 Years  

PubMed Central

OBJECTIVE To assess the possibility of improving nocturnal glycemic control as well as meal glycemic response using closed-loop therapy in children aged <7 years. RESEARCH DESIGN AND METHODS This was a randomized controlled crossover trial comparing closed-loop with standard open-loop insulin pump therapy performed in an inpatient clinical research center. Ten subjects aged <7 years with type 1 diabetes for >6 months treated with insulin pump therapy were studied. Closed-loop therapy and standard open-loop therapy were compared from 10:00 p.m. to 12:00 p.m. on 2 consecutive days. The primary outcome was plasma glucose time in range (110–200 mg/dL) during the night (10:00 p.m.–8:00 a.m.). Secondary outcomes included peak postprandial glucose levels, incidence of hypoglycemia, degree of hyperglycemia, and prelunch glucose levels. RESULTS A trend toward a higher mean nocturnal time within target range was noted for closed- versus open-loop therapy, although not reaching statistical significance (5.3 vs. 3.2 h, P = 0.12). There was no difference in peak postprandial glucose or number of episodes of hypoglycemia. There was significant improvement in time spent >300 mg/dL overnight with closed-loop therapy (0.18 vs. 1.3 h, P = 0.035) and the total area under the curve of glucose >200 mg/dL (P = 0.049). Closed-loop therapy returned prelunch blood glucose closer to target (189 vs. 273 mg/dL on open loop, P = 0.009). CONCLUSIONS Closed-loop insulin delivery decreases the severity of overnight hyperglycemia without increasing the incidence of hypoglycemia. The therapy is better able to reestablish target glucose levels in advance of a subsequent meal. Younger children with type 1 diabetes may reap significant benefits from closed-loop therapy.

Dauber, Andrew; Corcia, Liat; Safer, Jason; Agus, Michael S.D.; Einis, Sara; Steil, Garry M.

2013-01-01

109

Glycosylated Hemoglobin and Albumin-Corrected Fructosamine Are Good Indicators for Glycemic Control in Peritoneal Dialysis Patients  

PubMed Central

Purpose Diabetes mellitus (DM) is the most common cause of end-stage renal disease and is an important risk factor for morbidity and mortality after dialysis. However, glycemic control among such patients is difficult to assess. The present study examined glycemic control parameters and observed glucose variation after refilling different kinds of fresh dialysate in peritoneal dialysis (PD) patients. Methods A total of 25 DM PD patients were recruited, and continuous glucose monitoring system (CGMS) was applied to measure interstitial fluid (ISF) glucose levels at 5-min intervals for 3 days. Patients filled out diet and PD fluid exchange diaries. The records measured with CGMS were analyzed and correlated with other glycemic control parameters such as fructosamine, albumin-corrected fructosamine (AlbF), glycosylated hemoglobin (HbA1c), and glycated albumin levels. Results There were significant correlations between mean ISF glucose and fructosamine (r?=?0.45, P<0.05), AlbF (r?=?0.54, P<0.01), and HbA1c (r?=?0.51, P<0.01). The ISF glucose levels in glucose-containing dialysate increased from approximately 7–8 mg/dL within 1 hour of exchange in contrast to icodextrin dialysate which kept ISF glucose levels unchanged. Conclusion HbA1c and AlbF significantly correlated with the mean ISF glucose levels, indicating that they are reliable indices of glycemic control in DM PD patients. Icodextrin dialysate seems to have a favorable glycemic control effect when compared to the other glucose-containing dialysates.

Tsai, I-Chieh; Yen, Chung-Jen; Chueh, Shu-Neng; Chuang, Hsueh-Fang; Wu, Hon-Yen; Chiang, Chih-Kang; Cheng, Hui-Teng; Hung, Kuan-Yu; Huang, Jenq-Wen

2013-01-01

110

The "glucose pentagon": assessing glycemic control of patients with diabetes mellitus by a model integrating different parameters from glucose profiles.  

PubMed

Measuring the hemoglobin A(1c) (HbA(1c)) is the standard-of-care method to assess long-term glycemic control of patients with diabetes, describing the average glycemic level. However, the HbA(1c) does not reflect acute fluctuations in glucose levels. Variability of glycemia probably has an impact on the development of diabetes-related late complications. A novel model presented in this article combines different summary measures derived from continuously recorded glucose profiles (including parameters describing glycemic variability) and the HbA(1c). The five parameters taking into account are the axes of a "glucose pentagon." Connecting the values of these parameters provided an enclosed area of a given size. For a patient with diabetes, these parameters and the connected area describe how his or her glycemia was during the monitoring period. The area of the glucose pentagon for a patient with diabetes, divided by the standard area of healthy subjects, yields a non-dimensional characteristic value defined as the glycemic risk parameter. It is assume that this risk parameter provides a more meaningful overall description of metabolic control than the HbA(1c) alone. In addition, it might also allow a better assessment of a patient's risk for developing diabetes-related late complications in comparison to the HbA(1c) alone. Of critical importance is, of course, that the clinical relevance of the glucose pentagon is verified in adequate long-term clinical studies. PMID:19459770

Thomas, Andreas; Schönauer, Martin; Achermann, Frank; Schnell, Oliver; Hanefeld, Markolf; Ziegelasch, Hans-Jürgen; Mastrototaro, John; Heinemann, Lutz

2009-06-01

111

Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort  

PubMed Central

We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass-Angioplasty-Revascularization-Investigation-2-Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing versus insulin-providing treatments for diabetes. 2368 patients with type 2 diabetes and CAD were evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression, adjusted for multiple covariates including age, sex, HbA1c, diabetes duration. 51% BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR1.57, 1.15, 2.13). Patients on sulfonylurea or combination of sulfonylurea/metformin/TZD had marginally higher rates of DPN than the metformin/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.

Pop-Busui, Rodica; Lu, Jiang; Lopes, Neuza; Jones, Teresa L. Z.

2009-01-01

112

Examination of implementation of intravenous and subcutaneous insulin protocols and glycemic control in heart transplant patients.  

PubMed

Objective: Perioperative glycemic management is particularly challenging in heart transplant (HT) patients who are on high-dose steroids and subject to surgical stress. The objective of the study was to examine the efficacy and safety of perioperative insulin administration in HT patients with and without diabetes.Methods: Medical records of 71 HT patients from June 1, 2005 to July 31, 2009 whose hyperglycemia was managed by our Glucose Management Service (GMS) were analyzed for up to 1 year after HT. Their daily blood glucose (BG) averages on intravenous (IV) insulin drips and subcutaneous (SQ) insulin, hypoglycemia rates, reasons for hypoglycemia, and deviations from insulin protocols were analyzed.Results: Daily BG averages between diabetic (DM) and nondiabetic (nonDM) patients were not significantly different while on the drip but were significantly different for first 5 days on SQ (P<.05). The daily insulin glargine doses were similar. No patients developed severe hypoglycemia (BG ?40 mg/dL) while on drip, and only 2.8% experienced hypoglycemia on SQ. Among 40 episodes of moderate hypoglycemia while on drip, 15 had nurse deviations from protocol prior to the episode. Posttransition day fasting glucose was at goal (mean 124.7 ± 35.4 mg/dL); however 39.4% (28/71) of patients received a transition insulin glargine dose that was different from the amount indicated by protocol. The likelihood of developing moderate hypoglycemia on SQ was associated with the glargine dose used at the time of transition (odds ratio [OR] 1.03, P = .034).Conclusion: Inpatient insulin protocols implemented by a GMS are successful in obtaining glycemic control with minimal side effects in patients with and without diabetes, even when they are on a high-dose steroid regimen. PMID:24326001

Wallia, Amisha; Gupta, Suruchi; Garcia, Cristina; Schmidt, Kathleen; Oakes, Diana Johnson; Aleppo, Grazia; Glossop, Valerie; Andrei, Adin-Cristian; Grady, Kathleen L; McGee, Edwin; Molitch, Mark E

2014-06-01

113

A Randomized Controlled Trial of an Internet-Based Mentoring Program for Type 1 Diabetes Patients with Inadequate Glycemic Control  

PubMed Central

Background To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). Methods Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c (HbA1c) ?8.0% were randomized to mentored (glucometer transmission with feedback from mentors) or control (glucometer transmission without feedback) groups and were examined for 12 weeks. Five mentors were interviewed and selected, of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago. Results A total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center. Unfortunately, the mentored group failed to show significant improvements in HbA1c levels or other outcomes, including the quality of life, after completion of the study. However, the mentored group monitored their blood glucose (1.41 vs. 0.30) and logged into our website (http://ubisens.co.kr/) more frequently (20.59 times vs. 5.07 times) than the control group. Conclusion A 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up. However, the noted increase in the subjects' frequency of blood glucose monitoring may lead to clinical benefits.

Suh, Sunghwan; Jean, Cheol; Koo, Mihyun; Lee, Sun Young; Cho, Min Ja; Sim, Kang-Hee; Jin, Sang-Man; Bae, Ji Cheol

2014-01-01

114

Glycemic Effects of Once-a-Day Rapid-Acting Insulin Analogue Addition on a Basal Insulin Analogue in Korean Subjects with Poorly Controlled Type 2 Diabetes Mellitus  

PubMed Central

Background The present study investigates the efficacy in glycemic control by adding once-a-day glulisine to glargine as a basal plus regimen and factors influencing glycemic control with the basal plus regimen in Korean subjects with type 2 diabetes. Methods In the present retrospective study, subjects previously treated with the basal plus regimens for at least 6 months were reviewed. Changes in glycemic profiles and clinical parameters were evaluated. Results A total of 87 subjects were ultimately enrolled in this study. At baseline, mean glycated hemoglobin (A1c) and glycated albumin were 8.5% (8.0% to 9.6%) and 25.2±7.6%, respectively. After treatment with the basal plus regimen, patients had significant reductions of A1c at 6 months (0.8±0.1%, P<0.001) and their postprandial glucose levels were decreased by 48.7±10.3 mg/dL (P<0.001). Multiple logistic regression showed old age (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02 to 1.55), high initial A1c (OR, 22.21; 95% CI, 2.44 to 201.78), and lower amounts of glargine (OR, 0.85; 95% CI, 0.76 to 0.99), and glimepiride (OR, 0.23; 95% CI, 0.06 to 0.93) at baseline were independently associated with good responders whose A1c reduction was more than 0.5%. Conclusion The authors suggest a basal plus regimen may be effective in reducing glucose levels of subjects with old age, high initial A1c, and patients on low doses of glimepiride and glargine. Despite the use of high doses of hypoglycemic agents, elderly patients with poorly-controlled diabetes are preferred for early initiation of the basal plus regimen.

Choe, Eun Yeong; Lee, Yong-ho; Kang, Eun-Seok; Cha, Bong Soo; Lee, Hyun Chul

2012-01-01

115

Technical Challenges and Clinical Outcomes of Using a Closed-Loop Glycemic Control System in the Hospital  

PubMed Central

According to large randomized trials, results suggest that maintaining normoglycemia postoperatively through tight glycemic control (TGC) and intensive insulin therapy (IIT) can improve surgical outcomes as well as reduce mortality and morbidity in critically ill patients. However, trials examining the effects of TGC have had conflicting results. Systematic reviews and meta-analyses have also led to differing conclusions. The main reason these clinical trials and meta-analyses show negative results for TGC is the high incidence of hypoglycemia induced by IIT. This could not be prevented because there is no reliable technique that can avoid this condition during IIT. The development of accurate, continuous blood glucose monitoring devices and closed-loop systems for computer-assisted blood glucose control in the intensive care unit (ICU) will probably help avoid hypoglycemia in these situations. The STG closed-loop glycemic control system was introduced to our department to be used and evaluated for strict serum glucose control with no hypoglycemic episodes during IIT in the surgical ICU, to reduce the workload of ICU nurses, and to decrease incidents related to the management of blood glucose levels according to manual conventional venous infusion insulin therapy. The goal of our team was to use the STG closed-loop glycemic control system for perioperative TGC in surgical patients to solve the complications of IIT and reduce risk of hypoglycemia. The challenge at our hospital demonstrated that the STG closed-loop glycemic control system can be expected to achieve TGC with no occurrence of hypoglycemia induced by IIT after surgery.

Okabayashi, Takehiro; Kozuki, Akihito; Sumiyoshi, Tatsuaki; Shima, Yasuo

2013-01-01

116

Periprocedural glycemic control in patients with diabetes mellitus undergoing coronary angiography with possible percutaneous coronary intervention.  

PubMed

Periprocedural hyperglycemia is an independent predictor of mortality in patients who underwent percutaneous coronary intervention (PCI). However, periprocedural management of blood glucose is not standardized. The effects of routinely continuing long-acting glucose-lowering medications before coronary angiography with possible PCI on periprocedural glycemic control have not been investigated. Patients with diabetes mellitus (DM; n = 172) were randomized to continue (Continue group; n = 86) or hold (Hold group; n = 86) their clinically prescribed long-acting glucose-lowering medications before the procedure. The primary end point was glucose level on procedural access. In a subset of patients (no DM group: n = 25; Continue group: n = 25; and Hold group: n = 25), selected measures of platelet activity that change acutely were assessed. Patients with DM randomized to the Continue group had lower blood glucose levels on procedural access compared with those randomized to the Hold group (117 [97 to 151] vs 134 [117 to 172] mg/dl, p = 0.002). There were two hypoglycemic events in the Continue group and none in the Hold group, and no adverse events in either group. Selected markers of platelet activity differed across the no DM, Continue, and Hold groups (leukocyte platelet aggregates: 8.1% [7.2 to 10.4], 8.7% [6.9 to 11.4], 10.9% [8.6 to 14.7], p = 0.007; monocyte platelet aggregates: 14.0% [10.3 to 16.3], 20.8% [16.2 to 27.0], 22.5% [15.2 to 35.4], p <0.001; soluble p-selectin: 51.9 ng/ml [39.7 to 74.0], 59.1 ng/ml [46.8 to 73.2], 72.2 ng/ml [58.4 to 77.4], p = 0.014). In conclusion, routinely continuing clinically prescribed long-acting glucose-lowering medications before coronary angiography with possible PCI help achieve periprocedural euglycemia, appear safe, and should be considered as a strategy for achieving periprocedural glycemic control. PMID:24630791

Shah, Binita; Berger, Jeffrey S; Amoroso, Nicholas S; Mai, Xingchen; Lorin, Jeffrey D; Danoff, Ann; Schwartzbard, Arthur Z; Lobach, Iryna; Guo, Yu; Feit, Frederick; Slater, James; Attubato, Michael J; Sedlis, Steven P

2014-05-01

117

The Effects of Salsalate on Glycemic Control in Patients With Type 2 Diabetes  

PubMed Central

Background Salsalate, a nonacetylated prodrug of salicylate, has been shown to decrease blood glucose concentration in small studies. Objective To compare the efficacy and safety of salsalate at different doses in patients with type 2 diabetes. Design Parallel randomized trial with computer-generated randomization and centralized allocation. Patients and investigators, including those assessing outcomes and performing analyses, were masked to group assignment. (ClinicalTrials.gov registration number: NCT00392678) Setting 3 private practices and 14 universities in the United States. Patients Persons aged 18 to 75 years with fasting plasma glucose concentrations of 12.5 mmol/L or less (?225 mg/dL) and hemoglobin A1c (HbA1c) levels of 7.0% to 9.5% treated by diet, exercise, and oral medication at stable doses for at least 8 weeks. Intervention After a 4-week, single-masked run-in period, patients were randomly assigned to receive placebo or salsalate in dosages of 3.0, 3.5, or 4.0 g/d for 14 weeks (27 patients each) in addition to their current therapy. Measurements Change in HbA1c was the primary outcome. Adverse effects and changes in measures of coronary risk and renal function were secondary outcomes. Results Higher proportions of patients in the 3 salsalate treatment groups experienced decreases in HbA1c levels of 0.5% or more from baseline (P = 0.009). Mean HbA1c changes were ?0.36% (P = 0.02) at 3.0 g/d, ?0.34% (P = 0.02) at 3.5 g/d, and ?0.49% (P = 0.001) at 4.0 g/d compared with placebo. Other markers of glycemic control also improved in the 3 salsalate groups, as did circulating triglyceride and adiponectin concentrations. Mild hypoglycemia was more common with salsalate; documented events occurred only in patients taking sulfonylureas. Urine albumin concentrations increased in all salsalate groups compared with placebo. The drug was otherwise well tolerated. Limitation The number of patients studied and the trial duration were insufficient to warrant recommending the use of salsalate for type 2 diabetes at this time. Conclusion Salsalate lowers HbA1c levels and improves other markers of glycemic control in patients with type 2 diabetes and may therefore provide a new avenue for treatment. Renal and cardiac safety of the drug require further evaluation. Primary Funding Source National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Goldfine, Allison B.; Fonseca, Vivian; Jablonski, Kathleen A.; Pyle, Laura; Staten, Myrlene A.; Shoelson, Steven E.

2011-01-01

118

Effect of Nigella sativa seeds on the glycemic control of patients with type 2 diabetes mellitus.  

PubMed

Diabetes mellitus is a common chronic disease affecting millions of people world wide. Standard treatment is failing to achieve required correction of blood glucose in many patients. Therefore, there is a need for investigating potential hypoglycemic drugs or herbs to improve glycemic control in diabetic patients. Nigella sativa seeds were used as an adjuvant therapy in patients with diabetes mellitus type 2 added to their anti-diabetic medications. A total of 94 patient were recruited and divided randomly into three dose groups. Capsules containing Nigella sativa were administered orally in a dose of 1, 2 and 3 gm/day for three months. The effect of Nigella sativa on the glycemic control was assessed through measurement of fasting blood glucose (FBG), blood glucose level 2 hours postprandially (2 hPG), and glycosylated hemoglobin (HbA1c). Serum C-peptide and changes in body weight were also measured. Insulin resistance and beta-cell function were calculated usin the homeostatic model assessment (HOMA2). Nigella sativa at a dose of 2 gm/day caused significant reductions in FBG, 2hPG, and HbA1 without significant change in body weight. Fasting blood glucose was reduced by an average of 45, 62 and 56 mg/dl at 4, 8 and 12 weeks respectively. HbAlC was reduced by 1.52% at the end of the 12 weeks of treatment (P<0.0001). Insulin resistance calculated by HOMA2 was reduced significantly (P<0.01), while B-cell function was increased (P<0.02) at 12 weeks of treatment. The use of Nigella sativa in a dose of 1 gm/day also showed trends in improvement in all the measured parameters but it was not statistically significant from the baseline. However, no further increment in the beneficial response was observed with the 3 gm/day dose. The three doses of Nigella sativa used in the study did not adversely affect either renal functions or hepatic functions of the diabetic patients throughout the study period. In Conclusion: the results of this study indicate that a dose of 2 gm/ day of Nigella sativa might be a beneficial adjuvant to oral hypoglycemic agents in type 2 diabetic patients. PMID:21675032

Bamosa, Abdullah O; Kaatabi, Huda; Lebdaa, Fatma M; Elq, Abdul-Muhssen Al; Al-Sultanb, Ali

2010-01-01

119

Current Status of Glycemic Control of Patients with Diabetes in Korea: The Fifth Korea National Health and Nutrition Examination Survey  

PubMed Central

Background The Korea National Health and Nutrition Examination Survey (KNHANES) III (2005) reported that 22.9% of individuals with diabetes have a glycated hemoglobin (HbA1c) <6.5% and that 43.5% have an HbA1c <7%. We investigated the levels of glycemic control and the factors associated with glycemic control using data from the KNHANES V (2010 to 2012). Methods Subjects with diabetes diagnosed by a physician or those taking antidiabetic medications were classified as individuals with known diabetes. Of 1,498 subjects aged ?30 years with diabetes, we excluded 157 individuals who were missing HbA1c data. A total of 1,341 subjects were included in the final analysis. Results The prevalence of known diabetes was 7.7% (n=1,498, estimated to be 2.32 million people). The proportions of well-controlled diabetes meeting a HbA1c goal of <6.5% and <7% were 27% and 45.6%, respectively. HbA1c increased as the duration of diabetes increased. HbA1c in subjects with a duration of diabetes ?5 years was lower than in subjects with a duration >5 years. HbA1c in the group taking only oral hypoglycemic agents (OHAs) was significantly lower than that in the group administered only insulin or OHA and insulin in combination. In logistic regression analysis, a longer duration of diabetes, insulin use and the absence of chronic renal failure were associated with HbA1c levels >6.5%. Conclusion The level of adequate glycemic control was similar to but slightly improved compared with previous levels. The glycemic control of long-standing diabetes patients is more difficult even though they receive insulin treatment.

Jeon, Ja Young; Kim, Dae Jung; Ko, Seung-Hyun; Kwon, Hyuk-Sang; Lim, Soo; Choi, Sung Hee; Kim, Chul Sik; An, Jee Hyun; Kim, Nan Hee; Won, Jong Chul; Kim, Jae Hyeon; Cha, Bong-Yun

2014-01-01

120

Effect of Rimonabant on Glycemic Control in Insulin-Treated Type 2 Diabetes: The ARPEGGIO Trial  

PubMed Central

OBJECTIVE To examine the efficacy and safety of rimonabant, a selective cannabinoid receptor type-1 antagonist, in patients with type 2 diabetes receiving insulin monotherapy. RESEARCH DESIGN AND METHODS Patients (n = 368; A1C ?7%) were randomized to 20 mg/day rimonabant or placebo in this 48-week, double-blind, placebo-controlled multicenter trial. Change in baseline A1C to week 48 (primary outcome) and changes in body weight, waist circumference, and lipid levels (secondary outcomes) were assessed. RESULTS Rimonabant significantly reduced baseline A1C versus placebo (?0.89 vs. ?0.24%; P < 0.0001), and significantly greater improvements were observed in cardiometabolic risk factors. More rimonabant patients achieved >10% reduction in mean total daily insulin dose versus placebo (P = 0.0012), and fewer required rescue medication (P < 0.0001). Hypoglycemia, nausea, dizziness, anxiety, and depression were more frequent with rimonabant. CONCLUSIONS Rimonabant improved glycemic control and cardiometabolic risk factors in patients with type 2 diabetes receiving insulin.

Hollander, Priscilla A.; Amod, Aslam; Litwak, Leon E.; Chaudhari, Umesh

2010-01-01

121

Repaglinide/metformin fixed-dose combination to improve glycemic control in patients with type 2 diabetes: an update  

PubMed Central

Type 2 diabetes is a progressive disease associated with high levels of morbidity and mortality and for which there is both a large and growing prevalence worldwide. Lifestyle advice plus metformin is commonly recommended initially to manage hyperglycemia and to minimize the risk of vascular complications. However, additional agents are required when glycemic targets cannot be achieved or maintained due to the progressive nature of the disease. Repaglinide/metformin fixed-dose combination (FDC) therapy (PrandiMet®; Novo Nordisk, Bagsværd, Denmark) has been approved for use in the USA. This FDC is a rational second-line therapy given the complementary mechanisms of action of the components. Repaglinide is a rapidly absorbed, short-acting insulin secretagogue targeting postprandial glucose excursions; metformin is an insulin sensitizer with a longer duration of action that principally regulates basal glucose levels. A pivotal, 26-week, randomized study with repaglinide/metformin FDC therapy has been conducted in patients experiencing suboptimal control with previous oral antidiabetes therapy. Repaglinide/metformin FDC improved glycemic control and weight neutrality without adverse effects on lipid profiles. There were no major hypoglycemic episodes and patients expressed greater satisfaction with repaglinide/metformin FDC than previous treatments. Repaglinide/metformin FDC is expected to be more convenient than individual tablets for patients taking repaglinide and metformin in loose combination, and it is expected to improve glycemic control in patients for whom meglitinide or metformin monotherapies provide inadequate control.

Moses, Robert G

2010-01-01

122

In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: A systematic review  

Microsoft Academic Search

BACKGROUND: Our purpose was to evaluate the impact of lifestyle behavior modification on glycemic control among children and youth with clinically defined Type 2 Diabetes (T2D). METHODS: We conducted a systematic review of studies (randomized trials, quasi-experimental studies) evaluating lifestyle (diet and\\/or physical activity) modification and glycemic control (HbA1c). Our data sources included bibliographic databases (EMBASE, CINAHL®, Cochrane Library, Medline®,

Steven T Johnson; Amanda S Newton; Meera Chopra; Jeanette Buckingham; Terry TK Huang; Paul W Franks; Mary M Jetha; Geoff DC Ball

2010-01-01

123

First pilot trial of the STAR-Liege protocol for tight glycemic control in critically ill patients  

Microsoft Academic Search

Tight glycemic control (TGC) has shown benefits in ICU patients, but been difficult to achieve consistently due to inter- and intra- patient variability that requires more adaptive, patient-specific solutions. STAR (Stochastic TARgeted) is a flexible model-based TGC framework accounting for patient variability with a stochastically derived maximum 5% risk of blood glucose (BG) below 72mg\\/dL. This research describes the first

Sophie Penning; Aaron J. Le Compte; Katherine T. Moorhead; Thomas Desaive; Paul Massion; Jean-Charles Preiser; Geoffrey M. Shaw; J. Geoffrey Chase

124

Platelet-dependent thrombin generation in patients with diabetes mellitus: Effects of glycemic control on coagulability in diabetes  

Microsoft Academic Search

Objectives. This study sought to assess the usefulness of platelet-dependent thrombin generation as an index of coagulability in diabetes and to determine the effect of glycemic control on coagulability in diabetes.Background. It is important to investigate the interaction of platelets and the coagulation factors to clarify the processes of the coagulation system in detail.Methods. Platelet-rich plasma (150 × 109\\/liter), 0.5

Isao Aoki; Katsuya Shimoyama; Nobuo Aoki; Masashi Homori; Atsuo Yanagisawa; Kazuhiko Nakahara; Yohko Kawai; Shin-Ichi Kitamura; Kyozo Ishikawa

1996-01-01

125

Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes  

Microsoft Academic Search

We previously demonstrated that a loosely restricted 45%-carbohydrate diet led to greater reduction in hemoglobin A1c (HbA1c) compared to high-carbohydrate diets in outpatients with mild type 2 diabetes (mean HbA1c level: 7.4%) over 2 years. To determine whether good glycemic control can be achieved with a 30%-carbohydrate diet in severe type 2 diabetes, 33 outpatients (15 males, 18 females, mean

Hajime Haimoto; Tae Sasakabe; Kenji Wakai; Hiroyuki Umegaki

2009-01-01

126

The ubiquitin–proteasome system contributes to the inflammatory injury in ischemic diabetic myocardium: the role of glycemic control  

Microsoft Academic Search

BackgroundBecause the ubiquitin–proteasome pathway (UPS) is required for activation of nuclear factor kappa beta (NFkB), a transcription factor that regulates inflammatory genes, we evaluated the UPS activity, NFkB activation, and tumor necrosis factor-alpha (TNF-alpha), a proinflammatory cytokine, in ischemic specimens of diabetic myocardium and relate them to the glycemic control (HbA1c), oxidative stress (nitrotyrosine, a modified amino acid produced by

Raffaele Marfella; Clara Di Filippo; Michele Portoghese; Mario Siniscalchi; Simone Martis; Franca Ferraraccio; Salvatore Guastafierro; Gianfranco Nicoletti; Michelangela Barbieri; Antonino Coppola; Francesco Rossi; Giuseppe Paolisso; Michele D'Amico

2009-01-01

127

Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes  

Microsoft Academic Search

Objective To evaluate an ambulatory, family-focused intervention aimed at optimizing glycemic control, minimizing diabetes-related family conflict (DFC), and maintaining quality of life in youth with type 1 diabetes (T1DM). Study design We randomly assigned 105 children and adolescents, 8 to 17 years of age, with T1DM for ?6 years, to a family-focused teamwork (TW) intervention or to standard multidisciplinary diabetes

Lori M. B. Laffel; Laura Vangsness; Alexa Connell; Ann Goebel-Fabbri; Deborah Butler; Barbara J. Anderson

2003-01-01

128

Telmisartan improves lipid metabolism and adiponectin production but does not affect glycemic control in hypertensive patients with type 2 diabetes  

Microsoft Academic Search

Angiotensin II receptor blockers as a class are reported to act as insulin sensitizers. Of these, telmisartan has been shown\\u000a to have additional unique peroxisome proliferator-activated receptor-gamma-mediated, insulin-sensitizing properties. In this\\u000a study, investigators explored the effects of telmisartan on glycemic control and lipid metabolism in hypertensive patients\\u000a with type 2 diabetes who had switched to telmisartan from another angiotensin II

Yutaka Mori; Yohta Itoh; Naoko Tajima

2007-01-01

129

SKELETAL MUSCLE MITOCHONDRIAL CAPACITY PLAYS A MINIMAL ROLE IN MEDIATING INSULIN SIGNALING AND REGULATION IN INDIVIDUALS WITH IMPAIRED GLYCEMIC CONTROL  

Microsoft Academic Search

This thesis examined the biochemical role of skeletal muscle mitochondria and metabolic consequences of mitochondrial adaptations to exercise in individuals with poor glycemic control. Mitochondrial dysfunction and\\/or ectopic lipid accumulation has been implicated in the pathogenesis of metabolic-related diseases such as obesity and type 2 diabetes (T2D). However, whether mitochondrial dysfunction is the cause of insulin resistance and T2D or

Imtiaz Samjoo

2011-01-01

130

Factors Associated with Glycemic Control in Patients with Type 2 Diabetes Mellitus in Rural Areas of the United States  

Microsoft Academic Search

Background: According to the US Department of Health and Human Services, an estimated 18.2 million Americans, or 6.3% of the population, has diabetes mellitus (DM). Approximately 90% of these individuals have type 2 DM. The most widely used clinical test for defining glycemic control is measurement of blood glycosylated hemoglobin (AIC).Objective: The goal of this study was to estimate the

Yue-Fang Chang

2007-01-01

131

Treatment satisfaction and glycemic control in young Type 1 diabetic patients in transition from pediatric health care: CSII versus MDI.  

PubMed

To evaluate whether continuous subcutaneous insulin infusion (CSII) may have any advantage over multiple daily injections (MDI) on glycemic control and treatment satisfaction in young patients with Type 1 diabetes in transition to an adult diabetes center. The study population consisted of 125 patients on MDI; 38 out of the 43 patients considered eligible for CSII completed the study and the 82 remaining on MDI served as control group. Glycemic control and treatment satisfaction [diabetes treatment satisfaction questionnaire (DTSQ)] were evaluated in all patients at baseline and after 12 weeks. At baseline, the two groups were well matched for demographic characteristics and glycemic control. DTSQ score was lower in CSII group (21.1 ± 8.8 vs. 25.1 ± 7.1, P = 0.011). After 12 weeks, a similar decrease in HbA1C was observed in both groups [difference -0.3 % (95 % CI-0.6 to 0.1, P = 0.847)]. Mean amplitude glucose excursions,blood glucose standard deviation, and overall hypoglycemia were significantly reduced in CSII group. DTSQ overall score increased in CSII and decreased in MDI (difference between groups = 9.9, 95 % CI 8.0-12.0, P<0.001), while perceived hyperglycemia and hypoglycemia decreased in CSII compared with MDI (difference:-2.5 and -2.0, respectively, P<0.001 for both). Among young Type 1 diabetic patients in transition from Pediatrics,CSII showed a similar efficacy in reducing HbA1c compared with MDI, with less hypoglycemia and glycemic excursions, and was better in improving overall treatment satisfaction and the rate of perceived hyperglycemia and hypoglycemia. PMID:24078410

Maiorino, Maria Ida; Bellastella, Giuseppe; Petrizzo, Michela; Improta, Maria Rosaria; Brancario, Clementina; Castaldo, Filomena; Olita, Laura; Giugliano, Dario

2014-06-01

132

Improved Glycemic Control in Intensively Treated Adult Subjects with Type 1 Diabetes Using Insulin Guidance Software  

PubMed Central

Abstract Background Management of type 1 diabetes could be significantly improved with the availability of computerized insulin algorithms for home use. Methods This was a 1-year open label randomized control trial involving 123 adult subjects with type 1 diabetes (hemoglobin A1c values 7.5–11%) assigned to either the insulin guidance software (ACCU-CHEK® [Roche, Indianapolis, IN] Advisor) for personal data assistant (experimental group) or the control group. The primary aim of the study was to see if subjects using insulin dosing advisor software will improve glucose control over 1 year. The principal end point was an improvement in A1c at 6 and 12 months by ?0.4%. Results Baseline demographics were similar in the two groups. Mean A1c was 8.54 ± 0.11% in the control group and 8.42 ± 0.11% (P = 0.4265) in the experimental group. The mean A1c was significantly lower from 3 to 12 months in the experimental group (P < 0.02). A1c reduction of ?0.6% was maintained at 12 months in the experimental group. Also, a significantly higher number of subjects achieved A1c <7.5% in the experimental group from 3 to 9 months. Within target range glycemia (70–150 mg/dL) was higher in the experimental group at 3–9 months without any change in insulin dose or weight. Above target range glycemia was lower in the experimental group throughout the study. Frequency of testing per day was higher in the experimental group. Nocturnal hypoglycemia was not different between groups; however, the experimental group experienced more severe hypoglycemic events. Conclusions This is the first report that shows improved glycemic control can be maintained over 12 months in patients with type 1 diabetes by using Advisor with no change in insulin dose and weight.

Bookout, Tevin R.; McFann, Kim K.; Kelly, William C.; Beatson, Christie; Ellis, Samuel L.; Gutin, Raymond S.; Gottlieb, Peter A.

2008-01-01

133

Computer decision support software safely improves glycemic control in the burn intensive care unit: a randomized controlled clinical study  

PubMed Central

Objective The optimal method for glycemic control in the critically burned patient is unknown. The purpose of this randomized controlled study was to determine the safety and efficacy of computer decision support software (CDSS) to control serum glucose concentration in a burn intensive care unit. Methods Eighteen adult burn/trauma patients receiving continuous insulin infusion were initially randomized to receive glucose management via a traditional paper-based protocol (PP) or a computer protocol (CP) for 72 hours, then crossed over to the alternate method for an additional 72 hours. Results Time in target glucose range (80-110 mg/dl) was higher in the CP group (47 ± 17% versus 41 ± 16.6%; p ? 0.05); time over target range was not significantly reduced in the CP group (49 ± 17.8% versus 54 ± 17.1; p = 0.08); and no difference was noted in time under target range of 80 mg/dl (CP 4.5 ± 2.8, PP 4.8 ± 3.3%; p = 0.8), under 60 mg/dl (p = 0.7), and under 40 mg/dl (p = 1.0). Severe hypoglycemic events (< 40 mg/dl) did not differ from the CP group compared to historical controls for patients receiving no insulin (p = 0.6). More glucose measurements were performed in the CP group (p = 0.0003), and nursing staff compliance with CP recommendations was greater (p < 0.0001). Conclusions Glycemic control using CDSS is safe and effective for the critically burned patient. Time in target range improved without increase in hypoglycemic events. CDSS enhanced consistency in practice, providing standardization among nursing staff.

Mann, Elizabeth A.; Jones, John A.; Wolf, Steven E.; Wade, Charles E.

2011-01-01

134

Strict glycemic control in diabetic dogs with closed-loop intraperitoneal insulin infusion algorithm designed for an artificial endocrine pancreas.  

PubMed

The ultimate goal of the development of an artificial endocrine pancreas is to achieve long-term strict glycemic regulation. To establish the physiological insulin delivery route of the artificial endocrine pancreas, intraperitoneal insulin infusion may be important. For this purpose, we tried to develop a closed-loop intraperitoneal insulin infusion algorithm by analyzing the pharmacokinetics of intraperitoneal regular insulin absorption using a mathematical model. The parameters for this algorithm were calculated to simulate the plasma insulin profile after intraperitoneal insulin injection as closely as possible. To evaluate the appropriateness of this algorithm, we tried glycemic control after an oral glucose load of 2 g/kg or a meal load of 80 kcal/kg in diabetic dogs by applying the algorithm. With the use of the subcutaneous insulin lispro infusion algorithm, which we have previously reported, alloxan-induced diabetic dogs exhibited postprandial hyperglycemia and delayed hyperinsulinemia, followed by hypoglycemia after an oral glucose load of 2 g/kg. However, by using the intraperitoneal insulin infusion algorithm, excellent glycemic control (postprandial blood glucose levels of 9.1 +/- 0.8 mmol/l at 70 min and 3.8 +/- 0.3 mmol/l at 240 min, respectively) could be achieved without any associated delayed hyperinsulinemia or hypoglycemia. Glycemic excursion after a meal load of 80 kcal/kg was also controlled from 3.9 to 10.1 mmol/l. Our results confirm that the intraperitoneal insulin infusion algorithm in vivo is feasible and that this algorithm can be superior to the subcutaneous insulin lispro infusion algorithm in the regulation of blood glucose. PMID:14598126

Matsuo, Yasuto; Shimoda, Seiya; Sakakida, Michiharu; Nishida, Kenro; Sekigami, Taiji; Ichimori, Shinji; Ichinose, Kenshi; Shichiri, Motoaki; Araki, Eiichi

2003-01-01

135

Inflammatory biomarkers in type 2 diabetic patients: effect of glycemic control and impact of ldl subfraction phenotype  

PubMed Central

Background Type 2 diabetes mellitus (T2D) is associated with higher cardiovascular risk partly related to an increase in inflammatory parameters. The aim of this study was to determine the association of inflammatory biomarkers with low-density lipoprotein (LDL) subfraction phenotype and glycemic control in subjects with T2D and poor glycemic control. Methods A cross-sectional study was performed comparing 122 subjects with T2D (59 ± 11 years old, body mass index 30.2 ± 5.6 kg/m2) with 54 control subjects. Patients with T2D were classified according to their LDL subfraction phenotype and inflammatory biomarkers (C-reactive protein, Interleukin-6, Interleukin-8, Transforming growth factor ?1, Monocyte chemotactic protein 1, Leptin, Adiponectin) were evaluated according to the degree of glycemic control, LDL phenotype and other clinical characteristics. Forty-two subjects with T2D were studied before and after 3 months of improving glycemic control by different strategies. Results Patients with T2D had higher C-reactive protein (CRP) and monocyte chemotactic protein-1 (MCP1) levels and lower adiponectin concentration, compared to controls. T2D subjects with body mass index???30 kg/m2 had higher CRP levels (5.2?±?4.8 mg/l vs 3.7?±?4.3 mg/l; p?glycemic control reduces TGF-?1 levels, which may contribute partly to its renoprotective role.

2014-01-01

136

Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort.  

PubMed

We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15-2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN. PMID:19335534

Pop-Busui, Rodica; Lu, Jiang; Lopes, Neuza; Jones, Teresa L Z

2009-03-01

137

Colestimide improves glycemic control via hepatic glucose production in db/db mice.  

PubMed

The objective of this study was to assess the chronic effects of a bile acid sequestrant, colestimide, on glucose metabolism. After db/db mice were fed a diet containing colestimide or cholic acid (CA) for 12 weeks, we investigated the impact of these agents on glucose and lipid metabolism. Colestimide significantly reduced the elevated fasting blood glucose level (p<0.01), and CA even more markedly reduced fasting blood glucose. The blood glucose level after an oral glucose load was significantly lower in the CA group than in the control group, but the colestimide group showed no significant difference. The insulin response to a glucose load was abolished in the control and colestimide groups. A hyperinsulinemic-euglycemic clamp study revealed that colestimide significantly improved the GIR (p=0.013). Hepatic EGP and Rd were also improved by colestimide, suggesting that it alleviated insulin resistance by suppressing hepatic glucose production and increasing peripheral glucose usage. CA significantly increased both the weight and cholesterol content of the liver, while colestimide reduced these parameters. Colestimide suppressed hepatic gene expression of SHP, but enhanced SREBP2 expression. On the other hand, CA increased the expression of SHP and lipogenic enzymes such as ACC and SCD-1, but had no effect on SREBP2. The present study demonstrated that colestimide improves hyperglycemia and hyperlipidemia, as well as reducing the hepatic lipid content. In contrast, CA exacerbates hyperlipidemia and increases the hepatic lipid content, although it improves glycemic control. Thus, colestimide is a well-balanced drug for the treatment of diabetes mellitus. PMID:24553582

Yamakawa, Tadashi; Ogihara, Kikumi; Utsunomiya, Hirotoshi; Muraoka, Tomonori; Kadonosono, Kazuaki; Terauchi, Yasuo

2014-05-31

138

A proprietary alpha-amylase inhibitor from white bean (Phaseolus vulgaris): A review of clinical studies on weight loss and glycemic control  

Microsoft Academic Search

Obesity, and resultant health hazards which include diabetes, cardiovascular disease and metabolic syndrome, are worldwide\\u000a medical problems. Control of diet and exercise are cornerstones of the management of excess weight. Foods with a low glycemic\\u000a index may reduce the risk of diabetes and heart disease as well as their complications. As an alternative to a low glycemic\\u000a index diet, there

Marilyn L Barrett; Jay K Udani

2011-01-01

139

Glycemic variability: Clinical implications.  

PubMed

Glycemic control and its benefits in preventing microvascular diabetic complications are convincingly proved by various prospective trials. Diabetes control and complications trial (DCCT) had reported variable glycated hemoglobin (HbA1C) as a cause of increased microvascular complications in conventional glycemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved. Glycemic variability (GV) is one more tool to explain relation between hyperglycemia and increased cardiovascular risk in diabetic patients. In fact GV along with fasting blood sugar, postprandial blood sugar, HbA1C, and quality of life has been proposed to form glycemic pentad, which needs to be considered in diabetes management. Postprandial spikes in blood glucose as well as hypoglycemic events, both are blamed for increased cardiovascular events in Type 2 diabetics. GV includes both these events and hence minimizing GV can prevent future cardiovascular events. Modern diabetes management modalities including improved sulfonylureas, glucagon like peptide-1 (GLP-1)-based therapy, newer basal insulins, and modern insulin pumps address the issue of GV effectively. This article highlights mechanism, clinical implications, and measures to control GV in clinical practice. PMID:23961476

Satya Krishna, Surabhi Venkata; Kota, Sunil K; Modi, Kirtikumar D

2013-07-01

140

Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults  

PubMed Central

The management reporting and assessment of glycemic control lacks standardization. The use of different methods to measure the blood glucose concentration and to report the performance of insulin treatment yields major disparities and complicates the interpretation and comparison of clinical trials. We convened a meeting of 16 experts plus invited observers from industry to discuss and where possible reach consensus on the most appropriate methods to measure and monitor blood glucose in critically ill patients and on how glycemic control should be assessed and reported. Where consensus could not be reached, recommendations on further research and data needed to reach consensus in the future were suggested. Recognizing their clear conflict of interest, industry observers played no role in developing the consensus or recommendations from the meeting. Consensus recommendations were agreed for the measurement and reporting of glycemic control in clinical trials and for the measurement of blood glucose in clinical practice. Recommendations covered the following areas: How should we measure and report glucose control when intermittent blood glucose measurements are used? What are the appropriate performance standards for intermittent blood glucose monitors in the ICU? Continuous or automated intermittent glucose monitoring - methods and technology: can we use the same measures for assessment of glucose control with continuous and intermittent monitoring? What is acceptable performance for continuous glucose monitoring systems? If implemented, these recommendations have the potential to minimize the discrepancies in the conduct and reporting of clinical trials and to improve glucose control in clinical practice. Furthermore, to be fit for use, glucose meters and continuous monitoring systems must match their performance to fit the needs of patients and clinicians in the intensive care setting. See related commentary by Soto-Rivera and Agus, http://ccforum.com/content/17/3/155

2013-01-01

141

Counting Carbs? Understanding Glycemic Index and Glycemic Load  

MedlinePLUS

... to know. The glycemic index and load concern carbohydrates, or carbs—one of the main types of ... to support the concept that the more complex carbohydrates will lead to better blood sugar control than ...

142

Effect on Glycemic Control by Short- and Long-Term Use of Continuous Glucose Monitoring in Clinical Practice  

PubMed Central

Background In Sweden, patients with diabetes mellitus frequently receive short-term (<3 months) continuous glucose monitoring (CGM) to study glucose patterns or long-term CGM to treat poor glycemic control or severe hypoglycemia. The effects of CGM on glycemic control in clinical practice in relation to indication and duration of use has not been completely studied. Methods Patients with diabetes, among which 99% were diagnosed as type 1, receiving CGM at 10 outpatient clinics in Sweden were studied retrospectively. Long-term use of CGM was defined as ?3 months use of CGM and short-term as <3 months. A control group matched on start date and date of latest value 3 months after the start was selected for both long- and short-term groups. Results In 34 long-term users of CGM, over a mean follow-up of 1.1 years, the adjusted mean difference of hemoglobin A1c (HbA1c) compared with controls (n = 408) was -0.76 (95% confidence interval -1.17; -0.33, p < .001). Long-term users with indications for high HbA1c (n = 15) had a reduction of 1.2% in HbA1c from 10.1 to 8.9% (p = .003), whereas patients with hypoglycemia as their indication (n = 16) decreased by 0.3% (p = .17). Nonsevere hypoglycemic events decreased in long-term users within the same follow-up period (p = .004). Short-term users showed no statistically significant improvement in HbA1c compared with controls at 1.1 years (n = 41), p = .85 or at 2.6 years (n = 43), p = .19. Conclusion Long-term CGM use was associated with improved glycemic control in clinical practice and a reduction in nonsevere hypoglycemic events, whereas short-term use had no effect on HbA1c. The effect on glycemic control varied by indication.

Anderson, Jenny; Attvall, Stig; Sternemalm, Lennart; Pivodic, Aldina; Fahlen, Martin; Hanas, Ragnar; Ekeroth, Gunnar; Lind, Marcus

2011-01-01

143

Enhanced Fitness: A Randomized Controlled Trial of the Effects of Home-Based Physical Activity Counseling on Glycemic Control in Older Adults with Prediabetes  

PubMed Central

Background/Objective To determine whether a home-based multi-component physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older prediabetic outpatients. Design, Setting, and Participants Controlled clinical trial of 302 overweight (body mass index 25–45 kg/m2), older (ages 60–89) outpatients with impaired glucose tolerance (fasting blood glucose 100–125 mg/dL, HbA1c <7%), randomly assigned to a PAC intervention group (n=180), compared to a Usual Care (UC) control group (n=122) and recruited through primary care clinics of the Durham VA Medical Center between September 29, 2008 and March 25, 2010. Intervention A 12 month, home-based multi-component PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and tailored mailed materials. All study participants, including UC, received a consult to a VA weight management program. Measurements The primary outcome was HOMA-IR, calculated from fasting insulin and glucose levels at baseline, 3 and 12 months. Hemoglobin A1C was the secondary indicator of glycemic control. Other secondary outcomes included anthropometric measures, and self-reported physical activity, health-related quality of life, and physical function. Results There were no significant differences between the PAC or Usual Care groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose, p< 0.001, while other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in PAC group, P<0.001 compared to UC. Conclusion Home-based telephone counseling increased physical activity levels but was insufficient for improving glycemic indicators among older prediabetic outpatients.

Morey, Miriam C.; Pieper, Carl F.; Edelman, David E.; Yancy, William S.; Green, Jennifer B.; Lum, Helen; Peterson, Matthew J.; Sloane, Richard; Cowper, Patricia A.; Bosworth, Hayden B.; Huffman, Kim M.; Cavanaugh, James T.; Hall, Katherine S.; Pearson, Megan P.; Taylor, Gregory A.

2012-01-01

144

Does tight glycemic control improve outcomes in pediatric patients undergoing surgery and/or those with critical illness?  

PubMed Central

This literature review examines the current evidence regarding the potential usefulness of tight glycemic control in pediatric surgical patients. In adults, fluctuations in glucose levels and/or prolonged hyperglycemia have been shown to be associated with poor outcomes with respect to morbidity and mortality. This review begins by summarizing the findings of key papers in adult patients and continues by investigating whether or not similar results have been seen in pediatric patients by performing a comprehensive literature review using Medline (OVID). A database search using the OVID interface and including the search terms (exp glucose) AND (exp surgery) AND (exp Paediatric/pediatric) AND (exp Hypoglycaemia/hypoglycemia) AND (exp Hyperglycaemia/hyperglycemia) yielded a total of 150+ papers, of which 24 fulfilled our criteria. We isolated papers utilizing pediatric patients who were hospitalized due to illness and/or surgery. Our review highlights several difficulties encountered in addressing this potentially useful clinical intervention. An absence of scientifically robust and randomized trials and the existence of several small-powered trials yielding conflicting results mean we cannot recommend tight glycemic control in these patients. Differences in study design and disagreements concerning the crucial stage of surgery where hyperglycemia becomes important are compounded by an over-reliance on the discretion of clinicians in the absence of well described treatment protocols. Closer inspection of key papers in adult patients identified fundamental discrepancies between exact definitions of both hyperglycemia and hypoglycemia. This lack of consensus, along with a fear of inducing iatrogenic hypoglycemia in pediatric patients, has resulted in professional bodies advising against this form of intervention. In conclusion, we cannot recommend use of tight glycemic control in pediatric surgical patients due to unclear glucose definitions, unclear thresholds for treatment, and the unknown long-term effects of iatrogenic hypoglycemia on the developing body and brain.

Forbes, Neil Christopher; Anders, Nicola

2014-01-01

145

Color record in self-monitoring of blood glucose improves glycemic control by better self-management.  

PubMed

Abstract Background: Color affects emotions, feelings, and behaviors. We hypothesized that color used in self-monitoring of blood glucose (SMBG) is helpful for patients to recognize and act on their glucose levels to improve glycemic control. Here, two color-indication methods, color record (CR) and color display (CD), were independently compared for their effects on glycemic control in less frequently insulin-treated type 2 diabetes. Subjects and Methods: One hundred twenty outpatients were randomly allocated to four groups with 2×2 factorial design: CR or non-CR and CD or non-CD. Blood glucose levels were recorded in red or blue pencil in the CR arm, and a red or blue indicator light on the SMBG meter was lit in the CD arm, under hyperglycemia or hypoglycemia, respectively. The primary end point was difference in glycated hemoglobin (HbA1c) reduction in 24 weeks. Secondary end points were self-management performance change and psychological state change. Results: HbA1c levels at 24 weeks were significantly decreased in the CR arm by -0.28% but were increased by 0.03% in the non-CR arm (P=0.044). In addition, diet and exercise scores were significantly improved in the CR arm compared with the non-CR arm. The exercise score showed significant improvement in the CD arm compared with the non-CD arm but without a significant difference in HbA1c reduction. Changes in psychological states were not altered between the arms. Conclusions: CR has a favorable effect on self-management performance without any influence on psychological stress, resulting in improved glycemic control in type 2 diabetes patients using less frequent insulin injection. Thus, active but not passive usage of color-indication methods by patients is important in successful SMBG. PMID:24506479

Nishimura, Akiko; Harashima, Shin-Ichi; Honda, Ikumi; Shimizu, Yoshiyuki; Harada, Norio; Nagashima, Kazuaki; Hamasaki, Akihiro; Hosoda, Kiminori; Inagaki, Nobuya

2014-07-01

146

Dyadic Measures of the Parent-Child Relationship During the Transition to Adolescence and Glycemic Control in Children with Type 1 Diabetes  

PubMed Central

To identify aspects of family behavior associated with glycemic control in youth with type 1 diabetes mellitus (T1DM) during the transition to adolescence, we studied 121 9- to 14-year-olds (M = 12.1 yrs) and their parents, who completed the Diabetes Family Conflict Scale (DFCS) and the Diabetes Family Responsibility Questionnaire (DFRQ). From the DFRQ, we derived 2 dyadic variables, frequency of agreement (parent and child concurred exactly on who was responsible for a task) and frequency of discordance (parent and child had completely opposite reports of who was responsible). To examine the relationship between these variables and age, we divided the cohort into Younger (n = 57, M = 10.6 yrs) and Older (n = 64, M = 13.5 yrs) age groups. Family conflict was significantly related to glycemic control in the entire cohort and in both the Younger and Older age groups. However, only in the Younger (pre-teen) group was Agreement about responsibility for diabetes tasks related to glycemic control, with higher Agreement associated with better glycemic control. Findings suggest that Agreement about sharing of diabetes management responsibilities may be an important target for family-based interventions with pre-teen youth to optimize glycemic control during their transition to adolescence.

Anderson, Barbara J.; Holmbeck, Grayson; Iannotti, Ronald J.; McKay, Siripoom V.; Lochrie, Amanda; Volkening, Lisa K.; Laffel, Lori

2009-01-01

147

Effect of fruit restriction on glycemic control in patients with type 2 diabetes - a randomized trial  

PubMed Central

Background Medical nutrition therapy is recognized as an important treatment option in type 2 diabetes. Most guidelines recommend eating a diet with a high intake of fiber-rich food including fruit. This is based on the many positive effects of fruit on human health. However some health professionals have concerns that fruit intake has a negative impact on glycemic control and therefore recommend restricting the fruit intake. We found no studies addressing this important clinical question. The objective was to investigate whether an advice to reduce the intake of fruit to patients with type 2 diabetes affects HbA1c, bodyweight, waist circumference and fruit intake. Methods This was an open randomized controlled trial with two parallel groups. The primary outcome was a change in HbA1c during 12 weeks of intervention. Participants were randomized to one of two interventions; medical nutrition therapy + advice to consume at least two pieces of fruit a day (high-fruit) or medical nutrition therapy + advice to consume no more than two pieces of fruit a day (low-fruit). All participants had two consultations with a registered dietitian. Fruit intake was self-reported using 3-day fruit records and dietary recalls. All assessments were made by the “intention to treat” principle. Results The study population consisted of 63 men and women with newly diagnosed type 2 diabetes. All patients completed the trial. The high-fruit group increased fruit intake with 125 grams (CI 95%; 78 to 172) and the low-fruit group reduced intake with 51 grams (CI 95%; -18 to ?83). HbA1c decreased in both groups with no difference between the groups (diff.: 0.19%, CI 95%; -0.23 to 0.62). Both groups reduced body weight and waist circumference, however there was no difference between the groups. Conclusions A recommendation to reduce fruit intake as part of standard medical nutrition therapy in overweight patients with newly diagnosed type 2 diabetes resulted in eating less fruit. It had however no effect on HbA1c, weight loss or waist circumference. We recommend that the intake of fruit should not be restricted in patients with type 2 diabetes. Trial registration http://www.clinicaltrials.gov; Identifier: NCT01010594.

2013-01-01

148

Impact of lifestyle modification on glycemic control in patients with type 2 diabetes mellitus  

PubMed Central

Background: Current treatment guidelines support the role of lifestyle modification, in terms of increasing the quantity and quality of physical activity to achieve target glycemia in patients with type 2 diabetes mellitus. Objective: To assess the effect of structured exercise training and unstructured physical activity interventions on glycemic control. Materials and Methods: This was a randomized six-month exercise intervention study conducted with previously inactive 279 patients of type 2 diabetes mellitus. Before randomization, all enrolled T2DM participants (n: 300; 30 to 60 year old, having diabetes for more than a year with HbA1c levels of 6.5% or higher) entered a one-month run-in phase to reduce dropout and maintain adherence. Results: A recommendation to increase physical activity was beneficial (0.14% HbA1c reduction; P = 0.12), but was not bringing significantly declines in HbA1c, whereas, structured exercise training is associated with a significant HbA1c decline of 0.59%. (P = 0.030). In a subgroup analysis limited to participants with a baseline HbA1c value > 7%, both the unstructured (0. 48%; P = 0.04) and structured exercise training (0.77%; P < 0.01) groups experienced significant decline in HbA1c Vs the control, whereas among participants with baseline hemoglobin A1c values less than 7%, significant reduction occurred only in the structured exercise training group. Changes in blood pressure; total cholesterol, HDL-cholesterol (high-density lipoprotein), LDL-cholesterol (low-density lipoprotein) and the atherogenic index factors did not statistically significantly differ within (baseline to follow-up) and among groups. Conclusion: Supervised structured training was more efficacious than unstructured activity in achieving declines in HbA1c. Although both structured and unstructured training provide benefits, only the former was associated with significant reductions in HbA1c levels. Therefore, T2DM patients should be stimulated to participate in specifically designed exercise intervention programs.

Sanghani, Nandita B.; Parchwani, Deepak N.; Palandurkar, Kamlesh M.; Shah, Amit M.; Dhanani, Jatin V.

2013-01-01

149

Gene Expression in Low Glycemic Index Diet - Impact on Metabolic Control  

Microsoft Academic Search

Background: Correcting postprandial hyperglycemia forms an important part of the prevention and management of type 2 diabetes. Methods: A low-glycemic-index liquid formula designated as Inslow was prepared by replacing dextrin in the standard balanced formula (SBF) with 55.7% palatinose. Long-term administration of Inslow prevented fatty liver and improved insulin resistance in rats. Expressions of mRNA of factors involved in glucose

E. Takeda; H. Arai; K. Muto; K. Matsuo; M. Sakuma; M. Fukaya; H. Yamanaka-Okumura; H. Yamamoto; Y. Taketani

2007-01-01

150

Acceleration of Biliary Cholesterol Secretion Restores Glycemic Control and Alleviates Hypertriglyceridemia in Obese db/db Mice  

PubMed Central

Objective Recent studies support a role for cholesterol in the development of obesity and nonalcoholic fatty liver disease. Mice lacking the ABCG5 ABCG8 (G5G8) sterol transporter have reduced biliary cholesterol secretion and are more susceptible to steatosis, hepatic insulin resistance, and loss of glycemic control when challenged with a high-fat diet. We hypothesized that accelerating G5G8-mediated biliary cholesterol secretion would correct these phenotypes in obese mice. Approach and Results Obese (db/db) male and their lean littermates were administered a cocktail of control adenovirus or adenoviral vectors encoding ABCG5 and ABCG8 (AdG5G8). Three days after viral administration, measures of lipid and glucose homeostasis were determined, and tissues were collected for biochemical analyses. AdG5G8 increased biliary cholesterol and fecal sterol elimination. Fasting glucose and triglycerides declined, and glucose tolerance improved in obese mice expressing G5G8 compared with mice receiving control adenovirus. These changes were associated with a reduction in phosphorylated eukaryotic initiation factor 2? and c-Jun N-terminal kinase in liver, suggesting alleviation of endoplasmic reticulum stress. Phosphorylated insulin receptor and protein kinase B were increased, indicating restored hepatic insulin signaling. However, there was no reduction in hepatic triglycerides after the 3-day treatment period. Conclusions Accelerating biliary cholesterol secretion restores glycemic control and reduces plasma triglycerides in obese db/db mice.

Su, Kai; Sabeva, Nadezhda S.; Wang, Yuhuan; Liu, Xiaoxi; Lester, Joshua D.; Liu, Jingjing; Liang, Shuang; Graf, Gregory A.

2014-01-01

151

Prospective memory and glycemic control in children with type 1 diabetes mellitus: a cross-sectional study  

PubMed Central

Background Prospective memory is that memory which is required to carry out intended actions and is therefore essential in carrying out the daily activities required in the self-management of type 1 diabetes mellitus (T1DM). This study aimed to identify the relationships between prospective memory and diabetic control in children with T1DM. Method 94 children aged 6–18 years with T1DM completed an innovative prospective memory screen, PROMS, and a series of cognitive tests. Parents answered questionnaires about their children's diabetic histories and cognitive skills. Results No association between total PROMS score and glycemic control was found. Lower HbA1C was associated with higher (better) scores on the 20 minute event-based task on the PROMS. Parental concerns about working memory and metacognition in their children were mirrored by higher HbA1C. Conclusions This study suggests that there may be an association between glycemic control and prospective memory for event based tasks. Additional studies need to be done to determine reproducibility, causality, and if prospective memory based interventions can improve diabetic control.

2012-01-01

152

Which factors predict glycemic control in children diagnosed with type 1 diabetes before 6.5 years of age?  

PubMed

Predictors of long-term glycemic control and growth patterns in children diagnosed with type 1 diabetes (T1D) before 6.5 years of age were evaluated. One hundred seventy-three children (84 boys) with a mean diabetes duration of 4.9 ± 2.8 years participated in this observational study. Medical charts were reviewed for background, disease- and treatment-related parameters, and growth parameters. Study endpoints were HbA1c value, rates of severe hypoglycemia and diabetic ketoacidosis events, and growth patterns. Mean HbA1c for the total duration of diabetes (HbA1c-TDD) was 7.9 ± 0.8%. Comparison of the study variables between patients with HbA1c-TDD <7.5% (n = 53) or ?7.5% yielded a significantly shorter duration of diabetes (P = 0.01) and lower rate of diabetic ketoacidosis (P = 0.02) in those with HbA1C-TDD <7.5%, without differences between these groups in age at diabetes onset, insulin regimens, daily glucose measurements, and rate of severe hypoglycemia. Factors significantly predicting achievement of the mean target HbA1c-TDD <7.5% were lower HbA1c at 0.5 years and 1 year after diabetes diagnosis (P = 0.002 and P < 0.001, respectively). Patients followed for at least 5 years (n = 48) showed a significant decrease in height-SDS (P < 0.001) and a significant increase in weight-SDS (P = 0.004) from diabetes diagnosis to the last follow-up visit, without a significant change in weight-SDS from 0.5 years after diagnosis to the last follow-up visit. Our results suggest that in patients with T1D diagnosed during the preschool-age, mean HbA1c level in the first year is a strong predictor of achieving target HbA1c level in the subsequent years, regardless the type of insulin regimen. This "metabolic tracking" emphasizes the importance of achieving early optimal control even in younger children. PMID:21866397

Shalitin, S; Phillip, M

2012-10-01

153

Intensive glycemic control after heart transplantation is safe and effective for diabetic and non-diabetic patients.  

PubMed

Some studies have shown increased mortality, infection, and rejection rates among diabetic (DM) compared to non-diabetic (non-DM) patients undergoing heart transplant (HT). This is a retrospective chart review of adult patients (DM, n = 26; non-DM, n = 66) undergoing HT between June 1, 2005, and July 31, 2009. Glycemic control used intravenous (IV) and subcutaneous (SQ) insulin protocols with a glucose target of 80-110 mg/dL. There were no significant differences between DM and non-DM patients in mean glucose levels on the IV and SQ insulin protocols. Severe hypoglycemia (glucose <40 mg/dL) did not occur on the IV protocol and was experienced by only 3 non-DM patients on the SQ protocol. Moderate hypoglycemia (glucose >40 and <60 mg/dL) occurred in 17 (19%) patients on the IV protocol and 24 (27%) on the SQ protocol. There were no significant differences between DM and non-DM patients within 30 d of surgery in all-cause mortality, treated HT rejection episodes, reoperation, prolonged ventilation, 30-d readmissions, ICU readmission, number of ICU hours, hospitalization days after HT, or infections. This study demonstrates that DM and non-DM patients can achieve excellent glycemic control post-HT with IV and SQ insulin protocols with similar surgical outcomes and low hypoglycemia rates. PMID:23574363

Garcia, Cristina; Wallia, Amisha; Gupta, Suruchi; Schmidt, Kathleen; Malekar-Raikar, Shilpa; Johnson Oakes, Diana; Aleppo, Grazia; Grady, Kathleen; McGee, Edwin; Cotts, William; Andrei, Adin-Cristian; Molitch, Mark E

2013-01-01

154

Night eating in patients with type 2 diabetes. Associations with glycemic control, eating patterns, sleep, and mood.  

PubMed

Night eating is a complex behavior associated with disruptions in eating, sleep, and mood regulation. While night eating has been associated with alterations in neuroendocrine functioning, night eating and Night Eating Syndrome (NES) are not well understood in patients with prevalent metabolic conditions, such as diabetes. In this study, 194 adults with Type 2 diabetes completed questionnaires assessing night eating symptoms as well as eating, sleep, and depressive symptoms. Glycemic control data, as measured by hemoglobin A1c (HbA1c), were gathered from patient medical charts. Results indicated that 7% of participants met criteria for NES. Increased symptoms of night eating were associated with poorer glycemic control and disruptions in eating, sleep, and mood, including significantly increased likelihood of having HbA1c levels >7% and endorsing clinical levels of depressive symptoms. Increasing understanding of the relationship between night eating and metabolic and psychosocial functioning in patients with diabetes may provide new avenues for treatment of these patients. PMID:24751916

Hood, Megan M; Reutrakul, Sirimon; Crowley, Stephanie J

2014-08-01

155

A Telemedicine System That Includes a Personal Assistant Improves Glycemic Control in Pump-Treated Patients with Type 1 Diabetes  

PubMed Central

Background The DIABTel system, a Web-based telemedicine application, integrates a whole communication system (glucometer, insulin pump, wireless hand-held assistant) for medical remote advice. We sought to evaluate, in terms of glycemic control, the DIABTel system in a randomized crossover clinical study. Methods Ten patients with type 1 diabetes [5 women, age 40.6 (21–62) years, diabetes duration 14.7 (3–52) years] were included. During the 4-week active phase, data sent by patients were analyzed by the physician and modifications of the basal rate and bolus were advised in the following 24 hours. During the control phase, patients sent glucose data without any feedback from the medical center. Results The mean numbers of daily glucose values and bolus sent by patients during the active period were 4.46 ± 0.91 and 4.58 ± 0.89, respectively. The personal digital assistant functionalities used more frequently by patients were (times per week) data visualization (8.1 ± 6.8), data download from the insulin pump (6.8 ± 3.3), and synchronization with the telemedicine server (8.5 ± 4.9). After the experimental phase, serum fructosamine decreased significantly (393 ± 32 vs 366 ± 25 µmol/liter; p < 0.05) and hemoglobin A1c (HbA1c) tended to decrease (8.0 ± 0.6 vs 7.78 ± 0.6; p = 0.073), whereas no changes were observed during the control phase. The number of treatment modifications proposed and performed by the patients correlated with the change observed in HbA1c during the active phase (r = ?0.729, p = 0.017). Conclusions The DIABTel system, a telemedicine system that includes a wireless personal assistant for remote treatment advising, allows better glycemic control in pump-treated patients with type 1 diabetes. To our knowledge, this is the first study that demonstrates improved glycemic control with the use of a telemedicine system that incorporates insulin delivery data.

Rigla, Mercedes; Hernando, M. Elena; Gomez, Enrique J.; Brugues, Eulalia; Garcia-Saez, Gema; Torralba, Veronica; Prados, Agustina; Erdozain, Luisa; Vilaverde, Joana; de Leiva, Alberto

2007-01-01

156

The Effects of Free-Living Interval-Walking Training on Glycemic Control, Body Composition, and Physical Fitness in Type 2 Diabetic Patients  

PubMed Central

OBJECTIVE To evaluate the feasibility of free-living walking training in type 2 diabetic patients and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness, body composition, and glycemic control. RESEARCH DESIGN AND METHODS Subjects with type 2 diabetes were randomized to a control (n = 8), continuous-walking (n = 12), or interval-walking group (n = 12). Training groups were prescribed five sessions per week (60 min/session) and were controlled with an accelerometer and a heart-rate monitor. Continuous walkers performed all training at moderate intensity, whereas interval walkers alternated 3-min repetitions at low and high intensity. Before and after the 4-month intervention, the following variables were measured: VO2max, body composition, and glycemic control (fasting glucose, HbA1c, oral glucose tolerance test, and continuous glucose monitoring [CGM]). RESULTS Training adherence was high (89 ± 4%), and training energy expenditure and mean intensity were comparable. VO2max increased 16.1 ± 3.7% in the interval-walking group (P < 0.05), whereas no changes were observed in the continuous-walking or control group. Body mass and adiposity (fat mass and visceral fat) decreased in the interval-walking group only (P < 0.05). Glycemic control (elevated mean CGM glucose levels and increased fasting insulin) worsened in the control group (P < 0.05), whereas mean (P = 0.05) and maximum (P < 0.05) CGM glucose levels decreased in the interval-walking group. The continuous walkers showed no changes in glycemic control. CONCLUSIONS Free-living walking training is feasible in type 2 diabetic patients. Continuous walking offsets the deterioration in glycemia seen in the control group, and interval walking is superior to energy expenditure–matched continuous walking for improving physical fitness, body composition, and glycemic control.

Karstoft, Kristian; Winding, Kamilla; Knudsen, Sine H.; Nielsen, Jens S.; Thomsen, Carsten; Pedersen, Bente K.; Solomon, Thomas P.J.

2013-01-01

157

Evaluation of glutathione S-transferase P1 genetic variants affecting type-2 diabetes susceptibility and glycemic control  

PubMed Central

Introduction Type 2 diabetes mellitus (T2DM) is associated with increased production of reactive oxygen species and a reduction in antioxidant defenses leading to oxidative stress. Glutathione S-transferases (GSTs) modulate oxidative stress. The present cross-sectional study was aimed at investigating the association between the GSTP1 gene polymorphism and T2DM and to clarify their effect on the glycemic control parameters. Material and methods From the Egyptian population, we enrolled 112 T2DM patients and 188 healthy controls matched for age, sex and origin. Serum lipid profile, blood-glucose level, glycated hemoglobin (HbA1c) and body mass index (BMI) were measured. DNA was extracted from the blood samples. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to measure GSTP1 Ile105Val gene polymorphism of study participants. Results The frequency of the Val allele in exon 5 of the GSTP1 gene in patients with T2DM was higher than that observed in healthy controls (15.2% vs. 9.6%); the difference was considered statistically significant when compared to Ile allele carriers (p = 0.03). The presence of the GSTP1 heterozygous mutant allele Ile/Val was more common in subjects with T2DM than in the control group (30.4% and 19.2%, respectively; p = 0.02). Variation in the GSTP1 gene was associated with BMI (p = 0.02) and not associated with glycemic control parameters (fasting serum glucose and HbA1c) or smoking-related risk of T2DM. Conclusions GSTP1 gene polymorphism may play a significant role in increasing the susceptibility to and risk of T2DM and obesity regardless of smoking status and had no apparent effect on HbA1c in patients with diabetes mellitus.

Amer, Mahmoud A.; Abo-ElMatty, Dina M.; Abou-El-Ela, Soad H.

2012-01-01

158

The status of glycemic control: A cross-sectional study of outpatients with type 2 diabetes mellitus across primary, secondary, and tertiary hospitals in the jiangsu province of China  

Microsoft Academic Search

Objectives: The aims of the study were to determine the following: the status of glycemic control in patients with type 2 diabetes mellitus (DM) at primary, secondary, and tertiary hospitals in the Jiangsu province of China; and the factors associated with achieving glyce-mic targets.Methods: This study, in which patients were enrolled from July 20 to 31, 2009, at 56 diabetes

Yan Bi; Dalong Zhu; Jinluo Cheng; Yan Zhu; Ning Xu; Shiwei Cui; Wei Li; Xingbo Cheng; Fei Wang; Yun Hu; Shanmei Shen; Jianping Weng

2010-01-01

159

Raloxifene Does Not Affect Insulin Sensitivity or Glycemic Control in Postmenopausal Women with Type 2 Diabetes Mellitus: A Randomized Clinical Trial  

Microsoft Academic Search

Little is known about the metabolic or cardiovascular effects of selective ER modulators (SERMs), such as raloxifene hy- drochloride (RLX), in postmenopausal women with type 2 di- abetes mellitus (DM). Therefore, the effect of RLX vs. placebo (PL) on glycemic control, insulin sensitivity, as well as effects on a number of hormone, lipid, coagulation, and safety factors were determined in

BJORN ANDERSSON; GUDMUNDUR JOHANNSSON; GORAN HOLM; BENGT-AKE BENGTSSON; ANDREAS SASHEGYI; IMRE PAVO; TIMOTHY MASON; PAMELA W. ANDERSON

160

Effect of the glycemic control on intracellular cytokine production from peripheral blood mononuclear cells of type 1 and type 2 diabetic patients  

Microsoft Academic Search

AimsTo evaluate the intracellular production of tumor necrosis factor (TNF-?), interleukine-6 (IL-6), INF-?, IL-8 and IL-10 in peripheral blood lymphomononuclear cells from type 1 and type 2 diabetic patients, stratified according to the glycemic control.

M. C. Foss-Freitas; N. T. Foss; E. A. Donadi; M. C. Foss

2008-01-01

161

Effects of Pioglitazone and rosiglitazone on blood lipid levels and glycemic control in patients with type 2 diabetes mellitus: A retrospective review of randomly selected medical records  

Microsoft Academic Search

Background: The antihyperglycemic effects of pioglitazone hydrochloride and rosiglitazone maleate are well documented. The results of clinical trials and observational studies have suggested, however, that there are individual differences in the effects of these drugs on blood lipid levels.Objective: The present study evaluated the effects of pioglitazone and rosiglitazone on blood lipid levels and glycemic control in patients with type

Patrick J. Boyle; Allen Bennett King; Leann Olansky; Albert Marchetti; Helen Lau; Raf Magar; John Martin

2002-01-01

162

Optimizing glycemic control and minimizing the risk of hypoglycemia in patients with type 2 diabetes  

PubMed Central

Diabetic microvascular and macrovascular complications arise from hyperglycemia, presenting an increasing healthcare burden as the diabetic population continues to grow. Clinical trial evidence indicates that antihyperglycemic medications are beneficial with regard to microvascular disease (retinopathy, renal impairment, and perhaps neuropathy); however, the benefit of aggressive use of these medications with regard to cardiovascular risk has been less clear in recent studies. These studies were confounded by the propensity of the antihyperglycemic medications involved to cause hypoglycemia, which itself presents cardiovascular risk. This article presents additional context for these seemingly discordant results and maintains that the achievement of glycemic targets is warranted in most patients and provides cardiovascular benefit, provided that hypoglycemia is avoided and the treatment regimen is tailored to the needs of the individual patient. A treatment approach that is driven by these principles and emphasizes diet and exercise, a combination of noninsulin antidiabetic agents, not including sulfonylureas and glinides, and judicious use of insulin is also presented.

Schwartz, Stanley S

2013-01-01

163

[Indicators of glycemic control --hemoglobin A1c (HbA1c), glycated albumin (GA), and 1,5-anhydroglucitol (1,5-AG)].  

PubMed

The clinical goal of diabetes management is a good quality of life that is not different from that of a healthy subjects. To fulfill the goal, prevention of complications is needed under good glycemic control. Although blood glucose measurement is essential for glycemic control, there are diurnal variations in blood glucose levels. An indicator of long-term glycemic control is necessary. HbA1c is the gold standard measurement for the assessment of glycemic control, and worldwide large scale clinical studies of diabetes complications have greatly valued HbA1c as an indicator of glycemic control. In addition, recently, HbA1c was recommended for use in the diagnosis of diabetes in Japan and in the United States. Although HbA1c is used widely and internationally, international standardization of the HbA1c value has not been achieved. In Japan, from April 2014, it has been decided to adopt the National Glycohemoglobin Standardization Program (NGSP) value, which is used by many countries globally, as the first step toward internationalization. Recently, cardiovascular disease in diabetic patients has been increasing in Japan. Relationships between postprandial hyperglycemia and cardiovascular disease have been noted. Therefore, the correction of postprandial hyperglycemia is one of the important goals of glycemic control to prevent cardiovascular disease. HbA1c or glycated albumin (GA) results from the glycation of hemoglobin or serum albumin and represents 2-month or 2-week glycemia, respectively. In addition, the glycation speed of GA is ten times faster than HbA1c, so GA is likely to reflect the variation in blood glucose and postprandial hyperglycemia in combination with HbA1c and its value. 1,5-anhydroglucitol (AG) is a marker of glycemia-induced glycosuria, since reabsorption of filtered 1,5-AG in the proximal tubule is competitively inhibited by glucose. It is an indicator to identify rapid changes in hyperglycemia. Understanding the characteristics of the indicators above, it is important to use them suitably for each diabetes subject and to recognize glycemic control conditions more accurately. PMID:24724426

Sato, Asako

2014-01-01

164

Successful implementation of a perioperative glycemic control protocol in cardiac surgery: barrier analysis and intervention using lean six sigma.  

PubMed

Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200?mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200?mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218

Martinez, Elizabeth A; Chavez-Valdez, Raul; Holt, Natalie F; Grogan, Kelly L; Khalifeh, Katherine W; Slater, Tammy; Winner, Laura E; Moyer, Jennifer; Lehmann, Christoph U

2011-01-01

165

Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma  

PubMed Central

Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200?mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200?mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.

2011-01-01

166

The negative effects of obesity and poor glycemic control on cognitive function: a proposed model for possible mechanisms.  

PubMed

Obesity has reached epidemic proportions and is a contributor to many adverse health outcomes, including increased risk for dementia and adverse structural and functional brain changes. Milder forms of cognitive impairment in multiple domains can also be found in obese individuals of all ages that are believed to stem from brain abnormalities long prior to onset of neurologic conditions such as dementia. However, the mechanisms for adverse brain changes and subsequent cognitive dysfunction in obesity are complex and poorly understood. This paper proposes a possible etiologic model for obesity associated cognitive impairment with emphasis on the role of poor glycemic control and conditions like type 2 diabetes mellitus. Clinical implications associated with treatment of obesity in persons with cognitive deficits in addition to the cognitive promoting effects of weight loss surgery are also discussed. PMID:24752836

Alosco, Michael L; Gunstad, John

2014-06-01

167

Association of IGF1 with glycemic control and occurrence of severe hypoglycemia in patients with type 1 diabetes mellitus  

PubMed Central

Objective GH is implicated in the counter-regulatory response to hypoglycemia. We tested whether IGF1 levels are associated with occurrence of severe hypoglycemic events in patients with type 1 diabetes and whether the IGF1 concentration is influenced by glycemic control. Methods A total of 228 outpatients with type 1 diabetes were included in a post hoc analysis of a 1-year observational study on severe hypoglycemia. Serum total IGF1 was measured at entry into the study. The occurrence of severe episodes of hypoglycemia, mild symptomatic, and biochemical as well as hypoglycemia awareness status was assessed. Also patients were included in a multiple regression analysis to investigate the role of HbA1c in the IGF1 concentration. Results IGF1 levels were associated with neither severe hypoglycemia in the entire cohort (P=0.30) nor in any gender nor when confining the analysis to those with long-standing diabetes (>20 years) (n=112, P=0.68) and those with both long-standing diabetes and undetectable C-peptide (n=51, P=0.067). Levels of IGF1 were associated with neither mild symptomatic hypoglycemia (P=0.24) nor biochemical hypoglycemia (0.089) nor hypoglycemia awareness (P=0.16). At a multiple regression analysis, HbA1c was negatively associated with IGF1 (P=0.001). Conclusion In type 1 diabetes, circulating IGF1 levels are negatively associated with glycemic control. However, IGF1 levels were not associated with occurrence of hypoglycemia or hypoglycemia awareness in these patients.

Faerch, Louise; Juul, Anders; Pedersen-Bjergaard, Ulrik; Thorsteinsson, Birger

2012-01-01

168

Risk Factors for Childhood Overweight in Offspring of Type 1 Diabetic Women With Adequate Glycemic Control During Pregnancy  

PubMed Central

OBJECTIVE Pregnancy in type 1 diabetic women remains a high-risk situation for both mother and child. In this study, we investigated long-term effects on body composition, prevalence of overweight, and insulin resistance in children of type 1 diabetic women who had had adequate glycemic control during pregnancy (mean A1C 6.2%), and we related their outcome to perinatal factors, including macrosomia (birth weight >90th percentile). RESEARCH DESIGN AND METHODS Anthropometric measurements were performed at 6–8 years of age in 213 offspring of type 1 diabetic mothers who participated in a previous nationwide study. Homeostasis model assessment of insulin resistance (HOMA-IR) was determined from a fasting blood sample in 155 of these children. In addition, we studied BMI standard deviation score (SDS) growth trajectories. Results were compared with national reference data. RESULTS The prevalence of overweight in the study population was not different from that in the reference population. However, children who were born macrosomic showed twice as much overweight as nonmacrosomic children. Macrosomia and maternal overweight were independent predictors of childhood overweight. Overweight children showed an increase in BMI SDS starting already after 6 months of age and had a significantly increased HOMA-IR. CONCLUSIONS In type 1 diabetic women with adequate glycemic control during pregnancy, long-term effects on body composition and overweight in their offspring at school age are limited and related mainly to macrosomia at birth. Possible targets for prevention of childhood overweight are fetal macrosomia, maternal overweight, and an increase in BMI SDS during the first years of life.

Rijpert, Maarten; Evers, Inge M.; de Vroede, Monique A.M.J.; de Valk, Harold W.; Heijnen, Cobi J.; Visser, Gerard H.A.

2009-01-01

169

Trajectories in Glycemic Control over Time Are Associated with Cognitive Performance in Elderly Subjects with Type 2 Diabetes  

PubMed Central

Objective To study the relationships of long-term trajectories of glycemic control with cognitive performance in cognitively normal elderly with type 2 diabetes (T2D). Methods Subjects (n?=?835) pertain to a diabetes registry (DR) established in 1998 with an average of 18 HbA1c measurements per subject, permitting identification of distinctive trajectory groups of HbA1c and examining their association with cognitive function in five domains: episodic memory, semantic categorization, attention/working memory, executive function, and overall cognition. Analyses of covariance compared cognitive function among the trajectory groups adjusting for sociodemographic, cardiovascular, diabetes-related covariates and depression. Results Subjects averaged 72.8 years of age. Six trajectories of HbA1c were identified, characterized by HbA1c level at entry into the DR (Higher/Lower), and trend over time (Stable/Decreasing/Increasing). Both groups with a trajectory of decreasing HbA1c levels had high HbA1c levels at entry into the DR (9.2%, 10.7%), and high, though decreasing, HbA1c levels over time. They had the worst cognitive performance, particularly in overall cognition (p<0.02) and semantic categorization (p<0.01), followed by that of subjects whose HbA1c at entry into the DR was relatively high (7.2%, 7.8%) and increased over time. Subjects with stable HbA1c over time had the lowest HbA1c levels at entry (6.0%, 6.8%) and performed best in cognitive tests. Conclusion Glycemic control trajectories, which better reflect chronicity of T2D than a single HbA1c measurement, predict cognitive performance. A trajectory of stable HbA1c levels over time is associated with better cognitive function.

Ravona-Springer, Ramit; Heymann, Anthony; Schmeidler, James; Moshier, Erin; Godbold, James; Sano, Mary; Leroith, Derek; Johnson, Sterling; Preiss, Rachel; Koifman, Keren; Hoffman, Hadas; Silverman, Jeremy M.; Beeri, Michal Schnaider

2014-01-01

170

Adding glimepiride to current insulin therapy increases high-molecular weight adiponectin levels to improve glycemic control in poorly controlled type 2 diabetes  

PubMed Central

Background To observe the efficacy and safety of adding glimepiride to established insulin therapy in poorly controlled type 2 diabetes (T2D) and to assess the relationship of changes in the serum high-molecular weight (HMW) adiponectin levels and glycemic control after glimepiride treatment. Methods Fifty-six subjects with poorly controlled insulin-treated T2D were randomly assigned to either the glimepiride-added group (the group A, n?=?29) or the insulin-increasing group (the group B, n?=?27) while continuing current insulin-based therapy. Glycosylated hemoglobin (HbA1c) value, daily insulin dose, body weight, waist circumference, plasma lipid concentration, serum HMW adiponectin level and the number of hypoglycemic events were evaluated before and after treatment. Results At the end of study, insulin doses were significantly reduced, and the mean HbA1c, fasting blood glucose (FBG) and 2-hour postprandial blood glucose (P2BG) were improved greater in the group A compared with the group B. The serum HMW adiponectin levels were significantly increased in the group A compared with the group B. Most importantly, we found that changes in HbA1c were inversely correlated with changes in serum HMW adiponectin in the group A (r?=??0.452, p?=?0.02). Conclusions Adding glimepiride to current insulin treatment led to better improvement in glycemic control with a significant smaller daily insulin dose, and the increases in the serum HMW adiponectin levels may directly contribute to improvement glycemic control.

2014-01-01

171

Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study  

PubMed Central

Introduction Hyperglycemia, hypoglycemia, and increased glycemic variability have each been independently associated with increased risk of mortality in critically ill patients. The role of diabetic status on modulating the relation of these three domains of glycemic control with mortality remains uncertain. The purpose of this investigation was to determine how diabetic status affects the relation of hyperglycemia, hypoglycemia, and increased glycemic variability with the risk of mortality in critically ill patients. Methods This is a retrospective analysis of prospectively collected data involving 44,964 patients admitted to 23 intensive care units (ICUs) from nine countries, between February 2001 and May 2012. We analyzed mean blood glucose concentration (BG), coefficient of variation (CV), and minimal BG and created multivariable models to analyze their independent association with mortality. Patients were stratified according to the diagnosis of diabetes. Results Among patients without diabetes, mean BG bands between 80 and 140 mg/dl were independently associated with decreased risk of mortality, and mean BG bands >140 mg/dl, with increased risk of mortality. Among patients with diabetes, mean BG from 80 to 110 mg/dl was associated with increased risk of mortality and mean BG from 110 to 180 mg/dl with decreased risk of mortality. An effect of center was noted on the relation between mean BG and mortality. Hypoglycemia, defined as minimum BG <70 mg/dl, was independently associated with increased risk of mortality among patients with and without diabetes and increased glycemic variability, defined as CV >20%, was independently associated with increased risk of mortality only among patients without diabetes. Derangements of more than one domain of glycemic control had a cumulative association with mortality, especially for patients without diabetes. Conclusions Although hyperglycemia, hypoglycemia, and increased glycemic variability is each independently associated with mortality in critically ill patients, diabetic status modulates these relations in clinically important ways. Our findings suggest that patients with diabetes may benefit from higher glucose target ranges than will those without diabetes. Additionally, hypoglycemia is independently associated with increased risk of mortality regardless of the patient's diabetic status, and increased glycemic variability is independently associated with increased risk of mortality among patients without diabetes. See related commentary by Krinsley, http://ccforum.com/content/17/2/131 See related commentary by Finfer and Billot, http://ccforum.com/content/17/2/134

2013-01-01

172

Accelerated Insulin Pharmacokinetics and Improved Postprandial Glycemic Control in Patients With Type 1 Diabetes After Coadministration of Prandial Insulins With Hyaluronidase  

PubMed Central

OBJECTIVE To compare the pharmacokinetics, pharmacodynamics, and safety of insulin lispro or regular human insulin (RHI) with or without recombinant human hyaluronidase (rHuPH20) administered before a standardized meal. RESEARCH DESIGN AND METHODS In this four-way, crossover study, 22 patients with type 1 diabetes received injections of individually optimized doses of lispro or RHI with and without rHuPH20 before a liquid meal. RESULTS With rHuPH20 coadministration, early insulin exposure (0–60 min) increased by 54% (P = 0.0011) for lispro and 206% (P < 0.0001) for RHI compared with the respective insulin alone. Peak blood glucose decreased 26 mg/dL for lispro (P = 0.002) and 24 mg/dL for RHI (P = 0.017), reducing hyperglycemic excursions (area under the curve for blood glucose >140 mg/dL) by 79% (P = 0.09) and 85% (P = 0.049), respectively. Rates of hypoglycemia were comparable for lispro with or without rHuPH20, whereas coadministration of RHI and rHuPH20 reduced hypoglycemia. CONCLUSIONS Lispro or RHI with rHuPH20 produced earlier and greater peak insulin concentrations and improved postprandial glycemic control.

Hompesch, Marcus; Muchmore, Douglas B.; Morrow, Linda; Vaughn, Daniel E.

2011-01-01

173

Dietary glycemic index and glycemic load in relation to HbA1c in Japanese obese adults: a cross-sectional analysis of the Saku Control Obesity Program  

PubMed Central

Background Dietary glycemic index or load is thought to play an important role in glucose metabolism. However, few studies have investigated the relation between glycemic index (GI) or load (GL) and glycemia in Asian populations. In this cross-sectional analysis of a randomized controlled trial, the Saku Control Obesity Program, we examined the relation between the baseline GI or GL and glycemia (HbA1c and fasting plasma glucose [FPG] levels), insulin resistance (HOMA-IR), ?-cell function (HOMA-?), and other metabolic risk factors (lipid levels, diastolic and systolic blood pressure, and adiposity measures). Methods The participants were 227 obese Japanese women and men. We used multiple linear regression models and logistic regression models to adjust for potential confounding factors such as age, sex, visceral fat area, total energy intake, and physical activity levels. Results After adjustments for potential confounding factors, GI was not associated with HbA1c, but GL was positively associated with HbA1c. For increasing quartiles of GI, the adjusted mean HbA1c were 6.3%, 6.7%, 6.4%, and 6.4% (P for trend?=?0.991). For increasing quartiles of GL, the adjusted mean HbA1c were 6.2%, 6.2%, 6.6%, and 6.5% (P for trend?=?0.044). In addition, among participants with HbA1c???7.0%, 20 out of 28 (71%) had a high GL (? median); the adjusted odds ratio for HbA1c???7.0% among participants with higher GL was 3.1 (95% confidence interval [CI]?=?1.2 to 8.1) compared to the participants with a lower GL (glycemic control tend to have a higher GL in an obese Japanese population.

2012-01-01

174

The Challenges of Measuring Glycemic Variability  

PubMed Central

This commentary reviews several of the challenges encountered when attempting to quantify glycemic variability and correlate it with risk of diabetes complications. These challenges include (1) immaturity of the field, including problems of data accuracy, precision, reliability, cost, and availability; (2) larger relative error in the estimates of glycemic variability than in the estimates of the mean glucose; (3) high correlation between glycemic variability and mean glucose level; (4) multiplicity of measures; (5) correlation of the multiple measures; (6) duplication or reinvention of methods; (7) confusion of measures of glycemic variability with measures of quality of glycemic control; (8) the problem of multiple comparisons when assessing relationships among multiple measures of variability and multiple clinical end points; and (9) differing needs for routine clinical practice and clinical research applications.

Rodbard, David

2012-01-01

175

Permanent Neonatal Diabetes Mellitus: Same Mutation, Different Glycemic Control with Sulfonylurea Therapy on Long-Term Follow-up  

PubMed Central

Permanent neonatal diabetes mellitus (PNDM) is a rare condition presenting before six months of age. Mutations in the genes encoding the ATP-sensitive potassium (KATP) channel are the most common causes. Sulfonylurea (SU) therapy leads to dramatic improvement in diabetes control and quality of life in most patients who carry these mutations. Here, we report the long-term follow-up results of two siblings with PNDM who were treated with insulin until ABCC8 gene mutation was identified, and were successfully transferred to oral SU therapy. After 3.5 years of follow-up on SU, one patient had a very good response, while the other one had a poor response. Bad compliance to diet was thought to be the most probable reason for poor glycemic control in this patient. In conclusion, molecular genetic diagnosis in all patients with PNDM is recommended. Compliance to treatment should be an important aspect of the follow-up of these patients. Conflict of interest:None declared.

Bundak, Ruveyde; Bas, Firdevs; Maras, Hulya; Saka, Nurcin; Gunoz, Hulya; Darendeliler, Feyza

2012-01-01

176

The Combined Deletion of S6K1 and Akt2 Deteriorates Glycemic Control in a High-Fat Diet  

PubMed Central

Signaling downstream of mechanistic target of rapamycin complexes 1 and 2 (mTORC1 and mTORC2) controls specific and distinct aspects of insulin action and nutrient homeostasis in an interconnected and as yet unclear way. Mice lacking the mTORC1 substrate S6 kinase 1 (S6K1) maintain proper glycemic control with a high-fat diet. This phenotype is accompanied by insulin hypersensitivity, Akt- and AMP-activated kinase upregulation, and increased lipolysis in adipose tissue and skeletal muscle. Here, we show that, when S6K1 inactivation is combined with the deletion of the mTORC2 substrate Akt2, glucose homeostasis is compromised due to defects in both insulin action and ?-cell function. After a high-fat diet, the S6K1?/? Akt2?/? double-mutant mice do not become obese, though they are severely hyperglycemic. Our data demonstrate that S6K1 is required for pancreatic ?-cell growth and function during adaptation to insulin resistance states. Strikingly, the inactivation of two targets of mTOR and phosphatidylinositol 3-kinase signaling is sufficient to reproduce major hallmarks of type 2 diabetes.

Treins, Caroline; Alliouachene, Samira; Hassouna, Rim; Xie, Yun; Birnbaum, Morris J.

2012-01-01

177

Post hoc analysis of data from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial on the effects of three years of raloxifene treatment on glycemic control and cardiovascular disease risk factors in women with and without type 2 diabetes  

Microsoft Academic Search

Background: The long-term effects of the selective estrogen-receptor modulator raloxifene hydrochloride on glycemic control and markers of cardiovascular disease risk in postmenopausal women with type 2 diabetes mellitus are unknown.Objective: The aim of this analysis was to compare the effects of 3-year treatment with raloxifene 60 mg\\/d versus placebo on glycemic control and markers of cardiovascular disease risk in osteoporotic

Elizabeth Barrett-Connor; Kristine E. Ensrud; Kristine Harper; Timothy M. Mason; Andreas Sashegyi; Kathryn A. Krueger; Pamela W. Anderson

2003-01-01

178

Effect of two dietary fibers on satiety and glycemic parameters: a randomized, double-blind, placebo-controlled, exploratory study  

PubMed Central

Background Dietary carbohydrates may affect metabolic and physiologic parameters. The present study evaluated whether a combination of two dietary fibers, oligofructose (OFS) and pectin (P), altered satiety and glycemic parameters. The primary objective of this study was to determine whether dietary supplementation for 3 weeks with OFS?+?P would produce a greater reduction in energy intake of an ad libitum test meal compared to control. Methods This was a single center, randomized, double-blind, placebo-controlled, parallel group study in overweight and obese, otherwise healthy, subjects (N?=?96). There were two OFS?+?P treatment groups: high-dose (30 g/d), low-dose (15 g/d), and a control group (maltodextrin 15 g/d). Energy intake, appetite measures based on Satiety Labeled Intensity Magnitude (SLIM) scale, fasting and post-prandial glucose, and insulin levels and body weight were measured at baseline and at the end of 3 weeks. Adverse events and gastrointestinal tolerability of the treatments were also assessed. Results An analysis of covariance (ANCOVA) performed on the primary endpoint change from baseline in energy intake, showed no statistically significant difference in energy intake among the three treatment groups (p?=?0.5387). The LS mean changes (SE) in energy intake from baseline to week 3 were ?58.3 (42.4) kilocalories (kcal) for the high dose group, ?74.2 (43.6) kcal for the low dose group, and ?9.0 (42.9) kcal for the control group. For the pairwise comparisons of OFS?+?P doses and control, confidence intervals were constructed around the difference in LS mean changes. All study products were generally well tolerated. Conclusion There was a directional benefit in ad libitum energy intake for both OFS?+?P doses compared to control, with a greater reduction in kilocalories in the low dose comparison, but the reductions were not significant. Further studies are warranted. Clinical trial registration GSK Clinical Study Register # W7781293

2014-01-01

179

A comparison of insulin use, glycemic control, and health care costs with insulin detemir and insulin glargine in insulin-naive patients with type 2 diabetes  

Microsoft Academic Search

Objectives: The goal of this study was to compare daily insulin use, glycemic control, and health care costs in insulin-naive patients with type 2 diabetes who initiated treatment with either insulin detemir or insulin glargine.Methods: This was a retrospective cohort analysis of health care claims data and laboratory results for adult, insulin-naive patients with type 2 diabetes who were enrolled

Bijan J. Borah; Theodore Darkow; Jonathan Bouchard; Mark Aagren; Felicia Forma; Berhanu Alemayehu

2009-01-01

180

Effects of insulin glargine versus metformin on glycemic variability, microvascular and beta-cell function in early type 2 diabetes.  

PubMed

We investigated whether basal insulin as first-line treatment in recently diagnosed type 2 diabetes (T2D) can improve glucose control, microvascular function and preserve insulin secretion in comparison with metformin (MET). In this open-label, randomized, prospective 36-week study, 75 patients (44 m, 31 f, mean age 60.7 ± 9.2 year) were allocated to treatment with either MET 1,000 mg b.i.d. (n = 36) or insulin glargine (GLA) at bedtime (n = 39). At baseline and study end, we performed a continuous glucose monitoring for assessment of interstitial glucose (IG) and measured microvascular function using Laser-Doppler fluxmetry. GLA versus MET treatment resulted in a more pronounced reduction in FPG (?: 3.1 ± 2.5 vs. 1.4 ± 1.5 mmol/l; p < 0.001) and overall IG (? AUC. 671 ± 507 vs. 416 ± 537 mmol/l min; p = 0.04). Postprandial PG and IG differences after a standardized test meal did not reach significance. Proinsulin/C-peptide and HOMA B as marker of endogenous insulin secretion were significantly more improved by GLA. Microvascular blood flow improved only in MET-treated patients. Early basal insulin treatment with GLA in T2D patients provided a better control of FPG, overall IG load and biomarker of beta-cell function compared to the standard treatment with MET. MET treatment resulted in an improvement of microvascular function. Studies of longer duration are needed to evaluate the durability of glucose control and ? cell protection with early GLA treatment. PMID:23430192

Pistrosch, F; Köhler, C; Schaper, F; Landgraf, W; Forst, T; Hanefeld, M

2013-08-01

181

The utility of hemoglobin A1c at diagnosis for prediction of future glycemic control in children with type 1 diabetes  

PubMed Central

Introduction We evaluated the relationships of hemoglobin A1c (A1c) at diagnosis of type 1 diabetes (T1DM) to future glycemic control and to a series of clinical variables in children with T1DM. Materials and methods Patients <18 years old diagnosed with T1DM during a one year period who had an A1c at diagnosis and at least one follow-up visit at our center were eligible for inclusion. Baseline variables examined included age, race, gender, symptom duration, admission acuity, anthropometrics, bicarbonate, and A1c. Annual anthropometric and A1c data were also obtained from clinic visits through 4 years after diagnosis. Results We identified 120 children (53 males). Mean age at diagnosis was 7.6 ± 3.9 years. Mean A1c at diagnosis was 10.9 ± 1.9%. A1c at diagnosis correlated with age at diagnosis, symptom duration, and A1c at 3-years, with trends towards correlations at 6 weeks and 4 years. A1c at 1 year correlated highly with A1c at subsequent visits. No other baseline variables correlated with subsequent glycemic control. Conclusions In children with newly diagnosed diabetes, A1cs at diagnosis and one year post diagnosis are related to subsequent glycemic control. Children with high A1cs particularly at one year post diagnosis may benefit from targeted intensification of resources.

Viswanathan, Vidhya; Sneeringer, M. Rhonda; Miller, Adam; Eugster, Erica A.; DiMeglio, Linda A.

2014-01-01

182

The potent synergistic effects of the combination of liraglutide and canagliflozin on glycemic control and weight loss  

PubMed Central

Patient: Male, 57 Final Diagnosis: Diabetes mellitus type 2 Symptoms: Weight loss Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual or unexpected effect of treatment Background: Studies of the efficacy of the combination of the incretin mimetic liraglutide and the SGLT2 inhibitor canagliflozin or indeed studies of the combination of any incretin mimetic with an SGLT2 inhibitor have neither been performed nor published. Pharmacologically, the combination of an incretin-mimetic and an SGLT2-receptor blocker should result in a more significant weight loss and a greater reduction in postprandial glucose and HbA1c. Case Report: An insulin-dependent type 2 diabetic patient with multiple diabetic complications was placed on the combination of liraglutide and canagliflozin and 4 weeks later was able to discontinue insulin. In addition, in spite of discontinuing insulin, his HbA1c dropped from 7.0% to 6.8%, and he had reductions in body (weight from 247 to 218 lbs), BMI (from 34 to 29.5 Kg/m2), waist circumference (from 47 to 44 ½ inches), and neck circumference (from 19 ½ to 18 ¼ inches). Conclusions: The combination of an SGLT2 inhibitor and an incretin mimetic/analog results in improved glycemic control accompanied by significant weight loss. This combination needs to be studied in a prospective randomized trial because the effect of each of the components of this combination is synergistically magnified by the addition of the partner drug.

Bell, David S.H.

2014-01-01

183

Role of Motivation in the Relationship between Depression, Self-Care, and Glycemic Control in Adults with Type 2 Diabetes  

PubMed Central

Objective The mechanism by which depression influences health outcomes in persons with diabetes is uncertain. The purpose of this study was to test whether depression is related to self-care behavior via social motivation; and indirectly related to glycemic control via self-care behavior. Methods Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, depression, diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the predicted pathways. Results Higher levels of depressive symptoms were significantly related to having less social support, and decreased performance of diabetes self-care behavior. In addition, when depressive symptoms were included in the model, fatalistic attitudes were no longer associated with behavioral performance. Conclusions Among adults with diabetes, depression impedes the adoption of effective self-management behaviors (including physical activity, appropriate dietary behavior, and appropriate self-monitoring of blood glucose behavior) through a decrease in social motivation.

Egede, Leonard E.; Osborn, Chandra Y.

2011-01-01

184

Hydrogen Improves Glycemic Control in Type1 Diabetic Animal Model by Promoting Glucose Uptake into Skeletal Muscle  

PubMed Central

Hydrogen (H2) acts as a therapeutic antioxidant. However, there are few reports on H2 function in other capacities in diabetes mellitus (DM). Therefore, in this study, we investigated the role of H2 in glucose transport by studying cultured mouse C2C12 cells and human hepatoma Hep-G2 cells in vitro, in addition to three types of diabetic mice [Streptozotocin (STZ)-induced type 1 diabetic mice, high-fat diet-induced type 2 diabetic mice, and genetically diabetic db/db mice] in vivo. The results show that H2 promoted 2-[14C]-deoxy-d-glucose (2-DG) uptake into C2C12 cells via the translocation of glucose transporter Glut4 through activation of phosphatidylinositol-3-OH kinase (PI3K), protein kinase C (PKC), and AMP-activated protein kinase (AMPK), although it did not stimulate the translocation of Glut2 in Hep G2 cells. H2 significantly increased skeletal muscle membrane Glut4 expression and markedly improved glycemic control in STZ-induced type 1 diabetic mice after chronic intraperitoneal (i.p.) and oral (p.o.) administration. However, long-term p.o. administration of H2 had least effect on the obese and non-insulin-dependent type 2 diabetes mouse models. Our study demonstrates that H2 exerts metabolic effects similar to those of insulin and may be a novel therapeutic alternative to insulin in type 1 diabetes mellitus that can be administered orally.

Amitani, Haruka; Asakawa, Akihiro; Cheng, Kaichun; Amitani, Marie; Kaimoto, Kaori; Nakano, Masako; Ushikai, Miharu; Li, Yingxiao; Tsai, Minglun; Li, Jiang-Bo; Terashi, Mutsumi; Chaolu, Huhe; Kamimura, Ryozo; Inui, Akio

2013-01-01

185

A Prospective Study of Variability in Glycemic Control during Different Phases of the Menstrual Cycle in Type 2 Diabetic Women Using High Sensitivity C - Reactive Protein  

PubMed Central

Introduction: Diabetes mellitus (DM) is one of the metabolic syndromes prevalent worldwide, with more concentration in the Asian region. Many studies have been conducted in order to understand the complex pathogenesis of this disease. Yet, there exists a lacuna in our knowledge about DM. This study aims at establishing the reason for glycemic variation in menstruating Type-2 diabetic women by estimation of C-reactive protein, an inflammatory marker that exhibits significant association with changes in blood glucose levels. Methodology: A prospective study was undertaken in Type-2 diabetic women of reproductive age group to assess the variability of glycemic control during different phases of menstrual cycle using high sensitivity C reactive protein (hs-CRP) as the biomarker. Fifty women were enrolled after satisfying a set of inclusion and exclusion criteria. The fasting blood glucose, hs-CRP concentration and endogenous female hormones were assayed in follicular and luteal phases of the cycle. The observed parameters were analyzed statistically for significant correlation. Observation and Result: The result showed that hs-CRP level significantly correlates with increasing levels of fasting blood glucose level in both the phases of menstrual cycle in Type-2 diabetic women. The significance is statistically stronger during luteal phase of the cycle (r = 0.807; p<0.05). The correlation observed between hs-CRP and Estrodiol in follicular phase (r = –0.311; p < 0.05) was not statistically significant. The hs-CRP level increased significantly with progesterone level during luteal phase (r = 0.826; p <0.05). Conclusion: This study concludes that Type-2 diabetic women of reproductive age group encounter a period of poor glycemic control during luteal phase, as shown by statistically high hs-CRP level mediated by endogenous progesterone hormone. Therefore, this study advocates careful monitoring, life style adjustments and drug regime to reduce the fluctuation in glycemic level experienced by Type-2 diabetic premenopausal women in the luteal phase.

Karthick, S.; Nagarjuna, B.

2014-01-01

186

Impact of Glycemic Control on Healthcare Resource Utilization and Costs of Type 2 Diabetes: Current and Future Pharmacologic Approaches to Improving Outcomes  

PubMed Central

Background The incidence and prevalence of type 2 diabetes continue to grow in the United States and worldwide, along with the growing prevalence of obesity. Patients with type 2 diabetes are at greater risk for comorbid cardiovascular (CV) disease (CVD), which dramatically affects overall healthcare costs. Objectives To review the impact of glycemic control and medication adherence on morbidity, mortality, and healthcare costs of patients with type 2 diabetes, and to highlight the need for new drug therapies to improve outcomes in this patient population. Methods This comprehensive literature search was conducted for the period between 2000 and 2013, using MEDLINE, to identify published articles that report the associations between glycemic control, medication adherence, CV morbidity and mortality, and healthcare utilization and costs. Search terms included “type 2 diabetes,” “adherence,” “compliance,” “nonadherence,” “drug therapy,” “resource use,” “cost,” and “cost-effectiveness.” Discussion Despite improvements in the management of CV risk factors in patients with type 2 diabetes, outcomes remain poor. The costs associated with the management of type 2 diabetes are increasing dramatically as the prevalence of the disease increases. Medication adherence to long-term drug therapy remains poor in patients with type 2 diabetes and contributes to poor glycemic control in this patient population, increased healthcare resource utilization and increased costs, as well as increased rates of comorbid CVD and mortality. Furthermore, poor adherence to established evidence-based guidelines for type 2 diabetes, including underdiagnosis and undertreatment, contributes to poor outcomes. New approaches to the treatment of patients with type 2 diabetes currently in development have the potential to improve medication adherence and consequently glycemic control, which in turn will help to reduce associated costs and healthcare utilization. Conclusions As the prevalence of type 2 diabetes and its associated comorbidities grows, healthcare costs will continue to increase, indicating a need for better approaches to achieve glycemic control and manage comorbid conditions. Drug therapies are needed that enhance patient adherence and persistence levels far above levels reported with currently available drugs. Improvements in adherence to treatment guidelines and greater rates of lifestyle modifications also are needed. A serious unmet need exists for greatly improved patient outcomes, more effective and more tolerable drugs, as well as marked improvements in adherence to treatment guidelines and drug therapy to positively impact healthcare costs and resource use.

Banerji, Mary Ann; Dunn, Jeffrey D.

2013-01-01

187

Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes  

PubMed Central

Background The purpose of this study was to evaluate the impact of symptomatic hypoglycemia on medication adherence, satisfaction with treatment, and glycemic control in patients with type 2 diabetes based on the treatment goals stated in the Swedish national guidelines. Methods This cross-sectional, multicenter study was carried out between January and August 2009 in 430 consecutive primary health care patients on stable doses of metformin and sulfonylureas for at least 6 months. The patients completed questionnaires covering their experiences of low blood glucose and adherence, as well as barriers to and satisfaction with drug treatment (using the Treatment Satisfaction Questionnaire for Medication). Physicians collected the data from medical records. Results Patients who experienced moderate or worse symptoms of hypoglycemia reported poorer adherence to medication (46% versus 67%; P<0.01) and were more likely to perceive barriers such as “bothered by medication side effects” (36% versus 14%; P<0.001) compared with patients with no or mild symptoms. Patients with moderate or worse symptoms of hypoglycemia were less satisfied with their treatment than those with no or mild symptoms as determined by the Treatment Satisfaction Questionnaire for Medication-Global satisfaction (67.0 versus 71.2; P<0.05). Overall, achievement of target glycated hemoglobin (HbA1c) based on the treatment goals stated in the Swedish national guidelines was 40%. Despite poorer adherence, patients who experienced moderate or worse symptoms of hypoglycemia had lower mean HbA1c values than patients with no or mild symptoms (7.0% versus 7.3% [Diabetes Control and Complications Trial standard]; P<0.05). Conclusion Symptomatic hypoglycemia in patients with type 2 diabetes on metformin and sulfonylureas was associated with nonadherence and decreased treatment satisfaction despite lower mean HbA1c values. A broader understanding of patient preferences and self-reported outcomes could improve the management of patients with type 2 diabetes.

Walz, Lotta; Pettersson, Billie; Rosenqvist, Ulf; Deleskog, Anna; Journath, Gunilla; Wandell, Per

2014-01-01

188

Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age?  

PubMed

The relationship between optimal levels of glycemic control and perinatal outcome was assessed in a prospective study of 334 gestational diabetic women and 334 subjects matched for control of obesity, race, and parity. All women with gestational diabetes mellitus were instructed in the use of a memory-based reflectance meter. They were treated with the same metabolic goal according to a predetermined protocol. Three groups were identified on the basis of mean blood glucose level throughout pregnancy (low, less than or equal to 86 mg/dl; mid, 87 to 104 mg/dl; and high, greater than or equal to 105 mg/dl). The low group had a significantly higher incidence of small-for-gestational-age infants (20%). In contrast, the incidence of large-for-gestational-age infants was 21-fold higher in the mean blood glucose category than in the low mean blood glucose category (24% vs. 1.4%, p less than 0.0001). An overall incidence of 11% small-for-gestational-age and 12% large-for-gestational-age infants was calculated for the control group. A significantly higher incidence of small-for-gestational-age infants (20% vs. 11%, p less than 0.001) was found between the control and the low category. In the high mean blood glucose category an approximate twofold increase was found in the incidence of large-for-gestational-age infants when compared with the control group (p less than 0.03). No significant difference was found between the control and mean blood glucose categories (87 to 104 mg/dl). Our data suggest that a relationship exists between level of glycemic control and neonatal weight. This information is helpful in targeting the level of glycemic control while optimizing pregnancy outcome in gestational diabetes comparable to the general population. PMID:2782347

Langer, O; Levy, J; Brustman, L; Anyaegbunam, A; Merkatz, R; Divon, M

1989-09-01

189

Effect of natural honey from Ilam and metformin for improving glycemic control in streptozotocin-induced diabetic rats  

PubMed Central

Objective(s): Diabetes mellitus is a public health problem and one of the five leading causes of death globally. In the present study, the effect of Metformin with natural honey was investigated on glycemia in the Streptozotocin-induced diabetic rats. Materials and Methods: Thirty Wistar male rats were randomly divided into six groups including C: non diabetic rats received distilled water, CH: non diabetic rats received honey, CD: diabetic rats administered with distilled water, DM: Metformin treated diabetic rats, DH: honey treated diabetic rats, and DMH: diabetic rats treated with a combination of Metformin and natural honey. Diabetes was induced by a single dose of Streptozotocin (65 mg/kg; i.p.). The animals were treated by oral gavage once daily for four weeks. At the end of the treatment period, the animals were sacrificed and their blood samples collected. Amount of glucose, triglyceride (TG), total cholesterol (TC), HDL cholesterol, LDL cholesterol, VLDL cholesterol, total bilirubin, and albumin were determined in serum. Results: Group CD: showed hyperglycemia (252.2±4.1 mg/dl), while level of blood glucose was significantly (p<0.01) reduced in groups DH (124.2±2.7 mg/dl), DM (108.0±3.4 mg/dl), and DMH (115.4±2.1 mg/dl). Honey in combination with Metformin significantly (p<0.01) reduced level of bilirubin but Metformin alone did not reduce bilirubin. Honey alone and in combination with Metformin also significantly reduced triglycerides, total cholesterol, LDL, VLDL and increased HDL, but Metformin did not reduced triglycerides and increased HDL. Conclusion: The results of the present study demonstrated that consuming natural honey with Metformin improves glycemic control and is more useful than consuming Metformin alone. The higher therapeutic effect of Ilam honey on lipid abnormalities than Tualang honey was also evident.

Nasrolahi, Ozra; Heidari, Reza; Rahmani, Fatima; Farokhi, Farah

2012-01-01

190

Hydrogen improves glycemic control in type1 diabetic animal model by promoting glucose uptake into skeletal muscle.  

PubMed

Hydrogen (H(2)) acts as a therapeutic antioxidant. However, there are few reports on H(2) function in other capacities in diabetes mellitus (DM). Therefore, in this study, we investigated the role of H(2) in glucose transport by studying cultured mouse C2C12 cells and human hepatoma Hep-G2 cells in vitro, in addition to three types of diabetic mice [Streptozotocin (STZ)-induced type 1 diabetic mice, high-fat diet-induced type 2 diabetic mice, and genetically diabetic db/db mice] in vivo. The results show that H(2) promoted 2-[(14)C]-deoxy-d-glucose (2-DG) uptake into C2C12 cells via the translocation of glucose transporter Glut4 through activation of phosphatidylinositol-3-OH kinase (PI3K), protein kinase C (PKC), and AMP-activated protein kinase (AMPK), although it did not stimulate the translocation of Glut2 in Hep G2 cells. H(2) significantly increased skeletal muscle membrane Glut4 expression and markedly improved glycemic control in STZ-induced type 1 diabetic mice after chronic intraperitoneal (i.p.) and oral (p.o.) administration. However, long-term p.o. administration of H(2) had least effect on the obese and non-insulin-dependent type 2 diabetes mouse models. Our study demonstrates that H(2) exerts metabolic effects similar to those of insulin and may be a novel therapeutic alternative to insulin in type 1 diabetes mellitus that can be administered orally. PMID:23326534

Amitani, Haruka; Asakawa, Akihiro; Cheng, Kaichun; Amitani, Marie; Kaimoto, Kaori; Nakano, Masako; Ushikai, Miharu; Li, Yingxiao; Tsai, Minglun; Li, Jiang-Bo; Terashi, Mutsumi; Chaolu, Huhe; Kamimura, Ryozo; Inui, Akio

2013-01-01

191

Conflicts of Interest among Authors of Clinical Practice Guidelines for Glycemic Control in Type 2 Diabetes Mellitus  

PubMed Central

Background Conflict of interest (COI) is an important potential source of bias in the development of clinical practice guidelines (CPGs). Objectives To examine rates of disclosure of COI, including financial interests in companies that manufacture drugs that are recommended in CPGs on glycemic control in type 2 diabetes mellitus, and to explore the relationship between recommendations for specific drugs in a guideline and author COI. Methods We identified a cohort of relevant guidelines from the National Guideline Clearinghouse (NGC) and abstracted COI disclosures from all guideline authors for this observational, cross-sectional study. We determined which hypoglycemic drugs were recommended in each guideline, and explored the relationship between specific disclosures and whether a drug was recommended. Results Among 13 included guidelines, the percentage of authors with one or more financial disclosures varied from 0 to 94% (mean 44.2%), and was particularly high for two US-based guidelines (91% and 94%). Three guidelines disclosed no author financial COI. The percentage of authors with disclosures of financial interests in manufacturers of recommended drugs was also high (mean 30%). On average, 56% of manufacturers of patented drugs recommended in each guideline had one or more authors with a financial interest in their company. We did not find a significant relationship between financial interests and whether a drug was recommended in our sample; US-based guidelines were more likely to make recommendations for a specific drug compared to non-US based guidelines. Discussion Authors of this cohort of guidelines have financial interests directly related to the drugs that they are recommending. Although we did not find an association between author COI and drugs recommended in these guidelines and we cannot draw conclusions about the validity of the recommendations, the credibility of many of these guidelines is in doubt.

Norris, Susan L.; Holmer, Haley K.; Ogden, Lauren A.; Burda, Brittany U.; Fu, Rongwei

2013-01-01

192

Clinical value of glycated hemoglobin and fructosamine in the long-term glycemic control of children with acute lymphoblastic leukemia.  

PubMed

Hyperglycemia in children with acute lymphoblastic leukemia (ALL) has been well documented in the literature. The purpose of the present study was to evaluate the clinical value of glycated hemoglobin (GHb) and fructosamine (Frc) in the long-term glycemic control of ALL patients. An attempt was made to identify the risk factors for hyperglycemia in ALL patients. The study group comprised 26 newly diagnosed ALL patients admitted to hospital during 1995-96. Patients with a history of blood transfusion or infection within the past 3 months were excluded from the study. White blood cell (WBC) counts, fasting blood glucose (FBG), GHb and Frc levels were analyzed in venous blood on screening day 0, before induction of chemotherapy. Frc analysis was repeated on the 21st day and GHb level on the 60th day of chemotherapy. FBG tests were performed before each dose of L-asparaginase, on days 21 and 60. None of the patients was obese. Although six children (23%) had hyperglycemia during the induction therapy, four of them had a GHb level higher than normal on admission. Only one patient who developed hyperglycemia had a family history of diabetes mellitus. Patients with a high initial WBC count (> 20 x 10(9)/L) had a significantly higher baseline GHb than patients with a WBC count below this level. GHb values returned to normal after achievement of complete remission. It is suggested that the leukemic process could impair glucose metabolism and baseline GHb may be used to monitor possible small changes in glucose homeostasis of ALL patients, prior to chemotherapy. PMID:9583201

Yetgin, S; Yalçin, S S; Ozbek, N

1998-02-01

193

Effect of the carbohydrate counting method on glycemic control in patients with type 1 diabetes  

Microsoft Academic Search

BACKGROUND: The importance of achieving and maintaining an appropriate metabolic control in patients with type 1 diabetes mellitus (DM1) has been established in many studies aiming to prevent the development of chronic complications. The carbohydrate counting method can be recommended as an additional tool in the nutritional treatment of diabetes, allowing patients with DM1 to have more flexible food choices.

Viviane M Dias; Juliana A Pandini; Raquel R Nunes; Sandro LM Sperandei; Emilson S Portella; Roberta A Cobas; Marília de B Gomes

2010-01-01

194

Effects of high performance inulin supplementation on glycemic status and lipid profile in women with type 2 diabetes: a randomized, placebo-controlled clinical trial.  

PubMed

Background: Type 2 diabetes mellitus, as a noncommunicable disease, is the main public health challenge in the 21st century. The prevalence of diabetes mellitus adjusted for the world population in Iran was 8% until the year 2010.Lipid levels are considered as important parameters to be evaluated, as high serum lipid levels are often reported as a complication in patients with diabetes mellitus.It is claimed that functional foods may improve complications of diabetes mellitus, so this study was designed to evaluate the effects of high performance inulin on glycemic status and lipid profile of women with type 2 diabetes. Methods: The study was a randomized controlled clinical trial. Forty-nine type 2 diabetic females (fiber intake <30g/d, 25control group (n=25) received 10g/d maltodextrin for 8 weeks.Glycemic status and lipid profile indices were measured pre and post intervention. Data were analyzed using SPSS software (verision11.5). Paired, unpaired t-test and ANCOVA were used to compare quantitative variables. Results: Supplementation with inulin caused a significant reduction in FBS (8.50%), HbA1c (10.40%), total cholesterol (12.90%), triglyceride (23.60 %), LDL-c (35.30 %), LDL-c/HDL-c ratio (16.25%) and TC/HDL-c ratio (25.20%) and increased HDL-c (19.90%). The changes for the control group parameters were not significant at the end of study. Conclusion: Inulin may help to control diabetes and its complications via improving glycemic and lipid parameters. PMID:24688953

Dehghan, Parvin; Pourghassem Gargari, Bahram; Asgharijafarabadi, Mohammad

2013-01-01

195

Vildagliptin-insulin combination improves glycemic control in Asians with type 2 diabetes  

PubMed Central

AIM: To assess the efficacy and safety of vildagliptin 50 mg bid as add-on therapy to insulin in Asian patients with type 2 diabetes mellitus (T2DM). METHODS: This was a post hoc analysis of a subgroup of Asian patients from a multicenter, randomized, double-blind, placebo-controlled, parallel-group study in T2DM patients inadequately controlled by stable insulin therapy, with or without metformin. A total of 173 patients were randomized 1:1 to receive treatment with vildagliptin 50 mg bid (n = 87) or placebo (n = 86) for 24 wk. Changes in HbA1c and fasting plasma glucose (FPG), from baseline to study endpoint, were analyzed using an analysis of covariance model. Change from baseline to endpoint in body weight was summarized by treatment. Safety and tolerability of vildagliptin was also evaluated. RESULTS: After 24 wk, the difference in adjusted mean change in HbA1c between vildagliptin and placebo was 0.82% (8.96 mmol/mol; P < 0.001) in Asian subgroup, 0.85% (9.29 mmol/mol; P < 0.001) in patients also receiving metformin, and 0.73% (7.98 mmol/mol; P < 0.001) in patients without metformin, all in favor of vildagliptin. There was no significant difference in the change in FPG between treatments. Weight was stable in both treatment groups (+0.3 kg and -0.2 kg, for vildagliptin and placebo, respectively). Overall, vildagliptin was safe and well tolerated with similarly low incidences of hypoglycemia (8.0% vs 8.1%) and no severe hypoglycemic events were experienced in either group. CONCLUSION: In Asian patients inadequately controlled with insulin (with or without concomitant metformin), insulin-vildagliptin combination treatment significantly reduced HbA1c compared with placebo, without an increase in risk of hypoglycemia or weight gain.

Kozlovski, Plamen; Foley, James; Shao, Qing; Lukashevich, Valentina; Kothny, Wolfgang

2013-01-01

196

Aging effects on glycemic control and inflammation for politicians in Taiwan.  

PubMed

Insulin sensitivity is deteriorating with age leading to many metabolic complications, yet fasting glucose is the common metabolic predictor in preventive medicine. In this study we compared the differences in fasting glucose, glucose tolerance, and inflammatory markers between two generations in politically active families. Their physical activity levels and dietary intake amounts were also evaluated. Eight elected councilors and their first order descendents participated in this study. Oral glucose tolerance test (OGTT), insulin, triglyceride, cholesterol, and inflammatory markers including C-reactive protein (CRP) and interleukin-6 (IL-6) were determined. Fasting glucose concentration in politicians was smaller than 100 mg/dL (considered clinically normal), and only approximately 14% concentration difference was observed between two generations. However, all politicians were substantially insulin resistant, compared with their young descendents, evidenced by exaggerated glucose and insulin responses (>100% greater area under curves above baseline) under oral glucose challenged condition. Their waist circumference, diastolic blood pressure, and cholesterol levels were significantly greater than controls. Furthermore, CRP of the politicians was approximately 2.3 folds of the control value suggesting a low grade inflammation. The levels of physical activity and dietary intake were not different between groups. However, the weekly walking energy expenditure for the politician group was approximately 3 times greater than that of the control. Conclusion: To reflect the age-dependent metabolic deterioration for the purpose of prevention, OGTT and CRP are far more sensitive measures than fasting glucose value. Greater walking activity in politicians was not sufficient to counterbalance the age-dependent changes. PMID:19280885

Ho, Chien-Te; Su, Chih-Ling; Chen, Mu-Tsung; Liou, Yuh-Feng; Lee, Shin-Da; Chien, Kuei-Yu; Kuo, Chia-Hua

2008-12-31

197

Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control  

Microsoft Academic Search

\\u000a Specific Aim  Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes\\u000a self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management\\u000a among veterans with poorly controlled diabetes.\\u000a \\u000a \\u000a \\u000a Methods  Surveys were mailed to patients with type 2 diabetes and a HbA1c of 8% or greater who attended 1

Karin M. Nelson; Lynne McFarland; Gayle Reiber

2007-01-01

198

Glucose monitoring as an impediment to Improving glycemic control: a case report.  

PubMed

Diabetes mellitus is increasing in frequency and is associated with disabling acute and chronic complications. There is evidence to indicate that excellent glucose control may retard the development and/or progression of these complications. In order to optimize diabetic control, patients are encouraged to monitor their glucose frequently We describe a patient who provided inaccurate glucose monitoring results, delaying effective management of his progressively increasing glycosylated hemoglobin level. The diagnostic clue to his erroneous glucose monitoring results was the lack of intra-day variation in this patient on insulin therapy. Moreover, glucose records within the patient's glucometer pointed to a much less frequent glucose monitoring than the written data provided by the patient. The glucometer was accurate when used by the patient under direct observation. It remains unclear whether this patient deliberately misled his providers or if the erroneous data reflected underlying cognitive dysfunction. Providers are encouraged to approximate average blood sugars based on glycosylated hemoglobin values and compare this to home monitoring results provided by the patient. Primary providers should also expect a certain degree of variability when reviewing home blood sugar values with their patients (on insulin therapy) and consider further investigation should the numbers lack such variation. Clinicians are urged to inspect the actual glucose readings on the patient's glucometer as well as inspecting written glucose records. Observing the patient's technique and accuracy when using their personal glucometer should also be considered. PMID:24592619

Russell, Aimee G; Chen, Lei; Jones, Kelli; Peiris, Alan N

2014-01-01

199

Glucose monitoring as an impediment to improving glycemic control: a case report.  

PubMed

Diabetes mellitus is increasing in frequency and is associated with disabling acute and chronic complications. There is evidence to indicate that excellent glucose control may retard the development and/or progression of these complications. In order to optimize diabetic control, patients are encouraged to monitor their glucose frequently. We describe a patient who provided inaccurate glucose monitoring results, delaying effective management of hisprogressively increasing glycosylated hemoglobin level. The diagnostic due to his erroneous glucose monitoring results was the lack of intra-day variation in this patient on insulin therapy. Moreover, glucose records within the patient's glucometer pointed to a much less frequent glucose monitoring than the written data provided by the patient. The glucometer was accurate when used by the patient under direct observation. It remains unclear whether this patient deliberately misled his providers or if the erroneous data reflected underlying cognitive dysfunction. Providers are encouraged to approximate average blood sugars based on glycosylated hemoglobin values and compare this to home monitoring results provided by the patient. Primary providers should also expect a certain degree of variability when reviewing home blood sugar values with their patients (on insulin therapy) and consider further investigation should the numbers lack such variation. Clinicians are urged to inspect the actual glucose readings on the patient's glucometer as well as inspecting written glucoserecords. Observing the patient's technique and accuracy when using their personal glucometer should also be considered. PMID:23617038

Russell, Aimee G; Chen, Lei; Jones, Kelli; Peiris, Alan N

2013-04-01

200

Antecedent glycemic control reduces severe hypoglycemia-induced neuronal damage in diabetic rats  

PubMed Central

Brain damage due to severe hypoglycemia occurs in insulin-treated people with diabetes. This study tests the hypothesis that chronic insulin therapy that normalizes elevated blood glucose in diabetic rats would be neuroprotective against brain damage induced by an acute episode of severe hypoglycemia. Male Sprague-Dawley rats were split into three groups: 1) control, non-diabetic; 2) STZ-diabetic; and 3) insulin-treated STZ-diabetic. After 3 wk of chronic treatment, unrestrained awake rats underwent acute hyperinsulinemic severe hypoglycemic (10–15 mg/dl) clamps for 1 h. Rats were subsequently analyzed for brain damage and cognitive function. Severe hypoglycemia induced 15-fold more neuronal damage in STZ-diabetic rats compared with nondiabetic rats. Chronic insulin treatment of diabetic rats, which nearly normalized glucose levels, markedly reduced neuronal damage induced by severe hypoglycemia. Fortunately, no cognitive defects associated with the hypoglycemia-induced brain damage were observed in any group. In conclusion, antecedent blood glucose control represents a major modifiable therapeutic intervention that can afford diabetic subjects neuroprotection against severe hypoglycemia-induced brain damage.

Reno, Candace M.; Tanoli, Tariq; Bree, Adam; Daphna-Iken, Dorit; Cui, Chen; Maloney, Susan E.; Wozniak, David F.

2013-01-01

201

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus: Comparative Results of Traditional and Time-Dependent Cox Model Analyses  

PubMed Central

Background and objectives: The benefits and risks of aggressive glycemic control in diabetes mellitus complicated by end-stage kidney failure remain uncertain but have importance because of the large patient population with inferior overall prognosis. Recent large observational studies with differing methodologies reached somewhat contrasting conclusions regarding the association of hemoglobin A1c with survival in diabetic chronic hemodialysis patients. Design, setting, participants, & measurements: This study supplements the authors' previous analysis (which found no correlation) by extending the follow-up period to 3 years and using time-dependent survival models with repeated measures. Among 24,875 nationally distributed study patients, 94.5% had type 2 diabetes, allowing additional analysis in the subset with type 1 diabetes. Data were collected at baseline and every quarter to a maximum of 3 years' follow-up. Results: Adjusted standard and time-dependent Cox models indicated that only extremes of glycemia were associated with inferior survival. There was no effect modification by serum albumin levels, a marker of protein nutrition status, and no trend associated with random glucose measurements in a post hoc analysis. In type 1 diabetic patients, upper extreme hemoglobin A1c values indicated lower survival risk. Conclusions: Sustained extremes of glycemia were only variably and weakly associated with decreased survival in this population. In the absence of randomized, controlled trials, these results suggest that aggressive glycemic control cannot be routinely recommended for all diabetic hemodialysis patients on the basis of reducing mortality risk. Physicians are encouraged to individualize glycemic targets based on potential risks and benefits in diabetic ESRD patients.

Lacson, Eduardo; Wang, Weiling; Lazarus, J. Michael; Hakim, Raymond

2010-01-01

202

Target for glycemic control in type 2 diabetic patients on hemodialysis: effects of anemia and erythropoietin injection on hemoglobin A(1c).  

PubMed

In hemodialysis (HD) patients the glycated hemoglobin (Hb(A1c)) level may underestimate glycemic control. The aim of this study is to estimate accurate glycemic control in type 2 diabetic patients on HD. Type 2 diabetes patients (N = 87) who had been receiving maintenance HD for at least one year were enrolled. Hb(A1c) and the percentage of glycated albumin relative to total the serum albumin (%GA) were measured in blood samples and the factors that affected the %GA/Hb(A1c) ratio were examined. There were significant and positive correlations between the plasma glucose and either the Hb(A1c) levels (r = 0.539, P < 0.01) or the %GA level (r = 0.520, P < 0.01). No relationship between the serum albumin levels and %GA levels was observed. A weekly dose of erythropoietin (EPO) was positively correlated with the ratio of %GA/Hb(A1c) and hematocrit (Ht) correlated negatively. There was no significant correlation between the %GA/Hb(A1c) level and the EPO dose in patients with Ht > or = 30%, although a significant correlation was found between those parameters in the Ht < 30% group. The mean of the %GA/Hb(A1c) ratios in patients with Ht > or = 30%, with Ht < 30% and treated with EPO < 100 IU/kg/week, and with Ht < 30% and treated with EPO > or = 100 IU/kg/week were 3.41, 3.56 and 4.13, respectively. In HD patients, accurate glycemic control may be estimated as: Hb(A1c) x 1.14 if Ht > or = 30%; Hb(A1c) x 1.19 if Ht < 30% and treated with low dosages of EPO; and Hb(A1c) x 1.38 if Ht < 30% and treated with high dosages of EPO. PMID:19379146

Uzu, Takashi; Hatta, Tsuguru; Deji, Naoko; Izumiya, Tamani; Ueda, Hisami; Miyazawa, Itsuko; Kanasaki, Masami; Isshiki, Keiji; Nishio, Toshiji; Arimura, Tetsuro

2009-04-01

203

Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up  

PubMed Central

Background Low-carbohydrate diets in the management of obese patients with type 2 diabetes seem intuitively attractive due to their potent antihyperglycemic effect. We previously reported that a 20 % carbohydrate diet was significantly superior to a 55–60 % carbohydrate diet with regard to bodyweight and glycemic control in 2 non-randomised groups of obese diabetes patients observed closely over 6 months. The effect beyond 6 months of reduced carbohydrate has not been previously reported. The objective of the present study, therefore, was to determine to what degree the changes among the 16 patients in the low-carbohydrate diet group at 6-months were preserved or changed 22 months after start, even without close follow-up. In addition, we report that, after the 6 month observation period, two thirds of the patients in the high-carbohydrate changed their diet. This group also showed improvement in bodyweight and glycemic control. Method Retrospective follow-up of previously studied subjects on a low carbohydrate diet. Results The mean bodyweight at the start of the initial study was 100.6 ± 14.7 kg. At six months it was 89.2 ± 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 ± 4.2 kg to an average of 92.0 ± 14.0 kg. Seven of the 16 patients (44%) retained the same bodyweight from 6 to 22 months or reduced it further; all but one had lower weight at 22 months than at the beginning. Initial mean HbA1c was 8.0 ± 1.5 %. After 6 and 12 months it was 6.6 ± 1.0 % and 7.0 ± 1.3 %, respectively. At 22 months, it was still 6.9 ± 1.1 %. Conclusion Advice on a 20 % carbohydrate diet with some caloric restriction to obese patients with type 2 diabetes has lasting effect on bodyweight and glycemic control.

Nielsen, J?rgen Vesti; Joensson, Eva

2006-01-01

204

Impact of Leisure-Time Physical Activity on Glycemic Control and Cardiovascular Risk Factors in Japanese Patients with Type 2 Diabetes Mellitus: The Fukuoka Diabetes Registry  

PubMed Central

Aims/hypothesis The effects of leisure-time physical activity (LTPA) on glycemia and cardiovascular risk factors are not fully understood in Asian type 2 diabetic patients, who are typically non-obese. We studied associations between LTPA and glycemia and cardiovascular risk factors in Japanese type 2 diabetic patients. Methods A total of 4,870 Japanese type 2 diabetic patients aged ?20 years were divided into eight groups according to their LTPA. We investigated associations between the amount and intensity levels of physical activity (PA) and glycemic control, insulin sensitivity, cardiovascular risk factors, and low-grade systemic inflammation in a cross-sectional study. Results LTPA was dose-dependently associated with body mass index (BMI), waist circumference, hemoglobin A1c (HbA1c), fasting plasma glucose, homeostasis model assessment of insulin resistance, triglyceride, high density lipoprotein cholesterol, high sensitivity C-reactive protein, and prevalence of metabolic syndrome, but not with blood pressure, low density lipoprotein cholesterol or adiponectin. The amount of PA required to lower HbA1c was greater than that required to improve cardiovascular risk factors. LTPA was inversely associated with HbA1c in non-obese participants but not in obese participants after multivariate adjustments for age, sex, duration of diabetes, current smoking, current drinking, energy intake, cardiovascular diseases, depressive symptoms, and treatment of diabetes. Higher-intensity LTPA, not lower-intensity LTPA was associated with HbA1c after multivariate adjustments with further adjustment including BMI. Conclusions/interpretation LTPA was dose-dependently associated with better glycemic control and amelioration of some cardiovascular risk factors in Japanese type 2 diabetic patients. In addition, increased higher-intensity LTPA may be appropriate for glycemic control.

Kaizu, Shinako; Kishimoto, Hiro; Iwase, Masanori; Fujii, Hiroki; Ohkuma, Toshiaki; Ide, Hitoshi; Jodai, Tamaki; Kikuchi, Yohei; Idewaki, Yasuhiro; Hirakawa, Yoichiro; Nakamura, Udai; Kitazono, Takanari

2014-01-01

205

Add-on therapy with the DPP-4 inhibitor sitagliptin improves glycemic control in insulin-treated Japanese patients with type 2 diabetes mellitus.  

PubMed

The effect of add-on therapy with sitagliptin on glycemic control was prospectively investigated in patients with type 2 diabetes mellitus (T2DM) receiving insulin alone or insulin combined with oral antidiabetic drugs. Seventy-one patients were evaluated (38 men and 33 women aged 63.9 ± 10.2 years). They were divided into three groups, which were 45 patients receiving premixed insulin twice daily, 15 patients receiving multiple daily insulin injections, and 11 patients receiving basal insulin with oral antidiabetic drugs (basal insulin therapy). Concomitant oral drugs included sulfonylureas, ?-glucosidase inhibitors and metformin. The hemoglobin A1c (HbA1c) of all patients improved significantly from 8.1 ± 1.2% to 7.6 ± 1.1% after 12 weeks of add-on therapy with sitagliptin (p<0.01), and the insulin dosage was reduced from 27.3 ± 15.8 U/day to 24.5 ± 16.5 U/day (p<0.001). Body weight did not change after the start of concomitant therapy and severe hypoglycemia was not observed. The baseline HbA1c and glycated albumin levels were identified as factors that predicted the response to add-on therapy with sitagliptin. These findings suggest that add-on therapy with sitagliptin can be expected to achieve improvement of poor glycemic control irrespective of a patient's demographic profile. Stratified analysis based on the insulin regimen revealed a stronger antidiabetic effect and a high efficacy of sitagliptin when it was added to basal insulin therapy. The results of this investigation confirmed that add-on therapy with sitagliptin to various insulin regimens could improve glycemic control without severe hypoglycemia and/or weight gain. PMID:23386390

Katsuno, Tomoyuki; Ikeda, Hiroki; Ida, Kenichi; Miyagawa, Jun-Ichiro; Namba, Mitsuyoshi

2013-01-01

206

Changes in glycemic control are associated with changes in cognition in non-diabetic elderly.  

PubMed

The aim of the present study was to examine the relationship of changes in long term glucose levels as measured by Hemoglobin A1c (HbA1c) with simultaneous changes in cognition. The sample included in the present analysis consisted of 101 community dwelling non-diabetic elderly subjects participating in ongoing longitudinal studies of cognition. Subjects were included in this study if they were cognitively normal at baseline, had at least one co-temporaneous follow-up assessment of HbA1c and the Mini Mental State Exam (MMSE), and complete data on age, gender, race, and years of education. MMSE decline over time was the main outcome measure. In TOBIT mixed regression models, MMSE was the dependent variable and HbA1c the time-varying covariate. Sociodemographic (age, gender, and education), cardiovascular (hypertension and APOE4 status), and lifestyle (smoking and physical activity) covariates were included in the statistical model. After adjusting for age at follow-up, there was a decrease of 1.37 points in the MMSE (p = 0.0002) per unit increase in HbA1c. This result remained essentially unchanged after adjusting also for gender and education (p = 0.0005), cardiovascular factors (p = 0.0003), and lifestyle (p = 0.0006). Additionally, results remained very similar after excluding subjects with potentially incipient diabetes with HbA1c between 6 and 7. These findings suggest that in non-diabetic non-demented elderly subjects, an increase in HbA1c over time is associated with cognitive decline. Such results may have broad clinical applicability since manipulation of glucose control, even in non-diabetics, may affect cognitive performance, perhaps enabling preventive measures against dementia. PMID:22426020

Ravona-Springer, Ramit; Moshier, Erin; Schmeidler, James; Godbold, James; Akrivos, Jimmy; Rapp, Michael; Grossman, Hillel T; Wysocki, Michael; Silverman, Jeremy M; Haroutunian, Vahram; Beeri, Michal Schnaider

2012-01-01

207

Strict glycemic control in diabetic dogs with closed-loop intraperitoneal insulin infusion algorithm designed for an artificial endocrine pancreas  

Microsoft Academic Search

The ultimate goal of the development of an artificial endocrine pancreas is to achieve long-term strict glycemic regulation.\\u000a To establish the physiological insulin delivery route of the artificial endocrine pancreas, intraperitoneal insulin infusion\\u000a may be important. For this purpose, we tried to develop a closed-loop intraperitoneal insulin infusion algorithm by analyzing\\u000a the pharmacokinetics of intraperitoneal regular insulin absorption using a

Yasuto Matsuo; Seiya Shimoda; Michiharu Sakakida; Kenro Nishida; Taiji Sekigami; Shinji Ichimori; Kenshi Ichinose; M. Shichiri; E. Araki

2003-01-01

208

Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control  

PubMed Central

In patients with diabetes, glycemic improvement by sodium-glucose cotransporter-2 inhibition depends on the kidney's ability to filter glucose. Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, reduces hyperglycemia in patients with diabetes and normal or mildly impaired renal function. In this randomized, double-blind, placebo-controlled study we assessed daily treatment with dapagliflozin in 252 patients with inadequately controlled type 2 diabetes and moderate renal impairment. The primary endpoint, the mean change in HbA1c, was not statistically different from placebo after 24 weeks (?0.41% and ?0.44% for 5- and 10-mg doses, respectively, and ?0.32% for placebo). The mean weight change from baseline was ?1.54 and ?1.89?kg for the 5- and 10-mg doses, respectively, and +0.21?kg for placebo. The mean systolic and diastolic blood pressure decreased in the dapagliflozin groups compared to placebo. Through 104 weeks, 13 patients receiving dapagliflozin and no patients receiving placebo experienced bone fracture. At 1 week, the mean serum creatinine increased with dapagliflozin 5?mg (+0.13?mg/dl) and 10?mg (+0.18?mg/dl) and did not change further after 104 weeks. Mean serum electrolytes did not change in any group, and there were fewer episodes of hyperkalemia with dapagliflozin than placebo. Thus, in patients with moderate renal impairment, dapagliflozin did not improve glycemic control, but reduced weight and blood pressure.

Kohan, Donald E; Fioretto, Paola; Tang, Weihua; List, James F

2014-01-01

209

Treatment with the ?-glucosidase inhibitor miglitol from the preonset stage in Otsuka Long-Evans Tokushima Fatty rats improves glycemic control and reduces the expression of inflammatory cytokine genes in peripheral leukocytes  

Microsoft Academic Search

Otsuka Long-Evans Tokushima Fatty (OLETF) rats, an animal model of type 2 diabetes mellitus, exhibit chronic and slowly progressive hyperglycemia with obesity. In this study, we examined whether dietary supplementation with the ?-glucosidase inhibitor miglitol from the preonset stage improves glycemic control and reduces the gene expression of inflammatory cytokines in peripheral leukocytes. The OLETF rats were fed a control

Kazuki Mochizuki; Nanae Fukaya; Yutaro Tanaka; Masahiro Fuchigami; Toshinao Goda

2011-01-01

210

Serum leptin concentrations in children with type 1 diabetes mellitus: relationship to body mass index, insulin dose, and glycemic control.  

PubMed

Although obesity is a frequent feature of type 2 diabetes mellitus (DM), many patients with type 1 DM are prone to high body mass index (BMI). We measured serum leptin concentrations in a cohort of children (n = 55) with type 1 diabetes mellitus (DM), as well as their anthropometric parameters including BMI, skin fold thickness at multiple sites, and midarm circumference. Glycemic control was assessed by blood glucose (BG) monitoring before meals, and measurement of glycated hemoglobin (HbA1c) and insulin dose/kg/d was recorded. Dietary evaluation and assessment of caloric intake (kg/d) was performed by an expert dietitian. In the newly diagnosed children (n = 10) before initiation of insulin therapy, circulating leptin concentration was significantly lower (1.1 +/- 0.8 ng/dL) versus 5 days after insulin therapy (1.45 +/- 0.7 ng/dL). The decreased leptin level appears to be related to insulinopenia in these patients. In 45 children with type 1 DM on conventional therapy (2 doses of insulin mixture (NPH and regular) subcutaneous (SC) before breakfast and dinner for more than 2 years), serum leptin concentration was significantly higher (2.15 +/- 1 ng/dL) compared with age-matched normal children (1.3 +/- 1 ng/dL). Diabetic children were further divided into 2 groups according to their HbA1c level: group 1 with HbA1C less than 7.5% (less than 2 SD above the mean for normal population) (n = 29) and group 2 with HbA1c greater than 7.5%. (greater than 2 SD above the mean for normal population) (n = 16). Patients with a higher HbA1c level (group 2) had a higher leptin concentration (2.3 +/- 0.8 ng/dL), higher BMI (17.8 +/- 1.7), and were receiving higher insulin dose/kg (0.92 +/- 0.2 U/kg/d) compared with group 1 (lower HbA1c) (1.78 +/- 0.8 ng/dL, 16.7 +/- 1.5, and 0.59 +/- 0.2 U/kg/d, respectively). Group 2 patients had a higher incidence of late morning hypoglycemia (9/29) versus group 1 patients (2/16). Analysis of dietary intake showed that patients with a higher HbA1c (group 2) consumed more calories (73.5 +/- 10.5 kcal/kg/d) versus patients with lower HbA1c (64.2 +/- 8.7 kcal/kg/d). These findings pointed to the unphysiologic nature of injecting a mixture of insulin twice daily. To cover the relatively big lunch meal (40% to 50% of the total caloric intake in the Arab countries) and prevent afternoon hyperglycemia, there is a great tendency to increase NPH dose before breakfast. This, in turn, induces late-morning hypoglycemia and increases appetite and food intake at that time. Multiple regression analysis showed that circulating leptin concentrations (the dependent variable) were best correlated with the mean skinfold thickness (SFT), BMI, and caloric intake/kg/d (together they explained 65% of the variability in leptin concentrations). It appears that oversubstitution by insulin and increased food intake stimulate fat synthesis and subsequently BMI. Increased appetite and BMI contribute to increased leptin secretion and explains the higher leptin levels in undercontrolled diabetic children (higher circulating HbA1c concentrations) who were oversubstituted by insulin. PMID:11887162

Soliman, Ashraf T; Omar, Magdi; Assem, Hala M; Nasr, Ibrahim S; Rizk, Mohamed M; El Matary, Wael; El Alaily, Rania K

2002-03-01

211

LX4211, a dual SGLT1/SGLT2 inhibitor, improved glycemic control in patients with type 2 diabetes in a randomized, placebo-controlled trial.  

PubMed

Thirty-six patients with type 2 diabetes mellitus (T2DM) were randomized 1:1:1 to receive a once-daily oral dose of placebo or 150 or 300 mg of the dual SGLT1/SGLT2 inhibitor LX4211 for 28 days. Relative to placebo, LX4211 enhanced urinary glucose excretion by inhibiting SGLT2-mediated renal glucose reabsorption; markedly and significantly improved multiple measures of glycemic control, including fasting plasma glucose, oral glucose tolerance, and HbA(1c); and significantly lowered serum triglycerides. LX4211 also mediated trends for lower weight, lower blood pressure, and higher glucagon-like peptide-1 levels. In a follow-up single-dose study in 12 patients with T2DM, LX4211 (300 mg) significantly increased glucagon-like peptide-1 and peptide YY levels relative to pretreatment values, probably by delaying SGLT1-mediated intestinal glucose absorption. In both studies, LX4211 was well tolerated without evidence of increased gastrointestinal side effects. These data support further study of LX4211-mediated dual SGLT1/SGLT2 inhibition as a novel mechanism of action in the treatment of T2DM. PMID:22739142

Zambrowicz, B; Freiman, J; Brown, P M; Frazier, K S; Turnage, A; Bronner, J; Ruff, D; Shadoan, M; Banks, P; Mseeh, F; Rawlins, D B; Goodwin, N C; Mabon, R; Harrison, B A; Wilson, A; Sands, A; Powell, D R

2012-08-01

212

The effect of insurance status and parental education on glycemic control and cardiovascular disease risk profile in youth with Type 1 Diabetes  

PubMed Central

Background Adult studies have shown a correlation between low socioeconomic status and Type 1 Diabetes complications, but studies have not been done in children to examine the effect of socioeconomic status on risk for future complications. This study investigates the relationship between insurance status and parental education and both glycemic control and cardiovascular disease (CVD) risk factors in youth with type 1 diabetes. Methods A cross-sectional study of 295 youth with established type 1 diabetes who underwent examination with fasting blood draw and reported insurance status and parental education. Results Youth with type 1 diabetes and public insurance had higher hemoglobin A1c (HbA1c), body mass index, hs-CRP, and blood pressure (p?controlling for insulin regimen. Parental education was not associated with HbA1c or CVD risk factors. Conclusions Youth with type 1 diabetes and public insurance have worse glycemic control and elevated CVD risk factors compared to those with private insurance, but this was no longer seen when insulin regimen was controlled for. Further research is needed to look at differences between those with public insurance and private insurance that contribute to differences in type 1 diabetes outcomes, and to identify modifiable risk factors in pediatric patients in order to focus earlier interventions to decrease and prevent future diabetes complications.

2014-01-01

213

Effects of long-term optimization and short-term deterioration of glycemic control on glucose counterregulation in type I diabetes mellitus.  

PubMed

To assess the effects of glycemic control on glucose counterregulation, rates of plasma glucose recovery from hypoglycemia and counterregulatory hormonal responses were studied in 18 C-peptide-negative patients with insulin-dependent diabetes mellitus (IDDM) before and after either improvement, no change, or deterioration in glycemic control. Hypoglycemia was induced by an i.v. insulin infusion (30 mU/m2 X min for 1 h) after maintenance of euglycemia overnight with i.v. insulin. In 13 patients with long duration of IDDM (9 +/- 0.5 yr, mean +/- SEM) and initially poor glycemic control (mean diurnal blood glucose, MBG 199 +/- 8 mg/dl, ketoamine-HbA1 12.4 +/- 0.2%; nondiabetic subjects 104 +/- 4 mg/dl and 6.8 +/- 0.09%, respectively), rates of plasma glucose recovery from hypoglycemia (0.30 +/- 0.01 versus 0.60 +/- 0.01 mg/dl X min in nondiabetic subjects, P less than 0.001) and plasma glucagon (AUC 0.56 +/- 0.09 versus 6.3 +/- 0.50 ng/ml X 150 min in nondiabetic subjects, P less than 0.01) and epinephrine (AUC 16.9 +/- 0.2 versus 25.7 +/- 0.2 ng/ml X 150 min in nondiabetic subjects, P less than 0.001) responses to hypoglycemia were impaired. Intensive therapy (three daily injections of insulin) instituted in 7 out of 13 IDDM patients for up to 9 mo improved MBG (124 +/- 6 mg/dl, P less than 0.01) and ketoamine-HbA1 (7.9 +/- 0.02%, P less than 0.01) but not rates of plasma glucose recovery (0.31 +/- 0.01 mg/dl X min) and plasma glucagon (AUC 0.69 +/- 0.07 ng/ml X 150 min) and epinephrine (AUC 14.9 +/- 0.17 ng/ml X 150 min) responses.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6368295

Bolli, G; De Feo, P; De Cosmo, S; Perriello, G; Angeletti, G; Ventura, M R; Santeusanio, F; Brunetti, P; Gerich, J E

1984-04-01

214

Serum 1,5-Anhydroglucitol Concentrations Are a Reliable Index of Glycemic Control in Type 2 Diabetes With Mild or Moderate Renal Dysfunction  

PubMed Central

OBJECTIVE To assess the relationship between 1,5-anhydroglucitol (AG) levels, which are a marker of glycemic control, and stages of chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS This was a cross-sectional study with 269 subjects with type 2 diabetes who were divided into four groups based on estimated glomerular filtration rate (eGFR) using Modification of Diet in Renal Disease (eGFRMDRD) formula: 57 in control, 111 in CKD stages 1–2, 78 in stage 3, and 23 in stages 4–5. RESULTS The study groups differed significantly with respect to 1,5-AG and fasting plasma glucose (FPG), age, duration of diabetes, blood pressure, HDL, and percentage of antihypertension or antidyslipidemia medication use. Stepwise multivariate regression analyses showed that 1,5-AG levels in the control group, the CKD stages 1–2 group, and the CKD stage 3 group could be explained by HbA1c, age, duration of diabetes, FPG, and antihypertension medication. However, eGFRMDRD was the only independent determinant of 1,5-AG levels in CKD stages 4–5. Logarithmic transformed 1,5-AG values (ln[1,5-AG]) had significant inverse correlations with HbA1c and FPG levels for CKD stages 1–2 and CKD stage 3 (all P < 0.001). However, associations between ln(1,5-AG) and HbA1c or FPG were insignificant for CKD stages 4–5 (P = 0.274 and P = 0.080, respectively). CONCLUSIONS This study demonstrated that 1,5-AG levels do not appear to be influenced by mild or moderate renal dysfunction, suggesting it is a reliable glycemic marker in type 2 diabetes with CKD stages 1–3.

Kim, Won Jun; Park, Cheol-Young; Lee, Kyu-Beck; Park, Se Eun; Rhee, Eun Jung; Lee, Won Young; Oh, Ki Won; Park, Sung Woo

2012-01-01

215

The Impact of a Decision Support Tool Linked to an Electronic Medical Record on Glycemic Control in People with Type 2 Diabetes  

PubMed Central

Aims We retrospectively compared glycemic control and glycemic burden in type 2 diabetes patients treated by general physicians with access to decision support with those treated by general physicians without access to decision support. Methods A total of 875 patients [471 (53.8%) males] aged 54.3 [standard deviation (SD) 13.1] years followed up over 84 months. A total of 342 patients (39%) were managed with decision support, and effects on glycosylated hemoglobin (HbA1c) were assessed. Results There was no difference between groups in starting HbA1c [7.6 (SD 1.8) versus 7.5 (SD 1.5); p = not significant] at baseline. Patients treated with decision support were more likely to have planned review of HbA1c, adjustment of medication, prescription of statins, dietetic and nurse educator inputs (71.3% versus 58.5%; Chi squared = 14.7; p =.001). The mean HbA1c in the group treated with decision support was not significantly reduced within the first year [7.5% (SD 1.8) versus 7.6% (SD 1.5); p = not significant; 95% confidence interval (CI) ?0.33 to 0.17], but statistically significant differences were apparent at year 2 [7.2% (SD 2.0) versus 8% (SD 3.4); p = .0001; 95% CI ?1.3 to ?0.5] and sustained through year 3 [7.2% (SD 2.0) versus 8.0% (SD 2.0); p = .0001; 95% CI ?1.2 to ?0.6], year 4 [7.2% (SD 2.3) versus 8.2% (SD 2.5); p = .0001; 95% CI ?1.2 to ?0.6], year 5 [7.0% (SD 2.3) versus 8.3% (SD 2.6); p = .001; 95% CI ?1.5 to ?0.8], year 6 [7.0% (SD 2.0) versus 8.2% (SD 2.4); p = .001; 95% CI ?1.5 to ?0.9], and year 7 [6.9% (SD 1.2) versus 8% (SD 1.8); p = .001; 95% CI ?1.4 to ?1.0]. Conclusion Use of a decision support system showed benefits in adherence to clinical care pathways and achieving significant improvements in glycemic control.

Gunathilake, Waruna; Gunawardena, Sajith; Fernando, Ranga; Thomson, George; Fernando, Devaka

2013-01-01

216

Glycemic variability in gestational diabetes mellitus and its association with ? cell function.  

PubMed

Maternal hyperglycemia in gestational diabetes mellitus (GDM), especially hyperglycemic excursions, is associated with increased risks of adverse pregnancy outcomes. Continuous glucose monitoring (CGM) system (CGMS) is better than intermittent self-measurements in detecting detailed glucose profiles on the magnitude and duration of glucose fluctuations. Hyperglycemia resulted from impaired ? cell function. This study analyzed the characteristics of glycemic variability in GDM with 24-28 gestational weeks and its association with ? cell function. Thirty GDM with 24-28 gestational weeks (GDM group) were included in this study, and 20 normal gestational women (NGW group) and 20 normal glucose regulation non-pregnant women (NGRW group) were set as controls. The three groups were monitored using the CGMS for consecutive 72 h. The parameters of glycemic variability included the standard deviation of blood glucose (SDBG), mean of continuous 24-h blood glucose (MBG), mean amplitude of glycemic excursions (MAGEs), and mean of daily differences (MODDs). Homeostasis model assessments were applied to access the insulin resistance (HOMA-IR). The early insulinogenic index (?I30/?G30) and the area under the curve of insulin (AUCI180) derived from 75-g oral glucose tolerance test were applied to evaluate the early-phase insulin secretion and second-phase insulin secretion, respectively. After CGM, MAGE and MBG value increased progressively from NGRW, NGW to GDM group (p < 0.05); MODD and SDBG values of GDM group were all higher than those of NGRW and NGW groups (p < 0.05), but there are no differences in MODD and SDBG between NGRW and NGW groups (p > 0.05). After comparison of ? cell function, ?I30/?G30 decreased progressively from NGRW, NGW to GDM group (p < 0.05); HOMA-IR and AUCI180 increased progressively from NGRW, NGW to GDM group (p < 0.05). MAGE value was correlated with ?I30/?G30 and HOMA-IR in GDM group (r = -0.78 and 0.65, respectively, p < 0.05). Multiple linear stepwise regression analysis showed that ?I30/?G30 and HOMA-IR were the independent factors of MAGE (? = -0.61, 0.34, respectively, p < 0.05). Glycemic variability in GDM was higher than in normal pregnant women, and glycemic variability evaluated by MAGE correlates well with impaired early-phase insulin secretion in GDM. Further large-scale studies are needed to formulate treatment strategies to make up for the impaired early-phase insulin secretion and flat glycemic variability, and analyze the association between pregnancy outcomes improvement and glycemic variability remission in GDM. PMID:22815046

Su, Jian-bin; Wang, Xue-qin; Chen, Jin-feng; Wu, Gang; Jin, Yan; Xu, Feng; Wang, Xiao-hua; Liu, Yu-tian

2013-04-01

217

The hypoglycemic effect of pumpkin seeds, Trigonelline (TRG), Nicotinic acid (NA), and D-Chiro-inositol (DCI) in controlling glycemic levels in diabetes mellitus.  

PubMed

In the contemporary society, diabetes mellitus is considered as a common, growing, serious, costly, and potentially preventable public health problem. It is forecasted that in 2030, the number of people with diabetes will go up from 117 million in 2000 to 366 million in 2030. The prevalence of diabetes will place a huge burden on health and financial structures of countries, and these will impact on individuals, as well as families and nations. Polysaccharides, para-aminobenzoic acid, fixed oils, sterol, proteins, and peptides are biologically active ingredients, which are found in pumpkins. The chemicals within pumpkins such as the fruit pulp, oil from ungerminated seeds, and protein from germinated seeds have hypoglycemic properties. Preliminary investigation showed that pumpkin seeds, and the macromolecules, therein, such as Trigonelline (TRG), Nicotinic acid (NA), and D-chiro-inositol (DCI), possess hypoglycemic properties and could assist in maintaining glycemic control. PMID:24564589

Adams, Gary G; Imran, Shahwar; Wang, Sheng; Mohammad, Abubaker; Kok, M Samil; Gray, David A; Channell, Guy A; Harding, Stephen E

2014-01-01

218

Bromocriptine mesylate: Food and Drug Administration approved new approach in therapy of non-insulin dependant diabetes mellitus with poor glycemic control  

PubMed Central

Food and Drug Administration (FDA) approved bromocriptine mesylate, a quick release formulation, 0.8 mg tablets, as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Bromocriptine products were previously approved by the FDA for the treatment of pituitary tumors and Parkinson's disease. Bromocriptine is thought to act on circadian neuronal activities within the hypothalamus to reset abnormally elevated hypothalamic drive for increased plasma glucose, triglyceride, and free fatty acid levels in fasting and postprandial states in insulin-resistant patients. Adverse events most commonly reported in clinical trials of bromocriptine included nausea, fatigue, vomiting, headache, and dizziness. These events lasted a median of 14 days and were more likely to occur during initial titration of the drug. Due to novel mechanism of action, single daily dose, and lower incidence of stroke, myocardial infarction and vascular events, bromocriptine may act as landmark in treatment of type 2 diabetes.

Keche, Yogendra

2010-01-01

219

Effect of Pramlintide on Prandial Glycemic Excursions During Closed-Loop Control in Adolescents and Young Adults With Type 1 Diabetes  

PubMed Central

OBJECTIVE Even under closed-loop (CL) conditions, meal-related blood glucose (BG) excursions frequently exceed target levels as a result of delays in absorption of insulin from the subcutaneous site of infusion. We hypothesized that delaying gastric emptying with preprandial injections of pramlintide would improve postprandial glycemia by allowing a better match between carbohydrate and insulin absorptions. RESEARCH DESIGN AND METHODS Eight subjects (4 female; age, 15–28 years; A1C, 7.5 ± 0.7%) were studied for 48 h on a CL insulin-delivery system with a proportional integral derivative algorithm with insulin feedback: 24 h on CL control alone (CL) and 24 h on CL control plus 30-?g premeal injections of pramlintide (CLP). Target glucose was set at 120 mg/dL; timing and contents of meals were identical on both study days. No premeal manual boluses were given. Differences in reference BG excursions, defined as the incremental glucose rise from premeal to peak, were compared between conditions for each meal. RESULTS CLP was associated with overall delayed time to peak BG (2.5 ± 0.9 vs. 1.5 ± 0.5 h; P < 0.0001) and reduced magnitude of glycemic excursion (88 ± 42 vs. 113 ± 32 mg/dL; P = 0.006) compared with CL alone. Pramlintide effects on glycemic excursions were particularly evident at lunch and dinner, in association with higher premeal insulin concentrations at those mealtimes. CONCLUSIONS Pramlintide delayed the time to peak postprandial BG and reduced the magnitude of prandial BG excursions. Beneficial effects of pramlintide on CL may in part be related to higher premeal insulin levels at lunch and dinner compared with breakfast.

Weinzimer, Stuart A.; Sherr, Jennifer L.; Cengiz, Eda; Kim, Grace; Ruiz, Jessica L.; Carria, Lori; Voskanyan, Gayane; Roy, Anirban; Tamborlane, William V.

2012-01-01

220

Four-Year Change in Cardiorespiratory Fitness and Influence on Glycemic Control in Adults With Type 2 Diabetes in a Randomized Trial  

PubMed Central

OBJECTIVE To examine an intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) on 4-year change in fitness and physical activity (PA), and to examine the effect of change in fitness and PA, adjusting for potential confounders, on glycemic control in the Look AHEAD Trial. RESEARCH DESIGN AND METHODS Subjects were overweight/obese adults with type 2 diabetes mellitus (T2DM) with available fitness data at 4 years (n = 3,942).This clinical trial randomized subjects to DSE or ILI. DSE subjects received standard care plus information related to diet, PA, and social support three times per year. ILI subjects received weekly intervention contact for 6 months, which was reduced over the 4-year period, and were prescribed diet and PA. Measures included weight, fitness, PA, and HbA1c. RESULTS The difference in percent fitness change between ILI and DSE at 4 years was significant after adjustment for baseline fitness and change in weight (3.70 vs. 0.94%; P < 0.01). At 4 years, PA increased by 348 (1,562) kcal/week in ILI vs. 105 (1,309) kcal/week in DSE (P < 0.01). Fitness change at 4 years was inversely related to change in HbA1c after adjustment for clinical site, treatment, baseline HbA1c, prescribed diabetes medication, baseline fitness, and weight change (P < 0.01). Change in PA was not related to change in HbA1c. CONCLUSIONS A 4-year ILI increased fitness and PA in overweight/obese individuals with T2DM. Change in fitness was associated with improvements in glycemic control, which provides support for interventions to improve fitness in adults with T2DM.

Jakicic, John M.; Egan, Caitlin M.; Fabricatore, Anthony N.; Gaussoin, Sarah A.; Glasser, Stephen P.; Hesson, Louise A.; Knowler, William C.; Lang, Wei; Regensteiner, Judith G.; Ribisl, Paul M.; Ryan, Donna H.

2013-01-01

221

The Diterpene Glycoside, Rebaudioside A, Does not Improve Glycemic Control or Affect Blood Pressure After Eight Weeks Treatment in the Goto-Kakizaki Rat  

PubMed Central

The plant, Stevia rebaudiana Bertoni (SrB), has been used for the treatment of diabetes in traditional medicine. Previously, we have demonstrated that long-term administration of the glycoside stevioside has insulinotropic, glucagonostatic, anti-hyperglycemic and blood pressure-lowering effects in type 2 diabetic animal models. The aim of this study was to elucidate if long-term administration of rebaudioside A, another glycoside isolated from the plant SrB, could improve glycemic control and lower blood pressure in an animal model of type 2 diabetes. We divided male Goto-Kakizaki (GK) rats into two groups which were fed a standard laboratory chow diet for eight weeks. The diet was supplemented with oral rebaudioside A (0.025 g/kg BW/day) in the experimental group. Blood glucose, weight, blood pressure and food intake were measured weekly. Animals were equipped with an intra-arterial catheter, and at week eight the conscious rats underwent an intra-arterial glucose tolerance test (IAGTT) (2.0 g/kg BW). During the IAGTT, the level of glucose, glucagon, and insulin responses did not differ significantly between the two groups. Fasting levels of glucose, glucagon, insulin or levels of blood lipids did not differ between the groups throughout the study period. We observed no effect on blood pressure or weight development. In conclusion, oral supplementation with rebaudioside A (0.025 g/kg BW/day) for eight weeks did not influence blood pressure or glycemic control in GK rats. Rebaudioside A failed to show the beneficial effects in diabetic animals previously demonstrated for stevioside.

Dyrskog, Stig E.U.; Jeppesen, Per B.; Chen, Jianguo; Christensen, Lars P.; Hermansen, Kjeld

2005-01-01

222

Motor Vehicle Crashes in Diabetic Patients with Tight Glycemic Control: A Population-based Case Control Analysis  

Microsoft Academic Search

Background: Complications from diabetes mellitus can compromise a driver's ability to safely operate a motor vehicle, yet little is known about whether euglycemia predicts normal driving risks among adults with diabetes. We studied the association between glycosylated hemoglobin (HbA1c) and the risk of a motor vehicle crash using a population-based case control analysis. Methods and Findings: We identified consecutive drivers

Donald A. Redelmeier; Anne B. Kenshole; Joel G. Ray

2009-01-01

223

Glycemic Index Values Database  

Cancer.gov

NCI has developed a listing of Glycemic Index (GI) values for individual foods. Food codes from the USDA Continuing Survey of Food Intakes of Individuals (CSFII) are used as a reference. This file provides GI values for those foods consumed by adults and queried on the DHQ or other FFQs used at NCI.

224

Sodium-Glucose Cotransporter 2 Inhibition and Glycemic Control in Type 1 Diabetes: Results of an 8-Week Open-Label Proof-of-Concept Trial.  

PubMed

OBJECTIVE Adjunctive-to-insulin therapy with sodium-glucose cotransporter 2 (SGLT2) inhibition may improve glycemic control in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS We evaluated the glycemic efficacy and safety of empagliflozin 25 mg daily in 40 patients treated for 8 weeks in a single-arm open-label proof-of-concept trial (NCT01392560). RESULTS Mean A1C decreased from 8.0 ± 0.9% (64 ± 10 mmol/mol) to 7.6 ± 0.9% (60 ± 10 mmol/mol) (P < 0.0001), fasting glucose from 9.0 ± 4.3 to 7.0 ± 3.2 mmol/L (P = 0.008), symptomatic hypoglycemia (<3.0 mmol/L) from 0.12 to 0.04 events per patient per day (P = 0.0004), and daily insulin dose from 54.7 ± 20.4 to 45.8 ± 18.8 units/day (P < 0.0001). Mean urinary excretion of glucose increased from 19 ± 19 to 134 ± 61 g/day (P < 0.0001). Weight decreased from 72.6 ± 12.7 to 70.0 ± 12.3 kg (P < 0.0001), and waist circumference decreased from 82.9 ± 8.7 to 79.1 ± 8.0 cm (P < 0.0001). CONCLUSIONS This proof-of-concept study strongly supports a randomized clinical trial of adjunctive-to-insulin empagliflozin in patients with T1D. PMID:24595630

Perkins, Bruce A; Cherney, David Z I; Partridge, Helen; Soleymanlou, Nima; Tschirhart, Holly; Zinman, Bernard; Fagan, Nora M; Kaspers, Stefan; Woerle, Hans-Juergen; Broedl, Uli C; Johansen, Odd-Erik

2014-05-01

225

Post-meal ?-cell function predicts the efficacy of glycemic control in patients with type 2 diabetes inadequately controlled by metformin monotherapy after addition of glibenclamide or acarbose  

PubMed Central

Background This study aimed to explore parameters which will predict good control of HbA1c after adding a second anti-diabetic drug in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin monotherapy. Methods Fifty-one patients (M/F: 25/26, mean age: 53.7?±?8.2 years, mean glycated hemoglobin [HbA1c] 8.4?±?1.2%) with T2DM inadequately controlled with metformin were randomized to add-on glibenclamide or acarbose for 16 weeks. Before and after combination therapy, the subjects underwent a 2-hour liquid mixed meal tolerance test to determine insulin secretion (HOMA-?, insulinogenic index, and disposition index [DI]) and insulin sensitivity (HOMA-IR and Matsuda insulin sensitivity index). Results At baseline, there was a significant inverse relationship between DI120 and HbA1c (p?=?0.001) in all subjects. The addition of glibenclamide and acarbose improved HbA1c significantly from 8.6?±?1.6% to 7.4?±?1.2% (p?controlled with metformin, add-on oral anti-diabetic agent with glibenclamide or acarbose resulted in the significant HbA1c reduction and improvement of ?-cell function. Subjects with greater baseline ?-cell function reserve displayed better glycemic response in the combination therapy of metformin with glibenclamide or acarbose. Trial registration This study was registered in the ClinicalTrials.gov with registration number of NCT00417729.

2014-01-01

226

Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up  

PubMed Central

Background Low-carbohydrate diets, due to their potent antihyperglycemic effect, are an intuitively attractive approach to the management of obese patients with type 2 diabetes. We previously reported that a 20% carbohydrate diet was significantly superior to a 55–60% carbohydrate diet with regard to bodyweight and glycemic control in 2 groups of obese diabetes patients observed closely over 6 months (intervention group, n = 16; controls, n = 15) and we reported maintenance of these gains after 22 months. The present study documents the degree to which these changes were preserved in the low-carbohydrate group after 44 months observation time, without close follow-up. In addition, we assessed the performance of the two thirds of control patients from the high-carbohydrate diet group that had changed to a low-carbohydrate diet after the initial 6 month observation period. We report cardiovascular outcome for the low-carbohydrate group as well as the control patients who did not change to a low-carbohydrate diet. Method Retrospective follow-up of previously studied subjects on a low carbohydrate diet. Results The mean bodyweight at the start of the initial study was 100.6 ± 14.7 kg. At six months it was 89.2 ± 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 ± 4.2 kg to an average of 92.0 ± 14.0 kg. At 44 months average weight has increased from baseline g to 93.1 ± 14.5 kg. Of the sixteen patients, five have retained or reduced bodyweight since the 22 month point and all but one have lower weight at 44 months than at start. The initial mean HbA1c was 8.0 ± 1.5%. After 6, 12 and 22 months, HbA1c was 6.1 ± 1.0%, 7.0 ± 1.3% and 6.9 ± 1.1% respectively. After 44 months mean HbA1c is 6.8 ± 1.3%. Of the 23 patients who have used a low-carbohydrate diet and for whom we have long-term data, two have suffered a cardiovascular event while four of the six controls who never changed diet have suffered several cardiovascular events. Conclusion Advice to obese patients with type 2 diabetes to follow a 20% carbohydrate diet with some caloric restriction has lasting effects on bodyweight and glycemic control.

Nielsen, Jorgen V; Joensson, Eva A

2008-01-01

227

Assessment of serum levels of soluble CD40L in Egyptian children and adolescents with type 1 diabetes mellitus: Relationship to microalbuminuria and glycemic control  

PubMed Central

Context: Soluble CD40 ligand (sCD40L) is known to be elevated in different clinical situations including hypercholesterolemia, acute coronary syndromes, and type 2 diabetes mellitus (T2DM), Data about the relationship between type 1 diabetes mellitus (T1DM) and sCD40L is limited. In addition, the potential role ofsCD40Lin the pathogenesis of vascular complications in children and adolescents with T1DM is to be clarified. Hence, the study aimed at assessment of sCD40L levels in children and adolescents with T1DM and correlation of these levels with glycemic control and microalbuminuria. Settings and Design: Cross-sectional controlled study. Materials and Methods: The study was performed in the Pediatric Endocrinology and Diabetes Unit, Assuit University Children Hospital, Assiut, Egypt. It included 70 children and adolescents with T1DM (mean age 14. 76 ± 2.21 years). Cases were further subdivided into 43 cases with normoalbuminuria and 27 cases with microalbuminuria according to presence or absence or microalbuminuria in fresh urine samples. Twentyfive healthy subjects, age- and sex-matched were included as control group (mean age = 13.62 ± 2.11 years). Studied cases were subjected to medical history, clinical examination, and laboratory assessment of fasting blood glucose (FBG), lipid profile, glycosylated hemoglobin (HbA1c), and sCD40L were performed. Results: Mean HbA1c and sCD40L were significantly higher in diabetic children (n = 70) compared to control (n = 25) (P < 0.001 for each). Mean HbA1c and sCD40L levels were significantly higher in microalbuminuric cases (n = 27) compared to normoalbuminuric cases (n = 43) (P < 0.05 and <0.01, respectively). We also observed a significant positive correlation between sCD40L levels and the age, diabetes duration, HbA1c, and urinary albumin creatinine ratio. Conclusions: The high serum sCD40L levels in children and adolescents with T1DM particularly in those with microalbminuria and its positive correlation with diabetes duration, urinary albumin excretion, and glycemic control may reflect the role of sCD40L in diabetic vasculopathy in the pediatric age group. Moreover, measurement of serum sCD40L levels in poorly controlled patients would help to identify those at high risk of developing nephropathy.

Metwalley, Kotb Abbass; Farghaly, Hekma Saad; El-Saied, Abdel-Rahman Abdel-Hamed

2013-01-01

228

Chronic administration of alogliptin, a novel, potent, and highly selective dipeptidyl peptidase-4 inhibitor, improves glycemic control and beta-cell function in obese diabetic ob\\/ob mice  

Microsoft Academic Search

Dipeptidyl peptidase-4 (DPP-4) inhibitors improve glycemic control in patients with type 2 diabetes by increasing plasma active glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide levels. However, the effects of chronic DPP-4 inhibition on in vivo beta-cell function are poorly characterized. We thus evaluated the chronic effects of the DPP-4 inhibitor alogliptin benzoate (formerly SYR-322) on metabolic control and beta-cell function

Yusuke Moritoh; Koji Takeuchi; Tomoko Asakawa; Osamu Kataoka; Hiroyuki Odaka

2008-01-01

229

Comparison of effects of gliclazide, metformin and pioglitazone monotherapies on glycemic control and cardiovascular risk factors in patients with newly diagnosed uncontrolled type 2 diabetes mellitus.  

PubMed

Objective: The objective of this study was to evaluate and compare the effects of gliclazide-modified release (gliclazide-MR), metformine (MET) and pioglitazone (PIO) monotherapies on glycemic control and conventional/non-conventional cardiovascular risk factors in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Material and Methods: A single center, randomized, 52-wk comparator-controlled clinical study was carried out in patients with newly diagnosed uncontrolled T2DM. A total of 57 patients were randomized into gliclazide-MR, metformin and pioglitazone groups. Drugs were administered for 12 months. Anthropometric measurements, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), HbA1c, insulin, HOMA-IR, lipid parameters, the markers of coagulation/fibrinolysis, inflammation and endothelial dysfunction were measured at baseline and at months 3, 6, and 12. Results: In the gliclazide-MR group, HC, FPG, HbA1c, insulin, HOMA-IR, TC, trigylcerides, Lp (a), E-selectin and Hcy were significantly decreased after treatment compared to baseline. In the MET group, BMI, WC, FPG, PPG, HbA1c, ICAM-1 and Hcy significantly decreased after treatment compared to baseline. In PIO group, WC, HC, FPG, PPG, HbA1c, C-peptid, HOMA-IR, trigylcerides, vWF, IL-6, ICAM-1, E-selectin and Hcy significantly decreased after treatment compared to baseline, whereas, HDL-C increased. At the end of the month 12, the decreases in insulin and HOMA-IR score were more pronounced with PIO compared to gliclazide. Conclusions: Gliclazide-MR, MET and PIO monotherapies, were equally effective in proving glycemic control in patients with newly diagnosed, oral antidiabetic (OAD)-naive T2DM. But, improvements in conventional/non-conventional cardiovascular risk factors were more pronounced in patients on PIO therapy compared to gliclazide and MET therapies. Also, all of the 3 drugs represent effective and safe first-line pharmacological treatment options in these patients. PMID:24710641

Erem, C; Ozbas, H M; Nuhoglu, I; Deger, O; Civan, N; Ersoz, H O

2014-05-01

230

Efficacy of Continuous Glucose Monitoring in Improving Glycemic Control and Reducing Hypoglycemia: A Systematic Review and Meta-Analysis of Randomized Trials  

PubMed Central

Objective We conducted a systematic review and meta-analysis to assess the efficacy of continuous glucose monitoring (CGM) in improving glycemic control and reducing hypoglycemia compared to self-monitored blood glucose (SMBG). Methods We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and Scopus for randomized trials of adults and children with type 1 or type 2 diabetes mellitus (T1DM or T2DM). Pairs of reviewers independently selected studies, assessed methodological quality, and extracted data. Meta-analytic estimates of treatment effects were generated using a random-effects model. Results Nineteen trials were eligible and provided data for meta-analysis. Overall, CGM was associated with a significant reduction in mean hemoglobin A1c [HbA1c; weighted mean difference (WMD) of -0.27% (95% confidence interval [CI] -0.44 to -0.10)]. This was true for adults with T1DM as well as T2DM [WMD -0.50% (95% CI -0.69 to -0.30) and -0.70 (95% CI, -1.14 to -0.27), respectively]. No significant effect was noted in children and adolescents. There was no significant difference in HbA1c reduction between studies of real-time versus non-realtime devices (WMD -0.22%, 95% CI, -0.59 to 0.15 versus -0.30%, 95% CI, -0.49 to -0.10; p for interaction 0.71). The quality of evidence was moderate due to imprecision, suggesting increased risk for bias. Data for the incidence of severe or nocturnal hypoglycemia were sparse and imprecise. In studies that reported patient satisfaction, users felt confident about the device and gave positive reviews. Conclusion Continuous glucose monitoring seems to help improve glycemic control in adults with T1DM and T2DM. The effect on hypoglycemia incidence is imprecise and unclear. Larger trials with longer follow-up are needed to assess the efficacy of CGM in reducing patient-important complications without significantly increasing the burden of care for patients with diabetes.

Gandhi, Gunjan Y; Kovalaske, Michelle; Kudva, Yogish; Walsh, Kristin; Elamin, Mohamed B; Beers, Melody; Coyle, Cathy; Goalen, Melissa; Murad, Mohammad Safwan; Erwin, Patricia J; Corpus, Joshua; Montori, Victor M; Murad, M. Hassan

2011-01-01

231

Streptozotocin-Induced Early Thermal Hyperalgesia is independent of Glycemic State of Rats: Role of Transient Receptor Potential Vanilloid 1(TRPV1) and Inflammatory mediators  

PubMed Central

Background Streptozotocin (STZ) is used as a common tool to induce diabetes and to study diabetes-induced complications including diabetic peripheral neuropathy (DPN). Previously, we have reported that STZ induces a direct effect on neurons through expression and function of the Transient receptor potential vanilloid 1 (TRPV1) channel in sensory neurons resulting in thermal hyperalgesia, even in non-diabetic STZ-treated mice. In the present study, we investigated the role of expression and function of TRPV1 in the central sensory nerve terminals in the spinal cord in STZ-induced hyperalgesia in rats. Results We found that a proportion of STZ-treated rats were normoglycemic but still exhibited thermal hyperalgesia and mechanical allodynia. Immunohistochemical data show that STZ treatment, irrespective of glycemic state of the animal, caused microglial activation and increased expression of TRPV1 in spinal dorsal horn. Further, there was a significant increase in the levels of pro-inflammatory mediators (IL-1?, IL-6 and TNF-?) in spinal cord tissue, irrespective of the glycemic state. Capsaicin-stimulated release of calcitonin gene related peptide (CGRP) was significantly higher in the spinal cord of STZ-treated animals. Intrathecal administration of resiniferatoxin (RTX), a potent TRPV1 agonist, significantly attenuated STZ-induced thermal hyperalgesia, but not mechanical allodynia. RTX treatment also prevented the increase in TRPV1-mediated neuropeptide release in the spinal cord tissue. Conclusions From these results, it is concluded that TRPV1 is an integral component of initiating and maintaining inflammatory thermal hyperalgesia, which can be alleviated by intrathecal administration of RTX. Further, the results suggest that enhanced expression and inflammation-induced sensitization of TRPV1 at the spinal cord may play a role in central sensitization in STZ-induced neuropathy.

2011-01-01

232

The Interrelationships of Glycemic Control Measures: HbA1c, Glycated Albumin, Fructosamine, 1,5-Anhydroglucitrol, and Continuous Glucose Monitoring  

PubMed Central

Objectives To describe the interrelationships of glycemic control measures: HbA1c, glycated albumin, fructosamine, 1,5-anhydroglucitrol (1,5-AG), and continuous glucose monitoring (CGM) in children and adolescents with type 1 diabetes (T1D). Study Design 26 subjects 4–17 years old had HbA1c measurement followed within 14 days by 3 laboratory measures of glycemia and the collection of CGM glucose data (N=21). Results Glycated albumin and fructosamine levels had a higher correlation with each other than with HbA1c. The correlation of 1,5-AG with HbA1c was lower (absolute r value = 0.25). All four measures had a similar degree of correlation with CGM-measured mean glucose (absolute r value=0.50 to 0.56), and with hyperglycemic area under the curve (AUC) at 180 mg/dL (0.50 to 0.60). Conclusion Each of the four measures (i.e., HbA1c, glycated albumin, fructosamine and 1,5-AG) had a similar correlation with mean glucose and hyperglycemic AUC-180. 1,5 AG did not correlate with hyperglycemic AUC-180 better than did HbA1c.

Beck, Roy; Steffes, Michael; Xing, Dongyuan; Ruedy, Katrina; Mauras, Nelly; Wilson, Darrell M.; Kollman, Craig

2011-01-01

233

Changes in Glycemic Control and Quality of Life in Pediatric Type 1 Diabetics with Continuous Subcutaneous Insulin Infusion of Insulin Aspart Following Multiple Daily Injection Therapy  

PubMed Central

The efficacy of continuous subcutaneous insulin infusion (CSII) of the rapid-acting insulin analogue, insulin aspart, was evaluated in 26 patients with childhood-onset type 1 diabetes aged between 6 and 18 yr who had been on basal-bolus therapy (multiple daily injection (MDI) of regular human insulin or rapid-acting insulin and intermediate/long-acting insulin). The glycemic control in the patients was evaluated based on changes in the clinical parameters and the patient quality of life (QOL) was evaluated by using the insulin therapy-related QOL questionnaire. Twenty two patients continued CSII during the 6-mo study period. The mean HbA1c was 7.8 ± 1.8% at baseline and it decreased to 7.4 ± 0.8% at 6 mo after the start of the CSII. Overall, no decrease of the QOL post-CSII initiation was noted. The possible superiority of CSII as compared to MDI was suggested for patients who “eat out” or “have to look for an appropriate place for insulin injection.” Aside from an inadequate indwelling needle placement detected after the initiation of CSII in several patients, no adverse event associated with NovoRapid® was seen. In conclusion, CSII of rapid-acting insulin appears to be a useful therapy for patients with childhood-onset type 1 diabetes.

Kawamura, Tomoyuki; Urakami, Tatsuhiko; Sugihara, Shigetaka; Kim, Hey Sook; Mochizuki, Mie; Amamiya, Shin

2008-01-01

234

Adiponectin levels in south Indian children with type 1 diabetes mellitus and nondiabetic children and its correlation with anthropometry and glycemic control.  

PubMed

Studies have reported high adiponectin levels in children with type 1 diabetes mellitus (T1DM). Adiponectin has been found to have anti-atherogenic action and other protective functions. We wanted to estimate adiponectin level in south Indian T1DM children and compare it with that of non-diabetic children and study its correlation with anthropometry and glycemic status. Sixty children with T1DM and forty non-diabetic children of age less than 15 years were analysed. Mean adiponectin level was higher in T1DM group than in non diabetic group (p < 0.001) irrespective of the age group or sex. Negative correlation was observed between SFT- triceps and adiponectin in diabetic and control group. Multiple regression coefficient analysis of various parameters showed SFT- triceps as a statistically significant predictor of adiponectin level (p = 0.001). We conclude that, children with T1DM had higher adiponectin level than non-diabetic children. Low SFT- triceps measuremet may be a predictor of higher adiponectin level. PMID:24079077

Solomon, J Ritchie Sharon; Varadarajan, Poovazhagi; Varadarajan, V Poovazhagi

2013-09-01

235

The Effect of Tele-Monitoring on Exercise Training Adherence, Functional Capacity, Quality of Life and Glycemic Control in Patients With Type II Diabetes  

PubMed Central

We used tele-monitoring to attempt to improve exercise adherence (number of hours of exercise completed), peak VO2, HbA1c% and quality of life in an unsupervised, home based exercise program in people with type II diabetes, a cost analysis was also conducted. Thirty-nine patients with type II diabetes were randomized to tele-monitoring (TELE) or control (CON) groups. All patients were asked to complete 6 months exercise training and complete an exercise activity diary. The TELE group was instructed to record their exercise heart rates using a monitor and received weekly telephone calls from an exercise physiologist. Six TELE patients and seven CON patients did not complete the 6 month testing. TELE patients completed a mean weekly volume of 138 minutes, moderate intensity exercise, while CON patients completed 58 minutes weekly (p < 0.02). Neither group achieved the American Heart Association statement guideline for weekly exercise volume of 150 minutes. TELE patients improved peak VO2 (5.5 %), but neither group improved HbA1c% or quality of life. The CON group showed a 4.9% reduction in peak VO2. While tele-monitored patients completed more hours of exercise and demonstrated improved peak VO2 compared to controls, the exercise volume completed was insufficient to improve glycemic control. There is the potential via tele-monitoring to enable people with diabetes to meet exercise training guidelines. Key points Weekly telephone calls from a health professional providing encouragement, increases the amount of exercise completed by people with diabetes Weekly telephone calls will result in improved fitness At least 150 minutes weekly exercise is required to improve diabetes control The cost of home exercise with telephone monitoring is cheaper (and more convenient for the patient) than delivering an exercise program at the hospital Longer term research is needed to examine whether telephone supervised exercise will prevent serious events such as heart attack, strokes and death

Marios, Tracy; A. Smart, Neil; Dalton, Sara

2012-01-01

236

Mosapride improves food intake, while not worsening glycemic control and obesity, in ob\\/ ob obese mice with decreased gastric emptying  

Microsoft Academic Search

Many patients with diabetes mellitus complain of early satiety and postprandial gastric fullness and discomfort. Mosapride citrate, a 5-HT4 receptor agonist, enhances gastric emptying and alleviates gastrointestinal discomfort in patients with diabetic gastroparesis. This study was undertaken to investigate the effects of mosapride citrate on feeding behavior in ob\\/ob obese mice with decreased gastric emptying. Mosapride citrate (1 mg\\/kg\\/day) was

Akihiro Asakawa; Naohiko Ueno; Miwako Katagi; Yuka Ijuin; Yoshinori Morita; Shigeto Mizuno; Toshio Inui; Ruka Sakamaki; Naotaka Shinfuku; Msaharu Uemoto

2006-01-01

237

The Benefit of Subcutaneous Glucagon During Closed-Loop Glycemic Control in Rats With Type 1 Diabetes  

Microsoft Academic Search

Because of its prolonged action, subcutaneously administered insulin has a potential for overcorrection hypoglycemia during closed-loop glucose control. For this reason, we hypothesized that subcutaneous glucagon, whose action is faster, could lessen the risk for hypoglycemia during closed-loop control. We therefore compared insulin alone versus insulin plus glucagon in diabetic rats in a controlled closed-loop study. Both hormones were delivered

W. Kenneth Ward; Julia Engle; Heather M. Duman; Colin P. Bergstrom; Sonia F. Kim; Isaac F. Federiuk

2008-01-01

238

Differentiating Approaches to Diabetes Self-Management of Multi-Ethnic Rural Older Adults at the Extremes of Glycemic Control  

ERIC Educational Resources Information Center

Purpose of the Study: This study identified approaches to diabetes self-management that differentiate persons with well-controlled from poorly controlled diabetes. Previous research has focused largely on persons participating in self-management interventions. Design and Methods: In-depth qualitative interviews were conducted with 48 adults, drawn…

Brewer-Lowry, Aleshia Nichol; Arcury, Thomas A.; Bell, Ronny A.; Quandt, Sara A.

2010-01-01

239

Glycemic management of diabetes by insulin therapy.  

PubMed

Recent technological innovations as insulin analogue formulation, devices for insulin delivery and glucose monitoring have allowed diabetic patients to improve their glycemic control and decrease their level of burden due to diabetes. Intensive insulin therapy via insulin pens, subcutaneous or intraperitoneal insulin infusions using pumps instead of vials and syringes, are associated with improved absorption reproducibility, HbA1c levels, reduced risk of hypo- or hyperglycemia, and increased quality of patient's life. These currently used systems are discussed in this review as well as the future of exogenous insulin therapy: closed loop system, the artificial pancreas, and oral insulin delivery. Glucose homeostasis is directly linked to glycemic regulated by portal insulin administration, thus endogenous insulin therapy might be the most promising treatment to "cure" diabetes. Consequently, pancreas and islet transplantation, and the bioartificial pancreas are described. PMID:23435441

Reix, N; Sigrist, S; Heurtault, B; Agin, A; Moreau, F; Pinget, M; Jeandidier, N

2013-03-01

240

Improved Glycemic Control through Continuous Glucose Sensor-Augmented Insulin Pump Therapy: Prospective Results from a Community and Academic Practice Patient Registry  

PubMed Central

Background Conducted by highly experienced investigators with abundant time and resources, phase III studies of continuous glucose sensing (CGS) may lack generalizability to everyday clinical practice. Method Community or academic practices in six Central and Eastern European or Mediterranean countries prospectively established an anonymized registry of consecutive patients with type 1 insulin-dependent diabetes mellitus starting CGS-augmented insulin pump therapy with the Paradigm® X22 (Medtronic MiniMed, Northridge, CA) under everyday conditions, without prior CGS with another device. We compared glycosylated hemoglobin (GHb) values before and after 3 months of CGS and assessed relationships between insulin therapy variables and glycemia-related variables at weeks 1, 4, and 12 of CGS. Results Of 102 enrolled patients, 85 (83%) with complete weeks 1, 4, and 12 sensor data and baseline/3-month GHb data were evaluable. Evaluable patients were ?54% male and ?75% adult (mean age, 33.2 ± 16.9 years) with longstanding diabetes and high personal/family education levels. Mean GHb declined significantly after 3 months of CGS (7.55 ± 1.33% at baseline to 6.81 ± 1.08% after 12 weeks, 0.74% absolute decrease, P < 0.001). The absolute GHb reduction correlated significantly (P < 0.0005) with baseline GHb: larger absolute reductions tended to occur when baseline levels were higher. An increased basal insulin dose as a percentage of the total daily insulin dose and a decreased daily bolus count from week 1 to week 12 of CGS predicted GHb improvement from baseline to week 12. Conclusions CGS-augmented insulin pump therapy appears to improve glycemic control in type 1 diabetes in varied everyday practice settings.

Cohen, Ohad; Korner, Anna; Chlup, Rudolf; Zoupas, Christos S.; Ragozin, Anton K.; Wudi, Krisztina; Bartaskova, Dagmar; Pappas, Aggelos; Niederland, Tamas; Taybani, Zoltan; Barak, Lubomir; Vazeou, Andriani

2009-01-01

241

Better Glycemic Control and Weight Loss With the Novel Long-Acting Basal Insulin LY2605541 Compared With Insulin Glargine in Type 1 Diabetes  

PubMed Central

OBJECTIVE To compare effects of LY2605541 versus insulin glargine on daily mean blood glucose as part of a basal-bolus regimen for type 1 diabetes. RESEARCH DESIGN AND METHODS In this randomized, Phase 2, open-label, 2 × 2 crossover study, 137 patients received once-daily basal insulin (LY2605541 or glargine) plus mealtime insulin for 8 weeks, followed by crossover treatment for 8 weeks. Daily mean blood glucose was obtained from 8-point self-monitored blood glucose profiles. The noninferiority margin was 10.8 mg/dL. RESULTS LY2605541 met noninferiority and superiority criteria compared with insulin glargine in daily mean blood glucose (144.2 vs. 151.7 mg/dL, least squares mean difference = ?9.9 mg/dL [90% CI ?14.6 to ?5.2], P < 0.001). Fasting blood glucose variability and A1C were reduced with LY2605541 compared with insulin glargine (both P < 0.001). Mealtime insulin dose decreased with LY2605541 and increased with insulin glargine. Mean weight decreased 1.2 kg with LY2605541 and increased 0.7 kg with insulin glargine (P < 0.001). The total hypoglycemia rate was higher for LY2605541 (P = 0.04) and the nocturnal hypoglycemia rate was lower (P = 0.01), compared with insulin glargine. Adverse events (including severe hypoglycemia) were similar, although more gastrointestinal-related events occurred with LY2605541 (15% vs. 4%, P < 0.001). Mean changes (all within normal range) were higher for alanine aminotransferase, aspartate aminotransferase, triglycerides, and LDL-cholesterol and lower for HDL-cholesterol with LY2605541 compared with insulin glargine (all P < 0.02). CONCLUSIONS In type 1 diabetes, compared with insulin glargine, LY2605541, a novel, long-acting basal insulin, demonstrated greater improvements in glycemic control, increased total hypoglycemia, and reduced nocturnal hypoglycemia, as well as reduced weight and lowered mealtime insulin doses.

Rosenstock, Julio; Bergenstal, Richard M.; Blevins, Thomas C.; Morrow, Linda A.; Prince, Melvin J.; Qu, Yongming; Sinha, Vikram P.; Howey, Daniel C.; Jacober, Scott J.

2013-01-01

242

COH-SR4 reduces body weight, improves glycemic control and prevents hepatic steatosis in high fat diet-induced obese mice.  

PubMed

Obesity is a chronic metabolic disorder caused by imbalance between energy intake and expenditure, and is one of the principal causative factors in the development of metabolic syndrome, diabetes and cancer. COH-SR4 ("SR4") is a novel investigational compound that has anti-cancer and anti-adipogenic properties. In this study, the effects of SR4 on metabolic alterations in high fat diet (HFD)-induced obese C57BL/J6 mice were investigated. Oral feeding of SR4 (5 mg/kg body weight.) in HFD mice for 6 weeks significantly reduced body weight, prevented hyperlipidemia and improved glycemic control without affecting food intake. These changes were associated with marked decreases in epididymal fat mass, adipocyte hypertrophy, increased plasma adiponectin and reduced leptin levels. SR4 treatment also decreased liver triglycerides, prevented hepatic steatosis, and normalized liver enzymes. Western blots demonstrated increased AMPK activation in liver and adipose tissues of SR4-treated HFD obese mice, while gene analyses by real time PCR showed COH-SR4 significantly suppressed the mRNA expression of lipogenic genes such as sterol regulatory element binding protein-1c (Srebf1), acetyl-Coenzyme A carboxylase (Acaca), peroxisome proliferator-activated receptor gamma (Pparg), fatty acid synthase (Fasn), stearoyl-Coenzyme A desaturase 1 (Scd1), carnitine palmitoyltransferase 1a (Cpt1a) and 3-hydroxy-3-methyl-glutaryl-CoA reductase (Hmgcr), as well as gluconeogenic genes phosphoenolpyruvate carboxykinase 1 (Pck1) and glucose-6-phosphatase (G6pc) in the liver of obese mice. In vitro, SR4 activates AMPK independent of upstream kinases liver kinase B1 (LKB1) and Ca2+/calmodulin-dependent protein kinase kinase ? (CaMKK?). Together, these data suggest that SR4, a novel AMPK activator, may be a promising therapeutic compound for treatment of obesity, fatty liver disease, and related metabolic disorders. PMID:24376752

Figarola, James Lester; Singhal, Preeti; Rahbar, Samuel; Gugiu, Bogdan Gabriel; Awasthi, Sanjay; Singhal, Sharad S

2013-01-01

243

Impaired left ventricular diastolic function in newborn infants of mothers with pregestational or gestational diabetes with good glycemic control  

Microsoft Academic Search

The aim of the study: We assessed by echocardiography the left ventricular systolic and diastolic function in newborn infants of mothers with well-controlled pregestational type 1 or gestational diabetes (IDM) in comparison to normal term neonates. Subjects and methods: Two-dimensional\\/M-mode and Doppler transmitral flow velocity measurements were performed in 18 IDM and 26 control infants of non-diabetic mothers (gestational ages

Andrea Kozák-Bárány; Eero Jokinen; Pentti Kero; Juhani Tuominen; Tapani Rönnemaa; Ilkka Välimäki

2004-01-01

244

Glycemic variability and outcome in critically ill  

PubMed Central

Background: Acute hyperglycemia, hypoglycemia and glycemic variability (GV) have been found to be the three principal domains of glycemic control, which can adversely affect patient outcome. GV may be the confounding factor in tight glycemic control trials in surgical and medical patient. Objective: This study was conducted to establish if there was any relationship between GV and intensive care unit (ICU) mortality in the Indian context. Study Design: A retrospective review of a large cohort of prospectively collected database. Setting: Adult Medical/Surgical/Trauma/Neuro ICU of a tertiary care hospital. Patient Population: All patients who had four or more blood glucose measured during the ICU stay. Outcome: ICU mortality. Result: 2208 patients with a total of 11,335 blood glucose values were analyzed. GV measured by the standard deviation (SD) of mean blood glucose and glycemic lability index (GLI), both were significantly (P < 0.001) associated with ICU mortality. This relationship was maintained (odds ratio (OR): 2.023, 95% confidence interval (CI): 1.483-2.758) even after excluding patients with hypoglycemia (<60 mg/dl). Patients with blood glucose values in the euglycemic range but highest SD had higher mortality (54%) compared to mortality (24%) in patients above the euglycemic range. Similarly patients with blood sugar values below the average for study cohort and high GLI, another marker of GV had higher mortality (OR: 5.62, CI: 3.865-8.198) than compared to patients in the hyperglycemic range, reflecting the importance of GV as a prognostic marker in patients with blood sugar in the euglycemic range. Conclusion: This study demonstrated that high glucose variability is associated with increased ICU mortality in a large heterogeneous cohort of ICU patients. This effect was particularly evident among patients in the euglycemic range.

Todi, Subhash; Bhattacharya, Mahuya

2014-01-01

245

What do herbalists suggest to diabetic patients in order to improve glycemic control? Evaluation of scientific evidence and potential risks  

Microsoft Academic Search

In the course of 12 continuing education seminars given in different regions of Italy in 2001, we distributed a questionnaire to all the attending herbalists asking information about the herbal remedy and dietary supplement they mainly recommended to subjects who required a “natural” treatment to control glycemia. We distributed 720 questionnaires and we received 685 completed ones. We have compiled

A. F. G. Cicero; G. Derosa; A. Gaddi

2004-01-01

246

Effect of butanol fraction from Cassia tora L. seeds on glycemic control and insulin secretion in diabetic rats  

PubMed Central

Cassia tora L. seeds have previously been reported to reduce blood glucose level in human and animals with diabetes. In the present study, the effects of Cassia tora L. seed butanol fraction (CATO) were studied on postprandial glucose control and insulin secretion from the pancreas of the normal and diabetic rats. Diabetes was induced by an i.p. injection of Streptozotocin (55 mg/kg BW) into the male Sprague-Dawley rats. The postprandial glucose control was monitored during a 240 min-period using a maltose loading test. In normal rats, rats fed CATO (20 mg/100 g BW/d) showed lower postprandial glucose levels in all the levels from 30 min up to 180 min than those in the control rats without CATO (p<0.05). In diabetic rats, those levels in the CATO group seemed to be lower during the 30~180 min, but only glucose level at 30 min showed significant difference compared to that in the control group. Moreover, CATO delayed the peak time of the glucose rise in both normal and diabetic rats in the glucose curves. On the other hand, when CATO was administered orally to the diabetic rats for 5 days, 12 hr fasting serum glucose level was decreased in the diabetic rats (p<0.05). Degree of a decrease in 12 hr fasting serum insulin levels was significantly less in the diabetic CATO rats as compared to diabetic control rats. On the last day of feeding, ? cells of the pancreas were stimulated by 200 mg/dL glucose through a 40 min-pancreas perfusion. Amounts of the insulin secreted from the pancreas during the first phase (11~20 min) and the second phase (21~40 min) in the CATO fed diabetic rats were significantly greater than those in the diabetic control group (p<0.05). These findings indicated that constituents of Cassia tora L. seeds have beneficial effect on postprandial blood glucose control which may be partially mediated by stimulated insulin secretion from the pancreas of the diabetic rats.

Nam, Jeongsu

2008-01-01

247

Failure to achieve glycemic control despite intensive insulin therapy in a medical ICU: incidence and influence on ICU mortality  

Microsoft Academic Search

Objective  Intensive insulin therapy reduces mortality in subgroups of intensive care unit (ICU) patients, and awareness of the importance\\u000a of blood glucose level (BGL) control has increased among ICU physicians and nurses. The impact of insulin treatment strategies\\u000a on mortality may be influenced by their efficacy in achieving the target BGL range. We assessed the efficacy of an insulin\\u000a treatment strategy

Jean-Claude Lacherade; Patricia Jabre; Sylvie Bastuji-Garin; David Grimaldi; Pascal Fangio; Valerie Théron; Hervé Outin; Bernard De Jonghe

2007-01-01

248

Serum Visfatin and Fetuin-A Levels and Glycemic Control in Patients with Obese Type 2 Diabetes Mellitus  

PubMed Central

Background Visfatin is an adipokine produced by visceral adipose tissue and has insulin-mimicking effects. Fetuin-A is a hepatic secretory protein that binds the insulin receptor and inhibits insulin action both in vivo and in vitro. The authors of the present study aimed to investigate the levels of serum visfatin and fetuin-A and their correlation with hemoglobin A1c (HbA1c) and urine albumin levels in patients with type 2 diabetes mellitus (T2DM). Methods A total of 40 obese patients with T2DM (11 males and 29 females; age, 54.47±10.83 years and 23 obese nondiabetic controls (8 males and 15 females; age, 53.04±11.33 years) were included in the study. Age, sex, and body mass index were similar in the 2 groups. Serum visfatin and fetuin-A levels were measured by enzyme-linked immunosorbent assay. HbA1c and urine albumin levels were measured by high performance liquid chromatography and nephelometric method, respectively. Results Serum levels of visfatin in patients with T2DM (4.03±2.44 ng/mL) were similar to the control group (3.65±3.02 ng/mL). Serum fetuin-A levels were significantly lower in patients with T2DM than the controls (298.75±78.86 and 430.73±94.46 µg/mL, respectively). HbA1c levels were significantly higher in the T2DM group compared with controls (7.33±1.32 and 5.44±0.84%, respectively). Correlations between visfatin, fetuin-A and HbA1c levels were not observed. Conclusion The present study suggests fetuin-A may play a role in the pathogenesis of T2DM.

Gunduz, Fethiye Oztop; Temizel, Mustafa; Faki, Yilmaz; Cakmak, Mustafa; Durmuscan, Mustafa; Sezgin, Funda

2011-01-01

249

Changes in glycemic control from 1996 to 2006 among adults with type 2 diabetes: a longitudinal cohort study  

Microsoft Academic Search

BACKGROUND: Our objectives were to examine temporal changes in HbA1c and lipid levels over a 10-year period and to identify predictors of metabolic control in a longitudinal patient cohort. METHODS: We identified all adults within our hospital network with T2DM who had HbA1c's measured in both 1996 and 2006 (longitudinal cohort). For patients with no data in 2006, we used

Karen J Blumenthal; Mary E Larkin; Gail Winning; David M Nathan; Richard W Grant

2010-01-01

250

Peer-Led Diabetes Education Programs in High-Risk Mexican Americans Improve Glycemic Control Compared With Standard Approaches  

PubMed Central

OBJECTIVE To evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost, peer-educator format (Project Dulce) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA1c >8% were randomly assigned to the Project Dulce peer intervention or continuation of standard diabetes care. The primary outcome of interest was HbA1c. RESULTS The majority of subjects were born in Mexico, were female, were middle-aged, had less than an eighth-grade education, and had high baseline HbA1c levels. Significant time-by-group interaction effects for HbA1c (P = 0.02) and diastolic blood pressure (P = 0.04) indicated that the Project Dulce group exhibited greater improvement (i.e., decreases) across time. Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA1c (?1.7%, P = 0.001) and HDL cholesterol (+1.4 mg/dL, P = 0.01) and from baseline to month 10 in absolute levels of HbA1c (?1.5%, P = 0.01), total cholesterol (?7.2 mg/dL, P = 0.04), HDL cholesterol (+1.6 mg/dL, P = 0.01), and LDL cholesterol (?8.1 mg/dL, P = 0.02). No significant changes were noted in the control group. CONCLUSIONS This randomized trial, using the Project Dulce model of culturally sensitive, peer-led education, demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic populations is effective.

Philis-Tsimikas, Athena; Fortmann, Adelaide; Lleva-Ocana, Leticia; Walker, Chris; Gallo, Linda C.

2011-01-01

251

Feedback Control of Random Early Detection  

Microsoft Academic Search

Recently, the authors presented a first-order discrete-time nonlinear dynamic model for a simplified TCP (Transmission Control Protocol) network with RED (Random Early Detection) control, and numerically studied the nonlinear dynamics of the system. In this paper a simple real time control using washout filter is proposed to modify the existing RED scheme to enhance the stability of the operating point.

Richard J. La; Priya Ranjan; Eyad H. Abed

252

Angiotensin I-Converting Enzyme Type 2 (ACE2) Gene Therapy Improves Glycemic Control in Diabetic Mice  

PubMed Central

OBJECTIVE Several clinical studies have shown the benefits of renin-angiotensin system (RAS) blockade in the development of diabetes, and a local RAS has been identified in pancreatic islets. Angiotensin I–converting enzyme (ACE)2, a new component of the RAS, has been identified in the pancreas, but its role in ?-cell function remains unknown. Using 8- and 16-week-old obese db/db mice, we examined the ability of ACE2 to alter pancreatic ?-cell function and thereby modulate hyperglycemia. RESEARCH DESIGN AND METHODS Both db/db and nondiabetic lean control (db/m) mice were infected with an adenovirus expressing human ACE2 (Ad-hACE2-eGFP) or the control virus (Ad-eGFP) via injection into the pancreas. Glycemia and ?-cell function were assessed 1 week later at the peak of viral expression. RESULTS In 8-week-old db/db mice, Ad-hACE2-eGFP significantly improved fasting glycemia, enhanced intraperitoneal glucose tolerance, increased islet insulin content and ?-cell proliferation, and reduced ?-cell apoptosis compared with Ad-eGFP. ACE2 overexpression had no effect on insulin sensitivity in comparison with Ad-eGFP treatment in diabetic mice. Angiotensin-(1–7) receptor blockade by d-Ala7–Ang-(1-7) prevented the ACE2-mediated improvements in intraperitoneal glucose tolerance, glycemia, and islet function and also impaired insulin sensitivity in both Ad-hACE2-eGFP– and Ad-eGFP–treated db/db mice. d-Ala7–Ang-(1-7) had no effect on db/m mice. In 16-week-old diabetic mice, Ad-hACE2-eGFP treatment improved fasting blood glucose but had no effect on any of the other parameters. CONCLUSIONS These findings identify ACE2 as a novel target for the prevention of ?-cell dysfunction and apoptosis occurring in type 2 diabetes.

Bindom, Sharell M.; Hans, Chetan P.; Xia, Huijing; Boulares, A. Hamid; Lazartigues, Eric

2010-01-01

253

Determinants of the Changes in Glycemic Control with Exercise Training in Type 2 Diabetes: A Randomized Trial  

PubMed Central

Aims To assess the determinants of exercise training-induced improvements in glucose control (HbA1C) including changes in serum total adiponectin and FFA concentrations, and skeletal muscle peroxisome proliferator-activated receptor-? coactivator-1? (PGC-1?) protein content. Methods A sub-cohort (n?=?35; 48% men; 74% Caucasian) from the HART-D study undertaking muscle biopsies before and after 9 months of aerobic (AT), resistance (RT), or combination training (ATRT). Results Changes in HbA1C were associated with changes in adiponectin (r?=??0.45, P?=?0.007). Participants diagnosed with type 2 diabetes for a longer duration had the largest increase in PGC-1? (r?=?0.44, P?=?0.008). Statistical modeling examining changes in HbA1C suggested that male sex (P?=?0.05), non-Caucasian ethnicity (P?=?0.02), duration of type 2 diabetes (r?=?0.40; P<0.002) and changes in FFA (r?=?0.36; P<0.004), adiponectin (r?=??0.26; P<0.03), and PGC-1? (r?=??0.28; P?=?0.02) explain ?65% of the variability in the changes in HbA1C. Conclusions Decreases in HbA1C after 9 months of exercise were associated with shorter duration of diabetes, lowering of serum FFA concentrations, increasing serum adiponectin concentrations and increasing skeletal muscle PGC-1? protein expression. Trial Registration ClinicalTrials.gov NCT00458133

Zhang, Zhengyu; Earnest, Conrad P.; Smith, Steven R.; Church, Timothy S.; Ravussin, Eric

2013-01-01

254

Resveratrol Increases Glucose Induced GLP-1 Secretion in Mice: A Mechanism which Contributes to the Glycemic Control  

PubMed Central

Resveratrol (RSV) is a potent anti-diabetic agent when used at high doses. However, the direct targets primarily responsible for the beneficial actions of RSV remain unclear. We used a formulation that increases oral bioavailability to assess the mechanisms involved in the glucoregulatory action of RSV in high-fat diet (HFD)-fed diabetic wild type mice. Administration of RSV for 5 weeks reduced the development of glucose intolerance, and increased portal vein concentrations of both Glucagon-like peptid-1 (GLP-1) and insulin, and intestinal content of active GLP-1. This was associated with increased levels of colonic proglucagon mRNA transcripts. RSV-mediated glucoregulation required a functional GLP-1 receptor (Glp1r) as neither glucose nor insulin levels were modulated in Glp1r-/- mice. Conversely, levels of active GLP-1 and control of glycemia were further improved when the Dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin was co-administered with RSV. In addition, RSV treatment modified gut microbiota and decreased the inflammatory status of mice. Our data suggest that RSV exerts its actions in part through modulation of the enteroendocrine axis in vivo.

Dao, Thi-Mai Anh; Waget, Aurelie; Klopp, Pascale; Serino, Matteo; Vachoux, Christelle; Pechere, Laurent; Drucker, Daniel J.; Champion, Serge; Barthelemy, Sylvain; Barra, Yves; Burcelin, Remy; Seree, Eric

2011-01-01

255

Blood glucose monitoring and glycemic control in adolescence: Contribution of diabetes-specific responsibility and family conflict  

PubMed Central

Purpose To examine age and time trends in responsibility for diabetes management tasks and diabetes-specific family conflict and their relationship to blood glucose monitoring (BGM) frequency and blood glucose control (HbA1c). Methods A sample of 147 adolescents (mean=15.5±.4 years) with type 1 diabetes and their caregivers completed measures of diabetes-specific responsibility and family conflict at baseline and six months. BGM frequency and HbA1c were measured during outpatient clinic appointments. Results Responsibility for diabetes management tasks shifted from caregivers to adolescents with increasing age by adolescent and caregiver report. Diabetes-specific conflict was stable. Similar trends in responsibility and conflict were seen over the 6 month follow-up period. Less frequent BGM and higher HbA1c were also observed with increasing adolescent age. Multivariate analyses demonstrated adolescents taking greater responsibility for management tasks and experiencing greater family conflict at baseline reported lower BGM at six months. Family, demographic, psychosocial, and disease-specific variables accounted for 26% of the variance in BGM frequency by both adolescent and caregiver report. Adolescents reporting greater diabetes-specific family conflict at baseline experienced higher HbA1c values at six months. Variables accounted for 23 and 28% of the variance in HBA1c by adolescent and caregiver report respectively. Conclusions Diabetes-specific responsibility and conflict have important implications for improving disease outcomes. Interventions targeting responsibility and conflict (i.e., reducing conflict while keeping caregivers involved in diabetes management) may help prevent the deterioration in BGM and HbA1c frequently seen during adolescence.

Ingerski, Lisa M.; Anderson, Barbara J.; Dolan, Lawrence M.; Hood, Korey K.

2010-01-01

256

Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil  

PubMed Central

Background To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. Methods This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22?±?11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7?±?8.1 years. Results Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p?

2014-01-01

257

Stress Hyperglycemia and Glycemic Control  

Microsoft Academic Search

\\u000a Stress hyperglycemia is common in critically ill and injured patients and is a component of the “fight-and-flight” response.\\u000a Until recently, stress hyperglycemia was considered a beneficial adaptive response, with the raised blood glucose providing\\u000a a ready source of fuel for the brain, skeletal muscle, heart, and other vital organs at a time of increased metabolic demand.\\u000a However, retrospective studies in

Paul Ellis Marik

258

Glycemic index in chronic disease: a review  

Microsoft Academic Search

Aim: The intent of this review is to critically analyze the scientific evidence on the role of the glycemic index in chronic Western disease and to discuss the utility of the glycemic index in the prevention and management of these disease states.Background: The glycemic index ranks foods based on their postprandial blood glucose response. Hyperinsulinemia and insulin resistance, as well

LS Augustin; S Franceschi; DJA Jenkins; CWC Kendall; C La Vecchia

2002-01-01

259

Effect of Intensive Glycemic Lowering on Health-Related Quality of Life in Type 2 Diabetes  

PubMed Central

OBJECTIVE To compare the effect of intensive versus standard glycemic control strategies on health-related quality of life (HRQL) in a substudy of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS A randomly selected subsample of 2,053 ACCORD participants enrolled in the HRQL substudy was assessed at baseline and 12-, 36-, and 48-month visits. HRQL assessment included general health status (the 36-Item Short Form Health Survey [SF-36]), diabetes symptoms (the Diabetes Symptom Distress Checklist), depression (Patient Health Questionnaire [PHQ]-9), and treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire [DTSQ]). Repeated-measures ANOVA models were used to estimate change in HRQL outcomes by treatment group over 48 months adjusting for model covariates. The effects of early discontinuation of the ACCORD intensive glycemic control arm on study results were explored. RESULTS A total of 1,956 (95%) completed the self-report HRQL instrument(s) at baseline. The intensive arm had a larger decrease in SF-36 physical health component score than the standard arm (?1.6 vs. ?1.1, P = 0.0345). Treatment satisfaction (DTSQ) showed larger improvement with intensive than standard (P = 0.0004). There were no differences in mean scores of the Diabetes Symptom Checklist and PHQ-9. Effects of participant transition following discontinuation of the intensive arm on HRQL were not significant. CONCLUSIONS The ACCORD trial strategy of intensive glycemic control did not lead to benefits in HRQL and was associated with modest improvement in diabetes treatment satisfaction. Thus patient acceptability was apparently not compromised with intensive and complex interventions such as those used in ACCORD.

Anderson, Roger T.; Narayan, K.M. Venkat; Feeney, Patricia; Goff, David; Ali, Mohammed K.; Simmons, Debra L.; Sperl-Hillen, Jo-Ann; Bigger, Thomas; Cuddihy, Robert; O'Conner, Patrick J.; Sood, Ajay; Zhang, Ping; Sullivan, Mark D.

2011-01-01

260

Dietary carbohydrate, glycemic index, and glycemic load and the risk of colorectal cancer in the BCDDP cohort  

Microsoft Academic Search

Background  There is considerable support for associations between insulin and IGF-I levels and colorectal cancer. Diet may relate to\\u000a colorectal cancer through this mechanism, for example, diets high in glycemic index, glycemic load and\\/or carbohydrate are\\u000a hypothesized to increase insulin load and the risk of insulin resistance, hyperinsulinemia. Case–control studies support this\\u000a hypothesis, but prospective cohorts have had mixed results.\\u000a \\u000a \\u000a \\u000a Methods  In

Lori Strayer; David R. Jacobs Jr; Catherine Schairer; Arthur Schatzkin; Andrew Flood

2007-01-01

261

Relations between Long-term Glycemic Control and Postoperative Wound and Infectious Complications after Total Knee Arthroplasty in Type 2 Diabetics  

PubMed Central

Background The authors examined whether poor preoperative glucose control, as indicated by the hemoglobin A1c (HbA1c) level of more than 8%, is associated with postoperative wound and infectious complications in diabetic patients that have undergone total knee arthroplasty (TKA). Methods One hundred and sixty-seven TKAs performed in 115 patients with type 2 diabetes mellitus, from January 2001 through March 2007, were retrospectively reviewed. Logistic regression was used to identify the variables that had a significant effect on the risk of wound complications or early deep infection. The variables considered were age, gender, body mass index, comorbidities, operation time, antibiotic-impregnated cement use, amount of blood transfusion, close suction drain use, duration of diabetes, method of diabetes treatment, diabetes complications, and preoperative HbA1c level. Results The overall incidence of wound complications was 6.6% (n = 11) and there were seven cases (4.2%) of early postoperative deep infection. Logistic regression revealed that the independent risk factors of wound complications were preoperative HbA1C ? 8% (odds ratio [OR], 6.07; 95% confidence interval [CI], 1.12 to 33.0) and operation time (OR, 1.01; 95% CI, 1.00 to 1.03). No variable examined was found to be significantly associated with the risk of early postoperative deep infection. Conclusions Poorly controlled hyperglycemia before surgery may increase the incidence of wound complications among diabetic patients after TKA.

Han, Hyuk-Soo

2013-01-01

262

Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: a randomized controlled trial1234  

PubMed Central

Background: In Hispanic children and adolescents, the prevalence of obesity and insulin resistance is considerably greater than in non-Hispanic white children. A low–glycemic load diet (LGD) has been proposed as an effective dietary intervention for pediatric obesity, but to our knowledge, no published study has examined the effects of an LGD in obese Hispanic children. Objective: We compared the effects of an LGD and a low-fat diet (LFD) on body composition and components of metabolic syndrome in obese Hispanic youth. Design: Obese Hispanic children (7–15 y of age) were randomly assigned to consume an LGD or an LFD in a 2-y intervention program. Body composition and laboratory assessments were obtained at baseline and 3, 12, and 24 mo after intervention. Results: In 113 children who were randomly assigned, 79% of both groups completed 3 mo of treatment; 58% of LGD and 55% of LFD subjects attended 24-mo follow-up. Compared with the LFD, the LGD decreased the glycemic load per kilocalories of reported food intakes in participants at 3 mo (P = 0.02). Both groups had a decreased BMI z score (P < 0.003), which was expressed as a standard z score relative to CDC age- and sex-specific norms, and improved waist circumference and systolic blood pressure (P < 0.05) at 3, 12, and 24 mo after intervention. However, there were no significant differences between groups for changes in BMI, insulin resistance, or components of metabolic syndrome (all P > 0.5). Conclusions: We showed no evidence that an LGD and an LFD differ in efficacy for the reduction of BMI or aspects of metabolic syndrome in obese Hispanic youth. Both diets decreased the BMI z score when prescribed in the context of a culturally adapted, comprehensive weight-reduction program. This trial was registered at clinicaltrials.gov as NCT01068197.

Mirza, Nazrat M; Palmer, Matilde G; Sinclair, Kelly B; McCarter, Robert; He, Jianping; Ebbeling, Cara B; Ludwig, David S; Yanovski, Jack A

2013-01-01

263

Glycemic Index, Obesity, and Diabetes  

Microsoft Academic Search

Prescribing diets to treat obese patients and to prevent type 2 diabetes poses a challenge to clinicians. Overemphasis on\\u000a carbohydrate-to-fat ratio, with insufficient attention directed toward diet quality, may partially explain disappointing outcomes\\u000a with available approaches. The glycemic index (GI) is an alternative system for classifying carbohydrate-containing foods\\u000a according to postprandial blood glucose responses to portions containing a standard amount

Cara B. Ebbeling; David S. Ludwig

264

Effects of switching from prandial premixed insulin therapy to basal plus two times bolus insulin therapy on glycemic control and quality of life in patients with type 2 diabetes mellitus  

PubMed Central

Background The effects of switching from prandial premixed insulin therapy (PPT) injected three times a day to basal plus two times bolus insulin therapy (B2B) on glycemic control and quality of life were investigated in patients with type 2 diabetes mellitus. Methods The clinical course was prospectively observed during the first 16 weeks after switching to B2B (insulin glargine plus insulin glulisine before breakfast and dinner) in 27 subjects previously treated with PPT using 50/50 premixed insulin. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was administered at the start and end of the study. Results The glycated hemoglobin (HbA1c) level (8.3%±1.8% to 8.2%±1.1%) and the DTSQ score did not change between the start and end of the study. An improvement in HbA1c level was found in nine (33%) subjects. The change in HbA1c showed a significant negative correlation with baseline HbA1c, and was significantly better in patients with a baseline HbA1c >8.0% than in those with an HbA1c ?8.0% (?0.9±2.0 versus 0.3±0.6, respectively, P=0.02). The change in DTSQ score representing treatment satisfaction was significantly greater in patients whose HbA1c level was improved than in those in whom it was not (2.7±3.6 versus ?0.8±3.5, P=0.04). Conclusion B2B was noninferior to PPT with regard to HbA1c levels in patients with type 2 diabetes mellitus. B2B should be considered particularly for subjects whose glycemic control is poor despite PPT.

Ito, Hiroyuki; Abe, Mariko; Antoku, Shinichi; Omoto, Takashi; Shinozaki, Masahiro; Nishio, Shinya; Mifune, Mizuo; Togane, Michiko

2014-01-01

265

Body composition, dietary composition, and components of metabolic syndrome in overweight and obese adults after a 12-week trial on dietary treatments focused on portion control, energy density, or glycemic index  

PubMed Central

Background Given the rise in obesity and associated chronic diseases, it is critical to determine optimal weight management approaches that will also improve dietary composition and chronic disease risk factors. Few studies have examined all these weight, diet, and disease risk variables in subjects participating in recommended multi-disciplinary weight loss programs using different dietary strategies. Methods This study compared effects of three dietary approaches to weight loss on body composition, dietary composition and risk factors for metabolic syndrome (MetS). In a 12-week trial, sedentary but otherwise healthy overweight and obese adults (19?M & 138?F; 38.7?±?6.7 y; BMI 31.8?±?2.2) who were attending weekly group sessions for weight loss followed either portion control, low energy density, or low glycemic index diet plans. At baseline and 12?weeks, measures included anthropometrics, body composition, 3-day food diaries, blood pressure, total lipid profile, HOMA, C-reactive protein, and fasting blood glucose and insulin. Data were analyzed by repeated measures analysis of variance. Results All groups significantly reduced body weight and showed significant improvements in body composition (p?control, low energy density, or low glycemic index produced similar, significant short-term improvements in body composition, diet compositin, and MetS components in overweight and obese adults undergoing weekly weight loss meetings. This may allow for flexibility in options for dietary counseling based on patient preference.

2012-01-01

266

Neural circulatory control during exercise: early insights.  

PubMed

During exercise, the cardiovascular response is rapidly and appropriately matched to the intensity of the physical activity. The autonomic nervous system plays an important role in achieving this closely matched circulatory response by an increase in the sympathetic nerve activity to the heart, blood vessels and adrenal medulla and a decrease in the parasympathetic nerve activity to the heart. Early insights into the mechanisms that controlled these cardiovascular changes during exercise were reported in the 19th century. At that time, two mechanisms were hypothesized to be responsible for these changes. In one mechanism, a signal arising in a central area of the brain causes a parallel activation of skeletal muscle contraction and of autonomic nervous system changes (now termed 'central command'). In the other mechanism, a signal arising in the contracting skeletal muscle causes a reflex activation of the autonomic nervous system changes (now termed 'exercise pressor reflex'). Some important investigators involved in early studies include Johan Johansson, August Krogh, Johannes Lindhard and Horace Smirk. Also, Florence Buchanan and Louis Fridericia should be recognized for their contributions. In more recent years, the important involvement of a third mechanism, the arterial baroreflex, has been elucidated. Since those early insights, experiments in both animals and humans have added important findings that strongly support these early hypotheses. PMID:23261851

Mitchell, Jere H

2013-04-01

267

Effect of Intensive Glycemic Control on Levels of Markers of Inflammation in Type 1 Diabetes Mellitus in the Diabetes Control and Complications Trial  

Microsoft Academic Search

Background—Type 1 diabetes mellitus is associated with an increased risk of cardiovascular disease (CVD) that is not fully explained by conventional risk factors. The Diabetes Control and Complications Trial (DCCT) showed that intensive diabetes therapy reduced levels of LDL cholesterol and triglycerides but increased the risk of major weight gain, which might adversely affect CVD risk. The present study examined

Debra A. Schaumberg; Robert J. Glynn; Alicia J. Jenkins; Timothy J. Lyons; Nader Rifai; JoAnn E. Manson; Paul M Ridker; David M. Nathan

2010-01-01

268

The influence of chromium chloride–containing milk to glycemic control of patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial  

Microsoft Academic Search

The aim of this study is to evaluate the effect and safety of chromium-containing milk powder in patients with type 2 diabetes mellitus. A randomized, double-blind, placebo-controlled trial was conducted in Taiwan. A total of 60 patients with type 2 diabetes mellitus, aged 30 to 75 years, and on a dose of gliclazide sulfonylurea agent (?160 mg\\/d) for at least

Dee Pei; Chang-Hsun Hsieh; Yi-Jen Hung; Jer-Chuang Li; Chien-Hsing Lee; Shi-Wen Kuo

2006-01-01

269

Dietary glycemic index, glycemic load and incidence of type 2 diabetes in Japanese men and women: the Japan public health center-based prospective study  

PubMed Central

Background Japanese diets contain a relatively high amount of carbohydrates, and its high dietary glycemic index and glycemic load may raise the risk of diabetes in the Japanese population. The current study evaluated the associations between the dietary glycemic index, glycemic load, and the risk of type 2 diabetes in a population based cohort in Japan. Methods We observed 27,769 men and 36,864 women (45–75 y) who participated in the second survey of the Japan Public Health Center-based Prospective Study. The dietary glycemic index and glycemic load were estimated using a food-frequency questionnaire. The development of diabetes was reported in a questionnaire administered five years later, and the associations were analyzed using logistic regression after controlling for age, area, total energy intake, smoking status, family history of diabetes, physical activity, hypertension, BMI, alcohol intake, magnesium, calcium, dietary fiber and coffee intake, and occupation. Results The dietary glycemic load was positively associated with the risk of diabetes among women: the multivariable-adjusted odds ratio comparing the highest vs. the lowest quartile was 1.52 (95% CI, 1.13-2.04; P-trend?=?0.01). The association was implied to be stronger among women with BMI?glycemic index was positively associated with the risk of diabetes among men with a high intake of total fat: the multivariable-adjusted odds ratio comparing the highest vs. the lowest quartile was 1.46 (95% CI, 0.94-2.28; P-trend?=?0.04). Among women with a high total fat intake, those in the first and second quartiles of the dietary glycemic index had a significant reduced risk of diabetes, compared with those in the first quartile who had a lower total fat level (multivariable-adjusted odds ratio?=?0.59 with 95% CI, 0.37-0.94, and odds ratio?=?0.63 with 95% CI, 0.40-0.998 respectively). Conclusions The population-based cohort study in Japan indicated that diets with a high dietary glycemic load increase the risk of type 2 diabetes among women. Total fat intake may modify the association between the dietary glycemic index and the risk of type 2 diabetes among men and women.

2013-01-01

270

Today`s control systems evolved from early pioneers` dreams  

SciTech Connect

In the last 100 years, power plant controls have evolved from manual operation and simple instruments to automatic state-of-the-art computerized control systems using smart instruments. This article traces the evolution of controls. The topics of the article include early control systems, developments in the early 20th century, Bailey controls, and developments in the late 20th century.

Smith, D.J.

1996-04-01

271

Low glycemic index treatment for epilepsy in tuberous sclerosis complex.  

PubMed

Retrospective chart review of 15 patients with tuberous sclerosis complex (TSC) who initiated the low glycemic index treatment (LGIT) for epilepsy management at Massachusetts General Hospital over a five-year period. Prior to dietary therapy, this cohort (average age: 8.5 years) had tried an average of 5.8 anti-epileptic drugs with incomplete seizure control. At 6 months on the LGIT, 7/15 (47%) patients experienced >50% reduction in seizure frequency. PMID:22119636

Larson, Anna M; Pfeifer, Heidi H; Thiele, Elizabeth A

2012-03-01

272

The Effects of Vitamin D Supplementation on Hepatic Dysfunction, Vitamin D Status, and Glycemic Control in Children and Adolescents with Vitamin D Deficiency and Either Type 1 or Type 2 Diabetes Mellitus  

PubMed Central

Background The effects of vitamin D supplementation on mild hepatic dysfunction and glycemic control are unclear in children and adolescents with either type 1 (T1D) or type 2 diabetes (T2D). Hypothesis Vitamin D supplementation will improve hepatic dysfunction and glycemic control. Aim To determine the effect of vitamin D supplementation on alanine transaminase (ALT), hemoglobin A1c (HbA1c), and serum 25-hydroxyvitamin D [25(OH)D] concentration. Subjects and Methods A retrospective study of 131 subjects with either T1D (n?=?88?46 females, 42 males), or T2D (n?=?43?26 females, 17 males) of ages 3–18 years between 2007–2013. All subjects had (1) a diagnosis of diabetes for >12 mo, (2) received vitamin D supplementation for the management of vitamin D deficiency (3) had baseline and subsequent simultaneous measurements of HbA1c, ALT, and 25(OH)D. Vitamin D deficiency was defined as 25(OH)D concentration of <50 nmol/L (20 ng/mL). Results At baseline, vitamin D deficiency occurred in 72.1% of patients with T2D and in 37.5% of T1D patients (p<0.001). Patients with T2D had significantly higher values for BMI SDS (p<0.001), alanine transaminase (ALT) (p?=?0.001), but lower 25(OH)D (p<0.001), and no difference in HbA1c (p?=?0.94), and total daily dose (TDD) of insulin per kg body weight (p?=?0.48) as compared to T1D patients. After 3 months of vitamin D supplementation, there was a significant increase in 25(OH)D in both T2D (p?=?0.015), and T1D patients (p<0.001); significant reduction in BMI SDS (p?=?0.015) and ALT (p?=?0.012) in T2D, but not in T1D. There was a clinically-significant decrease in HbA1c in T2D from 8.5±2.9% at baseline to 7.7±2.5 at 3 mo, but not in T1D, 8.5±1.2 to 8.53±1.1%. Conclusions Vitamin D supplementation in subjects with T2D was associated with statistically significant decreases in BMI SDS, ALT, and a clinically-significant decrease in HbA1c.

Nwosu, Benjamin Udoka; Maranda, Louise

2014-01-01

273

Attentional control of early perceptual learning.  

PubMed Central

The performance of adult humans in simple visual tasks improves dramatically with practice. This improvement is highly specific to basic attributes of the trained stimulus, suggesting that the underlying changes occur at low-level processing stages in the brain, where different orientations and spatial frequencies are handled by separate channels. We asked whether these practice effects are determined solely by activity in stimulus-driven mechanisms or whether high-level attentional mechanisms, which are linked to the perceptual task, might control the learning process. We found that practicing one task did not improve performance in an alternative task, even though both tasks used exactly the same visual stimuli but depended on different stimulus attributes (either orientation of local elements or global shape). Moreover, even when the experiment was designed so that the same responses were associated with the same stimuli (although subjects were instructed to attend to the attribute underlying one task), learning did not transfer from one task to the other. These results suggest that specific high-level attentional mechanisms, controlling changes at early visual processing levels, are essential in perceptual learning. Images Fig. 3

Ahissar, M; Hochstein, S

1993-01-01

274

Glycemic response in children with insulin-dependent diabetes mellitus after high- or low-glycemic-index  

Microsoft Academic Search

To examine the effects ofvarious carbohydrate foods on postprandial glycemia in diabetic children, we fed a mixed, isocaloric diet containing either high- or low-glycemic- index (GI) breakfast foods to 22 children with poorly controlled insulin-dependent diabetes mellitus (IDDM) and measured blood sugar response with and without adjustment of insulin doses. We found that IDDM children fed a high-GI meal showed

Michelle Weyman-Daum; Pavel Fort; Bridget Recker; Roberto Lanes; Fima Lifshitz

275

Importance of premeal injection time in insulin therapy: Humalog Mix25 is convenient for improved post-prandial glycemic control in type 2 diabetic patients with Italian dietary habits.  

PubMed

We investigated the use, in a short period, of Humalog Mix25 (Mix25) in a twice-daily administration regimen compared to a twice-daily injection therapy with Humulin 30/70 (30/70) in diabetic patients with Italian dietary habits. We studied 33 type 2 diabetic patients aged 59.1 +/- 8.1 years, BMI 29.8 +/- 2.7 kg/m2, duration of diabetes and insulin therapy of 14.4 +/- 9.8 and 4.2 +/- 4.6 years, respectively. After a 4-day lead-in period of twice-daily human insulin 30/70 treatment, patients were randomized to one of two treatment sequences: (1) a twice-daily regimen with Mix25 just 5 minutes before the morning and evening meals for 12 days, followed by a twice-daily therapy with human insulin 30/70 given 30 minutes before the morning and evening meals for an additional 12 days; or (2) the alternate sequence. Each patient underwent a mixed meal test: Humulin 30/70 was administered 30 minutes before the meal, while Mix25 was given 5 minutes before. The 2-hour post-prandial glucose concentration after breakfast was significantly lower during treatment with Mix25 than with Humulin 30/70 (157 +/- 43.2 vs. 180 +/- 43.2 mg/dl, p<0.05). The glycemic excursion after dinner on Mix25 treatment was significantly lower than with Humulin 30/70 (12.2 +/- 48.01 vs. 35.5 +/- 36.92 mg/dl, p<0.05). AUCglucose after Mix25 was lower than after Humulin 30/70. Glycemia after test meal was significantly lower with Mix25 than with Humulin 30/70. Insulin and free insulin concentrations after the test meal were significantly higher with Mix25 in comparison to Humulin 30/70. AUC serum insulin and free insulin curves after Mix25 were significantly higher than after Humulin 30/70 (p=0.028 and p=0.005, respectively). Twice-daily injections of Humalog Mix25, compared to human insulin 30/70 in type 2 diabetic patients with Italian dietary habits, provide improved and lasting post-prandial glycemic control, with the great convenience of the injection just before the meal. PMID:14740279

Coscelli, C; Iacobellis, G; Calderini, C; Carleo, R; Gobbo, M; Di Mario, U; Leonetti, F; Galluzzo, A; Pirrone, V; Lunetta, M; Casale, P; Paleari, F; Falcelli, C; Valle, D; Camporeale, A; Merante, D

2003-12-01

276

Postprandial Hyperglycemia and Glycemic Variability  

PubMed Central

The aim of this article is to evaluate the pros and cons of a specific impact of postprandial hyperglycemia and glycemic variability on the—mainly cardiovascular (CV)—complications of diabetes, above and beyond the average blood glucose (BG) as measured by HbA1c or fasting plasma glucose (FPG). The strongest arguments in favor of this hypothesis come from impressive pathophysiological studies, also in the human situation. Measures of oxidative stress and endothelial dysfunction seem to be especially closely related to glucose peaks and even more so to fluctuating high and low glucose concentrations and can be restored to normal by preventing those glucose peaks or wide glucose excursions. The epidemiological evidence, which is more or less confined to postprandial hyperglycemia and postglucose load glycemia, is also rather compelling in favor of the hypothesis, although certainly not fully conclusive as there are also a number of conflicting results. The strongest cons are seen in the missing evidence as derived from randomized prospective intervention studies targeting postprandial hyperglycemia longer term, i.e., over several years, and seeking to reduce hard CV end points. In fact, several such intervention studies in men have recently failed to produce the intended beneficial outcome results. As this evidence by intervention is, however, key for the ultimate approval of a treatment concept in patients with diabetes, the current net balance of attained evidence is not in favor of the hypothesis here under debate, i.e., that we should care about postprandial hyperglycemia and glycemic variability. The absence of a uniformly accepted standard of how to estimate these parameters adds a further challenge to this whole debate.

Standl, Eberhard; Schnell, Oliver; Ceriello, Antonio

2011-01-01

277

Dietary glycemic load and atherothrombotic risk  

Microsoft Academic Search

Hyperglycemia and hyperinsulinemia are central features of the metabolic syndrome and type 2 diabetes mellitus, which contribute\\u000a to the pathogenesis of coronary heart disease (CHD). Recent data indicate that increased dietary glycemic load (GL) due to\\u000a replacing fats with carbohydrates or increasing intake of rapidly absorbed carbohydrates (ie, high glycemic index [GI]) can create a self-perpetuating insulin resistance state and

Simin Liu; Walter C. Willett

2002-01-01

278

Glycemic response of mashed potato containing high-viscocity hydroxypropylmethylcellulose.  

PubMed

Potatoes generally have one of the highest glycemic index values of any food. Relatively small differences in the glycemic response (GR) of regularly consumed starch foods have shown beneficial effects on health. Lowering the GR of a potato-based meal has potentially wide-reaching health benefits. High-viscosity hydroxypropylmethylcellulose (HV-HPMC) is a modified cellulose dietary fiber extensively used in the food industry. We hypothesized that the GR of a high-glycemic index product such as mashed potato would be lower with the addition of HV-HPMC. In a nonblind, randomized, repeat-measure, crossover controlled trial, 15 healthy adults consumed portions of mashed potato with different doses (0%, 1%, 2%, and 4%) of a specially selected and optimized HV-HPMC and a reference food (glucose) on separate occasions. Five subjects were excluded from the final analysis due to noncompliance with study procedures. Capillary blood glucose was measured in fasted subjects and at 15, 30, 45, 60, 90, and 120 minutes after starting to eat. For each sample, the incremental area under the blood glucose response curve was calculated and the GR determined. There was a significant lowering effect of HV-HPMC on GR (P < .001) of mashed potato. Glycemic responses for all mashed potato samples with the HV-HPMC were significantly lower than the standard mashed potato: 1% level (P < .05), 2% level (P < .05), and 4% level (P < .05). However, there was no significant effect of the HV-HPMC dose on GR. We conclude that addition of select HV-HPMC to mashed potato blunts GR. PMID:19761889

Lightowler, Helen J; Henry, C Jeya K

2009-08-01

279

Overall Glycemic Index and Glycemic Load of Vegan Diets in Relation to Plasma Lipoproteins and Triacylglycerols  

Microsoft Academic Search

Background: To investigate the overall glycemic index (GI), glycemic load (GL), and intake of dietary fiber, and to examine the associations between these factors and plasma lipoproteins and triacylglycerols in adult vegans in the German Vegan Study (GVS). Methods: Cross-sectional study, Germany. Healthy men (n = 67) and women (n = 87), who fulfilled the study criteria (vegan diet for

Annika Waldmann; Alexander Ströhle; Jochen W. Koschizke; Claus Leitzmann; Andreas Hahn

2007-01-01

280

Mosapride improves food intake, while not worsening glycemic control and obesity, in ob\\/ob obese mice with decreased gastric emptying  

Microsoft Academic Search

Many patients with diabetes mellitus complain of early satiety and postprandial gastric fullness and discomfort. Mosapride citrate, a 5-HT4 receptor agonist, enhances gastric emptying and alleviates gastrointestinal discomfort in patients with diabetic gastroparesis. This study was undertaken to investigate the effects of mosapride citrate on feeding behavior in ob\\/ob obese mice with decreased gastric emptying. Mosapride citrate (1 mg\\/kg\\/day) was

Akihiro Asakawaa

281

Effects of the Antitumor Drug OSI-906, a Dual Inhibitor of IGF-1 Receptor and Insulin Receptor, on the Glycemic Control, ?-Cell Functions, and ?-Cell Proliferation in Male Mice.  

PubMed

The IGF-1 receptor has become a therapeutic target for the treatment of cancer. The efficacy of OSI-906 (linstinib), a dual inhibitor of IGF-1 receptor and insulin receptor, for solid cancers has been examined in clinical trials. The effects of OSI-906, however, on the blood glucose levels and pancreatic ?-cell functions have not yet been reported. We investigated the impact of OSI-906 on glycemic control, insulin secretion, ?-cell mass, and ?-cell proliferation in male mice. Oral administration of OSI-906 worsened glucose tolerance in a dose-dependent manner in the wild-type mice. OSI-906 at a dose equivalent to the clinical daily dose (7.5 mg/kg) transiently evoked glucose intolerance and hyperinsulinemia. Insulin receptor substrate (IRS)-2-deficient mice and mice with diet-induced obesity, both models of peripheral insulin resistance, exhibited more severe glucose intolerance after OSI-906 administration than glucokinase-haploinsufficient mice, a model of impaired insulin secretion. Phloridzin improved the hyperglycemia induced by OSI-906 in mice. In vitro, OSI-906 showed no effect on insulin secretion from isolated islets. After daily administration of OSI-906 for a week to mice, the ?-cell mass and ?-cell proliferation rate were significantly increased. The insulin signals in the ?-cells were apparently unaffected in those mice. Taken together, the results suggest that OSI-906 could exacerbate diabetes, especially in patients with insulin resistance. On the other hand, the results suggest that the ?-cell mass may expand in response to chemotherapy with this drug. PMID:24712877

Shirakawa, Jun; Okuyama, Tomoko; Yoshida, Eiko; Shimizu, Mari; Horigome, Yuka; Tuno, Takayuki; Hayasaka, Moe; Abe, Shiori; Fuse, Masahiro; Togashi, Yu; Terauchi, Yasuo

2014-06-01

282

Effects of high-intensity interval exercise versus continuous moderate-intensity exercise on postprandial glycemic control assessed by continuous glucose monitoring in obese adults.  

PubMed

The purpose of this study was to examine the impact of acute high-intensity interval training (HIIT) compared with continuous moderate-intensity (CMI) exercise on postprandial hyperglycemia in overweight or obese adults. Ten inactive, overweight or obese adults (41 ± 11 yrs, BMI = 36 ± 7 kg/m(2)) performed an acute bout of HIIT (10 × 1 min at approximately 90% peak heart rate (HRpeak) with 1-min recovery periods) or matched work CMI (30 min at approximately 65% HRpeak) in a randomized, counterbalanced fashion. Exercise was performed 2 h after breakfast, and glucose control was assessed by continuous glucose monitoring under standardized dietary conditions over 24 h. Postprandial glucose (PPG) responses to lunch, dinner, and the following day's breakfast were analyzed and compared with a no-exercise control day. Exercise did not affect the PPG responses to lunch, but performing both HIIT and CMI in the morning significantly reduced the PPG incremental area under the curve (AUC) following dinner when compared with control (HIIT = 110 ± 35, CMI = 125 ± 34, control = 162 ± 46 mmol/L × 2 h, p < 0.05). The PPG AUC (HIIT = 125 ± 53, CMI = 186 ± 55, control = 194 ± 96 mmol/L × 2 h) and the PPG spike (HIIT = ?2.1 ± 0.9, CMI = ?3.0 ± 0.9, control = ?3.0 ± 1.5 mmol/l) following breakfast on the following day were significantly lower following HIIT compared with both CMI and control (p < 0.05). Absolute AUC and absolute glucose spikes were not different between HIIT, CMI, or control for any meal (p > 0.05 for all). We conclude that a single session of HIIT has greater and more lasting effects on reducing incremental PPG when compared with CMI. PMID:24773254

Little, Jonathan P; Jung, Mary E; Wright, Amy E; Wright, Wendi; Manders, Ralph J F

2014-07-01

283

Early diabetic neuropathy: Triggers and mechanisms  

PubMed Central

Peripheral neuropathy, and specifically distal peripheral neuropathy (DPN), is one of the most frequent and troublesome complications of diabetes mellitus. It is the major reason for morbidity and mortality among diabetic patients. It is also frequently associated with debilitating pain. Unfortunately, our knowledge of the natural history and pathogenesis of this disease remains limited. For a long time hyperglycemia was viewed as a major, if not the sole factor, responsible for all symptomatic presentations of DPN. Multiple clinical observations and animal studies supported this view. The control of blood glucose as an obligatory step of therapy to delay or reverse DPN is no longer an arguable issue. However, while supporting evidence for the glycemic hypothesis has accumulated, multiple controversies accumulated as well. It is obvious now that DPN cannot be fully understood without considering factors besides hyperglycemia. Some symptoms of DPN may develop with little, if any, correlation with the glycemic status of a patient. It is also clear that identification of these putative non-glycemic mechanisms of DPN is of utmost importance for our understanding of failures with existing treatments and for the development of new approaches for diagnosis and therapy of DPN. In this work we will review the strengths and weaknesses of the glycemic hypothesis, focusing on clinical and animal data and on the pathogenesis of early stages and triggers of DPN other than hyperglycemia.

Dobretsov, Maxim; Romanovsky, Dmitry; Stimers, Joseph R

2007-01-01

284

Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on time  

Microsoft Academic Search

INTRODUCTION: Control of blood glucose (BG) in critically ill patients is considered important, but is difficult to achieve, and often associated with increased risk of hypoglycemia. We examined the use of a computerized insulin dosing algorithm to manage hyperglycemia with particular attention to frequency and conditions surrounding hypoglycemic events. METHODS: This is a retrospective analysis of adult patients with hyperglycemia

Rattan Juneja; Corbin P Roudebush; Adam A Golas; Judith Jacobi; Joni Carroll; Deborah Nelson; Victor J Abad; Samuel J Flanders

2009-01-01

285

Elevated circulating vaspin levels were decreased by rosiglitazone therapy in T2DM patients with poor glycemic control on metformin alone  

Microsoft Academic Search

Vaspin has been regarded as a novel adipokine with potential insulin sensitizing properties. The aim of the present study is to investigate the effects of rosiglitazone therapy on plasma vaspin in type 2 diabetes patients (T2DM) inadequately controlled on metformin alone. A total of 105 subjects, including 37 subjects with normal glucose tolerance (NGT), 37 subjects with impaired glucose regulating

Lili Zhang; Ling Li; Mengliu Yang; Hua Liu; Gangyi Yang

2011-01-01

286

Glycemic index of common Malaysian fruits.  

PubMed

The objective of the present study was to measure the glycemic index of durian, papaya, pineapple and water-melon grown in Malaysia. Ten (10) healthy volunteers (5 females, 5 males; body mass index 21.18+/-1.7 kg/m2) consumed 50 g of available carbohydrate portions of glucose (reference food) and four test foods (durian, papaya, pineapple and watermelon) in random order after an overnight fast. Glucose was tested on three separate occasions, and the test foods were each tested once. Postprandial plasma glucose was measured at intervals for two hours after intake of the test foods. Incremental areas under the curve were calculated, and the glycemic index was determined by expressing the area under the curve after the test foods as a percentage of the mean area under the curve after glucose. The results showed that the area under the curve after pineapple, 232+/-24 mmolxmin/L, was significantly greater than those after papaya, 147+/-14, watermelon, 139+/-8, and durian, 124+/-13 mmolxmin/L (p<0.05). Similarly, the glycemic index of pineapple, 82+/-4, was significantly greater than those of papaya, 58+/-6, watermelon, 55+/-3, and durian, 49+/-5 (p<0.05). The differences in area under the curve and glycemic index among papaya, watermelon and durian were not statistically significant. We conclude that pineapple has a high glycemic index, whereas papaya is intermediate and watermelon and durian are low glycemic index foods. The validity of these results depends on the accuracy of the data in the food tables upon which the portion sizes tested were based. PMID:18364324

Robert, S Daniel; Ismail, Aziz Al-Safi; Winn, Than; Wolever, Thomas M S

2008-01-01

287

Mindfulness and Inhibitory Control in Early Adolescence  

ERIC Educational Resources Information Center

This study examined the relationship between the executive control process of inhibition and self-reported dispositional mindfulness, controlling for gender, grade, and cortisol levels in 99 (43% female) fourth- and fifth-graders ([X-bar] = 10.23 years, SD = 0.53). Students completed a measure of mindful attention awareness and a computerized…

Oberle, Eva; Schonert-Reichl, Kimberly A.; Lawlor, Molly Stewart; Thomson, Kimberly C.

2012-01-01

288

Lipoprotein profile, glycemic control and physical fitness after strength and aerobic training in post-menopausal women with type 2 diabetes  

Microsoft Academic Search

We studied the effects on blood lipids and physical fitness after a training program that combined strength and aerobic exercise\\u000a in postmenopausal women with type 2 diabetes. Ten patients (55.0 ± 5.2 years) followed four exercise sessions per week, two\\u000a strength and two aerobic, and ten (59.4 ± 3.2 years) served as a control group. Lipid profile, glycated hemoglobin (HbA1c), HOMA2 index, exercise stress and muscular

Zois E. Christos; Savvas P. Tokmakidis; Konstantinos A. Volaklis; Kalliopi Kotsa; Anna-Maria Touvra; Eleni Douda; Ioannis G. Yovos

2009-01-01

289

Rationale, design and baseline characteristics of a 4-year (208-week) phase III trial of empagliflozin, an SGLT2 inhibitor, versus glimepiride as add-on to metformin in patients with type 2 diabetes mellitus with insufficient glycemic control  

PubMed Central

Background Sulfonylureas (SUs) are commonly used in the treatment of type 2 diabetes (T2DM), usually as second-line treatment after the failure of metformin. However, SUs are associated with poor durability, hypoglycemia and weight gain. Empagliflozin is a sodium glucose cotransporter 2 (SGLT2) inhibitor in development for the treatment of T2DM. In Phase II/III trials, empagliflozin reduced hyperglycemia, body weight and blood pressure, with a low incidence of hypoglycemia. The aim of this Phase III study is to compare the effects of empagliflozin and the SU glimepiride as second-line therapy in patients with T2DM inadequately controlled with metformin immediate release (IR) and diet/exercise. Method After a 2-week placebo run-in, patients were randomized to receive empagliflozin 25 mg once daily (qd) or glimepiride 1–4 mg qd double-blind for 2 years, in addition to metformin IR. Patients who participate in the initial 2-year randomization period will be eligible for a 2-year double-blind extension. The primary endpoint is change from baseline in HbA1c. Secondary endpoints are change from baseline in body weight, the incidence of confirmed hypoglycemia and changes in systolic and diastolic blood pressure. Exploratory endpoints include markers of insulin secretion, body composition and responder analyses. Safety endpoints include the incidence of adverse events (AEs) (including macro- and microvascular adverse events) and changes from baseline in clinical laboratory parameters. Results Between August 2010 and June 2011, 1549 patients were randomized and 1545 patients were treated. At baseline, mean (SD) age was 55.9 (10.4) years, HbA1c was 7.92 (0.84)%, body mass index was 30.11 (5.59) kg/m2, systolic blood pressure was 133.5 (15.9) mmHg and diastolic blood pressure was 79.5 (9.4) mmHg. Discussion This is the largest study to compare the efficacy and safety of an SGLT2 inhibitor with an SU in patients with T2DM inadequately controlled on metformin to date. In addition to determining the effects of these treatments on glycemic control over the long term, this study will investigate effects on beta-cell function, cardiovascular risk factors and markers of renal function/damage. The results will help to inform the choice of second-line treatment in patients with T2DM who have failed on metformin. Trial registration Clinicaltrials.gov NCT01167881.

2013-01-01

290

Genetic Variant in HK1 Is Associated With a Proanemic State and A1C but Not Other Glycemic Control-Related Traits  

PubMed Central

OBJECTIVE A1C is widely considered the gold standard for monitoring effective blood glucose levels. Recently, a genome-wide association study reported an association between A1C and rs7072268 within HK1 (encoding hexokinase 1), which catalyzes the first step of glycolysis. HK1 deficiency in erythrocytes (red blood cells [RBCs]) causes severe nonspherocytic hemolytic anemia in both humans and mice. RESEARCH DESIGN AND METHODS The contribution of rs7072268 to A1C and the RBC-related traits was assessed in 6,953 nondiabetic European participants. We additionally analyzed the association with hematologic traits in 5,229 nondiabetic European individuals (in whom A1C was not measured) and 1,924 diabetic patients. Glucose control–related markers other than A1C were analyzed in 18,694 nondiabetic European individuals. A type 2 diabetes case-control study included 7,447 French diabetic patients. RESULTS Our study confirms a strong association between the rs7072268–T allele and increased A1C (? = 0.029%; P = 2.22 × 10?7). Surprisingly, despite adequate study power, rs7072268 showed no association with any other markers of glucose control (fasting- and 2-h post-OGTT–related parameters, n = 18,694). In contrast, rs7072268–T allele decreases hemoglobin levels (n = 13,416; ? = ?0.054 g/dl; P = 3.74 × 10?6) and hematocrit (n = 11,492; ? = ?0.13%; P = 2.26 × 10?4), suggesting a proanemic effect. The T allele also increases risk for anemia (836 cases; odds ratio 1.13; P = 0.018). CONCLUSIONS HK1 variation, although strongly associated with A1C, does not seem to be involved in blood glucose control. Since HK1 rs7072268 is associated with reduced hemoglobin levels and favors anemia, we propose that HK1 may influence A1C levels through its anemic effect or its effect on glucose metabolism in RBCs. These findings may have implications for type 2 diabetes diagnosis and clinical management because anemia is a frequent complication of the diabetes state.

Bonnefond, Amelie; Vaxillaire, Martine; Labrune, Yann; Lecoeur, Cecile; Chevre, Jean-Claude; Bouatia-Naji, Nabila; Cauchi, Stephane; Balkau, Beverley; Marre, Michel; Tichet, Jean; Riveline, Jean-Pierre; Hadjadj, Samy; Gallois, Yves; Czernichow, Sebastien; Hercberg, Serge; Kaakinen, Marika; Wiesner, Susanne; Charpentier, Guillaume; Levy-Marchal, Claire; Elliott, Paul; Jarvelin, Marjo-Riitta; Horber, Fritz; Dina, Christian; Pedersen, Oluf; Sladek, Robert; Meyre, David; Froguel, Philippe

2009-01-01

291

Progressive zinc-induced changes in glycemic responses in lean and obese LAIN-cp rats  

SciTech Connect

The effect of diet and phenotype on glycemic status was studied in 9-17 week (wk) old female LAIN-cp rats fed isoenergetic diets containing 0, 20 (control), or 100 ppm Zn. At 9, 13 and 17 wks of age, fasting glucose (FG) of obese > lean. At age 13 wks, Fg of obese + 0 ppm Zn < control obese, and by 17 weeks, lean + 0 ppm Zn < controls, consistent with both diet and phenotype effects on FG. Four point glucose tolerance tests were determined via both intraperitoneal (ipGTT) and oral (OGT) routes at periodic intervals. ipGTT glycemic responses of control obese > lean at all ages, and at both 13 and 17 weeks, obese rats fed both 0 ppm and 100 ppm Zn diets had greater glycemic excursions at +30, +60, and +120 minutes than obese controls, and the glycemic excursions became progressively more impaired as the dietary regimens progressed. In contrast, the corresponding plasma glucoses following ipGTT in lean rats fed 0 or 100 ppm Zn diets and the OGT responses of all rats of both phenotypes remained similar to lean controls at those point. Plasma insulin concentrations of obese 0 ppm Zn < controls following ipGTT, and became progressively more impaired in obese rats fed 0 ppm Zn diet as the duration of treatment continued. These observations suggest that the progressive deterioration of glucose homeostasis when fed diets deficient or excessive in Zn content may be due to impaired pancreatic secretion and/or release of insulin.

Zwick, D.; Frimpong, N.A.; Tulp, O.L. (Drexel Univ., Philadelphia, PA (United States))

1991-03-15

292

Glutamic acid decarboxylase and ICA512/IA-2 autoantibodies as disease markers and relationship to residual beta-cell function and glycemic control in young type 1 diabetic patients.  

PubMed

Circulating autoantibodies (Ab) to islet autoantigens, glutamic acid decarboxylase (GAD(65)), and tyrosine phosphatase ICA512/IA-2 have been proposed as predictive markers of type 1 diabetes mellitus. To ascertain residual beta-cell function and the clinical relevance for monitoring autoimmunity after clinical manifestation of disease, we studied 63 children at diagnosis of type 1 diabetes (mean SD age 7.5 +/- 4 years) and 91 adolescent patients with type 1 diabetes (age 14.7 +/- 1.6 years) with a mean duration of disease of 7 +/- 3.5) years. Forty-two normal adolescent subjects (age 14.6 +/- 1.8 years) without a family history of diabetes were the control group. Anti-GAD(65) and ICA512/IA-2 Ab were assessed by a quantitative radioimmunoprecipitation assay. The relationship between humoral autoimmunity and clinical parameters was explored. GAD(65) and ICA512/IA-2 Ab were detected in 56% and 63% of newly diagnosed children and the prevalence was not different in relationship to clinical characteristics. Levels of GAD(65) Ab positively correlated with diagnosis age (P <.05). Both Ab were associated with islet cell antibodies (ICA) (P <.05), but one fifth of patients had at least 1 of the 2 Ab and absent ICA. At onset, only age showed a significant relationship to residual C-peptide secretion. Among the cohort of patients with diabetes of short-mid duration, GAD(65) and ICA512/IA-2 Ab were present in 44% and 45% of cases (P >.05 and P <.05 v newly diagnosed children, respectively) and more patients were identified by these Ab (68%) than by ICA alone (34%) (P <.05). In this cohort, levels of ICA512/IA-2 Ab negatively correlated with levels of glycosylated hemoglobin (HbA(1c)) (P <.005) and with daily insulin requirement (P <.05). Moreover, the presence of some residual C-peptide secretion was significantly associated with the presence of ICA512/IA-2 Ab (P <.05). Our findings confirm that positivity for either GAD(65) or ICA512/IA-2 Ab is a highly sensitive marker of type 1 diabetes in the pediatric age group, identifying a group of patients with absent ICA immunofluorescence. The persistence of Ab to islet tyrosine phosphatase possibly represents a marker of better glycemic control and less insulin requirement, indicating residual beta-cell function, thus conferring clinical and prognostic relevance to these Ab, as well as potential usefulness in intervention strategies. PMID:12524658

Zanone, M M; Catalfamo, E; Pietropaolo, S L; Rabbone, I; Sacchetti, C; Cerutti, F; Trucco, M; Cavallo-Perin, P

2003-01-01

293

Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study  

PubMed Central

Background Combination therapy consisting of basal insulin and oral hypoglycemic agents (OHAs) is effective for the treatment of type 2 diabetes (T2DM) that cannot be adequately controlled using OHAs alone. Though basal insulin with metformin or sulfonylurea is an effective therapy, it cannot reduce postprandial glycemia without the risk of hypoglycemia. We examined a two-step regimen consisting of the addition of postprandial hypoglycemic agents (an alpha-glucosidase inhibitor and a glinide) in patients whose T2DM was poorly controlled using basal insulin therapy. Methods Inpatients between the ages of 30–79 years who had T2DM and an HbA1c level of more than 7.0% were recruited. The patients were treated with once-daily insulin glargine with or without metformin, depending on the patient’s age and renal function. Insulin glargine was titrated to achieve a target fasting glucose level of 70–130 mg/dL as a first step (STEP0). If the 2-hour postprandial glucose (PBG) level was higher than the target of 180 mg/dL, miglitol treatment (150 mg/day) was initiated, with dose adjustments (75–225 mg) allowed depending on abdominal symptoms and the PBG (STEP1). If the PBG of the patients remained higher than the target after 3 days of treatment, mitiglinide (30 mg/day, titrated up to 60 mg) was added (STEP2). We then evaluated the proportion of patients who achieved the target PBG before and after the two-step regimen. Continuous Glucose Monitoring (CGM) was performed throughout the two-step protocol in most of the patients. Results Of the 16 patients who were recruited (median age, 67.0 [58.0-71.0] years; body mass index, 25.0 [22.0-27.9] kg/m2; HbA1c level at admission, 9.1% [8.35-10.4%]), 1 patient (6.25%) achieved the target PBG at STEP 0 and 14 patients (87.5%) had achieved the target PBG at the end of the treatment protocol (P?=?0.002). CGM showed a significant decrease in the glucose level at each step of the protocol. The standard deviations in the CGM glucose levels for 24 hours, MAGE, and M-value also improved. Conclusions The two-step addition of postprandial hypoglycemic agents to basal insulin therapy is potentially effective and safe for decreasing both the fasting and postprandial glucose levels.

2014-01-01

294

Control Networks and Neuromodulators of Early Development  

ERIC Educational Resources Information Center

In adults, most cognitive and emotional self-regulation is carried out by a network of brain regions, including the anterior cingulate, insula, and areas of the basal ganglia, related to executive attention. We propose that during infancy, control systems depend primarily upon a brain network involved in orienting to sensory events that includes…

Posner, Michael I.; Rothbart, Mary K.; Sheese, Brad E.; Voelker, Pascale

2012-01-01

295

The ABCG5 ABCG8 Sterol Transporter Opposes the Development of Fatty Liver Disease and Loss of Glycemic Control Independently of Phytosterol Accumulation*  

PubMed Central

ABCG5 and ABCG8 form a complex (G5G8) that opposes the absorption of plant sterols but is also expressed in liver where it promotes the excretion of cholesterol into bile. Hepatic G5G8 is transcriptionally regulated by a number of factors implicated in the development of insulin resistance and nonalcoholic fatty liver disease. Therefore, we hypothesized that G5G8 may influence the development of diet-induced obesity phenotypes independently of its role in opposing phytosterol absorption. G5G8 knock-out (KO) mice and their wild type (WT) littermates were challenged with a plant sterol-free low fat or high fat (HF) diet. Weight gain and the rise in fasting glucose were accelerated in G5G8 KO mice following HF feeding. HF-fed G5G8 KO mice had increased liver weight, hepatic lipids, and plasma alanine aminotransferase compared with WT controls. Consistent with the development of nonalcoholic fatty liver disease, macrophage infiltration, the number of TUNEL-positive cells, and the expression of proinflammatory cytokines were also increased in G5G8 KO mice. Hepatic lipid accumulation was associated with increased peroxisome proliferator activated receptor ?, CD36, and fatty acid uptake. Phosphorylation of eukaryotic translation initiation factor 2? (eiF2?) and expression of activating transcription factor 4 and tribbles 3 were elevated in HF-fed G5G8 KO mice, a pathway that links the unfolded protein response to the development of insulin resistance through inhibition of protein kinase B (Akt) phosphorylation. Phosphorylation of Akt and insulin receptor was reduced, whereas serine phosphorylation of insulin receptor substrate 1 was elevated.

Su, Kai; Sabeva, Nadezhda S.; Liu, Jingjing; Wang, Yuhuan; Bhatnagar, Saloni; van der Westhuyzen, Deneys R.; Graf, Gregory A.

2012-01-01

296

Acarbose improves glycemic control as add-on or monotherapy in Indian type-2 diabetes: Findings from the GlucoVIP multinational observational study  

PubMed Central

Objective: To investigate the efficacy and tolerability of the anti-diabetic agent acarbose (Glucobay®) as add-on or monotherapy in a range of patients with type-2 diabetes mellitus (T2DM), including those with cardiovascular morbidities in India. Materials and Methods: This was a part of a prospective, non-interventional, non-controlled, multicentre, multinational, observational study. The study included patients of either gender if they were aged at least 18 years and had untreated or pre-treated type-2 diabetes mellitus (T2DM) or impaired glucose tolerance and no acarbose treatment within the 3 months before study inclusion. Results: In total, 1996 Indian patients were included in the effectiveness and 2010 in the safety analysis. Patients received acarbose (25-150 mg/day). The mean age of the patients was 50.1 years and the mean BMI was 27.2 kg/m2. Mean 2-h post-prandial plasma glucose (PPG) value and fasting blood glucose (FBG) decreased from 243.9 to 169.5 mg/dl and 158.3 to 120.4 mg/dl, respectively after the last follow-up of 12.4 weeks. The mean HbA1c value at initial visit was 8.4% and was 7.4% at the last follow-up visit. FBG, PPG and HbA1c deceased in 90.6%, 94.4% and 52.4% patients respectively, by the last follow-up visit. The mean decrease in weight and waist circumference was 1.4 kg and 1.6 cm, respectively by the last follow-up visit. Physicians assessed the efficacy of drug as positive response in “very good to good” in 91.08%, “sufficient” in 7.92% and “insufficient” in 0.90% of patients. Also, continuation of Acarbose was reported in 97.09% of patients. Adverse events were reported in 2.74% and drug-related adverse events were reported in 2.19% of patients. Majority of them were gastrointestinal adverse events but were not serious. Conclusion: Acarbose is effective and safe in Indian patients with T2DM. Further, it helps in weight reduction and has very good compliance in patients with T2DM.

Philip, Elizabeth; Sundaram, Meenakshi L.; Das, Rupam; Chauhan, Sushil Kumar; Deshpande, Sandeep; Ambhore, Sanjay; Rathod, Rahul; Manjrekar, Pravin

2013-01-01

297

Early deficits in cortical control of swallowing in Alzheimer's disease  

PubMed Central

The goal of this study was to determine whether functional changes in cortical control of swallowing are evident in early Alzheimer’s disease (AD), before dysphagia (swallowing impairment) is evident. Cortical function was compared between an early AD group and a group of age-matched controls during swallowing. Swallowing oropharyngeal biomechanics examined from videofluoroscopic recordings were also obtained to more comprehensively characterize changes in swallowing associated with early AD. Our neuroimaging results show that the AD group had significantly lower BOLD response in many cortical areas that are traditionally involved in normal swallowing (i.e. pre and postcentral gyri, Rolandic and frontal opercula). There were no regions where the AD group recruited more brain activity than the healthy controls during swallowing and only 13% of all active voxels were unique to the AD group, even at this early stage. This suggests that the AD group is not recruiting new regions, nor are they compensating within regions that are active during swallowing. In videofluoroscopic measures, the AD group had significantly reduced hyo-laryngeal elevation than the controls. Although, swallowing impairment is usually noted in the late stages of AD, changes in cortical control of swallowing may begin long before dysphagia becomes apparent.

Humbert, Ianessa A.; McLaren, Donald G.; Kosmatka, Kris; Fitzgerald, Michelle; Johnson, Sterling; Porcaro, Eva; Kays, Stephanie; Umoh, Eno-Obong; Robbins, JoAnne

2010-01-01

298

GLYCEMIC INDEX OF SPRIULINA SUPPLEMENTED MEALS  

Microsoft Academic Search

Glycemic index (GI) of four Indian regional meals (Punjabi, South Indian, Gujarathi, and West Bengali) supplemented with 2.5 g of spray dried spriulina powder, was determined in twenty four normal subjects in the age group of 20-25 years. The subjects were fed equicarbohydrate meals providing 75 g of carbohydrates. The GI of Punjabi meal supplemented with 2.5 g of sprirulina

Uma Iyer; Uliyar Mani

1999-01-01

299

Early history space astronomy. Issues of patronage, management and control  

NASA Astrophysics Data System (ADS)

The history of space astronomy is usually written from the perspective of the remarkable scientific findings garnered by space astronomers and the ways these findings have enriched and guided new views of the universe. This paper examines some aspects of the history of space astronomy in the early years of NASA, but takes patronage, management and control as its key issues.

Smith, Robert W.

2009-08-01

300

77 FR 66469 - Breast and Cervical Cancer Early Detection and Control Advisory Committee (BCCEDCAC)  

Federal Register 2010, 2011, 2012, 2013

...Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and...the aforementioned committee: Name: Breast and Cervical Cancer Early Detection and...regarding the early detection and control of breast and cervical cancer. The committee...

2012-11-05

301

Plasma thyroid hormones in cyclostomes: do they have a role in regulation of glycemic levels?  

PubMed

Plasma levels of thyroxine (T4) and triiodothyronine (T3) were measured by radioimmunoassay in intact Pacific lamprey (Entosphenus tridentatus) undergoing the period of natural fasting and in Pacific hagfish (Eptatretus stouti) maintained unfed in the laboratory. Plasma T3 levels in both lamprey and hagfish were always severalfold lower than T4 levels. The influence of thyroid hormones on glycemic level was studied following intraperitoneal injection of T4 or T3 (13-20 micrograms/100 g body wt), as well as after implantation of sealed Silastic capsules containing the goitrogen, 6-propylthiouracil (6-PTU), or after intraperitoneal injections of an antithyroglobulin serum (ATgS) exhibiting both anti-T4 and anti-T3 activities. Measured plasma T4 and T3 levels after hormonal injection were extremely high and could be considered pharmacological. The 6-PTU treatment decreased plasma levels of both T4 and T3 within several weeks. The glycemic levels in lampreys and hagfish after thyroid hormone treatment were lower than in control animals, whereas in animals treated with either 6-PTU or ATgS, hyperglycemic levels prevailed. It is concluded that thyroid hormones, possibly acting with other hormones, may participate in the maintenance of glycemic levels in cyclostomes and that their action is to reduce glycemic levels. PMID:6826052

Plisetskaya, E; Dickhoff, W W; Gorbman, A

1983-01-01

302

Life Stress Impairs Self-Control in Early Adolescence  

PubMed Central

The importance of self-control to a wide range of developmental outcomes prompted the current investigation of negative life events and self-control in early adolescence. In three prospective, longitudinal studies, negative life events reported by the mother (in Study 1) or child (in Studies 2 and 3) predicted rank-order decreases in self-control over time. In all studies, self-control was measured at two different time points using questionnaires completed by three separate raters, including a classroom teacher who knew the child well and two other raters (parents, caregivers, and/or the child himself/herself). Psychological distress measured in Studies 2 and 3 mediated the deleterious effects of negative life events on self-control. These findings extend prior experimental laboratory research documenting the acute effects of stress on self-control.

Duckworth, Angela L.; Kim, Betty; Tsukayama, Eli

2013-01-01

303

A low glycemic diet lifestyle intervention improves fat utilization during exercise in older obese humans  

PubMed Central

Objective To determine the influence of dietary glycemic index on exercise training-induced adaptations in substrate oxidation in obesity. Design and Methods Twenty older, obese individuals undertook 3-months of fully-supervised aerobic exercise and were randomised to low (LoGIX) or high glycemic (HiGIX) diets. Changes in indirect calorimetry (VO2; VCO2) were assessed at rest, during a hyperinsulinemic-euglycemic clamp, and during submaximal exercise (walking: 65% VO2max, 200 kcal energy expenditure). Intramyocellular lipid (IMCL) was measured by 1H-magnetic resonance spectroscopy. Results Weight loss (?8.6±1.1%) and improvements (P<0.05) in VO2max, glycemic control, fasting lipemia, and metabolic flexibility were similar for both LoGIX and HiGIX groups. During submaximal exercise, energy expenditure was higher following the intervention (P<0.01) in both groups. Respiratory exchange ratio (RER) during exercise was unchanged in the LoGIX group but increased in the HiGIX group (P<0.05). However, fat oxidation during exercise expressed relative to changes in body weight was increased in the LoGIX group (+10.6±3.6%; P<0.05). Fasting IMLC was unchanged, however extramyocellular lipid was reduced (P<0.05) after LoGIX. Conclusions A low glycemic diet/exercise weight-loss intervention increases fat utilization during exercise independent of changes in energy expenditure. This highlights the potential therapeutic value of low glycemic foods for reversing metabolic defects in obesity.

Solomon, Thomas P.J.; Haus, Jacob M.; Cook, Marc A.; Flask, Chris A.; Kirwan, John P.

2013-01-01

304

Glycemic index, glycemic load, and chronic disease risk—a meta- analysis of observational studies1,2  

Microsoft Academic Search

Background: Inconsistent findings from observational studies have prolonged the controversy over the effects of dietary glycemic index (GI) and glycemic load (GL) on the risk of certain chronic diseases. Objective: The objective was to evaluate the association between GI, GL, and chronic disease risk with the use of meta-analysis tech- niques. Design: A systematic review of published reports identified a

Alan W Barclay; Peter Petocz; Tania Prvan; Paul Mitchell; Jennie C Brand-Miller

305

Archean komatiite volcanism controlled by the evolution of early continents.  

PubMed

The generation and evolution of Earth's continental crust has played a fundamental role in the development of the planet. Its formation modified the composition of the mantle, contributed to the establishment of the atmosphere, and led to the creation of ecological niches important for early life. Here we show that in the Archean, the formation and stabilization of continents also controlled the location, geochemistry, and volcanology of the hottest preserved lavas on Earth: komatiites. These magmas typically represent 50-30% partial melting of the mantle and subsequently record important information on the thermal and chemical evolution of the Archean-Proterozoic Earth. As a result, it is vital to constrain and understand the processes that govern their localization and emplacement. Here, we combined Lu-Hf isotopes and U-Pb geochronology to map the four-dimensional evolution of the Yilgarn Craton, Western Australia, and reveal the progressive development of an Archean microcontinent. Our results show that in the early Earth, relatively small crustal blocks, analogous to modern microplates, progressively amalgamated to form larger continental masses, and eventually the first cratons. This cratonization process drove the hottest and most voluminous komatiite eruptions to the edge of established continental blocks. The dynamic evolution of the early continents thus directly influenced the addition of deep mantle material to the Archean crust, oceans, and atmosphere, while also providing a fundamental control on the distribution of major magmatic ore deposits. PMID:24958873

Mole, David R; Fiorentini, Marco L; Thebaud, Nicolas; Cassidy, Kevin F; McCuaig, T Campbell; Kirkland, Christopher L; Romano, Sandra S; Doublier, Michael P; Belousova, Elena A; Barnes, Stephen J; Miller, John

2014-07-15

306

Postmastication digestion factors influence glycemic variability in humans.  

PubMed

The glycemic response (GR) to food is influenced by both intrinsic and extrinsic factors. A consistent observation in GR studies is the wide within- and between-individual variations. The authors hypothesize that between-individual variations in the GR, insulin response (IR) and gastric emptying occur even when food particle size is standardized. Volunteers were tested on 2 nonconsecutive days after an overnight fast in randomized order. On 1 day, the volunteers consumed large (>2000 ?m) rice particles, and on the second day, small rice particles (500-1000 ?m). Subsequently, gastric emptying using the sodium [(13)C] acetate breath test (for 240 minutes) and GR and IR (for 120 minutes) from finger-prick blood samples were measured. The incremental area under the curve (IAUC) for the GR for small particles varied 45% more compared with whole rice. The small particles elicited a significantly greater GR IAUC than the large particles. The standard deviations associated with the IR IAUC for the small particles was 140% greater than that of the large particles. The total IAUC for IR was also significantly greater for the small particles than the large particles. The between-individual variations associated with gastric emptying times were similar for both samples. The gastric emptying latency phase, lag, and half time were significantly shorter for the small particles. Ingesting small particles causes faster gastric emptying and produces greater glycemic and IRs. Between-individual variations in GR and IR can be observed even when all the food associated factors including ingested particle size (mastication) are controlled for in humans. PMID:21745627

Ranawana, Viren; Clegg, Miriam E; Shafat, Amir; Henry, C Jeya

2011-06-01

307

Translational Control of Protein Synthesis: The Early Years  

PubMed Central

For the past fifty-five years, much of my research has focused on the function and biogenesis of red blood cells, including the cloning and study of many membrane proteins such as glucose and anion transporters and the erythropoietin receptor. We have also elucidated the mechanisms of membrane insertion, folding, and maturation of many plasma membrane and secreted proteins. Despite all of this work and more, I remain extremely proud of our very early work on the regulation of mRNA translation: work on bacteriophage f2 RNA in the 1960s and on translation of ?- and ?-globin mRNAs in the early 1970s. Using techniques hopelessly antiquated by today's standards, we correctly elucidated many important aspects of translational control, and I thought readers would be interested in learning how we did these experiments.

Lodish, Harvey F.

2012-01-01

308

Glycemic index, glycemic load and mammographic breast density: the EPIC Florence longitudinal study.  

PubMed

A few studies have evaluated the association between diet and mammographic breast density (MBD) and results are inconsistent. MBD, a well-recognized risk factor for breast cancer, has been proposed as a marker of cumulative exposure to hormones and growth factors. Diets with a high glycemic index (GI) or glycemic load (GL) may increase breast cancer risk, via an effect on the insulin-like growth factor axis. We have investigated the association between carbohydrate intake, GI, GL and MBD in a prospective study. We identified a large series of women, in the frame of the EPIC-Florence cohort, with a mammogram taken five years after enrolment, when detailed information on dietary and lifestyle habits and anthropometric measurements had been collected. Mammograms have been retrieved (1,668, 83%) and MBD assessed according to Wolfe's classification. We compared women with high MBD (P2+DY Wolfe's categories) with those with low MBD (N1+P1) through logistic models adjusted for age, education, body mass index, menopause, number of children, breast feeding, physical activity, non-alcohol energy, fibers, saturated fat and alcohol. A direct association between GL and high MBD emerged in the highest quintile of intake in comparison with the lowest quintile (OR = 1.73, 95%CI 1.13-2.67, p for trend = 0.048) while no association with glycemic index was evident. These results were confirmed after exclusion of women reporting to be on a diet or affected with diabetes, and when Hormone Replacement Therapy at the date of mammographic examination used to assess MBD was considered. The effect was particularly evident among leaner women, although no interaction was found. A positive association was suggested for increasing simple sugar and total carbohydrates intakes limited to the highest quintiles. In this Italian population we observed an association between glycemic load, total and rapidly absorbed carbohydrates and high MBD. These novel results warrant further investigations. PMID:23951047

Masala, Giovanna; Assedi, Melania; Bendinelli, Benedetta; Ermini, Ilaria; Occhini, Daniela; Sieri, Sabina; Brighenti, Furio; Del Turco, Marco Rosselli; Ambrogetti, Daniela; Palli, Domenico

2013-01-01

309

Glycemic Index and Glycemic Load of Carbohydrates in the Diabetes Diet  

Microsoft Academic Search

Medical nutrition therapy is the first line of treatment for the prevention and management of type 2 diabetes and plays an\\u000a essential part in the management of type 1 diabetes. Although traditionally advice was focused on carbohydrate quantification,\\u000a it is now clear that both the amount and type of carbohydrate are important in predicting an individual’s glycemic response\\u000a to a

Kate Marsh; Alan Barclay; Stephen Colagiuri; Jennie Brand-Miller

2011-01-01

310

75 FR 7282 - Breast and Cervical Cancer Early Detection and Control Advisory Committee (BCCEDCAC)  

Federal Register 2010, 2011, 2012, 2013

...Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and...regarding the early detection and control of breast and cervical cancer. The committee makes...Preventive Services Task Force guidelines for breast and cervical cancer screening;...

2010-02-18

311

DIETARY HYPERGLYCEMIA, GLYCEMIC INDEX AND METABOLIC RETINAL DISEASES  

PubMed Central

The glycemic index (GI) indicates how fast blood glucose is raised after consuming a carbohydrate-containing food. Human metabolic studies indicate that GI is related to patho-physiological responses after meals. Compared with a low-GI meal, a high-GI meal is characterized with hyperglycemia during the early postprandial stage (0~2 h) and a compensatory hyperlipidemia associated with counter-regulatory hormone responses during late postprandial stage (4~6 h). Over the past three decades, several human health disorders have been related to GI. The strongest relationship suggests that consuming low-GI foods prevents diabetic complications. Diabetic retinopathy (DR) is a complication of diabetes. In this aspect, GI appears to be useful as a practical guideline to help diabetic people choose foods. Abundant epidemiological evidence also indicates positive associations between GI and risk for type 2 diabetes, cardiovascular disease, and more recently, age-related macular degeneration (AMD) in people without diabetes. Although data from randomized controlled intervention trials are scanty, these observations are strongly supported by evolving molecular mechanisms which explain the pathogenesis of hyperglycemia. This wide range of evidence implies that dietary hyperglycemia is etiologically related to human aging and diseases, including DR and AMD. In this context, these diseases can be considered metabolic retinal diseases. Molecular theories that explain hyperglycemic pathogenesis involve a mitochondria-associated pathway and four glycolysis-associated pathways, including advanced glycation end products formation, protein kinase C activation, polyol pathway, and hexosamine pathway. While the four glycolysis-associated pathways appear to be universal for both normoxic and hypoxic conditions, the mitochondria-associated mechanism appears to be most relevant to the hyperglycemic, normoxic pathogenesis. For diseases that affect tissues with highly active metabolism and that frequently face challenge from low oxygen tension, such as retina in which metabolism is determined by both glucose and oxygen homeostases, these theories appear to be insufficient. Several lines of evidence indicate that the retina is particularly vulnerable when hypoxia coincides with hyperglycemia. We propose a novel hyperglycemic, hypoxia-inducible factor (HIF) pathway, to complement the current theories regarding hyperglycemic pathogenesis. HIF is a transcription complex that responds to decreases in oxygen in the cellular environment. In addition to playing a significant role in the regulation of glucose metabolism, under hyperglycemia HIF has been shown to increase the expression of HIF-inducible genes, such as vascular endothelial growth factor (VEGF) leading to angiogenesis. To this extent, we suggest that HIF can also be described as a hyperglycemia-inducible factor. In summary, while management of dietary GI appears to be an effective intervention for the prevention of metabolic diseases, specifically AMD and DR, more interventional data is needed to evaluate the efficacy of GI management. There is an urgent need to develop reliable biomarkers of exposure, surrogate endpoints, as well as susceptibility for GI. These insights would also be helpful in deciphering the detailed hyperglycemia-related biochemical mechanisms for the development of new therapeutic agents.

Chiu, Chung-Jung; Taylor, Allen

2014-01-01

312

No difference in body weight decrease between a low-glycemic- index and a high-glycemic-index diet but reduced LDL cholesterol after 10-wk ad libitum intake of the low-glycemic-index diet1-3  

Microsoft Academic Search

Background: The role of glycemic index (GI) in appetite and body- weight regulation is still not clear. Objective: The objective of the study was to investigate the long- term effects of a low-fat, high-carbohydrate diet with either low glycemic index (LGI) or high glycemic index (HGI) on ad libitum energy intake, body weight, and composition, as well as on risk

Birgitte Sloth; Inger Krog-Mikkelsen; Anne Flint; Inge Tetens; Inger Björck; Sophie Vinoy; Helena Elmståhl; Arne Astrup; Vincent Lang; Anne Raben

313

Alliance for a Healthy Border: factors related to weight reduction and glycemic success.  

PubMed

We examined the factors related to success in achieving weight reduction and glycemic control in Alliance for a Healthy Border (AHB), a chronic disease prevention program implemented from 2006 to 2009 through 12 federally qualified community health centers serving primarily Hispanics in communities located along the US-Mexico border region. We analyzed data from Phase I of AHB using logistic regression to examine the determinants of success in achieving weight reduction and glycemic control among the participants in AHB programs. Factors affecting weight reduction success were sex, age, employment status, income, insurance, diabetes, baseline body mass index (BMI), smoking status, family history of diabetes, session type, program duration, and physical activity changes. Factors affecting achievement of glycemic success included sex, age, employment status, diabetes, baseline BMI, family history of diabetes, program duration, and physical activity changes. We found that the AHB interventions were more successful in reducing participants' HbA1c level than BMI. In addition to sociodemographic factors, participants with better baseline health conditions (ie, participants without diabetes or family history of diabetes, normal BMI, former smokers) were more likely to achieve success after the interventions. Of the 4 key features defining each of the 12 interventions, session type and program duration were associated with success. Within a relatively short time period, physical activity improvements had a stronger effect on weight reduction and glycemic success than improvements in dietary habits. The effectiveness of diabetes and cardiovascular disease prevention programs can be improved substantially by considering these factors during program design and structure. PMID:22506803

Wang, Xiaohui; Ghaddar, Suad; Brown, Cynthia; Pagán, José A; Balboa, Marvelia

2012-04-01

314

Predicting the Glycemic Response to Gastric Bypass Surgery in Patients With Type 2 Diabetes  

PubMed Central

OBJECTIVE To find clinically meaningful preoperative predictors of diabetes remission and conversely inadequate glycemic control after gastric bypass surgery. Predicting the improvement in glycemic control in those with type 2 diabetes after bariatric surgery may help in patient selection. RESEARCH DESIGN AND METHODS Preoperative details of 154 ethnic Chinese subjects with type 2 diabetes were examined for their influence on glycemic outcomes at 1 year after gastric bypass. Remission was defined as HbA1c ?6%. Analysis involved binary logistic regression to identify predictors and provide regression equations and receiver operating characteristic curves to determine clinically useful cutoff values. RESULTS Remission was achieved in 107 subjects (69.5%) at 12 months. Diabetes duration <4 years, body mass >35 kg/m2, and fasting C-peptide concentration >2.9 ng/mL provided three independent preoperative predictors and three clinically useful cutoffs. The regression equation classification plot derived from continuous data correctly assigned 84% of participants. A combination of two or three of these predictors allows a sensitivity of 82% and specificity of 87% for remission. Duration of diabetes (with different cutoff points) and C-peptide also predicted those cases in which HbA1c ?7% was not attained. Percentage weight loss after surgery was also predictive of remission and of less satisfactory outcomes. CONCLUSIONS The glycemic response to gastric bypass is related to BMI, duration of diabetes, fasting C-peptide (influenced by insulin resistance and residual ?-cell function), and weight loss. These data support and refine previous findings in non-Asian populations. Specific ethnic and procedural regression equations and cutoff points may vary.

Dixon, John B.; Chuang, Lee-Ming; Chong, Keong; Chen, Shu-Chun; Lambert, Gavin W.; Straznicky, Nora E.; Lambert, Elisabeth A.; Lee, Wei-Jei

2013-01-01

315

Dietary glycemic index, glycemic load, insulin index, fiber and whole-grain intake in relation to risk of prostate cancer  

Microsoft Academic Search

Objective  Insulin may play a role in prostate cancer tumorigenesis. Postprandial blood glucose and insulin responses of foods depend\\u000a importantly on the carbohydrate quality and quantity, represented by glycemic index (GI), glycemic load (GL), fiber and whole-grain\\u000a content, but are also influenced by intake of protein and other characteristics. The recently developed insulin index (II)\\u000a quantifies the postprandial insulin secretion, also

K. Nimptsch; S. Kenfield; M. K. Jensen; M. J. Stampfer; M. Franz; L. Sampson; J. C. Brand-Miller; W. C. Willett; E. Giovannucci

2011-01-01

316

Diabetic Autonomic Imbalance and Glycemic Variability  

PubMed Central

Diabetic autonomic neural imbalance is a severe complication of long-term diabetes patients and may progress to diabetic autonomic neuropathy (DAN). The prevalence of DAN is reported to be between 20 and 70%, depending on the studies. The pathogenesis of DAN remains unresolved. However, emerging evidence suggests that glycemic variability (GV) may be associated with autonomic imbalance in patients with both type 1 and type 2 diabetes. As symptoms are initially weak and uncharacteristic, the condition often remains undiagnosed until late manifestations present themselves. Predominant symptoms may include nausea, vomiting, gastroparesis, involuntary diarrhea, postural hypotension, voiding difficulties, and sexual dysfunction. Analyzing the patterns of heart rate variability carries the potential for detection of autonomic imbalance in the subclinical and asymptomatic stages. In this context, GV may affect the sympathovagal balance by increasing oxidative stress and proinflammatory cytokines. Establishing a GV risk profile could therefore be important in determining risk factors in diabetes patients. This review addresses the issues above and in particular the possible association between diabetic autonomic imbalance and GV.

Fleischer, Jesper

2012-01-01

317

The glycemic index (GI) and glycemic load (GL) of five commonly consumed foods of the South Pacific.  

PubMed

Glycemic index (GI) has been widely used in the management of blood sugar levels among diabetes however; in the South Pacific very little information regarding the GI of local foods is made available. The objectives of this research were to determine the glycemic index and the glycemic load of 5 South Pacific foods, which have not been studied. The foods tested were plantain (Musa AAB), tannia (Xanthosoma sagittifolium), roti or chappati, homemade pancake and Lees cabin crackers. Glucose powder mixed in 200 mL of water was used as reference food. Eight apparently healthy indigenous Fijian males from the Fiji Military Forces aged 25-36 years old were recruited for this study. Participants were given a 50 g carbohydrate portion of the test foods to ingest after a 10-12 hour fast the night before the test and the standard reference food were administered to participants on different days for comparison. In the morning, capillary blood samples were drawn from the fingers at 0 min, 15, 30, 45, 60, 90 and 120 minutes postprandially and the blood glucose level was determined. The equation of Wolever using computer software was used to calculate the glycemic index and the glycemic load was calculated using the formular provided in the Harvard Health Online. The results showed that individuals respond to foods differently thus affecting the GI average values. The glycemic index has been categorized by Miller as low GI is pounds 55, moderate GI is between 56-69 and high GI is > or = 70. All the five carbohydrate foods understudy have moderate GI values ranging from 59 to 68. The Glycemic Load (GL) for cabin biscuit was the highest. PMID:18181442

Lako, Jimaima; Sotheeswaran, Subramania; Aalbersberg, William; Sreekumar, K P

2004-03-01

318

The roots of ego-control in young adulthood: links with parenting in early childhood.  

PubMed

This study examined the early parenting correlates of ego-control, the modal threshold for the expression or containment of impulse. Fifty-three female and 50 male participants were followed between 3 and 23 years of age. Ego-control was measured in early childhood (ages 3 and 4) and, independently, in early adulthood (ages 18 and 23) using a Q-sort prototype based on observer ratings. Parenting during early childhood was indexed using a self-report inventory of child-rearing orientations at age 3 and observer ratings of parent-child interactions at age 5. Correlations between early parenting and later ego-control, after partialing out early ego-control to control for parents' reactions to their children, revealed meaningful and convergent relations between independently measured data sets. The patterns of results, which differed between male and female participants, are discussed in terms of gender differences in socialization outcomes. PMID:9825535

Kremen, A M; Block, J

1998-10-01

319

Chemical compositions and glycemic responses to banana varieties.  

PubMed

Chemical compositions and glycemic indices of four varieties of banana (Musa spp.) (kolikuttu-Silk AAB, embul-Mysore AAB, anamalu-Gros Michel AAA, seeni kesel-Pisang Awak ABB) were determined. Silk, Gros Michel, Pisang Awak and Mysore contained the highest percentages of starch (14%), sucrose (38%), free glucose (29%) and fructose (58%) as a percentage of the total available carbohydrate content respectively. Total dietary fiber contents of four varieties ranged from 2.7 to 5.3%. Glycemic indices of Silk, Mysore, Gros Michel and Pisang Awak were 61 ± 5, 61 ± 6, 67 ± 7, 69 ± 9 and can be categorized as low against white bread as the standard. A single banana of the four varieties elicited a low glycemic load. Thus, consumption of a banana from any of these varieties can be recommended as a snack for healthy or diabetic patients who are under dietary management or pharmacological drugs to regulate blood glucose responses in between meals. PMID:21250902

Hettiaratchi, U P K; Ekanayake, S; Welihinda, J

2011-06-01

320

Performance modeling of the Early External Active Thermal Control System for the International Space Station  

Microsoft Academic Search

The Early External Active Thermal Control System (EEATCS) is used to perform the cooling of the US Laboratory (USL) during early assembly stages of the International Space Station (ISS) to support assured early research (AER). It will provide the ability to transport the thermal load generated by the USL to space by thermal radiation via two photovoltaic radiators (PVR). The

1997-01-01

321

Brewer's Yeast Improves Glycemic Indices in Type 2 Diabetes Mellitus  

PubMed Central

Background: Brewer's yeast may have beneficial effects on insulin receptors because of itsglucose tolerance factor in diabetic patients. This study was conducted to investigate the effects of brewer's yeast supplementation on glycemic indices in patients with type 2 diabetes mellitus. Methods: In a randomized double-blind controlled clinical trial, 84 adults (21 men and 63 women) aged 46.3 ± 6.1 years old with type 2 diabetes mellitus were recruited and divided randomly into two groups: Supplement group receiving brewer's yeast (six 300mg tablets/day, total 1800 mg) and control group receiving placebo (six 300mg tablets/day) for 12 weeks. Body weight, height, body mass index, food consumption (based on 24h food record), fasting blood sugar (FBS), glycosylated hemoglobin, insulin sensitivity, and insulin resistance were measured before and after the intervention. Data analysis was performed using the Statistical Package for Social Sciences (version 18.0). Results: The changes in FBS, glycosylated hemoglobin, and insulin sensitivity were significantly different between the two groups during the study (respectively P < 0.001, P < 0.001, P = 0.02 independent sample t-test). There was a significant difference in FBS, glycosylated hemoglobin, and insulin sensitivity at the end of the study between the two groups after removing the effects of baseline values (respectively P = 0.002, P < 0.001, P = 0.02, analysis of covariance). Changes in body mass index, 24h food record, insulin resistance were not significant. Conclusions: Dietary supplementation with brewer›s yeast besides the usual treatment of diabetes can ameliorate blood glucose variables in type 2 diabetes mellitus.

Hosseinzadeh, Payam; Javanbakht, Mohammad Hassan; Mostafavi, Seyed-Ali; Djalali, Mahmoud; Derakhshanian, Hoda; Hajianfar, Hossein; Bahonar, Ahmad; Djazayery, Abolghassem

2013-01-01

322

Use of dynamic light scattering and Scheimpflug imaging for the early detection of cataracts.  

PubMed

Cataract is a leading cause of blindness. Diabetes and glycemic conditions enhance the chances of developing cataracts early. At clinical stage cataracts are detected and documented by slit-lamp biomicroscopy and Scheimpflug photography. A compact fiber optic probe, developed for space experiments, was mounted on a Scheimpflug imaging system. The probe detects and documents cataracts at pre-clinical stage noninvasively and quantitatively. The early detection at the molecular level may lead to medical treatment of cataracts, better control of glycemia, and diabetes mellitus. PMID:11475288

Ansari, R R; Datiles, M B

1999-01-01

323

75 FR 57472 - Breast and Cervical Cancer Early Detection and Control Advisory Committee (BCCEDCAC): Notice of...  

Federal Register 2010, 2011, 2012, 2013

...DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and Control Advisory Committee (BCCEDCAC): Notice of Charter Renewal This gives...

2010-09-21

324

76 FR 30723 - Breast and Cervical Cancer Early Detection and Control Advisory Committee (BCCEDCAC)  

Federal Register 2010, 2011, 2012, 2013

...Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and...regarding the early detection and control of breast and cervical cancer. The committee makes...of Healthcare Reform and its impact for breast and cervical cancer screening;...

2011-05-26

325

Public Health Implications of Recommendations to Individualize Glycemic Targets in Adults With Diabetes  

PubMed Central

OBJECTIVE To estimate how many U.S. adults with diabetes would be eligible for individualized A1C targets based on 1) the 2012 American Diabetes Association (ADA) guideline and 2) a published approach for individualized target ranges. RESEARCH DESIGN AND METHODS We studied adults with diabetes ?20 years of age from the National Health and Nutrition Examination Survey 2007–2008 (n = 757). We assigned A1C targets based on duration, age, diabetes-related complications, and comorbid conditions according to 1) the ADA guideline and 2) a strategy by Ismail-Beigi focused on setting target ranges. We estimated the number and proportion of adults with each A1C target and compared individualized targets to measured levels. RESULTS Using ADA guideline recommendations, 31% (95% CI 27–34%) of the U.S. adult diabetes population would have recommended A1C targets of <7.0%, and 69% (95% CI 66–73%) would have A1C targets less stringent than <7.0%. Using the Ismail-Beigi strategy, 56% (51–61%) would have an A1C target of ?7.0%, and 44% (39–49%) would have A1C targets less stringent than <7.0%. If a universal A1C <7.0% target were applied, 47% (41–54%) of adults with diabetes would have inadequate glycemic control; this proportion declined to 30% (26–36%) with the ADA guideline and 31% (27–36%) with the Ismail-Beigi strategy. CONCLUSIONS Using individualized glycemic targets, about half of U.S. adults with diabetes would have recommended A1C targets of ?7.0% but one-third would still be considered inadequately controlled. Diabetes research and performance measurement goals will need to be revised in order to encourage the individualization of glycemic targets.

Laiteerapong, Neda; John, Priya M.; Nathan, Aviva G.; Huang, Elbert S.

2013-01-01

326

Comparison of multiple and novel measures of dietary glycemic carbohydrate with insulin resistant status in older women  

Microsoft Academic Search

BACKGROUND: Previous epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL). We explored multiple and novel measures of dietary glycemic intake to determine which was most predictive of an association with insulin resistance. METHODS: Usual dietary intakes were assessed by diet history interview in women

Therese A O'Sullivan; Alexandra P Bremner; Sheila O'Neill; Philippa Lyons-Wall

2010-01-01

327

Slowly Digestible Starch: Concept, Mechanism, and Proposed Extended Glycemic Index  

Microsoft Academic Search

Starch is the major glycemic carbohydrate in foods, and its nutritional property is related to its rate and extent of digestion and absorption in the small intestine. A classification of starch into rapidly digestible starch (RDS), slowly digestible starch (SDS), and resistant starch (RS) based on the in vitro Englyst test is used to specify the nutritional quality of starch.

Genyi Zhang; Bruce R. Hamaker

2009-01-01

328

Glycemic Impact and Health: New Horizons in White Bread Formulations  

Microsoft Academic Search

The challenge of provision of a much wider range of foods of relatively low glycemic response than is currently available, especially in terms of cereal products, has been highlighted in recent years and this has particular relevance to bread consumption. Although there has been some transition to brown bread consumption, white bread remains a firm feature in the typical average

Pat M. Burton; John A. Monro; Laura Alvarez; Eimear Gallagher

2011-01-01

329

Inhibitory Control as a Contributor to Conscience in Childhood: From Toddler to Early School Age.  

ERIC Educational Resources Information Center

Examined contribution of temperamental inhibitory control to conscience development. Found longitudinal stability in inhibitory control from toddlerhood to early school age, with inhibitory control increasing with age, and girls outperforming boys. Reaffirmed links between inhibitory control and multiple, diverse measures of children's conscience…

Kochanska, Grazyna; And Others

1997-01-01

330

Early Archean stromatolites: Paleoenvironmental setting and controls on formation  

NASA Technical Reports Server (NTRS)

The earliest record of terrestrial life is contained in thin, silicified sedimentary layers within enormously thick, predominantly volcanic sequences in South Africa and Western Australia. This record includes bacteria-like microfossils, laminated carbonaceous structures resembling flat bacterial mats and stromatolites, and a morphologically diverse assemblage of carbonaceous particles. These structures and particles and their host sediments provide the only direct source of information on the morphology, paleoecology, and biogeochemistry of early life; the nature of interactions between organisms and surface systems on the early earth; and possible settings within which life might have evolved. The three known occurrences of 3.5 to 3.2 billion-year-old stromalites were evaluated in terms of depositional setting and biogenicity.

Lowe, D. R.

1991-01-01

331

Large-scale association analyses identify new loci influencing glycemic traits and provide insight into the underlying biological pathways  

PubMed Central

Through genome-wide association meta-analyses of up to 133,010 individuals of European ancestry without diabetes, including individuals newly genotyped using the Metabochip, we have raised the number of confirmed loci influencing glycemic traits to 53, of which 33 also increase type 2 diabetes risk (q < 0.05). Loci influencing fasting insulin showed association with lipid levels and fat distribution, suggesting impact on insulin resistance. Gene-based analyses identified further biologically plausible loci, suggesting that additional loci beyond those reaching genome-wide significance are likely to represent real associations. This conclusion is supported by an excess of directionally consistent and nominally significant signals between discovery and follow-up studies. Functional follow-up of these newly discovered loci will further improve our understanding of glycemic control.

Scott, Robert A; Lagou, Vasiliki; Welch, Ryan P; Wheeler, Eleanor; Montasser, May E; Luan, Jian'an; Magi, Reedik; Strawbridge, Rona J; Rehnberg, Emil; Gustafsson, Stefan; Kanoni, Stavroula; Rasmussen-Torvik, Laura J; Yengo, Loic; Lecoeur, Cecile; Shungin, Dmitry; Sanna, Serena; Sidore, Carlo; Johnson, Paul C D; Jukema, J Wouter; Johnson, Toby; Mahajan, Anubha; Verweij, Niek; Thorleifsson, Gudmar; Hottenga, Jouke-Jan; Shah, Sonia; Smith, Albert V; Sennblad, Bengt; Gieger, Christian; Salo, Perttu; Perola, Markus; Timpson, Nicholas J; Evans, David M; Pourcain, Beate St; Wu, Ying; Andrews, Jeanette S; Hui, Jennie; Bielak, Lawrence F; Zhao, Wei; Horikoshi, Momoko; Navarro, Pau; Isaacs, Aaron; O'Connell, Jeffrey R; Stirrups, Kathleen; Vitart, Veronique; Hayward, Caroline; Esko, Tonu; Mihailov, Evelin; Fraser, Ross M; Fall, Tove; Voight, Benjamin F; Raychaudhuri, Soumya; Chen, Han; Lindgren, Cecilia M; Morris, Andrew P; Rayner, Nigel W; Robertson, Neil; Rybin, Denis; Liu, Ching-Ti; Beckmann, Jacques S; Willems, Sara M; Chines, Peter S; Jackson, Anne U; Kang, Hyun Min; Stringham, Heather M; Song, Kijoung; Tanaka, Toshiko; Peden, John F; Goel, Anuj; Hicks, Andrew A; An, Ping; Muller-Nurasyid, Martina; Franco-Cereceda, Anders; Folkersen, Lasse; Marullo, Letizia; Jansen, Hanneke; Oldehinkel, Albertine J; Bruinenberg, Marcel; Pankow, James S; North, Kari E; Forouhi, Nita G; Loos, Ruth J F; Edkins, Sarah; Varga, Tibor V; Hallmans, Goran; Oksa, Heikki; Antonella, Mulas; Nagaraja, Ramaiah; Trompet, Stella; Ford, Ian; Bakker, Stephan J L; Kong, Augustine; Kumari, Meena; Gigante, Bruna; Herder, Christian; Munroe, Patricia B; Caulfield, Mark; Antti, Jula; Mangino, Massimo; Small, Kerrin; Miljkovic, Iva; Liu, Yongmei; Atalay, Mustafa; Kiess, Wieland; James, Alan L; Rivadeneira, Fernando; Uitterlinden, Andre G; Palmer, Colin N A; Doney, Alex S F; Willemsen, Gonneke; Smit, Johannes H; Campbell, Susan; Polasek, Ozren; Bonnycastle, Lori L; Hercberg, Serge; Dimitriou, Maria; Bolton, Jennifer L; Fowkes, Gerard R; Kovacs, Peter; Lindstrom, Jaana; Zemunik, Tatijana; Bandinelli, Stefania; Wild, Sarah H; Basart, Hanneke V; Rathmann, Wolfgang; Grallert, Harald; Maerz, Winfried; Kleber, Marcus E; Boehm, Bernhard O; Peters, Annette; Pramstaller, Peter P; Province, Michael A; Borecki, Ingrid B; Hastie, Nicholas D; Rudan, Igor; Campbell, Harry; Watkins, Hugh; Farrall, Martin; Stumvoll, Michael; Ferrucci, Luigi; Waterworth, Dawn M; Bergman, Richard N; Collins, Francis S; Tuomilehto, Jaakko; Watanabe, Richard M; de Geus, Eco J C; Penninx, Brenda W; Hofman, Albert; Oostra, Ben A; Psaty, Bruce M; Vollenweider, Peter; Wilson, James F; Wright, Alan F; Hovingh, G Kees; Metspalu, Andres; Uusitupa, Matti; Magnusson, Patrik K E; Kyvik, Kirsten O; Kaprio, Jaakko; Price, Jackie F; Dedoussis, George V; Deloukas, Panos; Meneton, Pierre; Lind, Lars; Boehnke, Michael; Shuldiner, Alan R; van Duijn, Cornelia M; Morris, Andrew D; Toenjes, Anke; Peyser, Patricia A; Beilby, John P; Korner, Antje; Kuusisto, Johanna; Laakso, Markku; Bornstein, Stefan R; Schwarz, Peter E H; Lakka, Timo A; Rauramaa, Rainer; Adair, Linda S; Smith, George Davey; Spector, Tim D; Illig, Thomas; de Faire, Ulf; Hamsten, Anders; Gudnason, Vilmundur; Kivimaki, Mika; Hingorani, Aroon; Keinanen-Kiukaanniemi, Sirkka M; Saaristo, Timo E; Boomsma, Dorret I; Stefansson, Kari; van der Harst, Pim; Dupuis, Josee; Pedersen, Nancy L; Sattar, Naveed; Harris, Tamara B; Cucca, Francesco; Ripatti, Samuli; Salomaa, Veikko; Mohlke, Karen L; Balkau, Beverley; Froguel, Philippe; Pouta, Anneli; Jarvelin, Marjo-Riitta; Wareham, Nicholas J; Bouatia-Naji, Nabila; McCarthy, Mark I; Franks, Paul W; Meigs, James B; Teslovich, Tanya M; Florez, Jose C; Langenberg, Claudia; Ingelsson, Erik; Prokopenko, Inga; Barroso, Ines

2012-01-01

332

Serum glycated albumin as a new glycemic marker in pediatric diabetes  

PubMed Central

Purpose Serum glycated albumin (GA) has been recently used as another glycemic marker that reflects shorter term glycemic control than glycated hemoglobin (HbA1c). Insulin secretory function and glycemic fluctuation might be correlated with the ratio of GA to HbA1c (GA/HbA1c) in diabetic adult patients. This study investigated the association of GA and GA/HbA1c ratio with the levels of fasting C-peptide, fasting plasma glucose in type 1 and type 2 pediatric diabetes. Methods Total 50 cases from 42 patients were included. The subjects were classified into type 1 diabetes mellitus (T1DM) (n=30) and type 2 diabetes mellitus (T2DM) (n=20) group. The associations among HbA1c, GA, and GA/HbA1c ratio were examined. The relationship between the three glycemic indices and fasting glucose, fasting C-peptide were analyzed. Results Mean values of GA, the GA/HbA1c ratio were significantly higher in T1DM than T2DM. GA (r=0.532, P=0.001), HbA1c (r=0.519, P=0.002) and the GA/HbA1c ratio (r=0.409, P=0.016) were correlated with the fasting plasma glucose. Fasting C-peptide level arranged 4.22±3.22 ng/mL in T2DM, which was significantly above the values in T1DM (0.26±0.49 ng/mL). There were no significant correlation between HbA1c and fasting C-peptide level. However, GA and the GA/HbA1c ratio exhibited inverse correlations with fasting C-peptide level (r=-0.214, P=0.002; r=-0.516, P<0.001). Conclusion GA seems to more accurately reflects fasting plasma glucose level than HbA1c. GA, GA/HbA1c ratio appear to reflect insulin secretory function.

Lee, Ji Woo; Kim, Hyung Jin; Kwon, Young Se; Jun, Yong Hoon; Kim, Soon Ki; Choi, Jong Weon

2013-01-01

333

Effects of Cinnamon Consumption on Glycemic Status, Lipid Profile and Body Composition in Type 2 Diabetic Patients  

PubMed Central

Objective: Type 2 diabetes is the most common metabolic disorder worldwide. Traditional herbs and spices can be used to control blood glucose concentrations. The objective of this study was to evaluate the effects of the daily intake of three grams cinnamon over eight weeks on glycemic status, lipid profiles and body composition in type 2 diabetic patients. Methods: A double blind, randomized, placebo controlled clinical trial was conducted on 44 patients with type 2 diabetes. Participants were randomly assigned to take either a three g/day cinnamon supplement (n=22) or a placebo (n=22) for eight weeks. Weight, height, body fat mass and systolic and diastolic blood pressure were measured at baseline and after intervention. The fasting blood glucose, insulin, HbA1c, total cholesterol, LDL C, HDL C, Apo lipoprotein A I and B were measured at baseline and endpoint. Results: From 44 subjects participated in this study 37 completed the study. There were no significant differences in baseline characteristics, dietary intake and physical activity between groups. In the treatment group, the levels of fasting blood glucose, HbA1c, triglyceride, weight, BMI and body fat mass decreased significantly compared to baseline, but not in placebo group. No significant differences were observed in glycemic status indicators, lipid profile and anthropometric indicators between the groups at the end of intervention. Conclusion: These data suggest that cinnamon may have a moderate effect in improving glycemic status indicators.

Vafa, Mohammadreza; Mohammadi, Farhad; Shidfar, Farzad; Sormaghi, Mohammadhossein Salehi; Heidari, Iraj; Golestan, Banafshe; Amiri, Fatemehsadat

2012-01-01

334

Milestones:Early Developments in Remote-Control, 1901  

NSDL National Science Digital Library

This site provides a brief history of the development of remote control devices by Spanish engineer Leonardo Torres-Quevedo. He was the first person to lay down the modern remote control operation principles, which he expressed in a prototype that he patented in 1903 under the name Telekine.

335

The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis  

Microsoft Academic Search

Objective To evaluate the effectiveness of a service for early psychosis. Design Randomised controlled clinical trial. Setting Community mental health teams in one London borough. Participants 144 people aged 16-40 years presenting to mental health services for the first or second time with non-organic, non-affective psychosis. Interventions Assertive outreach with evidence based biopsychosocial interventions (specialised care group) and standard care

Tom K J Craig; Philippa Garety; Paddy Power; Nikola Rahaman; Susannah Colbert; Miriam Fornells-Ambrojo; Graham Dunn

2004-01-01

336

Glycated albumin versus glycated hemoglobin as glycemic indicator in hemodialysis patients with diabetes mellitus: variables that influence.  

PubMed

The significance of glycated albumin (GA) compared with casual plasma glucose (PG) and glycated hemoglobin (HbA1c) was evaluated as an indicator of the glycemic control state in hemodialysis (HD) patients with diabetes. In HD patients with diabetes (n = 25), the mean PG, GA and HbA1c levels were 192.9 + 23 mg/dL, 278.8 + 43 ?mol/L and 5.9 + 0.5%, respectively, which were higher by 43.9%, 67.04% and 18%, respectively, compared with HD patients without diabetes (n = 25). HbA1c levels were significantly lower than simultaneous PG and GA values in those patients in comparison with the three parameters in patients who had diabetes without renal dysfunction (n = 25). A significant negative correlation was found between GA and serum albumin (r = 0.21, P <0.05) in HD patients with diabetes, whereas HbA1c correlated positively and negatively with hemoglobin (r = 0.11, P <0.01) and weekly dose of erythropoietin injection (r = -0.19, P < 0.01), respectively. Although PG and GA did not differ significantly between HD patients with diabetes and with and without erythropoietin injection, HbA1c levels were significantly higher in patients without erythropoietin. Categorization of glycemic control into arbitrary quartiles by GA level led to better glycemic control in a significantly higher proportion of HD patients with diabetes than those assessed by HA1c. Multiple regression analysis demonstrated that hemoglobin in addition to PG emerged as an independent factor associated with HbA1c in HD patients with diabetes, while PG, body mass index and albumin were an independent factor associated with GA. Conclusion: it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA1c in these patients might lead to likely underestimation as a result of the increasing proportion of young erythrocyte by the use of erythropoietin. PMID:23538348

Sany, Dawlat; Elshahawy, Yasser; Anwar, Walid

2013-03-01

337

Combined Insulin Pump Therapy with Real-Time Continuous Glucose Monitoring Significantly Improves Glycemic Control Compared to Multiple Daily Injection Therapy in Pump Naïve Patients with Type 1 Diabetes; Single Center Pilot Study Experience  

Microsoft Academic Search

Objectives: This study assessed the safety and clinical effectiveness of the training protocol for initiating insulin pump therapy with real-time continuous glucose monitoring (MiniMed Paradigm REAL-Time System) in a stepwise approach on pump naive subjects with type 1 diabetes compared to a control group who remained on multiple daily injection (MDI) therapy. Methods: This was a 15-week treat-to-target pilot study

Scott W. Lee; Tom Sweeney; Debbie Clausen; Celia Kolbach; Allen Hassen; Anthony Firek; Charles Brinegar; Jerrold Petrofsky

2007-01-01

338

Gain Control Network Conditions in Early Sensory Coding  

PubMed Central

Gain control is essential for the proper function of any sensory system. However, the precise mechanisms for achieving effective gain control in the brain are unknown. Based on our understanding of the existence and strength of connections in the insect olfactory system, we analyze the conditions that lead to controlled gain in a randomly connected network of excitatory and inhibitory neurons. We consider two scenarios for the variation of input into the system. In the first case, the intensity of the sensory input controls the input currents to a fixed proportion of neurons of the excitatory and inhibitory populations. In the second case, increasing intensity of the sensory stimulus will both, recruit an increasing number of neurons that receive input and change the input current that they receive. Using a mean field approximation for the network activity we derive relationships between the parameters of the network that ensure that the overall level of activity of the excitatory population remains unchanged for increasing intensity of the external stimulation. We find that, first, the main parameters that regulate network gain are the probabilities of connections from the inhibitory population to the excitatory population and of the connections within the inhibitory population. Second, we show that strict gain control is not achievable in a random network in the second case, when the input recruits an increasing number of neurons. Finally, we confirm that the gain control conditions derived from the mean field approximation are valid in simulations of firing rate models and Hodgkin-Huxley conductance based models.

Serrano, Eduardo; Nowotny, Thomas; Levi, Rafael; Smith, Brian H.; Huerta, Ramon

2013-01-01

339

Metamorphic density controls on early-stage subduction dynamics  

NASA Astrophysics Data System (ADS)

Subduction is primarily driven by the densification of the downgoing oceanic slab, due to dynamic P-T-fields in subduction zones. It is crucial to unravel slab densification induced by metamorphic reactions to understand the influence on plate dynamics. By analyzing the density and metamorphic structure of subduction zones, we may gain knowledge about the driving, metamorphic processes in a subduction zone like the eclogitization (i.e., the transformation of a MORB to an eclogite), the breakdown of hydrous minerals and the release of fluid or the generation of partial melts. We have therefore developed a 2D subduction zone model down to 250 km that is based on thermodynamic equilibrium assemblage computations. Our model computes the "metamorphic density" of rocks as a function of pressure, temperature and chemical composition using the Theriak-Domino software package at different time stages. We have used this model to investigate how the hydration, dehydration, partial melting and fractionation processes of rocks all influence the metamorphic density and greatly depend on the temperature field within subduction systems. These processes are commonly neglected by other approaches (e.g., gravitational or thermomechanical in nature) reproducing the density distribution within this tectonic setting. The process of eclogitization is assumed as being important to subduction dynamics, based on the very high density (3.6 g/cm3) of eclogitic rocks. The eclogitization in a MORB-type crust is possible only if the rock reaches the garnet phase stability field. This process is primarily temperature driven. Our model demonstrates that the initiation of eclogitization of the slab is not the only significant process that makes the descending slab denser and is responsible for the slab pull force. Indeed, our results show that the densification of the downgoing lithospheric mantle (due to an increase of pressure) starts in the early subduction stage and makes a significant contribution to the slab pull, where eclogitization does not occur. Thus, the lithospheric mantle acts as additional ballast below the sinking slab shortly after the initiation of subduction. Our calculation shows that the dogma of eclogitized basaltic, oceanic crust as the driving force of slab pull is overestimated during the early stage of subduction. These results improve our understanding of the force budget for slab pull during the intial and early stage of subduction. Therefore, the complex metamorphic structure of a slab and mantle wedge has an important impact on the development and dynamics of subduction zones. Further Reading: Duesterhoeft, Oberhänsli & Bousquet (2013), submitted to Earth and Planetary Science Letters

Duesterhoeft, Erik; Oberhänsli, Roland; Bousquet, Romain

2013-04-01

340

Common variants near ATM are associated with glycemic response to metformin in type 2 diabetes.  

PubMed

Metformin is the most commonly used pharmacological therapy for type 2 diabetes. We report a genome-wide association study for glycemic response to metformin in 1,024 Scottish individuals with type 2 diabetes with replication in two cohorts including 1,783 Scottish individuals and 1,113 individuals from the UK Prospective Diabetes Study. In a combined meta-analysis, we identified a SNP, rs11212617, associated with treatment success (n = 3,920, P = 2.9 × 10(-9), odds ratio = 1.35, 95% CI 1.22-1.49) at a locus containing ATM, the ataxia telangiectasia mutated gene. In a rat hepatoma cell line, inhibition of ATM with KU-55933 attenuated the phosphorylation and activation of AMP-activated protein kinase in response to metformin. We conclude that ATM, a gene known to be involved in DNA repair and cell cycle control, plays a role in the effect of metformin upstream of AMP-activated protein kinase, and variation in this gene alters glycemic response to metformin. PMID:21186350

Zhou, Kaixin; Bellenguez, Celine; Spencer, Chris C A; Bennett, Amanda J; Coleman, Ruth L; Tavendale, Roger; Hawley, Simon A; Donnelly, Louise A; Schofield, Chris; Groves, Christopher J; Burch, Lindsay; Carr, Fiona; Strange, Amy; Freeman, Colin; Blackwell, Jenefer M; Bramon, Elvira; Brown, Matthew A; Casas, Juan P; Corvin, Aiden; Craddock, Nicholas; Deloukas, Panos; Dronov, Serge; Duncanson, Audrey; Edkins, Sarah; Gray, Emma; Hunt, Sarah; Jankowski, Janusz; Langford, Cordelia; Markus, Hugh S; Mathew, Christopher G; Plomin, Robert; Rautanen, Anna; Sawcer, Stephen J; Samani, Nilesh J; Trembath, Richard; Viswanathan, Ananth C; Wood, Nicholas W; Harries, Lorna W; Hattersley, Andrew T; Doney, Alex S F; Colhoun, Helen; Morris, Andrew D; Sutherland, Calum; Hardie, D Grahame; Peltonen, Leena; McCarthy, Mark I; Holman, Rury R; Palmer, Colin N A; Donnelly, Peter; Pearson, Ewan R

2011-02-01

341

High Hemoglobin A1c levels and glycemic variability increase risk of severe hypoglycemia in diabetic hemodialysis patients.  

PubMed

While hyperglycemia is central to the pathogenesis and management of diabetes mellitus, hypoglycemia and glucose variability also contribute to outcomes. We previously reported on the relationship of glycemic control to outcomes in a large population of diabetic end-stage renal disease (ESRD) patients. Recognizing that ESRD is a risk factor for severe hypoglycemia, we have now analyzed the association between glycosylated hemoglobin A1c (HgbA1c) levels and glycemic variability in those with hypoglycemia. This is a retrospective study of patients with diabetes enrolled in a large hemodialysis program. Hypoglycemia was identified from hospital discharge diagnostic codes. Glycemic variability was assessed by the standard deviation of HgbA1c and glucose levels over time. Hypoglycemia as a discharge diagnosis was documented in 4.1% of patients. Higher baseline HgbA1c was associated with greater risk for hypoglycemia hospitalization, a finding confirmed by time-lagged HgbA1c levels drawn a quarter earlier. Higher baseline HgbA1c categories were also associated with greater variability in HgbA1c levels during the analysis period. Similarly, greater glucose variability was associated with higher mean glucose levels by trend analysis. High, not low, HgbA1c levels are associated with greater risk of severe hypoglycemia, which may derive from glucose variability in the setting of treatment for hyperglycemia. High HgbA1c and glycemic variability are associated with increased risk of hypoglycemia in individuals with diabetes and ESRD. PMID:24274900

Williams, Mark E; Garg, Rajesh; Wang, Weiling; Lacson, Ronilda; Maddux, Franklin; Lacson, Eduardo

2014-04-01

342

Inhibitory Control during Emotional Distraction across Adolescence and Early Adulthood  

ERIC Educational Resources Information Center

This study investigated the changing relation between emotion and inhibitory control during adolescence. One hundred participants between 11 and 25 years of age performed a go-nogo task in which task-relevant stimuli (letters) were presented at the center of large task-irrelevant images depicting negative, positive, or neutral scenes selected from…

Cohen-Gilbert, Julia E.; Thomas, Kathleen M.

2013-01-01

343

The Effect of Intensive Glycemic Treatment on Coronary Artery Calcification in Type 1 Diabetic Participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study  

PubMed Central

The Epidemiology of Diabetes Interventions and Complications (EDIC) study, an observational follow-up of the Diabetes Control and Complications Trial (DCCT) type 1 diabetes cohort, measured coronary artery calcification (CAC), an index of atherosclerosis, with computed tomography (CT) in 1,205 EDIC patients at ~7–9 years after the end of the DCCT. We examined the influence of the 6.5 years of prior conventional versus intensive diabetes treatment during the DCCT, as well as the effects of cardiovascular disease risk factors, on CAC. The prevalences of CAC >0 and >200 Agatston units were 31.0 and 8.5%, respectively. Compared with the conventional treatment group, the intensive group had significantly lower geometric mean CAC scores and a lower prevalence of CAC >0 in the primary retinopathy prevention cohort, but not in the secondary intervention cohort, and a lower prevalence of CAC >200 in the combined cohorts. Waist-to-hip ratio, smoking, hypertension, and hypercholesterolemia, before or at the time of CT, were significantly associated with CAC in univariate and multivariate analyses. CAC was associated with mean HbA1c (A1C) levels before enrollment, during the DCCT, and during the EDIC study. Prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced levels of A1C during the DCCT.

Cleary, Patricia A.; Orchard, Trevor J.; Genuth, Saul; Wong, Nathan D.; Detrano, Robert; Backlund, Jye-Yu C.; Zinman, Bernard; Jacobson, Alan; Sun, Wanjie; Lachin, John M.; Nathan, David M.

2008-01-01

344

Sulfonylurea induction of caffeine-enhanced insulin secretion and reduction of glycemic levels in diabetic rats.  

PubMed

Abstract Context: Caffeine can stimulate insulin secretion by attenuating hyperglycemia in diabetes models with significant reduction of pancreatic functional ? cells. Knowledge of these mechanisms could contribute to new strategies for treating diabetes. Objective: This study evaluated the effects of caffeine and physical exercise on glycemic and insulin responses in diabetic rats. Materials and methods: The diabetes model was induced by intraperitoneal administration of 60?mg/kg of streptozotocin (STZ). Animals were divided into six groups: control, caffeine, STZ control, STZ caffeine, STZ sulfonylurea, and STZ caffeine?+?sulfonylurea. Acutely, control animals received 6?mg of caffeine and 10?mg/kg sulfonylurea or 10?mg/kg saline. Animals were sacrificed after physical exercise; blood samples were collected for glucose, glycerol, lactate, and insulin analyses. Cardiovascular responses were recorded before and after treatments. A one-way ANOVA and the post hoc Student-Newman-Keuls test were used to analyze statistical differences between treatments (p?control groups (387-187?mg/dL; p?glycemic and insulin control in diabetes. PMID:24601939

da Silva, Luiz Augusto; Pereira, Ricardo Aparecido; Túrmina, Janaína Angela; Kerppers, Ivo Ilvan; Osiecki, Raul; Altimari, Leandro Ricardo; Malfatti, Carlos Ricardo Maneck

2014-08-01

345

Lung cancer trends in young adults: an early indicator of progress in tobacco control (United States)  

Microsoft Academic Search

Objective: Tobacco smoking is known to increase lung cancer occurrence beginning in young adulthood, although age-specific rates have not been used to monitor the early consequences of tobacco control efforts in the United States. We evaluated state trends in lung cancer death rates among young adults in relation to an index of state tobacco control activities and conventional indices of

Ahmedin Jemal; Vilma E. Cokkinides; Omar Shafey; Michael J. Thun

2003-01-01

346

An Examination of Locus of Control, Epistemological Beliefs and Metacognitive Awareness in Preservice Early Childhood Teachers  

ERIC Educational Resources Information Center

This study aims to explore the locus of control, epistemological beliefs and metacognitive awareness levels of preservice early childhood education teachers and to determine the interrelations among these variables. 206 teacher candidates have been asked to fill out Rotter's Internal-External Locus of Control Scale, Central Epistemological Beliefs…

Bedel, Emine Ferda

2012-01-01

347

Kinetic controls on early karst aquifer porosity development  

SciTech Connect

A series of simulations using the newly developed model KARST has been performed to investigate limiting kinetic controls on limestone dissolution during the earliest stages of karst aquifer porosity development. This FORTRAN model couples fluid flow within and dissolution of circular cross section conduits, and considers surface reaction rates (both far from and close to thermodynamic equilibrium), mass transfer rates of reaction products to the bulk fluid, and rates of homogeneous reactions associated with dissolution of CO[sub 2] gas in water. Mass transfer theory for both laminar and turbulent flow cases is included. Runs were made with a wide variety of initial conditions of passage geometry, head gradient, and initial PCO[sub 2]. Results show a consistent pattern of kinetic control that varies as functions of time as well as position along the conduit. Slow, higher order surface reaction rates (close to equilibrium), diffusion rates, and rapid, lower order reaction rates (far from equilibrium) are found to be limiting steps at various times and location. Under no conditions in the simulations did the rate of CO[sub 2] hydration limit dissolution. Thresholds between the various kinetic regimes were found to be associated with a critical distance from equilibrium, as well as the transition from laminar to turbulent flow. As a result of interactions between flow and chemical conditions, passage growth (measure by fluid discharge rates) can be divided into an initial, slow period initiation and a more rapid one (enlargement). The onset of the enlargement phase was not found to coincide with any single kinetic event.

Groves, C.G. (Western Kentucky Univ., Bowling Green, KY (United States)); Howard, A.D. (Univ. of Virginia, Charlottesville, VA (United States). Dept. of Environmental Sciences)

1992-01-01

348

In vitro hydrolytic digestion, glycemic response in dogs, and true metabolizable energy content of soluble corn fibers.  

PubMed

The objective of this research was to measure in vitro hydrolytic digestion, glycemic and insulinemic responses in dogs, and true ME (TMEn) content of select soluble corn fibers (SCF) in roosters. The first generation (G1) SCF included hydrochloric acid-treated corn syrup (G1-CS-HCl), an SCF with an increased total dietary fiber (TDF) content (G1-SCF-HCl), an SCF that was spray-dried (G1-SCF-SD), and a hydrogenated SCF (G1-SCF-hydrog). The second generation (G2) SCF included those prepared using phosphoric acid catalyzation in both a liquid [G2-SCF-phos (Lq)] and powder [G2-SCF-phos (Pw)] form, and SCF that were prepared using hydrochloric acid catalyzation in both a liquid [G2-SCF-HCl (Lq)] and powder [G2-SCF-HCl (Pw)] form. Also, in the G2 set of samples were SCF prepared using the same method, but in 3 separate batches, all of which contained 70% TDF and 15% sugars. Two were in liquid form [G2-SCF-phos+HCl (Lq1)] and [G2-SCF-phos+HCl (Lq2)], and one in powder form ([G2-SCF-phos+HCl (Pw)]. A lower sugar form (80% TDF and 5% sugar) of SCF was also evaluated (G2-SCF-low sugar). Glucose was the major free sugar and bound monosaccharide in all SCF except for G1-SCF-hydrog that had greater concentrations of sorbitol. All SCF had intermediate to low amounts of monosaccharides released as a result of in vitro hydrolytic digestion, with glucose being the primary sugar component released. The G1-SCF were more digestible in vitro (approximately 50%) compared to G2-SCF (approximately 32%). All SCF had attenuated glycemic responses in adult dogs compared to a maltodextrin control (P < 0.05). The G2-SCF, on average, had lower glycemic responses and TMEn values in roosters than G1-SCF. All SCF had low free sugar concentrations with varying degrees of resistance to digestion, reduced caloric content, and attenuated glycemic and insulinemic responses in adult dogs. These ingredients are potential candidates for inclusion in reduced calorie and low glycemic canine diets. PMID:24867932

de Godoy, M R C; Knapp, B K; Parsons, C M; Swanson, K S; Fahey, George C

2014-06-01

349

Glycemic control and cardiovascular disease in chronic kidney disease  

Microsoft Academic Search

Diabetes increases cardiovascular (CV) risk to a similar extent as myocardial infarction. Epidemiologic data support the same\\u000a concept for the presence of Stage 3 (ie, glomerular filtration rate of < 60 mL\\/min) or higher nephropathy without diabetes.\\u000a The most common cause of end-stage kidney disease requiring dialysis is diabetes. Hence, CV risk is highest among those with\\u000a kidney disease and

Suma Dronovalli; Basil O. Burney; George L. Bakris

2009-01-01

350

Reduced antioxidant defense in early onset first-episode psychosis: a case-control study  

PubMed Central

Background Our objective is to determine the activity of the antioxidant defense system at admission in patients with early onset first psychotic episodes compared with a control group. Methods Total antioxidant status (TAS) and lipid peroxidation (LOOH) were determined in plasma. Enzyme activities and total glutathione levels were determined in erythrocytes in 102 children and adolescents with a first psychotic episode and 98 healthy controls. Results A decrease in antioxidant defense was found in patients, measured as decreased TAS and glutathione levels. Lipid damage (LOOH) and glutathione peroxidase activity was higher in patients than controls. Our study shows a decrease in the antioxidant defense system in early onset first episode psychotic patients. Conclusions Glutathione deficit seems to be implicated in psychosis, and may be an important indirect biomarker of oxidative stress in early-onset schizophrenia. Oxidative damage is present in these patients, and may contribute to its pathophysiology.

2011-01-01

351

Renal and Glycemic Effects of High-Dose Chromium Picolinate in db/db Mice: Assessment of DNA Damage  

PubMed Central

This study examined renal and glycemic effects of chromium picolinate (Cr(pic)3) supplementation in the context of its purported potential for DNA damage. In preventional protocol, male obese diabetic db/db mice were fed diets either lacking or containing 5, 10 or 100 mg/kg chromium as Cr(pic)3 from 6 to 24 weeks of age; male lean nondiabetic db/m mice served as controls. Untreated db/db mice displayed increased plasma glucose and insulin, hemoglobin A1c, renal tissue advanced glycation end (AGE) products, albuminuria, glomerular mesangial expansion, urinary 8-hydroxydeoxyguanosine (8-OHdG, an index of oxidative DNA damage) and renal tissue immunostaining for ?H2AX (a marker of double-strand DNA breaks) compared to db/m controls. Creatinine clearance was lower while blood pressure was similar between untreated db/db mice and their db/m controls. High Cr(pic)3 intake (i.e., 100 mg/kg diet) mildly improved glycemic status and albuminuria without affecting blood pressure or creatinine clearance. Treatment with Cr(pic)3 did not increase DNA damage despite marked renal accumulation of chromium. In interventional protocol, effects of diets containing 0, 100 and 250 mg/kg supplemental chromium, from 12 to 24 weeks of age, were examined in db/db mice. The results generally revealed similar effects to those of the 100 mg/kg diet of the preventional protocol. In conclusion, the severely hyperglycemic db/db mouse displays renal structural and functional abnormalities in association with DNA damage. High-dose Cr(pic)3 treatment mildly improves glycemic control and it causes moderate reduction in albuminuria, without affecting histopathological appearance of the kidney and increasing the risk for DNA damage.

Mozaffari, Mahmood S.; Baban, Babak; Abdelsayed, Rafik; Liu, Jun Yao; Wimborne, Hereward; Rodriguez, Nancy; Abebe, Worku

2011-01-01

352

Renal and glycemic effects of high-dose chromium picolinate in db/db mice: assessment of DNA damage.  

PubMed

This study examined renal and glycemic effects of chromium picolinate [Cr(pic)3] supplementation in the context of its purported potential for DNA damage. In preventional protocol, male obese diabetic db/db mice were fed diets either lacking or containing 5, 10 or 100 mg/kg chromium as Cr(pic)3 from 6 to 24 weeks of age; male lean nondiabetic db/m mice served as controls. Untreated db/db mice displayed increased plasma glucose and insulin, hemoglobin A1c, renal tissue advanced glycation end products, albuminuria, glomerular mesangial expansion, urinary 8-hydroxydeoxyguanosine (an index of oxidative DNA damage) and renal tissue immunostaining for ?H2AX (a marker of double-strand DNA breaks) compared to db/m controls. Creatinine clearance was lower in untreated db/db mice than their db/m controls, while blood pressure was similar. High Cr(pic)3 intake (i.e., 100-mg/kg diet) mildly improved glycemic status and albuminuria without affecting blood pressure or creatinine clearance. Treatment with Cr(pic)3 did not increase DNA damage despite marked renal accumulation of chromium. In interventional protocol, effects of diets containing 0, 100 and 250 mg/kg supplemental chromium, from 12 to 24 weeks of age, were examined in db/db mice. The results generally revealed similar effects to those of the 100-mg/kg diet of the preventional protocol. In conclusion, the severely hyperglycemic db/db mouse displays renal structural and functional abnormalities in association with DNA damage. High-dose Cr(pic)3 treatment mildly improves glycemic control, and it causes moderate reduction in albuminuria, without affecting the histopathological appearance of the kidney and increasing the risk for DNA damage. PMID:21959055

Mozaffari, Mahmood S; Baban, Babak; Abdelsayed, Rafik; Liu, Jun Yao; Wimborne, Hereward; Rodriguez, Nancy; Abebe, Worku

2012-08-01

353

Nateglinide and Acarbose Are Comparably Effective Reducers of Postprandial Glycemic Excursions in Chinese Antihyperglycemic Agent-Naive Subjects with Type 2 Diabetes  

PubMed Central

Abstract Background Recent studies have identified postprandial glycemic excursions as risk factors for diabetes complications. This study aimed to compare the effects of nateglinide and acarbose treatments on postprandial glycemic excursions in Chinese subjects with type 2 diabetes. Subjects and Methods This was a multicenter, open-label, randomized, active-controlled, parallel-group study. One hundred three antihyperglycemic agent–naive subjects with type 2 diabetes (hemoglobin A1c range, 6.5–9.0%) were prospectively recruited from four hospitals in China. The intervention was nateglinide (120?mg three times a day) or acarbose (50?mg three times a day) therapy for 2 weeks. A continuous glucose monitoring system was used to calculate the incremental area under the curve of postprandial blood glucose (AUCpp), the incremental glucose peak (IGP), mean amplitude of glycemic excursions, SD of blood glucose, the mean of daily differences, and 24-h mean blood glucose (MBG). Subjects' serum glycated albumin and the plasma insulin levels were also analyzed. Results Both agents caused significant reductions on AUCpp and IGP. Similarly, both treatment groups showed significant improvements in the intra- and interday glycemic excursions, as well as the 24-h MBG and serum glycated albumin compared with baseline (P<0.001). However, neither of the agents produced a significantly better effect (P>0.05). Moreover, the nateglinide-treated group had significantly increased insulin levels at 30?min and at 120?min after a standard meal compared with baseline, whereas the acarbose-treated group decreased. No serious adverse events occurred in either group. The rates of hypoglycemic episodes were comparable in the two groups, and no severe hypoglycemic episode occurred in either group. Conclusions Nateglinide and acarbose were comparably effective in reducing postprandial glycemic excursions in antihyperglycemic agent–naive Chinese patients with type 2 diabetes, possibly through different pathophysiological mechanisms.

Zhou, Jian; Li, Hong; Zhang, Xiuzhen; Peng, Yongde; Mo, Yifei; Bao, Yuqian

2013-01-01

354

Association between dietary glycemic index, glycemic load, and body mass index in the Inter99 study: is underreporting a problem?13  

Microsoft Academic Search

Background: The few studies examining the potential associations between glycemic index (GI), glycemic load (GL), and body mass index (BMI) have provided no clear pictures. Underreporting of energy intake may be one explanation for this. Objective:WeexaminedtheassociationsbetweenGI,GL,andBMI by focusing on the confounding factor of total energy intake and the effect of exclusion of low energy reporters (LERs). Design: This was a

Cathrine Lau; Ulla Toft; Inge Tetens; Bjørn Richelsen; Torben Jørgensen; Knut Borch-Johnsen; Charlotte Glumer

355

Dietary Glycemic Load and Glycemic Index and Risk of Coronary Heart Disease and Stroke in Dutch Men and Women: The EPIC-MORGEN Study  

Microsoft Academic Search

BackgroundThe associations of glycemic load (GL) and glycemic index (GI) with the risk of cardiovascular diseases (CVD) are not well-established, particularly in men, and may be modified by gender.ObjectiveTo assess whether high dietary GL and GI increase the risk of CVD in men and women.MethodsA large prospective cohort study (EPIC-MORGEN) was conducted within the general Dutch population among 8,855 men

Koert N. J. Burger; Joline W. J. Beulens; Jolanda M. A. Boer; Annemieke M. W. Spijkerman; Daphne L. van der A; Andreas Schäfer

2011-01-01

356

Acute helminth infection enhances early macrophage mediated control of mycobacterial infection.  

PubMed

Co-infection with mycobacteria and helminths is widespread in developing countries, but how this alters host immunological control of each pathogen is not comprehensively understood. In this study, we demonstrate that acute Nippostrongylus brasiliensis (Nb) murine infection reduce early pulmonary mycobacterial colonization. This Nb-associated reduction in pulmonary Mycobacterium tuberculosis colony-forming units was associated with early and increased activation of pulmonary CD4 T cells and increased T helper type 1 (Th1) and Th2 cytokine secretion. An accelerated and transient augmentation of neutrophils and alveolar macrophages (AMs) was also observed in co-infected animals. AMs displayed markers of both classical and alternative activation. Intranasal transfer of pulmonary macrophages obtained from donor mice 5 days after Nb infection significantly reduced pulmonary Mycobacterium bovis Bacille Calmette-Guérin clearance in recipient mice. These data demonstrate that early stage Nb infection elicits a macrophage response, which is protective during the early stages of subsequent mycobacterial infection. PMID:23250274

du Plessis, N; Kleynhans, L; Thiart, L; van Helden, P D; Brombacher, F; Horsnell, W G C; Walzl, G

2013-09-01

357

Differential neural control in early bilinguals and monolinguals during response inhibition.  

PubMed

We tested the hypothesis that early bilinguals and monolinguals use different brain areas when performing nonlinguistic executive control tasks. For this, we explored brain activity of early bilinguals and monolinguals during a manual stop-signal paradigm. Behaviorally, bilinguals and monolinguals did not show significant differences in the task, which led us to compare brain activation that cannot be attributed to differences in performance. Analyses demonstrated that monolinguals activated the anterior cingulate cortex more than bilinguals when performing the stop-signal task. These results offer direct support for the notion that early bilingualism exerts an effect on neural circuitry responsible for executive control. Consistent with recent reports, we found that bilinguals used the anterior cingulate more efficiently than monolinguals to monitor nonlinguistic cognitive conflicts. PMID:24735970

Rodríguez-Pujadas, Aina; Sanjuán, Ana; Fuentes, Paola; Ventura-Campos, Noelia; Barrós-Loscertales, Alfonso; Ávila, César

2014-05-01

358

In an early branching metazoan, bacterial colonization of the embryo is controlled by maternal antimicrobial peptides  

PubMed Central

Early embryos of many organisms develop outside the mother and are immediately confronted with myriads of potential colonizers. How these naive developmental stages control and shape the bacterial colonization is largely unknown. Here we show that early embryonic stages of the basal metazoan Hydra are able to control bacterial colonization by using maternal antimicrobial peptides. Antimicrobial peptides of the periculin family selecting for a specific bacterial colonization during embryogenesis are produced in the oocyte and in early embryos. If overexpressed in hydra ectodermal epithelial cells, periculin1a drastically reduces the bacterial load, indicating potent antimicrobial activity. Unexpectedly, transgenic polyps also revealed that periculin, in addition to bactericidal activity, changes the structure of the bacterial community. These findings delineate a role for antimicrobial peptides both in selecting particular bacterial partners during development and as important components of a “be prepared” strategy providing transgenerational protection.

Fraune, Sebastian; Augustin, Rene; Anton-Erxleben, Friederike; Wittlieb, Jorg; Gelhaus, Christoph; Klimovich, Vladimir B.; Samoilovich, Marina P.; Bosch, Thomas C. G.

2010-01-01

359

77 FR 60703 - Breast and Cervical Cancer Early Detection and Control Advisory Committee: Notice of Charter Renewal  

Federal Register 2010, 2011, 2012, 2013

...AND HUMAN SERVICES Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and Control Advisory Committee...Committee Act (Pub. L. 92-463) of October 6, 1972, that the Breast and Cervical Cancer Early Detection and Control Advisory...

2012-10-04

360

Nursing, social contexts, and ideologies in the early United States birth control movement.  

PubMed

Using historical discourse analysis, this study provides a thematic analysis of writings of nursing and birth control as found in The Birth Control Review from 1917 to 1927. The author contrasts this publication with the official journal of the American Nurses Association, the American Journal of Nursing from the same years to explore nursing voices and silences in early birth control stories. In dialogue with social contexts, nursing endeavors and inactivity have played important yet conflicting roles in the birth control movement in the United States. Nursing writings from the early twentieth century reflect eugenic beliefs, national fears of immigrants, and ambivalence about women's roles in society and the home. Nurses simultaneously empowered women to choose when to become pregnant and reinforced nativist and paternalistic views of the poor. PMID:10696211

Lagerwey, M D

1999-12-01

361

62 FR 36528 - National Organizational Strategies for the Prevention, Early Detection, and Control of Cancers  

Federal Register 2010, 2011, 2012, 2013

...control of cancers, especially cancers of the breast, cervix, colon...related to the priority areas of Cancer. (To order a copy of Healthy...Pro-Children Act of 1994, prohibits smoking in certain facilities that...priority population's access to cancer prevention and early...

1997-07-08

362

Multivariate statistical process control for continuous monitoring of networked early warning fire detection (EWFD) systems  

Microsoft Academic Search

Sensor array networks provide much information concerning an environment if the data is adequately used. However, monitoring large networks of sensor arrays can be data intensive. Multivariate statistical process control (MSPC) methods allow monitoring of an entire system at a supervisory level. These methods are demonstrated for fire detection using the early warning fire detection (EWFD) system. The EWFD system

Renee D. JiJi; Mark H. Hammond; Frederick W. Williams; Susan L. Rose-Pehrsson

2003-01-01

363

Developmental Changes in the Relations between Inhibitory Control and Externalizing Problems during Early Childhood  

ERIC Educational Resources Information Center

Deficits in executive function, and in particular, reduced capacity to inhibit a dominant action, are a risk factor for externalizing problems (EP). Inhibitory control (IC) develops in the later preschool and early childhood periods, such that IC might not regulate EP in toddlers and younger preschoolers. Aggression was observed during peer play…

Utendale, William T.; Hastings, Paul D.

2011-01-01

364

Benefit of an Extended Stroke Unit Service With Early Supported Discharge A Randomized, Controlled Trial  

Microsoft Academic Search

Background and Purpose—Several trials have shown that stroke unit care improves outcome for stroke patients. The aim of the present trial was to evaluate the effects of an extended stroke unit service (ESUS), with early supported discharge, cooperation with the primary healthcare system, and more emphasis on rehabilitation at home as essential elements. Methods—In a randomized, controlled trial, 160 patients

Bent Indredavik; Hild Fjærtoft; Gun Ekeberg; Anne D. Løge; Birgitte Mørch

365

Impact of Sleep Duration on Obesity and the Glycemic Level in Patients With Type 2 Diabetes  

PubMed Central

OBJECTIVE Few studies are currently available regarding the influence of sleep duration on glycemic control in diabetic patients. The objective of the current study was to examine the relationship between sleep duration, obesity, and the glycemic level in type 2 diabetic patients. RESEARCH DESIGN AND METHODS A total of 4,870 Japanese type 2 diabetic patients aged ?20 years were divided into six groups according to their self-reported sleep duration: less than 4.5 h, 4.5–5.4 h, 5.5–6.4 h, 6.5–7.4 h, 7.5–8.4 h, and more than 8.5 h. The associations of sleep duration with obesity and the HbA1c levels were examined in a cross-sectional manner. RESULTS The HbA1c levels showed a quadratic association with sleep duration; namely, a shorter or longer sleep duration was associated with a higher level compared with a sleep duration of 6.5–7.4 h (P for quadratic trend <0.001). This association remained significant after adjusting for potential confounders, including the total energy intake and depressive symptoms. Furthermore, additional adjustments for obesity, which also showed a U-shaped relationship with sleep duration, did not attenuate the U-shaped sleep-HbA1c association. A significant interaction between sleep duration and age or the use of insulin was observed for the HbA1c levels. CONCLUSIONS Sleep duration was shown to have U-shaped associations with obesity and the HbA1c levels in type 2 diabetic patients, independent of potential confounders, and therefore may be an important modifiable factor for the clinical management of patients with type 2 diabetes.

Ohkuma, Toshiaki; Fujii, Hiroki; Iwase, Masanori; Kikuchi, Yohei; Ogata, Shinako; Idewaki, Yasuhiro; Ide, Hitoshi; Doi, Yasufumi; Hirakawa, Yoichiro; Nakamura, Udai; Kitazono, Takanari

2013-01-01

366

Dietary glycemic load, glycemic index, and carbohydrates on the risk of primary liver cancer among Chinese women and men  

PubMed Central

Background Dietary glycemic index (GI) and glycemic load (GL) typically have a positive relationship with obesity and diabetes, which are risk factors for liver cancer. However, studies on their association with liver cancer have yielded inconsistent results. Therefore, we assessed the association of GI, GL, and carbohydrates with liver cancer risk. Patients and methods A total of 72 966 women and 60 207 men from the Shanghai Women's Health Study (SWHS) and the Shanghai Men's Health Study (SMHS) were included for analysis. Food frequency questionnaire (FFQ) data were used to calculate daily dietary GI, GL, and carbohydrate intake. These values were energy adjusted and categorized into quintiles. The hazard ratios (HRs) and 95% confidence intervals (CI) were calculated with adjustment for potential confounders. Results After a median follow-up time of 11.2 years for the SWHS and 5.3 years for the SMHS, 139 and 208 incident liver cancer cases were identified in the SWHS and SMHS, respectively. In multivariable Cox regression models, no statistically significant trends by quintile of GI, GL, or carbohydrate intake were observed. Stratification by chronic liver disease/hepatitis, diabetes, or body mass index (BMI) did not alter the findings. Conclusions There is little evidence that dietary GI, GL, or carbohydrates affect the incidence of liver cancer in this Asian population.

Vogtmann, E.; Li, H. L.; Shu, X. O.; Chow, W. H.; Ji, B. T.; Cai, H.; Gao, J.; Zhang, W.; Gao, Y. T.; Zheng, W.; Xiang, Y. B.

2013-01-01

367

Early Onset of Androgenetic Alopecia Associated With Early Severe Coronary Heart Disease: A Population-Based, Case-Control Study  

Microsoft Academic Search

Context The relationship of ischaemic heart disease (IHD) with androgenic alopecia (AGA) has been demonstrated, but no differentiation between early and late onsets of alopecia with regard to the risk and severity of IHD has been made.Objective To test if the early onset of alopecia is a risk factor for early severe, coronary artery disease (CAD) requiring surgery and to

Veikko A. Matilainen; Paavo K. Mäkinen; Sirkka M. Keinänen-Kiukaanniemi

2001-01-01

368

Familial liability, obstetric complications and childhood development abnormalities in early onset schizophrenia: a case control study  

PubMed Central

Background Genetic and environmental risk factors and gene-environment interactions are linked to higher likelihood of developing schizophrenia in accordance with the neurodevelopmental model of disease; little is known about risk factors and early development in early-onset schizophrenia (EOS) and very early-onset schizophrenia (VEOS). Methods We present a case-control study of a sample of 21 patients with EOS/VEOS and a control group of 21 patients with migraine, recruited from the Child Neuropsychiatry Unit, Department of Neurologic and Psychiatric Science, University of Bari, Italy. The aim was to assess the statistical association between VEOS/EOS and family history for psychiatric disorders, obstetric complications and childhood developmental abnormalities using 2 × 2 tables and a Chi Squared or Fisher test. Results The results show a statistical association between EOS/VEOS and schizophrenia and related disorders (P = 0.02) and personality disorders (P = 0.003) in relatives, and between EOS/VEOS and developmental abnormalities of early relational skills (P = 0.008) and learning (P = 0.04); there is not a statistically relevant difference between cases and controls (P > 0.05) for any obstetric complications (pre, peri and postpartum). Conclusions This study confirms the significant role of familial liability but not of obstetric complications in the pathogenesis of VEOS/EOS; the association between childhood developmental abnormalities and EOS/VEOS supports the neurodevelopmental model of disease.

2011-01-01

369

Effectiveness of lifestyle change plus dental care (LCDC) program on improving glycemic and periodontal status in the elderly with type 2 diabetes  

PubMed Central

Background Currently, there is an increased prevalence of diabetes mellitus among the elderly. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in diabetic patients is essential. The purpo