SEARCH · PubMed Health

Results for “Glycemic variability”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources

PubMed1987

Physiological relationships between growth hormone level, glycemia and metabolic control in dogs.

This study was undertaken to explore the physiological relationships between fasting glycemia, antecedent glycemic control and fasting growth hormone levels in pancreatectomized dogs. In contrast to other studies, we used continuous intravenous infusions of insulin in an attempt not only to normalize fasting plasma glycemia but also to eliminate the characteristic fluctuations of diabetes usually encountered in the postprandial and postabsorptive periods. For comparison, a similar group of healthy animals served as normal controls. In the healthy dogs, fasting growth hormone (GH) levels were stable and well within normal limits for this species, demonstrating an overall mean +/- SD of 2.50 +/- 0.46 ng/ml. In the pancreatectomized group as a whole, the fasting GH levels were significantly elevated (4.63 +/- 2.42 ng/ml, P less than 0.01) and significantly (P less than 0.001) more variable than in the controls. Multiple regression and analysis of variance confirmed the expected significant positive correlation between fasting GH and fasting plasma glucose levels, but also elucidated a heretofore unknown direct relationship between fasting GH levels and the preceding instability of glycemic control.

Animals↗

PubMed2002

Oxidative stress and antioxidant status in type 1 diabetes mellitus.

OBJECTIVES: To test the hypothesis that type 1 diabetes is associated with increased oxidative stress and/or antioxidant status by investigating concentrations of 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) in urine and plasma and malondialdehyde (MDA) in plasma as indicators of lipid peroxidation in vivo, and antioxidant status in diabetic subjects compared with healthy control subjects. DESIGN AND SUBJECTS: Thirty-eight subjects with type 1 diabetes mellitus and 41 healthy age- and sex-matched control subjects were included in the study. Blood and urine samples were obtained and analysed for 8-iso-PGF2alpha with a newly developed radioimmunoassay, as well as for MDA, total antioxidant capacity (TAOC) and serum tocopherol levels. RESULTS: None of the variables of lipid peroxidation showed any significant difference between the two groups. Similarly, there were no significant correlations between the levels of 8-iso-PGF2alpha or MDA, and degree of glycemic control (HbA1c). Total antioxidant capacity in plasma was 16% lower amongst the subjects with type 1 diabetes than in the control group (P < 0.0005). Lipid corrected levels of alpha-tocopherol in serum were significantly increased in type 1 diabetic subjects (P < 0.05), as were gamma-tocopherol levels (P < 0.005). CONCLUSIONS: In spite of lower total antioxidant defence, our results do not support the oxidative stress hypothesis for type 1 diabetes mellitus. The higher tocopherol levels suggest that no vitamin E supplementation is necessary for subjects with type 1 diabetes mellitus.

Adult↗

PubMed1988

Impact of pregnancy on complications of insulin-dependent diabetes mellitus.

The effects of pregnancy on acute metabolic complications of diabetes may have important consequences for both mother and fetus. The consequences of pregnancy for chronic complications of diabetes, including retinopathy, nephropathy, neuropathy, and hypertension, are not clear. Recent data are reviewed so that health care providers will be able to provide reasonable advice to insulin-dependent diabetic women contemplating pregnancy both for problems that may potentially arise during gestation and those that may affect long-term health and survival. Diabetic ketoacidosis is an uncommon problem that arises during gestation. Acute alterations in pH and electrolyte concentrations as well as hyperglycemia, however, may have important consequences for mother and fetus, including perinatal asphyxia and reduced fetal oxygen delivery. Hypoglycemia, on the other hand, may result in maternal coma or seizures and, when frequent, has been associated with infant respiratory distress syndrome. Background retinopathy often worsens during gestation, with regression common postpartum. Data suggest that progression of background disease is related to both glycemic control and the acute institution of intensive insulin therapy with those patients with poor control requiring more aggressive therapeutic intervention most adversely affected. The course of proliferative retinopathy is more variable, with both progression and regression reported. Preconception photocoagulation may prevent progression. Preconceptional ophthalmologic evaluation with frequent assessments during pregnancy is advised. Increases in 24-hour protein excretion are common during gestation in patients with preexisting renal disease and resolve in many patients postpartum. Serum creatinine and creatinine clearance increase during the first trimester and generally do not change during the remainder of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 1↗

PubMed2002

A prospective analysis of marital relationship factors and quality of life in diabetes.

OBJECTIVE: To prospectively assess the relation between marital relationship domains (i.e., intimacy and adjustment) and health-related quality of life (HRQoL) and glycemic control of individuals with diabetes. RESEARCH DESIGN AND METHODS: A previous cross-sectional study assessed the relationship between marital quality and adaptation to diabetes for 78 insulin-treated adults. Each participant completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) at time 1 (T1). A total of 61 subjects were contacted two years later (time 2 [T2]) and re-administered four HRQoL measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey-SF36, Problem Areas in Diabetes Scale, and Positive and Negative Affect Schedule). Glycemic control was assessed by HbA(1c). Demographic data (age, sex, type and duration of diabetes, years married, other medical problems, family history, and years of education) were gathered from charts and questionnaires. Linear regression analyses were used to assess the ability of the two marital measures at T1 to predict HRQoL at T2, controlling for confounding HRQoL and baseline subject variables. RESULTS: Both of the marital quality measures at T1 were prospective predictors of aspects of HRQoL at T2. Less diabetes-related distress at T2 was predicted by better marital adjustment at T1. Greater satisfaction with aspects of the diabetes care regimen at T2 was predicted by better marital adjustment and greater perceived marital intimacy at T1. Neither marital measure predicted general HRQoL or glycemic control. CONCLUSIONS: For insulin-treated adults with diabetes, quality of marriage prospectively predicts diabetes-related quality of life. This study highlights the sensitivity of diabetes-specific measures. Future work should explore the value of interventions that target the spouse and/or couple.

Cross-Sectional Studies↗

PubMed2004

Appraisal of four novel approaches to the prevention and treatment of sepsis.

PURPOSE: Four novel approaches to the management of sepsis are discussed. SUMMARY: Drotrecogin alfa (activated) has FDA-approved labeling for use in the treatment of severe sepsis. Risk of bleeding and identification of the most suitable patients have been the major issues related to use of this drug. Tight glycemic control and early goal-directed therapy (EGDT) are promising supportive strategies. Both have challenged existing views regarding safe glucose levels and the usefulness of increased oxygen delivery in sepsis. The routine maintenance of euglycemia is resource intensive, however, and benefits during treatment of sepsis are unclear. Very early initiation of measures to optimize hemodynamic variables and the ability to identify patients with cryptic shock appear to be key reasons for successful EGDT. The use of corticosteroids for septic shock has been extensively researched and has provoked controversy. Selection of patients likely to benefit on the basis of relative adrenal insufficiency and prolonged treatment may account for recently observed positive results. A model for combining the four strategies is proposed. CONCLUSION: Novel strategies for treating sepsis include drotrecogin alfa (activated), tight glycemic control, EGDT, and low-dose corticosteroids.

Adrenal Cortex Hormones↗

PubMed2006

Meta-analysis: efficacy and safety of inhaled insulin therapy in adults with diabetes mellitus.

BACKGROUND: Injection insulin therapy is not readily accepted by patients and many health care providers; therefore, less invasive options for insulin therapy are desirable. PURPOSE: To examine the efficacy, safety, and patient acceptability of inhaled insulin therapy in nonpregnant adults with diabetes mellitus. DATA SOURCES: English-language studies in MEDLINE, the Cochrane Clinical Trials Register (through June 2006), and U.S. Food and Drug Administration review documents of the first formulation of inhaled insulin approved for clinical use. STUDY SELECTION: Randomized, controlled trials of at least 12 weeks' duration that compared inhaled insulin with another active therapy and reported hemoglobin A1c levels in adults with type 1 or type 2 diabetes mellitus. DATA EXTRACTION: Two reviewers independently assessed trials for inclusion and extracted data. Differences were resolved by consensus. DATA SYNTHESIS: Sixteen open-label trials met the inclusion criteria (4023 patients; age range, 18 to 80 years). Among patients with type 1 or type 2 diabetes, there was a small decrease in hemoglobin A1c level from baseline that favored subcutaneous insulin over inhaled insulin (weighted mean difference, 0.08% [95% CI, 0.03% to 0.14%]), although there was no difference in the proportion of participants achieving hemoglobin A1c levels less than 7%. Inhaled insulin lowered hemoglobin A1c levels more (weighted mean difference favoring inhaled insulin, -1.45% [CI, -1.80% to - 1.10%]) compared with fixed doses of oral agents but much less when compared with oral agents titrated to glycemic efficacy (weighted mean difference favoring inhaled insulin, -0.20% [CI, -0.34% to - 0.07%]). Severe hypoglycemia was more likely to occur with inhaled insulin than with oral agents (risk ratio, 3.1 [CI, 1.0 to 9.1]), but there was no increased risk compared with subcutaneous insulin. There was an increased incidence of mild to moderate nonprogressive dry cough in patients treated with inhaled insulin (risk ratio, 3.5 [CI, 2.2 to 5.6]) and a mild decrease in certain pulmonary function testing variables, which did not progress over 2 years. Patients preferred inhaled insulin over subcutaneous insulin. LIMITATIONS: All trials were open label, which may introduce bias. Most of the trials were of 24 weeks' duration or less, limiting assessment of long-term safety. CONCLUSIONS: Inhaled insulin offers an alternative noninvasive option for premeal insulin administration, with glycemic efficacy slightly less than subcutaneous regular insulin and increased patient acceptability. Until long-term safety data are available, inhaled insulin should be reserved for nonpregnant adults with diabetes who are opposed to injections and who would otherwise delay appropriate and timely therapy with insulin.

Administration, Inhalation↗

PubMed2003

Acute-phase proteins among patients with type 1 diabetes.

OBJECTIVE: To determine whether young type 1 diabetic patients without clinical microvascular or macrovascular complications have altered levels of acute-phase proteins (AFP), alpha(1)-acid glycoprotein (AGP), C-reactive protein (CRP) and fibrinogen and whether their AFP levels are related to glycemic control. RESEARCH DESIGN AND METHODS: We studied cross-sectionally 48 type 1 diabetic outpatients (25 males) aged 19.9 +/- 9.8 years with a duration of diabetes of 5 (1-21) years, without clinical chronic complications and 66 non-diabetic subjects (26 males) aged 23.1 +/- 10.9 years. Inclusion criteria were normoalbuminuria, normal eye fundoscopy, and no evidence of cardiovascular disease or neuropathy. RESULTS: High CRP [0.23 (0.01-2.90 l) vs (0.14 (0.01-2.41l) mg/dl p=0.01] and AGP [53.5(40-78) vs 40.0(40-115) mg/dl p=0.0001] levels were found in patients with type 1 diabetes compared to nondiabetic subjects. In the pooled group studied, AGP was correlated with CRP, HbA(1c), fasting plasma glucose (FBG) and AER and CRP was correlated with HbA(1c) and AER. The correlation of AGP and CRP with AER persisted after controlling for HbA(1c) and FBG. Stepwise multiple regression with AGP as the dependent variable showed that FBG and HbA(1c) were the significant independent variables. No correlation between AFP and HBA(1c) and FBG was observed in the diabetic group. CONCLUSIONS: According to our results, AFP, a known marker of low-grade chronic inflammation, are increased in patients with type 1 diabetes probably independently of glycemic control and the presence of clinical microvascular or macrovascular disease. The influence of AFP on the development of chronic complications in patients with type 1 diabetes must be addressed in prospective studies.

Acute-Phase Proteins↗

PubMed2001

Association between maternal diabetes mellitus and newborn oral cleft.

Diabetes mellitus has been implicated in several studies as a possible etiological factor of various congenital anomalies. Oral clefts are common congenital malformations that may severely affect the quality of life. The authors conducted a population-based case-control study using the 1996 National Center for Health Statistics United States Natality database to investigate whether maternal diabetes mellitus is a risk factor (p < 0.05) for having a newborn with an oral cleft. The patients consisted of 2,207 live births with cleft lip/palate, and the control subjects were 4,414 randomly selected live births, excluding those with other congenital defects. After adjusting for potential confounding variables, diabetic mothers were found to be 1.352 times (95% confidence interval, 1.004-1.821; p < 0.05) more likely than nondiabetic mothers to have a newborn with cleft lip/palate. In counseling expectant mothers, early glycemic control may be an important factor in decreasing the incidence of this congenital anomaly.

Adult↗

PubMed2000

Controlling blood glucose levels in patients with type 2 diabetes mellitus. An evidence-based policy statement by the American Academy of Family Physicians and American Diabetes Association.

OBJECTIVE: To review evidence about the benefit of intensive glycemic control for patients with type 2 diabetes and to develop practice recommendations. PARTICIPANTS: A 9-member panel composed of family physicians, general internists, endocrinologists, and a practice guidelines methodologist was assembled by the American Academy of Family Physicians, the American Diabetes Association, and the American College of Physicians. EVIDENCE: Admissible evidence included published randomized controlled trials and observational studies regarding the effects of glycemic control on microvascular and macrovascular complications and on adverse effects. We followed systematic search and data abstraction procedures. Greater weight was given to clinical trials and to evidence about health outcomes. CONSENSUS PROCESS: Interpretations of evidence and approval of documents were finalized by unanimous vote, with recommendations linked to evidence and not expert opinion. The full report was prepared by the chair and 2 panel members, representing each of the 3 organizations. The initial draft underwent external review by 14 diabetologists and family physicians and changes consistent with the evidence were incorporated. CONCLUSIONS: The evidence demonstrates that the risk of microvascular and neuropathic complications is reduced by lowering glucose concentrations. Whether glycemic control affects macrovascular outcomes is less clear. The potential benefits of glycemic control must be balanced against factors that either preempt benefits (eg, limited life expectancy, comorbid disease) or increase risk (eg, severe hypoglycemia). The magnitude of benefit is a function of individual clinical variables (eg, baseline glycated hemoglobin level, presence of preexisting microvascular disease). Appropriate targets for treatment should be determined by considering these factors, patients' risk profiles, and personal preferences.

Aged↗

PubMed1991

Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes.

We studied the relationship between 1-h glucose response and the percentage of carbohydrates in a given meal in 14 gestational diabetic women who did not require insulin therapy and were between 32 and 36 wk gestation. Each subject was greater than 130% ideal body weight and was placed on a diet of 24 kcal.kg-1.24 h-1, with 12.5% of calories at breakfast and 28% of the calories at lunch and again at dinner, with other calorie intake divided among three snacks. Glycemic response was monitored by self-monitoring of blood glucose 1 h after the start of each meal. Ten postprandial values for each meal were averaged for each of the 14 women. The correlation between percentage of carbohydrates and postprandial glucose level at 1 h was strongest for dinner (r = 0.95, P less than 0.001), with more variability seen at breakfast (r = 0.75, P = 0.002) and lunch (r = 0.86, P = 0.001). To maintain a 1-h postprandial whole-blood glucose level less than 7.78 mM required the following percentages of carbohydrates in each meal: 45% at breakfast, 55% at lunch, and 50% at dinner. If 1-h postprandial whole-blood glucose level was to remain less than 6.67 mM, then the respective values were 33, 45, and 40%. We conclude that the glycemic response to a mixed meal in subjects with gestational diabetes is highly correlated with the percentage of carbohydrates of the ingested meal and varies among individuals and among breakfast, lunch, and dinner.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Reduction of nosocomial infections in the surgical intensive-care unit by strict glycemic control.

OBJECTIVE: To investigate whether hyperglycemia in glucose-intolerant patients without diabetes could lead to increased nosocomial infections in the surgical intensive-care unit (ICU). METHODS: A prospective, randomized, controlled clinical trial was conducted in the surgical ICU of a large teaching hospital in Hartford, Connecticut. Adult patients admitted to a 12-bed surgical ICU requiring treatment of hyperglycemia (glucose values > or = 140 mg/dL) were randomly assigned to receive standard insulin therapy (target glucose range, 180 to 220 mg/dL) or strict insulin therapy (target glucose range, 80 to 120 mg/dL) throughout their ICU stay. Demographic data, comorbidities, and confounding variables were analyzed. Outcome measures included mean daily serum glucose values, mean daily insulin doses, and number of nosocomial infections during the ICU stay. RESULTS: The study was completed by 61 critically ill surgical patients (27 in the standard glucose control group and 34 in the strict glucose control group). A significant reduction (P<0.001) in mean daily glucose level was achieved in the strict glycemic control group (125 +/- 36 mg/dL) in comparison with the standard glycemic control group (179 +/- 61 mg/dL). Furthermore, a significant reduction (P<0.05) in the incidence of total nosocomial infections, including intravascular device, bloodstream, intravascular device-related bloodstream, and surgical site infections, was observed in the strict glucose control group in comparison with the standard glucose control group. The incidence of hypoglycemia (glucose levels <60 mg/dL) was significantly increased (P<0.001) in the strict glycemic control group in comparison with the standard glycemic control group (32% versus 7.4% of patients or 0.8% versus 0.1% of total serum glucose values, respectively). CONCLUSION: Strict glycemic control is a safe and effective method for reducing the incidence of nosocomial infections in a predominantly nondiabetic, general surgical ICU patient population.

Adult↗

PubMed2002

Comparative efficacy of preprandial or postprandial Humalog Mix75/25 versus glyburide in patients 60 to 80 years of age with type 2 diabetes mellitus.

BACKGROUND: Humalog Mix75/25 (Mix75/25) is a novel premixed insulin containing 75% neutral protamine lispro (an intermediate-acting insulin) and 25% insulin lispro. OBJECTIVE: The purpose of this study was to compare glycemic control and hypoglycemia rates with Mix75/25 versus glyburide, and with preprandial versus postprandial Mix75/25, in patients aged 60 to 80 years with type 2 diabetes mellitus and persistent hyperglycemia on sulfonylurea therapy. METHODS: In this open-label, 16-week, parallel-group study, patients were randomized to 1 of 2 treatments: glyburide 15 mg/d (or up to the maximum daily dose) or Mix75/25. The Mix75/25 group was randomly subdivided into preprandial (immediately before breakfast and dinner) and postprandial (within 15 minutes after the start of breakfast and dinner) injection subgroups. The primary outcomes were glycemic control and rate of hypoglycemia. RESULTS: A total of 143 patients were randomized; 127 completed the study. The change in glycosylated hemoglobin (HbA(1c)) from baseline to end point was significantly greater with Mix75/25 than with glyburide (mean +/- SEM, -1.14% +/- 0.18% vs -0.36% +/- 0.15%, P = 0.001). HbA(1c) changes with preprandial and postprandial Mix75/25 were not significantly different (-1.20% +/- 0.26% vs -1.08% +/- 0.26%, P = 0.748). Fasting blood glucose (BG), 2-hour postprandial BG, and mean daily BG reductions were greater with Mix75/25 than with glyburide (P < 0.001); preprandial and postprandial Mix75/25 administration did not differ significantly with respect to any of these BG variables. The hypoglycemia rate increased with Mix75/25 by 0.17 +/- 0.02 episodes per patient per 30 days, but there was no change with glyburide (P = 0.077). Body weight increased by 1.02 +/- 0.35 kg with Mix75/25 and decreased by 0.85 +/- 0.18 kg with glyburide (P < 0.001). CONCLUSIONS: Compared with glyburide, Mix75/25 significantly improved glycemic control in older patients with type 2 diabetes mellitus, could be administered after meals without compromising glycemic control, and was well tolerated.

Aged↗

PubMed2006

Evaluation of a new measure of blood glucose variability in diabetes.

OBJECTIVE: Recent studies show the importance of controlling blood glucose variability in relationship to both reducing hypoglycemia and attenuating the risk for cardiovascular and behavioral complications due to hyperglycemia. It is therefore important to design variability measures that are equally predictive of low and high blood glucose excursions. RESEARCH DESIGN AND METHODS: We introduce the average daily risk range (ADRR), a variability measure computed from routine self-monitored blood glucose (SMBG) data. The ADRR was constructed using a development dataset for 39 and 31 adults with type 1 and type 2 diabetes, respectively. The formula was then fixed, and the ADRR was compared against other variability measures using an independent validation dataset containing approximately 4 months of SMBG for 254 and 81 adults with type 1 and type 2 diabetes. RESULTS: From the 1st month of validation SMBG data, we computed the ADRR, blood glucose SD and coefficient of variation, daily blood glucose range and interquartile range, mean amplitude of glycemic excursion, M-value, and lability index. Then all measures were tested as predictors of low blood glucose (<2.2 mmol/l; <3.9 mmol/l) and high (>10 mmol/l; >22.2 mmol/l) events in the subsequent 3 months. The ADRR was the best predictor of both hypoglycemia and hyperglycemia, with a 6-fold increase in the likelihood of hypoglycemia and 3.5-fold increase in the likelihood of hyperglycemia across its risk categories. CONCLUSIONS: In a large SMBG database, the ADRR showed strong association with subsequent out-of-control glucose readings. Compared with other variability measures, the ADRR demonstrated a superior balance of sensitivity to predicting both hypoglycemia and hyperglycemia. This prediction was independent from type of diabetes.

Adult↗

PubMed2000

Carbohydrates, dietary fiber, and incident type 2 diabetes in older women.

BACKGROUND: Dietary carbohydrates may influence the development of type 2 (non-insulin-dependent) diabetes, for example, through effects on blood glucose and insulin concentrations. OBJECTIVE: We examined the relations of baseline intake of carbohydrates, dietary fiber, dietary magnesium, and carbohydrate-rich foods and the glycemic index with incidence of diabetes. DESIGN: This was a prospective cohort study of 35988 older Iowa women initially free of diabetes. During 6 y of follow-up, 1141 incident cases of diabetes were reported. RESULTS: Total grain, whole-grain, total dietary fiber, cereal fiber, and dietary magnesium intakes showed strong inverse associations with incidence of diabetes after adjustment for potential nondietary confounding variables. Multivariate-adjusted relative risks of diabetes were 1.0, 0.99, 0.98, 0.92, and 0.79 (P for trend: 0.0089) across quintiles of whole-grain intake; 1.0, 1.09, 1.00, 0.94, and 0.78 (P for trend: 0.005) across quintiles of total dietary fiber intake; and 1.0, 0.81, 0.82, 0.81, and 0.67 (P for trend: 0.0003) across quintiles of dietary magnesium intake. Intakes of total carbohydrates, refined grains, fruit and vegetables, and soluble fiber and the glycemic index were unrelated to diabetes risk. CONCLUSION: These data support a protective role for grains (particularly whole grains), cereal fiber, and dietary magnesium in the development of diabetes in older women.

Aged↗

PubMed2000

Diabetic retinopathy in African Americans with type 1 diabetes: The New Jersey 725: II. Risk factors.

OBJECTIVE: To determine whether diabetic retinopathy in African Americans with type 1 diabetes is associated with the following 6 putative risk factors: duration of diabetes, glycemic control, systemic hypertension, renal disease, socioeconomic status, and male sex. METHODS: Patients in The New Jersey 725 study underwent detailed ocular evaluation, a structured clinical interview, blood pressure measurements, and assays of blood and urine samples. RESULTS: Glycemic control was poor; 89.8% of the patients had glycosylated hemoglobin values of more than 0.08. Renal disease and systemic hypertension were present in 49.8% and 34.3% of patients, respectively. Frequency and severity of retinopathy were significantly associated with longer duration of diabetes (P<.001). After adjusting for duration of diabetes and other confounding variables, on average, patients with total glycosylated hemoglobin values in the highest quartile were 3 times more likely to have any retinopathy than those in the lowest quartile; patients with renal disease, 3 times more likely to have any retinopathy and 10 times more likely to have proliferative retinopathy than patients without renal disease; and patients in the highest quartile of systolic sitting blood pressure, 3 times more likely to have proliferative retinopathy than patients in the lowest quartile. CONCLUSIONS: Risk factors for diabetic retinopathy in African Americans with type 1 diabetes include presence of renal disease, poor glycemic control, high systolic blood pressure, and long duration of diabetes.

Adolescent↗

PubMed1995

Effects of the normal nocturnal rise in cortisol on carbohydrate and fat metabolism in IDDM.

Plasma cortisol concentrations increase approximately three- to five-fold during sleep in healthy humans. To determine the effects of the normal nocturnal rise in cortisol on carbohydrate and fat metabolism independent of changes in endogenous insulin secretion, we studied the disposition of a mixed meal in individuals with insulin-dependent diabetes mellitus (IDDM) in whom the normal nocturnal rise in cortisol had been either prevented or mimicked by using metyrapone and a constant or variable hydrocortisone infusion. Insulin was infused intravenously on both occasions in amounts sufficient to create relative postprandial insulin deficiency. The nocturnal rise in cortisol resulted in an approximately 30 mg/dl greater (P < 0.001) peak postprandial glycemic excursion due to greater (P < 0.01) systemic glucose appearance and inappropriately low (P < 0.05) tissue glucose uptake. The latter was most evident when postprandial glucose concentrations in the presence and absence of the nocturnal rise in cortisol were matched by means of an exogenous glucose infusion to avoid the confounding effects of differences in glycemia. The nocturnal rise in cortisol also resulted in increased (P < 0.01) incorporation of 14CO2 into glucose (an index of gluconeogenesis), decreased (P < 0.05) carbohydrate oxidation, and increased (P < 0.05) rates of palmitate appearance, lipid oxidation, and beta-hydroxybutyrate concentrations. Thus the normal nocturnal rise in cortisol, independent of changes in insulin secretion, is an important regulator of postabsorptive and postprandial carbohydrate, fat, and ketone body metabolism in humans.

Adult↗

PubMedDate not supplied

Effects of duration of type 2 diabetes mellitus on insulin secretion.

OBJECTIVE: To gain insight into the effects of duration of type 2 diabetes on insulin secretion in patients with type 2 diabetes mellitus. METHODS: C-peptide concentrations were measured every 2 years before and after intravenous injection of 1 mg of glucagon in 89 patients with type 2 diabetes (51 men and 38 women) as part of the Rochester Diabetic Neuropathy Study in those subjects who participated in follow-up (median, 12 years; range, 6 to 14). RESULTS: Although insulin secretion decreased over time (P<0.001) in the group as a whole, both the pattern and the rate of decline in C-peptide concentration differed considerably among the study subjects. Insulin secretion, whether measured as fasting C-peptide, 6-minute C-peptide, or postglucagon increment in C-peptide concentrations, declined with increasing duration of diabetes in approximately half of the patients but either increased or remained essentially constant over time in the other half. The decrease in insulin secretion was not associated with a deterioration in glycemic control because hemoglobin A1c also declined (P<0.005) during the same interval. CONCLUSION: We conclude that insulin secretion decreases over time in many patients with type 2 diabetes. Because the rate of decline is variable, the predictive value of any single measurement is limited. These data indicate that although a decrease in insulin secretion over time is characteristic of type 2 diabetes mellitus, it is not inevitable.

Blood Glucose↗

PubMed2003

Progression of retinopathy during pregnancy in type 1 diabetic women treated with insulin lispro.

OBJECTIVE: To evaluate the progression of retinopathy during pregnancy and postpartum in (insulin-dependent) women with type 1 diabetes treated with insulin lispro or with regular human insulin. RESEARCH DESIGN AND METHODS: A prospective open study of 69 pregnant women with diabetes was performed. A total of 36 of the women were treated with insulin lispro (lispro group) and 33 were treated with conventional short-acting human insulin (regular insulin group). The retinopathy level was estimated by color fundus photography every trimester and postpartum. Glycemic control during pregnancy, hypoglycemia (blood glucose level <3 mmol/l) in 24-h glucose profile, blood pressure, and proteinuria were registered. RESULTS: HbA(1c) values were similar at baseline in the first trimester but thereafter were lower in the lispro group than in the regular insulin group throughout pregnancy (P = 0.022, repeated-measures ANOVA). The number of hypoglycemic episodes did not differ between the treatment groups. In multivariable logistic regression analysis with retinopathy severity (Diabetes Control and Complications Trial level) in the third trimester as the dependent variable, only nulliparity qualified as a predictor in the model [Exp(B) = 4.0, 95% CI 1.1-13.7, P = 0.030]. Factors such as duration of diabetes, type of insulin used, mean HbA(1c) level throughout pregnancy, blood pressure (systolic or diastolic), preeclampsia in the current pregnancy, smoking, or prepregnancy planning did not explain the retinopathy progression. CONCLUSIONS: Insulin lispro improves glycemic control during diabetic pregnancy compared with regular insulin with no adverse impact on progression of diabetic retinopathy.

Adult↗