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Results for “Glycemic variability”

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At least 433 records · Page 24Linked to original sources

PubMed2001

Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study.

OBJECTIVES: To evaluate the effects of Trigonella foenum-graecum (fenugreek) seeds on glycemic control and insulin resistance, determined by HOMA model, in mild to moderate type 2 diabetes mellitus we performed a double blind placebo controlled study. METHODS: Twenty five newly diagnosed patients with type 2 diabetes (fasting glucose < 200 mg/dl) were randomly divided into two groups. Group I (n=12) received 1 gm/day hydroalcoholic extract of fenugreek seeds and Group II (n=13) received usual care (dietary control, exercise) and placebo capsules for two months. RESULTS: At baseline both the groups were similar in anthropometric and clinical variables. Oral glucose tolerance test, lipid levels, fasting C-peptide, glycosylated haemoglobin, and HOMA-model insulin resistance were also similar at baseline. In group 1 as compared to group 2 at the end of two months, fasting blood glucose (148.3 +/- 44.1 to 119.9 +/- 25 vs. 137.5 +/- 41.1 to 113.0 +/- 36.0) and two hour postglucose blood glucose (210.6 +/- 79.0 to 181.1 +/- 69 vs. 219.9 +/- 41.0 to 241.6 +/- 43) were not different. But area under curve (AUC) of blood glucose (2375 +/- 574 vs 27597 +/- 274) as well as insulin (2492 +/- 2536 vs. 5631 +/- 2428) was significantly lower (p < 0.001). HOMA model derived insulin resistance showed a decrease in percent beta-cell secretion in group 1 as compared to group 2 (86.3 +/- 32 vs. 70.1 +/- 52) and increase in percent insulin sensitivity (112.9 +/- 67 vs 92.2 +/- 57) (p < 0.05). Serum triglycerides decreased and HDL cholesterol increased significantly in group 1 as compared to group 2 (p < 0.05). CONCLUSIONS: Adjunct use of fenugreek seeds improves glycemic control and decreases insulin resistance in mild type-2 diabetic patients. There is also a favourable effect on hypertriglyceridemia.

Adult↗

PubMed2003

Relationship between glycemic control, ethnicity and socioeconomic status in Hispanic and white non-Hispanic youths with type 1 diabetes mellitus.

OBJECTIVES: To determine if there is a disparity in glycemic control between Hispanic and white non-Hispanic children and adolescents with type 1 diabetes mellitus (DM) and to delineate the factors associated with glycemic control in these populations. STUDY DESIGN: This cross-sectional study included 183 youths with type 1 DM (99 white non-Hispanics and 84 Hispanics) and their parents/guardians cared for in a well-defined, private pediatric endocrine diabetes clinic, where the same physician and diabetes educators treat all patients. The youths were invited to participate if they had been diagnosed with diabetes at least 3 months before the study and were < 21 yr of age. Self-report questionnaires and chart reviews were used to assess individual familial and sociodemographic variables. OUTCOMES MEASURED: Mean hemoglobin A1c (HbA1c) levels, compliance with home monitoring of blood sugar, level of parental supervision of treatment, and socioeconomic status of Hispanic and white non-Hispanic families in the study. RESULTS: Hispanic youths with type 1 DM were in poorer metabolic control than their white non-Hispanic counterparts (0.45% difference in HbA1c levels, p = 0.02). Hispanic youths exhibited lower compliance with home monitoring of blood sugar but their parents reported greater supervision of their diabetes treatment. Hispanic families were found to have significantly lower income, rate of health insurance, father's educational attainment, and mother's educational attainment. Lower family socioeconomic status, but not ethnicity or educational attainment of parents, was associated with a significantly higher HbA1c, regardless of ethnicity. CONCLUSIONS: This study suggests that Hispanic youths with type 1 diabetes may be at greater risk for poor glycemic control because of their lower socioeconomic status rather than their ethnicity.

Adolescent↗

PubMed2003

Glycemic control in patients with type 2 diabetes mellitus switched from twice-daily immediate-release metformin to a once-daily extended-release formulation.

BACKGROUND: The extended-release formulation of metformin (MXR) prolongs drug absorption in the upper gastrointestinal tract and permits once-daily dosing in patients with type 2 diabetes mellitus. This newer formulation may enhance patient compliance with oral therapy and improve long-term control of diabetes compared with the conventional immediate-release formulation of metformin (MIR). OBJECTIVE: The goal of this study was to determine the effects on glycemic control of a switch to MXR therapy in patients with type 2 diabetes currently treated with MIR. METHODS: This was a multicenter, randomized, double-blind, parallel-group study in patients with established type 2 diabetes. Eligible patients were to have a glycated hemoglobin (HbA1c) value < or = 8.5% and mean fasting plasma glucose (FPG) concentrations < or = 200 mg/dL while receiving MIR 500 mg BID for at least 8 weeks. After a 2-week, single-blind lead-in period, patients were randomly assigned to receive MXR 1000 or 1500 mg QD for 24 weeks or to continue MIR 500 mg BID for 24 weeks. The primary efficacy variable was change in HbA1c from baseline to week 12. Other variables included change in FPG levels; change in HbA1c; distribution of HbA1c values; mean daily blood glucose concentrations (self-monitored); levels of fructosamine, serum insulin, and lipids; and body weight. RESULTS: Two hundred seventeen patients were randomized to treatment. The mean change from baseline in HbA1c values at weeks 12 and 24 were small and similar in the 3 treatment groups. At week 12, the mean change from baseline in HbA1c was 0.15% for MIR, 0.23% for MXR 1000 mg, and 0.04% for MXR 1500 mg. The corresponding mean changes at week 24 were 0.06%, 0.25%, and 0.14%. CONCLUSIONS: In this study, patients with type 2 diabetes who had been receiving twice-daily MIR achieved comparable glycemic control when therapy was switched to once-daily MXR at the same or a greater total daily dose.

Blood Glucose↗

PubMed2001

Treatment for the procoagulant state in type 2 diabetes.

A procoagulant state has been found to exist in diabetes mellitus. There may be activation of the intrinsic coagulation system, decreased fibrinolytic activity, or alterations in platelet function. Intensive glycemic control with insulin is effective in reducing the impact of this procoagulant state by favorably affecting all three components of the system. Decreased fibrinolytic activity, as influenced by plasma PAI-1 levels, may be favorably affected by weight loss, exercise, a low-GI diet, or by metformin, thiazolidinediones, gemfibrozil, and ACE inhibitor therapy. Insulin has variable effects on plasma PAI-1 activity. Estrogens will lower the elevated PAI-1 levels seen in the menopausal state. Collaborative trial evidence supports the use of low-dose aspirin as a primary or secondary prevention strategy in diabetic persons who are at high cardiovascular risk. A recent study suggests that this category includes virtually every type 2 diabetic individual in the United States. The American Diabetes Association recommends enteric-coated aspirin, 81 to 325 mg/day, as the first choice. In the case of aspirin allergy, clopidrogel is an alternate choice. Thus, recognition of and therapy for a procoagulant state in diabetes mellitus is likely to result in a decrease in the atherothrombotic events that characterize the later stages of this disease.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

Long-term ingestion of a fermented soybean-derived Touchi-extract with alpha-glucosidase inhibitory activity is safe and effective in humans with borderline and mild type-2 diabetes.

Water-extracted Touchi, a traditional Chinese food, exerts a strong inhibitory activity against rat intestinal alpha-glucosidase in foodstuffs, and Touchi-extract (TE) has been shown to have an antihyperglycemic effect in rats and humans after a single oral administration. In the present complementary study, the effects of powdered Houji-tea with or without (placebo) TE, a formula designed to enhance good compliance, were monitored in a 3-mo double-blind randomized group comparison study with placebo controls in humans with borderline and mild type-2 diabetes (n = 36). All subjects ingested Houji-tea with or without 0.3 g of TE before each of three meals per day for 3 mo. In the TE group, initial fasting blood glucose (6.9 +/- 0.1 mmol/L) and glycated hemoglobin (HbA(1c); 6.1 +/- 0.1%) levels gradually decreased; fasting blood glucose decreased significantly after 3 mo (6.4 +/- 0.3 mmol/L; P < 0.05) as did HbA(1c) (5.6 +/- 0.2%; P < 0.01) levels at 2 mo postingestion of TE and thereafter. In contrast, fasting blood glucose and HbA(1c) levels did not change in the placebo group. In this study, other biochemical variables were not affected in any of the subjects, and no one complained of any side effects or abdominal distension. Moreover, there was no deterioration as assessed by fasting blood glucose and HbA(1c) levels after withdrawal of TE ingestion. Thus, the alpha-glucosidase inhibitory TE demonstrated an antihyperglycemic effect and may prove useful for improving glycemic control in subjects suffering from borderline and type-2 diabetes mellitus.

Administration, Oral↗

PubMed2002

Identifying older diabetic patients at risk of poor glycemic control.

BACKGROUND: Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. METHODS: A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia > or = 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population. RESULTS: Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143-218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia > or = 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia > or = 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population. CONCLUSION: A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control.

Journal Article↗

PubMed2004

Combined therapy with insulin lispro Mix 75/25 plus metformin or insulin glargine plus metformin: a 16-week, randomized, open-label, crossover study in patients with type 2 diabetes beginning insulin therapy.

OBJECTIVE: This study aimed to assess glycemic response to a mixture of 75% insulin lispro protamine suspension and 25% insulin lispro (Mix 75/25) BID plus metformin versus insulin glargine QD plus metformin in patients with type 2 diabetes mellitus (DM). METHODS: Adults new to insulin therapy were enrolled in a multicenter, randomized, prospective, open-label, crossover study with 16 weeks on each treatment. Variables included glycosylated hemoglobin (HbA(1c)), hypoglycemia rate, fasting blood glucose (FBG), 2-hour postprandial blood glucose (ppBG), and rise in blood glucose after meals. RESULTS: One hundred five patients (mean age, 55 years) were randomized. There was no difference in baseline mean values for either treatment sequence group for body mass index, duration of DM, or HbA(1c). Ninety-five patients completed the study and 67 were included in the efficacy analysis. Mix 75/25 was associated with lower mean (SD) HbA(1c) at end point (7.4% [1.1%] vs 7.8% [1.1%]; P = 0.002). More patients using Mix 75/25 achieved target HbA(1c) < or =7.0% (42% [30/71] vs 18% [13/71]; P < 0.001). With Mix 75/25, the mean (SD) 2-hour ppBG was similar after lunch but lower after breakfast (156.4 [43.6] vs 171.1 [44.9] mg/dL; P = 0.012) and dinner (164.8 [42.5] mg/dL vs 193.8 [51.0] mg/dL; P < 0.001), although FBG was higher (139.3 [36.6] mg/dL vs 123.9 [34.9] mg/dL; P < 0.001). Rise in ppBG was lower with Mix 75/25 after breakfast (16.9 [47.0] mg/dL vs 47.4 [34.8] mg/dL; P < 0.001) and dinner (14.2 [44.1] mg/dL vs 45.9 [41.3] mg/dL; P < 0.001). Gain in mean (SD) body weight was greater with Mix 75/25 than insulin glargine (2.3 [4.0] kg vs 1.6 [4.0] kg; P = 0.006). For all randomized patients, mean (SD) hypoglycemia rates were lower with insulin glargine (0.68 [1.38] vs 0.39 [1.24] episodes/patient per 30 days; P = 0.041), although nocturnal hypoglycemia was similar. CONCLUSION: In this study population, Mix 75/25 plus metformin was associated with lower HbA(1c) than insulin glargine plus metformin, smaller rise in ppBG after breakfast and dinner, and higher proportion of patients achieving HbA(1c) < or =7.0%, with a slight increase in overall (but not nocturnal) hypoglycemia.

Adult↗

PubMed2006

Relations of glycemic index and glycemic load with plasma oxidative stress markers.

BACKGROUND: Recent data suggest that acute hyperglycemia may increase in vivo free radical production. This increased production has been implicated in many disease processes. OBJECTIVE: The objective was to investigate whether a diet with a high glycemic index (GI) or glycemic load (GL) is associated with greater oxidative stress as measured by 2 lipid peroxidation markers, malondialdehyde (MDA) and F2-isoprostanes (IsoPs). DESIGN: Plasma MDA and IsoP concentrations were measured in 292 healthy adults, and dietary GI and GL were assessed by using a validated food-frequency questionnaire. Cross-sectional associations between GI, GL, and the 2 markers were examined by using multiple regression techniques with adjustment for potential confounding variables. RESULTS: Dietary GI was positively associated with both plasma MDA and IsoPs. The mean multivariate-adjusted MDA concentrations increased from 0.55 to 0.73 micromol/L as GI increased from the lowest to the highest quartile (P for trend = 0.02); the corresponding IsoP concentrations increased from 0.034 to 0.040 ng/mL (P for trend = 0.03). GL was positively associated with both MDA and IsoPs, but the linear relation was significant only for MDA. In addition, a marginally significant interaction between overall GI and body mass index (BMI; in kg/m2) for plasma MDA was observed (P = 0.09). The positive association between overall GI and MDA was stronger in those with a BMI < 26.5 than for those with a BMI > or = 26.5. CONCLUSIONS: Chronic consumption of high-GI foods may lead to chronically high oxidative stress. A low-GI diet, not a low-carbohydrate diet, appears to be beneficial in reducing oxidative stress.

Adolescent↗

PubMed2003

Predictors of angiographic restenosis after coronary intervention in patients with diabetes mellitus.

BACKGROUND: Patients with diabetes mellitus are particularly prone to restenosis after percutaneous coronary intervention. An exploratory, nested, case-control study was undertaken to identify clinical, lesional, and procedural predictors of angiographic restenosis in these patients. METHODS: Seventy-five patients with diabetes mellitus with 86 coronary lesions were selected from a larger population of 217 patients who had undergone 6-month angiographic follow-up after a first, successful balloon angioplasty (PTCA) or stent implantation procedure. Data collection was by patient interview and review of hospital database and other medical records. All angiograms were analyzed with quantitative coronary angiography, and restenosis was defined as a >or=50% diameter reduction at the treated site. A multivariate analysis of 10 prespecified explanatory variables, derived from a literature review, was performed on a per-lesion basis. RESULTS: There were 45 patients (53 lesions) with restenosis and 30 patients (33 lesions) without restenosis. Univariate predictors of binary restenosis were periprocedural glycosylated hemoglobin level, vessel reference diameter, PTCA, and larger final balloon size to reference artery diameter ratio. Multiple logistic regression identified poor glycemic control (odds ratio [OR] 3.03, 95% CI 1.06-8.65, P =.038), small vessel reference diameter (OR 3.41, 95% CI 1.17-9.95, P =.025), and mode of intervention (OR 3.12, 95% CI 1.08-9.00, P =.036) as independent risk factors. Vessel reference diameter appeared to be an important effect modifier of the association between type of intervention and angiographic outcome, with stenting no longer superior to PTCA in patients with diabetes mellitus who had vessels <2.87 mm in diameter (P =.054). CONCLUSION: Poor glycemic control, vessel size, and PTCA were independent predictors of restenosis in patients with diabetes mellitus. It is possible that improved periprocedural glycemic control, in addition to stenting, may reduce the restenosis rate in these patients.

Algorithms↗

PubMed1992

Puberty and insulin-dependent diabetes mellitus.

Puberty and IDDM interact at many different levels, each affecting the other. Pediatricians, diabetologists, and patients with IDDM must be aware of these interactions and be prepared to adjust their management of IDDM accordingly. Glycemic control in the young prepubertal patient has not been associated with the development of subsequent diabetic microvascular disease. However, extremely tight glycemic control (percent HbA1 in the nondiabetic range) may expose patients to more severe and more frequent hypoglycemic episodes. This may be particularly detrimental for the very young (less than age 3 years) patient whose brain growth and myelinization has not yet been completed. Glycemic control must be maintained in the prepubertal diabetic patient to ensure normal physical and psychological growth, to avoid hospitalizations, and to allow participation in school and other age-appropriate activities. During puberty, health-care professionals and patients should anticipate more difficulty in maintaining glycemic control. Insulin doses commonly need to be increased, sometimes dramatically. Timing of insulin injections will frequently need to be adjusted to blunt the dawn phenomenon. Patients should be allowed to give themselves additional doses of regular insulin (5% to 10% of their total daily dose) when their blood-sugar levels are intermittently elevated to blunt the increased variability in blood-sugar levels seen during puberty. The use of supplemental regular insulin to correct intermittent hyperglycemia is preferable to withholding food in the adolescent patient, since overzealous food restriction can in itself lead to problems with linear growth and pubertal development.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2000

RH blood groups and diabetic disorders: is there an effect on glycosylated hemoglobin level?

Recent cloning of RH genes has elucidated their structure, suggesting that RH proteins are part of an oligomeric complex with transport function in the erythrocyte. This observation prompted us to investigate a possible relationship between the RH system and the glycosylated hemoglobin level (Hb A(1c)) in diabetes. This compound is considered an important indicator- of glycemic control in diabetic disorders. We studied 278 subjects with non-insulin-dependent diabetes mellitus (NIDDM) from the population of Penne, Italy. Glycemic and glycosylated hemoglobin (Hb A(1c)) levels are associated with RH phenotype. Glucose and Hb A(1c) levels are increased in DCcEe subjects and decreased in ddccee subjects as compared to the mean values for other genotypes. Sex, age at onset of disease, duration of disease, and age of patients were also considered. Correlation analysis suggests that these variables influence glycemia directly and Hb A(1c) indirectly. The RH system, on the other hand, seems to influence the Hb A(1c) level directly. Preliminary data on 53 children with insulin-dependent diabetes mellitus (IDDM) from Sardinia seem to confirm the relationship between RH and Hb A(1c) observed in NIDDM. Since glycosylated hemoglobin is found inside red blood cells, the relationship between RH genetic variability and Hb A(1c) level suggests that RH proteins may influence glucose transport through red cell membrane and/or hemoglobin glycation.

Adult↗

PubMed2005

The K469E polymorphism of the intercellular adhesion molecule-1 gene is associated with plasma fibrinogen level in type 2 diabetes.

Intercellular adhesion molecule-1 (ICAM-1) is involved in inflammation and development of atherosclerotic change of vascular endothelium. The aim of the present study is to investigate whether K469E polymorphism of the ICAM-1 gene is associated with various clinical factors including plasma fibrinogen in patients with type 2 diabetes. ICAM-1 gene polymorphism was examined using polymerase chain reaction and restriction enzyme analysis in 360 type 2 diabetic patients. Plasma fibrinogen levels and other clinical variables were measured as well as circulating soluble ICAM-1 (sICAM-1) levels by enzyme-linked immunosorbent assay. The distribution of ICAM-1 genotypes, EE, EK, and KK, was not significantly different between type 2 diabetes and 152 healthy control subjects. Among 3 groups according to ICAM-1 genotypes in type 2 diabetes, no difference was found in adiposity, glycemic control, lipid profile, insulin sensitivity evaluated by homeostasis model assessment, or sICAM-1. Regarding fibrinogen, the patients with E allele showed significantly lower plasma fibrinogen levels in a dose-dependent manner (P = .033). Spearman rank correlation analyses revealed that ICAM-1 genotype showed significant correlation with plasma fibrinogen level (P < .001). In multiple regression analysis, ICAM-1 genotype was independent contribution factor of plasma fibrinogen level as well as high-density lipoprotein-cholesterol and urinary albumin excretion (R2 = 0.148, P < .001). In conclusion, K469E polymorphism of the ICAM-1 gene had impact on plasma fibrinogen level independently of other clinical factors in 360 type 2 diabetic patients, suggesting that fibrinogen is a candidate which links the ICAM-1 gene polymorphism to atherosclerosis.

Albuminuria↗

PubMed1993

The effects of age and diabetes mellitus on nerve function.

OBJECTIVE: This project evaluated the association of age and vibratory thresholds (assessment modality of large sensory nerve fibers) in subjects with and without diabetes mellitus. DESIGN: Cross-sectional study. SETTING: Medical Research Institute of Delaware. PARTICIPANTS: Individuals with non-insulin-dependent diabetes mellitus and non-diabetic control subjects. MEASUREMENTS: Vibratory thresholds were examined in four age groups (ie, < 45 yrs, 45-54 yrs, 55-64 yrs, > or = 65 yrs). The independent association of age, duration of diabetes, height, gender, glycemic control, and smoking history were analyzed in terms of their relationship to vibratory thresholds. MAIN RESULTS: Vibratory thresholds increased with age for both control and diabetic subjects. Comparing controls with diabetic subjects in the same age categorizes revealed significant differences for vibratory thresholds only in the > or = 65 year old age group. Modeling with vibratory thresholds as the dependent variable showed that age and male gender were independently associated with vibratory thresholds for the controls and explained the majority of the variability (R2 = 0.79). Age, duration of diabetes, and height were independently associated with vibratory thresholds for the diabetic subjects but explained much less of the variability (R2 = 0.39). CONCLUSIONS: The results suggest an acceleration of the natural aging process for large sensory nerve fiber function in diabetic subjects. Thus, young diabetic subjects may be at a risk of lower extremity complications as a result of injuries similar to that older non-diabetic individuals.

Adult↗

PubMed2006

Alexithymia in diabetes mellitus.

BACKGROUND: Diabetes mellitus is a chronic, progressive disease with complex therapy protocols requiring major coping efforts from patients to achieve and maintain glycaemic control in order to reduce risk of diabetic complications. Disease coping strategies including good knowledge of diabetes and high ability of self-care have been reported to be impaired by alexithymic features. Alexithymia is a psychological construct characterised by inability to express emotions verbally, poor imagination and operational thinking, leading to failure in psychological self-regulation. OBJECTIVE: To compare prevalence of alexithymia and mean Toronto Alexithymia Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls; to investigate the association of alexithymia with glycemic control in diabetes. METHOD: In this cross- sectional study, TAS-26 scores of 193 diabetic patients and 49 non-diabetic controls were compared. Disease related factors were obtained from patient records. Alexithymia was used as a continuous (mean TAS-26 scores) and semi-quantitative (dichotomised into non-alexithymic 11>TAS-26 scores>11 and alexithymic individuals) variable. Descriptive data are presented as mean +/- SD, median (range) or %. Differences in means were compared via Independent-Samples T Test and One-Way ANOVA. Proportions were analysed with chi-square test and odds ratios (OR) were calculated via cross tabulation with a confidence interval (CI) of 95%. P<0.05 was considered statistically significant. RESULTS: The control group was similar with respect to age, gender and education with the diabetic group. In the diabetic study population (n=193, male/female: 42/58%, age 54.2 +/- 14.0 years, median diabetes duration 7 years (1-32 years), postprandial blood glucose (PBG) 243 +/- 110 mg/dl HbA1 c 7.3 +/- 3.6%) prevalence of alexithymia was significantly higher than in the control group (65 % in diabetics vs. 45 % in controls, p=0.011; mean TAS-26 score 12.3 +/- 3.7 vs. 10.6 +/- 3.6, p=0.004, respectively). Poor postprandial glycaemic control (p=0.002), female gender (p=0.026), combination therapy (p=0.037) and poor educational level (p=0.005) were positively associated with TAS-26 scores in diabetic individuals. Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and under worse glycaemic control (OR=2.4, p=0.005) compared to their non-alexithymic counterparts.

Adult↗

PubMedDate not supplied

Clinical utility of nonenzymatically glycosylated blood proteins as an index of glucose control.

This study compares the utility of nonenzymatically glycosylated serum proteins (lys-GSP) to glycosylated hemoglobins (HbA1a-c) as control indices of glucose homeostasis in patients with IDDM. The diagnostic value of lys-GSP was also examined in patients with non-insulin-dependent diabetes mellitus, in subjects with impaired glucose tolerance, and in two patients with insulinoma. The intraindividual fluctuation of lys-GSP in normoglycemic subjects is very small, resulting in an interindividual range of 3.0 +/- 0.3 lysine-bound glucose/mg protein (means +/- SD, N = 52). HbA1a-c with a normal range of 6.4 +/- 0.9% (N = 52) shows greater variability. In IDDM there is no overlap of lys-GSP levels between the normal and the diabetic range at the 95% confidence level. In patients treated with an open-loop insulin delivery system failure of normalization of the glucose balance was clearly discernible by an elevation of GSP. In contrast, in about 40% of the patients with incomplete glycemic control the HbA1a-c levels fell within the normal range. The utility of lys-GSP for diagnosis of diabetes is compared with the results of 60 oral glucose tolerance tests. Two patients suffering from insulinoma displayed decreased lys-GSP values. From these results it appears that determination of lys-GSP represents a more sensitive parameter for long-term control than HbA1a-c and is suitable for monitoring even small fluctuations of blood glucose.

Adolescent↗

PubMed2006

Feasibility and safety of insulin pump therapy in children aged 2 to 7 years with type 1 diabetes: a retrospective study.

BACKGROUND AND OBJECTIVES: Although insulin pump therapy has been successful in adults, adolescents and school children, its use has been limited in young children. The purpose of this study was to evaluate the glycemic control, safety and efficacy of continuous subcutaneous insulin infusion via pump in young children (2-7 years old) with type 1 diabetes who were transitioned from twice-a-day insulin injection (neutral protamine Hagedorn/Lente + Humalog/Novalog) to insulin pump therapy. Hemoglobin A1c, BMI, average fasting blood glucose, episodes of severe hypoglycemia, episodes of diabetic ketoacidosis, episodes of lipohypertrophy, blood glucose variability, and number of sick day calls were compared before and after insulin pump therapy. METHODS: Data were collected retrospectively by chart review over a 2-year period during quarterly diabetes clinic visits from 33 patients who were managed on neutral protamine Hagedorn/Lente + Humalog/Novolog twice-a-day injections for at least 1 year prior to transitioning to insulin pump therapy. RESULTS: There was a significant improvement in the average hemoglobin A1c after continuous subcutaneous insulin infusion therapy. The average fasting blood sugar was lower in the continuous subcutaneous insulin infusion group. Severe episodes of hypoglycemia and episodes of lipohypertrophy were significantly higher before insulin pump therapy initiation. There were significantly fewer sick day calls after continuous subcutaneous insulin infusion. Blood sugar variability improved significantly after insulin pump therapy. There was no significant difference in BMI or amount of carbohydrate consumed. None of the patients experienced diabetic ketoacidosis requiring emergency treatment before or after insulin pump therapy. CONCLUSIONS: Continous subcutaneous insulin infusion therapy in young children with type 1 diabetes is a safe, effective and superior alternative to a twice-a-day insulin regimen.

Child↗

PubMed1986

Determinants of microangiopathy in growth-onset diabetes. With special reference to retinopathy and glycaemic control.

In a quasi-experiment all diabetic children in a defined area were exposed either to an intense clinical treatment or served as a constructed control. The cohort of 146 diabetics was observed prospectively for at least 15 years as to diabetic control, mainly glycosuria, and cross-sectionally examined for microangiopathy on four occasions. Data on family background, social situation, smoking, blood pressure, biochemical status, anthropometry, HLA factors and mortality were also gathered. Throughout the analysis duration was considered and treated as a concomitant variable. Two different strategies have been followed in the analysis, one trying to predict microangiopathy at a fixed and predetermined duration, the other to study determinants of the pattern of microangiopathy occurrence over time. Multiple logistic regression and Cox analysis have been used to fit these strategies. The prevalence of microaneurysms or more advanced stages of retinopathy at 10 years duration was 30 per cent and within 20 years 81 per cent. About 52 per cent had haemorrhages after 20 years. Mild and severe nephropathy after 20 years have been contracted by 50 and 15 per cent respectively. No clear sex differences were seen. Variables significantly explaining retinopathy within 10 years were post-pubertal duration, blood pressure, place of medical supervision and the HLA/DR4 marker. The mean glycosuria was high during puberty irrespective of age at onset. The overall pattern of retinopathy occurrence seemed to be influenced by place of medical supervision, age at onset, blood pressure, family history of ischaemic heart disease and glycemic control. For the progression of retinopathy the role of factors reflecting medical supervision and control of diabetes seemed even greater. Even after accounting for degree of diabetic control the experimental group had a more favourable outcome, suggesting additional quality of care components. Mild nephropathy was less predictable from the above risk factors while previous findings of the important role of elevated blood pressure for severe nephropathy was confirmed. We estimate that half of retinopathy cases were preventable by the "experimental" care and conclude the near-normalization of glycaemia under routine conditions favourably influences the development of diabetic retinopathy.

Adolescent↗

PubMed1996

High-fat diet-induced hyperglycemia and obesity in mice: differential effects of dietary oils.

Mice fed a high-fat diet develop hyperglycemia and obesity. Using non-insulin-dependent diabetes mellitus (NIDDM) model mice, we investigated the effects of seven different dietary oils on glucose metabolism: palm oil, which contains mainly 45% palmitic acid (16:0) and 40% oleic acid (18:1); lard oil, 24% palmitic and 44% oleic acid; rapeseed oil, 59% oleic and 20% linoleic acid (18:2); soybean oil, 24% oleic and 54% linoleic acid; safflower oil, 76% linoleic acid; perilla oil, 58% alpha-linolenic acid; and tuna fish oil, 7% eicosapentaenoic acid and 23% docosahexaenoic acid. C57BL/6J mice received each as a high-fat diet (60% of total calories) for 19 weeks (n = 6 to 11 per group). After 19 weeks of feeding, body weight induced by the diets was in the following order: soybean > palm > or = lard > or = rapeseed > or = safflower > or = perilla > fish oil. Glucose levels 30 minutes after a glucose load were highest for safflower oil (approximately 21.5 mmol/L), modest for rapeseed oil, soybean oil, and lard (approximately 17.6 mmol/L), mild for perilla, fish, and palm oil (approximately 13.8 mmol/L), and minimal for high-carbohydrate meals (approximately 10.4 mmol/L). Only palm oil-fed mice showed fasting hyperinsulinemia (P < .001). By stepwise multiple regression analysis, body weight (or white adipose tissue [WAT] weight) and intake of linoleic acid (or n-3/n-6 ratio) were chosen as independent variables to affect glucose tolerance. By univariate analysis, the linoleic acid intake had a positive correlation with blood glucose level (r = .83, P = .02) but not with obesity (r = .46, P = .30). These data indicate that (1) fasting blood insulin levels vary among fat subtypes, and a higher fasting blood insulin level in palm oil-fed mice may explain their better glycemic control irrespective of their marked obesity; (2) a favorable glucose response induced by fish oil feeding may be mediated by a decrease of body weight; and (3) obesity and a higher intake of linoleic acid are independent risk factors for dysregulation of glucose tolerance.

Animals↗