Fasting Blood Glucose-A Missing Variable for GFR-Estimation in Type 1 Diabetes?

Replacement of the insulin-secreting beta cells through transplantation of pancreatic islets to the liver is a promising treatment for type-1 diabetes. However, low oxygen tension, shear stress, and the induction of inflammation lead to significant islet dysfunction and loss. The anterior chamber of the eye (ACE) has gained considerable interest and represents an alternative therapeutic islet transplantation site because of its accessibility, high oxygen tension, and immune-privileged milieu. We have previously demonstrated the feasibility of intraocular islet transplant in mouse and nonhuman primate models of type-1 diabetes and are now assessing its efficacy on glucose homeostasis in a nonhuman primate model of type-2 diabetes. We transplanted allogeneic donor islets (1,500 islet equivalents/kg) into the anterior chamber of one eye in a cynomolgus monkey with high-fat-diet-induced type-2 diabetes. Repeated examinations of the anterior and posterior segments of both eyes were done to monitor the engrafted islets and assess the overall ocular health. Fasting blood glucose level, blood biochemistry, and other metabolic parameters were routinely evaluated to determine the function of the islet graft and diabetes status. The transplanted islets were rapidly engrafted onto the iris and became vascularized 1 month after transplantation. We did not detect changes in intraocular pressure, cataract formation, ophthalmitis, or retinal vessel deformation. A significant lower fasting blood glucose level was observed while the graft was in place, and the transplantation reverts the progression of diabetes. The metabolic markers, hemoglobin A1C and fructosamine, demonstrated improvement following islet transplantation. As a conclusion, intraocular islet transplantation in one eye of a cynomolgus monkey with type-2 diabetes improved its overall plasma glucose homeostasis, as evidenced by short-term measures and long-term metabolic markers. These results further support the future application of the ACE as an alternative site for clinical islet transplants in the context of type-2 diabetes.

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COVID-19 Pneumonia, Diabetes and Alteration of the Biochemical Values of Blood: A Case Report and Review of the Literature

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i630865 ◽

2021 ◽

pp. 92-96

Author(s):

Petronela Vicoveanu ◽

Roxana Covali ◽

Laura Riscanu ◽

Demetra Socolov ◽

Ioana Pavaleanu ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Serum Iron ◽

Serum Magnesium ◽

Fasting Blood Glucose ◽

Shortness Of Breath ◽

Serum Urea ◽

X Ray ◽

Low Serum

Aims: The variability in evolution of the novel coronavirus has perplexed the medical community. We herein report the case of a patient with specific characteristics, somewhat outside the reported average values. Presentation of Case: A 60-year-old type I diabetic patient was admitted as an outpatient to a university hospital for the following symptoms: fever up to 38.1˚C, malaise, and shortness of breath. Upon admittance, the chest X-ray revealed a homogenous triangular opacity, of medium intensity, located in the lower lobe of the left lung, suggesting pneumonia. Altered biochemistry values in our hospital included ALT = 86U/L, AST = 118 U/L, serum urea = 43.4 mg/dL, serum creatinine = 1.43 mg/dL, fasting blood glucose = 167.9 mg/dL (she had type 1 diabetes and received insulin only in the evening), triglycerides = 214.9 mg/dL, serum magnesium = 1.48 mg/dL, serum iron = 14.1 mg/dL. Fever, malaise, and shortness of breath, together with the X-ray image of the chest suggested COVID-19. RT-PCR confirmed the diagnosis 12 hours later. Three days after admission, she felt dyspneic, and oxygen therapy was administered for 7 days, together with Lopinavir/Ritonavir, Dexamethasone, Heparin and Vitamin C. After 18 days in the hospital, she felt good, and was released from the hospital. Conclusion: Despite the numerous aggravating factors for COVID-19 (age [60 years old], type 1 diabetes, increased values of ALT, AST, serum urea, serum creatinine, fasting blood glucose, low serum magnesium, one whole lobe pneumonia, and only one favorable factor–low serum iron), the patient survived and recovered.

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Effects of Switching From Degludec to Glargine U300 in Patients With Type 1 Diabetes Having Large Day-to-day Glycemic Variability: a Retrospective Study

10.21203/rs.3.rs-503447/v1 ◽

2021 ◽

Author(s):

Toshitaka Sawamura ◽

Shigehiro Karashima ◽

Azusa Ohbatake ◽

Takuya Higashitani ◽

Yuko Katsuda ◽

...

Keyword(s):

Type 1 Diabetes ◽

Retrospective Study ◽

Blood Glucose ◽

Serum Albumin ◽

Fasting Blood Glucose ◽

Glycemic Variability ◽

Nocturnal Hypoglycemia ◽

Insulin Dependent ◽

Dependent Type

Abstract Background: Degludec (Deg) and Glargine U300 (Gla-300) are new insulin analogues with longer and smoother pharmacodynamic action than Glargine U100. Both improve glycemic variability (GV) unlike Glargine U100. However, it is not clear which insulin analogue has a better effect on GV in insulin-dependent type 1 diabetes. We evaluated the effects of switching from Deg to Gla-300 on day-to-day GV in patients with insulin-dependent type 1 diabetes treated with Deg.Methods: We conducted a retrospective study on 22 insulin-dependent type 1 diabetes patients having large day-to-day GV or frequent hypoglycemia who were treated with multiple insulin injection therapy including Deg and were advised to switch from Deg to Gla-300. We evaluated day-to-day GV and frequency of hypoglycemia in two groups. The first group included patients whose treatment was changed to Gla-300, and the second group included patients who opted to continue receiving Deg. We evaluated the change in standard deviation (SD) of fasting blood glucose (SD-FBG) calculated from self-monitoring of blood glucose (SMBG) and frequency of hypoglycemia (total, severe, and nocturnal).Results: SD-FBG and frequency of nocturnal hypoglycemia decreased in Gla-300 group compared to those in Deg group. The change in SD-FBG had a negative correlation with SD-FBG and hemoglobin A1c (HbA1c) at baseline and positive correlation with serum albumin levels at baseline in Gla-300 group. On the other hands, the change in SD-FBG had no correlation with these markers in Deg group.Conclusions: Switching from Deg to Gla-300 effectively stabilized blood glucose levels and decreased nocturnal hypoglycemia in insulin-dependent type 1 diabetes treated with Deg, especially in cases with low serum albumin, large GV, and high HbA1c.

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Altered Tim-1 and IL-10 Expression in Regulatory B Cell Subsets in Type 1 Diabetes

Frontiers in Immunology ◽

10.3389/fimmu.2021.773896 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yikai Liu ◽

Zhiying Chen ◽

Junlin Qiu ◽

Hongzhi Chen ◽

Zhiguang Zhou

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

B Cells ◽

B Cell ◽

Fasting Blood Glucose ◽

Healthy Controls ◽

Regulatory B Cell ◽

Significant Difference ◽

B Cell Subsets

BackgroundType 1 diabetes (T1D) is an autoimmune disease with a complex aetiology. B cells play an important role in the pathogenesis of T1D. Regulatory B cells (Bregs) are a subset of B cells that produce and secrete the inhibitory factor interleukin-10 (IL-10), thereby exerting an anti-inflammatory effect. It was recently discovered that T-cell immunoglobulin mucin domain 1 (Tim-1) is essential for maintaining Bregs function related to immune tolerance. However, the detailed understanding of Tim-1+ Bregs and IL-10+ Bregs in T1D patients is lacking. This study aimed to characterize the profile of B cell subsets in T1D patients compared with that in controls and determine whether Tim-1+ Bregs and IL-10+ Bregs play roles in T1D.Materials and MethodsA total of 47 patients with T1D, 30 patients with type 2 diabetes (T2D) and 24 healthy controls were recruited in this study. Flow cytometry was used to measure the levels of different B cell subsets (including B cells, plasmablasts, and Bregs) in the peripheral blood. Radiobinding assays were performed to detect the antibody titres of T1D patients. In addition, the correlations between different B cell subsets and patient parameters were investigated.ResultsCompared with healthy controls, differences in frequency of Tim-1+ Bregs were significantly decreased in patients with T1D (36.53 ± 6.51 vs. 42.25 ± 6.83, P=0.02*), and frequency of IL-10+ Bregs were lower than healthy controls (17.64 ± 7.21vs. 24.52 ± 11.69, P=0.009**), the frequency of total Bregs in PBMC was also decreased in patients with T1D (1.42 ± 0.53vs. 1.99 ± 0.93, P=0.002.**). We analyzed whether these alterations in B cells subsets were associated with clinical features. The frequencies of Tim-1+ Bregs and IL-10+ Bregs were negatively related to fasting blood glucose (FBG) (r=-0.25 and -0.22; P=0.01* and 0.03*, respectively). The frequencies of Tim-1+ Bregs and IL-10+ Bregs are positively correlated with fast C-peptide (FCP) (r=0.23 and 0.37; P=0.02* and 0.0001***, respectively). In addition, the frequency of IL-10+ Breg was also negatively related to glycosylated haemoglobin (HbA1c) (r=-0.20, P=0.04*). The frequencies of Tim-1+ Bregs, IL-10+ Bregs and Bregs in T2D patients were reduced, but no statistically significant difference was found between other groups. Interestingly, there was positive correlation between the frequencies of Tim-1+ Bregs and IL-10+ Bregs in T1D (r=0.37, P=0.01*). Of note, it is worth noting that our study did not observe any correlations between B cell subsets and autoantibody titres.ConclusionsOur study showed altered Tim-1 and IL-10 expression in regulatory B cell in T1D patients. Tim-1, as suggested by the present study, is associated with islet function and blood glucose levels. These findings indicate that Tim-1+ Bregs and IL-10+ Bregs were involved in the pathogenesis of T1D.

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A Web-Based Study of the Relationship of Duration of Insulin Pump Infusion Set Use and Fasting Blood Glucose Level in Adults with Type 1 Diabetes

Diabetes Technology & Therapeutics ◽

10.1089/dia.2014.0336 ◽

2015 ◽

Vol 17 (5) ◽

pp. 307-310 ◽

Cited By ~ 8

Author(s):

Alysa J. Sampson Perrin ◽

Russell C. Guzzetta ◽

Kellee M. Miller ◽

Nicole C. Foster ◽

Anna Lee ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Insulin Pump ◽

Fasting Blood Glucose ◽

Fasting Blood Glucose Level ◽

Web Based ◽

Relationship Of ◽

The Relationship ◽

Pump Infusion

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Effects of Continuous Subcutaneous Insulin Infusion on Glycaemic Control and Acute Complications in Young People with Type 1 Diabetes in Bangladesh

Dubai Diabetes and Endocrinology Journal ◽

10.1159/000511241 ◽

2020 ◽

pp. 1-6

Author(s):

Bedowra Zabeen ◽

Jebun Nahar ◽

Nasreen Islam ◽

Kishwar Azad ◽

Kim Donaghue

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Glycaemic Control ◽

Continuous Subcutaneous Insulin Infusion ◽

Insulin Infusion ◽

Insulin Pump ◽

Fasting Blood Glucose ◽

Subcutaneous Insulin ◽

Acute Complications

Objective: The objective of this study was to assess the effects of continuous subcutaneous insulin infusion (CSII) therapy on glycaemic control and acute complications in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). Methods: The prospective observational study was done in patients on multiple daily injection (MDI) switching to pump system. All patients were followed at the Paediatric Diabetes Clinic at BIRDEM Hospital. They were trained on carbohydrates counting and started on continuous basal insulin infusion in addition to meal and high blood glucose correction insulin boluses. They were followed on insulin pump therapy for a 6-month period. Results: Twenty patients were analysed, from baseline to visit 2 after 6 months. The patients included in the study had T1DM for a mean duration of 4.7 ± 3.1 years. The age ranged from 3 to 25 years (mean 13.7 ± 6.1). There was 1% reduction in haemoglobin A1c (HbA1c) after 6 months, though it did not reach the statistical significance (p = 0.084). There was significant reduction of mean fasting blood glucose level 13.4 ± 7.0 versus 6.9 ± 1.6 mmol/L (p = 0.001), total insulin requirement (p = 0.043), frequency of hypoglycaemic episodes (p = 0.006), and diabetic ketoacidosis (p = 0.002) events during CSII therapy. Conclusion: In our study, we found that switching young T1DM patients from MDI to insulin pump had been effective with achievement of a reduction in fasting blood glucose, HbA1c, and acute complications.

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Effects of Switching from Degludec to Glargine U300 in Patients with Type 1 Diabetes Having Large Day-to-Day Glycemic Variability: A Retrospective Study

10.21203/rs.3.rs-503447/v2 ◽

2021 ◽

Author(s):

Toshitaka Sawamura ◽

Shigehiro Karashima ◽

Azusa Ohbatake ◽

Takuya Higashitani ◽

Yuko Katsuda ◽

...

Keyword(s):

Type 1 Diabetes ◽

Retrospective Study ◽

Blood Glucose ◽

Serum Albumin ◽

Fasting Blood Glucose ◽

Glycemic Variability ◽

Nocturnal Hypoglycemia ◽

Insulin Dependent ◽

Dependent Type

Abstract Background: Degludec (Deg) and Glargine U300 (Gla-300) are new insulin analogues with longer and smoother pharmacodynamic action than Glargine U100. Both improve glycemic variability (GV) unlike Glargine U100. However, it is not clear which insulin analogue has a better effect on GV in insulin-dependent type 1 diabetes. We evaluated the effects of switching from Deg to Gla-300 on day-to-day GV in patients with insulin-dependent type 1 diabetes treated with Deg.Methods: We conducted a retrospective study on 22 insulin-dependent type 1 diabetes patients having large day-to-day GV or frequent hypoglycemia who were treated with multiple insulin injection therapy including Deg and were advised to switch from Deg to Gla-300. We evaluated day-to-day GV and frequency of hypoglycemia in two groups. The first group included patients whose treatment was changed to Gla-300, and the second group included patients who opted to continue receiving Deg. We evaluated the change in standard deviation (SD) of fasting blood glucose (SD-FBG) calculated from self-monitoring of blood glucose (SMBG) and frequency of hypoglycemia (total, severe, and nocturnal).Results: SD-FBG and frequency of nocturnal hypoglycemia decreased in Gla-300 group compared to those in Deg group. The change in SD-FBG had a negative correlation with SD-FBG and hemoglobin A1c (HbA1c) at baseline and positive correlation with serum albumin levels at baseline in Gla-300 group. On the other hands, the change in SD-FBG had no correlation with these markers in Deg group.Conclusions: Switching from Deg to Gla-300 effectively stabilized blood glucose levels and decreased nocturnal hypoglycemia in insulin-dependent type 1 diabetes treated with Deg, especially in cases with low serum albumin, large GV, and high HbA1c.

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Altered Regulatory B Cell Subsets in Children with Type 1 Diabetes Mellitus

Journal of Immunology Research ◽

10.1155/2020/8935694 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Mohamed A. El-Mokhtar ◽

Nahla M. Elsherbiny ◽

Douaa Sayed ◽

Duaa M. Raafat ◽

Eman Askar ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

B Cells ◽

B Cell ◽

Fasting Blood Glucose ◽

Interleukin 10 ◽

Peripheral Tolerance ◽

Regulatory B Cell ◽

B Cell Subsets

B regulatory cells (Breg) refer to characteristic subsets of B cells that generally exert anti-inflammatory functions and maintain peripheral tolerance mainly through their ability to secrete interleukin-10 (IL10). Dysregulation in the function of Breg cells was reported in several autoimmune diseases. However, the relation between Breg and children with type 1 diabetes (T1D) is poorly understood. Thus, this study is aimed at determining whether Breg cells play a role in T1D in children or not, so we hypothesized that an altered phenotype of B cell subsets is associated with T1D in children. Children with T1D (n=29) and control children with normal blood glucose levels (n=14) were recruited. The percentages of different circulating IL10-producing Breg subsets, including B10, immature transitional, and plasmablasts were determined using flow cytometry analysis. Furthermore, the association between different IL10-producing B cells and patient parameters was investigated. The percentage of circulating IL10+CD24hiCD27+ (B10) and IL10+CD24hiCD38hi (immature transitional) subsets of Breg cells was significantly lower in T1D patients than in healthy controls. Moreover, these cells were also negatively correlated with fasting blood glucose and HbA1c levels. Breg cells did not correlate with autoantibody levels in the serum. These findings suggest that certain Breg subsets are numerically deficient in children with T1D. This alteration in frequency is associated with deficient islet function and glycemia. These findings suggest that Breg cells may be involved in the loss of auto-tolerance and consequent destruction of pancreatic cells and could, therefore, be a potential target for immunotherapy.

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