scholarly journals Glycaemic variability in diabetes: a tool for assessing the quality of glycaemic control and the risk of complications

2014 ◽  
Vol 17 (2) ◽  
pp. 76-82 ◽  
Author(s):  
Vadim Valer'evich Klimontov ◽  
Natalya Evgen'evna Myakina
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Computational Methods ◽  
Temporal Structure ◽  
Vascular Complications ◽  
Vascular Lesions ◽  
Diabetic Patients ◽  
Glycaemic Variability ◽  
Hypoglycaemia Unawareness ◽  
Vascular Walls

The routine approach to evaluating the effectiveness of diabetes treatment based on the level of glycated haemoglobin (HbA. 1c) accounts for the average glucose level but does not consider the scope and frequency of its fluctuations. The development of computational methods to analyse glycaemic oscillations has made it possible to propose the concept of glycaemic variability (GV). The interest in research focused on GV increased dramatically after continuous glucose monitoring (CGM) technology was introduced, which provided the opportunity to study in detail the temporal structure of blood glucose curves. Numerous methods for assessing GV proposed over the past five decades characterize glycaemic fluctuations as functions of concentration and time and estimate the risks of hypoglycaemia and hyperglycaemia. Accumulating evidence indicates that GV may serve as a significant predictor of diabetic complications. Prospective studies demonstrate that certain GV parameters have independent significance for predicting diabetic retinopathy, nephropathy and cardiovascular diseases. There is evidence that GV correlates with the severity of atherosclerotic vascular lesions and cardiovascular outcomes in diabetic patients. The mechanisms underlying the relationship between GV and vascular complications are being intensively studied, and recent data show that the effect of GV on vascular walls may be mediated by oxidative stress, chronic inflammation and endothelial dysfunction. Average blood glucose levels and GV are considered independent predictors of hypoglycaemia. Increased GV is associated with impaired hormonal response to hypoglycaemia and is a long-term predictor of hypoglycaemia unawareness. These data allow us to conclude that computational methods for analysing GV in patients with diabetes may serve as a promising tool for personalized assessment of glycaemic control and the risk of vascular complications and hypoglycaemia. Thus, the reduction of GV can be regarded as one of the therapeutic targets to treat diabetes.

scholarly journals Sample of Aboriginal Australians, 2-hour post-load insulin concentrations are greatest between fasting plasma glucose values of 6.7-7.3 mmol/l

2018 ◽  
Vol 1 (2) ◽  
pp. 01-05
Author(s):  
Paul Aveyard
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Routine Care ◽  
Systematic Sampling ◽  
Control Group ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Good Glycaemic Control ◽  
Blood Glucose Levels ◽  
The Impact

Background: Prevention of diabetic complications requires good glycaemic control. This study aimed to provide type 2 diabetes patients with remote active care and glycaemic control through the use of videophone technology without the need for them to attend hospital. The literature recommends additional research to study the impact of technical innovations on improved disease self-management and medical outcome. This is the only study to be conducted in Turkey concerning patient monitoring using videophone technology. The aim of the study was to establish the effectiveness of the use of videophone technology in the glycaemic control of patients with diabetes living in remote areas. Methods: This is a prospective, randomized control study using the systematic sampling method (using half ratio), in which 24 patients were chosen for the Experimental Group (EG) and another 24 for the Control Group (CG). All of the patients agreed to participate in the study. Patients in the CG received routine care, while the glycaemic control and consultations for patients in the EG were conducted using videophone technology. The patients were monitored by videophone for a total of 6 months. The HbA1c and blood glucose values recorded over the 6 month monitoring period were analyzed to determine the effectiveness of using a videophone. Results: The mean age of the individuals in the EG was 54.41 ± 8.54 years (Min=43 Max=78) and in the CG it was 57.25 ± 9.61 (Min=40 Max=77). In both groups, 50% of the individuals were men and 50% were women. When the two groups were compared, it was was found that the preprandial blood glucose levels of the diabetic patients in the EG (mean 159.48 ± 40.71mg/dl) were lower by 13.55 ± 52.89 mg / dl than the preprandial blood glucose levels of the diabetic patients in the CG (mean 173.03 ± 65.07 mg/dl). It was determined at the end of the six-month monitoring that the A1c levels of the individuals in the EG were significinatly lowered by 0.49% in total, and that the A1c levels of the individuals in the CG were higher by 0.17 % in total. Conclusions: It was shown that videophone technology can be useful in the glycaemic control of diabetic patients in Turkey.

scholarly journals Different antihyperglycaemic drug effects on glycaemic variability in Type 2 diabetic patients

2014 ◽  
Vol 17 (4) ◽  
pp. 72-80 ◽  
Author(s):  
Alina Babenko ◽  
Elena Ivanovna Krasilnikova ◽  
Nikolay Pavlovich Likhonosov ◽  
Anna Pavlovna Likhonosova ◽  
Elena Nikolaevna Grineva
Keyword(s):  
Treatment Strategies ◽  
Vascular Complications ◽  
Drug Effects ◽  
Glycated Haemoglobin ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Glycaemic Variability ◽  
Beneficial Effects

Optimizing treatments for type 2 diabetes mellitus (T2DM) remains an urgent issue. In addition to T2DM treatment strategies, such as glycaemic goals (glucose and glycated haemoglobin ? HbА1c) among different patient populations, the influence of glycaemic variability (GV) on the prognosis of patients with T2DM is also important. According to recent data, GV is associated with cardiovascular complications arising from T2DM. However, although the influence of GV on the development of vascular complications arising from diabetes and underlying mechanisms has been extensively investigated, few studies have investigated the effects of different glucose-lowering medications on GV, and there are even fewer reviews of this topic. This type of analysis is highly relevant, particularly because new classes of antidiabetic medications with potent glucose-dependent insulinotropic effects have been developed. These include groups of drugs that mimic or enhance incretin activity, such as glucagon-like peptide (GLP)-1 analogues/mimetics and dipeptidyl peptidase (DPP)-4 inhibitors. A glucose-dependent mechanism suggests that these groups of antidiabetic medications have beneficial effects on GV. Thus, the current study focusses on the comparative analysis of drugs based on their incretin effects (GLP-1 analogues/mimetics and DPP-4 inhibitors) and оther antidiabetic medications with regard to GV in the patients with T2DM.

Circulating Platelet-Leukocyte Aggregates as a Marker of Microvascular Lesions in Diabetic Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3965-3965
Author(s):  
Ismail Elalamy ◽  
Tahar Chakroun ◽  
Francoise Robert ◽  
Chantal Lecrubier ◽  
Fabienne Elgrably ◽  
...  
Keyword(s):  
Type Ii Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Inflammatory Cells ◽  
Vascular Lesions ◽  
Diabetic Patients ◽  
Type I ◽  
Flow Cytometry Assay ◽  
Thrombotic Diseases ◽  
Circulating Levels

Abstract Introduction: Evolution of diabetes is associated with multiple disorders including metabolic, cellular and blood disturbances leading to various vascular complications (micro-and macro-angiopathies). Increased circulating levels of platelet-leukocyte aggregates (PLA) have been described in several thrombotic diseases. Material and Methods: In this study, we have evaluated the circulating PLA in diabetic patients and we have investigated whether they may be linked to the vascular complications currently occurring during diabetes evolution. Using flow cytometry assay, we have quantified PLA percentages in 65 diabetics (37 males/28 females, 57 ± 11 years old) including 20 patients with type I and 45 with type II diabetes, and 25 healthy subjects (15 males/10 females, 44 ± 9 years old). Labelling approach using specific monoclonal antibodies permitted us to identify platelet-polymorphonuclear aggregates (PPA) and platelet-monocyte aggregates (PMA). Results: We have observed a significant increase of PPA and PMA levels in diabetics (22 ± 12% and 45 ± 18%, respectively) compared to control subjects (7 ± 4% and 19 ± 10%, respectively). However, both PPA and PMA values were similar in the two types of diabetes and they were not correlated to the disease duration. Circulating PPA and PMA percentages were significantly enhanced in diabetics with vascular lesions (n=37; PPA: 24 ± 13%; PMA: 50 ± 18%) than in diabetics without vascular lesions (n=28; PPA: 18 ± 8%; PMA: 38 ± 15%). Patients with PPA > 18% and /or PMA > 38% had a more important vascular thrombotic damage (OR: 6; 95%; IC: 1.6; 23). The increased PMA circulating percentage seems to be more specific for micro-retinopathy occurrence (OR: 19, 95% IC: 2.3; 154). The rare patients with elevated PMA percentage and without vascular lesions have a shorter duration of diabetes (7 ± 5 years) than patients presenting retinopathy lesions (16 ± 11 years). Conclusion: Together our findings established a relationship between increased circulating PLA rate, particularly that of PMA, and the incidence of microvascular complications in diabetic patients. In addition, they reinforce the concept that pro-inflammatory cells are involved in diabetic retinopathy pathogenesis.

Hormonal Control of Haemostasis During Hypoglycaemia in Diabetes Mellitus

1987 ◽  
Vol 57 (03) ◽  
pp. 341-344 ◽  
Author(s):  
P J Grant ◽  
M H Stickland ◽  
P G Wiles ◽  
J A Davies ◽  
J K Wales ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Plasma Insulin ◽  
Vascular Complications ◽  
Hormonal Control ◽  
Diabetic Patients ◽  
Coagulant Activity ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic ◽  
Von Willebrand ◽  
Willebrand Factor

SummaryFactor VIII (FVIII) and plasminogen activator activity (PAA) rise during hypoglycaemia, and this might contribute to the vascular complications of diabetes. Similar changes in haemostasis accompany raised plasma levels of vasopressin (aVP) and adrenaline. To investigate the effects of these hormones on haemostasis during hypoglycaemia and the role of plasma insulin concentrations, eight insulin-dependent diabetic patients underwent controlled hypoglycaemia for 20 min and 13 diabetic patients were investigated during hyperinsulinaemia with blood glucose maintained at 8.0 mmol/1. During hypoglycaemia, insulin levels increased to median values of 114 mU/1, aVP rose from 0.5 to 4.4 (p <0.005) pg/ml and adrenaline from 0.4 to 4.4 nmol/l (p <0.005). FVIII coagulant activity (FVIII :C) rose from 0.75 to 1.09 iU/ml (p <0.01) and the ristocetin co-factor (FVIIIR:Co) and von Willebrand factor antigen (vWF:Ag) showed similar responses. PAA increased from 156 to 745 units (p <0.005). During hyperinsulinaemia, insulin rose following infusion from 24 to 52 and 118 mU/l, maintained for an hour at each level. Despite this, plasma aVP, FVIII :C, FVIIIR:Co, vWF:Ag and PAA remained unchanged. This study indicates that the marked changes in FVIII, vWF and PAA concentrations which accompany hypoglycaemia depend on low blood glucose and not raised plasma insulin. The response in probably mediated by increases in adrenaline and aVP, which are part of the physiological response to hypoglycaemia.

scholarly journals 3D kernel-density stochastic model for more personalized glycaemic control: development and in-silico validation

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Vincent Uyttendaele ◽  
Jennifer L. Knopp ◽  
Shaun Davidson ◽  
Thomas Desaive ◽  
Balazs Benyo ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Insulin Sensitivity ◽  
Glycaemic Control ◽  
Stochastic Model ◽  
Kernel Density ◽  
Estimation Methods ◽  
Effective Control ◽  
Patient Specific ◽  
Glycaemic Variability ◽  
Glucose Levels

Abstract Background The challenges of glycaemic control in critically ill patients have been debated for 20 years. While glycaemic control shows benefits inter- and intra-patient metabolic variability results in increased hypoglycaemia and glycaemic variability, both increasing morbidity and mortality. Hence, current recommendations for glycaemic control target higher glycaemic ranges, guided by the fear of harm. Lately, studies have proven the ability to provide safe, effective control for lower, normoglycaemic, ranges, using model-based computerised methods. Such methods usually identify patient-specific physiological parameters to personalize titration of insulin and/or nutrition. The Stochastic-Targeted (STAR) glycaemic control framework uses patient-specific insulin sensitivity and a stochastic model of its future variability to directly account for both inter- and intra-patient variability in a risk-based insulin-dosing approach. Results In this study, a more personalized and specific 3D version of the stochastic model used in STAR is compared to the current 2D stochastic model, both built using kernel-density estimation methods. Fivefold cross validation on 681 retrospective patient glycaemic control episodes, totalling over 65,000 h of control, is used to determine whether the 3D model better captures metabolic variability, and the potential gain in glycaemic outcome is assessed using validated virtual trials. Results show that the 3D stochastic model has similar forward predictive power, but provides significantly tighter, more patient-specific, prediction ranges, showing the 2D model over-conservative > 70% of the time. Virtual trial results show that overall glycaemic safety and performance are similar, but the 3D stochastic model reduced median blood glucose levels (6.3 [5.7, 7.0] vs. 6.2 [5.6, 6.9]) with a higher 61% vs. 56% of blood glucose within the 4.4–6.5 mmol/L range. Conclusions This improved performance is achieved with higher insulin rates and higher carbohydrate intake, but no loss in safety from hypoglycaemia. Thus, the 3D stochastic model developed better characterises patient-specific future insulin sensitivity dynamics, resulting in improved simulated glycaemic outcomes and a greater level of personalization in control. The results justify inclusion into ongoing clinical use of STAR.

scholarly journals Glycaemic Control and Associated Self-Management Behaviours in Diabetic Outpatients: A Hospital Based Observation Study in Lusaka, Zambia

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Emmanuel Mwila Musenge ◽  
Charles Michelo ◽  
Boyd Mudenda ◽  
Alexey Manankov
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Self Management ◽  
Diabetic Patients ◽  
Observation Study ◽  
Poor Glycaemic Control ◽  
Community Factors ◽  
Antidiabetic Treatment

Background. The control ofdiabetes mellitusdepends on several factors that also include individual lifestyles. We assessed glycaemic control status and self-management behaviours that may influence glycaemic control among diabetic outpatients.Methods. This cross-sectional study among 198 consenting randomly selected patients was conducted at the University Teaching Hospital diabetic clinic between September and December 2013 in Lusaka, Zambia. A structured interview schedule was used to collect data on demographic characteristics, self-management behaviours, and laboratory measurements. Binary logistic regression analysis using IBM SPSS for Windows version 20.0 was carried out to predict behaviours that were associated with glycaemic control status.Results. The proportion of patients that had good glycaemic control status (HbA1c≤48 mmol/mol) was 38.7% compared to 61.3% that had poor glycaemic control status (HbA1c≥49 mmol/mol). Adherence to antidiabetic treatment and fasting plasma glucose predicted glycaemic control status of the patients. However, self-blood glucose monitoring, self-blood glucose monitoring means and exercise did not predict glycaemic control status of the patients.  Conclusion. We find evidence of poor glycaemic control status among most diabetic patients suggesting that health promotion messages need to take into account both individual and community factors to promote behaviours likely to reduce nonadherence.

scholarly journals Level of physical activity, determinants and barriers to motivate physical activities among south Indian diabetic patients: a prospective, questionnaire based study

2019 ◽  
Vol 7 (6) ◽  
pp. 2100
Author(s):  
Kamal Lochan Behera ◽  
K. N. S. V. Chalapathi Rao ◽  
Suresh Babu Sayana ◽  
D. S. S. K. Raju
Keyword(s):  
Physical Activity ◽  
Glycaemic Control ◽  
Lifestyle Modification ◽  
Demographic Data ◽  
Tertiary Care ◽  
Vascular Complications ◽  
General Medicine ◽  
Diabetic Patients ◽  
Entire Study ◽  
South Indian

Background: Several clinical trials have been reported that sedentary lifestyle modification including physical activity (PA) and weight loss significantly alters the sort-term as well as long-term incidence of diabetes. The present study explored the level of physical activity and its barriers among south Indian naïve patients who are attending the tertiary care teaching hospital.Methods: A prospective observational, questionnaire-based study. Patients with diabetes (both Type-1 and 2) who were attended diabetic clinic in the Department of General Medicine, Maharaja Institute of Medical Sciences (MIMS), Vijayanagaram, Andhra Pradesh, India was selected and recruited. Demographic data, clinical data were collected from the study participants. International Physical Activity questionnaire was used to determine each patient level of physical activity (PA). Physical activity is graded into low (<600 metabolic equivalent (MET)), moderate (600-3000 MET) and high (>3000 MET).Results: A total of 300 subjects were completed the entire study. Majority (62.7%) of the patients were suffering from Type-2 diabetes mellitus. Both male and female study subjects had low physical activity (70.5% and 74.1%) and moderate PA was seen in only one thirds of the patients. Patients with low physical activity had low glycaemic control compared to patients who were involved in moderate PA. Moderate PA patients had adequate glycaemic control (65.9 vs 34.1%, P <0.001). A total of 42.0% of subjects were suffering from one of the joint pains and friction joints, due to the following reason subjects were not involved in the PA.Conclusions: Low level of physical activity was observed in the study population, which is a risk factor for several micro-vascular complications over a period of time. It is very important to address the barriers of PA and vigorous counselling is needed which directs towards increasing PA.

Sign in / Sign up

Export Citation Format

Share Document