901-P: Effects of Dapagliflozin, Metformin, or Exercise on Glycaemic Variability and Mean Glucose Levels in Prediabetes: The PRE-D Trial

✓ Plasma glucose levels were studied in 616 patients admitted within 72 hours after subarachnoid hemorrhage (SAH). Glucose levels measured at admission showed a statistically significant association with Glasgow Coma Scale scores, Botterell grade, deposition of blood on computerized tomography (CT) scans, and level of consciousness at admission. Elevated glucose levels at admission predicted poor outcome. A good recovery, as assessed by the Glasgow Outcome Scale at 3 months, occurred in 70.2% of patients with normal glucose levels (≤ 120 mg/dl) and in 53.7% of patients with hyperglycemia (> 120 mg/dl) (p = 0.002). The death rates for these two groups were 6.7% and 19.9%, respectively (p = 0.001). The association was still maintained after adjusting for age (> or ≤ 50 years) and thickness of clot on CT scans (thin or thick) in the subset of patients who were alert/drowsy at admission. Increased mean glucose levels between Days 3 and 7 also predicted a worse outcome; good recovery was observed in 132 (73.7%) of 179 patients who had normal mean glucose levels (≤ 120 mg/dl) and 160 (49.7%) of 322 who had elevated mean glucose levels (> 120 mg/dl) (p < 0.0001). Death occurred in 6.7% and 20.8% of the two groups, respectively (p < 0.0001). It is concluded that admission plasma glucose levels can serve as an objective prognostic indicator after SAH. Elevated glucose levels during the 1st week after SAH also predict a poor outcome. However, a causal link between hyperglycemia and outcome after delayed cerebral ischemia, although suggested by experimental data, cannot be established on the basis of this study.

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Metabolic and lifestyle determinants of glycemic variability in persons at high risk of type 2 diabetes: a study with continuous monitoring of diet, physical activity, and glucose level. (Preprint)

10.2196/preprints.30105 ◽

2021 ◽

Author(s):

Su Hyun Park ◽

Jiali Yao ◽

Clare Whitton ◽

Xin Hui Chua ◽

Suresh Rama Chandran ◽

...

Keyword(s):

Physical Activity ◽

High Risk ◽

Glycemic Variability ◽

Tolerance Test ◽

Glucose Levels ◽

Intensity Physical Activity ◽

Time In Range ◽

Vigorous Intensity ◽

Mean Glucose

BACKGROUND Frequent and large fluctuations in blood glucose concentration during the day may increase risk of type 2 diabetes. It remains unclear how diet and physical activity affect glycemic variability in real-world conditions in persons without diabetes. OBJECTIVE We examined metabolic and lifestyle determinants (diet, physical activity, and sleep) of blood glucose levels over a seven-day period in people at high risk for diabetes METHODS Twenty-eight participants with a mean age of 46.0 (SD 9.9) years and a mean body mass index (BMI) of 27.5 (SD 1.8) kg/m2 underwent a mixed meal tolerance test to assess glucose homeostasis at baseline. Subsequently, they wore an accelerometer to assess movement behaviors, recorded their dietary intakes through a mobile phone application, and wore a flash glucose monitoring device that measured glucose levels every 15 min for seven days. Generalized estimating equation models were used to assess the associations of metabolic and lifestyle risk factors with daily mean glucose levels (mmol/L), the coefficient of variation (CV%) of glucose levels, and time-in-range (3.0 to 7.8 mmol/L, %). RESULTS A higher BMI (β = 0.12 per kg/m2; P = 0.01), body fat (β = 0.03 per kg; P = 0.01), and selected markers of hyperglycemia and insulin resistance from the meal tolerance test were associated with higher mean glucose levels during the seven days. Moderate-to-vigorous intensity physical activity (β = -1.77 per hr./d, P = 0.008) and polyunsaturated fat intake (β = -2.23 per 5 energy %, P < 0.001) were independently associated with less variation in glucose levels (CV%). Higher protein (β = 0.90, P = 0.007) and polyunsaturated fatty acid (β = 3.21, P = 0.02) intakes were associated with more time-in-range. In contrast, higher carbohydrates intake was associated with less time-in-range (β = -0.59, P = 0.04). Sleep, sedentary behavior, or light intensity physical activity were not independently associated with glucose measures. CONCLUSIONS Body fatness was associated with higher mean glucose levels, and moderate-to-vigorous intensity physical activity was associated with less glycemic variability throughout a week. Diets with higher protein and polyunsaturated fat, and lower carbohydrates were associated with more time in normal glucose range. Physical activity and dietary composition can substantially influence glucose variation in people at high risk of diabetes.

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Glucose levels in normal and mastitic milk

Journal of Dairy Research ◽

10.1017/s0022029900023499 ◽

1984 ◽

Vol 51 (2) ◽

pp. 233-237 ◽

Cited By ~ 8

Author(s):

Ronald J. Marschke ◽

Barry J. Kitchen

Keyword(s):

Somatic Cell ◽

Cell Count ◽

Diagnostic Test ◽

Standard Error ◽

Somatic Cell Count ◽

Glucose Content ◽

Glucose Levels ◽

Lower Glucose ◽

Mastitic Milk ◽

Mean Glucose

SummaryGlucose levels in 188 quarter fore milks from different cows were determined by an enzymic procedure. Mean glucose content was 0·22 mM (standard error ±0·009) and results ranged from 0·02–0·57 mM. Abnormal quarters had lower glucose levels (P < 0·01) than normal quarters but variability within each classification was large. Glucose content was negatively correlated with both somatic cell count (r = –0·49) and N-acetyl-²-D-glucosaminidase level (r = –0·61). Milk glucose was considered to be of limited value as a diagnostic test for mastitis.

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Glycaemic variability affects ischaemia-induced angiogenesis in diabetic mice

Clinical Science ◽

10.1042/cs20110043 ◽

2011 ◽

Vol 121 (12) ◽

pp. 555-564 ◽

Cited By ~ 13

Author(s):

Federico Biscetti ◽

Dario Pitocco ◽

Giuseppe Straface ◽

Francesco Zaccardi ◽

Raimondo de Cristofaro ◽

...

Keyword(s):

Murine Model ◽

Basal Insulin ◽

Vascular Complications ◽

Diabetic Mice ◽

Glycaemic Variability ◽

Ischaemic Injury ◽

Once Daily ◽

Glucose Levels ◽

Diabetic Vascular Complications ◽

Significant Difference

The aim of the present study was to investigate the role of GV (glycaemic variability) in diabetic vascular complications and to explore the molecular pathways modulated by glycaemic ‘swings’. We developed a murine model. A total of 30 diabetic mice received once daily basal insulin administration plus two oral boluses of glucose solution (GV group, named ‘V’) and 30 diabetic mice received once daily basal insulin plus two oral boluses of saline solution (stable hyperglycaemia group, named ‘S’) for a period of 30 days. Glycaemia was measured eight times daily to detect GV. Finally, postischaemic vascularization, induced by hindlimb ischaemia 30 days after diabetes onset, was evaluated. We found that GV was significantly different between S and V groups, whereas no significant difference in the mean glycaemic values was detected. Laser Doppler perfusion imaging and histological analyses revealed that the ischaemia-induced angiogenesis was significantly impaired in V mice compared with S group, after ischaemic injury. In addition, immunostaining and Western blot analyses revealed that impaired angiogenic response in V mice occurred in association with reduced VEGF (vascular endothelial growth factor) production and decreased eNOS (endothelial nitric oxide synthase) and Akt (also called protein kinase B) phosphorylation. In conclusion, we describe a murine model of GV. GV causes an impairment of ischaemia-induced angiogenesis in diabetes, likely to be independent of changes in average blood glucose levels, and this impaired collateral vessel formation is associated with an alteration of the VEGF pathway.

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The Association Between HbA1c and Time in Hypoglycemia During CGM and Self-Monitoring of Blood Glucose in People With Type 1 Diabetes and Multiple Daily Insulin Injections: A Randomized Clinical Trial (GOLD-4)

10.2337/figshare.12357506.v2 ◽

2020 ◽

Author(s):

Shilan Seyed Ahmadi ◽

Klara Westman ◽

Aldina Pivodic ◽

Arndís F Ólafsdóttir ◽

Sofia Dahlqvist ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Conventional Therapy ◽

Self Monitoring ◽

Glucose Levels ◽

Daily Insulin ◽

Multiple Daily Insulin Injections ◽

Mean Glucose ◽

Hba1c Levels

Objective: According to recent guidelines, individuals with type 1 diabetes should spend less than 4.0% per day with glucose levels <3.9 mmol/L (<70 mg/dL) and less than 1.0% per day <3.0 mmol/L (<54 mg/dL). Research methods: In the GOLD randomised cross-over trial, 161 individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) were randomised to Continuous Glucose Monitoring (CGM) or conventional therapy with self-monitoring of blood glucose (SMBG) and evaluated over 16 months. We estimated the association between time spent in hypoglycaemia and various mean glucose and HbA1c levels. Results: Time spent in hypoglycaemia (<3.9 mmol/L and <3.0 mmol/L) increased significantly with lower mean HbA1c and mean glucose levels during both CGM and conventional therapy. During CGM, 24 (57.1%) individuals with HbA1c <7.5 % (<58 mmol/mol) had <1.0% time spent in hypoglycaemia <3.0 mmol/L and 23 (54.8%) had <4.0% time spent in hypoglycaemia <3.9 mmol/L. During CGM, mean time spent in hypoglycaemia for individuals with mean HbA1c 7.0% (52 mmol/mol) was estimated to be 5.4% for <3.9 mmol/L and 1.5% for <3.0 mmol/L. The corresponding values during SMBG were 9.2% and 3.5%, respectively. Individuals with mean glucose levels of 8 mmol/L spent 4.9% more time with glucose levels <3.9 mmol/L and 2.8% more time <3.0 mmol/L during SMBG compared with CGM. Conclusions: Reaching current targets for time in hypoglycaemia and at the same time HbA1c targets is challenging for type 1 diabetes patients treated with MDI both with CGM and SMBG monitoring. However, CGM is associated with considerably less time in hypoglycaemia than SMBG at a broad range of HbA1c levels and is crucial for patients with MDI treatment to have a chance to approach hypoglycaemia targets.

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The Association Between HbA1c and Time in Hypoglycemia During CGM and Self-Monitoring of Blood Glucose in People With Type 1 Diabetes and Multiple Daily Insulin Injections: A Randomized Clinical Trial (GOLD-4)

10.2337/figshare.12357506 ◽

2020 ◽

Author(s):

Shilan Seyed Ahmadi ◽

Klara Westman ◽

Aldina Pivodic ◽

Arndís F Ólafsdóttir ◽

Sofia Dahlqvist ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Conventional Therapy ◽

Self Monitoring ◽

Glucose Levels ◽

Daily Insulin ◽

Multiple Daily Insulin Injections ◽

Mean Glucose ◽

Hba1c Levels

Objective: According to recent guidelines, individuals with type 1 diabetes should spend less than 4.0% per day with glucose levels <3.9 mmol/L (<70 mg/dL) and less than 1.0% per day <3.0 mmol/L (<54 mg/dL). Research methods: In the GOLD randomised cross-over trial, 161 individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) were randomised to Continuous Glucose Monitoring (CGM) or conventional therapy with self-monitoring of blood glucose (SMBG) and evaluated over 16 months. We estimated the association between time spent in hypoglycaemia and various mean glucose and HbA1c levels. Results: Time spent in hypoglycaemia (<3.9 mmol/L and <3.0 mmol/L) increased significantly with lower mean HbA1c and mean glucose levels during both CGM and conventional therapy. During CGM, 24 (57.1%) individuals with HbA1c <7.5 % (<58 mmol/mol) had <1.0% time spent in hypoglycaemia <3.0 mmol/L and 23 (54.8%) had <4.0% time spent in hypoglycaemia <3.9 mmol/L. During CGM, mean time spent in hypoglycaemia for individuals with mean HbA1c 7.0% (52 mmol/mol) was estimated to be 5.4% for <3.9 mmol/L and 1.5% for <3.0 mmol/L. The corresponding values during SMBG were 9.2% and 3.5%, respectively. Individuals with mean glucose levels of 8 mmol/L spent 4.9% more time with glucose levels <3.9 mmol/L and 2.8% more time <3.0 mmol/L during SMBG compared with CGM. Conclusions: Reaching current targets for time in hypoglycaemia and at the same time HbA1c targets is challenging for type 1 diabetes patients treated with MDI both with CGM and SMBG monitoring. However, CGM is associated with considerably less time in hypoglycaemia than SMBG at a broad range of HbA1c levels and is crucial for patients with MDI treatment to have a chance to approach hypoglycaemia targets.

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PEG-rhG-CSF Use Reduces Glucose Level Significantly in Cancer Patients Receiving Chemotherapy

Proceedings of Anticancer Research ◽

10.26689/par.v4i6.1680 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

Shasha Cui ◽

Xinqiang Liu ◽

Dayan Zhang ◽

Lu Zhang ◽

Ying Wang

Keyword(s):

Cancer Patients ◽

Cancer Chemotherapy ◽

Side Effect ◽

Fasting Blood Glucose ◽

Time Interval ◽

Glucose Levels ◽

Significant Difference ◽

Anti Cancer ◽

Chemotherapy Induced Neutropenia ◽

Mean Glucose

Background: In patients receiving anti-cancer chemotherapy, polyethylene glycolated recombinant human granulocyte-colony stimulating factor (PEG-rhG-CSF) was used for prophylaxis of chemotherapy-induced neutropenia. However, the side effect of PEG-rhG-CSF use on fasting blood glucose (FBG) level remains unclear. Materials and Methods: Cancer patients receiving chemotherapy and PEG-rhG-CSF were enrolled in our study. Baseline glucose (Glucose 1) was measured before PEG-rhG-CSF use, a second FBG test (Glucose 2) was performed after PEG-rhG-CSF use. Mean glucose levels were compared using t test. Results: The time interval between PEG-rhG-CSF use and the second glucose test was 2.4±1.5 days. The mean Glucose 1 was 5.18±0.53 mmol/L, and Glucose 2 was 3.80±1.13 mmol/L. Statistical analysis showed a significant difference between Glucose 1 and 2 existed (P<0.001). Conclusion: Our study identifies a hypoglycemic side effect of PEG-rhG-CSF occurs in cancer patients undergoing anti-cancer chemotherapy. Our results highlight the caution required when using PEG-rhG-CSF for prophylaxis of chemotherapy-induced neutropenia.

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Insulin and oral anti-hyperglycaemic agents in critical illness

10.1093/med/9780199600830.003.0050 ◽

2016 ◽

Author(s):

Roosmarijn T. M. van Hooijdonk ◽

Marcus J. Schultz

Keyword(s):

Blood Glucose ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Insulin Infusion ◽

Venous Catheter ◽

Glycaemic Variability ◽

Mortality And Morbidity ◽

Glucose Levels ◽

Measuring Devices

Dysglycaemia is frequently seen in the intensive care unit (ICU). Hyperglycaemia, hypoglycaemia and glycaemic variability are all independently associated with mortality and morbidity in critically-ill patients. It is common practice to treat hypergycaemia in these patients, while at the same time preventing hypoglycaemia and glycaemic variability. Insulin infusion is preferred over oral anti–hyperglycaemic agents for glucose control in the ICU because of the highly unpredictable biological availability of oral anti-hyperglycaemic agents during critical illness. Many oral anti–hyperglycaemic agents are relatively contraindicated in critically-ill patients. Intravenously-administered insulin has a predictable effect on blood glucose levels, in particular because of its short half-life. Notably, effective and safe insulin titration requires frequent blood glucose measurements, a dedicated lumen of a central venous catheter for infusion of insulin, an accurate syringe pump, and trained nurses for delicate adoptions of the infusion rate. Insulin infusion increases the risk of hypoglycaemia, which should be prevented at all times. In addition, precautions should be taken against overcorrection of hypoglycaemia, using only small amounts of glucose. Whether glycaemic variability can be kept minimal is uncertain. Use of continuous glucose measuring devices has the potential to improve glycaemic control in critically-ill patients.

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Differences in glucose level between right arm and left arm using continuous glucose monitors

Digital Health ◽

10.1177/2055207620970342 ◽

2020 ◽

Vol 6 ◽

pp. 205520762097034

Author(s):

Nicole Kim ◽

Kevin Pham ◽

Allen Shek ◽

Jeremy Lim ◽

Xiaohan Liu ◽

...

Keyword(s):

Glucose Level ◽

Skin Irritation ◽

Glucose Monitoring ◽

Target Range ◽

Glucose Levels ◽

Significant Difference ◽

Freestyle Libre ◽

The Right ◽

Mean Glucose ◽

Time In Target Range

Background Continuous glucose monitoring (CGM) measures interstitial glucose levels through a sensor with a thin filament inserted under the skin. It is customary for patients to rotate sensor application sites between arms to minimize skin irritation. However, there is limited data regarding the degree of inter-arm differences with CGM technology. Methods Self-proclaimed right-handed (n = 5) and left-handed (n = 5) participants, regardless of concurrent comorbidities, were enrolled for CGM. Participants wore a FreeStyle Libre Pro sensor on each arm for a maximum of 14 days. Muscle mass and body fat analysis was conducted using a multi-frequency segmental body composition analyzer. Glucose levels from both arms were time-matched with the first 12 hours eliminated from analysis. Mean glucose and time in target range were compared between readings from the right and left arm. Results A total of 9830 paired glucose levels were included for analysis. In all participants (n = 10), mean glucose on the right arm was 89.1 mg/dL (SD, 19.9) and 85.3 mg/dL (SD, 19.3) on the left arm (P < 0.001). Glucose was out of target range (70-180 mg/dL) for 12.7% of the time in the right arm compared to 18.5% in the left arm (P < 0.001). Conclusions In a group of 10 nondiabetic and diabetic adults, there was a statistically significant difference in CGM readings between the right and left arms. Time in target range may differ based on arm selection when using a CGM. Arm dominance did not explain the inter-arm glucose level discordance.

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Assessment of the “Second Day” Exercise Effect on Glycemic Control, Insulin Requirements, and CHO Intake in Type 1 Diabetes Adults

Journal of Diabetes Science and Technology ◽

10.1177/1932296819879419 ◽

2019 ◽

Vol 15 (1) ◽

pp. 127-133 ◽

Cited By ~ 1

Author(s):

Michael Müller-Korbsch ◽

Lisa Frühwald ◽

Michael Heer ◽

Maria Fangmeyer-Binder ◽

David Reinhart-Mikocki ◽

...

Keyword(s):

Type 1 Diabetes ◽

Aerobic Exercise ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Target Range ◽

Pump Therapy ◽

Glucose Levels ◽

Insulin Requirements ◽

Mean Glucose

Background: Glucose control during consecutive days of aerobic exercise has not been well studied. We assessed glycemia, insulin requirements, and carbohydrate (CHO) needs during two consecutive days of prolonged cycling in type 1 diabetes (T1D) adults using sensor-augmented insulin pump therapy. Methods: Twenty adults with well-controlled T1D and six healthy adults (for comparison) were enrolled. Assessments were made during two consecutive days of cycling activities (30 miles per day). On day 1 (D1), basal rates were reduced 50% and CHO intake was guided by real-time continuous glucose monitoring (rtCGM) data to maintain a target range (70-180 mg/dL). On day 2 (D2), basal insulin infusion was stopped for the first hour of biking and resumed at a minimal rate during biking. Carbohydrate intake one hour before, during, and ten minutes after biking was recorded. Times within/below target range, glycemic variability, and mean glucose were calculated from rtCGM data. Results: Among 17 T1D participants who completed the study, mean glucose levels at the start of cycling were slightly lower on D2 vs D1: 138 ± 16 mg/dL and 122 ± 16, respectively, P = NS. Type 1 diabetes participants achieved near-normal glucose levels at the end of both cycling events; however, the reduction in glucose was most notable at one hour into the event on D2 vs D1. Carbohydrate intake was notably lower during D2 vs D1 with no difference in time <54 mg/dL (both P = NS). Conclusions: Type 1 diabetes individuals using rtCGM-augmented insulin pump therapy can safely engage in consecutive days of prolonged aerobic exercise by significantly reducing insulin dosages with no increase in CHO intake.

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