scholarly journals The Effects of Glucagon and Insulin Combination toward on Neurodegeneration Following Traumatic Brain Injury in Rat Model

2021 ◽  
Vol 9 (A) ◽  
pp. 982-987
Author(s):  
Akhmad Imron ◽  
Bethy Hernowo ◽  
Dany Hilmanto ◽  
Kahdar Wiriadisastra ◽  
Yulius Hermanto
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Lower Number ◽  
Secondary Brain Injury ◽  
Neuronal Necrosis ◽  
High Blood Glucose ◽  
Glucagon And Insulin

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability in the productive age. Glutamate excitotoxicity and hyperglycemia those occur following TBI are among the factors those influence secondary brain injury. AIM: This study aimed to determine the effect of glucagon and insulin combination on neuronal necrosis following TBI. METHODS: A total of 28 male wistar rats were randomized into four experimental groups: placebo, insulin, glucagon, and combination of glucagon and insulin. Each animal underwent controlled cortical impact model of TBI. The blood glucose and glutamate levels were measured before and 4 h following TBI. The brain tissues were collected to evaluate neuronal necrosis. RESULTS: Glucagon or glucagon and insulin combination were able to prevent the increased of blood glutamate levels following TBI (p < 0.05). Glucagon administration was associated high blood glucose level (198.10 ± 32.58 mg/dL); a combination with insulin was able to minimize the increased of blood glucose level (166.53 ± 18.48 mg/dL). Combination of glucagon and insulin had a lower number of neuronal necrosis compare to the other groups (p < 0.005). CONCLUSION: The combination of glucagon and insulin potentially exhibit neuroprotection effect on rats following TBI as being demonstrated by lower number of neuronal necrosis. This finding further indicates the role of glucose homeostasis in neuroprotection.

scholarly journals Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Tao Yuan ◽  
Hongyu He ◽  
Yuepeng Liu ◽  
Jianwei Wang ◽  
Xin Kang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Threshold Effect ◽  
Glasgow Outcome Score ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Average Blood Glucose

Abstract Background Blood glucose levels that are too high or too low after traumatic brain injury (TBI) negatively affect patient prognosis. This study aimed to demonstrate the relationship between blood glucose levels and the Glasgow Outcome Score (GOS) in TBI patients. Methods This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. Information on the disease, laboratory examination, insulin therapy, and surgery for patients with TBI was collected as candidate variables according to clinical importance. Additionally, data on 5-year and 6-month GOS were collected as primary and secondary outcomes, respectively. For multivariate analysis, a generalized additive model (GAM) was used to investigate relationships between blood glucose levels and GOS. The results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We further applied a two- piecewise linear regression model to examine the threshold effect of blood glucose level and GOS. Results A total of 182 patients were included in the final analysis. Multivariate GAM analysis revealed that a bell-shaped relationship existed between average blood glucose level and 5-year GOS score or 6-month GOS score. The inflection points of the average blood glucose level were 8.81 (95% CI: 7.43–9.48) mmol/L considering 5-year GOS as the outcome and were 8.88 (95% CI 7.43−9.74) mmol/L considering 6-month GOS score as the outcome. The same analysis revealed that there was also a bell relationship between average blood glucose levels and the favorable outcome group (GOS score ≥ 4) at 5 years or 6 months. Conclusion In a population of patients with traumatic brain injury, blood glucose levels were associated with the GOS. There was also a threshold effect between blood glucose levels and the GOS. A blood glucose level that is either too high or too low conveys a poor prognosis. Trial registration ClinicalTrials.gov NCT02161055. Registered on 11 June 2014.

scholarly journals Prospective analysis of glycemic variability in patients with severe traumatic brain injury: modified Leuven’s adjustment process versus conventional adjustment process

2018 ◽  
Vol 46 (4) ◽  
pp. 1505-1516
Author(s):  
Bing Xue ◽  
Shiyan Ruan ◽  
Ping Xie ◽  
Kaixuan Yan ◽  
Zhi'e Gu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Severe Traumatic Brain Injury ◽  
Early Stage ◽  
Glycemic Variability ◽  
Adjustment Process ◽  
Significant Difference

Objective This study was performed to evaluate the effect of two different methods of controlling glycemic variability (GV) in patients with severe traumatic brain injury (STBI) undergoing surgery. Methods Patients with STBI were randomly grouped into a conventional adjustment process (CAP) group and modified Leuven’s adjustment process (mLAP) group. Each group included 50 patients. Blood glucose levels were continuously monitored and data were recorded and analyzed. Results The mean blood glucose level was stable in both groups for 5 days postoperatively with no significant difference. The standard deviation of the blood glucose level, mean amplitude of glycemic excursions, and glycemic lability index were significantly higher in the CAP than mLAP group for the first 2 days. In the final 3 days, no significant differences were observed between the two groups. The incidence of hypoglycemia was significantly higher in the CAP than mLAP group on the first day. This value gradually declined during the following 4 days, but the difference between the two groups was not significant. Conclusion The mLAP produced more favorable results than the CAP for GV control in the early stage after surgery for STBI.

scholarly journals The association between blood glucose level and cognitive dysfunction among acute traumatic brain injury in Manado, Indonesia

2018 ◽  
Vol 6 (4) ◽  
pp. 1073
Author(s):  
Sekplin A. S. Sekeon ◽  
Mieke A. H. N. Kembuan
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Cognitive Dysfunction ◽  
Glucose Level ◽  
P Value ◽  
Random Blood Glucose ◽  
History Of ◽  
Acute Traumatic Brain Injury

Background: Traumatic brain injury (TBI) is a public health challenge. TBI contributes to chronic physical impairment and also disrupt mental and personality aspects. Cognitive dysfunction is influenced by multiple factors, including blood glucose level. The objective of the study was to analyze the association between blood glucose level and cognitive dysfunction among TBI patients.Methods: A hospital-based observational study was conducted with cross-sectional design for six months period. Population of research were all of TBI patients treated at the emergency unit. Eligible sample were obtained with total sampling technique. Dyslgycemia was defined as random blood glucose level outside the range of 80-200mg/dl; cognitive dysfunction was defined as MMSE score <26. Statistical analysis with SPSS version 17.0 was employed. Chi square test and odd ratio were executed, p value <0,05 were regarded as significant level.Results: Majority of the 124 patients was male (75.8%), in 21-30 age group (20.7%), mostly due to RTA, specifically from motorcycle-related accident. Most of the motorcyclist (56,5%) were not using helmet. Unconsciousness was in 65.8% sample. Seizure was found in 3.9% of total patients; almost half of patients had history of headache (40.8%). Vomit was found in 30.3% of patients. Vertigo or dizziness post-trauma was in 3.9% patients; almost one third of patients had history of alcohol consumption (30.3%). Majority (65.8%) were in GCS 13-15. Proportion of dysglycemia and cognitive dysfunction were 4.8% and 14.5% consecutively. Odd ratio analysis revealed that dysglycemic group have 3 times higher risk to develop cognitive dysfunction, but the association was statistically not significant.Conclusions: The association between random blood glucose level and cognitive dysfunction among acute traumatic brain injury was statistically not significant.

scholarly journals Diabetes in COVID-19 patients: challenges and possible management strategies

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Riyan Al Islam Reshad ◽  
Sumaiya Hafiz Riana ◽  
Mohammad Al-baruni Chowdhury ◽  
Abu Tayab Moin ◽  
Faruque Miah ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Healthy Lifestyle ◽  
Management Strategies ◽  
Diabetic Patients ◽  
Main Body ◽  
High Blood Glucose ◽  
High Blood Glucose Level ◽  
Global Population

Abstract Background The recent pandemic of coronavirus disease 19 (COVID-19) has been causing intense stress among the global population. In the case of hospitalized and ICU-admitted COVID-19 patients with comorbidities, it has been observed that a major portion of them are diabetic. Therefore, researchers had indicated a link between diabetes mellitus (DM) and COVID-19. Furthermore, DM is a potential risk factor for the severity of COVID-19 cases. Thus, in this study, the correlation existing between diabetic patients and COVID-19 was summarized. Main body of the abstract Diabetic patients have a weaker immune system, less viral clearance rate, malfunctions of metabolic activity due to their high blood glucose level, and other associated problems. This does not increase the susceptibility for the patients to be infected with COVID-19. However, the severity of COVID-19 can worsen due to the comorbidity of DM. Short conclusion Proper management, appropriate use of drugs that do not increase the ACE2 expression, lowering blood glucose level, decreasing the susceptibility of SARS-CoV-2, and maintaining a healthy lifestyle could be effective.

Galectin-3 mediates high-glucose-induced cardiomyocyte injury by the NADPH oxidase/reactive oxygen species pathway

2020 ◽  
Vol 98 (11) ◽  
pp. 826-833
Author(s):  
Jingang Sun ◽  
Lijuan Zhang ◽  
Jianhai Fang ◽  
Shuguo Yang ◽  
Lianghua Chen
Keyword(s):  
Oxidative Stress ◽  
Blood Glucose ◽  
Nadph Oxidase ◽  
Blood Glucose Level ◽  
Body Mass ◽  
Glucose Level ◽  
High Glucose ◽  
Cardiac Injury ◽  
High Blood Glucose ◽  
Galectin 3

Galectin-3 is a member of the β-galactoside-binding lectin family taking part in the regulation of inflammation, angiogenesis, and fibrosis. This study was designed to study the improved effect of galectin-3 inhibition on diabetic cardiomyopathy (DCM). Sprague–Dawley rats were randomized into the control, DCM, and DCM + modified citrus pectin (MCP) (a galectin–3 pharmacological inhibitor) groups. After 8 weeks, streptozotocin-induced DCM led to high blood glucose level, oxidative stress, cardiac injury, and dysfunction accompanied by suppressed body mass. On the contrary, MCP (100 mg·kg−1·day−1) administration improved body mass and blood glucose level and attenuated cardiac injury and dysfunction in DCM rats. Additionally, MCP attenuated pathological changes in plasma and myocardial tissue markers of oxidative stress, such as hydrogen peroxide and malonyldialdehyde, although it did not change superoxide dismutase activities, which were decreased in the DCM group. The levels of oxidative stress associated proteins evaluated by Western blot, such as p67phox and NADPH oxidase 4, were obviously increased in the DCM group, while they were reversed by MCP treatment. Therefore, galectin-3-mediated high-glucose-induced cardiomyocyte injury and galectin-3 inhibition attenuated DCM by suppressing NADPH oxidase. These findings suggested that galectin-3 could be a potential target for treatment of patients with DCM.

scholarly journals Metabolome of Cerebral Thrombi Reveals an Association between High Glycemia at Stroke Onset and Good Clinical Outcome

Metabolites ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 483
Author(s):  
Laurent Suissa ◽  
Jean-Marie Guigonis ◽  
Fanny Graslin ◽  
Emilie Doche ◽  
Ophélie Osman ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Discriminant Analysis ◽  
Clinical Outcome ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Area Under The Curve ◽  
Stroke Onset ◽  
Stroke Patients ◽  
High Blood Glucose ◽  
High Blood Glucose Level

Despite the fact that glucose is the main fuel of the brain, hyperglycemia at hospital admission is generally associated with a poor functional outcome in stroke patients. This paradox may be explained by the lack of information about the blood glucose level at stroke onset. Here, we analyzed the metabolome of blood cells entrapped in cerebral thrombi to gain insight into their metabolism at stroke onset. Fourty-one consecutive stroke patients completely recanalized by mechanical thrombectomy within 6 h were included. The metabolome of retrieved thrombi was analyzed by liquid chromatography tandem with mass spectrometry. Discriminant Analysis (sparse Partial Least Squares Discriminant Analysis (sPLS-DA)) was performed to identify classification models and significant associated features of favorable clinical outcome at 3 months (modified Rankin Scale (mRS) < 2). sPLS-DA of the metabolomes of cerebral thrombi discriminated between stroke patients with a favorable or poor clinical outcome (Area Under the Curve (AUC) = 0.992 (0.931–1)). In addition, our results revealed that high sorbitol and glucose levels in the thrombi positively correlated with favorable clinical outcomes. Sorbitol, a short-term glycemic index reflecting a high blood glucose level at stroke onset, was found to be an independent predictor of good outcome (AUC = 0.908 (0.807–0.995)). This study demonstrates that a high blood glucose level at stroke onset is beneficial to the clinical outcome of the patient.

scholarly journals Association between neutrophil to lymphocyte ratio and blood glucose level at admission in patients with spontaneous intracerebral hemorrhage

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Zhang ◽  
Yanming Ren ◽  
Wei Fu ◽  
Yuelong Wang ◽  
Juan Qian ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Blood Glucose ◽  
Intracerebral Hemorrhage ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Inflammatory Responses ◽  
Neutrophil To Lymphocyte Ratio ◽  
Secondary Brain Injury ◽  
Imaging Features ◽  
Lymphocyte Ratio

Abstract Previous studies indicated that both inflammatory responses and hyperglycemia are involved in the similar pathophysiological mechanisms after onset of intracerebral hemorrhage (ICH). However the relationship between hyperglycemia and inflammation remains unknown. We aim to evaluate the associations of hyperglycemia with inflammation and neutrophil to lymphocyte ratio (NLR) in patients with ICH. Patients with acute ICH were retrospectively enrolled. Clinical characteristics and imaging features were obtained. The associations between outcome and laboratory biomarkers were assessed by multivariable logistic regression analysis. Spearman analysis and multiple linear regression analysis were performed to estimate the association of NLR and serum glucose. 175 patients were enrolled. Poor outcome occurred in 86 patients at 30 days. Elevated blood glucose level (BGL) and NLR were strongly associated with outcome in patients with ICH. Moreover, combined NLR-BGL exhibited a better predictive accuracy compared with the peripheral leukocyte counts. Furthermore, there was a robust association between BGL and NLR. We first demonstrated both of NLR and BGL were independently associated with each other. Our results indicate that inflammatory responses and the pathological process of hyperglycemia may influence each other by several complex pathological mechanisms and have a mutual promoting effect to secondary brain injury.

scholarly journals Association between blood glucose levels in insulin therapy and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

2021 ◽  
Author(s):  
Tao Yuan ◽  
Hongyu He ◽  
Yuepeng Liu ◽  
Jianwei Wang ◽  
Xin Kang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Insulin Therapy ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Medium Level ◽  
Level Group

Abstract Background: Too high or low blood glucose levels after traumatic brain injury (TBI) negatively affect the prognosis of patients with TBI. This study aimed to examine the relationship between different levels of blood glucose in insulin therapy and Glasgow Outcome Score (GOS) in patients with TBI.Methods: This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. The information on disease, lab examination, insulin therapy, and operation of patients with TBI was collected. Also, the data on 5-year and 6-month GOS were collected as primary and secondary outcomes. The univariate analysis was used to detect variables that might contribute to outcomes, while the multivariate regression analysis was used to reveal the independent relationship between insulin therapy and outcomes. A generalized additive model (GAM) was used to investigate dose–response relationships between blood glucose levels and GOS. The results were presented as odds ratios (ORs) with their 95% confidence intervals (95% CIs). We further applied a two-piecewise linear regression model to examine the threshold effect of blood glucose level and GOS.Results: A total of 182 patients were involved in the final analysis. Compared with the non-intensive insulin therapy group, the 5-year GOS in the moderate-control intensive insulin therapy (IIT) group and the slight-control IIT group was 1.45 and 1.39 higher, respectively (both P < 0.05); the 5-year GOS in the strict-control IIT group was 0.23 higher (P > 0.05). GAM revealed that a bell-shaped relationship existed between blood glucose levels in insulin therapy and 5-year or 6-month GOS. The inflection points of the mean blood glucose level were 6.73 and 8.97 mmol/L considering 5-year GOS as the outcome and were 6.95 and 8.88 mmol/L considering 6-month GOS as the outcome. The multivariate analysis showed that the 5-year GOS in the medium-level group (≥6.73 and <8.97 mmol/L) increased by 0.83 [95% confidence interval (CI): 0.22–1.47] compared with that in the low-level group (<6.73 mmol/L). Also, the 5-year GOS in the medium-level group increased by 0.57 (95% CI: 0.02–1.08) compared with that in the high-level group (≥8.97 mmol/L).Conclusion: A proper blood glucose range in insulin therapy could improve the outcomes of patients with TBI; the range was 6.73–8.97 mmol/L according to our limited analysis.Clinical Trial Registration: ClinicalTrials.gov, NCT02161055. Registered 11 Jun 2014.

scholarly journals Healing of Extraction Socket in Diabetic Patients- A Hospital based Retrospective Study

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 1427-1430
Author(s):  
Chidambaram Shathviha P ◽  
Herald J Sherlin ◽  
Mebin Mathew
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Healing Process ◽  
Diabetic Patients ◽  
Age Group ◽  
High Blood Glucose ◽  
High Blood Glucose Level ◽  
Surgical Extraction ◽  
Extraction Treatment

Diabetes is a common metabolic disorder which is an inability to regulate blood glucose due to insulin deficiency or resistance. During extraction, diabetic patients suffer various complications. One among them is most commonly seen delayed wound healing. The aim of this study is to evaluate the prevalence of delay in the healing process of extraction sockets in diabetic patients. This retrospective cross-sectional study was carried out in a hospital setting where all case sheets for six months were filtered from the patient management software. Samples of all patients with diabetes and the extraction treatment were filtered. Three hundred sixteen patients were used for this study. The data is collected and imported to SPSS for statistical analysis and results are obtained. Among 316 patients, 77 were diabetic and had undergone extraction treatment. Satisfactory healing was observed in diabetic patients undergoing normal extraction within the age group 60-70 years and with blood glucose level within normal range (54%). Unhealed sockets were observed in diabetic patients who underwent surgical extraction within the age group of 60-70 years and with high blood glucose level (10.2%). Majority of patients with normal blood glucose level have satisfactory healing and patients with high blood glucose level have unhealed sockets. Dentists should be aware that diabetic patients of poor glucose control undergoing traumatic extraction are prone to delayed healing processes which lead the patient to discomfort and infections. Patients should be advised to have a proper diet and controlled level of glucose to prevent oral complications.

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