EFFECT OF EXERCISE ON INSULIN RESISTANCE IN OBESE TYPE 2 DIABETES PATIENTS

ABSTRACT Introduction: Type 2 diabetes mellitus (T2DM), also known as non-insulin-dependent diabetes mellitus (NIDDM), accounts for more than 90% of the total number of diabetes mellitus cases and often occurs in middle-aged and elderly people. Objective: To investigate the effect of exercise intervention on insulin resistance in obese type 2 diabetes patients. Methods: Eighty-six obese diabetic patients were screened as experimental subjects in physical examinations and randomly divided into observation and control groups. Visceral fat volume, fasting blood glucose, and fasting insulin of all subjects were measured before and after completion of the 6-month experimental implementation. The insulin resistance was calculated for both groups and the values for each indicator were compared statistically between groups. Results: Control of body weight, body mass index, blood glucose, blood lipids and insulin resistance index were better in the observation group than in the control group, and the difference was statistically significant (P < 0.05). Conclusions: Basal intervention with quantitative exercise can significantly improve insulin resistance in obese type 2 diabetes patients and the effect is better than treatment with diet and conventional exercise. Level of evidence II; Therapeutic studies - investigation of treatment results.

Continuous infusion of dipyrone in bitches in the intraoperative period: cardiorespiratory effects

Dipyrone is an effective analgesic for managing moderate or severe postoperative pain and can be used alone for mild pain or in combination with other analgesics for any type of pain. This study aimed to examine the administration of dipyrone by continuous infusion (CI) as an adjuvant analgesic in the intraoperative period for bitches undergoing elective ovariohysterectomy (OH) and its effect on these patients’ cardiorespiratory parameters. Twenty bitches underwent an elective OH procedure. The pre-anesthetic agent was a combination of acepromazine and morphine. Propofol was used to induce anesthesia, and isoflurane was used for maintenance. Subsequently, the animals were randomly allocated into two groups: the dipyrone group (DG) received a bolus dose of dipyrone (25 mg kg-1) by CI at a rate of 10 mg kg-1 h, and the control group (CG) received a bolus dose and a CI of 0.9% NaCl solution, both groups at a rate of 5 mL kg-1 h. The parametric variables were analyzed by ANOVA, followed by Tukey's test (p<0.05). The paired t-test (p<0.05) was used for comparison between the groups. Statistical differences were observed for heart rate, systolic, diastolic, and mean arterial pressure, respiratory rate, and blood glucose between the periods in both groups. There were differences only in the basal values of MAP between the groups; however, most values remained within the physiological range for the species. Using the drug as an adjuvant to anesthesia did not alter cardiorespiratory parameters, and it can be used as an adjuvant in analgesia during the intraoperative period of OH.

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

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.

Retrospective, observational study to see the effect of evogliptin on continuous glucose monitoring (CGM) in T2DM Indian patients: A real-world experience

This study aimed to assess effectiveness of Evogliptin 5 mg through continues glucose monitoring (CGM) in patients with T2DM in retrospective observational real world settings. Overall 6 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. FreeStyle Librepro 1.0.6 was used for CGM. CGM was done 15 days prior to adding Evogliptin and repeated immediately after that for next 15 days. Mean BG level, Percentage time in target range (80-140mg/dl), Percentage time above target and Percentage time below target were assessed prior and after adding Evogliptin in existing treatment regimen. Significant reduction in Mean blood glucose level seen after adding Evogliptin in existing treatment regimen from 215 mg/dl to 138 mg/dl (-77 mg/dl P=0.006). Significant improvement seen in Percentage time in target range (80-140mg/dl) from 17% to 44% (27% P value 0.007) and in Percentage time above target from 81% to 43% (- 38%, P valve 0.003). 13.5 % of the patients seen below target. Evogliptin was found to be effective when added to the patients who were uncontrolled on other oral anti-diabetic medications. It effectively showed improvement in continues glucose monitoring (CGM) parameters like Mean blood glucose, more number of patients were in Time in Target range i.e (80-140mg/dl) after adding Evogliptin to existing anti-diabetic medications & well tolerated. Small sample size and retrospective study

Effects of Sambiloto (Andrographis paniculata) on GLP-1 and DPP-4 Concentrations between Normal and Prediabetic Subjects: A Crossover Study

Background. The extract of Andrographis paniculata (Burm. F.) Wall. Ex. Nees. (sambiloto) (穿心蓮 chuān xīn lián) has been reported to have an antidiabetic effect on mice models and has been used traditionally in the community. The exact mechanism of sambiloto extract in decreasing plasma glucose is unclear, so we investigated the role of sambiloto extract in the incretin pathway in healthy and prediabetic subjects. Methods. This study was a randomized, placebo-controlled, crossover, double-blind trial. It included 38 people who were healthy and 35 people who had prediabetes. All subjects were randomly assigned to receive either the intervention sambiloto extract or a placebo. All subjects were randomly assigned to receive the first intervention for 14 days. There was a washout period between subsequent interventions. The primary outcome was glucagon-like peptide 1 (GLP-1) concentration, and secondary outcomes were fasting insulin, 2-hour postprandial insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glucose, 2-hour postprandial blood glucose, dipeptidyl peptidase-4 (DPP-4), and glycated albumin before and after the intervention. Result. After the intervention, GLP-1 concentration significantly increased in prediabetes by 19.6% compared to the placebo ( p = 0.043 ). There were no significant differences in the changes of fasting insulin, 2-hour postprandial insulin, HOMA-IR, fasting blood glucose, 2-hour postprandial blood glucose, DPP-4, and glycated albumin levels after the intervention. Sambiloto extract did not inhibit the DPP-4 enzyme in healthy and prediabetic subjects. Conclusion. Sambiloto extract increased GLP-1 concentration without inhibiting the DPP-4 enzyme in prediabetic subjects. This trial is registered with ClinicalTrials.gov (ID: NCT03455049), registered on 6 March 2018—retrospectively registered (https://clinicaltrials.gov/ct2/show/NCT03455049).

Comprehensive Review on Wearable Sweat-Glucose Sensors for Continuous Glucose Monitoring

The incidence of diabetes is increasing at an alarming rate, and regular glucose monitoring is critical in order to manage diabetes. Currently, glucose in the body is measured by an invasive method of blood sugar testing. Blood glucose (BG) monitoring devices measure the amount of sugar in a small sample of blood, usually drawn from pricking the fingertip, and placed on a disposable test strip. Therefore, there is a need for non-invasive continuous glucose monitoring, which is possible using a sweat sensor-based approach. As sweat sensors have garnered much interest in recent years, this study attempts to summarize recent developments in non-invasive continuous glucose monitoring using sweat sensors based on different approaches with an emphasis on the devices that can potentially be integrated into a wearable platform. Numerous research entities have been developing wearable sensors for continuous blood glucose monitoring, however, there are no commercially viable, non-invasive glucose monitors on the market at the moment. This review article provides the state-of-the-art in sweat glucose monitoring, particularly keeping in sight the prospect of its commercialization. The challenges relating to sweat collection, sweat sample degradation, person to person sweat amount variation, various detection methods, and their glucose detection sensitivity, and also the commercial viability are thoroughly covered.

Monitoring of blood glucose levels, ketones and insulin bolus advice using 4SURE products and app-based technology

With more people being diagnosed with diabetes and requiring insulin therapy as they live longer, an increasing number of individuals are needing access to blood and ketone monitoring that is simple to use and provides accurate results. Having access to a bolus advisor is equally important in order for people with diabetes to calculate accurate insulin doses based on the foods that they are eating. The use of app-based technology for healthcare purposes has increased over recent years and now includes the Diabetes:M application that can be used in conjunction with the 4SURE smart meters with no additional cost to the individual.