The association between rest-activity rhythms and glycemic markers: the US National Health and Nutrition Examination Survey, 2011-2014

OBJECTIVES Previous studies conducted in mostly homogeneous sociodemographic samples have reported a relationship between weakened and/or disrupted rest-activity patterns and metabolic dysfunction. This study aims to examine rest-activity rhythm characteristics in relation to glycemic markers in a large nationally-representative and diverse sample of American adults. METHODS This study used data from the National Health and Nutrition Examination Survey 2011-2014. Rest-activity characteristics were derived from extended cosine models using 24-hour actigraphy. We used multinomial logistic regression and multiple linear regression models to assess the associations with multiple glycemic markers (i.e., glycated hemoglobin, fasting glucose and insulin, homeostatic model assessment of insulin resistance, and results from the oral glucose tolerance test), and compared the results across different categories of age, gender, race/ethnicity and body-mass index. RESULTS We found that compared to those in the highest quintile of F statistic , a model-fitness measure with higher values indicating a stronger cosine-like pattern of daily activity, participants in the lowest quintile (i.e, those with the weakest rhythmicity) were 2.37 times more likely to be diabetic (OR Q1 vs. Q5 2.37 (95% CI 1.72, 3.26), p-trend <.0001). Similar patterns were observed for other rest-activity characteristics, including lower amplitude (2.44 (1.60, 3.72)), mesor (1.39 (1.01, 1.91)), and amplitude:mesor ratio (2.09 (1.46, 2.99)), and delayed acrophase (1.46 (1.07, 2.00)). Results were consistent for multiple glycemic biomarkers, and across different sociodemographic and BMI groups. CONCLUSIONS Our findings support an association between weakened and/or disrupted rest-activity rhythms and impaired glycemic control among a diverse US population.

Association between Dietary Magnesium Intake and Glycemic Markers in Ghanaian Women of Reproductive Age: A Pilot Cross-Sectional Study

Low magnesium intake has been shown to be associated with an increased risk of type 2 diabetes mellitus (T2DM) in several studies conducted in high-income countries. However, very few studies have been performed in Africa, where many countries have a growing rate of T2DM. We conducted a pilot cross-sectional study among 63 women in Ghana to investigate the association between magnesium intake and glycemic markers. We assessed dietary magnesium using a food frequency questionnaire and glycemic markers using fasting blood glucose and glycated hemoglobin A1c (HbA1c). Our findings showed that the mean magnesium intake was 200 ± 116 mg/day. The prevalence of T2DM was 5% by measuring fasting blood glucose and 8% by measuring HbA1c. Unadjusted linear regression models revealed that higher magnesium intake significantly predicted higher fasting blood glucose levels (β = 0.31; 95% CI: 0.07, 0.55; p = 0.01) and HbA1c levels (β = 0.26; 95% CI: 0.01, 0.51; p = 0.04). In adjusted analyses, magnesium intake was no longer significantly associated with either fasting blood glucose levels (β = 0.22; 95% CI: −0.03, 0.46; p = 0.08) or HbA1c levels (β = 0.15; 95% CI: −0.08, 0.39; p = 0.20). In conclusion, our study did not show a significant association between magnesium intake and glycemic markers in women of reproductive age in Ghana. The results of this study need to be further substantiated because this was the first study to examine magnesium intake and glycemic markers in this population in Africa.

Albumin-corrected fructosamine predicts all-cause and non-CVD mortality among the very elderly aged ≥ 80 years without diabetes

Background Several guidelines have suggested alternative glycemic markers for hemoglobin A1c among older adults with limited life expectancy or multiple coexisting chronic illnesses. We evaluated associations between fructosamine, albumin-corrected fructosamine (AlbF) and fasting plasma glucose (FPG) and mortality in the diabetic and non-diabetic subpopulations, compared which marker better predicts mortality among participants aged 80 and above. Methods Included were 2,238 subjects from the Healthy Ageing and Biomarkers Cohort Study (2012-2018) and 207 participants had diabetes at baseline. Multivariable Cox proportional hazards regression models investigated the associations of fructosamine, AlbF, FPG and all-cause, cardiovascular disease (CVD), and non-CVD mortality in the diabetic and non-diabetic subpopulations. Restricted cubic splines (RCS) explored potential non-linear relations. C-statistic, integrated discrimination improvement (IDI) and net reclassification improvement (NRI) evaluated the additive value of different glycemic markers to predict mortality. Results Overall, 1,191 deaths were documented during 6,793 person-years of follow-up. In the linear model, per unit increases of fructosamine, AlbF and FPG were associated with higher risk of mortality in non-diabetic participants, with hazard ratios of 1.02 (1.00, 1.05), 1.27 (1.14, 1.42) and 1.04 (0.98, 1.11) for all-cause mortality, and 1.04 (1.00, 1.07), 1.38 (1.19, 1.59) and 1.10 (1.01, 1.19) for non-CVD mortality, respectively. Comparisons indicated AlbF better predicts all-cause and non-CVD mortality in non-diabetic participants with significant improvement in IDI and NRI. Conclusions Higher concentrations of fructosamine, AlbF, and FPG were associated with higher risk of all-cause or non-CVD mortality among very elderly where AlbF may constitute an alternative prospective glycemic predictor of mortality.

A COMPARATIVE STUDY OF HIGH SENSITIVITY C-REACTIVE PROTEIN (HS-CRP) AND GLYCEMIC MARKERS IN TYPE 2 DIABETES MELLITUS

Objective: To determine the relationship between high sensitivity CRP (hs-CRP) and glycemic markers in samples of individuals with diabetes. Study Design: Cross sectional study. Place and Duration of Study: Fatima Memorial Hospital Lahore, from Feb to Aug 2019. Methodology: Consecutive patients aged 18-65 years coming for screening of diabetes mellitus (DM) were included. Blood sample for plasma glucose and glycated hemoglobin (HbA1c), high sensitivity CRP (hs-CRP) were analyzed. Results: Total 93 subjects were included, out of which 42 (45.2%) were males and 51 (54.8%) were females with the mean age of 48.3 ± 12 years and 42.6 ± 14 years respectively. Median concentration of hs-CRP in males and females was 0.7 (IQR1.2) mg/L and 0.6 (IQR1.4) mg/L (p-value=0.844) respectively. A significant positive correlation was observed between hs-CRP levels, HBA1c with r=0.205 (p=0.05) and fasting plasma glucose (FPG) with r=0.225 (p=0.03). However, no significant relationship was found between hs-CRP and age, BMI, waist circumference and systolic blood pressure (SBP) and diastolic blood pressure (DBP), cholesterol, LDL-cholesterol, triglycerides (TG), HDL-cholesterol. Conclusion: HbA1c and fasting plasma glucose is significantly associated with hs-CRP. This implies a significant relation between inflammation and glycemic markers. This leads to the conclusion that patients with diabetes and high hs-CRP need further evaluation, follow-up and therapy for inflammation compared to those with low hs-CRP.

Hemodialysis-Related Glycemic Disarray Proven by Continuous Glucose Monitoring: Glycemic Markers and Hypoglycemia

<b>OBJECTIVE</b> <p>There is a high risk of asymptomatic hypoglycemia associated with hemodialysis (HD) using glucose-free dialysate; therefore, the inclusion of glucose in the dialysate is believed to prevent intradialytic hypoglycemia. However, the exact glycemic fluctuation profiles and frequency of asymptomatic hypoglycemia using dialysates containing >100 mg/dL glucose have not been determined.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We evaluated the glycemic profiles of 98 type 2 diabetes patients undergoing HD (68 men, HbA1c 6.4±1.2%, glycated albumin 20.8±6.8%) with a dialysate containing 100, 125, or 150 mg/dL glucose using continuous glucose monitoring.</p> <p><b>RESULTS</b></p> <p>Sensor glucose level (SGL) showed a sustained decrease during HD, irrespective of the dialysate glucose concentration, and reached a nadir that was lower than the dialysate glucose concentration in 49 participants (50%). Twenty-one participants (21%) presented with HD-related hypoglycemia, defined by an SGL <70 mg/dL during HD and/or between the end of HD and their next meal. All these hypoglycemic episodes were asymptomatic. Measures of glycemic variability calculated using the SGL data (standard deviation, coefficient of variation, and range of SGL) were higher and time below range (<70 mg/dL) was lower in participants who experienced HD-related hypoglycemia than in those who did not, whereas time in range between 70 and 180 mg/dL, time above range (>180 mg/dL), HbA1c and GA of the two groups were similar.</p> <p><b>CONCLUSIONS</b></p> <p>Despite the use of dialysate containing 100–150 mg/dL glucose, diabetic HD patients experienced HD-related hypoglycemia unawareness frequently. SGL may fall well below the dialysate glucose concentration toward the end of HD.<br> </p>

Hemodialysis-Related Glycemic Disarray Proven by Continuous Glucose Monitoring: Glycemic Markers and Hypoglycemia

<b>OBJECTIVE</b> <p>There is a high risk of asymptomatic hypoglycemia associated with hemodialysis (HD) using glucose-free dialysate; therefore, the inclusion of glucose in the dialysate is believed to prevent intradialytic hypoglycemia. However, the exact glycemic fluctuation profiles and frequency of asymptomatic hypoglycemia using dialysates containing >100 mg/dL glucose have not been determined.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We evaluated the glycemic profiles of 98 type 2 diabetes patients undergoing HD (68 men, HbA1c 6.4±1.2%, glycated albumin 20.8±6.8%) with a dialysate containing 100, 125, or 150 mg/dL glucose using continuous glucose monitoring.</p> <p><b>RESULTS</b></p> <p>Sensor glucose level (SGL) showed a sustained decrease during HD, irrespective of the dialysate glucose concentration, and reached a nadir that was lower than the dialysate glucose concentration in 49 participants (50%). Twenty-one participants (21%) presented with HD-related hypoglycemia, defined by an SGL <70 mg/dL during HD and/or between the end of HD and their next meal. All these hypoglycemic episodes were asymptomatic. Measures of glycemic variability calculated using the SGL data (standard deviation, coefficient of variation, and range of SGL) were higher and time below range (<70 mg/dL) was lower in participants who experienced HD-related hypoglycemia than in those who did not, whereas time in range between 70 and 180 mg/dL, time above range (>180 mg/dL), HbA1c and GA of the two groups were similar.</p> <p><b>CONCLUSIONS</b></p> <p>Despite the use of dialysate containing 100–150 mg/dL glucose, diabetic HD patients experienced HD-related hypoglycemia unawareness frequently. SGL may fall well below the dialysate glucose concentration toward the end of HD.<br> </p>