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.

The Effects of Snack Control Education and Telephone Coaching on Self-Management, Social Support, Self-Efficacy, and Blood Glucose in Diabetes Patients

Dietary therapy for diabetes is the most basic way to manage blood glucose. Currently, the nutritional intake rate of diabetic patients in Korea is beyond the recommended rate of the Korean Diabetes Association, showing large amounts of carbohydrates in foods consumed as snacks with an additional focus on sugar. Thus, it is necessary to support healthy dietary habits through snack control. This study is a random assignment experimental study with a total of 56 participants; 28 participants were in the control group, while the remaining 28 patients had type 2 diabetes and had visited Kyung Hee University Hospital. The experimental group with snack control education and telephone coaching exhibited a higher self-management score (t = –9.494, P < 0.001), perceived social support score (t = 7.201, P < 0.001), and self-efficacy score (t = 7.185, P < 0.001) than the control group. Additionally, the experimental group showed lower levels of glycosylated hemoglobin and average blood glucose compared to the control group (t = –4.820, P < 0.001). Thus, snack control education and telephone coaching are effective in improving diabetes self-management behavior, perceived social support, self-efficacy, and reducing glycosylated hemoglobin and average blood glucose. These results confirm the usefulness of snack education materials, and I suggest snack control education as a means of arbitration to improve the self-care of diabetics.

Gambaran Kadar Glukosa Darah Sewaktu Pada Penderita Hipertensi di Puskesmas II Mendoyo

<p class="normal" align="center"><strong>Description </strong><strong>o</strong><strong>f Blood Glucose Levels </strong><strong>i</strong><strong>n Hypertension Patients </strong><strong>in</strong><strong> Mendoyo Public </strong><strong>H</strong><strong>ealth </strong><strong>C</strong><strong>enter</strong></p><p class="normal" align="center"> </p><p class="normal"><strong> Abstract</strong></p><p class="normal"> </p><p>Hypertension is a degenerative disease that still affects many people in Bali Province. Hypertension occurs due to many factors where it can start from genetics and lifestyle. Hypertension can lead to insulin resistance which is the main cause of increased blood glucose, so that people who suffer from hypertension have the risk of suffering from diabetes mellitus. The purpose of this study is to describe the current blood glucose levels in patients with hypertension at Puskesmas II Mendoyo. Method this research uses descriptive quantitative method involving 30 respondents through purposive sampling technique. The research was conducted in March - April 2021. Data collection was carried out by filling out questionnaires and examining blood glukose level with POCT EasyTouch GCU. The results showed that (13.3%) patients with hypertension had blood glucose levels in the non-DM category, (80%) with the uncertain DM category, and (6.7%) in the DM category. The average blood glucose level is 120.7 mg/dl with the lowest level is 84 mg/dl and the highest level up to 273 mg/dl. In conclusion, most patients with hypertension have blood glucose levels during the uncertain DM category.</p><p><strong>Keyword</strong>s: blood glucose levels; hypertension; diabetes melitus</p>

Does Participation in Sport Protect Former Saudi Arabian Athletes from High Blood Glucose after Retirement?

<b><i>Introduction:</i></b> The prevalence of type 2 diabetes (T2D) has increased dramatically in the last decades in developed and developing countries. In this regard, the purpose of this study is to investigate the prevalence of prediabetes and diabetes in retired athletes in Saudi Arabia and compare it to nonathletes. This study hypothesizes that early participation in sport can prevent former athletes from abnormal blood glucose levels after retirement. <b><i>Methods:</i></b> : The leading methods of researching the issues of the study include the analysis of theoretical sources, analysis of statistics, and comparison. Seventy-three former athletes and 26 nonathletes aged between 20 and 60 years participated in this study. Height, weight, and blood glucose levels were collected by the researcher. The former athletes were divided into 3 groups according to their type of training: endurance, mixed sports, and power sports. <b><i>Results:</i></b> The study results showed that 40.59% of former athletes had prediabetes compared to 16.83% of nonathletes. Furthermore, 8.91% of the former athletes had T2D, while 3.96% of the nonathletes had T2D. The results of this study indicated that former athletes had lower average blood glucose than nonathletes. Also, the study results indicated that no statistically significant differences were found between former athletes and nonathletes after retirement. About fasting blood glucose, former power athletes had higher average blood glucose than endurance athletes and mixed sports athletes. <b><i>Conclusion:</i></b> It was concluded that no statistically significant differences were found between the former athlete groups.

Estimation of Average Blood Glucose Values Based on Fructosamine Values

Introduction: The fructosamine is originated of the glycation of plasmatic proteins, especially albumin, in addition to immunoglobulins and proteins diverse. It constitutes an alternative biomarker of glycemic control when glycated hemoglobin is not indicated for this purpose. Objective: To define the mathematical relationship between fructosamine and average glucose values. Method: The study comprised the laboratorial data collected of 1227 diabetic subjects (type 1 and type 2). Fructosamine levels obtained at the end of three weeks and measured were compared with the average glucose levels of the three previous weeks. The average glucose levels were determined by the weighted mean of the daily fasting capillary glucose results performed during the study period, and the plasma glucose taken at the time of the fructosamine. Results: A total of 9,450 glucoses were performed. Linear regression analysis between the fructosamine and average glucose levels showed that each increase of 1.0 lower case Greek mumol/L in fructosamine increase 0.5mg/dL in the average glucose levels as evidenced in the equation forward: Average glucose levels = 0.5157 x Fructosamine - 20. According to the coefficient of determination (r2 = 0.353492, P < 0.006881), making it possible to calculate the estimated average glucose according to the frutosamine values. Conclusion: Fructosamine levels can be expressed as average glucose levels for assessing the metabolic control of diabetic patients.

HYPERGLYCEMIAAS AN INDEPENDENT RISK FACTOR FOR RETINOPATHY OF PREMATURITY (ROP): A COHORT STUDY

OBJECTIVE: Retinopathy of prematurity (ROP) is a severe morbidity that can lead to blindness in premature babies. Neonatal hyperglycemia has been related to the growth of ROP in a variety of studies. However, there aren't many observational trials to show whether hyperglycemia is linked to ROP in the absence of other comorbidities. The aim of this research was to see if hyperglycemia in premature babies is linked to ROP in a different way. STUDY DESIGN: Premature infants (<1500 g or⩽ 32 weeks gestational age) were enrolled in a prospective longitudinal cohort study. All demographic, clinical and laboratory data were collected. Bedside whole-blood glucose concentration was measured every 8 hours daily for rst 7 , days of live. For any glucose reading <50 or>150 mg dl 1 serum sample was sent to the laboratory for conrmation. Hyperglycemia was dened as any blood glucose level⩾ 150 mg dl − 1. ROP patients were compared with non-ROP patients in a bivariate analysis. Variables signicantly associated with ROP were studied in a logistic regression model. RESULT:Atotal of 100 patients were enrolled with gestational age <32weeks and birth weight <1500g. Forty-eight patients (48%) were identied with hyperglycemia. On eye examination, 30 cases (30%) had ROP (19 with stage 1, 10 with stage 2 and 1 with stage 3). There were more cases of ROPin the hyperglycemia group compared with the euglycemia group (45.83% vs 15.38%, P = 0.007). Patients who developed ROP had signicantly higher maximum and average glucose concentrations when compared with non-ROP patients. Multiple factors have been associated with ROP on bivariate analysis, including gestational age, exposure to oxygen, respiratory support and poor weight gain. However, in a logistic regression model including all signicant variables, average blood glucose in the rst week of life was the factor independently associated with ROPwith an odds ratio of: 1.77 (95% condence interval: 1.08 to 2.86), P= 0.024 CONCLUSION: In a prospective cohort study of premature infants, elevated average blood glucose concentrations in the rst week of life is an independent risk factor associated with the development of ROP.

A Subsidized Healthy Food Prescription Program for Adults With Type 2 Diabetes Who Are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial

Objectives It is vital for individuals with type 2 diabetes (T2DM) to adhere to a healthy dietary pattern to maintain optimal blood glucose levels and overall health. Increasing costs of healthy foods, however, are a barrier to maintaining healthful dietary patterns, particularly for individuals with T2DM who are experiencing food insecurity. Poor diet quality may result in difficulties maintaining optimal blood glucose levels, leading to higher rates of diabetes complications, and increased acute care usage and costs. Although the adverse impacts of food insecurity on maintaining optimal blood glucose levels are well documented, effective strategies to this among individuals with T2DM are lacking. One approach is providing subsidies to purchase healthy foods through subsidized healthy food prescription programs. These programs may help reduce food insecurity and improve diet quality, thereby improving blood glucose levels and reducing diabetes complications over time. Methods A parallel group randomized controlled trial will examine the effectiveness of a subsidized healthy food prescription program compared to a healthy food prescription alone in improving average blood glucose levels (primary outcome), and other secondary outcomes among 404 adults who are experiencing food insecurity and persistent hyperglycemia. The subsidized healthy food prescription program consists of two core elements: 1) A one-time healthy food prescription pamphlet that outlines an evidence-based healthy dietary pattern; 2) A healthy food subsidy of $1.50/day/household member to purchase healthy foods in participating supermarkets for 6 months. At baseline and 6-month follow-up, participants will provide responses to sociodemographic and health-related items, and a variety of patient-reported outcomes. Biochemical and physical measurements will also be obtained. Results The study's theory of change posits that reducing food insecurity and improving diet quality will be key mediators in improving blood glucose levels, which may reduce diabetes complications, and healthcare usage and costs over time. Conclusions The results of this study will demonstrate if a subsidized healthy food prescription program results in meaningful changes in average blood glucose levels and other clinically relevant outcomes. Funding Sources Alberta Innovates, Alberta Health Services.

Συγκριτική μελέτη δύο σχημάτων ινσουλινοθεραπείας σε ασθενείς με σακχαρώδη διαβήτη τύπου 2 με την χρήση αισθητήρων γλυκόζης

ΣΚΟΠΟΣ: Η συγκριτική μελέτη δύο σχημάτων ινσουλινοθεραπείας (μίγμα ανθρώπινης ινσουλίνης 30/70-PIΗ και μίγμα ανάλογου-PAI, και συγκεκριμένα διφασική ινσουλίνη Aspart 30/70-Biasp30) με τη χρήση αισθητήρων γλυκόζης, και εκτίμηση της συσχέτισης της γλυκοζυλιωμένης αιμοσφαιρίνης (HbA1c), της γλυκοζυλιωμένης αλβουμίνης(GA) και της φρουκτοζαμίνης(FA) με τα δεδομένα της συνεχούς καταγραφής(CGM). ΑΣΘΕΝΕΙΣ-ΜΕΘΟΔΟΙ: Μια cross-over μελέτη σε 36 καλά ρυθμισμένα άτομα με Σακχαρώδη Διαβήτη τύπου 2 (ΣΔτ2), οι οποίοι υποβλήθηκαν σε 7ήμερη CGM με το PHI και στη συνέχεια με το Biasp30. ΑΠΟΤΕΛΕΣΜΑΤΑ: Το Biasp30 πέτυχε χαμηλότερη μέση τιμή γλυκόζης (Average Blood Glucose- ABG) για το διάστημα 23:00-03:00 (PHI: 135.08± 28.94mg/dl, Biasp30: 117.75± 21.24 mg/dl, p<0.001) και το διάστημα 00:00-06:00 (PHI: 120.42 ±23.13mg/dl, Biasp30: 111.17± 14.74, p=0.008, περισσότερο χρόνο σε επίπεδα γλυκόζης κάτω από το όριο των 70mg/dl (Time Below Range-TBR) για το διάστημα 23:00-03:00 (PHI: 58.75 ± 99.49min, Biasp30: 179.17 ± 249.30min,p=0.003). Το PHI πέτυχε χαμηλότερη ABG πριν το πρωινό (PHI: 111.75± 23.9 mg/dl, Biasp30: 128.25± 35.9mg/dl, p=0.013). Δεν υπήρξαν διαφορές μεταξύ των δύο ομάδων στην ABG για το συνολικό διάστημα του 24ώρου (PHI: 140.08± 20.71mg/dl, Biasp30:138.08± 17.93mg/dl,p=0.502), στο χρόνο εντός του στόχου (Time In Range -TIR-% του συνολικού χρόνου καταγραφής) (PHI: 75.92± 12.42%, Biasp30:74.17± 15.90%, p=0.534) και στο συνολικό TBR (% of the total CGM time) (PHI: 4.17± 3.55%, Biasp30: 5.5± 3.40%, p=0.063),και στο TBR για το διάστημα 00:00-06:00 period (PHI: 8.45 ± 8.81%, Biasp30: 12.08 ± 16.13%, p=0.253). Οι συνολικές μονάδες ινσουλίνης ήταν περισσότερες με το Biasp30(PHI: 47.92± 12.18 IU, Biasp30:49.58± 14.12 IU, p=0.001). HbA1c, GA and FA εμφάνισαν στατιστικά σημαντική συσχέτιση με την ABG (GA: r=0.512, p=0.011, FA: r=0.555, p=0.005, HbA1c: r=0.642, p=0.001).ΣΥΜΠΕΡΑΣΜΑΤΑ: Σε καλά ρυθμισμένους ασθενείς με ΣΔτ2 τα PIA και αποτελούν ισάξιες επιλογές με τα PHI. Από τους διάφορους δείκτες γλυκαιμικής μεταβλητότητας η HbA1c παρουσιάζει την ισχυρότερη συσχέτιση με την ABG.

Role of Digital Engagement in Diabetes Care Beyond Measurement: Retrospective Cohort Study

Background The use of remote data capture for monitoring blood glucose and supporting digital apps is becoming the norm in diabetes care. One common goal of such apps is to increase user awareness and engagement with their day-to-day health-related behaviors (digital engagement) in order to improve diabetes outcomes. However, we lack a deep understanding of the complicated association between digital engagement and diabetes outcomes. Objective This study investigated the association between digital engagement (operationalized as tagging of behaviors alongside glucose measurements) and the monthly average blood glucose level in persons with type 2 diabetes during the first year of managing their diabetes with a digital chronic disease management platform. We hypothesize that during the first 6 months, blood glucose levels will drop faster and further in patients with increased digital engagement and that difference in outcomes will persist for the remainder of the year. Finally, we hypothesize that disaggregated between- and within-person variabilities in digital engagement will predict individual-level changes in blood glucose levels. Methods This retrospective real-world analysis followed 998 people with type 2 diabetes who regularly tracked their blood glucose levels with the Dario digital therapeutics platform for chronic diseases. Subjects included “nontaggers” (users who rarely or never used app features to notice and track mealtime, food, exercise, mood, and location, n=585) and “taggers” (users who used these features, n=413) representing increased digital engagement. Within- and between-person variabilities in tagging behavior were disaggregated to reveal the association between tagging behavior and blood glucose levels. The associations between an individual’s tagging behavior in a given month and the monthly average blood glucose level in the following month were analyzed for quasicausal effects. A generalized mixed piecewise statistical framework was applied throughout. Results Analysis revealed significant improvement in the monthly average blood glucose level during the first 6 months (t=−10.01, P<.001), which was maintained during the following 6 months (t=−1.54, P=.12). Moreover, taggers demonstrated a significantly steeper improvement in the initial period relative to nontaggers (t=2.15, P=.03). Additional findings included a within-user quasicausal nonlinear link between tagging behavior and glucose control improvement with a 1-month lag. More specifically, increased tagging behavior in any given month resulted in a 43% improvement in glucose levels in the next month up to a person-specific average in tagging intensity (t=−11.02, P<.001). Above that within-person mean level of digital engagement, glucose levels remained stable but did not show additional improvement with increased tagging (t=0.82, P=.41). When assessed alongside within-person effects, between-person changes in tagging behavior were not associated with changes in monthly average glucose levels (t=1.30, P=.20). Conclusions This study sheds light on the source of the association between user engagement with a diabetes tracking app and the clinical condition, highlighting the importance of within-person changes versus between-person differences. Our findings underscore the need for and provide a basis for a personalized approach to digital health.

Effect of Average Blood Glucose Greater Than 140 mg/dL on Adverse Patient Outcomes in Adult Medical/Surgical Patients

Background: In hospitalized patients, hyperglycemia is defined as blood glucose greater than 140 mg/dL. Hyperglycemia can lead to the development of nosocomial infections as well as cardiovascular events. Despite these risks, current guidelines recommend blood glucose be maintained between 140-180 mg/dL. Previous studies have shown that elevated blood glucose levels are associated with increased patient mortality. However, these studies assessed blood glucose at a single point in time. Objective: The primary objective of this study is to determine the impact of average blood glucose >140 mg/dL on a composite outcome of intensive care unit transfer, death, length of stay > 4 days, development of nosocomial infection, or new cardiovascular event (myocardial infarction [MI], ischemic stroke, deep vein thrombosis [DVT], pulmonary embolism [PE], or new onset heart failure) occurring during patient admission. Methods: This single centered, randomized, case-control, retrospective chart review sorted adult medical/surgical patients into two groups, average blood glucose ≤140 mg/dL or >140 mg/dL, of 120 patients each. Results: Forty-seven (39.2%) patients in the >140 mg/dL group experienced the primary composite outcome versus 27 (22.5%) patients in the ≤140 mg/dL group (p=0.005). Secondary outcomes found that patients with diabetes in the >140 mg/dL group were more likely to experience the primary outcome than those in the ≤140 mg/dL group (41 (48.8%) vs 3 (13.6%) p=0.003). Conclusions: This study found that medical/surgical patients with an average blood glucose >140 mg/dL may be at an increased risk of developing adverse patient outcomes.