Antidiabetic Activity of Sungkai (Peronema canescens Jack) Leaves Ethanol Extract on the Male Mice Induced Alloxan Monohydrate

Sungkai (Peronema canescens Jack) is an alternative natural ingredient that can be used as an antidiabetic containing several secondary metabolites which are thought to reduce blood glucose levels by inhibiting the action of the α-glucokinase enzyme and increasing the activity of antioxidant enzymes and being able to regenerate β-cells, damaged pancreas so that insulin deficiency can be overcome. The aim of this study was to determine the effect of P. canescens leaves ethanol extract on antidiabetic activity and to determine the effect of various doses of sungkai leaf ethanol extract as antidiabetic. The scientific research method used in this study was a completely randomized design (CRD) and data analysis used in this study is the one way ANOVA, following by the Duncan test. Blood glucose measurement in treated mice was carried out 3 times. Mice were devided into five groups, three mice in each group, and each group was administered different dosages of sungkai extract (T1 = extract 175 mg/kg body weight; T2 = extract 350 mg/kg body weight; T3 = extract 700 mg/ kg body weight). First, the mice were acclimatized for six days and the injection of treatment was started at day 7. Blood glucose levels, urine volume, body weight and daily drinking of mice was carried out before induction (day 0), after induction (day 8) and after the end of treatment for 10 days (day 18), was carried out using the Point of Care Test (POCT) method using the Easy Touch GCU. The results showed that the ethanol extract of sungkai leaves had the potential to reduce blood glucose levels in mice. The ethanol extract of sungkai leaves at a dose of 350 mg/kg body weight has the most optimal potential to reduce blood glucose levels, urine volume, daily drinking, and body weight.

A comparative study of glycaemic variability using four different Point-of-Care Testing (POCT) devices

Background: Blood glucose measurement is a way of monitoring changes in glycaemia. Different point-of-care testing (POCT) glucose meters are on the market and hence there is an increase in variability of the results given by these meters. This study sought to measure the glycaemic variability using four different point-of-care glucose meters Methods: Four point of care glucometers namely; Accu-chek performer nano, OneTouch select plus flex, OneTouch Ultra 2 and Easy Check were used test blood samples from a total of 100 patients visiting the collection point of the Tamale Teaching Hospital Laboratory. A chemistry analyzer (Mindray BS 240 fully automated) was used as the reference method. Results: The median (interquartile range), Bland Altman Plot and Regression Equation were used to assess the agreement between the various meters and the reference method. The OneTouch Select plus had the least bias (-0.85) and the the OneTouch Ultra 2 had the highest bias (1.49). The OneTouch select had the best limits of agreement (-2.51 – 0.82) and the OneTouch Ultra 2 had the widest limits of agreement (-1.91 – 4.89) when compared to the reference method. Conclusion: OneTouch Select plus had the best agreement with the reference method and the OneTouch Ultra 2 had the least agreement with the reference method. Blood glucose meters should be used for the monitoring of blood glucose however, it should not be used as a diagnostic tool. Annals of Medical Laboratory Science (2021) 1(2), 1 - 8 Keywords: glucometer, point-of-care, blood glucose, glycaemia

Two-point flap blood glucose measurement for monitoring propeller flap perfusion – a case report

Monitoring flap perfusion is a helpful method of postoperative care allowing for proper early intervention in and salvage of a flap. The basic means of blood supply monitoring include the assessment of color, warmth, skin tension, and a pin-prick examination. Along with advances in microvascular surgery, methods of flap blood circulation assessment have been also developed. This paper presents the case of a peroneal artery propeller perforator flap for the treatment of a secondary wound resulting from an orthopedic complication of ankle arthrodesis. Blood glucose level (BGL) was used to monitor flap perfusion as an early indicator of possible venous congestion. It is well known that in case of vascular compromise, whether arterial or venous, the flap salvage rate depends on how fast the vascular problem is resolved. Arterial insufficiency is easily detectable, and the arterial flow may be also monitored with minidoppler, however venous insufficiency causes symptoms less dynamically. This fact emphasized the importance of early prediction of venous insufficiency before clinical symptoms appear. It is crucial that the time between pedicle impairment and clinical signs is as short as possible.

Betegségismeret 2-es típusú diabetesszel élők körében: a Diabetes Knowledge Test magyar nyelvű validálása

Összefoglaló. Bevezetés: Magyarországon a KSH szerint több mint 1 millió ismert cukorbeteg él. A diabetes karbantartásához elengedhetetlen a betegek tudásának, készségeinek és önhatékonyságának növelése és fenntartása. A legelterjedtebb diabetes-betegségismeretteszt a 23 kérdéses Michigan Diabetes Knowledge Test. Első 14 tétele általános tudást mér, például az ételek tápanyagtartalmával és a vércukorszint-változás okaival kapcsolatban. További 9 kérdése az inzulinhasználatról szól. Célkitűzés: Célunk ennek a tesztnek a magyar nyelvű validálása, valamint összefüggéseinek vizsgálata szociodemográfiai és betegségváltozókkal. Módszer: Keresztmetszeti kérdőíves kutatásunkban a tesztcsomagot 129, inzulint használó, 2-es típusú diabeteses beteg töltötte ki (84 nő, átlagéletkor: 59,67; szórás: 12,6) elsősorban online, betegszervezeteken keresztül. Eredmények: A betegségismeret-teszt belső konzisztenciája 0,603, ami elfogadható érték. A 23 kérdés helyes kitöltési arányának átlaga 81,66%, ami az amerikai arányokhoz hasonló, más kutatások speciális csoportjaihoz képest azonban kifejezetten magas érték. A válaszadók a ketoacidosis fogalmát, az egyes ételek tápanyag-összetevőit és az elfogyasztott ételek vércukorszintre gyakorolt hatását illető kérdésekre tudták a választ a legkevésbé. A magyar teszt a szakirodalomnak megfelelő gyenge, negatív irányú összefüggésben áll az életkorral, és pozitív a kapcsolata az inzulinhasználat hosszával, valamint a napi vércukorszintmérés és inzulinbeadás számával. A betegségismeretet függetlenül egyedül a napi vércukorszintmérés mennyisége jósolta meg. A teszt konvergens validitását mutatja gyenge, de szignifikáns összefüggése az egészségértést mérő Brief Health Literacy Screening kérdésekkel. Következtetés: A magyar nyelvű Diabetes Betegségismeret Teszt alkalmas a diabetesszel élők tudásszintjének felmérésére. Mintánkban a betegségismeret magas szintje az inzulint használók megfelelő edukációjával függhet össze. Ugyanakkor eredményeink felhívják a figyelmet a betegek diétával kapcsolatos magasabb szintű tudásának szükségességére. Orv Hetil. 2021; 162(22): 870–877. Summary. Introduction: According to the Hungarian Central Statistical Office, more than 1 million diabetic patients live in Hungary. It is essential to enhance and sustain the knowledge, skills and self-efficacy of patients. The most widely used measurement of illness knowledge is the 23-item Michigan Diabetes Knowledge Test (DKT). Its first 14 items measure general knowledge: the nutritional value of food, and causes of change in blood glucose level. Its further 9 items are about insulin usage. Objective: To examine the reliability and the validity of the Hungarian version of DKT2 as well as its association with sociodemographic and illness-related variables. Methods: In our cross-sectional quantitative study, 129 patients (84 women, mean age: 59.67; SD = 12.6) diagnosed with type 2 diabetes mellitus using insulin therapy filled in a questionnaire online. Results: The α coefficient for the test is 0.603, which is acceptable. The mean of the correct answer rate is 81.66%, which resembles the American results, but it is higher than that of other specific groups. Problem areas for our patients included interpreting ketoacidosis, the nutritional value of foods and the effect of foods on blood glucose level. The score of the Hungarian test – in accordance with the literature – correlates negatively with age, positively with the year of insulin-usage and with the number of daily insulin intake and of blood glucose measurement. Illness knowledge was independently predicted only by the number of daily blood glucose measurement. The convergent validity of the Hungarian test is supported by its weak but significant association with Brief Health Literacy Screen questions. Conclusion: The Hungarian DKT2 properly measures the illness knowledge of diabetic patients. Their high level of knowledge can be traced back to the speciality of the subjects as well as to the overall education of insulin users. Nevertheless, our results draw attention to the necessity of enhancing the level of dietetic knowledge of patients. Orv Hetil. 2020; 162(22): 870–877.

HbA1c Is Not Potent Glucose Control Assessment Tool in Type 2 Diabetes Patients Treated With Insulin

Glycated haemoglobin (HbA1c) is used for defining of glucose control in diabetic patients nevertheless its insufficiency to present overall control in some specific cases. Continuous Glucose Monitoring (CGM) is usually used for adjustment of insulin doses but the derived data are helpful for exact glucose control. We assess the potency of HbAc for defining of real glucose control in subgroup of type 2 diabetes patients treated with different insulin regimens. We studied 54 diabetic patients (33 men, 21 women; age 60.23±5.99 years, disease duration 12.64±5.02 years) - 33 with type 2 diabetes on pre-mixed insulin, 21 with type 2 on multiple insulin injection (MII). Patients performed multiple daily blood glucose measurements of fasting and prandial blood glucose for three months period. HbA1c was measured and CGM by using iProTM for seven days was performed at the end of this period. In pre-mixed insulin treated group and in intensified regimen group, moderate positive correlation was found between HbA1c and mean blood glucose derived from CGM (7.64±1.40% and 7.69±1.23%, respectively 7.64±1.48mmol/l and 7.60±1.30mmol/l), with r1=0.642 (p<0.01) and r2=0.570 (p<0.05). Even lower was correlation between HbA1c and time-in-range (r1=0.431 and r2 =0.401). There were no correlations between HbA1c and percentage of time spent below the target and number of hypoglycemic episodes in each group. Same trend of correlations was found comparing HbA1c and mean BG level in eight-point profile. Based on HbA1c assessment 36.36% of patients on premixed insulin, 19.05% of type 2 patients on MII were with good control. After estimation of results from SMBG these percentage were respectively 28.14% and 12.11%. CGM defined 27.27% of patients on premixed insulin, 13.80% of type 2 patients on MII as well controlled. We conclude that in insulin treated type 2 patients HbA1c gives relative information about overall control with no precise presenting of glucose fluctuations and out-of-range values of blood glucose with no information about hypoglycemic episodes. Nevertheless, short observed period CGM data could give much information that is comparable to three months blood glucose measurement and could replace the use of HbA1c for assessment of overall control. Reference: (1) Chehregosha H, et al. Diabetes Ther. 2019; 10, 853–863 (2) Beyond A1c Writing Group. Diab Care. 2018; 41: e92-e94 (3) Hirsch I et al. Diabetes Tech Ther 2017, 19 (3): S38-S48

Hypoglycemic effect of katakakhadiradi kashayam by alleviating the oxidative damage in experimentally induced diabetic rats

At present, herbal plants and their biologically active components have acquired importance in diabetes mellitus (DM) management, which has spread worldwide. The current study was carried out to analyse the antidiabetic action of Katakakhadiradi kashayam in streptozotocin administered diabetic rats. The study was done in wistar rats by inducing diabetes using streptozotocin and nicotinamide. Diabetic rats were given katakakhadiradi kashayam with various doses of 100, 200 and 300 mg/kg/b.wt for 14 days, and its efficacy was compared with glibenclamide drug. The hypoglycemic effect of this katakakhadiradi kashayam was tested by taking blood glucose measurement in experimental rats. The oxidative damage caused by streptozotocin was analysed by LPO levels and the antioxidants status was assessed by GSH levels, GPx, SOD and CAT activities in pancreatic tissues. The antidiabetic study of katakakhadiradi kashayam showed reduction in hyperglycemia by reducing the oxidative damage in pancreatic tissue and improving the antioxidants. Overall, the reports of the study showed that katakakhadiradi kashayam could be used to improve management of diabetic rats. The acquired data suggest the hypoglycemic efficacy of katakakhadiradi kashayam, which is practically a safe herbal formulation and may be used as a good alternative to cure diabetes mellitus.

Challenges in management of transient hyperinsulinism – a retrospective analysis of 36 severely affected children

Objectives Transient hyperinsulinism (THI) is a hypoglycemia disorder which resolves spontaneously within the first weeks or months of life. The pathomechanism of THI is not elucidated yet; however, it is known that perinatal stress predisposes for THI. We aimed to characterize the clinical phenotype and treatment of children with THI, and to identify options for improved management. Methods A retrospective analysis of 36 children with THI treated at the University Children’s Hospital Düsseldorf between 2007 and 2019 was performed. Results All children had risk factors for neonatal hypoglycemia or indicators of perinatal stress. Eighty three percent were diagnosed with hypoglycemia on day of life (DOL)1. None of the six diagnosed later had routine blood glucose screening and showed significantly lower blood glucose levels at the time of first blood glucose measurement compared to the children diagnosed on DOL1. Ninety seven percent of all children received intravenous glucose, 42% received continuous glucagon and 81% were started on diazoxide. Diazoxide withdrawal and subsequent fasting tests lacked standardization and were based on clinical experience. Three patients had a subsequent episode of hypoglycemia, after fasting studies only demonstrated “clinical” remission without proving the ability to ketogenesis. Conclusions Any kind of perinatal stress might pose a risk to develop THI, and postnatal monitoring for hypoglycemia still needs to be improved. Diazoxide is effective in children with THI; however, further studies are needed to guide the development of criteria and procedures for the initiation and discontinuation of treatment. Furthermore, establishing consensus diagnostic criteria/definitions for THI would improve comparability between studies.