The Clinical Presentation of Puumala Hantavirus Induced Hemorrhagic Fever with Renal Syndrome Is Related to Plasma Glucose Concentration

Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome characterized by thrombocytopenia, increased capillary leakage, and acute kidney injury (AKI). As glucosuria at hospital admission predicts the severity of PUUV infection, we explored how plasma glucose concentration associates with disease severity. Plasma glucose values were measured during hospital care in 185 patients with PUUV infection. They were divided into two groups according to maximum plasma glucose concentration: P-Gluc < 7.8 mmol/L (n = 134) and P-Gluc ≥ 7.8 mmol/L (n = 51). The determinants of disease severity were analyzed across groups. Patients with P-Gluc ≥7.8 mmol/L had higher hematocrit (0.46 vs. 0.43; p < 0.001) and lower plasma albumin concentration (24 vs. 29 g/L; p < 0.001) than patients with P-Gluc < 7.8 mmol/L. They presented with higher prevalence of pulmonary infiltrations and pleural effusion in chest radiograph, higher prevalence of shock and greater weight change during hospitalization. Patients with P-Gluc ≥ 7.8 mmol/L were characterized by lower platelet count (50 vs. 66 × 109/L; p = 0.001), more severe AKI (plasma creatinine 272 vs. 151 µmol/L; p = 0.001), and longer hospital treatment (8 vs. 6 days; p < 0.001) than patients with P-Gluc < 7.8 mmol/L. Plasma glucose level is associated with the severity of capillary leakage, thrombocytopenia, inflammation, and AKI in patients with acute PUUV infection.

Prediabetes and risk of heart failure: the link grows stronger

In a recently published paper in Cardiovascular Diabetology, Sinha et al. (Association of fasting glucose with lifetime risk of incident heart failure: the Lifetime Risk Pooling Project. Cardiovasc Diabetol. 2021;20(1):66) reported that prediabetes (defined as a fasting plasma glucose concentration of 100–125 mg/dL) was associated with a higher lifetime risk of heart failure in middle-aged White adults and Black women, with the association attenuating in older Black women. This study provides important evidence that the risk of heart failure is increased in people with a fasting plasma glucose concentration as low as 100 mg/dL, supporting the definition of prediabetes according to the American Diabetes Association guideline. The study also strongly supports the notion that prediabetes should be regarded not only as a high-risk state for the development of diabetes but also as a risk factor for cardiovascular morbidity.

Improved Functional Causal Likelihood-Based Causal Discovery Method for Diabetes Risk Factors

Diabetes mellitus is a disease that has reached epidemic proportions globally in recent years. Consequently, the prevention and treatment of diabetes have become key social challenges. Most of the research on diabetes risk factors has focused on correlation analysis with little investigation into the causality of these risk factors. However, understanding the causality is also essential to preventing the disease. In this study, a causal discovery method for diabetes risk factors was developed based on an improved functional causal likelihood (IFCL) model. Firstly, the issue of excessive redundant and false edges in functional causal likelihood structures was resolved through the construction of an IFCL model using an adjustment threshold value. On this basis, an IFCL-based causal discovery algorithm was designed, and a simulation experiment was performed with the developed algorithm. The experimental results revealed that the causal structure generated using a dataset with a sample size of 2000 provided more information than that produced using a dataset with a sample size of 768. In addition, the causal structures obtained with the developed algorithm had fewer redundant and false edges. The following six causal relationships were identified: insulin→plasma glucose concentration, plasma glucose concentration→body mass index (BMI), triceps skin fold thickness→BMI and age, diastolic blood pressure→BMI, and number of times pregnant→age. Furthermore, the reasonableness of these causal relationships was investigated. The algorithm developed in this study enables the discovery of causal relationships among various diabetes risk factors and can serve as a reference for future causality studies on diabetes risk factors.

Euglycemic Ketoacidosis as a Complication of SGLT2 Inhibitor Therapy

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are drugs designed to lower plasma glucose concentration by inhibiting Na+-glucose–coupled transport in the proximal tubule. Clinical trials demonstrate these drugs have favorable effects on cardiovascular outcomes to include slowing the progression of CKD. Although most patients tolerate these drugs, a potential complication is development of ketoacidosis, often with a normal or only a minimally elevated plasma glucose concentration. Inhibition of sodium-glucose cotransporter-2 in the proximal tubule alters kidney ATP turnover so that filtered ketoacids are preferentially excreted as Na+ or K+ salts, leading to indirect loss of bicarbonate from the body and systemic acidosis under conditions of increased ketogenesis. Risk factors include reductions in insulin dose, increased insulin demand, metabolic stress, low carbohydrate intake, women, and latent autoimmune diabetes of adulthood. The lack of hyperglycemia and nonspecific symptoms of ketoacidosis can lead to delays in diagnosis. Treatment strategies and various precautions are discussed that can decrease the likelihood of this complication.

Effect of Sample Volume Variation and Delay in Analysis on Plasma Glucose Concentration in Sri Lankan Healthy Adults

The correct volume of sample and time of storing prior to the analysis are important considerations in the estimation of plasma glucose concentration of patients. The present study was to determine the effect of sample volume variation and time delay in the analysis of plasma glucose results in healthy adults. A total of 30 individuals aged between 20 and 30 years were selected for the study. Blood samples were collected into three fluoride-oxalate collection tubes separately. The results revealed that the sample volume variation from 2.0 mL fluoride-oxalate tube to 1.0 mL and 3.0 mL did not significantly affect the plasma glucose concentration ( p > 0.05). However, the plasma glucose concentration in the sample significantly decreased upon delaying the analysis. The mean fasting plasma glucose concentration of analysis after one hour of collection and analysis after three hours of collection was not significantly different ( p > 0.05). The mean fasting plasma glucose concentrations between one hour and five hours timepoints after collection ( p < 0.001) and between three hours and five hours after collection ( p = 0.014) were significantly different. In conclusion, overfilling and underfilling (2.0 ± 1.0 mL) of fluoride-oxalate tubes did not affect the plasma glucose results significantly. If the samples are analyzed within three hours of collection, the time dependent change too is not statistically significant.

Breed and diurnal effects on leptin and glucose concentrations in tropical cattle

The effects of breed and time of day was evaluated on plasma leptin and glucose concentrations in four breeds of cattle. The breeds were Muturu, White Fulani, Ndama and Muturu x White Fulani cross. Animals had ad-libitum access to feed and water. Each animal was weighed daily and bled by jugular venipuncture using Vacutainer kits for three consecutive days. Plasma leptin was determined using the Millipore Multi-species radioimmunoassay and plasma glucose was determined using the Wako Autokit Glucose technique. Plasma leptin was significantly (P<0.0001) dependent on breed. The Muturu breed had the lowest amount of leptin (3.9 ± 1.8 ng/ml) while the White Fulani breed had the highest level (8.5 ± 3.2 ng/ml). There was a significant correlation between bodyweight and leptin. Leptin level was not affected by time of day. Mean plasma glucose ranged from 42.7 to 54.7 mg/dL and was significantly (P = 0.019) dependent on cattle breed. Also, time of day had no effect on plasma glucose concentration. These data indicated that significant breed differences exist in leptin concentrations in tropical cattle. These differences may reflect the disparity in muscularity and adiposity in the breeds.

Evaluation of the relationship between the one-hour plasma glucose concentration and beta-cell functions and cardiometabolic parameters during oral glucose tolerance test in obese children and adolescents

BackgroundIn this study, we aimed to evaluate the relationship between the 1-h plasma glucose (PG) level in the oral glucose tolerance test (OGTT) and conventional glycemic parameters, indices evaluating beta-cell functions, and cardiometabolic risk factors.MethodsThe records of 532 obese patients who were followed up in the Pediatric Endocrinology Polyclinic and who underwent standard OGTT were evaluated retrospectively. All patients were divided into two groups according to OGTT data as the 1-h plasma glucose concentration <155 mg/dL (n=329) and ≥155 mg/dL (n=203). Patients with normal glucose tolerance (NGT) were divided into two groups according to the 1-h PG level, as 218 patients with NGT 1 h-low (<155 mg/dL) and 53 patients with high NGT 1 h-high (≥155 mg/dL).ResultsThere was a statistically significant difference between the lipid profiles of individuals with NGT 1 h-low (<155 mg/dL) and individuals with NGT 1 h-high (≥155 mg/dL) (p<0.001). Total cholesterol, LDL cholesterol, and triglyceride levels were higher, while HDL cholesterol levels were lower in individuals with NGT 1 h-high (≥155 mg/dL). The indices evaluating beta-cell functions were significantly higher in individuals with NGT 1 h-low (<155 mg/dL).ConclusionAs a result, a plasma glucose concentration above or equal to 155 mg/dL at 1 h during an OGTT is associated with a worse clinical phenotype characterized by changes in insulin sensitivity and β-cell function. Therefore, this threshold value can predict the progression of prediabetes in obese young people with NGT.