Application of Continuous Glucose Monitoring for Assessment of Individual Carbohydrate Requirement during Ultramarathon Race

Background: The current study intended to evaluate the feasibility of the application of continuous glucose monitoring to guarantee optimal intake of carbohydrate to maintain blood glucose levels during a 160-km ultramarathon race. Methods: Seven ultramarathon runners (four male and three female) took part in the study. The glucose profile was monitored continuously throughout the race, which was divided into 11 segments by timing gates. Running speed in each segment was standardized to the average of the top five finishers for each gender. Food and drink intake during the race were recorded and carbohydrate and energy intake were calculated. Results: Observed glucose levels ranged between 61.9–252.0 mg/dL. Average glucose concentration differed from the start to the end of the race (104 ± 15.0 to 164 ± 30.5 SD mg/dL). The total amount of carbohydrate intake during the race ranged from 0.27 to 1.14 g/kg/h. Glucose concentration positively correlated with running speeds in segments (P < 0.005). Energy and carbohydrate intake positively correlated with overall running speed (P < 0.01). Conclusion: The present study demonstrates that continuous glucose monitoring could be practical to guarantee optimal carbohydrate intake for each ultramarathon runner.

Roles of Peritoneal Clearance and Residual Kidney Removal in Control of Uric Acid in Patients on Peritoneal Dialysis

Background: There have been few systematic studies regarding clearance of uric acid (UA) in patients undergoing peritoneal dialysis (PD). This study investigated peritoneal UA removal and its influencing factors in patients undergoing PD.Methods: This cross-sectional study enrolled patients who underwent peritoneal equilibration test and assessment of Kt/V from April 1, 2018 to August 31, 2019. Demographic data and clinical and laboratory parameters were collected, including UA levels in dialysate, blood, and urine.Results: In total, 180 prevalent patients undergoing PD (52.8% men) were included. Compared with the normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1±6.2 vs. 42.0±8.0 L/week/1.73m2; P=0.008). Furthermore, higher transporters (high or high-average) exhibited greater peritoneal UA clearance, compared with lower transporters (low or low-average) (42.0±7.0 vs. 36.4±5.6 L/week/1.73 m2; P<0.001). Among widely used solute removal indicators, peritoneal creatinine clearance showed the best performance for prediction of higher peritoneal UA clearance in receiver operating characteristic curve analysis [area under curve (AUC) 0.96; 95% confidence interval [CI], 0.93-0.99]. Peritoneal UA clearance was independently associated with continuous SUA [standardized coefficient (β), -0.32; 95% CI, -6.42 to -0.75] and hyperuricemia [odds ratio (OR), 0.86; 95% CI, 0.76–0.98] status, only in patients with lower (≤2.74 mL/min/1.73 m2) measured glomerular filtration rate (mGFR). In those patients with lower mGFR, lower albumin level (β -0.24; 95%CI -7.26 to -0.99), lower body mass index (β -0.29; 95%CI -0.98 to -0.24), higher transporter status (β 0.24; 95%CI 0.72-5.88) and greater dialysis dose (β 0.24; 95%CI 0.26-3.12) were independently associated with continuous peritoneal UA clearance. Furthermore, each 1kg/m2 decrease in body mass index (OR 0.79; 95% CI 0.63-0.99), each 1g/dL decrease in albumin level (OR 0.08; 95%CI 0.01-0.47), and each 0.1% increase in average glucose concentration in dialysate (OR 1.56; 95%CI 1.11-2.19) were associated with greater peritoneal UA clearance (>39.8 L/week/1.73m2).Conclusions: For patients undergoing PD who exhibited worse residual kidney function, peritoneal clearance dominated in SUA balance. Increasing dialysis dose or average glucose concentration may aid in controlling hyperuricemia in lower transporters.

Roles of Peritoneal Clearance and Residual Kidney Removal in Control of Uric Acid in Patients on Peritoneal Dialysis

Background: There have been few systematic studies regarding clearance of uric acid (UA) in patients undergoing peritoneal dialysis (PD). This study investigated peritoneal UA removal and its influencing factors in patients undergoing PD. Methods: This cross-sectional study enrolled patients who underwent peritoneal equilibration test and assessment of Kt/V from April 1, 2018 to August 31, 2019. Demographic data and clinical and laboratory parameters were collected, including UA levels in dialysate, blood, and urine. Results: In total, 180 prevalent patients undergoing PD (52.8% men) were included. Compared with the normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1±6.2 vs. 42.0±8.0 L/week/1.73m 2 ; P =0.008). Furthermore, higher transporters (high or high-average) exhibited greater peritoneal UA clearance, compared with lower transporters (low or low-average) (42.0±7.0 vs. 36.4±5.6 L/week/1.73 m 2 ; P <0.001). Among widely used solute removal indicators, peritoneal creatinine clearance showed the best performance for prediction of higher peritoneal UA clearance in receiver operating characteristic curve analysis [area under curve (AUC) 0.96; 95% confidence interval [CI], 0.93-0.99]. Peritoneal UA clearance was independently associated with continuous SUA [standardized coefficient (β), -0.32; 95% CI, -6.42 to -0.75] and hyperuricemia [odds ratio (OR), 0.86; 95% CI, 0.76–0.98] status, only in patients with lower (≤2.74 mL/min/1.73 m 2 ) measured glomerular filtration rate (mGFR). In those patients with lower mGFR, lower albumin level (β -0.24; 95%CI -7.26 to -0.99), lower body mass index (β -0.29; 95%CI -0.98 to -0.24), higher transporter status (β 0.24; 95%CI 0.72-5.88) and greater dialysis dose (β 0.24; 95%CI 0.26-3.12) were independently associated with continuous peritoneal UA clearance. Furthermore, each 1kg/m 2 decrease in body mass index (OR 0.79; 95% CI 0.63-0.99), each 1g/dL decrease in albumin level (OR 0.08; 95%CI 0.01-0.47), and each 0.1% increase in average glucose concentration in dialysate (OR 1.56; 95%CI 1.11-2.19) were associated with greater peritoneal UA clearance (>39.8 L/week/1.73m 2 ). Conclusions: For patients undergoing PD who exhibited worse residual kidney function, peritoneal clearance dominated in SUA balance. Increasing dialysis dose or average glucose concentration may aid in controlling hyperuricemia in lower transporters.

Roles of Peritoneal Clearance and Residual Kidney Removal in Control of Uric Acid in Patients on Peritoneal Dialysis

Background: There have been few systematic studies regarding clearance of uric acid (UA) in patients undergoing peritoneal dialysis (PD). This study investigated peritoneal UA removal and its influencing factors in patients undergoing PD. Methods: This cross-sectional study enrolled patients who underwent peritoneal equilibration test and assessment of Kt/V from April 1, 2018 to August 31, 2019. Demographic data and clinical and laboratory parameters were collected, including UA levels in dialysate, blood, and urine. Results: In total, 180 prevalent patients undergoing PD (52.8% men) were included. Compared with the normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1±6.2 vs. 42.0±8.0 L/week/1.73m2; P=0.008). Furthermore, higher transporters (high or high-average) exhibited greater peritoneal UA clearance, compared with lower transporters (low or low-average) (42.0±7.0 vs. 36.4±5.6 L/week/1.73 m2; P<0.001). Among widely used solute removal indicators, peritoneal creatinine clearance showed the best performance for prediction of higher peritoneal UA clearance in receiver operating characteristic curve analysis [area under curve (AUC) 0.96; 95% confidence interval [CI], 0.93-0.99]. Peritoneal UA clearance was independently associated with continuous SUA [standardized coefficient (β), -0.32; 95% CI, -6.42 to -0.75] and hyperuricemia [odds ratio (OR), 0.86; 95% CI, 0.76–0.98] status, only in patients with lower (≤2.74 mL/min/1.73 m2) measured glomerular filtration rate (mGFR). In those patients with lower mGFR, lower albumin level (β -0.24; 95%CI -7.26 to -0.99), lower body mass index (β -0.29; 95%CI -0.98 to -0.24), higher transporter status (β 0.24; 95%CI 0.72-5.88) and greater dialysis dose (β 0.24; 95%CI 0.26-3.12) were independently associated with continuous peritoneal UA clearance. Furthermore, each 1kg/m2 decrease in body mass index (OR 0.79; 95% CI 0.63-0.99), each 1g/dL decrease in albumin level (OR 0.08; 95%CI 0.01-0.47), and each 0.1% increase in average glucose concentration in dialysate (OR 1.56; 95%CI 1.11-2.19) were associated with greater peritoneal UA clearance (>39.8 L/week/1.73m2). Conclusions: For patients undergoing PD who exhibited worse residual kidney function, peritoneal clearance dominated in SUA balance. Increasing dialysis dose or average glucose concentration may aid in controlling hyperuricemia in lower transporters.

HbA1c as a diagnostic tool in diabetes mellitus

Hemoglobin A1c (HbA1c) expresses the ratio between glycated HbA1 and total HbA1 and reflects the average plasma glucose concentration the preceding 2-3 months. It has become the most important marker of chronic hyperglycemia and is closely correlated to late complications of diabetes. The analysis has now been standardized and traceable to an international reference material and reference methods. Standardization of the HbA1c analyses paved the way for it to become the primary tool for diagnosing diabetes. Despite some limitations in which HbA1c is not representative of average glucose concentration, the inclusion of HbA1c as a diagnostic tool will simplify the diagnostics of diabetes compared with the glucose criteria, and hopefully improve the prevention of late complications of diabetes.

Effects of lactational level on reactivation of ovarian function, and interval from parturition to first visual oestrus and conception in high-producing holstein cows

ABSTRACTData were collected on 19 high-producing Holstein dairy cows from day 20 post partum until they were either determined pregnant or reached 150 days post partum. Blood metabolites (progesterone (P4), glucose, beta-hydroxybutyrate (BHBA) and free fatty acids (FFA)) were related to the interval from parturition to first luteal phase, first visual oestrus and conception. Prior to data analysis, cows were divided into two groups based on their 120-day milk production and designated as below herd average (BHA; no. = 9) or above herd average (AHA; no. = 10). Average 120-day milk productions for BHA, AHA and herdmates (no. = 56) were 3932 (s.e. 157), 4841 (s.e. 60) and 4353 (s.e. 96) kg, respectively. Days from parturition to first luteal phase were not different between the BHA and AHA groups (31·7 (s.e. 1·7) and 31·5 (s.e. 6·9), respectively). In contrast, days from parturition to first visual oestrus and to conception oestrus were less for the BHA group than for the AHA group (46·8 (s.e. 4·6) and 76·9 (s.e. 7·5) v. 67·7 (s.e. 5·2) and 102·5 (s.e. 9·2) days, respectively (P < 0·05)). Further, average glucose concentration from day 20 to first luteal phase was higher (P < 0·05) for the BHA group than for the AHA group (64·1 (s.e. 1·6) v. 58·4 (s.e. 1·6) mg/dl). From day 20 to first visual oestrus, plasma glucose concentration increased while BHBA and FFA declined; all three metabolites then remained relatively constant until conception. These data suggest that as the amount of milk a dairy cow produces increases, the interval from parturition to first visual oestrus and conception increases. These data are consistent with a suppression of oestrus behaviour rather than with a delayed interval to ovarian cyclicity.

Hypoglycemia Pathogenesis in Children With Dumping Syndrome

Three children with severe hypoglycemic reactions secondary to dumping syndrome were studied to discern the mechanism by which hypoglycemia occurred. Symptoms in patient 1 developed after fundoplication, generalized autonomic dysfunction occurred in patient 2, and dumping syndrome developed in patient 3 after malplacement of a feeding gastrostomy tube. Average blood glucose levels studied during and after two to seven meals in each child were 375 ± 97 mg/dL (mean ± SD) 30 minutes postprandially and 35 ± 10 mg/dL &gt;120 minutes later. Swings in glucose values were proportional to the volume of meals. Insulin and glucagon levels were followed during a single meal challenge test in each patient; the average glucose concentration increased to 356 ± 59 mg/dL 30 minutes postprandially and decreased to 32 ± 11 mg/dL at 150 ± 30 minutes. Hormonal analyses indicated (1) inappropriate early release of glucagon (300 pg/mL at 15 minutes) in patient 1, (2) exuberant early release of insulin (maximum 190 ± 15 µU/mL) resulting in rapid decrease in glucose concentration in all patients, (3) development and/or persistence of hypoglycemia after the decline in circulating insulin to undetectable levels, and (4) inadequate glucagon response to hypoglycemia resulting in sustained hypoglycemia. These data indicate that gross disturbances of the insulin-glucagon axis attend childhood dumping syndrome.