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Introduction. Diabetes and stress hyperglycemia (SH) have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease.Objective. To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and stress hyperglycemia [SH]) with SARS-CoV-2 infection.Materials and methods. A retrospective cohort study was conducted in Cali-Colombia. Patients aged ≥18 years with a diagnosis of SARS-CoV-2 infection managed in the emergency room, hospitalization or intensive care unit (ICU) between March 2020 and December 2021 were included. Immunocompromised patients and pregnant women were excluded. Patients were classified in three groups: without diabetes, with diabetes and SH. A comparison between the groups was performed. Results. A total of 945 patients were included (59.6% without diabetes, 27% with diabetes and 13.4% with SH). Fifty-five-point three percent required ICU management, with a higher need in patients with SH (89.8%) and diabetes (67.1%), with no difference between these groups (p=0.249). A higher chance of death was seen in SH vs. without diabetes (adjOR= 8.12, 95% CI 5.12-12.88, p<0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, the need for de novo renal replacement therapy and mortality was higher in patients with metabolic alterations (diabetes and SH). Conclusions. Diabetes and SH are associated to worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered as high risk at moment of COVID-19 diagnosis that allow to mitigate adverse outcomes., Introducción. La diabetes y la hiperglucemia de estrés (HE) se han relacionado con peores desenlaces clínicos en pacientes infectados por SARS-CoV-2 y con riesgo de enfermedad grave. Objetivo. Evaluar los resultados clínicos en tres grupos de pacientes (con diabetes, sin diabetes e hiperglucemia de estrés [SH]) con infección por SARS-CoV-2.Materiales y métodos. Se realizó un estudio de cohorte retrospectivo en Cali-Colombia. Se incluyeron pacientes ≥18 años con diagnóstico de infección por SARS-CoV-2 atendidos en urgencias, hospitalización o unidad de cuidados intensivos (UCI) entre marzo de 2020 y diciembre de 2021. Se excluyeron pacientes inmunocomprometidos y mujeres embarazadas. Los pacientes fueron clasificados en tres grupos: sin diabetes, con diabetes e HE. Se realizó una comparación entre los grupos.Resultados. Se incluyeron un total de 945 pacientes (59,6% sin diabetes, 27% con diabetes y 13,4% con HE). El 55,3% requirió manejo en UCI, con mayor necesidad en pacientes con HE (89,8%) y diabetes (67,1%), sin diferencia entre estos grupos (p=0,249). Se observó una mayor probabilidad de muerte en HE vs. sin diabetes (adjOR= 8,12, 95% IC 5,12-12,88, p<0,01). La frecuencia de síndrome de distrés respiratorio agudo, necesidad de ventilación mecánica invasiva, uso de vasopresores e inotrópicos, necesidad de terapia de reemplazo renal de novo y la mortalidad fue mayor en pacientes con alteraciones metabólicas (diabetes e HE).Conclusiones. La diabetes y la HE se asociaron a peores resultados clínicos y mortalidad en pacientes con COVID-19. Estos pacientes deben ser identificados tempranamente y considerados de alto riesgo al momento del diagnóstico de COVID-19 que permitan mitigar los desenlaces adversos.

Background: Pancreatic ductal adenocarcinoma (pancreatic cancer) is often detected at late stages resulting in poor overall survival. To improve survival, more patients need to be diagnosed early when curative surgery is feasible. We aimed to identify circulating metabolites that could be used as early pancreatic cancer biomarkers. Methods: We performed metabolomics by liquid and gas chromatography-mass spectrometry in plasma samples from 82 future pancreatic cancer patients and 82 matched healthy controls within the Northern Sweden Health and Disease Study (NSHDS). Logistic regression was used to assess univariate associations between metabolites and pancreatic cancer risk. Least absolute shrinkage and selection operator (LASSO) logistic regression was used to design a metabolite-based risk score. We used receiver operating characteristic (ROC) analyses to assess the discriminative performance of the metabolite-based risk score. Results: Among twelve risk-associated metabolites with a nominal P value <0.05, we defined a risk score of three metabolites [indoleacetate, 3-hydroxydecanoate (10:0-OH), and retention index (RI): 2,745.4] using LASSO. A logistic regression model containing these three metabolites, age, sex, body mass index (BMI), smoking status, sample date, fasting status, and carbohydrate antigen 19-9 (CA 19-9) yielded an internal area under curve (AUC) of 0.784 [95% confidence interval (CI): 0.714–0.854] compared to 0.681 (95% CI: 0.597–0.764) for a model without these metabolites (P value =0.007). Seventeen metabolites were significantly associated with pancreatic cancer survival [false discovery rate (FDR) <0.1]. Conclusions: Indoleacetate, 3-hydroxydecanoate (10:0-OH), and RI: 2,745.4 were identified as the top candidate biomarkers for early detection. However, continued efforts are warranted to determine the usefulness of these metabolites as early pancreatic cancer biomarkers., CC BY-NC-ND 4.0 DEEDCorrespondence to: Emmy Borgmästars, PhD. Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Norrlands Universitetssjukhus, 6M, M31, 901 85 Umeå, Sweden. Email: emmy.borgmastars@umu.seThis work was supported by Umeå University, the Swedish Cancer Society (19 0273, 2017-557, CAN 2017/332, CAN 2017/827), the Swedish Research Council (2019-01690, 2016-02990, 2017-01531), Västerbotten Region (RV-583411, RV-549731, RV-841551, RV-930167, VLL-643451, RV-930478, RV-930132, RV-9960708, RV-99607108, VLL-837731), the Sjöberg Foundation, the Claes Groschinsky Memorial Foundation (M 19391), Bengt Ihre Foundation (SLS-885861, SLS-960529), Swedish Society of Medicine (SLS-960379), Lion’s Cancer Research Foundation, the Knut and Alice Wallenberg Foundation, Finska Läkaresällskapet, the Sigrid Juselius Foundation, Medicinska Understödsföreningen Liv och Hälsa, Bengt Ihre Fellowship Research Grant, and the JC Kempe Memorial Foundation Scholarship Fund.

Comparing the performance of different continuous glucose monitoring (CGM) systems is challenging due to the lack of comprehensive guidelines for clinical study design. In particular, the absence of concise requirements for the distribution of comparator (reference) blood glucose (BG) concentrations and their rate of change (RoC) that are used to evaluate CGM performance, impairs comparability. For this article, several experts in the field of CGM performance testing have collaborated to propose characteristics of the distribution of comparator measurements that should be collected during CGM performance testing. Specifically, it is proposed that at least 7.5% of comparator BG concentrations are <70 mg/dL (3.9 mmol/L) and >300 mg/dL (16.7 mmol/L), respectively, and that at least 7.5% of BG-RoC combinations indicate fast BG changes with impending hypo- or hyperglycemia, respectively. These proposed characteristics of the comparator data can facilitate the harmonization of testing conditions across different studies and CGM systems and ensure that the most relevant scenarios representing real-life situations are established during performance testing. In addition, a study protocol and testing procedure for the manipulation of glucose levels are suggested that enable the collection of comparator data with these characteristics. This work is an important step toward establishing a future standard for the performance evaluation of CGM systems.

In hyperglycemia, the serum sodium concentration ([Na]S) receives influences from (a) the fluid exit from the intracellular compartment and thirst, which cause [Na]S decreases; (b) osmotic diuresis with sums of the urinary sodium plus potassium concentration lower than the baseline euglycemic [Na]S, which results in a [Na]S increase; and (c), in some cases, gains or losses of fluid, sodium, and potassium through the gastrointestinal tract, the respiratory tract, and the skin. Hyperglycemic patients with hypernatremia have large deficits of body water and usually hypovolemia and develop severe clinical manifestations and significant mortality. To assist with the correction of both the severe dehydration and the hypovolemia, we developed formulas computing the fractional losses of the body water and monovalent cations in hyperglycemia. The formulas estimate varying losses between patients with the same serum glucose concentration ([Glu]S) and [Na]S but with different sums of monovalent cation concentrations in the lost fluids. Among subjects with the same [Glu]S and [Na]S, those with higher monovalent cation concentrations in the fluids lost have higher fractional losses of body water. The sum of the monovalent cation concentrations in the lost fluids should be considered when computing the volume and composition of the fluid replacement for hyperglycemic syndromes.

Material and Method: Cross-sectional, analytical study. 154 records of pregnant women in the first trimester, from January-February 2023. Obtaining sociodemographic and clinical variables. Descriptive statistics with the statistical program CIETmap SE, achieving simple frequencies, percentages, measures of central tendency and dispersion. Bivariate analysis for OR and 95%CI, the variables with the greatest association, were included in a multivariate model for adjusted OR and 95%CI. Results: The prevalence of metabolic syndrome according to the ATPIII criteria was 9.1% and according to the WHO criteria it was 5.8%, waist circumference prevailed with 27.27% and central obesity with 31.42%. The risk factors strongly associated in the multivariate analysis were complications in previous pregnancies (ORa 9.25, CI95% 2.25-38.06), obesity (ORa 5.70, CI95% 2.12-15.37), advanced maternal age (ORa 3.59, CI95% 1.33- 9.72). Conclusion: There is a prevalence of metabolic syndrome during pregnancy, which is underdiagnosed. Nine out of every hundred pregnant women present metabolic syndrome according to the ATPIII and six out of every hundred according to the WHO, the diagnostic criterion and factor with the greatest association was obesity., Objetivo: Determinar la prevalencia de síndrome metabólico y factores de riesgo asociados en embarazadas de la Unidad de Medicina Familiar No.9 de Acapulco, Guerrero. Material y método: Estudio transversal, analítico. 154 expedientes de embarazadas del primer trimestre, de enero-febrero 2023. Obteniendo variables sociodemográficas y clínicas. Estadística descriptiva con el programa estadístico CIETmap SE, logrando frecuencias simples, porcentajes, medidas de tendencia central y de dispersión. Análisis bivariado para OR e IC95%, las variables con mayor asociación, se incluyeron en un modelo multivariado para OR ajustados e IC95%. Resultados: La prevalencia del síndrome metabólico según los criterios de la ATPIII fue 9.1% y según los criterios de la OMS fue 5.8%, prevaleció la circunferencia de cintura con 27.27% y la obesidad central con 31.42%. Los factores de riesgo fuertemente asociados en el análisis multivariado fueron complicaciones en embarazos previos (ORa 9.25, IC95% 2.25-38.06), obesidad (ORa 5.70, IC95% 2.12-15.37), la edad materna avanzada (ORa 3.59, IC95% 1.33-9.72). Conclusión: Existe prevalencia del síndrome metabólico durante el embarazo, la cual es subdiagnosticada. Nueve de cada cien embarazadas presenta síndrome metabólico según la ATPIII y seis de cada cien según la OMS, el criterio diagnóstico y factor de mayor asociación fue la obesidad.

BACKGROUND: A recently undertaken multicenter randomized controlled trial (RCT) "Treatment Of BOoking Gestational diabetes Mellitus" (TOBOGM: 2017-2022) found that the diagnosis and treatment of pregnant women with early gestational diabetes mellitus (GDM) improved pregnancy outcomes. Based on data from the trial, this study aimed to assess the cost-effectiveness of diagnosis and treatment of early GDM (from <20 weeks') among women with risk factors for hyperglycemia in pregnancy compared with usual care (no treatment until 24-28 weeks') from a healthcare perspective. METHODS: Participants' healthcare resource utilization data were collected from their self-reported questionnaires and hospital records, and valued using the unit costs obtained from standard Australian national sources. Costs were reported in US dollars ($) using the purchasing power parity (PPP) estimates to facilitate comparison of costs across countries. Intention-to-treat (ITT) principle was followed. Missing cost data were replaced using multiple imputations. Bootstrapping method was used to estimate the uncertainty around mean cost difference and cost-effectiveness results. Bootstrapped cost-effect pairs were used to plot the cost-effectiveness (CE) plane and cost-effectiveness acceptability curve (CEAC). FINDINGS: Diagnosis and treatment of early GDM was more effective and tended to be less costly, i.e., dominant (cost-saving) [-5.6% composite adverse pregnancy outcome (95% CI: -10.1%, -1.2%), -$1373 (95% CI: -$3,749, $642)] compared with usual care. Our findings were confirmed by both the CE plane (88% of the bootstrapped cost-effect pairs fall in the south-west quadrant), and CEAC (the probability of the intervention being cost-effective ranged from 84% at a willingness-to-pay (WTP) threshold value of $10,000-99% at a WTP threshold value of $100,000 per composite adverse pregnancy outcome prevented). Sub-group analyses demonstrated that diagnosis and treatment of early GDM among women in t, FUNDING: National Health and Medical Research Council (grants 1104231 and 2009326), Region O¨rebro Research Committee (grants Dnr OLL-970566 and OLL-942177), Medical Scientific Fund of the Mayor of Vienna (project 15,205 and project 23,026), South Western Sydney Local Health District Academic Unit (grant 2016), and Western Sydney University Ainsworth Trust Grant (2019).

Background: Pancreatic ductal adenocarcinoma (pancreatic cancer) is often detected at late stages resulting in poor overall survival. To improve survival, more patients need to be diagnosed early when curative surgery is feasible. We aimed to identify circulating metabolites that could be used as early pancreatic cancer biomarkers. Methods: We performed metabolomics by liquid and gas chromatography-mass spectrometry in plasma samples from 82 future pancreatic cancer patients and 82 matched healthy controls within the Northern Sweden Health and Disease Study (NSHDS). Logistic regression was used to assess univariate associations between metabolites and pancreatic cancer risk. Least absolute shrinkage and selection operator (LASSO) logistic regression was used to design a metabolite-based risk score. We used receiver operating characteristic (ROC) analyses to assess the discriminative performance of the metabolite-based risk score. Results: Among twelve risk-associated metabolites with a nominal P value <0.05, we defined a risk score of three metabolites [indoleacetate, 3-hydroxydecanoate (10:0-OH), and retention index (RI): 2,745.4] using LASSO. A logistic regression model containing these three metabolites, age, sex, body mass index (BMI), smoking status, sample date, fasting status, and carbohydrate antigen 19-9 (CA 19-9) yielded an internal area under curve (AUC) of 0.784 [95% confidence interval (CI): 0.714–0.854] compared to 0.681 (95% CI: 0.597–0.764) for a model without these metabolites (P value =0.007). Seventeen metabolites were significantly associated with pancreatic cancer survival [false discovery rate (FDR) <0.1]. Conclusions: Indoleacetate, 3-hydroxydecanoate (10:0-OH), and RI: 2,745.4 were identified as the top candidate biomarkers for early detection. However, continued efforts are warranted to determine the usefulness of these metabolites as early pancreatic cancer biomarkers.

Background: Pancreatic ductal adenocarcinoma (pancreatic cancer) is often detected at late stages resulting in poor overall survival. To improve survival, more patients need to be diagnosed early when curative surgery is feasible. We aimed to identify circulating metabolites that could be used as early pancreatic cancer biomarkers. Methods: We performed metabolomics by liquid and gas chromatography-mass spectrometry in plasma samples from 82 future pancreatic cancer patients and 82 matched healthy controls within the Northern Sweden Health and Disease Study (NSHDS). Logistic regression was used to assess univariate associations between metabolites and pancreatic cancer risk. Least absolute shrinkage and selection operator (LASSO) logistic regression was used to design a metabolite-based risk score. We used receiver operating characteristic (ROC) analyses to assess the discriminative performance of the metabolite-based risk score. Results: Among twelve risk-associated metabolites with a nominal P value <0.05, we defined a risk score of three metabolites [indoleacetate, 3-hydroxydecanoate (10:0-OH), and retention index (RI): 2,745.4] using LASSO. A logistic regression model containing these three metabolites, age, sex, body mass index (BMI), smoking status, sample date, fasting status, and carbohydrate antigen 19-9 (CA 19-9) yielded an internal area under curve (AUC) of 0.784 [95% confidence interval (CI): 0.714–0.854] compared to 0.681 (95% CI: 0.597–0.764) for a model without these metabolites (P value =0.007). Seventeen metabolites were significantly associated with pancreatic cancer survival [false discovery rate (FDR) <0.1]. Conclusions: Indoleacetate, 3-hydroxydecanoate (10:0-OH), and RI: 2,745.4 were identified as the top candidate biomarkers for early detection. However, continued efforts are warranted to determine the usefulness of these metabolites as early pancreatic cancer biomarkers., CC BY-NC-ND 4.0 DEEDCorrespondence to: Emmy Borgmästars, PhD. Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Norrlands Universitetssjukhus, 6M, M31, 901 85 Umeå, Sweden. Email: emmy.borgmastars@umu.seThis work was supported by Umeå University, the Swedish Cancer Society (19 0273, 2017-557, CAN 2017/332, CAN 2017/827), the Swedish Research Council (2019-01690, 2016-02990, 2017-01531), Västerbotten Region (RV-583411, RV-549731, RV-841551, RV-930167, VLL-643451, RV-930478, RV-930132, RV-9960708, RV-99607108, VLL-837731), the Sjöberg Foundation, the Claes Groschinsky Memorial Foundation (M 19391), Bengt Ihre Foundation (SLS-885861, SLS-960529), Swedish Society of Medicine (SLS-960379), Lion’s Cancer Research Foundation, the Knut and Alice Wallenberg Foundation, Finska Läkaresällskapet, the Sigrid Juselius Foundation, Medicinska Understödsföreningen Liv och Hälsa, Bengt Ihre Fellowship Research Grant, and the JC Kempe Memorial Foundation Scholarship Fund.

Material and Method: Cross-sectional, analytical study. 154 records of pregnant women in the first trimester, from January-February 2023. Obtaining sociodemographic and clinical variables. Descriptive statistics with the statistical program CIETmap SE, achieving simple frequencies, percentages, measures of central tendency and dispersion. Bivariate analysis for OR and 95%CI, the variables with the greatest association, were included in a multivariate model for adjusted OR and 95%CI. Results: The prevalence of metabolic syndrome according to the ATPIII criteria was 9.1% and according to the WHO criteria it was 5.8%, waist circumference prevailed with 27.27% and central obesity with 31.42%. The risk factors strongly associated in the multivariate analysis were complications in previous pregnancies (ORa 9.25, CI95% 2.25-38.06), obesity (ORa 5.70, CI95% 2.12-15.37), advanced maternal age (ORa 3.59, CI95% 1.33- 9.72). Conclusion: There is a prevalence of metabolic syndrome during pregnancy, which is underdiagnosed. Nine out of every hundred pregnant women present metabolic syndrome according to the ATPIII and six out of every hundred according to the WHO, the diagnostic criterion and factor with the greatest association was obesity., Objetivo: Determinar la prevalencia de síndrome metabólico y factores de riesgo asociados en embarazadas de la Unidad de Medicina Familiar No.9 de Acapulco, Guerrero. Material y método: Estudio transversal, analítico. 154 expedientes de embarazadas del primer trimestre, de enero-febrero 2023. Obteniendo variables sociodemográficas y clínicas. Estadística descriptiva con el programa estadístico CIETmap SE, logrando frecuencias simples, porcentajes, medidas de tendencia central y de dispersión. Análisis bivariado para OR e IC95%, las variables con mayor asociación, se incluyeron en un modelo multivariado para OR ajustados e IC95%. Resultados: La prevalencia del síndrome metabólico según los criterios de la ATPIII fue 9.1% y según los criterios de la OMS fue 5.8%, prevaleció la circunferencia de cintura con 27.27% y la obesidad central con 31.42%. Los factores de riesgo fuertemente asociados en el análisis multivariado fueron complicaciones en embarazos previos (ORa 9.25, IC95% 2.25-38.06), obesidad (ORa 5.70, IC95% 2.12-15.37), la edad materna avanzada (ORa 3.59, IC95% 1.33-9.72). Conclusión: Existe prevalencia del síndrome metabólico durante el embarazo, la cual es subdiagnosticada. Nueve de cada cien embarazadas presenta síndrome metabólico según la ATPIII y seis de cada cien según la OMS, el criterio diagnóstico y factor de mayor asociación fue la obesidad.

Background: Pancreatic ductal adenocarcinoma (pancreatic cancer) is often detected at late stages resulting in poor overall survival. To improve survival, more patients need to be diagnosed early when curative surgery is feasible. We aimed to identify circulating metabolites that could be used as early pancreatic cancer biomarkers. Methods: We performed metabolomics by liquid and gas chromatography-mass spectrometry in plasma samples from 82 future pancreatic cancer patients and 82 matched healthy controls within the Northern Sweden Health and Disease Study (NSHDS). Logistic regression was used to assess univariate associations between metabolites and pancreatic cancer risk. Least absolute shrinkage and selection operator (LASSO) logistic regression was used to design a metabolite-based risk score. We used receiver operating characteristic (ROC) analyses to assess the discriminative performance of the metabolite-based risk score. Results: Among twelve risk-associated metabolites with a nominal P value <0.05, we defined a risk score of three metabolites [indoleacetate, 3-hydroxydecanoate (10:0-OH), and retention index (RI): 2,745.4] using LASSO. A logistic regression model containing these three metabolites, age, sex, body mass index (BMI), smoking status, sample date, fasting status, and carbohydrate antigen 19-9 (CA 19-9) yielded an internal area under curve (AUC) of 0.784 [95% confidence interval (CI): 0.714–0.854] compared to 0.681 (95% CI: 0.597–0.764) for a model without these metabolites (P value =0.007). Seventeen metabolites were significantly associated with pancreatic cancer survival [false discovery rate (FDR) <0.1]. Conclusions: Indoleacetate, 3-hydroxydecanoate (10:0-OH), and RI: 2,745.4 were identified as the top candidate biomarkers for early detection. However, continued efforts are warranted to determine the usefulness of these metabolites as early pancreatic cancer biomarkers., CC BY-NC-ND 4.0 DEEDCorrespondence to: Emmy Borgmästars, PhD. Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Norrlands Universitetssjukhus, 6M, M31, 901 85 Umeå, Sweden. Email: emmy.borgmastars@umu.seThis work was supported by Umeå University, the Swedish Cancer Society (19 0273, 2017-557, CAN 2017/332, CAN 2017/827), the Swedish Research Council (2019-01690, 2016-02990, 2017-01531), Västerbotten Region (RV-583411, RV-549731, RV-841551, RV-930167, VLL-643451, RV-930478, RV-930132, RV-9960708, RV-99607108, VLL-837731), the Sjöberg Foundation, the Claes Groschinsky Memorial Foundation (M 19391), Bengt Ihre Foundation (SLS-885861, SLS-960529), Swedish Society of Medicine (SLS-960379), Lion’s Cancer Research Foundation, the Knut and Alice Wallenberg Foundation, Finska Läkaresällskapet, the Sigrid Juselius Foundation, Medicinska Understödsföreningen Liv och Hälsa, Bengt Ihre Fellowship Research Grant, and the JC Kempe Memorial Foundation Scholarship Fund.

Diabetes mellitus (DM) affects 5-6% of global adult  population. “World Diabetes Congress” summarized on14th  Nov.2009; that Diabetes is expected to affect 380million by  2025. Every 10 seconds a person dies from Diabetes related  disorder. India has the largest Diabetes population in the  world with an estimated 41 million people, amounting to 6%  of the adult population. As age  Progresses, in either sex, the probability to get Diabetes  increases. In the population that is above 60 years of age,  approximately 18.3 percent have Diabetes. Now a day‟s  many Ayurvedic herbal or herbo-mineral formulations have  been used in the treatment of Diabetes mellitus throughout   the world. Naga Bhasma (lead calx) has significantly anti-diabetic potential and can be viewed  as rejuvenating tonic diabetic weakness and diabetic coma as well. It shows Rasayana effect  chiefly by enhancement of immunity i.e. Oja. By virtue of its kaphashamaka, Masa medokarshka and lekhana property it can be used a novel anti-diabetic drug. India has the largest

Introducción: se desconoce si los pacientes diagnosticados de infección respiratoria aguda por SARS-CoV-2 (COVID-19) presentan más riesgo de complicaciones asociadas a la nutrición parenteral (NP). Objetivo: conocer la incidencia, los factores de riesgo y la mortalidad de las complicaciones asociadas a la NP en esta población. Métodos: estudio de cohortes prospectivo de 87 pacientes diagnosticados de infección por SARS-CoV-2. Se analizan la tasa de incidencia de las complicaciones y las odds ratio (OR) de diferentes factores. Resultados: la edad ≥ 65 años (OR: 2,52, IC 95 %: 1,16 a 5,46), los antecedentes de obesidad (OR: 3,34, IC 95 %: 2,35 a 4,33) y el tratamiento con propofol (OR: 2,45, IC 95 %: 1,55 a 3,35) o lopinavir/ritonavir (OR: 4,98, IC 95 %: 3,60 a 6,29) se asociaron al desarrollo de hipertrigliceridemia. Los pacientes con obesidad (OR: 3,11, IC 95 %: 1,10 a 8,75) o dislipemia (OR: 3,22, IC 95 %: 1,23 a 8,40) y los tratados con propofol (OR: 5,47, IC 95 %: 1,97 a 15,1) presentaron mayor riesgo de infección asociada al catéter (IAC). No se observó ningún factor de riesgo relacionado con el desarrollo de hiperglucemia. La mortalidad fue mayor en los pacientes con IAC (46,7 % vs. 10,8 %, p = 0,014). El riesgo de mortalidad fue superior en los enfermos de ≥ 65 años (OR: 2,74, IC 95 %: 1,08 a 6,95) o con IAC (OR: 3,22, IC 95 %: 1,23 a 8,40). Conclusiones: la incidencia de complicaciones asociadas a la NP en pacientes diagnosticados de infección por SARS-CoV-2 es elevada. El riesgo de mortalidad es superior en los enfermos mayores de 65 años o con IAC., Background: it is unknown whether patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are at greater risk of developing complications associated with parenteral nutrition (PN). Aim: to describe the incidence, risk factors, and clinical impact of complications in patients with ARDS-COVID-19 receiving PN. Methods: a prospective cohort study of 87 patients with ARDS-COVID-19 infection. The incidence of complications and odds ratios of risk factors were analysed. Results: age ≥ 65 years (OR, 2.52, 95 % CI: 1.16 to 5.46), obesity (OR, 3.34, 95 % CI: 2.35 to 4.33) and treatment with propofol (OR, 2.45, 95 % CI: 1.55 to 3.35) or lopinavir/ritonavir (OR, 4.98, 95 % CI: 3.60 to 6.29) were risk factors for hipertriglyceridemia. Obesity (OR, 3.11, 95 % CI: 1.10 to 8.75), dyslipidemia (OR, 3.22, 95 % CI: 1.23 to 8.40) or treatment with propofol (OR, 5.47, 95 % CI: 1.97 to 15.1) were risk factors for intravascular catheter-related infection. No risk factors were described for hiperglycemia. Mortality was higher in patients with intravascular catheter-related infection (46.7 % vs 10.8 %, p = 0.014). Mortality risk was higher in older patients (OR, 2.74, 95 % CI: 1.08 to 6.95) or patients with intravascular catheter-related infection (OR, 3.22, 95 % CI: 1.23 to 8.40). Conclusions: the incidence of complications associated with PN in patients with COVID-19-related ARDS is frequent. The mortality risk is higher in older patients or those with catheter-related infection., Depto. de Medicina, Fac. de Medicina, TRUE, pub

In a developing country like India, systemic chronic diseases reach unsustainable heights as the population grows. According to WHO, diabetes affects an estimated 28.7 million people worldwide, or 28.5% of the population. Diabetes affects around 8.5 million people who have yet to be diagnosed (2022). Diabetes is one of these metabolic systemic chronic diseases that has captured the world's attention. The primary goal of our research is to develop non-invasive blood glucose monitoring technology that will benefit a large number of patients. We analyze the research progress and significant problems of non-invasive blood glucose detecting technologies in our project evaluation. In our study, we present an effective NIR-based optical detecting system. The existing non-invasive glucose monitoring device had a 60% accuracy level, however the proposed model will have an accuracy of 80% and will have a significant advantage over the existing system. Furthermore, the information is continuously delivered to the personal computer via serial communication via the UART protocol.

Bakgrund: Parodontit är en vanligt och multifaktoriell inflammatorisk sjukdom som skadar de mjuka vävnaderna kring tänderna. Diabetes mellitus typ 2 är en kronisk sjukdom som beror på bristfällig insulinproduktion i kroppen och höga sockernivåer i blodet. Syfte: Syftet med denna studie var att kartlägga sambandet mellan parodontit och diabetes typ 2 hos vuxna individer. Metod: Litteraturstudie. Resultat: Ett signifikant samband mellan parodontit och diabetes typ 2 kan påvisas. Diabetiker med dålig glykemisk kontroll har en högre svårighetsgrad av parodontit än de som har god glykemisk kontroll. Nio av tio granskade studier visar att icke-kirurgisk parodontitbehandling har en god effekt på minskning av blodglukosnivån. Dessutom tyder resultaten att personer med diabetes typ 2 och dålig glykemisk kontroll har färre kvarvarande tänder än icke-diabetiker. Slutsats: diabetes typ 2 är en stark riskfaktor för förekomsten och utvecklingen av parodontit. Diabetiker med dålig kontroll av blodglukosnivån har färre tänder än de som har god glykemisk kontroll. Icke-kirurgisk parodontitterapi har en god effekt på minskning av blodglukosnivå hos individer med typ 2 diabetes., Background: Periodontitis is a multifactorial inflammatory and common disease among the population that destroys the soft tissues around the teeth. Diabetes mellitus type 2 is a chronic metabolic disorder which depends on inadequate insulin production in the body and high sugar levels in the blood. Aim: The aim of the study was to evaluate the association between periodontal disease and diabetes mellitus type 2 in the adult population. Method: A literature review. Results: The results of the study showed a significant association between diabetes mellitus type 2 and periodontal disease. Diabetics with poor glycemic control had a higher severity of periodontal disease than those with good glycemic control. Almost all of the reviewed articles showed that a non-surgical periodontitis therapy reduced the hyperglycemic level. In addition, the results of the study showed that diabetics with poor glycemic control had fewer remaining teeth than those who had good glycemic control or non-diabetics. Conclusion: Diabetes mellitus type 2 is a significant risk factor for the incidence and progression of periodontal disease. Diabetics with good glycemic control had more teeth than non-diabetics. Non-surgical periodontitis treatment had a good effect on decreasing blood glucose level in patients with type 2 diabetes mellitus.

Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.

Background Observational studies have found that both short and long sleep duration are associated with increased risk of metabolic syndrome (MetS). This study aimed to examine the associations of genetically determined sleep durations with MetS and its five components (i.e., central obesity, high blood pressure, dyslipidemia, hypertriglyceridemia, and hyperglycemia) among a group of elderly population. Methods In 335,727 participants of White British from the UK Biobank, linear Mendelian randomization (MR) methods were first employed to examine the causal association of genetically predicted continuous sleep duration with MetS and its each component. Nonlinear MR analyses were performed to determine the nonlinearity of these associations. The causal associations of short and long sleep duration with MetS and its components were further assessed by using genetic variants that associated with short (<= 6 h) and long sleep (>= 9 h) durations. Results Linear MR analyses demonstrated that genetically predicted 1-h longer sleep duration was associated with a 13% lower risk of MetS, a 30% lower risk of central obesity, and a 26% lower risk of hyperglycemia. Non-linear MR analyses provided evidence for non-linear associations of genetically predicted sleep duration with MetS and its five components (all P values < 0.008). Genetically predicted short sleep duration was moderately associated with MetS and its four components, including central obesity, dyslipidemia, hypertriglyceridemia, and hyperglycemia (all P values < 0.002), whereas genetically long sleep duration was not associated with MetS and any of its components. Conclusions Genetically predicted short sleep duration, but not genetically predicted long sleep duration, is a potentially causal risk factor for MetS.

Bakgrund: Parodontit är en vanligt och multifaktoriell inflammatorisk sjukdom som skadar de mjuka vävnaderna kring tänderna. Diabetes mellitus typ 2 är en kronisk sjukdom som beror på bristfällig insulinproduktion i kroppen och höga sockernivåer i blodet. Syfte: Syftet med denna studie var att kartlägga sambandet mellan parodontit och diabetes typ 2 hos vuxna individer. Metod: Litteraturstudie. Resultat: Ett signifikant samband mellan parodontit och diabetes typ 2 kan påvisas. Diabetiker med dålig glykemisk kontroll har en högre svårighetsgrad av parodontit än de som har god glykemisk kontroll. Nio av tio granskade studier visar att icke-kirurgisk parodontitbehandling har en god effekt på minskning av blodglukosnivån. Dessutom tyder resultaten att personer med diabetes typ 2 och dålig glykemisk kontroll har färre kvarvarande tänder än icke-diabetiker. Slutsats: diabetes typ 2 är en stark riskfaktor för förekomsten och utvecklingen av parodontit. Diabetiker med dålig kontroll av blodglukosnivån har färre tänder än de som har god glykemisk kontroll. Icke-kirurgisk parodontitterapi har en god effekt på minskning av blodglukosnivå hos individer med typ 2 diabetes., Background: Periodontitis is a multifactorial inflammatory and common disease among the population that destroys the soft tissues around the teeth. Diabetes mellitus type 2 is a chronic metabolic disorder which depends on inadequate insulin production in the body and high sugar levels in the blood. Aim: The aim of the study was to evaluate the association between periodontal disease and diabetes mellitus type 2 in the adult population. Method: A literature review. Results: The results of the study showed a significant association between diabetes mellitus type 2 and periodontal disease. Diabetics with poor glycemic control had a higher severity of periodontal disease than those with good glycemic control. Almost all of the reviewed articles showed that a non-surgical periodontitis therapy reduced the hyperglycemic level. In addition, the results of the study showed that diabetics with poor glycemic control had fewer remaining teeth than those who had good glycemic control or non-diabetics. Conclusion: Diabetes mellitus type 2 is a significant risk factor for the incidence and progression of periodontal disease. Diabetics with good glycemic control had more teeth than non-diabetics. Non-surgical periodontitis treatment had a good effect on decreasing blood glucose level in patients with type 2 diabetes mellitus.

Purpose Obesity is characterized by chronic inflammation that may contribute to insulin resistance and promote type 2 diabetes. We have investigated whether inflammatory responses to glycemic and insulinemic variations are altered in obese individuals. Methods Eight obese and eight lean individuals without diabetes had undergone hyperinsulinemic-euglycemic-hypoglycemic and hyperglycemic clamps in a previous study. Using Proximity Extension Assay, 92 inflammatory markers were analyzed from plasma samples at fasting, hyperinsulinemia-euglycemia, hypoglycemia and hyperglycemia. Results In all participants, hyperinsulinemia, hypoglycemia and hyperglycemia led to reductions of 11, 19 and 62 out of the 70 fully evaluable biomarkers, respectively. FGF-21 increased during both hypoglycemia and hyperglycemia while IL-6 and IL-10 increased during hypoglycemia. In obese vs lean participants, Oncostatin-M, Caspase-8 and 4E-BP1 were more markedly suppressed during hypoglycemia, whereas VEGF-A was more markedly suppressed during hyperglycemia. BMI correlated inversely with changes of PD-L1 and CD40 during hyperinsulinemia, Oncostatin-M, TNFSF14, FGF-21 and 4EBP-1 during hypoglycemia and CCL23, VEGF-A and CDCP1 during hyperglycemia (Rho & LE; -0.50). HbA1c correlated positively with changes of MCP-2 and IL-15-RA during hyperinsulinemia (Rho & GE; 0.51) and inversely with changes of CXCL1, MMP-1 and Axin-1 during hypoglycemia (Rho & LE; -0.55). M-value correlated positively with changes of IL-12B and VEGF-A during hyperglycemia (Rho & GE; 0.51). Results above were significant (p < 0.05). Conclusion Overall, hyperinsulinemia, hypo- and hyperglycemia led to suppression of several inflammatory markers and this tended to be more marked in individuals with obesity, insulin resistance and dysglycemia. Thus, acute glycemic or insulinemic variations do not seem to potentiate possible inflammatory pathways in the development of insulin resistance and disturbed glucose met

According to the current paradigm, the development of type 2 diabetes is driven by insulin resistance and the gradual failure of beta cells to compensate for this by secreting adequate amounts of insulin. Obesity is an important risk factor for type 2 diabetes and is considered to influence disease development primarily by induction of insulin resistance, via mechanisms that have not been fully elucidated. Insulin-antagonistic, counter-regulatory neurohormonal pathways, including glucagon, cortisol (stimulated by the pituitary hormone ACTH), growth hormone and the autonomic nervous system have glucose-raising properties and constitute a physiological defense to hypoglycemia that is coordinated from the brain and brainstem. Glucose variations also trigger responses of several inflammatory mediators, that may also oppose the actions of insulin. The overarching aim of this thesis was to explore the importance of glucose-dependent dysregulation of these counter-regulatory pathways – hormonal, neural and inflammatory – in the development of type 2 diabetes. All selected papers in this thesis are based on data obtained during stepwise hyperinsulinemic-euglycemic-hypoglycemic clamps and hyperglycemic clamps, in which glucose levels are lowered or raised to prespecified target levels. In papers I and II, we found that overweight and insulin resistance was associated with cortisol/ACTH hyperreactivity to hypoglycemia and general hyperglucagonemia, insensitive to glucose-dependent suppression. Furthermore, in paper I, the autonomic nervous system was more rigid to glucose variations in overweight and insulin resistant individuals, with a failure to inhibit parasympathetic activity during hypoglycemia and an attenuated activity of sympathetic relative to parasympathetic activity during hyperglycemia. In paper III, cortisol/ACTH hyperreactivity was present already in individuals with prediabetes, with no further exacerbation in individuals with type 2 diabetes. By contrast, h

Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.

Background Observational studies have found that both short and long sleep duration are associated with increased risk of metabolic syndrome (MetS). This study aimed to examine the associations of genetically determined sleep durations with MetS and its five components (i.e., central obesity, high blood pressure, dyslipidemia, hypertriglyceridemia, and hyperglycemia) among a group of elderly population. Methods In 335,727 participants of White British from the UK Biobank, linear Mendelian randomization (MR) methods were first employed to examine the causal association of genetically predicted continuous sleep duration with MetS and its each component. Nonlinear MR analyses were performed to determine the nonlinearity of these associations. The causal associations of short and long sleep duration with MetS and its components were further assessed by using genetic variants that associated with short (<= 6 h) and long sleep (>= 9 h) durations. Results Linear MR analyses demonstrated that genetically predicted 1-h longer sleep duration was associated with a 13% lower risk of MetS, a 30% lower risk of central obesity, and a 26% lower risk of hyperglycemia. Non-linear MR analyses provided evidence for non-linear associations of genetically predicted sleep duration with MetS and its five components (all P values < 0.008). Genetically predicted short sleep duration was moderately associated with MetS and its four components, including central obesity, dyslipidemia, hypertriglyceridemia, and hyperglycemia (all P values < 0.002), whereas genetically long sleep duration was not associated with MetS and any of its components. Conclusions Genetically predicted short sleep duration, but not genetically predicted long sleep duration, is a potentially causal risk factor for MetS.

Purpose Obesity is characterized by chronic inflammation that may contribute to insulin resistance and promote type 2 diabetes. We have investigated whether inflammatory responses to glycemic and insulinemic variations are altered in obese individuals. Methods Eight obese and eight lean individuals without diabetes had undergone hyperinsulinemic-euglycemic-hypoglycemic and hyperglycemic clamps in a previous study. Using Proximity Extension Assay, 92 inflammatory markers were analyzed from plasma samples at fasting, hyperinsulinemia-euglycemia, hypoglycemia and hyperglycemia. Results In all participants, hyperinsulinemia, hypoglycemia and hyperglycemia led to reductions of 11, 19 and 62 out of the 70 fully evaluable biomarkers, respectively. FGF-21 increased during both hypoglycemia and hyperglycemia while IL-6 and IL-10 increased during hypoglycemia. In obese vs lean participants, Oncostatin-M, Caspase-8 and 4E-BP1 were more markedly suppressed during hypoglycemia, whereas VEGF-A was more markedly suppressed during hyperglycemia. BMI correlated inversely with changes of PD-L1 and CD40 during hyperinsulinemia, Oncostatin-M, TNFSF14, FGF-21 and 4EBP-1 during hypoglycemia and CCL23, VEGF-A and CDCP1 during hyperglycemia (Rho & LE; -0.50). HbA1c correlated positively with changes of MCP-2 and IL-15-RA during hyperinsulinemia (Rho & GE; 0.51) and inversely with changes of CXCL1, MMP-1 and Axin-1 during hypoglycemia (Rho & LE; -0.55). M-value correlated positively with changes of IL-12B and VEGF-A during hyperglycemia (Rho & GE; 0.51). Results above were significant (p < 0.05). Conclusion Overall, hyperinsulinemia, hypo- and hyperglycemia led to suppression of several inflammatory markers and this tended to be more marked in individuals with obesity, insulin resistance and dysglycemia. Thus, acute glycemic or insulinemic variations do not seem to potentiate possible inflammatory pathways in the development of insulin resistance and disturbed glucose met

According to the current paradigm, the development of type 2 diabetes is driven by insulin resistance and the gradual failure of beta cells to compensate for this by secreting adequate amounts of insulin. Obesity is an important risk factor for type 2 diabetes and is considered to influence disease development primarily by induction of insulin resistance, via mechanisms that have not been fully elucidated. Insulin-antagonistic, counter-regulatory neurohormonal pathways, including glucagon, cortisol (stimulated by the pituitary hormone ACTH), growth hormone and the autonomic nervous system have glucose-raising properties and constitute a physiological defense to hypoglycemia that is coordinated from the brain and brainstem. Glucose variations also trigger responses of several inflammatory mediators, that may also oppose the actions of insulin. The overarching aim of this thesis was to explore the importance of glucose-dependent dysregulation of these counter-regulatory pathways – hormonal, neural and inflammatory – in the development of type 2 diabetes. All selected papers in this thesis are based on data obtained during stepwise hyperinsulinemic-euglycemic-hypoglycemic clamps and hyperglycemic clamps, in which glucose levels are lowered or raised to prespecified target levels. In papers I and II, we found that overweight and insulin resistance was associated with cortisol/ACTH hyperreactivity to hypoglycemia and general hyperglucagonemia, insensitive to glucose-dependent suppression. Furthermore, in paper I, the autonomic nervous system was more rigid to glucose variations in overweight and insulin resistant individuals, with a failure to inhibit parasympathetic activity during hypoglycemia and an attenuated activity of sympathetic relative to parasympathetic activity during hyperglycemia. In paper III, cortisol/ACTH hyperreactivity was present already in individuals with prediabetes, with no further exacerbation in individuals with type 2 diabetes. By contrast, h

Purpose Obesity is characterized by chronic inflammation that may contribute to insulin resistance and promote type 2 diabetes. We have investigated whether inflammatory responses to glycemic and insulinemic variations are altered in obese individuals. Methods Eight obese and eight lean individuals without diabetes had undergone hyperinsulinemic-euglycemic-hypoglycemic and hyperglycemic clamps in a previous study. Using Proximity Extension Assay, 92 inflammatory markers were analyzed from plasma samples at fasting, hyperinsulinemia-euglycemia, hypoglycemia and hyperglycemia. Results In all participants, hyperinsulinemia, hypoglycemia and hyperglycemia led to reductions of 11, 19 and 62 out of the 70 fully evaluable biomarkers, respectively. FGF-21 increased during both hypoglycemia and hyperglycemia while IL-6 and IL-10 increased during hypoglycemia. In obese vs lean participants, Oncostatin-M, Caspase-8 and 4E-BP1 were more markedly suppressed during hypoglycemia, whereas VEGF-A was more markedly suppressed during hyperglycemia. BMI correlated inversely with changes of PD-L1 and CD40 during hyperinsulinemia, Oncostatin-M, TNFSF14, FGF-21 and 4EBP-1 during hypoglycemia and CCL23, VEGF-A and CDCP1 during hyperglycemia (Rho & LE; -0.50). HbA1c correlated positively with changes of MCP-2 and IL-15-RA during hyperinsulinemia (Rho & GE; 0.51) and inversely with changes of CXCL1, MMP-1 and Axin-1 during hypoglycemia (Rho & LE; -0.55). M-value correlated positively with changes of IL-12B and VEGF-A during hyperglycemia (Rho & GE; 0.51). Results above were significant (p < 0.05). Conclusion Overall, hyperinsulinemia, hypo- and hyperglycemia led to suppression of several inflammatory markers and this tended to be more marked in individuals with obesity, insulin resistance and dysglycemia. Thus, acute glycemic or insulinemic variations do not seem to potentiate possible inflammatory pathways in the development of insulin resistance and disturbed glucose met

Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.

Background Observational studies have found that both short and long sleep duration are associated with increased risk of metabolic syndrome (MetS). This study aimed to examine the associations of genetically determined sleep durations with MetS and its five components (i.e., central obesity, high blood pressure, dyslipidemia, hypertriglyceridemia, and hyperglycemia) among a group of elderly population. Methods In 335,727 participants of White British from the UK Biobank, linear Mendelian randomization (MR) methods were first employed to examine the causal association of genetically predicted continuous sleep duration with MetS and its each component. Nonlinear MR analyses were performed to determine the nonlinearity of these associations. The causal associations of short and long sleep duration with MetS and its components were further assessed by using genetic variants that associated with short (<= 6 h) and long sleep (>= 9 h) durations. Results Linear MR analyses demonstrated that genetically predicted 1-h longer sleep duration was associated with a 13% lower risk of MetS, a 30% lower risk of central obesity, and a 26% lower risk of hyperglycemia. Non-linear MR analyses provided evidence for non-linear associations of genetically predicted sleep duration with MetS and its five components (all P values < 0.008). Genetically predicted short sleep duration was moderately associated with MetS and its four components, including central obesity, dyslipidemia, hypertriglyceridemia, and hyperglycemia (all P values < 0.002), whereas genetically long sleep duration was not associated with MetS and any of its components. Conclusions Genetically predicted short sleep duration, but not genetically predicted long sleep duration, is a potentially causal risk factor for MetS.

ObjectiveTo determine the benefit of starting continuous glucose monitoring (CGM) in adult-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) with regard to longer-term glucose control and serious clinical events.Research design and methodsA retrospective observational cohort study within the Veterans Affairs Health Care System was used to compare glucose control and hypoglycemia- or hyperglycemia-related admission to an emergency room or hospital and all-cause hospitalization between propensity score overlap weighted initiators of CGM and nonusers over 12 months.ResultsCGM users receiving insulin (n = 5,015 with T1D and n = 15,706 with T2D) and similar numbers of nonusers were identified from 1 January 2015 to 31 December 2020. Declines in HbA1c were significantly greater in CGM users with T1D (-0.26%; 95% CI -0.33, -0.19%) and T2D (-0.35%; 95% CI -0.40, -0.31%) than in nonusers at 12 months. Percentages of patients achieving HbA1c <8 and <9% after 12 months were greater in CGM users. In T1D, CGM initiation was associated with significantly reduced risk of hypoglycemia (hazard ratio [HR] 0.69; 95% CI 0.48, 0.98) and all-cause hospitalization (HR 0.75; 95% CI 0.63, 0.90). In patients with T2D, there was a reduction in risk of hyperglycemia in CGM users (HR 0.87; 95% CI 0.77, 0.99) and all-cause hospitalization (HR 0.89; 95% CI 0.83, 0.97). Several subgroups (based on baseline age, HbA1c, hypoglycemic risk, or follow-up CGM use) had even greater responses.ConclusionsIn a large national cohort, initiation of CGM was associated with sustained improvement in HbA1c in patients with later-onset T1D and patients with T2D using insulin. This was accompanied by a clear pattern of reduced risk of admission to an emergency room or hospital for hypoglycemia or hyperglycemia and of all-cause hospitalization.

PurposeThere is a pressing need to investigate the impact of type II diabetes mellitus on the posterior cornea in donor tissues given its increasing prevalence and potential impact on endothelial keratoplasty surgical outcomes.MethodsImmortalized human cultured corneal endothelial cells (CECs; HCEC-B4G12) were grown in hyperglycemic media for 2 weeks. Extracellular matrix (ECM) adhesive glycoprotein expression and advanced glycation end products (AGEs) in cultured cells and corneoscleral donor tissues, as well as the elastic modulus for the Descemet membrane (DMs) and CECs of diabetic and nondiabetic donor corneas, were measured.ResultsIn CEC cultures, increasing hyperglycemia resulted in increased transforming growth factor beta-induced (TGFBI) protein expression and colocalization with AGEs in the ECM. In donor corneas, the thicknesses of the DM and the interfacial matrix (IFM) between the DM and stroma both increased from 8.42 ± 1.35 µm and 0.504 ± 0.13 µm in normal corneas, respectively, to 11.13 ± 2.91 µm (DM) and 0.681 ± 0.24 µm (IFM) in non-advanced diabetes (P = 0.013 and P = 0.075, respectively) and 11.31 ± 1.76 µm (DM) and 0.744 ± 0.18 µm (IFM) in advanced diabetes (AD; P = 0.0002 and P = 0.003, respectively). Immunofluorescence in AD tissues versus controls showed increased AGEs (P < 0.001) and markedly increased labeling intensity for adhesive glycoproteins, including TGFBI, that colocalized with AGEs. The elastic modulus significantly increased between AD and control tissues for the DMs (P < 0.0001) and CECs (P < 0.0001).ConclusionsDiabetes and hyperglycemia alter human CEC ECM structure and composition, likely contributing to previously documented complications of endothelial keratoplasty using diabetic donor tissue, including tearing during graft preparation and reduced graft survival. AGE accumulation in the DM and IFM may be a useful biomarker for determining diabetic impact on posterior corneal tissue.

Purpose Obesity is characterized by chronic inflammation that may contribute to insulin resistance and promote type 2 diabetes. We have investigated whether inflammatory responses to glycemic and insulinemic variations are altered in obese individuals. Methods Eight obese and eight lean individuals without diabetes had undergone hyperinsulinemic-euglycemic-hypoglycemic and hyperglycemic clamps in a previous study. Using Proximity Extension Assay, 92 inflammatory markers were analyzed from plasma samples at fasting, hyperinsulinemia-euglycemia, hypoglycemia and hyperglycemia. Results In all participants, hyperinsulinemia, hypoglycemia and hyperglycemia led to reductions of 11, 19 and 62 out of the 70 fully evaluable biomarkers, respectively. FGF-21 increased during both hypoglycemia and hyperglycemia while IL-6 and IL-10 increased during hypoglycemia. In obese vs lean participants, Oncostatin-M, Caspase-8 and 4E-BP1 were more markedly suppressed during hypoglycemia, whereas VEGF-A was more markedly suppressed during hyperglycemia. BMI correlated inversely with changes of PD-L1 and CD40 during hyperinsulinemia, Oncostatin-M, TNFSF14, FGF-21 and 4EBP-1 during hypoglycemia and CCL23, VEGF-A and CDCP1 during hyperglycemia (Rho & LE; -0.50). HbA1c correlated positively with changes of MCP-2 and IL-15-RA during hyperinsulinemia (Rho & GE; 0.51) and inversely with changes of CXCL1, MMP-1 and Axin-1 during hypoglycemia (Rho & LE; -0.55). M-value correlated positively with changes of IL-12B and VEGF-A during hyperglycemia (Rho & GE; 0.51). Results above were significant (p < 0.05). Conclusion Overall, hyperinsulinemia, hypo- and hyperglycemia led to suppression of several inflammatory markers and this tended to be more marked in individuals with obesity, insulin resistance and dysglycemia. Thus, acute glycemic or insulinemic variations do not seem to potentiate possible inflammatory pathways in the development of insulin resistance and disturbed glucose met

Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.

Background Observational studies have found that both short and long sleep duration are associated with increased risk of metabolic syndrome (MetS). This study aimed to examine the associations of genetically determined sleep durations with MetS and its five components (i.e., central obesity, high blood pressure, dyslipidemia, hypertriglyceridemia, and hyperglycemia) among a group of elderly population. Methods In 335,727 participants of White British from the UK Biobank, linear Mendelian randomization (MR) methods were first employed to examine the causal association of genetically predicted continuous sleep duration with MetS and its each component. Nonlinear MR analyses were performed to determine the nonlinearity of these associations. The causal associations of short and long sleep duration with MetS and its components were further assessed by using genetic variants that associated with short (<= 6 h) and long sleep (>= 9 h) durations. Results Linear MR analyses demonstrated that genetically predicted 1-h longer sleep duration was associated with a 13% lower risk of MetS, a 30% lower risk of central obesity, and a 26% lower risk of hyperglycemia. Non-linear MR analyses provided evidence for non-linear associations of genetically predicted sleep duration with MetS and its five components (all P values < 0.008). Genetically predicted short sleep duration was moderately associated with MetS and its four components, including central obesity, dyslipidemia, hypertriglyceridemia, and hyperglycemia (all P values < 0.002), whereas genetically long sleep duration was not associated with MetS and any of its components. Conclusions Genetically predicted short sleep duration, but not genetically predicted long sleep duration, is a potentially causal risk factor for MetS.

Type 2 diabetes mellitus (T2DM) is a major cause of microvascular dysfunction. However, its effect on blood flow patterns during ischemic demand has not been adequately elucidated. In this study, we investigated the hypothesis that microvascular dysfunction in patients with T2DM manifests as brachial reactive hyperemia (BRH), defined as the ratio of peak blood flow velocities in a brachial artery before and after forearm cuff occlusion. The study enrolled 943 subjects (men, n = 152 [T2DM] and n = 371 [non-T2DM]; women, n = 107 [T2DM] and n = 313 [non-T2DM], respectively) with no history of cardiovascular disease. Semiautomatic measurements were obtained three times at 1.5-year intervals to confirm the reproducibility of factors involved in BRH for each sex. An age-adjusted mixed model demonstrated attenuated BRH in the presence of T2DM in both men (p = 0.022) and women (p = 0.031) throughout the study period. Post hoc analysis showed that the estimated BRH was significantly attenuated in patients with T2DM regardless of sex, except at baseline in women. In multivariate regression analysis, T2DM was a negative predictor of BRH at every measurement in men. For women, BRH was more strongly associated with alcohol consumption. Repeated measurements analysis revealed that T2DM was associated with attenuated postocclusion reactive hyperemia.

BACKGROUND: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. METHODS: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. RESULTS: The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. CONCLUSION: The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clini

Pancreatic cancer (PC) is extremely aggressive, with symptoms occurring only in the advanced stage. The relationship between Type 2 Diabetes Mellitus (T2DM) and PC is complex. However, it is unclear whether long-standing diabetes causes cancer or whether cancer proceeds the development of impaired glucose metabolism. PubMed, Google Scholar, Scopus and Cochrane library were consulted to look for relevant literature. We narrowed down 20 articles after implementing inclusion and exclusion criteria. The database was searched using the keywords “Pancreatic Cancer” AND “Diabetes Mellitus.” This narrative literature review aims to analyze the literature on the analysis of the metabolic association of T2DM, the risk of carcinogenesis of the pancreas and their association, and the current understanding of metabolic pathways involved in cellular growth and metabolism. About 80% of patients with pancreatic disease have a previous diagnosis of diabetes within five years. We explored the literature to find metabolic associations between PC and T2DM due to insulin resistance, hyperinsulinemia, hyperglycemia, low-grade chronic inflammation, and insulin-like growth factor axis alteration.

This study compared the bioavailability and antihyperglycemic effect of 5 mg glibenclamide tablets available in Sudan. Nine healthy subjects were given a 5 mg dose of either micronized glibenclamide tablets (Euglucon®) or conventional non-micronized glibenclamide tablets (locally manufactured items). Blood samples were collected at 0, 1, 2, 3, 4, 5, 6, 7, and 8 hours and analyzed for glucose concentrations. The maximum mean serum concentration of the drug (Cmax) and the mean time to maximum serum concentration (Tmax) were calculated, and the area under the concentration versus time curve (AUC) and the drug clearance (Cl) were also recorded. The mean glucose concentration was also determined in different time intervals. The results show no significant difference in the mean Tmax between the tested items. However, the mean Cmax is significantly higher (p 0.001) when the non-micronized tablets are taken (456 ng/mL) rather than the micronized tablets (291 ng/mL). Similarly, the mean AUC0-8h is significantly higher (p 0.001) with the non-micronized tablets (1915 ng/mL.h) than with the micronized tablets (1163 ng/mL.h). After 8 hours, the subjects in the micronized group had a drug clearance of 0.0430 L/Kg.h, and a clearance of 0.0260 L/Kg.h was recorded in the unmicronized group. Both tablets lower the mean glucose concentrations of the nine volunteers after 8 hours, 99 mg/dL for micronized tablets and 98 mg/dL for non-micronized tablets. Overall, the non-micronized glibenclamide tablet used in this study similarly lowered the glucose concentrations in healthy volunteer subjects to that of imported micronized glibenclamide tablets.

This study compared the bioavailability and antihyperglycemic effect of 5 mg glibenclamide tablets available in Sudan. Nine healthy subjects were given a 5 mg dose of either micronized glibenclamide tablets (Euglucon®) or conventional non-micronized glibenclamide tablets (locally manufactured items). Blood samples were collected at 0, 1, 2, 3, 4, 5, 6, 7, and 8 hours and analyzed for glucose concentrations. The maximum mean serum concentration of the drug (Cmax) and the mean time to maximum serum concentration (Tmax) were calculated, and the area under the concentration versus time curve (AUC) and the drug clearance (Cl) were also recorded. The mean glucose concentration was also determined in different time intervals. The results show no significant difference in the mean Tmax between the tested items. However, the mean Cmax is significantly higher (p 0.001) when the non-micronized tablets are taken (456 ng/mL) rather than the micronized tablets (291 ng/mL). Similarly, the mean AUC0-8h is significantly higher (p 0.001) with the non-micronized tablets (1915 ng/mL.h) than with the micronized tablets (1163 ng/mL.h). After 8 hours, the subjects in the micronized group had a drug clearance of 0.0430 L/Kg.h, and a clearance of 0.0260 L/Kg.h was recorded in the unmicronized group. Both tablets lower the mean glucose concentrations of the nine volunteers after 8 hours, 99 mg/dL for micronized tablets and 98 mg/dL for non-micronized tablets. Overall, the non-micronized glibenclamide tablet used in this study similarly lowered the glucose concentrations in healthy volunteer subjects to that of imported micronized glibenclamide tablets.

Diabetes is associated with vascular injury and the onset of macrovascular complications. Advanced glycation endproducts (AGEs) and the AGE precursor methylglyoxal (MGO) have been identified as key players in establishing the relationship between diabetes and vascular injury. While most research has focused on the link between AGEs and vascular injury, less is known about the effects of MGO on vasculature. In this review, we focus on the mechanisms linking AGEs and MGO to the development of atherosclerosis. AGEs and MGO are involved in many stages of atherosclerosis progression. However, more research is needed to determine the exact mechanisms underlying these effects. Nevertheless, AGEs and MGO could represent valid therapeutic targets for the macrovascular complications of diabetes.

High-fat diet alone or in combination with high fructose has been known to induce diabetes, obesity, hypertension, and immune dysfunction. The study evaluates the role of Aloe vera in fat-rich and high fructose diet-induced (FRHFD) hyperglycemias in addition to testicular and splenic morphology in mice. Twenty BALB/c Mice were randomly distributed into four groups (n=5). The groups were fed on a normal diet, FRHFD, FRHFD + 10 g A. vera, and FRHFD + 20 g A. vera for 10 weeks. All the mice were sacrificed a day after the 10 weeks of treatment. The result showed that mice fed on FRHFD plus A. vera had a significantly lower (p<0.05) blood glucose level relative to the FRHFD-fed mice. The mice fed on FRHFD plus A. vera had a significantly lower (p<0.05) blood glucose level relative to the FRHFD-fed mice. Aloe vera was found to ameliorate FRHFD-induced pancreatic islet and acini damage. It also prevented distorted lymphoid cells and testicular damage induced by FRHFD. Aloe vera prevents hyperglycemia and protects pancreatic islets in FRHFD-fed mice. It further prevents immune dysfunction and protects against testicular damage. Hence, A. vera supplementation could be an alternative and/or complementary therapy for hyperglycemia-related disorders.

Aim To investigate the impact of treatment with once-weekly subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), for up to 2 years in people with type 2 diabetes (T2D) managed in routine clinical practice.Materials and methods The study was based on data from national registries. People who redeemed at least one prescription of semaglutide and had 2 years of follow-up were included. Data were collected at baseline and after 180, 360, 540 and 720 days of treatment (all timepoints +/- 90 days).Results In total, 9284 people redeemed at least one semaglutide prescription (intention-to-treat) and 4132 people redeemed semaglutide continuously (on-treatment). For the on-treatment cohort, the median (interquartile range) age was 62.0 (16.0) years, diabetes duration was 10.8 (8.7) years, and glycated haemoglobin (HbA1c) level was 62.0 (18.0) mmol/mol at baseline. A subset of the on-treatment cohort, comprising 2676 people, had HbA1c measurements at baseline and at least once during 720 days. The mean (95% confidence interval) changes in HbA1c after 720 days were -12.6 (-13.6; -11.6) mmol/mol (P < 0.001) for GLP-1RA-naive people, and -5.6 (-6.2; -5.0) mmol/mol (P < 0.001) for GLP-1RA-experienced people. Similarly, 55% of GLP-1RA-naive people and 43% of GLP-1RA-experienced people reached a HbA1c target of

Vypracovaná diplomová práce spočívá v testování buněčné viability a mitochondriální bioenergetiky v závislosti na rozdílné koncentraci glukózy použitých kultivačních médií. Glukóza a s ní spojována hyperglykémie či diabetes mellitus je v dnešní době stále neprobádanou oblastí. Práce se snažila pochopit vzájemný vztah mezi glukózou a metabolickými procesy uplatňujícími se v buňce. Věříme, že by tato studie mohla vést k celkovému pochopení pozměněné mitochondriální bioenergetiky, ovlivněné zvýšenou koncentrací glukózy. Předpokládáme, že mitochondrie jsou nedílnou součástí buňky a jejich porucha vede k řadě již definovaných, ale zejména ještě i neprobádaných komplikovaných stavů a nemocí. Snažíme se zjistit, zda je mezi mitochondriální dysfunkcí a hyperglykemií přímý mechanismus účinku. Energetický metabolismus je ovlivňován řadou impulzů z vnějšího a vnitřního prostředí. Je tedy těžké aplikovat metodu, která by byla schopná akceptovat i tyto rušivé elementy. Teoretická část práce je zaměřena na biosyntetickou organelu, která je hlavním intracelulárním producentem energie, zvanou mitochondrie. Jelikož je základem práce posuzování, zda rozdílná koncentrace glukózy ovlivňuje určitým způsobem energetický metabolismus, je v teoretické části práce věnována kapitola i glukóze a metabolickým dráhám, ve kterých se glukóza uplatňuje. V neposlední řadě je popisována i HepG2 buněčné linie, která byla důležitým předmětem zkoumání. Praktická část práce je zaměřena na testování buněčné viability a mitochondriálního metabolismu imortilizované lidské buněčné linie HepG2. Buňky byly rozděleny na dva fenotypy, které byly pěstovány na základě různých kultivačních podmínek. První fenotyp buněk byl vystaven dlouhodobým expozičním podmínkám normoglykemického prostředí, kde koncentrace glukózy byla 1 g/L. Druhý fenotyp buněk byl vystaven dlouhodobým expozičním podmínkám hyperglykemického prostředí, kde koncentrace glukózy byla 5 g/L., This work focuses on testing cellular viability and mitochondrial bioenergetics in relation to two different glucose concentrations used in the culture media. The effect of glucose level and its contribution to hyperglycemia or diabetes mellitus on cellular energy metabolism is still not fully understood. The study aimed to clarify the relationship between glucose and the metabolic processes that occur in the cell in order to obtain a better overall understanding of the altered mitochondrial bioenergetics influenced by increased glucose concentration. Mitochondria are an integral part of the cell, and their dysfunction leads to a range of well-defined, but especially understudied complicated conditions and diseases. The goal is to determine whether there is a direct mechanism of action between mitochondrial dysfunction and hyperglycemia. Since energy metabolism is influenced by various signals from the external and internal environment, therefore, applying a method that can also accept these interfering elements is challenging. The theoretical part of the thesis is focused on the biosynthetic organelle, mitochondria, which is the main intracellular energy producer. Since the basis of the work is to assess whether different glucose concentrations affect energy metabolism in a certain way, a chapter on glucose and metabolic pathways in which glucose is involved is included in the theoretical part. Finally, the HepG2 cell line, which was an important topic of investigation, is described. The practical part of the thesis focuses on testing the cellular viability and mitochondrial metabolism of the immortalised human cell line HepG2. The cells were divided into two phenotypes grown under different culture conditions. The first phenotype was exposed to a long-term normoglycemic condition, where the glucose concentration was 1 g/L. The second phenotype was exposed to a long-term hyperglycemic condition, where the glucose concentration was 5 g/L., Fakulta chemicko-technologická, 1. Prezentace výsledků diplomové práce. 2. Diskuze k posudkům vedoucího a oponenta diplomové práce. 3. Student/ka zodpověděl/la všechny dotazy a připomínky k DP., Dokončená práce s úspěšnou obhajobou

Introduction: in recent years, Diabetes Mellitus has been seen as one of the main morbidity and mortality problems worldwide according to the WHO, due to the multiple consequences it causes in diabetic patients, with diabetic foot being one of its causes. most relevant complications, which requires special care by health personnel because it can cause amputation of the affected limb. Objective: Currently, there are multiple clinical/surgical treatments for the diabetic foot, therefore, it is important to know the updates on patient well-being. Development: 48 articles were evaluated, which compiled important information about the most frequent risk factors for the appearance of diabetic foot ulcers, complications, as well as surgical clinical management. Conclusions: Diabetes mellitus is a chronic disease, considered the fourth cause of death in America, with diabetic foot being one of its most serious complications. Among the risk factors are previous amputation, smoking, decreased joint mobility, foot deformities, elevated plantar pressure, calluses., Introducción: en los últimos años la Diabetes Mellitus se ha visto como una de los principales problemas de morbi-mortalidad a nivel mundial de acuerdo a la OMS, debido a las múltiples consecuencias que ocasiona en el paciente diabético, siendo el pie diabético una de sus complicaciones más relevantes, el cual requiere un cuidado especial por el personal sanitario debido a que puede ocasionar la amputación de la extremidad afectada. Objetivo: En la actualidad existen múltiples tratamientos clínicos/quirúrgicos para el pie diabético, por lo tanto, es importante conocer las actualizaciones en bienestar de los pacientes. Desarrollo: se evaluaron 48 artículos, los cuales recopilaron información importante acerca de los factores de riesgo más frecuentes en la aparición de úlceras de pie diabético, las complicaciones, así como el manejo clínico quirúrgico. Conclusiones: la Diabetes mellitus es una enfermedad crónica, considerada la cuarta causa de muerte en América, siendo el pie diabético, una de sus complicaciones más graves. Entre los factores de riesgo, se encuentran: amputación previa, tabaquismo, movilidad articular disminuida, deformidades en el pie, presión plantar elevada, callosidades.

Tato bakalářská práce se zabývá zhodnocením úrovně znalostí pacientek s gestačním diabetem mellitem (GDM) ve třetím trimestru gravidity. Práce je rozdělena na teoretickou a praktickou část, kdy teoretická část se zaměřuje na rizikové faktory vzniku GDM, jeho dělení, diagnostiku, léčbu, dále popisuje hyperglykémii a hypoglykémii a hodnocení znalostí. Praktická část se věnuje hodnocení úrovně znalostí pacientek s GDM v oblasti léčebné výživy, pohybové aktivity, hyperglykémii a hypoglykémii a rizikům GDM pro matku a plod. Data byla sbírána pomocí dotazníku vytvořeného autorkou ve spolupráci s odborníkem z oboru diabetologie., The topic of this bachelor thesis is the evaluation of the knowledge of patients with gestational diabetes mellitus (GDM) in the third trimester of pregnancy. The thesis has a theoretical and a practical part. The theoretical part is focused on the risk factors of GDM, its diagnosis and treatment. It also describes hyperglycemia and hypoglycemia and knowledge evaluation. The practical part is focused on the knowledge evaluation of patients with GDM in the field of therapeutic nutrition, physical activity, hyperglycemia and hypoglycemia and the risks of GDM for the mother and her baby. The data were collected using a questionnaire created by the author in cooperation with an expert in the field of diabetology., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Tato bakalářská práce s názvem "Zkušenosti pacientů s diabetem mellitem 1. typu s fyzickou aktivitou" se zabývá problematikou hypoglykemií a hyperglykemií u osob s diabetem mellitem 1. typu (dále DM typ 1), kteří se věnují sportovním aktivitám. Teoretická část tvoří oporu části praktické a zabývá se popisem diabetu mellitu typ 1 a jeho komplikací a možné moderní léčbě. V praktické části se za pomoci mnou vytvořeného dotazníku snažím popsat zkušenosti pacientů s diabetem mellitem typ 1 a jejich kolísáním glykemie při sportu. Dále zjišťuji, jestli používání pumpy s hybridní smyčkou souvisí s častější sportovní aktivitou a zda výkyvy glykemie nebo hypoglykemie ovlivňují plánování fyzické aktivity., This bachelor thesis, entitled "The experience of patients with type 1 diabetes mellitus with physical activity", deals with the issue of hypoglycaemia and hyperglycaemia in people with type 1 diabetes mellitus (DM type 1) who engage in sporting activities. The theoretical part supports the practical part and deals with the description of diabetes mellitus type 1, its complications and possible modern treatment. In the practical part, using a questionnaire developed by me, I try to describe the experience of patients with diabetes mellitus type 1 and their glucose fluctuations during sports. Furthermore, I investigate whether the use of a hybrid loop pump is related to more frequent sports activity and whether glycaemic fluctuations or hypoglycaemia affect physical activity planning., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

According to the current paradigm, the development of type 2 diabetes is driven by insulin resistance and the gradual failure of beta cells to compensate for this by secreting adequate amounts of insulin. Obesity is an important risk factor for type 2 diabetes and is considered to influence disease development primarily by induction of insulin resistance, via mechanisms that have not been fully elucidated. Insulin-antagonistic, counter-regulatory neurohormonal pathways, including glucagon, cortisol (stimulated by the pituitary hormone ACTH), growth hormone and the autonomic nervous system have glucose-raising properties and constitute a physiological defense to hypoglycemia that is coordinated from the brain and brainstem. Glucose variations also trigger responses of several inflammatory mediators, that may also oppose the actions of insulin. The overarching aim of this thesis was to explore the importance of glucose-dependent dysregulation of these counter-regulatory pathways – hormonal, neural and inflammatory – in the development of type 2 diabetes. All selected papers in this thesis are based on data obtained during stepwise hyperinsulinemic-euglycemic-hypoglycemic clamps and hyperglycemic clamps, in which glucose levels are lowered or raised to prespecified target levels. In papers I and II, we found that overweight and insulin resistance was associated with cortisol/ACTH hyperreactivity to hypoglycemia and general hyperglucagonemia, insensitive to glucose-dependent suppression. Furthermore, in paper I, the autonomic nervous system was more rigid to glucose variations in overweight and insulin resistant individuals, with a failure to inhibit parasympathetic activity during hypoglycemia and an attenuated activity of sympathetic relative to parasympathetic activity during hyperglycemia. In paper III, cortisol/ACTH hyperreactivity was present already in individuals with prediabetes, with no further exacerbation in individuals with type 2 diabetes. By contrast, h

Introduction: Glycemic control in people in critical condition was implemented in an intensive care unit in 2003. Based on the publications of Dr. Greet Van Den Berghe and collaborators, a working group was created, and an action plan algorithm was designed. This algorithm underwent several changes, which were supported by scientific evidence and internal audits, to assess its effectiveness and safety. Objective: Verification of the safety and effectiveness of the protocol and the implications for nursing workload. Methods: Quantitative study of a prospective nature, data collection was carried out using a collection instrument prepared by the working group and statistical treatment using the Excel program. Results: The evolution from 2003 to 2019 is evidenced by the results and respective critical analysis of three audits carried out at different periods, with actual samples of 115, 61, and 112 patients, respectively, in which the different protocols for glycemic control with administration of continuous intravenous insulin infusion, applied in the unit, were effective and safe, and hypoglycemia did not translate into major complications (0.09%; 0.02% e 0,1% respectively). Conclusion: These results were mainly driven by the nursing team's ability to monitor and manage its responsibilities and less driven by the pre-defined goals of each protocol's blood glucose control. Since September of 2018, we use the modified Yale., Introdução: O controlo da glicemia na pessoa em situação crítica (PSC) foi implementado num Serviço de Medicina Intensiva de um Centro Hospitalar Universitário (CHU), em 2003. Tendo por base as publicações da Dra Greet Van Den Berghe e colaboradores, foi criado um grupo de trabalho e desenhado um algoritmo de atuação que foi sofrendo várias alterações, sustentadas pela evidência científica e auditorias internas, para aferir a sua eficácia e segurança. Objetivo: Verificação da segurança e eficácia do protocolo e as implicações na carga de trabalho de enfermagem. Métodos: Estudo quantitativo de natureza prospetiva, a colheita de dados foi realizada através de um instrumento de colheita elaborado pelo grupo de trabalho e o tratamento estatístico com recurso ao programa Excel. Resultados: A evolução de 2003 a 2019, tendo por base o avanço da aplicação do controlo da glicemia, é evidenciada pelos resultados e respetiva análise crítica de três auditorias realizadas em períodos distintos, com amostras efetivas de 115, 61 e 112 doentes respetivamente, em que os diferentes protocolos de controlo da glicemia com administração de insulina em perfusão contínua, aplicados no serviço, foram eficazes e seguros e as hipoglicemias nos doentes com insulina em perfusão contínua não se traduziram em complicações major (0.09%; 0.02% e 0,1% respetivamente). Conclusão: Estes resultados deveram-se sobretudo à capacidade de monitorização e organização do trabalho da equipa de enfermagem, sendo menos importante a ambição dos objetivos de controlo da glicemia de cada protocolo. Desde setembro de 2018 utilizamos o protocolo de Yale modificado., Introducción: El control de la glucemia en personas en estado critico se implantó en uno Servicio de Medicina Intensiva en 2003. A partir de las publicaciones del Dr. Greet Van Den Berghe y colaboradores, se creó un grupo de trabajo y un algoritmo de actuación que sufrió varios modificaciones, apoyadas en evidencias científicas y auditorías internas, para evaluar su eficacia y seguridad. Objetivo: Verificación de la seguridad y eficacia del protocolo y sus implicaciones en la carga de trabajo de enfermería. Métodos: Estudio cuantitativo de carácter prospectivo, la recolección de datos se realizó mediante un instrumento de recolección elaborado por el grupo de trabajo y tratamiento estadístico mediante el programa Excel. Resultados: La evolución desde 2003 hasta 2019, a partir de los avances en la implementación del control de la glucemia, se evidencia en los resultados y el respectivo análisis crítico de tres auditorías, en diferentes períodos, con muestras reales de 115, 61 y 112 pacientes repetivamente, en las que los diferentes protocolos de control de glucemia con infusión continua de insulina aplicados en el servicio han sido eficaces y seguros, y la hipoglucemia no se tradujo en complicaciones mayores (0.09%; 0.02% e 0,1% respetivamente). Conclusión: Estes resultados se relacionó sobre todo con la capacidad de monitorización y organización del equipo de enfermería, siendo menos importante la ambición de los objetivos de control de la glicemia. Desde septiembre de 2018 utilizamos el protocolo modificado de Yale.

According to the current paradigm, the development of type 2 diabetes is driven by insulin resistance and the gradual failure of beta cells to compensate for this by secreting adequate amounts of insulin. Obesity is an important risk factor for type 2 diabetes and is considered to influence disease development primarily by induction of insulin resistance, via mechanisms that have not been fully elucidated. Insulin-antagonistic, counter-regulatory neurohormonal pathways, including glucagon, cortisol (stimulated by the pituitary hormone ACTH), growth hormone and the autonomic nervous system have glucose-raising properties and constitute a physiological defense to hypoglycemia that is coordinated from the brain and brainstem. Glucose variations also trigger responses of several inflammatory mediators, that may also oppose the actions of insulin. The overarching aim of this thesis was to explore the importance of glucose-dependent dysregulation of these counter-regulatory pathways – hormonal, neural and inflammatory – in the development of type 2 diabetes. All selected papers in this thesis are based on data obtained during stepwise hyperinsulinemic-euglycemic-hypoglycemic clamps and hyperglycemic clamps, in which glucose levels are lowered or raised to prespecified target levels. In papers I and II, we found that overweight and insulin resistance was associated with cortisol/ACTH hyperreactivity to hypoglycemia and general hyperglucagonemia, insensitive to glucose-dependent suppression. Furthermore, in paper I, the autonomic nervous system was more rigid to glucose variations in overweight and insulin resistant individuals, with a failure to inhibit parasympathetic activity during hypoglycemia and an attenuated activity of sympathetic relative to parasympathetic activity during hyperglycemia. In paper III, cortisol/ACTH hyperreactivity was present already in individuals with prediabetes, with no further exacerbation in individuals with type 2 diabetes. By contrast, h

Purpose Obesity is characterized by chronic inflammation that may contribute to insulin resistance and promote type 2 diabetes. We have investigated whether inflammatory responses to glycemic and insulinemic variations are altered in obese individuals. Methods Eight obese and eight lean individuals without diabetes had undergone hyperinsulinemic-euglycemic-hypoglycemic and hyperglycemic clamps in a previous study. Using Proximity Extension Assay, 92 inflammatory markers were analyzed from plasma samples at fasting, hyperinsulinemia-euglycemia, hypoglycemia and hyperglycemia. Results In all participants, hyperinsulinemia, hypoglycemia and hyperglycemia led to reductions of 11, 19 and 62 out of the 70 fully evaluable biomarkers, respectively. FGF-21 increased during both hypoglycemia and hyperglycemia while IL-6 and IL-10 increased during hypoglycemia. In obese vs lean participants, Oncostatin-M, Caspase-8 and 4E-BP1 were more markedly suppressed during hypoglycemia, whereas VEGF-A was more markedly suppressed during hyperglycemia. BMI correlated inversely with changes of PD-L1 and CD40 during hyperinsulinemia, Oncostatin-M, TNFSF14, FGF-21 and 4EBP-1 during hypoglycemia and CCL23, VEGF-A and CDCP1 during hyperglycemia (Rho & LE; -0.50). HbA1c correlated positively with changes of MCP-2 and IL-15-RA during hyperinsulinemia (Rho & GE; 0.51) and inversely with changes of CXCL1, MMP-1 and Axin-1 during hypoglycemia (Rho & LE; -0.55). M-value correlated positively with changes of IL-12B and VEGF-A during hyperglycemia (Rho & GE; 0.51). Results above were significant (p < 0.05). Conclusion Overall, hyperinsulinemia, hypo- and hyperglycemia led to suppression of several inflammatory markers and this tended to be more marked in individuals with obesity, insulin resistance and dysglycemia. Thus, acute glycemic or insulinemic variations do not seem to potentiate possible inflammatory pathways in the development of insulin resistance and disturbed glucose met

40 p. -- Bibliogr.: p. 19-22, Introducción: la diabetes mellitus 2 (DM2) es el tipo de diabetes más prevalente. La educación diabetológica, realizada por enfermería, es clave para evitar el desarrollo de complicaciones agudas y crónicas. Desde hace varios años se pauta la práctica regular de ejercicio aeróbico por sus beneficios en el control glucémico. Pero algunos estudios sugieren que los ejercicios de resistencia producen mayores beneficios que los aeróbicos. Objetivo: identificar el efecto del ejercicio de resistencia, solo o combinado con ejercicio aeróbico, en el nivel de hemoglobina glicosilada (HbA1c) en personas con DM2. Metodología: se realizó una revisión crítica de la literatura. Se llevó a cabo una búsqueda en Medline, Cinalh, Cuiden, Cocranhe library, PEdro, Sportdiscus y WOS y una búsqueda manual en Google Académico y Science direct. Los filtros aplicados fueron artículos publicados en los últimos 10 años en inglés y castellano, con acceso a resumen y texto completo. Se identificaron 841 artículos y se incluyeron en la revisión 16. Resultados: en 7 estudios se observó una reducción significativa de la HbA1c tras la ejecución de ejercicios de resistencia, y en la mayoría de ellos (5 investigaciones) las personas tenían una HbA1c inicial >7,5%. En 7 estudios se observó una reducción significativa de la HbA1c tras la realización de ejercicios de resistencia combinados con aeróbicos, con independencia del nivel inicial de HbA1c. Conclusión: el ejercicio de resistencia puede ser beneficioso para mejorar el control glucémico en personas con DM2 que tienen una HbA1c inicial superior a 7,5%, pero combinado con ejercicio aeróbico se puede obtener el mismo beneficio con independencia del nivel inicial de dicho parámetro.

Guided bone regeneration (GBR) is a reconstructive procedure for treating atrophic alveolar ridges. This study aims to assess the correlation between different glycemic control levels and clinical findings in patients undergoing horizontal GBR before implant placement. The study population consisted of all patients requiring horizontal GBR. Patients were divided into three groups based on HbA1c levels: non-diabetic normoglycemic patients (HbA1c < 5.7%), non-diabetic hyperglycaemic patients (HbA1c < 6.5%), and patients with controlled diabetes (HbA1c < 7%). The primary outcomes were the horizontal (mm) and vertical (mm) dimensional changes of the alveolar ridge 6 months after the procedure. The study sample consisted of 54 patients. Sixty-eight implants (95.8%) were classified as "successful," meaning the possibility of inserting a standard-sized implant following the GBR (diameter ≥ 4 mm). There was a statistically significant difference between the three groups in terms of horizontal gain at 6 months: in particular, there was a statistically significant difference between group 1 and group 2 (p = 0.026) and between group 1 and group 3 (p = 0.030). The present investigation showed that patients with HbA1c levels below 7% could undergo GBR and obtain a statistically significant horizontal bone gain.