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Aims/Introduction: This study aimed to evaluate the problems in screening for gestational diabetes mellitus (GDM) by casual blood glucose (CBG) measurements at 24–28 gestational weeks. Materials and Methods: Overall, 763 pregnant women who underwent the 50‐g glucose challenge test (GCT) at 24–28 gestational weeks were enrolled. The preload blood glucose (0‐h BG) level of 50‐g GCT was considered as CBG. Results: A total of 240 women with BG levels at 1‐h after loading (1‐h BG) on 50‐g GCT ≥140 mg/dL underwent the 75‐g oral glucose tolerance test, and 98 (40.8%) were diagnosed with GDM. Of the 99 women with GDM, 71 (71.7%) had 0‐h BG on 50‐g GCT <100 mg/dL. Conclusions: This study, where pregnant women underwent both CBG and 50‐g GCT simultaneously, showed that when CBG at 24–28 gestational weeks ≥100 mg/dL alone was used for screening GDM, many pregnant women with GDM were overlooked. [ABSTRACT FROM AUTHOR]

The clinical diagnosis of diabetes mellitus typically depends on blood glucose measurements. Many laboratory studies have focused on enzyme–electrode biosensors that require an external power source. In this study, the potential of triboelectric nanogenerators (TENGs) as self‐driven sensors for glucose detection is investigated by utilizing the glucose specificity of glucose oxidase. When immersed in glucose solutions with concentrations ranging from 3.9 to 13.1 mmol L−1, the TENGs exhibit a linear relationship between the glucose concentration and current and voltage changes. These findings suggest that the TENGs developed in this study can effectively function as glucose sensors, providing a foundation for future human blood glucose monitoring applications and demonstrating a promising new approach for biomedical sensor technology. [ABSTRACT FROM AUTHOR]

Background and purpose: Maintaining mitochondrial quality is attracting attention as a new strategy to treat diabetes and diabetic complications. We previously reported that mitochondrial hyperfission by forming a protein complex between dynamin‐related protein (Drp) 1 and filamin, mediates chronic heart failure and cilnidipine, initially developed as an L/N‐type Ca2+ channel blocker, improves heart failure by inhibiting Drp1‐filamin protein complex. We investigated whether cilnidipine improves hyperglycaemia of various diabetic mice models. Experimental Approach: Retrospective analysis focusing on haemoglobin A1c (HbA1c) was performed in hypertensive and hyperglycaemic patients taking cilnidipine and amlodipine. After developing diabetic mice by streptozotocin (STZ) treatment, an osmotic pump including drug was implanted intraperitoneally, followed by weekly measurements of blood glucose levels. Mitochondrial morphology was analysed by electron microscopy. A Ca2+ channel‐insensitive cilnidipine derivative (1,4‐dihydropyridine [DHP]) was synthesized and its pharmacological effect was evaluated using obese (ob/ob) mice fed with high‐fat diet (HFD). Key Results: In patients, cilnidipine was superior to amlodipine in HbA1c lowering effect. Cilnidipine treatment improved systemic hyperglycaemia and mitochondrial morphological abnormalities in STZ‐exposed mice, without lowering blood pressure. Cilnidipine failed to improve hyperglycaemia of ob/ob mice, with suppressing insulin secretion. 1,4‐DHP improved hyperglycaemia and mitochondria abnormality in ob/ob mice fed HFD. 1,4‐DHP and cilnidipine improved basal oxygen consumption rate of HepG2 cells cultured under 25 mM glucose. Conclusion and implications: Inhibition of Drp1‐filamin protein complex formation becomes a new strategy for type 2 diabetes treatment. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the pharmacokinetics (PK) and pharmacodynamics (PD) of T‐glu (GP40321, test drug), and reference insulin glulisine in a hyperinsulinemic‐euglycemic clamp procedure. During this study, 34 healthy male volunteers underwent the hyperinsulinemic‐euglycemic clamp procedure following subcutaneous 0.3 U/kg injection of T‐glu or reference insulin glulisine in a randomized, double‐blind, crossover study. Plasma glucose levels were monitored every 5 minutes for 8 hours. Glucose infusion rate adjustment was based on the blood glucose measurements. Evaluation of PD was performed using the glucose infusion rate values, while PK was calculated using insulin concentrations measured via enzyme‐linked immunosorbent assay. The study results showed that the 90% CI for the geometric mean ratios of primary PK and PD of T‐glu and reference insulin glulisine were within 80%‐125% comparability limits, and that the safety profiles were comparable. PK, PD, and safety similarity of T‐glu and reference insulin glulisine was demonstrated. [ABSTRACT FROM AUTHOR]

The article discusses the proposal to change the name of diabetes insipidus to 'Arginine Vasopressin Deficiency (AVP‐D)' for central etiologies and 'Arginine Vasopressin Resistance (AVP‐R)' for nephrogenic etiologies. The rationale for this change includes avoiding confusion with diabetes mellitus, improving patient care, and aligning disease names with underlying pathophysiology. The proposal has been endorsed by various national and international endocrinology and pediatric societies. The working group suggests using the new terms alongside the old name initially to facilitate the transition. [Extracted from the article]

Objectives: To evaluate the feasibility of using the FreeStyle Libre (a continuous glucose monitoring system [CGMS]) for instantaneous continuous monitoring of interstitial glucose in adult horses and examine the applicability and accuracy of this system in horses submitted to combined glucose–insulin test (CGIT). Design: Laboratory measurements and continuous glucose monitoring system (CGMS) readings were analyzed using a 2 × 2 factorial statistical model with repeated measures over time. This analysis assessed the effects of the test (factor 1), group (factor 2), and their interactions (test × group, test × time, and group × time). Pearson's correlation analysis was applied to blood glucose values. Mean comparisons were conducted using the t‐test, and agreement between techniques was assessed via the Bland–Altman method, with a 95% confidence interval. Setting: Field study on private horse farms in association with a veterinary school. Animals: Ten healthy stallions were assigned to one of two groups based on their body condition scores (BCS). Group 1 (G1, n = 5) consisted of nonobese horses with a BCS of 5 or 6, while Group 2 (G2, n = 5) consisted of obese horses with a BCS of 7 or higher. Interventions: A CGMS sensor was attached to the dorsolateral aspect of the proximal one third of each horse's neck. Laboratory blood glucose measurements and CGMS interstitial glucose readings were compared at different time points for up to 7 days after sensor fixation. Obese horses were also submitted to CGIT on Day 4. Measurements and Main Results: A comparative analysis of glucose measurements obtained in G1 and G2 horses using the CGMS and enzymatic methods revealed significant group × time interactions (P < 0.001) and time effects (P < 0.001). No interactions were detected between group (P = 0.45), test (P = 0.62), group and test (P = 0.28), or time and test (P = 0.92). In G1 and G2, tests were significantly correlated (r = 0.84 and P = 0.00) at all time points (T0–T5). Agreement between the glucose values obtained using different methods was excellent despite a small time delay in CGMS detection of rapid changes in blood glucose. Conclusions: It was concluded that the CGMS can be used for indirect assessment of glycemic status (ie, based on interstitial glucose measurements) in nonobese and obese adult horses submitted to CGIT. [ABSTRACT FROM AUTHOR]

High‐resolution interference pattern images are vital for spatial heterodyne Raman spectroscopy to produce quality Raman spectra with a good signal‐to‐noise ratio. A sought‐after super‐resolution algorithm can enhance Raman interference pattern images, reducing reliance on expensive imaging sensors. This enables miniaturization and portability for point‐of‐care testing. This study proposes a generative adversarial network (GAN)‐based super‐resolution reconstruction algorithm explicitly designed for Raman interference patterns. Employing GAN adversarial training, the algorithm effectively reconstructs interference pattern images at higher resolution, improving Raman spectra signal‐to‐noise ratio. Considering Raman spectra analysis mainly focuses on characteristic peaks, a Raman characteristic peak‐focused network training scheme is used. For instance, acetaminophen is studied with two selected Raman characteristic peaks centered at 388 and 858 cm−1. These peaks are observed in Fourier transformed Raman spectra from corresponding low‐resolution interference pattern images obtained by down‐sampling high‐resolution ones by twofold and fourfold. The proposed GAN‐based algorithm successfully reconstructs low‐resolution interference patterns into high‐resolution ones, achieving high R‐square values (96.05% for twofold and 91.1% for fourfold). This innovation holds potential for point‐of‐care applications, like noninvasive blood glucose concentration measurements, enabling cost‐effective, portable Raman spectrometers with improved capabilities. [ABSTRACT FROM AUTHOR]

The treatment of type 1 diabetes through islet cell transplantation is a complex process, facing challenges such as allograft rejections and a limited supply of donors. One potential solution is to utilize the liver as an alternative for natural insulin production, as hepatocytes can secrete proteins and respond to glucose levels. Recent research has shown promising results in using mesenchymal stem cells as a potential cure for diabetes. The study utilized a diabetic rat model, confirmed through blood sugar measurement. A plasmid vector was designed with specific genetic components, synthesized by biotech company, and then Inserted vector into a plasmid with resistance genes and bacterial origin. Bone marrow‐derived mesenchymal stem cells (BM‐MSCs) were cultured and transfected with the plasmid using Lipofectamine 3000. Polymerase chain reaction was employed to confirm successful transfection using specific primers. For the animal study, 30 male Wistar rats were divided into six groups, each comprising five rats. The control group did not receive any treatment, while the second group received MSCs via Portal Vein Injection. The third group received MSCs transfected with a specific construct via Portal Vein Injection. The fourth group was induced to develop diabetes through streptozotocin (STZ) injection, the fifth group developed diabetes and received untransfected MSCs via Portal Vein Injection, and the sixth group received MSCs transfected with the specific construct via Portal Vein Injection. To manage Pain, appropriate pain control was administered to the rats for 3 days after the surgery. Fixed liver tissues obtained from the euthanized rats were utilized for immunohistochemistry. In this study, immunohistochemical techniques were used to examine insulin expression in different groups of rats. The control groups showed high levels of insulin expression, while the diabetic groups exhibited lower expression. However, there was a significant difference between the diabetic groups treated with MSC and transgenic MSC cells. All groups had similar baseline glucose levels, but the diabetic groups showed a significant increase after STZ injection, whereas the control and MSC groups did not. Postintervention, both the control and MSC groups had similar glucose levels to the post‐STZ levels. However, diabetes‐induced groups experienced a significant decrease in glucose levels, with the transfected MSCs showing a greater decrease than the untransfected MSCs. The study suggested that treatment with MSCs, especially transfected ones, can effectively reduce glucose levels in rats with diabetes. In this research, rat BM‐MSCs were utilized to create insulin‐producing mesenchymal cells with glucose‐sensitive insulin expression. The cells were transferred to the liver of diabetic rats via portal vein injection, leading to an increase in insulin expression. This study proposes a novel approach for cell therapy and delivery in the treatment of type 1 diabetes. Significance Statement: Type 1 diabetes arises from autoimmune destruction of pancreatic β cells, leading to insulin deficiency. Cell therapy, presents a promising avenue. cells can be genetically engineered to produce insulin in response to glucose fluctuations. Mesenchymal stem cells are potential candidates for generating insulin‐producing cells. This study employed a novel approach, genetically engineered using a plasmid vector with glucose‐responsive elements in bone marrow‐derived mesenchymal stem cells and cell transfer to rat liver through portal vein injection. Differing from conventional methodologies, this research utilized undifferentiated rat BM‐MSCs. The hypothesis revolved around the potential of rat BM‐MSCs to migrate into the rat liver via the Portal Vein Injection method, offering a distinctive perspective on diabetes treatment. [ABSTRACT FROM AUTHOR]

Whereas islet autoantibodies (AAs) are well‐established risk factors for developing type 1 diabetes (T1D), there is a lack of biomarkers endorsed by regulators to enrich clinical trial populations for those at risk of developing T1D. As such, the development of therapies that delay or prevent the onset of T1D remains challenging. To address this drug development need, the Critical Path Institute's T1D Consortium (T1DC) acquired patient‐level data from multiple observational studies and used a model‐based approach to evaluate the utility of islet AAs as enrichment biomarkers in clinical trials. An accelerated failure time model was developed, discussed in our previous publication, which provided the underlying evidence required to receive a qualification opinion for islet AAs as enrichment biomarkers from the European Medicines Agency (EMA) in March 2022. To further democratize the use of the model for scientists and clinicians, we developed a Clinical Trial Enrichment Graphical User Interface. The interactive tool allows users to specify trial participant characteristics, including the percentage of participants with a specific AA combination. Users can specify ranges for participant baseline age, sex, blood glucose measurement from the 120‐minute timepoints of an oral glucose tolerance test, and HbA1c. The tool then applies the model to predict the mean probability of a T1D diagnosis for that trial population and renders the results to the user. To ensure adequate data privacy and to make the tool open‐source, a deep learning‐based generative model was used to generate a cohort of synthetic subjects that underpins the tool. [ABSTRACT FROM AUTHOR]

Objective: To examine the efficacy and safety of Curalin supplement in patients with type 2 diabetes. Research design and methods: Adult patients with type 2 diabetes were randomized 1:1 to receive Curalin supplement or placebo. The primary endpoint was HbA1c decrease at 1 month. The secondary endpoint was a decrease in HbA1c by more than 0.5% and 1% and a change in 7 daily blood glucose measurements. A satisfaction questionnaire was used as an exploratory endpoint. Safety variables and adverse events were assessed. Results: After 1 month of intervention, HbA1c was reduced by 0.94% in the Curalin arm versus 0.4% in the placebo arm (P = 0.008). 72% of Curalin patients had decreased HbA1c levels >0.5% versus 35% in the placebo arm (P < 0.05). The Treatment Satisfaction Questionnaire indicated that Curalin arm patients reported higher overall satisfaction. Conclusions: Curalin treatment significantly reduced HbA1c over a 1‐month period and was well‐tolerated. [ABSTRACT FROM AUTHOR]

Background. Glucometers or portable sensors are used to quickly measure blood glucose at low cost. They are used in veterinary practice and by guardians to monitor diseases that require, as in diabetes mellitus. However, not all commercially available glucometers (human and veterinary) are suitable for this purpose. Hypotheses/Objectives. The objective was to evaluate the analytical and clinical precision of three human-use portable glucometers. Animals. This study evaluated 115 samples in three glycemic ranges (hypoglycemia, normoglycemia, and hyperglycemia) from 82 dogs recruited from veterinary services. Methods. The portable glucometers are the FreeStyle Freedom Lite®, FreeStyle Optium Neo®, and On Call Plus® models. Glucometer results were compared with the enzymatic colorimetric glucose oxidase laboratory reference method. Using descriptive and comparative statistical analysis, there were correlations between these devices and the standard method, ISO 15197 : 2003 and ISO 15197 : 2013 standards, and error grid analysis. Results. Only the Freedom Lite® device observed a statistical difference when compared with the reference method. Despite the underestimated glucose concentrations assessed with humane devices, all three tested herein showed a positive coefficient. However, none of these achieved all ISO guidelines. Conclusion and Clinical Importance. Although there was wide use of portable humane devices for dog glucose measurements on routine, the results are generally inferior when compared to the reference method. The FreeStyle Optium Neo® glucometer obtained the best result and is therefore the best option among the glucometers evaluated; however, for the first attendance on veterinary routine, all three glucometers had a satisfactory glucose measurement until the reference method availability. [ABSTRACT FROM AUTHOR]

Insulin aspart is a short‐acting insulin analogue that is used to control postprandial glycemia levels in diabetic patients. The aim of this clinical trial was to compare the pharmacokinetics and pharmacodynamics of GP40071 (GP‐Asp) and NovoRapid Penfill (Novo‐Asp) in a hyperinsulinemic euglycemic clamp (HEC). This trial was conducted as a part of a GP40071 biosimilar clinical development program. This was a phase I randomized, double‐blind, two‐period crossover study. Twenty‐six healthy male volunteers aged 18 to 45 years who met the inclusion criteria underwent the procedure of an HEC following a single subcutaneous injection of 0.3 IU/kg of either GP‐Asp or Novo‐Asp into the abdomen. After doses, plasma glucose levels were monitored every 5 minutes for 8 hours. The adjustment of the glucose infusion rate (GIR) was based on the blood glucose measurements. The GIR values were used to evaluate the PD profiles of the studied drugs. Regular blood sampling was performed during the study to obtain sufficient pharmacokinetic data. The 90% confidence intervals for the geometric mean ratios of the pharmacokinetic (AUCins.0‐t, Cins.max) and pharmacodynamic (GIRmax, AUCGIR0‐t) parameters of GP‐Asp were within the 80%–125% comparability limits. The safety profiles of the drugs were also comparable. Bioequivalence, similar PD, and safety of GP‐Asp and Novo‐Asp were demonstrated. [ABSTRACT FROM AUTHOR]

Background and purpose: No previous study has assessed the frequency and clinical–radiological characteristics of patients with diabetes mellitus (DM) and acute onset nonchoreic and nonballistic movements. We conducted a prospective study to investigate the spectrum of acute onset movement disorders in DM. Methods: We recruited all the patients with acute onset movement disorders and hyperglycemia who attended the wards of three hospitals in West Bengal, India from August 2014 to July 2021. Results: Among the 59 patients (mean age = 55.4 ± 14.3 years, 52.5% men) who were included, 41 (69.5%) had choreic or ballistic movements, and 18 (30.5%) had nonchoreic and nonballistic movements. Ballism was the most common movement disorder (n = 18, 30.5%), followed by pure chorea (n = 15, 25.4%), choreoathetosis (n = 8, 13.6%), tremor (n = 5, 8.5%), hemifacial spasm (n = 3, 5.1%), parkinsonism (n = 3, 5.1%), myoclonus (n = 3, 5.1%), dystonia (n = 2, 3.4%), and restless leg syndrome (n = 2, 3.4%). The mean duration of DM was 9.8 ± 11.4 years (89.8% of the patients had type 2 DM). Nonketotic hyperglycemia was frequently (76.3%) detected. The majority (55.9%) had no magnetic resonance imaging (MRI) changes; the remaining showed striatal hyperintensity. Eight patients with MRI changes exhibited discordance with sidedness of movements. Most of the patients (76.3%) recovered completely. Conclusions: This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders in DM. Of note was that almost one third of patients had nonchoreic and nonballistic movements. Our findings highlight the importance of a capillary blood glucose measurement in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status. [ABSTRACT FROM AUTHOR]

Objectives: To investigate and compare the accuracy of two veterinary portable blood glucose metres (AccuTell; AccubioTech; and AlphaTrak2; Abbott Laboratories). Materials and Methods: One hundred twenty venous blood samples were obtained for immediate whole blood glucose concentration measurement using two portable blood glucose metres designed for use in dogs. Plasma glucose concentration was measured by a laboratory analyser using a hexokinase reaction method. Packed cell volume was measured for each sample. Linear regression analysis was performed and Bland–Altman plots constructed with International Standards Organisation 15197:2013 standards applied to assess relationship and agreement between results of portable blood glucose metres and laboratory analyser methods, respectively. Clarke's error grid analysis was used to assess clinical accuracy and usefulness. Results: The AccuTell and the AlphaTrak2 had mean differences of −0.69 ± 0.70 mmol/L (bias ±sd) and −1.09 ± 1.22 mmol/L (bias ± sd) with the reference analyser, respectively. Eighty‐eight of 120 (73.3%) samples for the AccuTell, and 73 of 120 (60.8%) samples for the AlphaTrak2 were plotted in the zone of the error grid analysis that indicated less clinical risk of misdiagnosis of glucose status. Neither device fulfilled the International Standards Organisation 15197:2013 standards for system accuracy. A statistically significant effect of packed cell volume was identified on the difference between blood glucose concentration obtained by the AlphaTrak2 and the hexokinase reaction method, but not for the AccuTell. Clinical Significance: Both devices do not meet International Standards Organisation 15197:2013 standards. Users should expect 95% of the samples measured with the AccuTell to be between −0.7 and +2.1 mmol/L higher than actual values, and 95% of the samples measured with the AlphaTrak2 to be between −1.3 and +3.5 mmol/L higher than actual values. [ABSTRACT FROM AUTHOR]

The development of therapies to prevent or delay the onset of type 1 diabetes (T1D) remains challenging, and there is a lack of qualified biomarkers to identify individuals at risk of developing T1D or to quantify the time‐varying risk of conversion to a diagnosis of T1D. To address this drug development need, the T1D Consortium (i) acquired, remapped, integrated, and curated existing patient‐level data from relevant observational studies, and (ii) used a model‐based approach to evaluate the utility of islet autoantibodies (AAs) against insulin/proinsulin autoantibody, GAD65, IA‐2, and ZnT8 as biomarkers to enrich subjects for T1D prevention. The aggregated dataset was used to construct an accelerated failure time model for predicting T1D diagnosis. The model quantifies presence of islet AA permutations as statistically significant predictors of the time‐varying probability of conversion to a diagnosis of T1D. Additional sources of variability that greatly improved the accuracy of quantifying the time‐varying probability of conversion to a T1D diagnosis included baseline age, sex, blood glucose measurements from the 120‐minute timepoints of oral glucose tolerance tests, and hemoglobin A1c. The developed models represented the underlying evidence to qualify islet AAs as enrichment biomarkers through the qualification of novel methodologies for drug development pathway at the European Medicines Agency (EMA). Additionally, the models are intended as the foundation of a fully functioning end‐user tool that will allow sponsors to optimize enrichment criteria for clinical trials in T1D prevention studies. [ABSTRACT FROM AUTHOR]

The current study focuses on a non‐invasive microwave system based on a UWB antenna for blood glucose measurements in the frequency range of 1–4 GHz. Calculations of the minimal values of microwave reflection coefficient (S11 Min) corresponding to various blood glycemia, as well as comparisons to measured values using the Vector Network Analyzer Anritsu MS46121B, were the major findings of this study. The results were in good agreement, with a shift of less than 5%, demonstrating the effectiveness of our microwave method in detecting blood glycemia. To define an experimental approach between blood and dextrose solution, a comparative study in terms of slops in a linear approximation of both S11 Min and resonant frequency versus glucose concentration for the two mediums was interesting. The deviations in the results are less than 5% in the range of 1–2 GHz. However, it is not the case in the ranges of 2–3 GHz and 3–4 GHz since the two mediums show contrary behavior regarding S11 Min and resonant frequency. Consequently, D‐Solution might be used to simulate blood using our system for the investigation of glycemia only in the range of 1–2 GHz. [ABSTRACT FROM AUTHOR]

Aims: To conduct a pooled analysis to assess the performance of intermittently scanned continuous glucose monitoring (isCGM) in association with the rate of change in sensor glucose in a cohort of children, adolescents, and adults with type 1 diabetes. Material and Methods: In this pooled analysis, isCGM system accuracy was assessed depending on the rate of change in sensor glucose. Clinical studies that have been investigating isCGM accuracy against blood glucose, accompanied with collection time points were included in this analysis. isCGM performance was assessed by means of median absolute relative difference (MedARD), Parkes error grid (PEG) and Bland‐Altman plot analyses. Results: Twelve studies comprising 311 participants were included, with a total of 15 837 paired measurements. The overall MedARD (interquartile range) was 12.7% (5.9‐23.5) and MedARD differed significantly based on the rate of change in glucose (P < 0.001). An absolute difference of −22 mg/dL (−1.2 mmol/L) (95% limits of agreement [LoA] 60 mg/dL (3.3 mmol/L), −103 mg/dL (−5.7 mmol/L)) was found when glucose was rapidly increasing (isCGM glucose minus reference blood glucose), while a −32 mg/dL (1.8 mmol/L) (95% LoA 116 mg/dL (6.4 mmol/L), −51 mg/dL (−2.8 mmol/L)) absolute difference was observed in periods of rapidly decreasing glucose. Conclusions: The performance of isCGM was good when compared to reference blood glucose measurements. The rate of change in glucose for both increasing and decreasing glucose levels diminished isCGM performance, showing lower accuracy during high rates of glucose change. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Hyperglycemia, hypoglycemia, and blood glucose fluctuation are associated with the outcome in critically ill patients, but the target of blood glucose control is debatable especially in patients with diabetes regarding the status of blood glucose control before admission to ICU. This study aimed to investigate the association between the glycemic gap which is calculated as the mean blood glucose level during the first 7 days after admission to ICU minus the A1C‐derived average glucose and the outcome of critically ill patients with diabetes. Method: This study was undertaken in two intensive care units (ICUs) with a total of 30 beds. Patients with diabetes who were expected to stay for more than 24 h were enrolled, the HbA1c was tested within 3 days after admission and converted to the A1C‐derived average glucose (ADAG) by the equation: ADAG = [(HbA1c * 28.7) – 46.7 ] * 18‐1, arterial blood glucose measurements were four per day routinely during the first 7 days after admission, the APACHE II score within the first 24 h, the mean blood glucose level (MGL), standard deviation (SD), and coefficient of variation (CV) during the first 7 days were calculated for each person, the GAPadm and GAPmean were calculated as the admission blood glucose and MGL minus the ADAG, respectively, the incidence of moderate hypoglycemia (MH) and severe hypoglycemia (SH), the total dosage of glucocorticoids and average daily dosage of insulin within 7 days, the duration of renal replacement therapy (RRT), ventilator‐free hours, and non‐ICU stay days within 28 days were also collected. The enrolled patients were divided into a survival group and a nonsurvival group according to survival or not at 28 days and 1 year after admission, and the relationship between parameters derived from blood glucose and mortality in the enrolled critically ill patients was explored. Results: Five hundred and two patients were enrolled and divided into a survival group (n = 310) and a nonsurvival group (n = 192). It was shown that the two groups had a comparable level of HbA1c, the nonsurvivors had a greater APACHE II, MGL, SD, CV, GAPadm, GAPmean, and a higher incidence of hypoglycemia. A lesser duration of ventilator‐free, non‐ICU stay, and a longer duration of RRT were recorded in the nonsurvival group, who received a lower carbohydrate intake, a higher daily dosage of insulin and glucocorticoid. GAPmean had the greatest predictive power with an AUC of 0.820 (95%CI: 0.781–0.850), the cut‐off value was 3.60 mmol/L (sensitivity 78.2% and specificity 77.3%). Patients with a low GAPmean tended to survive longer than the high GAPmean group 1 year after admission. Conclusions: Glycemic GAP between the mean level of blood glucose within the first 7 days after admission to ICU and the A1C‐derived average glucose was independently associated with a 28 day mortality of critically ill patients with diabetes, the predictive power extended to 1 year. The incidence of hypoglycemia was associated with mortality either. [ABSTRACT FROM AUTHOR]

Blood glucose measurement is one of the most commonly performed clinical diagnostic tests used to monitor glycaemia in several animal diseases. Usually, these laboratory analyses are performed on blood venous samples in remote laboratories, and the results are delayed, at best. The use of portable glucometers could evidently solve many constraints but veterinary‐use glucometers are not usually available. The present study aimed to compare blood glucose levels obtained by Bionime glucometer to the reference method using glucose oxidase. Venous blood was collected from a total number of 140 healthy dogs (72 males and 68 females), of different breeds (28 German Shepherd, 27 Pitt bull, 21 Boxer, 24 Rottweiler and 40 cross‐bred dogs) and different ages (range: 3 months–14 years) for glucose measurement using the reference laboratory method. Capillary blood samples were used to conduct a glucose measurement with a human‐use glucometer. Our results revealed that there was no significant difference between the mean capillary blood glucose (CBG) measured with the human‐use glucometer (5.06 ± 0.84 mmol/L) and the mean venous blood glucose (VBG) measured with the laboratory reference method (4.90 ± 0.73 mmol/L) (p = 0.42). Similarly, there was no significant difference of the mean CBG and VBG in male dogs (5.11 ± 0.88 and 4.97 ± 0.75 mmol/L, respectively) and female dogs (5.01 ± 0.81 and 5.07 ± 0.72 mmol/L, respectively) (p = 0.73 and 0.21, respectively), and no correlation to neither age (5.43 ± 0.90 and 5.20 ± 0.70 mmol/L in 3 to 6 month‐old dogs, 5.03 ± 0.82 and 4.94 ± 0.79 mmol/L in 6 months to 1 year‐old, 4.94 ± 0.67 and 5.13 ± 0.66 mmol/L in 1 to 4 year‐old dogs; 4.88 ± 0.94 and 4.80 ± 0.75 mmol/L in dogs older than 4 years, respectively, p < 0.05), nor to breed (4.94 ± 1.01 and 4.99 ± 0.79 mmol/L in German Shepherd, 5.13 ± 0.84 and 4.99 ± 0.79 mmol/L in Pitt Bull, 5.07 ± 0.94 and 5.07 ± 0.77 mmol/L in Boxer, 5.40 ± 0.59 and 5.48 ± 0.55 mmol/L in Rottweiler and 4.89 ± 0.75 and 4.77 ± 0.59 mmol/L in cross‐bred dogs, respectively, p < 0.05). The present study confirms that human glucometer can be used to measure glucose in dogs with a good accuracy. [ABSTRACT FROM AUTHOR]

Aim: To examine blood glucose measurements recorded as part of the diabetes protocol operated by the UK, Ireland and Austria, which allows commercial airline pilots with insulin‐treated diabetes to fly. Methods: An observational study was conducted in pilots with insulin‐treated diabetes, granted medical certification to fly commercial or noncommercial aircraft, who recorded pre‐flight and hourly in‐flight blood glucose measurements. These values were correlated to a traffic light system (green 5.0 to 15.0 mmol/L; amber 4.0 to 4.9 mmol/L and 15.1 to 20.0 mmol/L; and red <4.0 mmol/L or >20.0 mmol/L) and studied for trends in glucose concentrations, time course within flight and any consequences. Pilot demographics were also analysed. Results: Forty‐four pilots (90%) recorded one or more blood glucose value outside the green range during the 7 years of the study. Pilot age, diabetes type and duration, and follow‐up period were comparable among subgroups, and mean glycated haemoglobin did not differ before and after certification in a way which would indicate poorer glycaemic control in any subgroup. A total of 892 blood glucose values (2.31%) were outside the green range, with half reported in‐flight at various time intervals. There were 48 (0.12%) low red range values recorded, 14 (0.04%) of which occurred in‐flight; all but four were restored to within the green range by the time of the next measurement. Appropriate corrective action was taken for all out‐of‐range values, with no reports of pilot incapacitation from any cause. Conclusions: The traffic light system appears effective in identifying and reducing the frequency and severity of out‐of‐range values. [ABSTRACT FROM AUTHOR]

Camel milk is a valuable source of nutrition with a wide range of therapeutic effects. Its unique composition helps to regulate the blood glucose level. The current study is aimed to evaluate the antidiabetic and hepatoprotective effects, as well as lipid profile restoration of camel milk in the diabetic mouse model. This innovative study evaluates the therapeutic effects of camel milk in diabetic mice by simultaneous measurement of blood glucose, HbA1c, ALT, AST, TG, cholesterol, and histopathological studies. The results showed that camel milk has significantly reduced blood glucose, HbA1c (p <.001), aspartate transaminase (AST), alanine transaminase (ALT) (p <.01), triglyceride (TG), and cholesterol (p <.01), compared to that in the diabetic control group. Also, the therapeutic effects of camel milk were completely comparable with the antidiabetic drug glibenclamide. The results of this study suggest that camel milk could be used as a proper alternative treatment regimen for diabetes therapy. [ABSTRACT FROM AUTHOR]

Background: Glycemic variability (GV) is an indicator of glycemic control and can be evaluated by calculating the SD of blood glucose measurements. In humans with diabetes mellitus (DM), adding a glucagon‐like peptide‐1 (GLP‐1) analogue to conventional therapy reduces GV. In diabetic cats, the influence of GLP‐1 analogues on GV is unknown. Objective: To evaluate GV in diabetic cats receiving the GLP‐1 analogue exenatide extended release (EER) and insulin. Animals Thirty client‐owned cats with newly diagnosed spontaneous DM. Methods: Retrospective study. Blood glucose curves from a recent prospective placebo‐controlled clinical trial generated 1, 3, 6, 10, and 16 weeks after starting therapy were retrospectively evaluated for GV. Cats received either EER (200 μg/kg) or 0.9% saline SC once weekly, insulin glargine and a low‐carbohydrate diet. Mean blood glucose concentrations were calculated and GV was assessed by SD. Data were analyzed using nonparametric tests. Results: In the EER group, GV (mean SD [95% confidence interval]) was lower at weeks 6 (1.69 mmol/L [0.9‐2.48]; P =.02), 10 (1.14 mmol/L [0.66‐1.62]; P =.002) and 16 (1.66 mmol/L [1.09‐2.23]; P =.02) compared to week 1 (4.21 mmol/L [2.48‐5.93]) and lower compared to placebo at week 6 (3.29 mmol/L [1.95‐4.63]; P =.04) and week 10 (4.34 mmol/L [2.43‐6.24]; P <.000). Cats achieving remission (1.21 mmol/L [0.23‐2.19]) had lower GV compared to those without remission (2.96 mmol/L [1.97‐3.96]; P =.01) at week 6. Conclusions and Clinical Importance: The combination of EER, insulin, and a low‐carbohydrate diet might be advantageous in the treatment of newly diagnosed diabetic cats. [ABSTRACT FROM AUTHOR]

The determination of blood glucose is usually performed in the laboratory or using invasive glucose meters. Unusual, fruity, or bad breath odor can be a sign of metabolic disease. The objective is the estimation of the blood glucose by breath analysis. To do that, we designed a three‐gas prediction model (alcohol, acetone, and propane). We exhaled in front of the three gas sensors and then recorded the concentrations of the three volatile organic compounds (VOCs) in a database. This database included the measurements of 200 volunteer people. We then systematically studied the correlation between the glucose level obtained by blood analysis and each of these three gases. We also studied the different possible combinations of two and three gases. The best correlation was obtained for the non‐diabetic subjects with a correlation coefficient (r = 0.97), for the diabetic subjects (r = 0.35). We implemented these two linear regressions and we used the validation set to estimate the accuracy of the prototype. For the non‐diabetic subjects, the relative error of the measurement of the glycemia was equal to 3.93%. For the diabetic subjects, the error = 13.42%. The results have shown that the determination of glycemia by breath analysis can become a serious alternative. © 2020 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

The standard procedure for blood glucose measurements is enzymatic testing. This method is cheap, but requires small samples of open blood with direct contact to the test medium. In principle, NMR provides non‐contact analysis of body fluids, but high‐field spectrometers are expensive and cannot be easily utilized under clinical conditions. Low‐field NMR systems with permanent magnets are becoming increasingly smaller and more affordable. The studies presented here aim at exploring the capabilities of low‐field NMR for measuring glucose concentrations in whole blood. For this purpose, a modern 1 T benchtop NMR spectrometer was used. Challenges arise from broad spectral lines, the glucose peak locations close to the water signal, low SNR and the interference with signals from other blood components. Whole blood as a sample comprises even more boundary conditions: crucial for reliable results are avoiding the separation of plasma and cells by gravitation and reliable reference values. First, the accuracy of glucose levels measured by NMR was tested using aqueous glucose solutions and commercially available bovine plasma. Then, 117 blood samples from oral glucose tolerance testing were measured with minimal preparation by simple pulse‐acquire NMR experiments. The analysis itself is the key to achieve high precision, so several approaches were investigated: peak integration, orthogonal projection to latent structure analysis and support vector machine regression. Correlations between results from the NMR spectra and the routine laboratory automated analyzer revealed an RMSE of 7.90 mg/dL for the best model. 91.5% of the model output lies within the limits of the German Medical Association guidelines, which require the glucose measurement to be within 11% of the reference method. It is concluded that spectral quantification of glucose in whole blood samples by high‐quality NMR spectrometers operating at 1 T is feasible with sufficient accuracy. [ABSTRACT FROM AUTHOR]

Background: Glucose monitoring systems, for example, Freestyle Libre (Abott) and Dexcom (Nintamed), are increasingly being used instead of conventional blood sugar measurement. However, many patients have experienced adverse skin reactions such as severe allergic contact dermatitis (ACD). Finally, in August 2017, the culprit allergen in Freestyle Libre, isobornyl acrylate (IBOA), was identified. Objectives: After patients have developed ACD, it is recommended that they no longer use their glucose monitoring systems. Thus, it is important to find an alternative IBOA‐free device. Patients and Methods: Five patients presented with ACD caused by Freestyle Libre. Each was patch tested with allergens from the baseline series and from a plastics and glues series, and additionally with IBOA 0.1% pet. Gas chromatography‐mass spectrometry (GC/MS) of the Freestyle Libre sensor and the Dexcom sensor was performed. The Dexcom sensor remained on the skin of all patients for at least 2 days. Results: All patients were sensitized to IBOA. GC/MS showed the presence of IBOA in the Freestyle Libre sensor, whereas the Dexcom sensor was IBOA‐free. None of the patients had skin reactions to the Dexcom sensor. Conclusions: Patients with Freestyle Libre and IBOA allergy may use the Dexcom sensor as an alternative for glucose monitoring. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Diabetic eye disease is a leading cause of blindness worldwide and diabetes‐related eye conditions are frequent presentations in Eye Emergency Departments (EEDs). Early detection and intervention of inadequate blood glucose control in the EED could be sight‐saving. The aims of this study are to determine the:prevalence of pre‐existing diabetes mellitus (DM) in the EED.prevalence of suboptimal (HbA1c 53–70 mmol/mol) or poor (HbA1c >70 mmol/mol) glycaemic control in the EED.proportion of diabetes patients with this diagnosis documented in the EED.proportion of EED patients at risk of undiagnosed diabetes.number of EED patients that had a capillary blood glucose measurement (BgM). Methods: A retrospective review of 683 patients attending the EED over 10 consecutive weekdays at Manchester Royal Eye Hospital, Manchester, United Kingdom. The following parameters were assessed:EED documentation: patient age, gender, presentation, diagnosis, management plan and whether a BgM was done.General Practitioner records: diabetes diagnosis cross‐referenced with EED documentation.If diabetes patients: diabetes type, duration, and glycaemic control.Potentially undiagnosed diabetes. Results: The prevalence of diabetes patients was 9.5%–64.6% of these patients had diabetes documented in EED and 1 had a capillary BgM. 70.7% of diabetes patients had pre‐existing suboptimal [33.8%] or poor [36.9%] glycaemic control. 8.5% of patients were considered high‐risk for undiagnosed diabetes of which 1 had a BgM. Conclusions: There is a high prevalence of diabetes patients in the EED, and most have inadequate glycaemic control. This makes the EED an important setting to detect patients at high risk of diabetes‐related ocular disease and complications. BgM testing for all suspected patients is a quick test to allow earlier detection and intervention of inadequately controlled diabetes and reduce the risk of diabetes‐related vision loss. [ABSTRACT FROM AUTHOR]

In this study, a novel gold-coated test strip for blood glucose measurement has been designed. Such gold-coated test strip is feasible for mass production to achieve economies of scale. Cyclic voltammetry was applied to test strips to undergo electrochemical reaction under a potential range of ±0.4 V. Glucose oxidase (GOD) was added into K3[Fe(CN)6]. When glucose oxidase undergoes electrochemical reaction, the medium, K3[Fe(CN)6], will act as an electron acceptor, causing the electrodes on the test strip to generate a pair of clear anodic and reductive peaks. The maximum of the anodic and reductive peaks can be used as reference to adjust the resistance of the blood glucose meter. The experimental results show that by adjusting the resistance of the blood glucose meter, the accuracy of blood glucose meter reading can be tuned and blood glucose reading can be stabilized. Therefore, when the resistance of the blood glucose meter is at 2.4 KΩ, the standard deviation (STD) and coefficient of variation (CV) of the test strip are lower than those of the test strips measured at resistances of 2.2 KΩ and 2.6 KΩ. It has been proved in this study that adjusting the resistance of the blood glucose meter can optimize the chemical reaction on gold-coated test strips as well as its reading. This method can also be applied to tune the accuracy of readings for test strips coated with other materials. [ABSTRACT FROM AUTHOR]

For patients with type 2 diabetes mellitus (T2DM) and inadequate glycaemic control, addition of basal insulin is recommended, but titration and optimization of basal insulin therapy in primary care is not well understood. We conducted an observational trial in 2470 patients with T2DM who initiated insulin glargine 100 U/L (Gla‐100) on top of oral antidiabetic drugs. Physicians were free to choose either a "Davies," "Fritsche" or "individual" titration algorithm. We found that fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) levels were effectively reduced by Gla‐100; 65.9% of patients achieved the primary endpoint (FBG ≤6.1 mmol/L (110 mg/dL) or an individual HbA1c target). There were no significant differences in efficacy and safety between the algorithms used. The mean FBG decreased by 3.2 mmol/L (59 mg/dL) over 12 months, while the mean HbA1c decreased by 15.3 mmol/mol (1.4%)%. From a starting dose of 11.7 U/d, the Gla‐100 dosage was 22.8 U/d at 12 months, with similar values in each group. Rates of hypoglycaemia were low and did not differ by titration algorithm. We conclude that Gla‐100 was effective at reducing FBG and HbA1c, independent of the titration algorithm, but observed that algorithms were inconsistently applied in clinical practice. [ABSTRACT FROM AUTHOR]

The burden of both tuberculosis (TB) and diabetes mellitus in developing countries including Ghana is high; often, the two coexist and impact each other negatively. Objective. The study aimed to determine the prevalence and predictive factors of dysglycaemia among newly diagnosed smear positive tuberculosis patients at a tertiary tuberculosis treatment centre in Ghana. Methods. Dysglycaemia at diagnosis was determined by the use of oral glucose tolerance test (OGTT), while sputum smear microscopy was used to assess the sputum status. Only smear positive patients were included in the study. Information on sociodemographic, anthropometrical, clinical, and medication history was also obtained. Results. In all, 146 participants, aged 18 to 75 years with a mean age of 38.7 years comprising 115 (78.8%) males and 31 (21.2%) females, were involved in the analysis. Upon initial screening, using fasting plasma glucose (FPG), 91.1 % had normal fasting level, 5.5 % had impaired fasting, and 3.4% were diagnosed with diabetes. Using 2-hour postprandial values (2HPP), 59.6% had normal plasma glucose, 28.8 % had impaired glucose tolerance (IGT), and 11.6 % were diagnosed with diabetes. Overall, the prevalence of dysglycaemia (i.e., impaired fasting and diabetes) was 8.9% (95% CI: 5.21–14.82%) with FPG test and 40.4% (95% CI: 32.68–48.65%) with 2HPP test. The analysis revealed that 2HPP was associated with high mean age compared to FPG (36.67 ± 13.97 versus 41.69 ± 13.97, p-value = 0.033). In addition, marital status was significantly associated with FPG status of patients (p=0.028). Conclusion. The prevalence of dysglycaemia was high among smear positive TB patients in Ghana. Higher mean age and marital status were associated with abnormal glucose tolerance and fasting plasma glucose, respectively. Clinical management of patients with tuberculosis should include screening for diabetes. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of and risk factors for metabolic syndrome (MS) in HIV-infected adults at three urban clinics in Bukavu, Democratic Republic of the Congo.Design: Cross-sectional study.Methods: From July to September 2016, baseline socio-demographics, risk factors and clinical characteristics were collected using a structured questionnaire or extracted from medical records. Fasting blood sugar and lipids were measured. MS was defined per the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) criteria. Adjusted odds ratio (OR) was generated through multivariate logistic regression models.Results: Of 495 participants, 356 (72%) were women and 474 (95.8%) were receiving antiretroviral therapy (ART). The median age (years) [interquartile range (IQR)] was 43 [36-51]. The overall prevalence of MS per NECP/ATP III and IDF criteria was 27% [95% CI: 20-35%] or 30% [95% CI: 23-38%], respectively. In a multivariate logistic regression, low physical activity (OR 2.47, 95% CI: 1.40-4.36); daily exposure to biomass fuel smoke (BMF) for more than 2 h (OR 2.18, 95% CI: 1.01-4.68); protease inhibitor containing ART (OR: 2.96, 95% CI: 1.07-8.18); and stavudine-containing ART regimen (OR: 2.57, 95% CI: 1.11-5.93) were independently associated with MS.Conclusions: MS was highly prevalent in this hospital-based study population. Beside known traditional risk factors and contribution of specific ART regimens to MS, daily exposure to BMF is new and of specific concern, necessitating targeted urgent prevention and management interventions. [ABSTRACT FROM AUTHOR]

Study Objective To determine if insulin detemir administration time affects the frequency of hypoglycemia (blood glucose level <70 mg/ dl) in hospitalized patients. Design Retrospective cohort study. Patients A total of 357 adults (aged 18-89 yrs) who received insulin detemir for at least 48 hours while hospitalized between January 1, 2014, and December 31, 2015, were included. Patients were categorized into one of three groups according to insulin detemir administration time: detemir given once/day between 7 a.m. and 10 a.m. ( AM group [71 patients]), detemir given once/day between 6 p.m. and 10 p.m. ( PM group [158 patients]), and detemir given twice/day ( BID group [128 patients]). Setting Community hospital. Measurements and Main Results The primary outcome was the percentage of patient days with any occurrence of hypoglycemia. The key secondary outcomes included the percentages of patients who experienced any hypoglycemic event, severe hypoglycemia, hypoglycemia requiring treatment, and refractory hypoglycemia; time of hypoglycemia; and percentage of patients experiencing one or more episodes of hyperglycemia. The AM group had a lower proportion of days with hypoglycemia compared with the PM group (7.9% vs 11.9%, p=0.008). There was a nonsignificant trend toward a lower proportion of days with hypoglycemia in the BID group compared with the PM group (9.1% vs 11.9%, p=0.0302). No significant differences in percentage of patient days with hyperglycemia and rates of severe hypoglycemia, hypoglycemia requiring treatment, or refractory hypoglycemia were noted among the three groups. Conclusion Administration of detemir in the morning may reduce the occurrence of hypoglycemia in hospitalized patients. Institutions that include detemir on their formularies may consider evaluating the incidence of hypoglycemia and modifying administration schedules as part of their medication safety program. [ABSTRACT FROM AUTHOR]

In this study, rats fed with a high-fat diet were treated with resistant starch (RS), chitosan oligosaccharide (COS), and a combination of these complexes with the aim of determining their effect on controlling blood glucose levels and improving insulin resistance (IR). Scanning electron microscopy (SEM) analysis demonstrated that an outer thin layer of film produced by COS covered the surface of RS granules and resulted in an increased particle size distribution. Cross-linking between RS and COS was confirmed by Fourier transform infrared (FTIR) spectroscopy analysis. Treatment of rats revealed that blood glucose concentration was lowered to almost normal levels following the administration of either COS or COS-RS complexes. Furthermore, the homeostasis model of assessment for insulin resistance index (HOMA-IR) was reduced and the quantitative insulinsensitivity check index (QUICKI) wasincreased with administrationofCOS-RScomplexes. In summary, the consumption of COS-RS complexes exerted a more efficient recovery of insulin sensitivity compared to individual treatments. Gene expression in liver tissue harvested from treated rats suggested that the improvement in insulin resistance was associated with enhanced hepatic glucose conversion through upregulation of GS2 and GYG1, reduction in gluconeogenesis was related to an upregulation in G6PC1 gene expression, and an alteration in glucolipid metabolism was associated with increased expression of Insig-2. [ABSTRACT FROM AUTHOR]

Background: Repeatability of the oral sugar test (OST) has not been evaluated. Objectives We hypothesized that OST glucose, insulin, active (aGLP-1) and total (tGLP-1) glucagon-like peptide 1, and high-molecular-weight (HMW) adiponectin results would be repeatable. Animals: Fifty-three horses from a Tennessee research facility (n = 23) and private practice in Missouri (n = 30), including animals with medical histories of equine metabolic syndrome. Methods: Two OSTs were performed 7–14 days apart and plasma glucose and insulin concentrations were measured at 0, 60, and 75 minutes; a positive result was defined as detection of an insulin concentration >45 μU/mL at 60 or 75 minutes. Plasma aGLP-1 and serum tGLP-1 concentrations at 75 minutes and serum HMW adiponectin concentrations at 0 minute were measured in the Missouri group. Bland-Altman analyses were performed. Results: No adverse events were reported. Bland-Altman analysis indicated mean ± SD bias of 1.5 ± 14.8 μU/mL (95% confidence interval [CI], −27.6 to 30.5 μU/mL) and 1.2 ± 16.1 μU/mL (95% CI, −30.4 to 32.8 μU/mL) for insulin concentrations at 60 and 75 minutes, respectively. There was 91 and 83% agreement in test interpretation between test days for OST insulin results for all horses in the Tennessee and Missouri groups, respectively. Conclusions and Clinical Importance: Repeatability of the OST was acceptable when values obtained from Bland-Altman analyses were evaluated, and there was good agreement in binary (negative/positive) test interpretation for insulin concentrations. However, wide 95% CIs were detected for insulin concentrations. [ABSTRACT FROM AUTHOR]

Differences in glucose metabolism between men and women have previously been reported. Our purpose was to determine if there is a gender difference in fasting hepatic glucose uptake (MRglu). Fifty-five patients (44 men, 11 women) referred for routine PET/CT using the glucose tracer 2-deoxy-2-[F-18]fluoro-D-glucose (FDG), mainly for cancer, had dynamic imaging for 30 min immediately following injection. Hepatic FDG clearance (mL/min/100 mL) was measured as gradient divided by intercept from Patlak-Rutland graphical analysis using a volume of interest over the abdominal aorta to record input function. Hepatic MRglu was obtained by multiplication of clearance by blood glucose concentration. Hepatic steatosis was diagnosed as CT density ≤40 HU. Mean (standard deviation) hepatic MRglu in 44 men was 2.30 (1.14) lmol/min/100 mL, significantly higher than in 11 women in whom it was 1.07 (1.35) lmol/min/100 mL (P = 0.003). CT density was 52 (12) HU in women compared with 45 (9) HU in men (P = 0.04), but there was no significant difference in blood glucose, BMI, or prevalence of recent chemotherapy (within 6 months preceding PET/CT). When patients were subdivided into those without hepatic steatosis (31 men/9 women), those without evidence of FDG-avid malignancy on PET/CT (15/6), and those without either (11/5), gender differences in hepatic MRglu remained highly significant, but there were no significant differences in CT density, blood glucose, BMI, or recent chemotherapy history. Despite this being a population of clinically referred patients, the results strongly suggest that fasting hepatic MRglu is higher in men than in women. [ABSTRACT FROM AUTHOR]

Objectives To examine the usefulness of including sodium (Na) levels as a criterion to the SOAR stroke score in predicting inpatient and 7-day mortality in stroke. Materials and Methods Data from the Norfolk and Norwich University Hospital Stroke & TIA register (2003-2015) were analysed. Univariate and then multivariate models controlling for SOAR variables were used to assess the association between admission sodium levels and inpatient and 7-day mortality. The prognostic ability of the SOAR and SOAR Na scores for mortality outcomes at both time points were then compared using the Area Under the Curve ( AUC) values from the Receiver Operating Characteristic curves. Results A total of 8493 cases were included (male=47.4%, mean (SD) 77.7 (11.6) years). Compared with normonatremia (135-145 mmol/L), hypernatraemia (>145 mmol/L) was associated with inpatient mortality and moderate (125-129 mmol/L) and severe hypontraemia (<125 mmol/L) with 7-day mortality after adjustment for stroke type, Oxfordshire Community Stroke Project classification, age, prestroke modified Rankin score and sex. The SOAR and SOAR-Na scores both performed well in predicting inpatient mortality with AUC values of .794 (.78-.81) and .796 (.78-.81), respectively. 7-day mortality showed similar results. Both scores were less predictive in those with chronic kidney disease ( CKD) and more so in those with hypoglycaemia. Conclusion The SOAR-Na did not perform considerably better than the SOAR stroke score. However, the performance of SOAR-Na in those with CKD and dysglycaemias requires further investigation. [ABSTRACT FROM AUTHOR]

Aims. We investigated whether self-monitoring of blood glucose could be used to assess dawn phenomenon in Chinese people with type 2 diabetes mellitus (T2DM). Methods. A total of 306 people with T2DM underwent continuous glucose monitoring and self-monitoring of blood glucose for 72 h. A linear model was used to fit the optimal linear formula of the magnitude of dawn phenomenon (ΔDawn) and self-monitoring of blood glucose values. Results. The prevalence of dawn phenomenon was similar within different oral antidiabetic drug groups (42.5%, 31.5%, and 40.9%, P=0.216). Multiple variable linear regression showed that prebreakfast, prelunch, and predinner glucose measurements were independently and significantly correlated with ΔDawn. The linear formula between ΔDawn and blood glucose was as follows: ΔDawn mg/dL=0.557×prebreakfast−0.065×prelunch−0.164×predinner−20.894 mg/dL (adjusted R2=0.302, P=0.000). Conclusions. Dawn phenomenon could be partly assessed by blood glucose self-monitoring in Chinese people with T2DM using the abovementioned formula. The incidence of dawn phenomenon was similar among patients in different oral antidiabetic drug groups. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate the effects of pentoxifylline ( PTX) on male reproductive parameters in diabetic mice. Male adult mice ( n = 24) were divided into control and three experimental groups ( n = 6) including Diabetic, Diabetic + PTX and PTX groups. Diabetes was induced by single injection of streptozotocin (60 mg kg−1). PTX was administered intraperitoneally at the dose of 12 mg kg−1 for 14 days 1 week after diabetes induction. Serum levels of testosterone and blood glucose were determined and collected spermatozoa from cauda epididymidis analysed. Based on histological slides prepared from testis, the diameter of seminiferous tubules was determined using Motic camera and software and also apoptosis using TUNEL assay. Data were analysed using one-way anova method, and P < 0.05 was considered statistically significant. The mean of seminiferous tubules diameter, final body weight, testis weight, sperm parameters and testosterone hormone level in PTX-treated diabetic group indicated a significant increase compared to diabetic one, whereas apoptosis index and blood glucose were decreased in this comparison ( P < 0.05). These results suggest that intraperitoneal administration of PTX is a potentially beneficial agent to reduce testicular damage and improves sperm parameters in diabetic mice by decreasing the ratio of apoptosis. [ABSTRACT FROM AUTHOR]

A new Chinese herbal formula called Mai Tong Formulae (MTF) has recently been used to treat lower limb macroangiopathy in type 2 diabetes mellitus (T2DM) patients. In this study, we investigated the effect of MTF on lower limb macroangiopathy in a spontaneous diabetic rat model (GK rats). We found that MTF treatment significantly reduced serum fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), IL6, and VEGF and increased serum insulin in this model. Histological and ultrastructural observations showed that MTF treatment significantly reduced vascular endothelial cell shedding and improved endothelium injuries. We further detect proteome alteration following MTF treatment. 25 differential proteins (DPs) abnormally expressed in GK rats were normalized by MTF treatment. These DPs significantly are enriched in biological processes and pathways that regulate muscle contraction and cGMP-PKG signaling pathway and so on. Additional protein-protein interaction (PPI) network analyses of the DPs showed that Fasn and Prkar2a are involved in the AMPK signaling pathway, and Gnas, Myh11, and Myh6 are involved in vascular smooth muscle contraction; these 5 DPs were validated by Western blotting. These results indicate that MTF treatment effectively treats lower limb macroangiopathy by regulating key proteins involved in AMPK signaling pathway and vascular smooth muscle contraction. [ABSTRACT FROM AUTHOR]

There are few data regarding postoperative hyperglycaemia in non-diabetic compared with diabetic patients following postoperative nausea and vomiting prophylaxis with dexamethasone. Eighty-five non-diabetic patients and patients with type-2 diabetes were randomly allocated to receive intravenous dexamethasone (8 mg) or ondansetron (4 mg). Blood glucose levels were measured at baseline and then 2, 4 and 24 h following induction of anaesthesia. In non-diabetic patients, the mean (SD) maximum blood glucose was higher in those who received dexamethasone compared with ondansetron (9.1 (2.2) mmol.l(-1) vs. 7.8 (1.4) mmol.l(-1) , p = 0.04). In diabetic patients, the mean (SD) maximum blood glucose was also higher in those who received dexamethasone compared with ondansetron (14.0 (2.5) mmol.l(-1) vs. 10.7 (2.4) mmol.l(-1) , p < 0.01). Multivariate analysis demonstrated that dexamethasone administration was a significant predictor of maximum postoperative blood glucose increase (p < 0.01) after adjusting for potential confounders. There was no interaction between baseline blood glucose level, or presence or absence of diabetes, and dexamethasone administration. We conclude that dexamethasone increases postoperative blood glucose levels in both non-diabetics and diabetics. [ABSTRACT FROM AUTHOR]

Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as “euglycemic DKA.” This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA. [ABSTRACT FROM AUTHOR]

Objective This study aimed to detect the effect of a new herbal extract salvianolic acid A (SalA) on gastrointestinal complications in diabetic rats. Methods Altogether 80 rats were divided randomly into five groups, including normal control (NC) group, high-fat (HF) diet group, diabetes mellitus (DM) control group, and DM treated with SalA (0.1 mg/kg and 0.3 mg/kg) groups, respectively. DM was induced by feeding the rats with HF diet and the administration of streptozotocin (30 mg/kg). Four weeks after the establishment of the DM model, the rats received SalA or double distilled water for 8 weeks. After the evaluation of intestinal motility, the animals were sacrificed and their intestines were isolated and collected. The levels of advanced glycation end-products (AGE) and malondialdehyde (MDA) were detected. Protein gene product 9.5 (PGP9.5) and neuronal nitric oxide synthase (nNOS) expressions in the intestine were also detected. Results Compared with the NC and HF rats, the DM control rats showed significantly increased blood glucose level and decreased weight. Compared with the DM control group, SalA did not influence their weight and blood glucose level, but significantly reduced the levels of AGE and MDA. Intestinal transit was promoted by SalA in diabetic rats, and the expressions of PGP9.5 and nNOS in the intestine were both upregulated. Conclusion The effect of SalA on the intestinal motility of diabetic rats might be due to its antioxidant capacity and restoring nNOS expression. [ABSTRACT FROM AUTHOR]

Background Islet allotransplantation is a promising way to treat some type 1 diabetic (T1D) patients with frequent hypoglycemic unawareness, and islet xenotransplantation is emerging to overcome the problem of donor organ shortage. Our recent study showing reproducible long-term survival of porcine islets in non-human primates ( NHPs) allows us to examine whether autologous regulatory T-cell (Treg) infusion at peri-transplantation period would induce transplantation tolerance in xenotransplantation setting. Methods Two diabetic rhesus monkeys were transplanted with porcine islets from wild-type adult Seoul National University ( SNU) miniature pigs with immunosuppression by anti-thymoglobulin ( ATG), cobra venom factor, anti- CD154 monoclonal antibody ( mAb), and sirolimus. CD4+ CD25high CD127low autologous regulatory T cells from the recipients were isolated, ex vivo expanded, and infused at the peri-transplantation period. Blood glucose and porcine C-peptide from the recipients were measured up to 1000 days. Maintenance immunosuppressants including a CD40- CD154 blockade were deliberately discontinued to confirm whether transplantation tolerance was induced by adoptively transferred Tregs. Results After pig islet transplantation via portal vein, blood glucose levels of diabetic recipients became normalized and maintained over 6 months while in immunosuppressive maintenance with a CD40- CD154 blockade and sirolimus. However, the engrafted pig islets in the long-term period were fully rejected by activated immune cells, particularly T cells, when immunosuppressants were stopped, showing a failure of transplantation tolerance induction by autologous Tregs. Conclusions Taken together, autologous Tregs infused at the peri-transplantation period failed to induce transplantation tolerance in pig-to- NHP islet xenotransplantation setting. [ABSTRACT FROM AUTHOR]

Diabetes is currently screened invasively by measuring glucose concentration in blood, which is inconvenient. This paper reports a study on modeling and simulation of a CMOS-MEMS sensor for noninvasive screening of diabetes via detection of acetone vapor in exhaled breath (EB). The sensor has two structures: movable (rotor) and fixed (stator) plates. The rotor plate is suspended on top of the stator by support of four flexible beams and maintaining certain selected initial gaps of 5, 6, 7, 8, 9, 10, or 11 μm to form actuation and sensing parallel plate capacitors. A chitosan polymer of varied thicknesses (1–20 μm) is deposited on the rotor plate and modeled as a sensing element for the acetone vapor. The minimum polymer coating thickness required to detect the critical concentration (1.8 ppm) of acetone vapor in the EB of diabetic subjects is found to be 4–7 μm, depending on the initial gap between the rotor and stator plates. However, to achieve sub-ppm detection limit to sense the acetone vapor concentration (0.4–1.1 ppm) in the EB of healthy people, up to 20 μm polymer thickness is coated. The mathematically modeled results were verified using the 2008 CoventorWare simulation software and a good agreement within a 5.3% error was found between the modeled and the simulated frequencies giving more confidence in the predicted results. [ABSTRACT FROM AUTHOR]

Parasympathetic activation reduces hepatic glucose release and increases pancreatic insulin secretion in hyperglycemic conditions. Thus, vagal nerve stimulation ( VNS) may potentially be effective in treating type II diabetes. To investigate this possibility, we hypothesized that VNS reduces blood glucose concentration [Glu] via insulin secretion. [Glu] together with insulin and glucagon serum concentrations were determined in anesthetized rats during baseline conditions and 120 min of cervical VNS with the nerve left intact for combined afferent and efferent VNS ( n = 9) or the nerve sectioned proximal or distal from the stimulation electrode for selective efferent ( n = 8) or afferent ( n = 7) VNS, respectively. Afferent VNS caused a strong and sustained increase in [Glu] (+108.9 ± 20.9% or +77.6 ± 15.4%, after 120 min of combined afferent and efferent VNS or selective afferent VNS) that was not accompanied by an increase in serum insulin concentration. However, serum insulin levels increased significantly with selective efferent VNS (+71.2 ± 27.0% after 120 min of VNS) that increased [Glu] only temporarily (+28.8 ± 11.7% at 30 min of VNS). Efferent VNS initially increased serum glucagon concentration which remained elevated for 120 min when efferent VNS was combined with afferent VNS, but returned to baseline with selective efferent VNS. These findings demonstrate that afferent VNS causes a marked and sustained increase in [Glu] that is partly mediated by suppression of pancreatic insulin secretion. In contrast, efferent VNS stimulates pancreatic glucagon secretion that appears to be antagonized by insulin secretion in the case of selective efferent VNS. Selective efferent VNS may potentially be effective in treating type II diabetes. [ABSTRACT FROM AUTHOR]

Automated closed-loop insulin infusion therapy has been studied for many years. In closed-loop system, the control algorithm is the key technique of precise insulin infusion. The control algorithm needs to be designed and validated. In this paper, an improved PID algorithm based on insulin-on-board estimate is proposed and computer simulations are done using a combinational mathematical model of the dynamics of blood glucose-insulin regulation in the blood system. The simulation results demonstrate that the improved PID algorithm can perform well in different carbohydrate ingestion and different insulin sensitivity situations. Compared with the traditional PID algorithm, the control performance is improved obviously and hypoglycemia can be avoided. To verify the effectiveness of the proposed control algorithm, in silico testing is done using the UVa/Padova virtual patient software. [ABSTRACT FROM AUTHOR]

Background. Type 2 diabetes (T2DM) patients, including those in good glycemic control, have an increased risk of cardiovascular disease (CVD). Maintaining good glycemic control may reduce long-term CVD risk. However, other risk factors such as elevated vascular sympathetic tone and/or endothelial dysfunction may be stronger potentiators of CVD. This study evaluated the impact of bromocriptine-QR, a sympatholytic dopamine D2 receptor agonist, on progression of metabolic disease and CVD in T2DM subjects in good glycemic control (HbA1c ≤7.0%). Methods. 1834 subjects (1219 bromocriptine-QR; 615 placebo) with baseline HbA1c ≤7.0% derived from the Cycloset Safety Trial (this trial is registered with ClinicalTrials.gov Identifier: NCT00377676), a 12-month, randomized, multicenter, placebo-controlled, double-blind study in T2DM, were evaluated. Treatment impact upon a prespecified composite CVD endpoint (first myocardial infarction, stroke, coronary revascularization, or hospitalization for angina/congestive heart failure) and the odds of losing glycemic control (HbA1c >7.0% after 52 weeks of therapy) were determined. Results. Bromocriptine-QR reduced the CVD endpoint by 48% (intention-to-treat; HR: 0.52 [0.28−0.98]) and 52% (on-treatment analysis; HR: 0.48 [0.24−0.95]). Bromocriptine-QR also reduced the odds of both losing glycemic control (OR: 0.63 (0.47−0.85), p=0.002) and requiring treatment intensification to maintain HbA1c ≤7.0% (OR: 0.46 (0.31−0.69), p=0.0002). Conclusions. Bromocriptine-QR therapy slowed the progression of CVD and metabolic disease in T2DM subjects in good glycemic control. [ABSTRACT FROM AUTHOR]

Background. Over the past two decades there has been an increase in type 2 diabetes mellitus (T2DM) in children. Baseline data is needed to assess the impact of changing lifestyles on Ado-Ekiti, a previously semiurban community in Southwest Nigeria. This study was therefore conducted to assess the fasting blood glucose (FBG) of adolescents in Ado-Ekiti, Nigeria. Methodology. This was a cross-sectional study involving 628 adolescents from three different secondary schools in Ado-Ekiti, Nigeria. With parental consent, volunteers completed a structured questionnaire, and an overnight FBG was measured. Results. There were 346 males and 282 females (male : female ratio = 1.2 : 1). Their ages ranged from 10 to 19 years (mean age: 14.2±1.7 years). Four hundred and forty-four (70.7%) had normal FBG, while 180 (28.7%) and 4 (0.6%) had FBG in the prediabetic and diabetic range, respectively. Female gender, age group 10–14 years, and family history of obesity were significantly associated with impaired FBG (P value <0.001, <0.001, and 0.045, resp.). Conclusion. Impaired FBG is common among secondary school adolescents and it is more prevalent among younger female adolescents (10–14 years) with positive family history of obesity. [ABSTRACT FROM AUTHOR]

Aims To assess the accuracy and reliability of the two most widely used continuous glucose monitoring ( CGM) systems. Methods We studied the Dexcom® G4 Platinum ( DG4P; Dexcom, San Diego, CA, USA) and Medtronic Paradigm Veo Enlite system ( ENL; Medtronic, Northridge, CA, USA) CGM systems, in 24 patients with type 1 diabetes. The CGM systems were tested during 6-day home use and a nested 6-h clinical research centre ( CRC) visit. During the CRC visit, frequent venous blood glucose samples were used as reference while patients received a meal with an increased insulin bolus to induce an aggravated postprandial glucose nadir. At home, patients performed at least six reference capillary blood measurements per day. A Wilcoxon signed-rank test was performed using all data points ≥15 min apart. Results The overall mean absolute relative difference ( MARD) value [standard deviation (s.d.)] measured at the CRC was 13.6 (11.0)% for the DG4P and 16.6 (13.5)% for the ENL [p < 0.0002, confidence interval of difference ( CI Δ) 1.7-4.3%, n = 530]. The overall MARD assessed at home was 12.2 (12.0)% for the DG4P and 19.9 (20.5)% for the ENL (p < 0.0001, CI Δ = 5.8-8.7%, n = 839). During the CRC visit, the MARD in the hypoglycaemic range [≤3.9 mmol/l (70 mg/dl)], was 17.6 (12.2)% for the DG4P and 24.6 (18.8)% for the ENL (p = 0.005, CI Δ 3.1-10.7%, n = 117). Both sensors showed higher MARD values during hypoglycaemia than during euglycaemia [3.9-10 mmol/l (70-180 mg/dl)]: for the DG4P 17.6 versus 13.0% and for the ENL 24.6 versus 14.2%. Conclusions During circumstances of intended use, including both a CRC and home phase, the ENL was noticeably less accurate than the DG4P sensor. Both sensors showed lower accuracy in the hypoglycaemic range. The DG4P was less affected by this negative effect of hypoglycaemia on sensor accuracy than was the ENL. [ABSTRACT FROM AUTHOR]

Aim To describe the clinical effects of single and multiple doses of a potent, selective, orally administered, small-molecule antagonist of the human glucagon receptor, LY2409021, in healthy subjects and in patients with type 2 diabetes. Methods LY2409021 was administered in dose-escalation studies to healthy subjects (n = 23) and patients with type 2 diabetes (n = 9) as single doses ( Study 1) and daily to patients with type 2 diabetes (n = 47) for 28 days ( Study 2). Safety, tolerability, pharmacokinetic ( PK) and pharmacodynamic ( PD) assessments were made after single doses and in patients receiving once-daily doses of LY2409021 (5, 30, 60 or 90 mg) for 28 days. Results LY2409021 was well tolerated at all dose levels in both studies. Fasting and postprandial glucose were reduced and glucagon levels increased after single and multiple dosing, with reductions in fasting serum glucose of up to ∼1.25 mmol/l on day 28. Serum aminotransferases increased in a dose-dependent manner with multiple dosing and reversed after cessation of dosing. Significant glucose-lowering was observed with LY2409021 at dose levels associated with only minor aminotransferase increases. Conclusion Blockade of glucagon signalling in patients with type 2 diabetes is well tolerated and results in substantial reduction of fasting and postprandial glucose with minimal hypoglycaemia, but with reversible increases in aminotransferases. Inhibition of glucagon signalling by LY2409021 is a promising potential treatment for patients with type 2 diabetes and should be evaluated in longer clinical trials to better evaluate benefits and risks. [ABSTRACT FROM AUTHOR]