Relationship between Habitual Intake of Vitamins and New-Onset Prediabetes/Diabetes after Acute Pancreatitis

Vitamins have many established roles in human health. However, the role of habitual dietary intake of vitamins in glucose homeostasis in individuals after acute pancreatitis (AP) is yet to be elucidated. The aim was to investigate the associations between habitual intake of fat- and water-soluble vitamins/vitamers and markers of glucose metabolism (fasting plasma glucose (FPG), homeostasis model assessment insulin resistance (HOMA-IR) index, and homeostasis model assessment β-cell function (HOMA-β)) in individuals after AP. A total of 106 participants after AP were included in this cross-sectional study and were grouped based on glycaemic status: new-onset prediabetes/diabetes after AP (NODAP), pre-existing prediabetes/type 2 diabetes (T2DM), and normoglycaemia after AP (NAP). Habitual intake of seven fat-soluble vitamins/vitamers and seven water-soluble vitamins were determined by the EPIC-Norfolk food frequency questionnaire. Multiple linear regression analyses were conducted using five statistical models built to adjust for covariates (age, sex, daily energy intake, visceral/subcutaneous fat volume ratio, smoking status, daily alcohol intake, aetiology of AP, number of AP episodes, cholecystectomy, and use of antidiabetic medications). In the NODAP group, three fat-soluble vitamins/vitamers (α-carotene, β-carotene, and total carotene) were significantly associated with HOMA-β. One water-soluble vitamin (vitamin B3) was also significantly associated with HOMA-β in the NODAP group. None of the studied vitamins were significantly associated with FPG or HOMA-IR in the NODAP group. Prospective longitudinal studies and randomised controlled trials are now warranted to investigate if the observed associations between vitamin/vitamer intake and NODAP are causal and to unveil the specific mechanisms underlying their involvement with NODAP.     

甘油三酯葡萄糖指数与心血管疾病相关性的研究进展

胰岛素抵抗是心血管疾病的危险因素之一,目前用于评价胰岛素抵抗的传统方法大多较为复杂且价格昂贵,临床应用较为局限。甘油三酯葡萄糖指数是一种新兴反映胰岛素抵抗水平的指标,被大量实验证实与心血管疾病相关。本文就胰岛素抵抗在心血管疾病中的作用机制以及甘油三酯葡萄糖指数与心血管疾病相关性的研究进展展开综述,旨在为早期发现和预防心血管疾病提供有力的指导。     

口腔颌面外科围手术期血糖管理专家共识

围手术期血糖水平异常现象是影响患者预后的重要因素。目前,已有较多关于外科手术围手术期血糖管理指南,但对于口腔颌面外科手术围手术期血糖异常情况尚未有规范的管理方案。根据已发表的相关指南、共识及文献,并结合颌面外科的特点及我们的经验,本文主要从术前高血糖的筛查、评估,术中血糖安全管理,术后血糖水平的监测及治疗等方面规范了标准化血糖管理操作规程,为颌面外科围手术期血糖管理提供参考。     

腹部创伤患者肠内营养喂养不耐受预警评估指标体系的构建

目的 构建腹部创伤患者喂养不耐受预警评估指标体系,为早期识别腹部创伤患者喂养不耐受风险提供参考。方法 基于循证,结合临床护理实践,采用德尔菲专家咨询法对16名专家进行2轮专家咨询,并对调查数据进行统计分析,最终确定方案。结果 专家的积极性分别为94%、100%;专家权威系数为0.906;2轮重要性及准确性的变异系数分别为0~0.265、0~0.255及0.084~0.250、0.068~0.178,肯德尔协调系数差异有统计学意义。最终形成患者基本状况、实验室指标、临床治疗措施、临床用药以及肠内营养相关因素5个维度,32个条目。结论 构建的腹部创伤患者喂养不耐受评估预警指标内容较为全面,具有科学性,临床实用性强,可为临床早期识别腹部创伤患者喂养不耐受风险提供参考。     

Use of Personal Continuous Glucose Monitoring Device Is Associated With Reduced Risk of Hypoglycemia in a 16-Week Clinical Trial of People With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion

Aims:Continuous glucose monitoring (CGM) has the potential to promote diabetes self-management at home with a better glycemic control as outcome. Investigation of the effect of CGM has typically been carried out based on randomized controlled trials with prespecified CGM devices on CGM-naïve participants. The aim of this study was to investigate the effect on glycemic control in people using their personal CGM before and during the trial.Materials and Methods:Data from the Onset 5 trial of 472 people with type 1 diabetes using either their personal CGM (n = 117) or no CGM (n = 355) and continuous subcutaneous insulin infusion in a 16-week treatment period were extracted. Change from baseline in glycated hemoglobin A1c (HbA_1c), number of hypoglycemic episodes, and CGM metrics at the end of treatment were analyzed with analysis of variance repeated-measures models.Results:Use of personal CGM compared with no CGM was associated with a reduction in risk of documented symptomatic hypoglycemia (event rate ratio: 0.82; 95% CI: 0.69-0.97) and asymptomatic hypoglycemia (event rate ratio: 0.72; 95% CI: 0.53-0.97), reduced time spent in hypoglycemia (P = .0070), and less glycemic variability (P = .0043) without a statistically significant increase in HbA_1c (P = .2028).Conclusions:Results indicate that use of personal CGM compared with no CGM in a population of type 1 diabetes is associated with a safer glycemic control without a statistically significantly deteriorated effect on HbA_1c, which adds to the evidence about the real-world use of CGM, where device type is not prespecified, and users are not CGM naïve.     

Glycemic Metrics Derived From Intermittently Scanned Continuous Glucose Monitoring

Background:Glucose data from intermittently scanned continuous glucose monitoring (isCGM) is a combination of scanned and imported glucose values. The present knowledge of glycemic metrics originate mostly from glucose data from real-time CGM sampled every five minutes with a lack of information derived from isCGM.Methods:Glucose data obtained with isCGM and hemoglobin A1c (HbA1c) were obtained from 169 patients with type 1 diabetes. Sixty-one patients had two observations with an interval of more than three months.Results:The best regression line of HbA1c against mean glucose was observed from 60 days prior to HbA_1c measurement as compared to 14, 30, and 90 days. The difference between HbA1c and estimated HbA1c (=glucose management indicator [GMI]) first observed correlated with the second observation (R2 0.61, P < .001). Time in range (TIR, glucose between 3.9 and 10 mmol/L) was significantly related to GMI (R2 0.87, P < .001). A TIR of 70% corresponded to a GMI of 6.8% (95% confidence interval, 6.3-7.4). The fraction of patients with the optimal combination of TIR >70% and time below range (TBR) <4% was 3.6%. The fraction of patients with TBR>4% was four times higher for those with high glycemic variability (coefficient of variation [CV] >36%) than for those with lower CV.Conclusion:The individual difference between HbA1c and GMI was reproducible. High glycemic variability was related to increased TBR. A combination of TIR and TBR is suggested as a new composite quality indicator.     

Perceived Burdens and Benefits Associated With Continuous Glucose Monitor Use in Type 1 Diabetes Across the Lifespan

Background:Continuous glucose monitors (CGMs) help people with type 1 diabetes (T1D) improve their glycemic profiles but are underutilized. To better understand why, perceived CGM burdens and benefits in nonusers versus users with type 1 diabetes across the lifespan were assessed.Methods:Burdens (BurCGM) and benefits of CGM (BenCGM) questionnaires were completed during T1D outpatient visits (n = 1334) from February 2019 to February 2020. Mean scores were calculated (scale one to five; higher scores reflect greater perceived burdens/benefits). Data were collected from medical records including glycated hemoglobin (HbA1c) within 3 months of the visit.Results:Individuals of all ages using CGM described more benefits and less burdens (mean scores 4.48 and 1.69, respectively) when compared with those who were not using CGM (mean score 4.19 and 2.35, respectively) (P < .001). There were no differences in burdens or benefits by sex. Non-CGM users aged ≥50 years had higher mean BurCGM scores than those aged <50 years (P = .004); the cost was the greatest barrier in those aged 27+ years. Other burdens were readings not trusted, painful to wear, and takes too much time to use. For those aged 65+, nonusers versus users, 18.5% versus 3.1% agreed with “it was too hard to understand CGM information,” and 21.4% versus 7.7% agreed that CGM causes too much worry. Mean HbA1C was lower in CGM users (8.1%) versus non-CGM users (mean A1c 9.1%; P < .001).Conclusions:CGM was perceived as having more burdens and less benefits in nonusers, with differences in concerns varying across the lifespan. Lower costs and age-appropriate education are needed to address these barriers.     

A New Meal Absorption Model for Artificial Pancreas Systems

Background:Artificial pancreas (AP) systems reduce the treatment burden of Type 1 Diabetes by automatically regulating blood glucose (BG) levels. While many disturbances stand in the way of fully closed-loop (automated) control, unannounced meals remain the greatest challenge. Furthermore, different types of meals can have significantly different glucose responses, further increasing the uncertainty surrounding the meal.Methods:Effective attenuation of a meal requires quick and accurate insulin delivery because of slow insulin action relative to meal effects on BG. The proposed Variable Hump (VH) model adapts to meals of varying compositions by inferring both meal size and shape. To appropriately address the uncertainty of meal size, the model divides meal absorption into two disjoint regions: a region with coarse meal size predictions followed by a fine-grain region where predictions are fine-tuned by adapting to the meal shape.Results:Using gold-standard triple tracer meal data, the proposed VH model is compared to three simpler second-order response models. The proposed VH model increased model fit capacity by 22% and prediction accuracy by 12% relative to the next best models. A 47% increase in the accuracy of uncertainty predictions was also found. In a simple control scenario, the controller governed by the proposed VH model provided insulin just as fast or faster than the controller governed by the other models in four out of the six meals. While the controllers governed by the other models all delivered at least a 25% excess of insulin at their worst, the VH model controller only delivered 9% excess at its worst.Conclusions:The VH Model performed best in accuracy metrics and succeeded over the other models in providing insulin quickly and accurately in a simple implementation. Use in an AP system may improve prediction accuracy and lead to better control around mealtimes.     

An Analysis of 2019 FDA Adverse Events for Two Insulin Pumps and Two Continuous Glucose Monitors

US Food and Drug Administration adverse event data for 2019 were analyzed for two insulin pumps and two continuous glucose monitors (CGMs). The analyses were selective—they were guided by the text described in the adverse events. They included (1) percent using auto mode for the Medtronic 670G pump, (2) distributions of hyper and hypo glucose values for Medtronic and Tandem pumps, (3) a Parkes error grid for Dexcom CGM vs glucose meter when the complaint was inaccuracy, and (4) the most frequent events for Abbott Freestyle. We found that for the 670G pump, there were more hypo events when auto mode was on than when auto mode was off. With Dexcom CGMs, users complained about inaccurate result when most results were in the B zone. With the Abbott Freestyle, the most frequent adverse event was an allergic skin reaction.     

肝硬化患者糖代谢特征的研究

目的 探讨肝硬化患者糖代谢特征.方法 对42例肝硬化患者及40例对照者行葡萄糖耐量试验及胰岛素释放试验,测定其空腹、服糖后30、60、120、180 min的血糖,胰岛素水平和C-肽值,计算各时段的胰岛素敏感指数和胰岛素抵抗指数.结果 肝硬化组各时段的胰岛素水平均高于对照组;空腹血糖、C-肽水平2组无差异;服糖后各时段血糖、C-肽,肝硬化组高于对照组;肝硬化组的胰岛素敏感指数低于对照组,胰岛素抵抗指数肝硬化组高于对照组.结论 肝硬化患者存在糖耐量减退,可能与肝硬化患者高胰岛素状态、胰岛素抵抗有关.