Persisting prediabetic conditions and glomerular filtration rate – A longitudinal study

The aim was to explore differences in the development of eGFR in persisting prediabetic conditions. This prospective study including 1327 individuals showed that eGFR decreased more in individuals with persisting IGT than in individuals with persisting IFG. Repeating OGTT and monitoring eGFR might improve the risk estimation in prediabetes.     

高剂量布地奈德混悬液雾化吸入治疗小儿哮喘急性发作的效果观察

目的：探讨高剂量布地奈德混悬液雾化吸入治疗小儿哮喘急性发作的临床疗效。方法将本院2012年3月~2014年3月收治的150例支气管哮喘急性发作患儿按不同治疗方案随机均分为对照组(给予低剂量布地奈德雾化吸入治疗)和观察组(给予高剂量布地奈德雾化吸入治疗),观察比较两组患儿治疗效果及肺功能改善情况。结果治疗24 h后,观察组治疗总有效率(88.00%)明显高于对照组(74.67%)(P<0.05);两组患儿经治疗后的PEF、FEV1较治疗前均有明显升高(P<0.05);观察组PEF、FEV1较对照组升高明显(P<0.05);两组均未见明显不良反应。结论高剂量布地奈德混悬液雾化吸入治疗小儿哮喘急性发作效果显著,安全性高,值得临床推广应用。     

黄芪颗粒联合门冬胰岛素治疗妊娠糖尿病的疗效观察

目的研究黄芪颗粒联合门冬胰岛素治疗妊娠糖尿病的临床疗效。方法选取成都市天府新区人民医院2013年2月—2015年2月收治的妊娠糖尿病产妇100例,随机分为对照组和治疗组,每组各50例。对照组在一般治疗的基础上皮下注射门冬胰岛素注射液,0.5~1.0 U/kg,其中2/3用量用餐时给药,剩余1/3用量是基础胰岛素。治疗组在对照组的基础上,服用黄芪颗粒15 g/d,2次/d。以连续服用4周为一个疗程。比较两组治疗前后的临床疗效,尿蛋白、尿素氮、血肌酐和糖化血红蛋白(Hb A1c),血糖、血脂指标总胆固醇(TC)和三酰甘油(TG),血糖达标时间、胰岛素用量和低血糖发生率,以及产后母婴的生理状况。结果治疗组总有效率(90.00%)明显高于对照组的总有效率(82.00%),两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的尿蛋白、尿素氮、血肌酐及Hb A1c均显著减少,同组治疗前后差异均具有统计学意义(P0.05);且治疗组的改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。两组的空腹和饭后2 h血糖以及TC、TG均较治疗前有所降低,同组治疗前后差异具有统计学意义(P0.05);治疗组治疗后的空腹和饭后2 h血糖以及TC、TG较对照组治疗后均有所降低,且差异具有统计学意义(P0.05)。治疗后,治疗组的血糖达标时间、胰岛素用量和低血糖发生率均低于对照组,且两组比较差异具有统计学意义(P0.05)。治疗组母婴的妊娠结局指标明显优于对照组(P0.05)。结论黄芪颗粒联合门冬胰岛素治疗妊娠糖尿病的具有较好的疗效,具有一定的临床推广应用价值。     

Design,Synthesis, Biological Screening,and Molecular Docking Studies of Piperazine-Derived Constrained Inhibitors of DPP-IV for the Treatment of Type 2 Diabetes

Novel piperazine-derived conformationally constrained compounds were designed, synthesized, and evaluated for in vitro Dipeptidyl peptidase-IV (DPP-IV) inhibitory activities. From a library of compounds synthesized, 1-(2-(4-(7-Chloro-4-quinolyl)piperazin-1-yl)acetyl)pyrrolidine ( 2g ) was identified as a potential DPP-IV inhibitor exhibiting better inhibitory activity than P32/98, reference inhibitor. The in vivo studies carried out in STZ and db/db mice models indicated that the compound 2g showed moderate antihyperglycemic activity as compared to the marketed drug Sitagliptin. A two-week repeated dose study in db/db mice revealed that compound 2g significantly declined blood glucose levels with no evidence of hypoglycemia risk. Furthermore, it showed improvement in insulin resistance reversal and antidyslipidemic properties. Molecular docking studies established good binding affinity of compound 2g at the DPP-IV active site and are in favor of the observed biological data. These data collectively suggest that compound 2g is a good lead molecule for further optimization studies.     

Evaluation of Opportunities and Limitations of Mid-Infrared Skin Spectroscopy for Noninvasive Blood Glucose Monitoring

Background:A wide range of optical techniques has recently been presented for the development of noninvasive methods for blood glucose sensing based on multivariate skin spectrum analysis, and most recent studies are reviewed in short by us. The vibrational spectral fingerprints of glucose, as especially found in the mid-infrared or Raman spectrum, have been suggested for achieving largest selectivity for the development of noninvasive blood glucose methods.Methods:Here, the different aspects on integral skin measurements are presented, which are much dependent on the absorption characteristics of water as the main skin constituent. In particular, different mid-infrared measurement techniques as realized recently are discussed. The limitations of the use of the attenuated total reflection technique in particular are elaborated, and confounding skin or saliva spectral features are illustrated and discussed in the light of recently published works, claiming that the attenuated total reflection technique can be utilized for noninvasive measurements.Results:It will be shown that the penetration depth of the infrared radiation with wavelengths around 10 µm is the essential parameter, which can be modulated by different measurement techniques as with photothermal or diffuse reflection. However, the law of physics is limiting the option of using the attenuated total reflection technique with waveguides from diamond or similar optical materials.Conclusions:There are confounding features from mucosa, stratum corneum, or saliva, which have been misinterpreted for glucose measurements. Results of an earlier study with multivariate evaluation based on glucose fingerprint features are again referred to as a negative experimental proof.     

Improved Real-World Glycemic Control With Continuous Glucose Monitoring System Predictive Alerts

Background:Most standalone real-time continuous glucose monitoring (RT-CGM) systems provide predictive low and high sensor glucose (SG) threshold alerts. The durations and risk of low and high SG excursions following Guardian™ Connect CGM system predictive threshold alerts were evaluated.Methods:Continuous glucose monitoring system data uploaded between January 2, 2017 and May 22, 2018 by 3133 individuals using multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) therapy were deidentified and retrospectively analyzed. Glucose excursions were defined as SG values that went beyond a preset low or high SG threshold for ≥15 minutes. For a control group, thresholds were based on the median of the low SG threshold limit (70 mg/dL) and the high SG threshold limit (210 mg/dL) preset by all system users. During periods when alerts were not enabled, timestamps were identified when a predictive alert would have been triggered. The time before low horizon was 17.5 minutes and the time before high horizon was 15 minutes, of all users who enabled alerts. Excursions occurring after a low SG or high SG predictive alert were segmented into prevented, ≤20, 20-60, and >60 minutes.Results:Excursions were prevented after 59% and 39% of low and high SG predictive alerts, respectively. The risk of a low or high excursion occurring was 1.9 (P < 0.001, 95% CI, 1.88-1.93) and 3.3 (P < 0.001, 95% CI, 3.20-3.30) times greater, respectively, when alerts were not enabled.Conclusions:The predictive alerts of the RT-CGM system under study can help individuals living with diabetes prevent some real-world low and high SG excursions. This can be especially important for those unable to reach or maintain glycemic control with basic RT-CGM or CSII therapy.     

Age-dependent changes in phenotypes and candidate gene analysis in a polygenic animal model of Type II diabetes mellitus; NSY mouse

Aims/hypothesis. The Nagoya-Shibata-Yasuda (NSY) mouse closely mimics human Type II (non-insulin-dependent) diabetes mellitus in that the onset is age-dependent, the animals are not severely obese, and both insulin resistance and impaired insulin response to glucose contribute to disease development. The aim of this study was to clarify the influence of age on the pathogenesis of diabetes and to analyse a candidate gene for Type II diabetes in this strain.¶Methods. Several phenotypic characteristics related to diabetes mellitus were monitored longitudinally in male NSY and control C3H/He mice. The nucleotide sequence of Glut4, a candidate gene for Nidd1nsy (a susceptibility gene for Type II diabetes) on Chromosome 11, encoding insulin-sensitive glucose transporter, was determined in NSY and C3H mice.¶Results. Glucose intolerance worsened with age, and fasting blood glucose and fasting plasma insulin concentration increased with age in NSY mice. Pancreatic insulin content increased until 24 weeks of age but then decreased at 48 weeks of age in NSY mice. The hypoglycaemic response to insulin was statistically significantly smaller in NSY than in C3H/He mice. The nucleotide sequence of GLUT4 cDNA was identical in NSY and C3H/He mice, but both were different from the sequence reported previously.¶Conclusion/interpretation. Insulin secretion and insulin resistance, as well as ageing possibly play an important part in the disease development in NSY mice. A decline of pancreatic insulin content in older age might cause the relative insulin deficiency in this strain. Nucleotide sequencing suggests that Glut4 is unlikely to be a candidate gene for Nidd1nsy. [Diabetologia (2000) 43: 932–938]     

Measuring Glucose Concentrations: Daily Practice, Current and Future Developments

Self-monitoring of blood glucose (SMBG) by means of modern glucose meters is of relevance for all patients with diabetes. It not only provides important information about the effect of therapeutic interventions on metabolic control, but about the effect of exercise and meals as well. Therefore, it is an essential part of diabetes therapy. However, it has received little interest from academia in the last 10 years. This is in sharp contrast to the massive increase in SMBG use in the last decades and its economic impact on health care systems. Many physicians and patients believe that SMBG and the measurement technologies behind it are a no-brainer nowadays, i.e., that the measurement provides reliable results in practically all cases. In reality, it appears as if patients have only mediocre knowledge about the appropriate handling of the procedure and subsequent therapeutic action. Also, evaluation of the measurement quality of blood glucose meters is not studied adequately in many cases. Such studies should also take into account handling by the patients themselves under daily life conditions. Unfortunately, most of such studies are initiated and sponsored by the manufacturers of blood glucose meters/test strips, and not by an independent institution. In view of the costs and risks combined with SMBG, we should consider that all patients participate in a course that ends with a little examination and provides them with a “driver''s license” for this diagnostic measure.