Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high B...Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL), and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL) might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.展开更多
Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically sea...Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. Results: Twenty-six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95%CI 0.58, 0.99). However, in terms of overall mortality and long-term neurological severity outcome, it didn't show differences with ORs of 0.93 (95%CI 0.79, 1.10) and 1.15 (95%CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay with OR of 0.51 (95%CI 0.42, 0.62) and WMD of -2.37 (95%CI -2.99, -1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95%CI 4.83, 8.07) and 2.73 (95%CI 2.56, 2.91) using two methods. Conclusion: In critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.展开更多
Neoplasms of the digestive system are uncommon in dogs, and may be of epithelial, neuroendocrine, hematopoietic and mesenchymal origin. The leiomyosarcoma is a tumor of mesenchymal origin of smooth, malignant, slow-gr...Neoplasms of the digestive system are uncommon in dogs, and may be of epithelial, neuroendocrine, hematopoietic and mesenchymal origin. The leiomyosarcoma is a tumor of mesenchymal origin of smooth, malignant, slow-growing muscles. Paraneoplastic syndromes can affect different systems, being the most commonly found: hypercalcemia, hypoglycemia, cachexia and anemia. There are rare cases of mesenchymal tumors of the gastrointestinal tract in dogs that result in hypoglycaemia with clinical signs. The objective of this study is to report a case of gastric leiomyosarcoma associated with clinical hypoglycemia. The patient had neurological signs such as ataxia and seizures associated with hypoglycemia, which did not recur after surgical excision of the tumor. The definitive diagnosis was based on the histopathological and immunohistochemical examination of the tumor.展开更多
Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circu...Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circumference (NC) is an anthropometric measure that has been used to evaluate the overweight and accumulation of subcutaneous fat in the upper body, regardless of age. It is also a useful tool to predict insulin resistance and other risk factors. This research aimed to study the relationship between the NC and glycemia in adolescents and, thus, to analyze the applicability of this anthropometric measure in the screening of glycemic alterations in this group. Methods: The study population consisted of 600 adolescents aged 10 to 19 years. Data on sex, birth date, NC, fasting blood glucose and stage of sexual maturation was collected. Results: The evolution of sexual maturation generated a significant difference in the NC in both sexes, but not affected glycemia. Thus, the association between NC and glycemia was investigated according to this parameter. Among the pre-pubertal adolescents, the NC was significantly higher among those who had glycemia within borderline values, and the opposite occurred among pubertal adolescents. Among post-pubertal adolescents, NC was similar between the two groups. A negative correlation was found in all adolescents, as well as among those who were in the pubertal and post-pubertal stages of sexual maturation. Differently, adolescents in the pre-pubertal stage showed a positive correlation between the NC and the biochemical parameters. Conclusion: This study showed that the relationship between the NC and glycemia varies according to the stage of sexual maturation. As this maturation factor is rarely considered in the glycemic alteration screening, the use of the NC in this age group is not safe and requires further investigations.展开更多
In this work, children’s persistent hyperglycemia has been revised using the available literature to support the proposed reasoning. Based on this study, we have shown that the human glycemic management system must b...In this work, children’s persistent hyperglycemia has been revised using the available literature to support the proposed reasoning. Based on this study, we have shown that the human glycemic management system must be seen as coupled and integrated by four subsystems, namely, production system, consumption system, distribution system, control system, and also it should be seen as coupled to external noxious factors/stressors, if not we show that the glycemic homeostasis analysis might be defective and might induce, in many cases, a misdiagnosis of the causes of the persistent hyperglycemia under consideration. Also, in this work, some considerations were presented to show that anomalies in the cerebral glycemic control through the glucose sensor neurons might be a possible cause/origin of some of the glycemic abnormalities and dysfunctions (however, not only the known related hypoglycemia but also hyperglycemia) that occur in childhood. Finally, it is shown that persistent novel external noxious factors of modernity or noxious factors already known, but amplified by modernity, such as persistent stress, media induced fears, and phobias, environmental pollution, and electromagnetic pollution, can and should also be considered as possible precursors for the development of anomalies in the juvenile homeostatic glycemic system that might well be, if intense and persistent, the driver of the worldwide observed T1DM epidemic events.展开更多
Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO...Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO), have been formulated to blunt postprandial hyperglycemia. The objective of this research was to evaluate the effectiveness of these products on postprandial glycemic and hormonal responses based on comparisons of GTSN with differing carbohydrate quantities or types. Methods: In two randomized, double-blind, crossover studies, participants (mean age 61 years) with type 2 diabetes consumed GTSN in a meal tolerance test. In the CHO Quantity Study, a standard nutritional beverage (STD) was compared to a low carbohydrate nutritional beverage with tapioca dextrin (GTSN-TDX) and a balanced carbohydrate nutritional beverage containing a blend of the slowly-digesting carbohydrates maltodextrin and sucromalt (GTSN-SDC). In the CHO Type Study, the GTSN beverages had similar carbohydrate quantities but varied in carbohydrate composition with GTSN-SDC compared to a formula with tapioca starch and fructose (GTSN-TS&F), and one with isomaltulose and resistant starch (GTSN-I&RS). Postprandial (0-240 min) concentrations of blood glucose, insulin (CHO Quantity Study only) and glucagon-like-peptide (GLP)-1 (CHO Quantity Study only) were measured. Results: Despite having substantially different carbohydrate quantities, the GTSN blunted the glucose positive area under the curve (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 min tended to be lower for GTSN-SDC (1477 ± 460) than GTSN-TS&F (2203 ± 412;p = 0.062) and GTSN-I&RS (2190 ± 412;p = 0.076). No differences were observed between GTSN-TS&F and GTSN-I&RS. Conclusions: These results demonstrate the effectiveness of several GTSN products and suggest that both CHO quantity and type play important roles in postprandial glycemic response in men and women with type 2 diabetes. Furthermore, GTSN products containing slow-digesting carbohydrates can blunt postmeal glucose and insulin concentration despite delivering greater total grams of CHO, which provides a dietary benefit for people with diabetes.展开更多
Through investigating the effect of mild hypothermia on activity of nitric oxide snythase (NOS) in cortical neurons and glycemia levels of neonatal rats with hypoxic ischemic brain damage (HIBD). We studied the mecha...Through investigating the effect of mild hypothermia on activity of nitric oxide snythase (NOS) in cortical neurons and glycemia levels of neonatal rats with hypoxic ischemic brain damage (HIBD). We studied the mechanism of protecting hypoxic ischemic neurons of mild hypothermia. We established neonatal rat HIBD models, used NOS immunohistochemistry and glycemia determination by micromethod. The number of cortical NOS positive neurons after hypoxic ischemia was significantly decreased as compared with controls. The glycemia levels was significantly increased than that controls. No significant difference was found in number of cortical NOS positive neurons and glycemia levels between 31℃ and 34℃ mild hypothemia. The results imply that hypothermia can decrease overproduction of NO through inhibiting the increase of the activity of NOS, and increase the glycemia levels, thus protect the hypoxic ischemic neurons.展开更多
Cardiovascular diseases are serious pathologies that affect an increasing number of people. Several preventive measures are generally used, including supplementing of oils in foods. Our objective was to compare the ef...Cardiovascular diseases are serious pathologies that affect an increasing number of people. Several preventive measures are generally used, including supplementing of oils in foods. Our objective was to compare the effects of Tetracarpidum conophorum oil (TC) and corn oil (CO) on serum lipid profiles of normal male rats. 42 Wistar rats were divided into 7 groups. Diets included TC oil (groups TC5, TC10 and TC20) and corn oil (groups CO5, CO10 and CO20) in proportions of 5%, 10% and 20%, with a control group (T). After 5 weeks of feeding, several parameters were measured during and after the study, including body weight, food intake and organ weights (kidney, liver and fat). Lipid profiles (total cholesterol, TG, HDL and LDL), glucose and protein levels were measured in the serum. The increase in body mass was inversely proportional to the amount of oil in the food. The decrease in body mass and adiposomatic index of group TC10 was significant (p < 0.05) compared with the other groups. The lowest glycaemia (64.17 ± 5.14 mg/dl) was noted with the diet containing 20% TC oil. A significant reduction in total cholesterol, LDL fraction and blood triglycerides was observed in the groups supplemented with TC and corn oils compared to controls. Results were also more beneficial for the TC10 group. HDL-cholesterol levels were significantly higher (p < 0.05) in the oil-supplemented groups than in the control group. Castelli’s risk indices decrease significantly (p < 0.05) with increasing oil content for TC. The oils had no impact on blood protein contents. One can conclude that a diet containing 10% crude oil from TC kernels could prevent or alleviate cardiovascular diseases and glycemia.展开更多
文摘Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL), and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL) might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.
文摘Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. Results: Twenty-six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95%CI 0.58, 0.99). However, in terms of overall mortality and long-term neurological severity outcome, it didn't show differences with ORs of 0.93 (95%CI 0.79, 1.10) and 1.15 (95%CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay with OR of 0.51 (95%CI 0.42, 0.62) and WMD of -2.37 (95%CI -2.99, -1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95%CI 4.83, 8.07) and 2.73 (95%CI 2.56, 2.91) using two methods. Conclusion: In critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.
文摘Neoplasms of the digestive system are uncommon in dogs, and may be of epithelial, neuroendocrine, hematopoietic and mesenchymal origin. The leiomyosarcoma is a tumor of mesenchymal origin of smooth, malignant, slow-growing muscles. Paraneoplastic syndromes can affect different systems, being the most commonly found: hypercalcemia, hypoglycemia, cachexia and anemia. There are rare cases of mesenchymal tumors of the gastrointestinal tract in dogs that result in hypoglycaemia with clinical signs. The objective of this study is to report a case of gastric leiomyosarcoma associated with clinical hypoglycemia. The patient had neurological signs such as ataxia and seizures associated with hypoglycemia, which did not recur after surgical excision of the tumor. The definitive diagnosis was based on the histopathological and immunohistochemical examination of the tumor.
文摘Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circumference (NC) is an anthropometric measure that has been used to evaluate the overweight and accumulation of subcutaneous fat in the upper body, regardless of age. It is also a useful tool to predict insulin resistance and other risk factors. This research aimed to study the relationship between the NC and glycemia in adolescents and, thus, to analyze the applicability of this anthropometric measure in the screening of glycemic alterations in this group. Methods: The study population consisted of 600 adolescents aged 10 to 19 years. Data on sex, birth date, NC, fasting blood glucose and stage of sexual maturation was collected. Results: The evolution of sexual maturation generated a significant difference in the NC in both sexes, but not affected glycemia. Thus, the association between NC and glycemia was investigated according to this parameter. Among the pre-pubertal adolescents, the NC was significantly higher among those who had glycemia within borderline values, and the opposite occurred among pubertal adolescents. Among post-pubertal adolescents, NC was similar between the two groups. A negative correlation was found in all adolescents, as well as among those who were in the pubertal and post-pubertal stages of sexual maturation. Differently, adolescents in the pre-pubertal stage showed a positive correlation between the NC and the biochemical parameters. Conclusion: This study showed that the relationship between the NC and glycemia varies according to the stage of sexual maturation. As this maturation factor is rarely considered in the glycemic alteration screening, the use of the NC in this age group is not safe and requires further investigations.
文摘In this work, children’s persistent hyperglycemia has been revised using the available literature to support the proposed reasoning. Based on this study, we have shown that the human glycemic management system must be seen as coupled and integrated by four subsystems, namely, production system, consumption system, distribution system, control system, and also it should be seen as coupled to external noxious factors/stressors, if not we show that the glycemic homeostasis analysis might be defective and might induce, in many cases, a misdiagnosis of the causes of the persistent hyperglycemia under consideration. Also, in this work, some considerations were presented to show that anomalies in the cerebral glycemic control through the glucose sensor neurons might be a possible cause/origin of some of the glycemic abnormalities and dysfunctions (however, not only the known related hypoglycemia but also hyperglycemia) that occur in childhood. Finally, it is shown that persistent novel external noxious factors of modernity or noxious factors already known, but amplified by modernity, such as persistent stress, media induced fears, and phobias, environmental pollution, and electromagnetic pollution, can and should also be considered as possible precursors for the development of anomalies in the juvenile homeostatic glycemic system that might well be, if intense and persistent, the driver of the worldwide observed T1DM epidemic events.
文摘Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO), have been formulated to blunt postprandial hyperglycemia. The objective of this research was to evaluate the effectiveness of these products on postprandial glycemic and hormonal responses based on comparisons of GTSN with differing carbohydrate quantities or types. Methods: In two randomized, double-blind, crossover studies, participants (mean age 61 years) with type 2 diabetes consumed GTSN in a meal tolerance test. In the CHO Quantity Study, a standard nutritional beverage (STD) was compared to a low carbohydrate nutritional beverage with tapioca dextrin (GTSN-TDX) and a balanced carbohydrate nutritional beverage containing a blend of the slowly-digesting carbohydrates maltodextrin and sucromalt (GTSN-SDC). In the CHO Type Study, the GTSN beverages had similar carbohydrate quantities but varied in carbohydrate composition with GTSN-SDC compared to a formula with tapioca starch and fructose (GTSN-TS&F), and one with isomaltulose and resistant starch (GTSN-I&RS). Postprandial (0-240 min) concentrations of blood glucose, insulin (CHO Quantity Study only) and glucagon-like-peptide (GLP)-1 (CHO Quantity Study only) were measured. Results: Despite having substantially different carbohydrate quantities, the GTSN blunted the glucose positive area under the curve (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 min tended to be lower for GTSN-SDC (1477 ± 460) than GTSN-TS&F (2203 ± 412;p = 0.062) and GTSN-I&RS (2190 ± 412;p = 0.076). No differences were observed between GTSN-TS&F and GTSN-I&RS. Conclusions: These results demonstrate the effectiveness of several GTSN products and suggest that both CHO quantity and type play important roles in postprandial glycemic response in men and women with type 2 diabetes. Furthermore, GTSN products containing slow-digesting carbohydrates can blunt postmeal glucose and insulin concentration despite delivering greater total grams of CHO, which provides a dietary benefit for people with diabetes.
文摘Through investigating the effect of mild hypothermia on activity of nitric oxide snythase (NOS) in cortical neurons and glycemia levels of neonatal rats with hypoxic ischemic brain damage (HIBD). We studied the mechanism of protecting hypoxic ischemic neurons of mild hypothermia. We established neonatal rat HIBD models, used NOS immunohistochemistry and glycemia determination by micromethod. The number of cortical NOS positive neurons after hypoxic ischemia was significantly decreased as compared with controls. The glycemia levels was significantly increased than that controls. No significant difference was found in number of cortical NOS positive neurons and glycemia levels between 31℃ and 34℃ mild hypothemia. The results imply that hypothermia can decrease overproduction of NO through inhibiting the increase of the activity of NOS, and increase the glycemia levels, thus protect the hypoxic ischemic neurons.
文摘Cardiovascular diseases are serious pathologies that affect an increasing number of people. Several preventive measures are generally used, including supplementing of oils in foods. Our objective was to compare the effects of Tetracarpidum conophorum oil (TC) and corn oil (CO) on serum lipid profiles of normal male rats. 42 Wistar rats were divided into 7 groups. Diets included TC oil (groups TC5, TC10 and TC20) and corn oil (groups CO5, CO10 and CO20) in proportions of 5%, 10% and 20%, with a control group (T). After 5 weeks of feeding, several parameters were measured during and after the study, including body weight, food intake and organ weights (kidney, liver and fat). Lipid profiles (total cholesterol, TG, HDL and LDL), glucose and protein levels were measured in the serum. The increase in body mass was inversely proportional to the amount of oil in the food. The decrease in body mass and adiposomatic index of group TC10 was significant (p < 0.05) compared with the other groups. The lowest glycaemia (64.17 ± 5.14 mg/dl) was noted with the diet containing 20% TC oil. A significant reduction in total cholesterol, LDL fraction and blood triglycerides was observed in the groups supplemented with TC and corn oils compared to controls. Results were also more beneficial for the TC10 group. HDL-cholesterol levels were significantly higher (p < 0.05) in the oil-supplemented groups than in the control group. Castelli’s risk indices decrease significantly (p < 0.05) with increasing oil content for TC. The oils had no impact on blood protein contents. One can conclude that a diet containing 10% crude oil from TC kernels could prevent or alleviate cardiovascular diseases and glycemia.
