Influence of blood glucose fluctuations on chemotherapy efficacy and safety in type 2 diabetes mellitus patients complicated with lung carcinoma

BACKGROUND Patients with type 2 diabetes mellitus(T2DM)have large fluctuations in blood glucose(BG),abnormal metabolic function and low immunity to varying degrees,which increases the risk of malignant tumor diseases and affects the efficacy of tumor chemotherapy.Controlling hyperglycemia may have important therapeutic implications for cancer patients.AIM To clarify the influence of BG fluctuations on chemotherapy efficacy and safety in T2DM patients complicated with lung carcinoma(LC).METHODS The clinical data of 60 T2DM+LC patients who presented to the First Affiliated Hospital of Ningbo University between January 2019 and January 2021 were retrospectively analyzed.All patients underwent chemotherapy and were grouped as a control group(CG;normal BG fluctuation with a mean fluctuation<3.9 mmol/L)and an observation group(OG;high BG fluctuation with a mean fluctuation≥3.9 mmol/L)based on their BG fluctuations,with 30 cases each.BGrelated indices,tumor markers,serum inflammatory cytokines and adverse reactions were comparatively analyzed.Pearson correlation analysis was performed to analyze the correlation between BG fluctuations and tumor markers.RESULTS The fasting blood glucose and 2-hour postprandial blood glucose levels in the OG were notably elevated compared with those in the CG,together with markedly higher mean amplitude of glycemic excursions(MAGE),mean of daily differences,largest amplitude of glycemic excursions and standard deviation of blood glucose(P<0.05).In addition,the OG exhibited evidently higher levels of carbohydrate antigen 19-9,carbohydrate antigen 125,carcinoembryonic antigen,neuron-specific enolase,cytokeratin 19,tumor necrosis factor-α,interleukin-6,and highsensitivity C-reactive protein than the CG(P<0.05).Pearson analysis revealed a positive association of MAGE with serum tumor markers.The incidence of adverse reactions was significantly higher in the OG than in the CG(P<0.05).CONCLUSION The greater the BG fluctuation in LC patients after chemotherapy,the more unfavorable the therapeutic effect of chemotherapy;the higher the level of tumor markers and inflammatory cytokines,the more adverse reactions the patient experiences.

Relationship Between Postprandial Blood Glucose,Fasting Insulin,and Glycated Hemoglobin Levels and Early Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus

Objective:To investigate the relationship between postprandial blood glucose(PBG),fasting insulin(FINS),and glycated hemoglobin(HbA1c)levels and early diabetic nephropathy in patients with type 2 diabetes.Methods:96 cases of type 2 diabetes mellitus treated in our hospital from May 2021 to May 2022 were selected as the research subjects.The patients were divided into two groups according to the urinary albumin excretion rate(UAER),with 53 cases in the type 2 diabetes group(UAER<30μg/min)and 43 cases in the early diabetic nephropathy group(30μg/min≤UAER<300μg/min).PBG,FINS,and HbA1c levels were detected in 87 healthy patients.Results:The levels of PBG,FINS,and HbA1c in the early diabetic nephropathy group were higher than those in the control group(P<0.01)and the type 2 diabetes group(P<0.01).Conclusion:PBG,FINS,and HbA1c are factors affecting the occurrence of diabetic nephropathy in patients with type 2 diabetes;thus,controlling the levels of PBG,FINS,and HbA1c can effectively prevent the occurrence of diabetic nephropathy in type 2 diabetes mellitus.

Continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus

Managing diabetes during pregnancy is challenging,given the significant risk it poses for both maternal and foetal health outcomes.While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests,the advent of continuous glucose monitoring(CGM)systems has revolutionized the approach.These devices offer a safe and reliable means of tracking glucose levels in real-time,benefiting both women with diabetes during pregnancy and the healthcare providers.Moreover,CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes,especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device.Such a combined approach has been demonstrated to improve overall blood sugar control,lessen the occurrence of preeclampsia and neonatal hypoglycaemia,and minimize the duration of neonatal intensive care unit stays.This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.

Can the Glucose Central Control System Dysfunctions Induce Diabetes Mellitus?

We study afresh how the glucose control system anomalies impact the organicity of the glucose homeostasis and build up events of persistent hyperglycemia and diabetes mellitus. We have used critically the state of art literature related to the subject, in order to cross, to compare, and to organize the relevant contents to create a logical and consistent support to the finds. We show that it is consistent to assume that persistent hyperglycemia and diabetes mellitus can have precursors not only in pancreas, but also in brain, mainly induced by noxious dysfunctions of hypothalamus sensor neurons circuits and external noxious elements, causing pancreas overload, and the consequent exhaustion—overburden.

Effects of DPP-4 inhibitor combined with metformin on blood glucose control, oxidative stress and inflammatory response in patients with type 2 diabetes mellitus

Objective: To investigate the effects of DPP-4 inhibitor combined with metformin on blood glucose control, oxidative stress and inflammatory response in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 138 patients with newly diagnosed T2DM who were treated in the hospital between March 2016 and April 2017 were divided into routine group (n=69) and combined treatment group (n=69) by random number table method. Routine group were treated with metformin alone and combined treatment group received DPP-4 inhibitor combined with metformin therapy. The differences in blood glucose control as well as oxidative stress-related indicator and inflammatory factor contents were compared between the two groups before and after treatment. Results: Before treatment, the differences in blood glucose index levels in peripheral blood as well as the oxidative stress index and inflammatory mediator contents in serum were not statistically significant between the two groups. After 4 weeks of treatment, blood glucose indexes FBG and HOMA-IR levels in peripheral blood of combined treatment group were lower than those of routine group;oxidative stress indexes MDA and LHP contents in serum were lower than those of routine group whereas GSH-Px and T-AOC contents were higher than those of routine group;inflammatory mediators hs-CRP, IL-1 and IL-6 contents in serum were lower than those of routine group. Conclusion: DPP-4 inhibitor combined with metformin therapy can effectively control the blood glucose and suppress the systemic oxidative stress and inflammatory response in T2DM paients.

Clinical correlation between blood glucose control-related factors and postoperative fundus hemorrhage after pan-retinal photocoagulation for diabetic retinopathy

Objective: To discuss the clinical correlation between blood glucose control-related factors and postoperative fundus hemorrhage after pan-retinal photocoagulation (PRP) for diabetic retinopathy (DR). Method: From February 2013 to January 2017, 98 patients at 7 d after PRP for DR were recruited. Depending on postoperative fundus status, the patients were divided into normal fundus group (n=42), fundus hemorrhage group (n=30) and proliferative DR group (n=27). The baseline data and monitoring data of blood glucose and blood lipid were recorded. Dynamic glucose monitor system was used to detect indicators of blood glucose fluctuation, MAGE and MBG. Result: The three groups were compared in terms of systolic pressure, diastolic pressure, course of disease, gender, age and body mass index (BMI), and no significant differences were found. As compared with the normal fundus group, the fundus hemorrhage group and proliferative DR group had a significant increase in FPG, HbA1c, 2hPG, LDL-C and TC, but a decrease in HDL-C. MAGE and MBG for the fundus hemorrhage group were (4.89±1.42) and (7.82±1.42), respectively, which were higher than those of the normal fundus group, but no significantly different from those of the proliferative DR group. Linear correlation analysis was performed in 98 patients, and significant linear correlations existed between MAGE, MBG, FPG, HbA1c and LDL-C with fundus hemorrhage. Conclusion: Blood glucose control-related factors MAGE, MBG, FPG, HbA1c and LDL-C were important influence factors of fundus hemorrhage following PRP for DR. Appropriate countermeasures are needed to reduce the fluctuation of blood glucose level.

Effect of liraglutide combined with basal insulin on blood glucose control, lipid metabolism and oxidative stress in patients with newly diagnosed type 2 diabetes mellitus complicated by obesity

Objective:To investigate the effect of liraglutide combined with basal insulin on blood glucose control, lipid metabolism and oxidative stress in patients with newly diagnosed type 2 diabetes mellitus complicated by obesity.Methods: A total of 58 patients with newly diagnosed type 2 diabetes mellitus complicated by obesity who were diagnosed and treated in Xi'an No. 4 Hospital between February 2017 and August 2017 were divided into the control group (n=29) who received basal insulin therapy and the liraglutide group (n=29) who received liraglutide combined with basal insulin therapy according to random number table. The differences in the levels of glycolipid metabolism indexes and the contents of oxidative stress indexes were compared between the two groups before and after treatment.Results: Before treatment, the differences in the levels of glycolipid metabolism indexes in peripheral blood and the contents of oxidative stress indexes in serum were not statistically significant between the two groups. After 1 month of treatment, glucose metabolism indexes FBG and HOMA-IR levels in peripheral blood of liraglutide group were lower than those of control group;lipid metabolism indexes TC, TG, ApoB levels in peripheral blood were lower than those of control group, ApoA1 level was higher than those of control group;serum oxidation indexes MDA and LHP contents were lower than those of control group whereas anti-oxidation indexes GSH-Px and T-AOC contents were higher than those of control group.Conclusion: Liraglutide combined with basal insulin therapy can further control the glucolipid metabolism levels and inhibit the systemic oxidative stress response in patients with newly diagnosed type 2 diabetes mellitus complicated by obesity.

Correlation of anxiety state with blood glucose control, microinflammation and oxidative stress in patients with type 2 diabetes mellitus

Objective:To study the correlation of anxiety state with blood glucose control, microinflammation and oxidative stress in patients with type 2 diabetes mellitus.Methods:A total of 138 patients with type 2 diabetes mellitus were divided into the non-anxiety group (n=43) (SAS score < 50 points), mild-to-moderate anxiety group (n=71) (SAS score 50-69 points) and severe anxiety group (n=24) (SAS score 70 points) according to the self-rating anxiety scale (SAS) score. The differences in levels of glucose metabolism indexes, microinflammation indexes and oxidative stress indexes were compared among the three groups.Results: Peripheral blood FPG, P2hPG, HOMA-IR, CRP, ASAA, IL-6, MDA and ROS levels of mild-to-moderate anxiety group and severe anxiety group were higher than those of non-anxiety group while CAT and GSH-Px contents were lower than those of non-anxiety group;peripheral blood FPG, P2hPG, HOMA-IR, CRP, ASAA, IL-6, MDA and ROS levels of severe anxiety group were higher than those of mid-to-moderate anxiety group while CAT and GSH-Px contents were lower than those of mid-to-moderate anxiety group.Conclusion:The increase of anxiety in patients with type 2 diabetes mellitus is a direct factor leading to the abnormal glucose metabolism as well as the aggravation of microinflammatory state and oxidative stress state.

Effect of hospital discharge plan for children with type 1 diabetes on discharge readiness,discharge education quality,and blood glucose control

BACKGROUND Type 1 diabetes is one of the most common chronic diseases in childhood.The number of type 1 diabetes patients in China still ranks fourth in the world.Therefore,children with type 1 diabetes in China are a group that needs attention.The management of type 1 diabetes mellitus(T1DM)involves many aspects of daily life.It is extremely challenging for children and their families.T1DM children have complex medical care needs.Despite the continuous development of therapeutic medicine and treatment technologies,blood glucose control in children with T1DM is still not ideal.They and their parents need to acquire more knowledge and skills before being discharged.AIM To explore the influence of hospital discharge plan based on parental care needs of children with T1DM on discharge readiness,quality of discharge education and blood glucose control level.METHODS In total,102 parents of children with type 1 diabetes were divided into control group and intervention group according to admission time.Fifty cases from February to June 2019 were selected as the control group,and 52 cases from July to October 2019 were selected as the intervention group to implement the discharge plan.The Readiness for Hospital Discharge Scale,Hospital Discharged Education Quality Scale and children's blood glucose metabolism indicators were used to compare the differences in discharge preparation,discharge education quality and blood glucose control between the two groups of children and their parents.RESULTS On the day of discharge,the two groups of children had the following scores of readiness for discharge:The intervention group score was 225.34±32.47,and the control group score was 208.68±29.31.The P value was 0.007,and the difference was statistically significant.The discharge education quality scores were as follows:The intervention group score was 135.11±19.86,the control group score was 124.13±15.56,the P value was 0.002 and the difference was statistically significant.Three months after discharge,the blood glucose metabolism indicator showed that the glycosylated hemoglobin value of the two groups was(7.45%±1.04%),and that of the control group was(8.04%±1.27%),P=0.012.Therefore,the improvement of parents'readiness for discharge,quality of discharge education and blood glucose metabolism indicators(glycosylated hemoglobin,fasting blood glucose and postprandial blood glucose)in the intervention group were better than those in the control group(P<0.05),and the difference was statistically significant.CONCLUSION The discharge plan for children with T1DM can help the children and their families realize the transition from hospital care to home self-management and improve the parents'readiness for discharge,thereby improving children’s blood glucose control levels.

Spouses of patients with diabetes mellitus type 2 at increased risk of high blood glucose levels

Introduction: Diabetes mellitus type 2 is a growing threat in developing countries already burdened with high levels of infectious disease. Screening the general population has debatable advantages. This study aims to determine whether spouses of patients with diabetes mellitus have higher random blood glucose (RBG) levels as well as the benefit of RBG testing as a targetted screening tool. Methodology: The survey employed a cross-sectional comparative study of spouses’ of diabetics and non-diabetics attending the general out-patient department of the LagosStateUniversityTeaching Hospital (LASUTH), Ikeja. A modified WHO STEPS Surveillance Instrument and a one-touch Glucometer were used to collect data. Blood pressures and BMI were measured and correlated to blood glucose levels. Results: Prevalence of high RBG was found to be 7% among spouses of diabetics and 3.3% among spouses of non-diabetic patients. Mean RBG was 5.57 mmol/L and 7.7 mmol/L within the age group 40 - 49 years and 50 - 59 years respectively among spouses of diabetic patients compared to 5.4 mmol/L and 5.5 mmol/L within the same age group among the spouses non-diabetics. Spouses of patients with diabetes mellitus had higher systolic and diastolic blood pressures and BMI compared to spouses of non-diabetics. Conclusion: Being male, married to a diabetic patient, lower educational levels and higher body mass index are significantly associated with higher random blood glucose in the spouses of diabetic patients. Random blood glucose measurements are an effective screening tool and spouses of diabetic patients can benefit from targeted screening in controlled clinical settings.

Efficacy of blood glucose self-monitoring on glycemic control in patients with non-insulin-treated type 2 diabetes: A meta-analysis

Objective:To evaluate the efficacy of blood glucose self-monitoring on glycemic control in patients with non-insulin-treated type 2 diabetes by performing a meta-analysis.Methods:Randomized controlled trials(RCTs)of the efficacy of blood glucose selfmonitoring were collected from the PubMed,EMBASE,Cochrane Library,CNKI,and VIP databases.Data were analyzed by RevMan 5.1 software.Results:Seven RCTs were included in this meta-analysis.The results indicated that blood glucose self-monitoring significantly reduced the glycated hemoglobin(HbA1c)level by 0.41%.Subgroup analysis showed that while implementation of a diabetes management regimen based on the blood glucose self-monitoring results effectively reduced the HbA1c level by 0.42%,no significant improvement in HbA1c level control was observed with the implementation of blood glucose self-monitoring alone.Conclusion:Blood glucose self-monitoring combined with diabetes management effectively improves glycemic control in patients with non-insulin-treated type 2 diabetes.

Establishment of blood glucose control model in diabetic mice

AIM:To explore the established method of the diabetic mouse blood glucose control model and preliminar y observation of its influence on the retinas of diabetic mice.METHODS:The db/db BKS-DB(Lepr^(ko/ko))mice were randomly divided into two groups:the poor blood glucose control group(PG group,n=18)and the stable blood glucose control group(SG group,n=12),with BKS-DB(Lepr^(wt/wt))as the normal blood glucose control group(NG group,n=18).According to the blood glucose values for 5 intervals which were monitored during the period of adaption,the PG group was injected with insulin aspart twice daily,fasted for 2h and then returned to normal.The SG group was injected with insulin aspart twice and insulin glargine once daily and fed with a quantitative ration.Fundus images were collected after eight weeks.The glycosylated hemoglobin(Hb A1c),mean blood glucose level(MBG),standard deviation of blood glucose(SDBG),coefficient of variation of blood glucose(CVBG),and mean amplitude of glycemic excursion(MAGE)in each group were examined and calculated.RESULTS:The Hb A1c,MBG,SDBG,CVBG,and MAGE levels in the PG group were significantly higher than those in the NG and SG groups(all P<0.05).MBG,SDBG,CVBG,and MAGE levels in the SG group were higher than those in the NG group(all P<0.05).There was no significant difference in Hb A1c levels between the NG and SG groups(P>0.05).Preliminary observation of fundus images in the PG group and SG groups showed scattered retinal bleeding spots,while bleeding was more obvious in the PG group.CONCLUSION:The blood glucose control model of type 2 diabetes mellitus mice can be successfully established by subcutaneous injection of insulin aspart insulin glargine and rationed food,which is valuable for studying the mechanism of blood glucose fluctuations in diabetic complications in vivo.

Is nonlinear model predictive control with fuzzy predictive model proper for managing the blood glucose level in typeI diabetes?

In recent decades, due to the increasing risk of diabetes, the measurement and control of the blood sugar is of great importance. In typeI diabetes, because of the lack of insulin secretion, the cells cannot absorb glucose, and thus have a low level of glucose. To control blood glucose, the insulin must be injected to the body. In fact, the injection must be in a completely controlled environment. If the level of the insulin exceeds the physiological limits, it may cause death. This paper presents an online approach to control the blood glucose level using a nonlinear model predictive control. This method, maintains the level of blood glucose concentration within a normal range. Thus, the blood glucose level is measured in each minute and predicted for the next time interval. If that is not in the normal range, amount of the insulin which must be injected will be determined. The proposed control approach includes important features such as model uncertainties and prevents acute decrease in the blood glucose level, and instability. In order to assess performance of the proposed controller, computer simulations have been carried out in Matlab/Simulink. Simulation results will reveal the effectiveness of the proposed nonlinear model predictive controller in adjusting the blood glucose level by injecting required insulin. So if the nutrition of the person decreases instantly, the hypoglycemia does not happen.

Abnormality of peripheral nerve conduction velocity associated with illness course, symptoms and fasting blood glucose in patients with type 2 diabetes mellitus

BACKGROUND: It has shown that abnormality of peripheral nerve conduction velocity during onset of diabetes mellitus is not related to age and sex, but to symptoms, illness course and level of fasting blood glucose. OBJECTIVE: To measure correlation of abnormality of peripheral nerve conduction velocity with various illness courses, symptoms and levels of fasting blood glucose of patients with type 2 diabetes mellitus. DESIGN: Case analysis. SETTING: Department of Neurology, Central People's Hospital of Huizhou. PARTICIPANTS: A total of 128 patients who were diagnosed as type 2 diabetes mellitus were selected from Central People's Hospital of Huizhou from September 2001 to October 2005. There were 75 males and 53 females aged 32-83 years and the illness course ranged from 1 month to 20 years. METHODS: All 128 patients with type 2 diabetes mellitus received neuro-electrophysiological study and their clinical data were retrospectively analyzed to measure peripheral nerve conduction velocity and fasting blood glucose so as to investigate the correlation of peripheral nerve conduction velocity with clinical symptoms, illness course and levels of fasting blood glucose. MAIN OUTCOME MEASURES: Correlation of peripheral nerve conduction velocity with clinical symptoms, illness course and levels of fasting blood glucose. RESULTS: All 128 patients with type 2 diabetes mellitus were involved in the final analysis. ① Among 128 patients, 114 patients had abnormality of peripheral nerve conduction velocity; 110 patients had clinical symptoms, including 102 patients having abnormality of peripheral nerve conduction velocity; 18 patients did not have clinical symptoms, including 12 patients having abnormality of peripheral nerve conduction velocity. There were significant differences between them (χ 2=8.275, P =0.04). ② Among 128 patients, illness course of 75 patients was equal to or less than 5 years, including 27 patients having abnormality of peripheral nerve conduction velocity; illness course of 53 patients was more than 5 years, including 35 patients having abnormality of peripheral nerve conduction velocity. There were significant differences between them (χ 2=11.469, P =0.003). ③ Among 128 patients, levels of fasting blood glucose of 75 patients was equal to or lower than 11 mmol/L, including 41 patients having abnormality of peripheral nerve conduction velocity; levels of fasting blood glucose of 53 patients was higher than 11 mmol/L, including 38 patients having abnormality of peripheral nerve conduction velocity. There were significant differences between them (χ 2=4.023, P =0.134). CONCLUSION: ① Abnormality of peripheral nerve conduction velocity of patients with type 2 diabetes mellitus is related to illness courses and clinical symptoms. The longer the illness course is, the severer the abnormality of peripheral nerve conduction velocity is. Abnormality of peripheral nerve conduction velocity always occurs on patients who have clinical symptoms. ② Abnormality of peripheral nerve conduction velocity is not related to levels of fasting blood glucose.

Study on relationship between diabetic retinopathy and blood glucose, blood lipid

Objective: To provide scientific basis for the pathogenesis and prevention and control of diabetic retinopathy through studying on relationship between different stages of diabetic retinopathy and blood glucose, blood lipid andother related factors. Mehods: Collected 196 type 2 diabetes patients in a hospital branch ,it could be divided into NDR (n=180), NPDR (n=11) and PDR (n=5) and collected 40 control cases. Each object were surveyed fundus colorized photographyorfundus fluorescence angiography examination, physical and blood tests, and the results were statistically analyzed. Results: BMI, SBP, HbAlc, FPG, P2hPG, TG, HDL, DN and urinary albumin/creatinine ratio (UACR) between the four groups were statistically difference;SBP, HbAlc, P2hPG, TG and UACR were positively correlated relationship with different stage of DR;HDL was negatively related with different stage of DR. Conclusion: SBP, HbAlc, P2hPG, HDL and UACR were factors of different stages of DR, the SBP, HbAlc, P2hPG and TG were more higher and the HDL was more lower, the DR was more serious.

Blood glucose response to aerobic exercise training programme among patients with type 2 diabetes mellitus at the University of Nigeria Teaching Hospital, Enugu South-East, Nigeria

The following article has been retracted due to the conflicts between the authors. The scientific community takes a very strong view on this matter, and HEALTH treats all unethical behavior seriously. This paper published in Vol.5 No.11, 1796-1802 (2013) has been removed from this site. Title: Blood glucose response to aerobic exercise training programme among patients with type 2 diabetes mellitus at the University of Nigeria Teaching Hospital, Enugu South-East, Nigeria Authors: Charles Ikechukwu Ezema, Amarachi Akuegbu Onwunali, Sikiru Lamina, Uche Anthonia Ezugwu, Augustine Amaeze Amaeze, Maduabuchukwu Joseph Nwankwo, Florence Ngozi

USING CAPILLARY WHOLE BLOOD GLUCOSE TEST IN SCREENING FOR GESTATIONAL DIABETES MELLITUS

Objective To discuss whether the capillary whole blood glucose (CBG) test can be used in glucose screening test (GST) for gestational diabetes mellitus (GDM) compared to the venous plasma glucose (VPG) method, and to determine the cutoff value of CBG. Methods This was a self-control test. The 50-g oral GST was conducted among 1 557 pregnant women between 24-28 weeks. Every woman was measured CBG and VPG at the same time and same arm. Three hundred and forty women underwent 100-g 3-h oral glucose tolerance test (OGTT). Receiver operation curve (ROC) was used to determine the potential cutoff level of CBG and VPG. Diagnose criteria of GDM was based on NDDG criteria. OGTT diagnosed GDM and VPG≥7.8 mmol/L were used as golden standard for ROC. Results There was good relationship between CBG and VPG (P<0.01). Correlation coefficient was 0.86. The value of CBG was lower than VPG. The statistical and high-sensitivity cutoff values were 7.4 mmol/L in CBG and 7.8 mmol/L in VPG when GDM was used as golden standard. Cutoff value of CBG was 7.0 mmol/L when VPG≥7.8 mmol/L was used as golden standard. The pregnant outcomes of positive cases of three thresholds had no significant differences. But it was better in case of the pregnant woman when the CBG value was more than 7.4 mmol/L. Conclusion CBG can be used in GST, the threshold of CBG was suggested as 7.4 mmol/L. CBG test was more convenience and effective than VPG test.

Blood glucose control in patients with severe sepsis and septic shock

The main pathophysiological feature of sepsis is the uncontrollable activation of both pro-and anti-inflammatory responses arising from the overwhelming pro-duction of mediators such as pro-and anti-inflammatory cytokines. Such an uncontrollable inflammatory response would cause many kinds of metabolic derangements. One such metabolic derangement is hyperglycemia. Accordingly, control of hyperglycemia in sepsis is considered to be a very effective therapeutic approach. However, despite the initial enthusiasm, recent studies reported that tight glycemic control with intensive insulin therapy failed to show a beneficial effect on mortality of patients with severe sepsis and septic shock. One of the main reasons for this disappointing result is the incidence of harmful hypoglycemia during intensive insulin therapy. Therefore, avoidance of hypoglycemia during intensive insulin therapy may be a key issue in effective tight glycemic control. It is generally accepted that glycemic control aimed at a blood glucose level of 80-100 mg/dL, as initially proposed by van den Berghe, seems to be too tight and that such a level of tight glycemic control puts septic patients at increased risk of hypoglycemia. Therefore, now many researchers suggest less strict glycemic control with a target blood glucose level of 140-180 mg/dL. Also specific targeting of glycemic control in diabetic patients should be considered. Since there is a significantcorrelation between success rate of glycemic control and the degree of hypercytokinemia in septic patients, some countermeasures to hypercytokinemia may be an important aspect of successful glycemic control. Thus, in future, use of an artificial pancreas to avoid hypoglycemia during insulin therapy, special consideration of septic diabetic patients, and control of hypercytokinemia should be considered for more effective glycemic control in patients with severe sepsis and septic shock.

Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus

Purpose:To investigate the sleep quality of patients with type 2 diabetes(T2D)and its impact on glycaemic control.Methods:Using a convenience sampling method,220 patients with T2D were recruited.The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the sleep quality with threshold at PSQI
8.The glycosylated haemoglobin A1c(HbA1c)test was used to measure the glycaemic control with threshold at HbA1c<7%.Results:The PSQI score was 8.30±4.12.The sleep disorder incidence rate was 47.1%.Patients with HbA1c
7%had significantly lower PSQI global and factor scores(p<0.01)versus the control group.Sleep latency,sleep disturbance,and daytime dysfunction were the risk factors for poor glycaemic control.Conclusion:Patients with T2D have high sleep disorder rate negatively impacting glycaemic control.Health care providers should pay close attention to the sleep quality of T2D patients,and provide them with appropriate educational material.