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Hypoglycemia prevention

Galit Weinstein, Kendra L Davis-Plourde, Sarah Conner, Jayandra J Himali, Alexa S Beiser, Anne Lee, Andreea M Rawlings, Sanaz Sedaghat, Jie Ding, Erin Moshier, Cornelia M van Duijn, Michal S Beeri, Elizabeth Selvin, M Arfan Ikram, Lenore J Launer, Mary N Haan, Sudha Seshadri
OBJECTIVE: To determine whether classes of diabetes medications are associated with cognitive health and dementia risk, above and beyond their glycemic control properties. RESEARCH DESIGN AND METHODS: Findings were pooled from 5 population-based cohorts: the Framingham Heart Study, the Rotterdam Study, the Atherosclerosis Risk in Communities (ARIC) Study, the Aging Gene-Environment Susceptibility-Reykjavik Study (AGES) and the Sacramento Area Latino Study on Aging (SALSA)...
2019: PloS One
Prakash Deedwania, Tushar Acharya
Diabetes mellitus is a major risk factor for cardiovascular (CV) disease. Conversely, CV disease is responsible for a majority of the deaths in patients with diabetes. Many drug trials have concentrated on blood glucose (hemoglobin A1c ) reduction. This strategy, while reducing microvascular outcomes like nephropathy and neuropathy, has little or no effect on reducing macrovascular events like heart attack, stroke, and heart failure. It has been postulated that hypoglycemia may counterbalance some of the beneficial effects of anti-hyperglycemic agents, but this is not proven...
February 15, 2019: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Charrise M Ramkissoon, Athur Bertachi, Aleix Beneyto, Jorge Bondia, Josep Vehi
The purpose of this study was to develop an algorithm that detects aerobic exercise and triggers disturbance rejection actions to prevent exercise-induced hypoglycemia. This approach can provide a solution to poor glycemic control during and after aerobic exercise, a major hindrance in the participation of exercise by patients with type 1 diabetes. This novel exercise-induced hypoglycemia reduction algorithm (EHRA) detects exercise using a threshold on a disturbance term, a parameter estimated from an augmented minimal model using an Unscented Kalman Filter...
February 11, 2019: IEEE Journal of Biomedical and Health Informatics
Alena Gerlinde Thiele, Maren Heckenmüller, Heike Bartelt, Sabine Klamt, Wieland Kiess, Thomas Michael Kapellen
OBJECTIVE: Continuous intravenous (IV) insulin infusion therapy minimizes blood glucose (BG) fluctuations and prevents metabolic deterioration in pediatric patients with type 1 diabetes (T1D) during intercurrent illness and surgery. However, data on the adequate fluid and insulin substitution in this situation is rare. We evaluated the effectiveness and safety of IV insulin therapy according to our local protocol. RESEARCH DESIGN AND METHODS: Retrospective study of 124 cases of hospitalization with IV insulin therapy due to intercurrent illness (n=78) or minor surgery (n=46) in 62 patients with T1D (mean age: 9...
February 13, 2019: Pediatric Diabetes
Jeannette C Bleeker, Irene L Kok, Sacha Ferdinandusse, W Ludo van der Pol, Inge Cuppen, Annet M Bosch, Mirjam Langeveld, Terry G J Derks, Monique Williams, Maaike de Vries, Margot F Mulder, Estela Rubio Gozalbo, Monique G M de Sain- van der Velden, Alexander J Rennings, Peter J C I Schielen, Eugenie Dekkers, Riekelt H Houtkooper, Hans R Waterham, Mia L Pras-Raves, Ronald J A Wanders, Peter M van Hasselt, Marja Schoenmakers, Frits A Wijburg, Gepke Visser
BACKGROUND: Most infants with very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD) identified by newborn screening (NBS) are asymptomatic at the time of diagnosis and remain asymptomatic. If this outcome is due to prompt diagnosis and initiation of therapy, or because of identification of individuals with biochemical abnormalities who will never develop symptoms, is unclear. METHODS: A 10 year longitudinal national cohort study of genetically confirmed VLCADD patients born before and after introduction of NBS...
February 13, 2019: Journal of Inherited Metabolic Disease
J Lawrence Merritt, Marie Norris, Shibani Kanungo
Fatty acid oxidation disorders (FAODs) are inborn errors of metabolism due to disruption of either mitochondrial β-oxidation or the fatty acid transport using the carnitine transport pathway. The presentation of a FAOD will depend upon the specific disorder, but common elements may be seen, and ultimately require a similar treatment. Initial presentations of the FAODs in the neonatal period with severe symptoms include cardiomyopathy, while during infancy and childhood liver dysfunction and hypoketotic hypoglycemia are common...
December 2018: Annals of Translational Medicine
Pei-Yun Chen, Han-Cheng Wang
The syndrome of acute bilateral basal ganglia lesions in diabetic uremia is uncommon and usually affects Asian patients. The underlying pathogenesis of this syndrome is not clear. We searched PUBMED using the keywords "bilateral basal ganglia", "diabetic", and "uremia", and found a total of 34 cases from 1998 to 2016. In most cases, blood sugar levels were normal. Here we report two Taiwanese cases presenting with dyskinesias. In one case the syndrome was triggered by hyperglycemia, and in the other by severe hypoglycemia...
March 2019: ENeurologicalSci
I Dicembrini, M Monami, E Mannucci
Dypeptidylpeptidase-4 (DPP-4) inhibitors are a therapeutic option for improving glucose control in patients with type 2 diabetes. They can be prescribed at different stages of the natural history of the disease because of their low risk for hypoglycemia and associated weight gain. For all new drugs for diabetes, the US Food and Drug Administration requires the demonstration of the cardiovascular (CV) safety profile through pooled analyses of phase 3 studies or specifically designed trials. A significant superiority over placebo has been observed with a sodium-dependent glucose transporter-2 inhibitor, empagliflozin, and two glucagon-like peptide-1 receptor agonists, liraglutide and semaglutide, thus suggesting cardioprotective effects for some antidiabetic drugs...
January 3, 2019: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
Wei-Yu Chou, Yan-Rong Li, Wai Kin Chan, Szu-Tah Chen
BACKGROUND: This study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy. METHODS: A total of 825 individuals aged ≤ 20 years with T1DM, using either basal-bolus or premixed insulin regimens, were retrospectively recruited from 2001 to 2015. Rates of DKA after diagnosis, severe hypoglycemia, and the level of glycated hemoglobin A1c (HbA1c) improvement during the follow-up period were analyzed...
December 2018: Biomedical Journal
León E Litwak, Ivanna Querzoli, Carla Musso, Alejandro Dain, Solange Houssay, Adrián Proietti, José E Costa Gil
An adequate glycemic control prevents and/or delays the development and/or progression of chronic complications in patients with diabetes mellitus (DM). To achieve this control, it is necessary to adjust insulin doses, in type 1 or insulinized type 2 DM persons, based on traditional capillary glucose self-monitoring, which has limitations to generate an adequate data record, is invasive and has low adherence. In contrast, new continuous glucose monitoring (CGM) systems provide more complete and dynamic information, and better compliance...
2019: Medicina
Sarah Stanley, Amir Moheet, Elizabeth R Seaquist
Glucose homeostasis requires an organism to rapidly respond to changes in plasma glucose concentrations. Iatrogenic hypoglycemia as a result of treatment with insulin or sulfonylureas is the most common cause of hypoglycemia in humans and is generally only seen in patients with diabetes who take these medications. The first response to a fall in glucose is the detection of impending hypoglycemia by hypoglycemia detecting sensors including glucose sensing neurons in the hypothalamus and other regions. This detection is then linked to a series of neural and hormonal responses that serve to prevent the fall in blood glucose and restore euglycemia...
January 22, 2019: Endocrine Reviews
Yoonyoung Choi, Ben Staley, Rene Soria-Saucedo, Carl Henriksen, Amy Rosenberg, Almut G Winterstein
Purpose: Common inpatient hypoglycemia risk factor patterns (phenotypes) from an electronic health record (EHR)-based prediction model and preventive strategies were identified. Methods: Patients admitted to 2 large academic medical centers who were in the top fifth percentile of a previously developed hypoglycemia risk score and developed hypoglycemia (blood glucose [BG] of <50mg/dL) were included in the study. Frequencies of all combinations of ≥4 risk factors contributing to the risk score among these patients were determined to identify common risk patterns...
January 25, 2019: American Journal of Health-system Pharmacy: AJHP
Johanna Stark, Burkhard Simma, Anya Blassnig-Ezeh
BACKGROUND: Temporary low plasma glucose concentrations are common in healthy newborns. Although there is no uniform definition of neonatal hypoglycemia, there is a consensus in the current literature that plasma glucose concentrations should be measured in infants at risk. Known risk groups for transient neonatal hypoglycemia include infants of diabetic mothers (IDM), large (LGA) or small (SGA) for gestational age and late preterm (LPT) infants. OBJECTIVES: The aim of this retrospective trial was to determine the incidence of hypoglycemia and the impact of the application of a 2011 revised guideline in respect of additional feeding or i...
January 27, 2019: Journal of Maternal-fetal & Neonatal Medicine
Noah M Ivers, Maggie Jiang, Javed Alloo, Alexander Singer, Daniel Ngui, Carolyn Gall Casey, Catherine H Yu
OBJECTIVE: To summarize the 2018 Diabetes Canada clinical practice guidelines, focusing on high-priority recommendations for FPs managing people who live with type 2 diabetes. QUALITY OF EVIDENCE: A prioritization process was conducted to focus the efforts of Diabetes Canada's guideline dissemination and implementation efforts. The resulting identified key messages for FPs to consider when managing patients with type 2 diabetes are described. Evidence supporting the guideline recommendations ranges from levels I to IV and grades A to D...
January 2019: Canadian Family Physician Médecin de Famille Canadien
A S M Hasan Mahmood, Santosh K Mandal, Khaggeswar Bheemanapally, Mostafa M H Ibrahim, K P Briski
The ventromedial hypothalamic nucleus (VMN) is a critical component of the neural circuitry that regulates glucostasis. Astrocyte glycogen is a vital reserve of glucose and its oxidizable metabolite L-lactate. In hypoglycemic female rats, estradiol-dependent augmentation of VMN glycogen phosphorylase (GP) protein requires hindbrain catecholamine input. The research here investigated the premise that norepinephrine (NE) regulation of VMN astrocyte metabolism shapes local glucoregulatory neurotransmitter signaling in this sex...
January 17, 2019: Molecular and Cellular Neurosciences
Xiuhua Yang, Tao Meng
OBJECTIVE: The admission of full-term neonates in the Neonatal Intensive Care Unit (NICU) is not an uncommon occurrence. All newborns admitted to the NICU attain benefits, such as highly specialized care, but there are also associated risks and high cost. This study aimed at identifying the patterns of full-term neonatal admissions at the NICU. METHODS: A hospital-based retrospective cross-sectional study was carried out among all full-term neonates (≥ 37-week gestation) admitted to the NICU at the First Hospital of China Medical University from 1 January, 2009 to 30 June, 2018...
January 9, 2019: Journal of Maternal-fetal & Neonatal Medicine
Marie-Anne Burckhardt, Tarini Chetty, Grant J Smith, Peter Adolfsson, Martin de Bock, Timothy W Jones, Elizabeth A Davis
Diabetes care during exercise frequently requires interruptions to activity and adds extra challenges particularly for young individuals with type 1 diabetes (T1D). This study investigated the use of a carbohydrate (CHO) intake algorithm based on continuous glucose monitoring (CGM) trends during physical activity. Children with T1D diagnosed for >1 year, ages 8-12 years, with a glycated hemoglobin of <10% were recruited into a randomized crossover study. They attended two similar mornings of fun-based physical activity and adhered to either a CHO intake algorithm based on CGM trends (intervention) or to standard exercise guidelines (consumption of 0...
January 2019: Diabetes Technology & Therapeutics
Mitsuyoshi Namba, Toshio Iwakura, Rimei Nishimura, Kohei Akazawa, Munehide Matsuhisa, Yoshihito Atsumi, Jo Satoh, Toshimasa Yamauchi
Despite great strides in pharmacotherapy for diabetes, there is increasing concern over the risk of hypoglycemia in patients with diabetes receiving pharmacotherapy as they become increasingly older. This has prompted the Japan Diabetes Society (JDS) to initiate a survey on the current status of severe hypoglycemia in clinical settings. In July 2015, following approval from the JDS Scientific Survey/Research Ethics Committee, the JDS extended an invitation to executive educators, who represented a total of 631 health-care facilities accredited by the JDS for diabetes education, to participate in the proposed survey...
May 2018: Diabetology International
Noriko Ujihara, Hiroshi Sakura, Naotake Hashimoto, Kazuo Sasamoto, Hiroshi Ohashi, Sumiko Hasumi, Tadasu Kasahara, Osamu Tomonaga, Hideo Nunome, Masashi Honda, Yasuhiko Iwamoto
Purpose: To determine the efficacy and safety of sitagliptin when used with some therapeutic drugs to treat elderly patients. Methods: Sitagliptin (50 mg/day) was added to the pre-existing therapy for type 2 diabetes. Changes in the glycated hemoglobin (HbA1c) level after 3 months of treatment were compared with the baseline, and exploratory analysis was performed. These analyses were conducted as subanalyses of the JAMP study, which was an open-label observational study...
February 2018: Diabetology International
Marco Dauriz, Chiara Maneschi, Claudia Castelli, Anna Tomezzoli, Arnaldo Fuini, Luca Landoni, Giuseppe Malleo, Marco Ferdeghini, Enzo Bonora, Paolo Moghetti
Context: Nesidioblastosis is a rare cause of adult hypoglycemia. Current medical therapy can mitigate disease symptoms. However, side-effects and limited efficacy may prevent long-term disease management. Case description: A 63-year-old Caucasian lady presented at our Institution on April 2017, with a history of distal spleno-pancreatectomy for well-differentiated insulinoma in 2013. Hypoglycaemic events did not resolve after surgery and residual nesidioblastosis near the pancreatic resection margins was identified...
December 28, 2018: Journal of Clinical Endocrinology and Metabolism
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