Clinical studies of glucose variability and hypoglycemia in adult patients with type 1 diabetes

Diabetes mellitus type 1 is a condition characterized by elevated blood glucose values due to impaired insulin production. This condition is associated with increased morbidity from microand macrovascular complications. Studies have shown that lowering blood glucose reduces the incidence of these complications. However, the question of whether glycemic variability is an independent risk factor for the development of microvascular complications remains. Studies I and II were retrospective observational studies performed on the same cohort of patients; it consisted of 100 patients who were randomly selected from 442 consecutive type 1 diabetic patients who attended our out-patient clinic. Standard deviation of blood glucose (SDBG) was calculated from 70 measurements over a period of 4 weeks. The onset and progression of microand macrovascular complications were recorded from 1990 to 2001. HbA1c values were recorded from 1985 to 2001. HbA1c variability was measured as the SD of collected HbA1c values. The prevalence of complications increased over time from 1990 to 2001. The prevalence of neuropathy increased from 29% to 47%. Statistical analysis showed that HbA1c was an independent predictor of the incidence (p = 0.004) and the prevalence (p = 0.01) of nephropathy. SDBG was found to be a predictor of the prevalence of peripheral neuropathy (p = 0.03) and showed borderline significance for the incidence of peripheral neuropathy (p = 0.07). The variability of HbA1c was found to be an independent factor that contributes to the development of microvascular complications. (p=0.019). We conclude that the short-term variability of blood glucose may be of importance for the development of peripheral neuropathy and that nerve tissue might be particularly vulnerable and we also conclude that the variability of HbA1c may be of importance for the development of microvascular complications. Study III was an open, randomized, cross-over trial in 15 type 1 diabetes patients to compare glucose control assessed by a continuous glucose monitoring system (CGMS) Gold during basal insulin substitution with either a continuous subcutaneous insulin infusion (CSII) or glargine. Comparing CSII with glargine revealed that the mean blood glucose was lower with CSII, 9.11 vs. 10.31 (p=0.002). There was an average of 1.3 more episodes of values below 3.5 mmol/l with CSII (p=0.053). There were no significant differences in glucose variability measured as SDPG or the mean amplitude of glucose excursions (MAGE), although significantly longer periods of glucose values were spent within the target of 4.5-10.0 mmol/l with CSII (p=0.034). CSII provided superior glucose control compared with glargine, with lower mean blood glucose at longer periods of glucose values within target and a lower HbA1c with a somewhat smaller insulin dose (n.s). However, there was no significant difference with respect to glucose variability. Study IV was an observational study of the prevalence of severe hypoglycemia (SH) in relation to risk factors in type 1 diabetic patients over a period of 14 years, 1984 to 1998. To investigate the problem of SH, we performed a cross-sectional survey of a cohort of 178 patients registered at our out-patient clinic in 1984 to be repeated in 1998. An identical questionnaire was sent to the patients at the beginning of 1985 and 1999 respectively, regarding the problem of SH in the preceding year. The use of multiple insulin injection therapy had increased from 71% to 98% (p<0.001) and the daily self-monitoring of blood glucose (SMBG) from 17% to 48% (p<0.001), between 1984 and 1998. An increasing number of patients reported unawareness of hypoglycemia, 54% vs. 40% (p<0.01), and nocturnal events were more frequent, 83% vs. 76% (p<0.05). The prevalence of SH had increased from 17% to 27% (p<0.05) and there was a slight decrease in HbA1c, 7.6% to 7.4% (p<0.05). In spite of the more frequent use of multiple injection therapy and more frequent SMBG, the prevalence of SH increased by more than 50% over 14 years, 1984 to 1998

Mjölmask Tenebrio molitor : en potentiell källa till matlipider

The yellow mealworm Tenebrio molitor is considered as a sustainable alternative to animal-derived source of protein. The population of the world increases and is believed to be over 9 billion by 2050, and the demand of protein will increase. Among edible insects, the mealworm is the one most commonly reared in Europe. After protein, the second largest part of the mealworm is lipids, which amounts to about 33% of dry matter. With this large amount of lipids, the mealworm could be a potential source of food lipids. In this work, the aim is to review the current knowledge about the lipid content and fatty acid composition in mealworms. The most common fatty acids in mealworms are palmitic acid, oleic acid and linoleic acid. The mealworm can synthesize both linoleic acid (LA) and alpha lino-lenic acid (ALA), which are essential fatty acids for humans. Ratios between poly-unsaturated fatty acids (PUFA) and saturated fatty acids (SFA) (PUFA/SFA) and ratios between n-6/n-3 are used as index of healthy diet. The PUFA/SFA ratio in the mealworm has been found to be within the recommended values. Mealworms are rich in unsaturated fatty acids (UFAs) (monounsaturated fatty acids and polyun-saturated fatty acids), but the ratio of n-6/n-3 varied greatly. It would be desirable with higher content of ALA (n-3) to get a better n-6/n-3 ratio. It has been shown that it is possible to manipulate the content of lipids and the composition of fatty acids in the mealworm through the feed. However, the composition of the feed and the content of the mealworms do not necessarily match, so there is a physiological regulation of the composition of FAs. Other conditions such as temperature, humid-ity and development stage are also factors that have an impact on the lipids and FAs. In the reviewed literature, the results vary and all conditions are not always known. The conclusion is that more research is needed before the mealworm can be promoted as a new source of food lipids. The reason could be that the meal-worm primarily has been highlighted as a source of protein, which may have over-shadowed the mealworm as a potential source of food lipids.Mjölmasken Tenebrio molitor framhålls som ett hållbart alternativ till animaliskt protein. När jordens befolkning ökar och antas vara över 9 miljarder år 2050 kommer efterfrågan på protein att öka. Bland ätbara insekter är mjölmasken den vanligaste som föds upp i Europa. Efter protein är den näst största delen av mjöl-masken lipider, som uppgår till cirka 33% torrsubstans. Med denna stora mängd lipider är mjölmasken intressant att utforska som en potentiell källa till mat lipider. Målet med detta arbete att granska den nuvarande kunskapen om lipidinnehåll och fettsyrasammansättning i mjölmask. De vanligaste fettsyrorna i mjölmaskar är palmitinsyra, oljesyra och linolsyra. Mjölmasken kan syntetisera både linolsyra (LA) och alfa-linolensyra (ALA), vilka är essentiella fettsyror för människan. För-hållandet mellan fleromättade fettsyror (PUFA) och mättade fettsyror (SFA) (PUFA/SFA) och förhållandet mellan n-6/n-3 används som index för hälsosam kost. PUFA/SFA-förhållandet i mjölmask har visat sig ligga inom de rekommende-rade värdena. Mjölmaskar är rika på omättade fettsyror (UFA) (enkelomättade fettsyror och fleromättade fettsyror). Förhållandet mellan n-6/n-3 har visat sig variera väldigt mycket. Det skulle vara önskvärt med ett högre innehåll av ALA (n-3) för att få ett bättre förhållande mellan n-6/n-3. Det har visat sig att det är möjligt att manipulera innehållet av lipider och sammansättningen av fettsyror i mjölmask genom fodret. Fodrets sammansättning och mjölmaskens innehåll följs däremot inte alltid åt. Således finns det en fysiologisk reglering av lipidinnehållet och fettsy-rornas sammansättning i mjölmasken. Förhållanden som temperatur, fuktighet och utvecklingsstadiet är också faktorer som påverkar sammansättningen av lipider och fettsyror. I den genomgångna litteraturen är resultaten varierande och alla förhållanden är inte alltid redogjorda för. Slutsatsen är att det behövs mer forsk-ning innan mjölmasken kan framhållas som en ny källa till mat lipider. Mjöl-masken har främst blivit uppmärksammad som en källa till protein, vilket kan ha överskuggat dess potential som källa till matlipider

Towards eco-efficient lean production systems

Lean Production has proved itself a worthwhile production strategy in many distinct industries across all regions of the planet by achieving higher levels of production efficiency. Several authors identified that Lean inadvertently has had significant environmental gains. Such achievements are considered of special relevance in a global and highly competitive economy which is progressively both tied-up and driven by an environmental agenda. The main goal of the present study is to enlighten the contribution of Lean for achieving a better environmental performance of production systems and identify this as an emergent business model for supporting eco-efficiency

Rate-limiting steps in bromide-free TEMPO-mediated oxidation of cellulose—Quantification of the N-Oxoammonium cation by iodometric titration and UV–vis spectroscopy

A iodometric titration method was introduced to study the conversion of 2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO) to the corresponding N-oxoammonium cation (TEMPO+) by hypochlorite in the absence and presence of bromide ion. The validity of the titration was verified with UV-vis spectroscopy combined with a multivariate curve resolution (MCR) algorithm to calculate the concentrations and spectral signatures of the pure components (i.e., TEMPO, Cl(+1) and TEMPO+). The formation of the oxoammonium cation was successfully followed during the activation of TEMPO by HOCl and HOBr. It was found that HOBr is a more effective activator for TEMPO than HOCl is. Moreover, the importance of a separate activation step for TEMPO with bromide-free TEMPO oxidations could be identified with this titration method. The content of TEMPO+ was also monitored during the TEMPO-mediated oxidation of a cellulosic pulp by hypochlorite in the absence and presence of bromide. It was found that the oxidation of the alcoholic groups by TEMPO+ was generally the rate-determining step and much slower than the regeneration of TEMPO+ through oxidation of the hydroxylamine by HOCl and HOBr. However, at high pH the latter reaction became rate-limiting.Peer reviewe