A review of flash glucose monitoring in type 2 diabetes

Abstract Background Continuous glucose monitoring systems are increasingly being adopted as an alternative to self-monitoring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy. Main body The FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min. Swiping the reader device over the sensor retrieves stored data and displays current interstitial glucose levels, a glucose trend arrow, and a graph of glucose readings over the preceding 8 h. In patients with type 2 diabetes (T2D) receiving insulin therapy, pivotal efficacy data were provided by the 6-month REPLACE randomized controlled trial (RCT) and 6-month extension study. Compared to SMBG, the flash system significantly reduced the time spent in hypoglycemia and frequency of hypoglycemic events, although no significant change was observed in glycosylated hemoglobin (HbA1c) levels. Subsequent RCTs and real-world chart review studies have since shown that flash glucose monitoring significantly reduces HbA1c from baseline. Real-world studies in both type 1 diabetes or T2D populations also showed that flash glucose monitoring improved glycemic control. Higher (versus lower) scanning frequency was associated with significantly greater reductions in HbA1c and significant improvements in other measures such as time spent in hypoglycemia, time spent in hyperglycemia, and time in range. Additional benefits associated with flash glucose monitoring versus SMBG include reductions in acute diabetes events, all-cause hospitalizations and hospitalized ketoacidosis episodes; improved well-being and decreased disease burden; and greater treatment satisfaction. Conclusion T2D patients who use flash glucose monitoring might expect to achieve significant improvement in HbA1c and glycemic parameters and several associated benefits

Comparison of Risk Factors for Developing Liver Fibrosis in Subjects With and Without Metabolic Syndrome: A Cohort Study.

Background: Metabolic syndrome (MS), a combination of diabetes, high blood pressure and obesity, is a well-known risk factor for developing non-alcoholic fatty liver disease, condition that can lead to serious liver damage such as liver fibrosis (LF), which is characterized by excessive deposition of connective tissue, progressing to cirrhosis and hepatocellular carcinoma. Nevertheless, subjects without MS may also develop LF. Non-invasive LF predictors based upon anthropometric and biochemical data have been reported. Aim: To compare anthropometric, genetic, and biochemical parameters in subjects with or without MS, and at risk for developing liver fibrosis. Methods: A randomized sample of 200 individuals was taken from the 2015 Nuevo León State Health Survey. Inclusion criteria were age ≥18 and a previously stored blood sample. According to the parameters obtained, subjects were classified as either with or without MS and their NAFLD fibrosis score was calculated considering variables such as age, BMI, glycemia, albumin, platelets, and AST/ALT ratio, to establish a high or low risk of LF. Comparisons of weight, age, BMI, blood glucose, total cholesterol, triglycerides, platelets, albumin, AST/ALT ratio, and HDL were made between groups. DNA was extracted from stored blood samples and genotyped, using q-PCR, according to variants in four genes related to: fatty acid (FA) metabolism (PNPLA3, rs738409), adipocyte differentiation (PLIN2, rs35568725), glucose metabolism (GCKR, rs1260326 and rs780094), and BMI (UCP2, rs659366). Statistical analysis was performed with SPSS v.22. A p value <0.05 was taken as level of significance. Results: A total of 134 subjects were included and divided into four groups (n): With MS+ high risk (35), With MS+ low risk (34), Without MS+ high risk (32), Without MS+ low risk (33). Table 1 shows the main significative findings. Higher age, low platelet count, and increased AST/ALT ratio, were significantly different in high risk subjects, independently of the presence of MS. No association between the polymorphisms and risk for fibrosis was found. In subjects at high risk for LF, statistical significance was found for high cholesterol blood levels (OR= 20.0 (95%CI 2.87;139.38) in carriers of the T allele of GCKR rs780094 polymorphism. Conclusion: Aging, thrombocytopenia, and increased transaminases, the last two indicators of liver disfunction, were found as important risk factors for LF in subjects without metabolic syndrome. None of the genetic variants analyzed resulted associated to risk of LF, although sample size could be a factor. GCKR rs780094 variant was found related with risk for hypercholesterolemia, even though dyslipidemia was not found associated with risk of LF in the present study. &nbsp

Hyperglycemia related to high-dose glucocorticoid use in noncritically ill patients

Background: Glucocorticoids commonly cause drug-induced diabetes. This association is well recognized but available evidence does not answer clinically relevant issues in subjects without diabetes. Methods: Thirty-five individuals without diabetes with a recent diagnosis of acute lymphoblastic leukemia or nonHodgkin’s lymphoma on high-dose glucocorticoid therapy were studied. Close systematic monitoring of fasting and postprandial glycemia and fasting insulin determinations, HOMA-insulin resistance and HOMA β-cell function were performed. The primary objective was to define the incidence of secondary diabetes in patients treated with highdose glucocorticoids. Secondary objectives were to specify the intensity, the moment it appears and the evolution of hyperglycemia, in addition to the risk factors, mechanisms and impact of continuous and cyclical glucocorticoids on the development of hyperglycemia. Results: Mean age of patients was 38.4 ± 18.7 years. The incidence of diabetes was 40.6% and was found after the first week; half the time it occurred between the second and fourth. Two-thirds spontaneously normalized by eight weeks. Continuous glucocorticoid administration had a higher incidence of fasting hyperglycemia (P = 0.003). Mean peak insulin levels were significantly higher in cases of diabetes. Conclusions: High-dose prednisone for 2 to 3 months produced an elevated incidence of diabetes, usually with mild hyperglycemia occurring between the second and fourth week, normalizing spontaneously in all cases. Hyperglycemia was more frequent with continuous doses and occurred in cases with increased insulin resistance. The clinical and therapeutic characteristics of our participants, who were otherwise healthy, could represent the clinical setting of many patients with illness from other medical areas that might require high doses of GC for six to twelve weeks

Association of Patient Profile with Glycemic Control and Hypoglycemia with Insulin Glargine 300 U/mL in Type 2 Diabetes: A Post Hoc Patient-Level Meta-Analysis

ABSTRACT Aims: To examine the association of baseline patient characteristics with study outcomes in people with type 2 diabetes receiving insulin glargine 300 U/mL (Gla-300) versus glargine 100 U/mL (Gla-100), over a 6-month period. Methods: A post hoc patient-level metaanalysis using data from three multicenter, randomized, open-label, parallel-group, phase 3a studies of similar design, in people previously receiving either basal and prandial insulin, basal insulin ? oral antihyperglycemic drugs, or no prior insulin (EDITION 1, 2 and 3, respectively). The endpoints, glycated hemoglobin (HbA1c), hypoglycemia, body weight change, and insulin dose were investigated by subgroups: age (\65 and C 65 years), body mass index (BMI; \ 30 and C 30 kg/m2), age at onset (\40, 40–50, and [ 50 years), and diabetes duration (\ 10 and C 10 years). Results: Reduction in HbA1c was comparable between insulins, regardless of subgroup. The lower risk of C 1 nocturnal (00:00–05:59 h) confirmed (B 3.9 mmol/L [B 70 mg/dL]) or severe hypoglycemic event with Gla-300 versus Gla-100 was also unaffected by participant characteristics. While heterogeneity of treatment effect between diabetes duration subgroups was seen for the risk of C 1 confirmed (B 3.9 mmol/L [B 70 mg/dL]) or severe hypoglycemic event at any time (24 h), treatment effect consistently favored Gla-300; no evidence of heterogeneity was observed for the other subgroups. Annualized rates of confirmed (B 3.9 mmol/L [B 70 mg/dL]) or severe hypoglycemia and body weight change were not influenced by participant characteristics; a similar pattern was observed with insulin dose. Conclusions: Comparable glycemic control was observed with Gla-300 versus Gla-100, with less hypoglycemia, regardless of age, BMI, age at onset or diabetes duration. Funding: Sanofi. Plain Language Summary: Plain language summary available for this article. Keywords: Glycated Hemoglobin A; Hypoglycemia; Insulin Glargine; Type 2 Diabetes PLAIN LANGUAGE SUMMARY Treatments for patients with type 2 diabetes aim to reduce the levels of blood glucose and can include injections with insulin. However, care must be taken to prevent blood glucose levels falling too low (a state called hypoglycemia). Previous studies have shown that insulin glargine 300 units/mL (Gla-300) provides similar reductions in blood glucose levels as insulin glargine 100 units/mL (Gla-100) but is less likely to cause hypoglycemia. However, different patients may respond differently to treatments depending on their individual clinical and biological characteristics. The aim of this study was to evaluate how different profiles of patients with type 2 diabetes responded to Gla-300 and Gla-100 injections. Patients were grouped by different ages, weights, age at diabetes diagnosis, and number of years since diagnosis of diabetes. We found that Gla-300 and Gla-100 reduced glycated hemoglobin (HbA1c; a marker of blood glucose control over the previous 2–3 months) similarly, regardless of how patients were grouped. However, patients treated with Gla-300 were less likely to experience hypoglycemia than those treated with Gla-100, and this association was also true regardless of different patient characteristics. We therefore concluded that Gla-300 is an effective and safe treatment in patients with type 2 diabetes, regardless of their age, weight, age at diabetes diagnosis, and years since diagnosis

Aptitud de los alumnos de pregrado de la carrera de Medicina ante dos modelos de evaluación: El caso de Endocrinología.

Antecedentes: La Facultad de Medicina de la UANL inició en agosto del 2006 un nuevo plan de estudios y un modelo educativo basado en el aprendizaje y en la participación más intensa del alumno. Esta modificación en la estrategia de formar a los futuros médicos requiere ser evaluada científicamente con el propósito de medir si los cambios esperados con la implementación del plan de estudios y del modelo educativo, están ocurriendo. Objetivo: Comparar la aptitud de los alumnos del curso de pregrado de endocrinología ante dos métodos de evaluación. Método: Comparación de dos exámenes como proceso de evaluación ante dos planteamientos académicos: el actual (basado en la aplicación del conocimiento, casos clínicos) y el próximo anterior (basado en la memorización de conocimientos). Se contrastó la aptitud de los alumnos del nuevo plan de estudios (n = 74) vs. los alumnos del plan anterior (n = 137), ante el mismo examen. Resultados: Los alumnos del nuevo plan de estudios tuvieron una aptitud casi idéntica al ser evaluados con el examen actual y con el aplicado en ciclos anteriores (73.4 + 7.8 vs. 72.9 + 10.7, respectivamente) p = 0.2553. El porcentaje de aprobación fue de un 71 vs. 67%. Al comparar la aptitud de los alumnos del plan actual y el anterior ante un mismo examen, la aptitud fue muy favorable en el grupo de alumnos del nuevo plan de estudios (74.7 ± 10.7 vs. 56.0 ± 9.3), p< 0.0001. Conclusiones: La combinación de un modelo educativo centrado en el aprendizaje, en una acentuada participación del alumno en la clase, en una forma de evaluación que incentiva el estudiar la clase diaria y en la aplicación de exámenes dirigidos a evaluar la aplicación del conocimiento como en la vida real de un médico, son los aspectos que debemos fortalecer en el proceso de formación de nuestros futuros médicos

Prevalencia de diabetes tipo 2 e hipertensión arterial en adultos de nivel económico bajo de Monterrey, México

Antecedentes: la hiperglucemia es signo característico de un grupo enfermedades, la diabetes tipo 2 abarca del 90 al 95% de los casos, y provoca alta morbilidad, e incapacidad e incluso muerte prematura. Objetivo: determinar la prevalencia de diabetes mellitus tipo 2, prediabetes y la de HA en adultos en área urbana de bajo nivel económico en Monterrey, México. Método: estudio de corte transversal con selección aleatoria de adultos (hombres y mujeres no embarazadas ni lactando) en una comunidad de bajo nivel económico. Se obtuvo glucemia capilar y plasmática en ayuno y 2h-poscarga oral de 75 g glucosa. Diagnósticos según criterios del American Diabetes Association 2004. Se presenta prevalencia con intervalo de confianza (IC95%) y regresión múltiple en inferencia de factores. Resultados: la prevalencia de diabetes mellitus tipo 2 fue 14.1% (9.6-18.6%), prediabetes 12.8% (8.5-17.1) y de hipertensión arterial 26.24% (20.4-32.4%). La edad, el índice de masa corporal y género justifican 38% de la variación de la hipertensión arterial (r = 0.616, todas p < 0.001); pero sólo 5% (r = 0.23) de la variación glucémica fue explicado por la edad (p < 0.01) y el índice de masa corporal (p < 0.05). Conclusiones: la prevalencia de hipertensión arterial fue la esperada, pero la de diabetes mellitus 2 sugiere ser más alta que en reportes previos. En esta población la adiposidad no justifica la alta prevalencia de diabetes mellitus 2, ni de prediabetes. ABSTRACT Background: Hyperglycemia is a characteristic sign of several diseases. In the case of type 2 diabetes, it has an effect on 90 to 95% of the patients. It produces a high morbidity, incapacity and even death. Objective: To determine the prevalence of type 2 diabetes mellitus, pre-diabetes and hypertension in a low-income urban area in Monterrey, Mexico. Method: A random, cross-sectional study was done in a low-income urban population in Monterrey, Mexico. Patients who had participated in a baseline glycemic study from 1992 to 1993 were re-examined. The concentration of capillary and plasmatic glucose on fasting and two hour post-load oral glucose (75 g) were determined. The diagnoses were established following the criteria of the American Diabetes Association 2004. Multiple regression analyses were done to infer the factors related with glycemia; the confidence interval was 95%. Results: The type 2 diabetes mellitus prevalence was 14.1%, pre-diabetes 12.8% and the one for hypertension was 26.24%. Age, body mass index and gender prognosticated in an independent manner the values of hypertension (p < 0.001). Glycemia was prognosticated based on age (p < 0.01) and body mass index (p < 0.05). Conclusions: Prevalence of type 2 diabetes was higher in low-income adult patients, but hypertension prevalence remained within normal parameters. In this population, the body mass index did not justify the high prevalence of type 2 diabetes nor that of pre-diabetes

The effect of concomitant DPPIVi use on glycaemic control and hypoglycaemia with insulin glargine 300 U/mL (Gla-300) versus insulin glargine 100 U/mL (Gla-100) in people with type 2 diabetes: A patient-level meta-analysis of EDITION 2 and 3

Abstract Aims To evaluate the effect of concomitant dipeptidyl peptidase IV inhibitor (DPPIVi) use on efficacy and safety of insulin glargine 300 U/mL (Gla-300) versus glargine 100 U/mL (Gla-100) in people with type 2 diabetes on oral antihyperglycaemic drugs. Methods A post hoc patient-level meta-analysis was performed using data from EDITION 2 (basal insulin [N = 811]) and EDITION 3 (insulin-naïve [N = 878]), multicentre, randomised, openlabel, parallel-group, phase 3a trials of similar design. Endpoints analysed included HbA1c, hypoglycaemia and adverse events, investigated in subgroups of participants with and without concomitant DPPIVi use. Results Of 1689 participants randomised, 107 (13%, Gla-300) and 133 (16%, Gla-100) received DPPIVi therapy. The least squares mean change in HbA1c (baseline to month 6) was comparable between treatment groups, irrespective of DPPIVi use (no evidence of heterogeneity of treatment effect across subgroups, p = 0.753), although group sizes were unbalanced. The cumulative mean number of confirmed (≤3.9 mmol/L [≤70 mg/dL]) or severe hypoglycaemic events, and the risk and annualised rate of such events, were consistently lower for Gla-300 than Gla-100 during the night (between 00:00 and 05:59 h) or at any time of day (24 h period), irrespective of DPPIVi use. Severe hypoglycaemia occurred in 8/838 and 10/844 participants in the Gla-300 and Gla-100 groups, respectively, and was not affected by DPPIVi use. The adverse event profile was similar between treatment groups and DPPIVi subgroups. Conclusions Glycaemic control with Gla-300 was comparable to Gla-100, with less hypoglycaemia during the night and at any time of day (24 h), irrespective of concomitant DPPIVi use

Ovarian and Adrenal Androgens and Their Link to High Human Chorionic Gonadotropin Levels: A Prospective Controlled Study

Background. Although the association between human chorionic gonadotropin (hCG) and hyperandrogenism was identified more than 40 years ago, relevant questions remain unanswered. Design and Methods. We conducted a prospective, longitudinal, and controlled study in 23 women with a diagnosis of a complete hydatidiform mole (HM). Results. All participants completed the study. Before HM evacuation mean hCG was markedly higher in the cases than in the control group (P≤0.001). Free testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) were found to be higher in the cases (2.78 ± 1.24 pg/mL and 231.50 ± 127.20 μ/dL) when compared to the control group (1.50 ± 0.75 pg/mL and 133.59 ± 60.69 μ/dL) (P=0.0001 and 0.001), respectively. There was a strong correlation between hCG and free T/total T/DHEA-S concentrations (r=0.78; P≤0.001, r=0.74;  P≤0.001, and r=0.71;  P≤0.001), respectively. In the cases group 48 hours after HM evacuation, hCG levels were found to be significantly lower when compared to initial levels (P=0.001) and free T and DHEA-S declined significantly (P=0.0002 and 0.009). Conclusion. Before uterus evacuation, hCG, free T, and DHEA-S levels were significantly higher when compared with controls finding a strong correlation between hCG and free T/DHEA-S levels. Forty-eight hours after HM treatment hCG levels declined and the difference was lost. A novel finding of our study is that in cases, besides free T, DHEA-S was also found to be significantly higher and both the ovaries and adrenal glands appear to be the sites of this androgen overproduction

Hepatogenous diabetes: Is it a neglected condition in chronic liver disease?

Diabetes mellitus (DM) that occurs because of chronic liver disease (CLD) is known as hepatogenous diabetes (HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus (HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease

Glycaemic benefit of iGlarLixi in insulin-naive type 2 diabetes patients with high HbA1c or those with inadequate glycaemic control on two oral antihyperglycaemic drugs in the LixiLan-O randomized trial

In this post hoc analysis of the randomized controlled LixiLan‐O trial in insulin‐naive type 2 diabetes mellitus (T2DM) patients not controlled on metformin with or without a second oral antihyperglycaemic drug (OAD), the efficacy and safety of the fixed‐ratio combination, iGlarLixi (insulin glargine 100 U [iGlar] and lixisenatide [Lixi]), compared to its individual components was assessed in two patient subgroups: (1) a baseline HbA1c ≥9% (n = 134); (2) inadequate control (HbA1c ≥7.0% and ≤9.0%) despite administration of two OADs at screening (n = 725). Treatment with iGlarLixi resulted in a significantly greater reduction in least squares mean HbA1c compared with iGlar or Lixi alone in both subgroups (HbA1c ≥9% group: 2.9%, 2.5%, 1.7%; two OADs group: 1.5%, 1.2%, 0.7%, respectively). Target HbA1c 70% of patients on iGlarLixi in both subgroups, while mitigating the weight gain observed with iGlar alone. Rates of hypoglycaemic events were low overall. These results suggest that iGlarLixi achieves superior glycaemic control compared with iGlar or Lixi alone in T2DM patients with HbA1c ≥9% or those inadequately controlled on two OADs