Toward Defining the Threshold Between Low and High Glucose Variability in Diabetes

International audienceOBJECTIVE:To define the threshold for excess glucose variability (GV), one of the main features of dysglycemia in diabetes.RESEARCH DESIGN AND METHODS:A total of 376 persons with diabetes investigated at the University Hospital of Montpellier (Montpellier, France) underwent continuous glucose monitoring. Participants with type 2 diabetes were divided into several groups-groups 1, 2a, 2b, and 3 (n = 82, 28, 65, and 79, respectively)-according to treatment: 1) diet and/or insulin sensitizers alone; 2) oral therapy including an insulinotropic agent, dipeptidyl peptidase 4 inhibitors (group 2a) or sulfonylureas (group 2b); or 3) insulin. Group 4 included 122 persons with type 1 diabetes. Percentage coefficient of variation for glucose (%CV = [(SD of glucose)/(mean glucose)] × 100) and frequencies of hypoglycemia (interstitial glucose 36% were compared with those with %CV ≤36%.CONCLUSIONS:A %CV of 36% appears to be a suitable threshold to distinguish between stable and unstable glycemia in diabetes because beyond this limit, the frequency of hypoglycemia is significantly increased, especially in insulin-treated subjects

Studying the Hurdles of Insulin Prescription (SHIP©): development, scoring and initial validation of a new self-administered questionnaire

<p>Abstract</p> <p>Background</p> <p>Although insulin therapy is well-accepted by symptomatic diabetic patients, it is still often delayed in less severe patients, in whom injectable insulin remains under-used. A better understanding of patients' perception of insulin would eventually help physicians to adopt the most appropriate dialogue when having to motivate patients to initiate or to intensify insulin injection.</p> <p>Methods</p> <p>The 'Studying the Hurdles of Insulin Prescription' (SHIP) questionnaire was developed based on a list of concepts derived from three diabetic patients' focus groups, and was included into two cross-sectional studies with similar design: SHIP Oral study and SHIP Premix study. Diabetic patients treated with oral hypoglycaemic agents (OHA; n = 1,494) and patients already treated with insulin (n = 1,150) completed the questionnaire at baseline, 6- and 12 months. Psychometric properties were assessed: 1) structure analysis by Principal Component Analysis (PCA) with Varimax rotation, 2) internal consistency reliability (Cronbach's alpha), and 3) concurrent validity (Spearman correlation coefficients with the Fear of Self-Injecting (FSI) score of the Diabetes Fear of Injecting and Self-testing Questionnaire. Reluctance/motivation towards insulin was assessed. Scores' ability to predict patients' insulin injection reluctance/motivation and initiation/intensification was evaluated with the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC).</p> <p>Results</p> <p>PCA analysis confirmed the structure of the 14 items grouped into 3 dimensions: 'acceptance and motivation', 'fear and constraints', and 'restraints and barriers' towards insulin injection. Internal consistency reliability was excellent (Cronbach's alpha > 0.70); concurrent validity was good. The three scores were significantly predictive of patients' reluctance/motivation towards insulin injection initiation, as they were of patients' actual switch, except for the 'restraints and barriers' dimension. 'Acceptance and motivation' and 'fears and constraints' dimensions were also significantly predictive of patients' reluctance/motivation towards insulin intensification. By the end of the 12-month study, 179 of the initially OHA-treated patients had started insulin injections; 186 of the patients already treated with insulin had increased their injections.</p> <p>Conclusion</p> <p>The SHIP questionnaire provides reliable and valid assessment of diabetic patients' attitude towards insulin and injections. The predictive power of scores for patients' reluctance/motivation and actual treatment decisions demonstrates encouraging potential for further application in clinical practice.</p

Morning hyperglycemic excursions. A constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes

WSTĘP. Celem pracy było ustalenie występowania w ciągu dnia epizodów hiperglikemii prowadzących do złej kontroli metabolicznej u chorych na cukrzycę typu 2. MATERIAŁ I METODY. Badana grupa liczyła 200 chorych na cukrzycę typu 2 leczonych lekami doustnymi i/lub dietą. W populacji tej badano profile dobowe glikemii i insulinemii. Pomiarów stężenia glukozy dokonywano na czczo bezpośrednio przed śniadaniem o 8.00 rano, następnie w okresie poposiłkowym o godz. 11.00 i 14.00) oraz w okresie poabsorpcyjnym o 17.00. WYNIKI. W całej populacji wartości glikemii przed obiadem (12,0 mmol/l) były znamiennie podwyższone (p < 0,0001) w porównaniu z glikemią mierzoną o godzinie 8.00 (8,8 mmol/l), 14.00 (10,5 mmol/l) i 17.00 (8,6 mmol/l). Podobny wzrost glikemii przedobiedniej (p < 0,0001) obserwowano w grupach chorych dobranych według kryteriów: 1) masy ciała; 2) wieku; 3) HbA1c; 4) sposobu leczenia; 5) rezydualnej funkcji komórek b. Z obliczeń pól pod krzywą dziennego przebiegu glikemii wynika, że w całkowitym podwyższeniu stężenia glukozy w surowicy względny udział glikemii na czczo i poposiłkowej jest zbliżony. WNIOSKI. Wysokie stężenia glukozy w surowicy w okresie przedpołudniowym są dość charakterystycznym wykładnikiem niepowodzenia leczenia cukrzycy typu 2 z zastosowaniem diety i leków doustnych. Hiperglikemie przedobiednie występują niezależnie od cech klinicznych (wskaźnik masy ciała [BMI, body mass index]), biologicznych (hemoglobina glikowana[HbA1c]), terapeutycznych i patofizjologicznych (rezydualna funkcja komórek b). W celu wykrycia takich zaburzeń powinno się zalecać dodatkowe pomiary glikemii przed obiadem. Przedpołudniowe hiperglikemie wymagają zmiany w leczeniu chorego.INTRODUCTION. To determine whether, over daytime, one or several hyperglycemic excursions exist that can be general failures in the glycemic control of patients with type 2 diabetes. MATERIAL AND METHODS. In 200 non-insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 A.M. immediately before breakfast), during the postprandial period (at 11:00 A.M. and 2:00 P.M.), and during the postabsorptive period (at 5:00 P.M., extended postlunch time). RESULTS. In the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 A.M. (8.8 mmol/l), at 2:00 P.M. (10.5 mmol/l), and at 5:00 P.M. (8.6 mmol/l). Similar significant excursions (P < < 0.0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight; 2) HbA1c; 3) categories of treatment and 4) residual &#946;-cell function. From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar. CONCLUSIONS. High plasma glucose excursions over morning periods seem to be a permanent failure in non&#8211;insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological (HbA1c), therapeutic, and pathophysiological (residual &#946;-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies

Measuring ocean surface velocities with the KuROS and KaRADOC airborne near-nadir Doppler radars: a multi-scale analysis in preparation of the SKIM mission, Submitted to Ocean SCience, July 2019

Surface currents are poorly known over most of the oceans. Satellite-borne Doppler Waves and Current Scatterom-eters (DWCS) can be used to fill this observation gap. The Sea surface KInematics Multiscale (SKIM) proposal, is the first satellite concept built on a DWCS design at near-nadir angles, and now one of the two candidates to become the 9th mission of the European Space Agency Earth Explorer program. As part of the detailed design and feasibility studies (phase A) funded by ESA, airborne measurements were carried out with both a Ku-Band and a Ka-Band Doppler radars looking at the sea surface at 5 near nadir-incidence in a real-aperture mode, i.e. in a geometry and mode similar to that of SKIM. The airborne radar KuROS was deployed to provide simultaneous measurements of the radar backscatter and Doppler velocity, in a side-looking configuration , with an horizontal resolution of about 5 to 10 m along the line of sight and integrated in the perpendicular direction over the real-aperture 3-dB footprint diameter (about 580 m). The KaRADOC system has a much narrower beam, with a circular footprint only 45 m in diameter. 10 The experiment took place in November 2018 off the French Atlantic coast, with sea states representative of the open ocean and a well known tide-dominated current regime. The data set is analyzed to explore the contribution of non-geophysical velocities to the measurement and how the geophysical part of the measured velocity combines wave-resolved and wave-averaged scales. We find that the measured Doppler velocity contains a characteristic wave phase speed, called here C 0 that is analogous to the Bragg phase speed of coastal High Frequency radars that use a grazing measurement geometry, with little 15 variations ∆ C associated to changes in sea state. The Ka-band measurements at an incidence of 12 • are 10% lower than the theoretical estimate C 0 2.4 m/s for typical oceanic conditions defined by a wind speed of 7 m/s and a significant wave height of 2 m. For Ku-band the measured data is 1 https://doi. 30% lower than the theoretical estimate 2.8 m/s. ∆ C is of the order of 0.2 m/s for a 1 m change in wave height, and cannot be confused with a 1 m/s change in tidal current. The actual measurement of the current velocity from an aircraft at 4 to 18 • incidence angle is, however, made difficult by uncertainties on the measurement geometry, which are much reduced in satellite measurements

Review of methods for detecting glycemic disorders

Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity

Branched-chain amino acid database integrated in MEDIPAD software as a tool for nutritional investigation of mediterranean populations

Branched-chained amino acids (BCAA) are essential dietary components for humans and can act as potential biomarkers for diabetes development. To efficiently estimate dietary intake, we developed a BCAA database for 1331 food items found in the French Centre d'Information sur la Qualité des Aliments (CIQUAL) food table by compiling BCAA content from international tables, published measurements, or by food similarity as well as by calculating 267 items from Greek, Turkish, Romanian, and Moroccan mixed dishes. The database embedded in MEDIPAD software capable of registering 24 h of dietary recalls (24HDR) with clinical and genetic data was evaluated based on archived 24HDR of the Saint Pierre Institute (France) from 2957 subjects, which indicated a BCAA content up to 4.2 g/100 g of food and differences among normal weight and obese subjects across BCAA quartiles. We also evaluated the database of 119 interviews of Romanians, Turkish and Albanians in Greece (27⁻65 years) during the MEDIGENE program, which indicated mean BCAA intake of 13.84 and 12.91 g/day in males and females, respectively, comparable to other studies. The MEDIPAD is user-friendly, multilingual, and secure software and with the BCAA database is suitable for conducting nutritional assessment in the Mediterranean area with particular facilities for food administration