Medicine › Endocrinology, Diabetes and Metabolism

Hyperglycemia and glycemic control in critically ill and hospitalized patients

Works Count: 37879

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This cluster of papers explores the impact of hyperglycemia, the use of intensive insulin therapy, and glycemic control on health outcomes in critically ill and surgical patients, with a focus on infection risk, mortality, and the inflammatory response. It also investigates the association between hyperglycemia and various medical conditions such as myocardial infarction, stroke, and traumatic brain injury.

Keywords

Hyperglycemia; Insulin Therapy; Critical Care; Infection Risk; Glycemic Control; Mortality; Diabetes Mellitus; Intensive Care Unit; Surgical Patients; Inflammatory Response

Hypoglycemia and Risk of Death in Critically Ill Patients

2012-09-19

Simon Finfer , Bette Liu , Dean R. Chittock +7 more

Whether hypoglycemia leads to death in critically ill patients is unclear.We examined the associations between moderate and severe hypoglycemia (blood glucose, 41 to 70 mg per deciliter [2.3 to 3.9 … Whether hypoglycemia leads to death in critically ill patients is unclear.We examined the associations between moderate and severe hypoglycemia (blood glucose, 41 to 70 mg per deciliter [2.3 to 3.9 mmol per liter] and ≤40 mg per deciliter [2.2 mmol per liter], respectively) and death among 6026 critically ill patients in intensive care units (ICUs). Patients were randomly assigned to intensive or conventional glucose control. We used Cox regression analysis with adjustment for treatment assignment and for baseline and postrandomization covariates.Follow-up data were available for 6026 patients: 2714 (45.0%) had moderate hypoglycemia, 2237 of whom (82.4%) were in the intensive-control group (i.e., 74.2% of the 3013 patients in the group), and 223 patients (3.7%) had severe hypoglycemia, 208 of whom (93.3%) were in the intensive-control group (i.e., 6.9% of the patients in this group). Of the 3089 patients who did not have hypoglycemia, 726 (23.5%) died, as compared with 774 of the 2714 with moderate hypoglycemia (28.5%) and 79 of the 223 with severe hypoglycemia (35.4%). The adjusted hazard ratios for death among patients with moderate or severe hypoglycemia, as compared with those without hypoglycemia, were 1.41 (95% confidence interval [CI], 1.21 to 1.62; P<0.001) and 2.10 (95% CI, 1.59 to 2.77; P<0.001), respectively. The association with death was increased among patients who had moderate hypoglycemia on more than 1 day (>1 day vs. 1 day, P=0.01), those who died from distributive (vasodilated) shock (P<0.001), and those who had severe hypoglycemia in the absence of insulin treatment (hazard ratio, 3.84; 95% CI, 2.37 to 6.23; P<0.001).In critically ill patients, intensive glucose control leads to moderate and severe hypoglycemia, both of which are associated with an increased risk of death. The association exhibits a dose-response relationship and is strongest for death from distributive shock. However, these data cannot prove a causal relationship. (Funded by the Australian National Health and Medical Research Council and others; NICE-SUGAR ClinicalTrials.gov number, NCT00220987.).

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Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus

1997-05-24

K. Malmberg

<h3>Abstract</h3> Objectives: To test the hypothesis that intensive metabolic treatment with insulin-glucose infusion followed by multidose insulin treatment in patients with diabetes mellitus and acute myocardial infarction improves the prognosis. … <h3>Abstract</h3> Objectives: To test the hypothesis that intensive metabolic treatment with insulin-glucose infusion followed by multidose insulin treatment in patients with diabetes mellitus and acute myocardial infarction improves the prognosis. Design: Patients with diabetes mellitus and acute myocardial infarction were randomly allocated standard treatment plus insulin-glucose infusion for at least 24 hours followed by multidose insulin treatment or standard treatment (controls). Subjects: 620 patients were recruited, of whom 306 received intensive insulin treatment and 314 served as controls. Main outcome measure: Long term all cause mortality. Results: The mean (range) follow up was 3.4 (1.6-5.6) years. There were 102 (33%) deaths in the treatment group compared with 138 (44%) deaths in the control group (relative risk (95% confidence interval) 0.72 (0.55 to 0.92); P=0.011).The effect was most pronounced among the predefined group that included 272 patients without previous insulin treatment and at a low cardiovascular risk (0.49 (0.30 to 0.80); P=0.004). Conclusion: Insulin-glucose infusion followed by intensive subcutaneous insulin in diabetic patients with acute myocardial infarction improves long term survival, and the effect seen at one year continues for at least 3.5 years, with an absolute reduction in mortality of 11%. This means that one life was saved for nine treated patients. The effect was most apparent in patients who had not previously received insulin treatment and who were at a low cardiovascular risk. <h3>Key messages</h3> Diabetes mellitus is common among patients with acute myocardial infarction Diabetic patients with myocardial infarction have a poor short and long term prognosis Poor metabolic control is common among diabetic patients with myocardial infarction Improved metabolic control by means of acute insulin-glucose infusion followed by long term intensive insulin treatment improves long term prognosis among these patients

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Effects of Glucagon-Like Peptide-1 in Patients With Acute Myocardial Infarction and Left Ventricular Dysfunction After Successful Reperfusion

2004-02-24

Lazaros A. Nikolaidis , Sunil Mankad , George Sokos +4 more

Background— Glucose-insulin-potassium infusions are beneficial in uncomplicated patients with acute myocardial infarction (AMI) but are of unproven efficacy in AMI with left ventricular (LV) dysfunction because of volume requirements associated … Background— Glucose-insulin-potassium infusions are beneficial in uncomplicated patients with acute myocardial infarction (AMI) but are of unproven efficacy in AMI with left ventricular (LV) dysfunction because of volume requirements associated with glucose infusion. Glucagon-like peptide-1 (GLP-1) is a naturally occurring incretin with both insulinotropic and insulinomimetic properties that stimulate glucose uptake without the requirements for concomitant glucose infusion. Methods and Results— We investigated the safety and efficacy of a 72-hour infusion of GLP-1 (1.5 pmol/kg per minute) added to background therapy in 10 patients with AMI and LV ejection fraction (EF) <40% after successful primary angioplasty compared with 11 control patients. Echocardiograms were obtained after reperfusion and after the completion of the GLP-1 infusion. Baseline demographics and background therapy were similar, and both groups had severe LV dysfunction at baseline (LVEF=29±2%). GLP-1 significantly improved LVEF (from 29±2% to 39±2%, P <0.01), global wall motion score indexes (1.94±0.11→1.63±0.09, P <0.01), and regional wall motion score indexes (2.53±0.08→2.02±0.11, P <0.01) compared with control subjects. The benefits of GLP-1 were independent of AMI location or history of diabetes. GLP-1 was well tolerated, with only transient gastrointestinal effects. Conclusions— When added to standard therapy, GLP-1 infusion improved regional and global LV function in patients with AMI and severe systolic dysfunction after successful primary angioplasty.

Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes

2002-03-01

Guillermo E. Umpierrez , Scott Isaacs , Niloofar Bazargan +3 more

Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with … Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate (16%) compared with those patients with a prior history of diabetes (3%) and subjects with normoglycemia (1.7%; both P < 0.01). In addition, new hyperglycemic patients had a longer length of hospital stay, a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to a transitional care unit or nursing home facility. Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia.

Intensive Insulin Therapy in Critically Ill Patients

2001-11-08

Greet Van den Berghe , Pieter Wouters , Frank Weekers +7 more

Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the … Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known.

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Variability of Blood Glucose Concentration and Short-term Mortality in Critically Ill Patients

2006-07-25

Moritoki Egi , Rinaldo Bellomo , Edward Stachowski +2 more

Background Intensive insulin therapy may reduce mortality and morbidity in selected surgical patients. Intensive insulin therapy also reduced the SD of blood glucose concentration, an accepted measure of variability. There … Background Intensive insulin therapy may reduce mortality and morbidity in selected surgical patients. Intensive insulin therapy also reduced the SD of blood glucose concentration, an accepted measure of variability. There is no information on the possible significance of variability in glucose concentration. Methods The methods included extraction of blood glucose values from electronically stored biochemical databases and of data on patient's characteristics, clinical features, and outcome from electronically stored prospectively collected patient databases; calculation of SD of glucose as a marker of variability and of several indices of glucose control in each patient; and statistical assessment of the relation between these variables and intensive care unit mortality. Results There were 168,337 blood glucose measurements in the study cohort of 7,049 critically ill patients (4.2 hourly measurements on average). The mean +/- SD of blood glucose concentration was 1.7 +/- 1.3 mM in survivors and 2.3 +/- 1.6 mM in nonsurvivors (P &lt; 0.001). Using multiple variable logistic regression analysis, both mean and SD of blood glucose were significantly associated with intensive care unit mortality (P &lt; 0.001; odds ratios [per 1 mM] 1.23 and 1.27, respectively) and hospital mortality (P &lt; 0.001 and P = 0.013; odds ratios [per 1 mM] 1.21 and 1.18, respectively). Conclusions The SD of glucose concentration is a significant independent predictor of intensive care unit and hospital mortality. Decreasing the variability of blood glucose concentration might be an important aspect of glucose management.

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Mutations in the Sulfonylurea Receptor Gene in Familial Persistent Hyperinsulinemic Hypoglycemia of Infancy

1995-04-21

Pamela M. Thomas , Gilbert J. Cote , Nelson Wohllk +6 more

Familial persistent hyperinsulinemic hypoglycemia of infancy (PHHI), an autosomal recessive disorder characterized by unregulated insulin secretion, is linked to chromosome 11p14-15.1. The newly cloned high-affinity sulfonylurea receptor ( SUR ) … Familial persistent hyperinsulinemic hypoglycemia of infancy (PHHI), an autosomal recessive disorder characterized by unregulated insulin secretion, is linked to chromosome 11p14-15.1. The newly cloned high-affinity sulfonylurea receptor ( SUR ) gene, a regulator of insulin secretion, was mapped to 11p15.1 by means of fluorescence in situ hybridization. Two separate SUR gene splice site mutations, which segregated with disease phenotype, were identified in affected individuals from nine different families. Both mutations resulted in aberrant processing of the RNA sequence and disruption of the putative second nucleotide binding domain of the SUR protein. Abnormal insulin secretion in PHHI appears to be caused by mutations in the SUR gene.

Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study

2002-06-01

Anna Norhammar , Åke Tenerz , Göran Nilsson +4 more

Stress-Induced Hyperglycemia

2001-01-01

Karen C. McCowen , Atul Malhotra , Bruce R. Bistrian

Severe hypoglycemia in critically ill patients: Risk factors and outcomes*

2007-10-01

James S. Krinsley , Aarti Grover

To determine the risk factors for development of severe hypoglycemia (defined as glucose <40 mg/dL) in critically ill patients and define the outcomes of this complication.Retrospective database review, including a … To determine the risk factors for development of severe hypoglycemia (defined as glucose <40 mg/dL) in critically ill patients and define the outcomes of this complication.Retrospective database review, including a case-control analysis that matched each patient with severe hypoglycemia with three controls.Adult intensive care unit of a university-affiliated community hospital.A total of 102 patients with at least one episode of severe hypoglycemia extracted from a series of 5,365 medical, surgical, and cardiac patients admitted consecutively between October 1, 1999, and June 15, 2006.A program of intensive glycemic monitoring and management, or tight glycemic control, was implemented on February 1, 2003; 2,666 patients were treated before and 2,699 after this date.Multivariable logistic regression analysis identified diabetes, septic shock, renal insufficiency, mechanical ventilation, severity of illness, reflected by Acute Physiology and Chronic Health Evaluation II score with the age component deleted, and treatment in the tight glycemic control period as independent risk factors for the development of severe hypoglycemia. Mortality was 55.9% among the 102 patients with severe hypoglycemia and 39.5% among the 306 controls (p = .0057). Multivariable logistic regression analysis identified severe hypoglycemia as an independent predictor of mortality for the entire cohort (odds ratio, 2.28; 95% confidence interval, 1.41-3.70; p = .0008). Among patients with severe hypoglycemia, only modified Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation were identified as independent predictors of mortality. A sensitivity analysis was constructed that suggested that quadrupling the rate of severe hypoglycemia and doubling the mortality attributable to severe hypoglycemia would negate the survival benefit of tight glycemic control in this series.Case-control methodology and multivariable logistic regression analysis concurred that even a single episode of severe hypoglycemia was independently associated with increased risk of mortality. Safe implementation of tight glycemic control requires appropriate monitoring to reduce the risk of this complication.

Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS

2006-05-26

Jin‐Kui Yang , Yun-Zhi Feng , Min Yuan +7 more

Abstract Aims To investigate the relationships between a known history of diabetes and ambient fasting plasma glucose (FPG) levels with death and morbidity rates in patients with severe acute respiratory … Abstract Aims To investigate the relationships between a known history of diabetes and ambient fasting plasma glucose (FPG) levels with death and morbidity rates in patients with severe acute respiratory syndrome (SARS). Methods In this retrospective analysis, the clinical and biochemical characteristics of 135 patients who had died from SARS, 385 survivors of SARS and 19 patients with non‐SARS pneumonia were compared. Results All patients were treated according to a predefined protocol. Before steroid treatment, the mean FPG level was significantly higher in the SARS group (deceased vs. survivors vs. non‐SARS pneumonia group: 9.7 ± 5.2 vs. 6.5 ± 3.0 vs. 5.1 ± 1.0 mmol/l, P < 0.01). In the SARS group, the percentage of patients with a known history of diabetes was significantly higher in the deceased patients than in the survivors (21.5% vs. 3.9%, P < 0.01). Among patients with no known history of diabetes and before commencement of steroid therapy, those who had hypoxaemia (SaO 2 < 93%) had higher FPG levels than those who did not have hypoxia in both the survivor (8.7 ± 4.9 vs. 6.3 ± 2.1 mmol/l, P < 0.001) and deceased (9.8 ± 4.8 vs. 7.2 ± 1.5 mmol/l, P < 0.001) groups. A known history of diabetes [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.4, 6.3; P = 0.005] and FPG ≥ 7.0 mmol/l before steroid treatment (OR 3.3, 95% CI 1.4, 7.7, P = 0.006) were independent predictors of death. During the course of the illness, FPG levels were negatively associated with SaO 2 (β =−0.682 ± 0.305, P = 0.025, general estimation equation model) in SARS patients. Survival analysis showed that FPG was independently associated with an increased hazard ratio (HR) of mortality (HR = 1.1, 95% CI 1.0, 1.1, P = 0.001) and hypoxia (HR = 1.1, 95% CI 1.0, 1.1, P = 0.002) after controlling for age and gender. Conclusions A known history of diabetes and ambient hyperglycaemia were independent predictors for death and morbidity in SARS patients. Metabolic control may improve the prognosis of SARS patients.

Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events

2004-03-09

Harold L. Lazar , Stuart R. Chipkin , Carmel Fitzgerald +3 more

This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes.One hundred forty-one diabetic … This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes.One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose <250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138+/-4 versus 260+/-6 mg/dL; P<0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%; P=0.0017), and a shorter postoperative length of stay (6.5+/-0.1 versus 9.2+/-0.3 days; P=0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (P=0.04) and decreased episodes of recurrent ischemia (5% versus 19%; P=0.01) and developed fewer recurrent wound infections (1% versus 10%, P=0.03).Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.

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Glycemic variability: A strong independent predictor of mortality in critically ill patients*

2008-10-21

James S. Krinsley

To determine the effect of glycemic variability, assessed by the standard deviation of each patient's mean glucose level, on mortality in a population of critically ill adult patients.Retrospective review of … To determine the effect of glycemic variability, assessed by the standard deviation of each patient's mean glucose level, on mortality in a population of critically ill adult patients.Retrospective review of a large cohort of prospectively evaluated patients.Fourteen-bed medical surgical adult intensive care unit of a university affiliated community hospital.Three thousand two hundred fifty-two patients consecutively admitted between October 1999 and October 2007 with at least three venous glucose samples.None.The mean (sd) Acute Physiology and Chronic Health Evaluation II score of the 3252 patients was 20.0 (8.9) and their mortality was 24.4%, ranging from 18.1% among patients with mean glucose level 70 mg/dL to 99 mg/dL to 35.9% among patients with mean glucose level 180+ mg/dL. The relationship between glycemic variability and mortality was strongest in the euglycemic range. For the 410 patients with mean glucose level 70 mg/dL to 99 mg/dL, mortality ranged from 5.9% in the first quartile of glycemic variability to 30.1% in the fourth; for the 1031 patients with mean glucose level 100 mg/dL to 119 mg/dL the corresponding range was 9.7% to 31.0%. Mortality among patients in the entire cohort with the lowest quartile of glycemic variability was 12.1%, increasing to 19.9%, 27.7%, and 37.8% in the second, third, and fourth quartiles. Intensive care unit length of stay was shorter among patients in the first quartile compared with those in the other three (p < .001).This study demonstrates that increasing glycemic variability conferred a strong independent risk of mortality in this heterogeneous population of critically ill patients. Previously published interventional studies of glycemic control may be reinterpreted using the metric of glycemic variability. Measures to ensure a low degree of glycemic variability may improve outcomes in intensive care unit's implementing glycemic control. Finally, ongoing and future investigations should consider including this new metric in their study design.

Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia.

1988-11-19

Alan Lucas , Ruth Morley , Tim Cole

There has been considerable debate over whether asymptomatic neonatal hypoglycaemia results in neurological damage. In a detailed multicentre study of 661 preterm infants hypoglycaemia was found to be common. Moderate … There has been considerable debate over whether asymptomatic neonatal hypoglycaemia results in neurological damage. In a detailed multicentre study of 661 preterm infants hypoglycaemia was found to be common. Moderate hypoglycaemia (plasma glucose concentration less than 2.6 mmol/l) occurred in 433 of the infants and in 104 was found on three to 30 separate days. There was considerable variation among the centres, implying differences in decisions to intervene. The number of days on which moderate hypoglycaemia occurred was strongly related to reduced mental and motor development scores at 18 months (corrected age), even after adjustment for a wide range of factors known to influence development. When hypoglycaemia was recorded on five or more separate days adjusted mental and motor developmental scores at 18 months (corrected age) were significantly reduced by 14 and 13 points respectively, and the incidence of neurodevelopmental impairment (cerebral palsy or developmental delay) was increased by a factor of 3.5 (95% confidence interval 1.3 to 9.4). These data suggest that, contrary to general belief, moderate hypoglycaemia may have serious neurodevelopmental consequences, and reappraisal of current management is urgently required.

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Early Postoperative Glucose Control Predicts Nosocomial Infection Rate in Diabetic Patients

1998-03-01

James J. Pomposelli , John Baxter , Timothy J. Babineau +4 more

Objectives: To determine the relationship between perioperative glucose control and postoperative nosocomial infection rate in 100 consecutive diabetic patients undergoing elective surgery. Design and Patients: One hundred initially uninfected diabetic … Objectives: To determine the relationship between perioperative glucose control and postoperative nosocomial infection rate in 100 consecutive diabetic patients undergoing elective surgery. Design and Patients: One hundred initially uninfected diabetic patients undergoing elective surgery were prospectively monitored for perioperative glucose control and postoperative nosocomial infection rate. Glucose control was determined by the attending surgeon or diabetologist. Setting: A large tertiary care hospital that serves as the in‐patient facility for a local diabetes center. Main Outcome Measures: All patients were screened for infection preoperatively. Only initially uninfected patients were enrolled, and all patients received perioperative antibiotic coverage. Perioperative glucose control and postoperative nosocomial infection rate were monitored prospectively. APACHE II scores were determined on all patients. Patients were stratified into two groups: those with relatively “good” perioperative glucose control (all values ≤220 mg/dL) and those with “poor” control (at least one value >220 mg/dL). Contingency tables were generated, comparing nosocomial infection rates vs perioperative glucose control. Correlation coefficients between APACHE II score and maximum and mean glucose values were also determined. Results: A serum glucose >220 mg/dL on postoperative day one (POD 1) was a sensitive (87.5%) but relatively nonspecific (33.3%) predictor of the later development of postoperative nosocomial infection. In patients with hyperglycemia (>220 mg/dL) on POD 1, the infection rate was 2.7 times that observed (31.3% vs 11.5%) in diabetic patients with all serum glucose values <220 mg/dL. When minor infection of the urinary tract was excluded, the relative risk for “serious” postoperative infection increased to 5.7 when any POD 1 blood glucose level was >220 mg/dL. On the basis of correlation coefficients between serum glucose values and APACHE II score, only 18% of the variance in the highest serum glucose could be explained by disease severity alone. Conclusions: We conclude that diabetic patients undergoing major cardiovascular or abdominal surgery have an increased risk of infection that is further exacerbated by early postoperative hyperglycemia. The high rate of nosocomial infection observed in diabetic patients with poor glucose control suggests that hyperglycemia itself may be an independent risk factor for the development of infection. Efforts to improve perioperative glucose homeostasis in diabetic patients may reduce the incidence of nosocomial infection and thereby improve outcome. (Journal of Parenteral and Enteral Nutrition 22: 77–81, 1998)

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Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting

2003-05-01

Anthony P. Furnary , Guangqiang Gao , Gary L. Grunkemeier +5 more

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Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery)

2011-01-13

Guillermo E. Umpierrez , Dawn Smiley , Sol Jacobs +7 more

The optimal treatment of hyperglycemia in general surgical patients with type 2 diabetes mellitus is not known.This randomized multicenter trial compared the safety and efficacy of a basal-bolus insulin regimen … The optimal treatment of hyperglycemia in general surgical patients with type 2 diabetes mellitus is not known.This randomized multicenter trial compared the safety and efficacy of a basal-bolus insulin regimen with glargine once daily and glulisine before meals (n = 104) to sliding scale regular insulin (SSI) four times daily (n = 107) in patients with type 2 diabetes mellitus undergoing general surgery. Outcomes included differences in daily blood glucose (BG) and a composite of postoperative complications including wound infection, pneumonia, bacteremia, and respiratory and acute renal failure.The mean daily glucose concentration after the 1st day of basal-bolus insulin and SSI was 145 ± 32 mg/dL and 172 ± 47 mg/dL, respectively (P < 0.01). Glucose readings <140 mg/dL were recorded in 55% of patients in basal-bolus and 31% in the SSI group (P < 0.001). There were reductions with basal-bolus as compared with SSI in the composite outcome [24.3 and 8.6%; odds ratio 3.39 (95% CI 1.50-7.65); P = 0.003]. Glucose <70 mg/dL was reported in 23.1% of patients in the basal-bolus group and 4.7% in the SSI group (P < 0.001), but there were no significant differences in the frequency of BG <40 mg/dL between groups (P = 0.057).Basal-bolus treatment with glargine once daily plus glulisine before meals improved glycemic control and reduced hospital complications compared with SSI in general surgery patients. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the hospital management of general surgery patients with type 2 diabetes.

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Postnatal Glucose Homeostasis in Late-Preterm and Term Infants

2011-03-01

David H. Adamkin

This report provides a practical guide and algorithm for the screening and subsequent management of neonatal hypoglycemia. Current evidence does not support a specific concentration of glucose that can discriminate … This report provides a practical guide and algorithm for the screening and subsequent management of neonatal hypoglycemia. Current evidence does not support a specific concentration of glucose that can discriminate normal from abnormal or can potentially result in acute or chronic irreversible neurologic damage. Early identification of the at-risk infant and institution of prophylactic measures to prevent neonatal hypoglycemia are recommended as a pragmatic approach despite the absence of a consistent definition of hypoglycemia in the literature.

Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview

2000-03-01

Sarah E. Capes , Dereck Hunt , Klas Malmberg +1 more

Intensive Insulin Therapy in the Medical ICU

2006-02-02

Greet Van den Berghe , Alexander Wilmer , Greet Hermans +6 more

Intensive insulin therapy reduces morbidity and mortality in patients in surgical intensive care units (ICUs), but its role in patients in medical ICUs is unknown. Intensive insulin therapy reduces morbidity and mortality in patients in surgical intensive care units (ICUs), but its role in patients in medical ICUs is unknown.

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Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity

2005-02-23

K. Malmberg , Lars Rydén , Hans Wedel +7 more

Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. In the first DIGAMI study, an insulin-based glucose management improved survival. In DIGAMI 2, three treatment strategies were … Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. In the first DIGAMI study, an insulin-based glucose management improved survival. In DIGAMI 2, three treatment strategies were compared: group 1, acute insulin-glucose infusion followed by insulin-based long-term glucose control; group 2, insulin-glucose infusion followed by standard glucose control; and group 3, routine metabolic management according to local practice.DIGAMI 2 recruited 1253 patients (mean age 68 years; 67% males) with type 2 diabetes and suspected acute myocardial infarction randomly assigned to groups 1 (n=474), 2 (n=473), and 3 (n=306). The primary endpoint was all-cause mortality between groups 1 and 2, and a difference was hypothesized as the primary objective. The secondary objective was to compare total mortality between groups 2 and 3, whereas morbidity differences served as tertiary objectives. The median study duration was 2.1 (interquartile range 1.03-3.00) years. At randomization, HbA1c was 7.2, 7.3, and 7.3% in groups 1, 2, and 3, respectively, whereas blood glucose was 12.8, 12.5, and 12.9 mmol/L, respectively. Blood glucose was significantly reduced after 24 h in all groups, more in groups 1 and 2 (9.1 and 9.1 mmol/L) receiving insulin-glucose infusion than in group 3 (10.0 mmol/L). Long-term glucose-lowering treatment differed between groups with multidose insulin (> or =3 doses/day) given to 15 and 13% of patients in groups 2 and 3, respectively compared with 42% in group 1 at hospital discharge. By the end of follow-up, HbA1c did not differ significantly among groups 1-3 ( approximately 6.8%). The corresponding values for fasting blood glucose were 8.0, 8.3, and 8.6 mmol/L. Hence, the target fasting blood glucose for patients in group 1 of 5-7 mmol/L was never reached. The study mortality (groups 1-3 combined) was 18.4%. Mortality between groups 1 (23.4%) and 2 (22.6%; primary endpoint) did not differ significantly (HR 1.03; 95% CI 0.79-1.34; P=0.831), nor did mortality between groups 2 (22.6%) and 3 (19.3%; secondary endpoint) (HR 1.23; CI 0.89-1.69; P=0.203). There were no significant differences in morbidity expressed as non-fatal reinfarctions and strokes among the three groups.DIGAMI 2 did not support the fact that an acutely introduced, long-term insulin treatment improves survival in type 2 diabetic patients following myocardial infarction when compared with a conventional management at similar levels of glucose control or that insulin-based treatment lowers the number of non-fatal myocardial reinfarctions and strokes. However, an epidemiological analysis confirms that the glucose level is a strong, independent predictor of long-term mortality in this patient category, underlining that glucose control seems to be an important part of their management.

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Glucose Control and Mortality in Critically Ill Patients

2003-10-14

Simon J. Finney

Hyperglycemia is common in critically ill patients, even in those without diabetes mellitus. Aggressive glycemic control may reduce mortality in this population. However, the relationship between mortality, the control of … Hyperglycemia is common in critically ill patients, even in those without diabetes mellitus. Aggressive glycemic control may reduce mortality in this population. However, the relationship between mortality, the control of hyperglycemia, and the administration of exogenous insulin is unclear.To determine whether blood glucose level or quantity of insulin administered is associated with reduced mortality in critically ill patients.Single-center, prospective, observational study of 531 patients (median age, 64 years) newly admitted over the first 6 months of 2002 to an adult intensive care unit (ICU) in a UK national referral center for cardiorespiratory surgery and medicine.The primary end point was intensive care unit (ICU) mortality. Secondary end points were hospital mortality, ICU and hospital length of stay, and predicted threshold glucose level associated with risk of death.Of 531 patients admitted to the ICU, 523 underwent analysis of their glycemic control. Twenty-four-hour control of blood glucose levels was variable. Rates of ICU and hospital mortality were 5.2% and 5.7%, respectively; median lengths of stay were 1.8 (interquartile range, 0.9-3.7) days and 6 (interquartile range, 4.5-8.3) days, respectively. Multivariable logistic regression demonstrated that increased administration of insulin was positively and significantly associated with ICU mortality (odds ratio, 1.02 [95% confidence interval, 1.01-1.04] at a prevailing glucose level of 111-144 mg/dL [6.1-8.0 mmol/L] for a 1-IU/d increase), suggesting that mortality benefits are attributable to glycemic control rather than increased administration of insulin. Also, the regression models suggest that a mortality benefit accrues below a predicted threshold glucose level of 144 to 200 mg/dL (8.0-11.1 mmol/L), with a speculative upper limit of 145 mg/dL (8.0 mmol/L) for the target blood glucose level.Increased insulin administration is positively associated with death in the ICU regardless of the prevailing blood glucose level. Thus, control of glucose levels rather than of absolute levels of exogenous insulin appear to account for the mortality benefit associated with intensive insulin therapy demonstrated by others.

Association Between Hyperglycemia and Increased Hospital Mortality in a Heterogeneous Population of Critically Ill Patients

2003-12-01

James S. Krinsley

Glycometabolic State at Admission: Important Risk Marker of Mortality in Conventionally Treated Patients With Diabetes Mellitus and Acute Myocardial Infarction

1999-05-25

Klas Malmberg , Anna Norhammar , Hans Wedel +1 more

Background —The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study addressed prognostic factors and the effects of concomitant treatment and glycometabolic control in diabetic patients with myocardial infarction … Background —The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study addressed prognostic factors and the effects of concomitant treatment and glycometabolic control in diabetic patients with myocardial infarction (AMI). Methods and Results —Of 620 diabetic patients with AMI, 306 were randomly assigned to a ≥24-hour insulin-glucose infusion followed by multidose subcutaneous insulin. Three hundred fourteen patients were randomized as controls, receiving routine antidiabetic therapy. Thrombolysis and β-blockers were administered when possible. Univariate and multivariate statistical analyses were applied to study predictors of long-term mortality. During an average follow-up of 3.4 years (range, 1.6 to 5.6 years), 102 patients (33%) in the intensive insulin group and 138 (44%) in the control group died ( P =0.011). Old age, previous heart failure, diabetes duration, admission blood glucose, and admission Hb A Ic were independent predictors of mortality in the total cohort, whereas previous AMI, hypertension, smoking, or female sex did not add independent predictive value. Metabolic control, mirrored by blood glucose and Hb A Ic , improved significantly more in patients on intensive insulin treatment than in the control group. β-Blockers improved survival in control subjects, whereas thrombolysis was most efficient in the intensive insulin group. Conclusions —Mortality in diabetic patients with AMI is predicted by age, previous heart failure, and severity of the glycometabolic state at admission but not by conventional risk factors or sex. Intensive insulin treatment reduced long-term mortality despite high admission blood glucose and Hb A Ic .

Management of Diabetes and Hyperglycemia in Hospitals

2004-02-01

Stephen Clement , Susan S. Braithwaite , Michelle Magee +4 more

Diabetes increases the risk for disorders that predispose individuals to hospitalization, including coronary artery, cerebrovascular and peripheral vascular disease, nephropathy, infection, and lower-extremity amputations. The management of diabetes in the … Diabetes increases the risk for disorders that predispose individuals to hospitalization, including coronary artery, cerebrovascular and peripheral vascular disease, nephropathy, infection, and lower-extremity amputations. The management of diabetes in the hospital is generally considered secondary in importance compared with the condition that prompted admission. Recent studies (1,2) have focused attention to the possibility that hyperglycemia in the hospital is not necessarily a benign condition and that aggressive treatment of diabetes and hyperglycemia results in reduced mortality and morbidity. The purpose of this technical review is to evaluate the evidence relating to the management of hyperglycemia in hospitals, with particular focus on the issue of glycemic control and its possible impact on hospital outcomes. The scope of this review encompasses adult nonpregnant patients who do not have diabetic ketoacidosis or hyperglycemic crises. For the purposes of this review, the following terms are defined (adapted from the American Diabetes Association [ADA] Expert Committee on the Diagnosis and Classification of Diabetes Mellitus) (3): The prevalence of diabetes in hospitalized adult patients is not known. In the year 2000, 12.4% of hospital discharges in the U.S. listed diabetes as a diagnosis. The average length of stay was 5.4 days (4). Diabetes was the principal diagnosis in only 8% of these hospitalizations. The accuracy of using hospital discharge diagnosis codes for identifying patients with …

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A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study

2009-07-27

Jean‐Charles Preiser , Philippe Devos , Sergio Ruiz‐Santana +7 more

Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline

2012-01-01

Guillermo E. Umpierrez , Richard Hellman , Mary T. Korytkowski +5 more

Objective:The aim was to formulate practice guidelines on the management of hyperglycemia in hospitalized patients in the non-critical care setting. Objective:The aim was to formulate practice guidelines on the management of hyperglycemia in hospitalized patients in the non-critical care setting.

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Intensive versus Conventional Glucose Control in Critically Ill Patients

2009-03-25

Nice-Sugar Study Investigators , Dean R. Chittock , Sheng‐Chiang Su +7 more

Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned … Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization.

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Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis

2008-01-09

Frank M. Brunkhorst , Christoph Engel , Frank Bloos +7 more

The role of intensive insulin therapy in patients with severe sepsis is uncertain. Fluid resuscitation improves survival among patients with septic shock, but evidence is lacking to support the choice … The role of intensive insulin therapy in patients with severe sepsis is uncertain. Fluid resuscitation improves survival among patients with septic shock, but evidence is lacking to support the choice of either crystalloids or colloids.

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American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control

2009-05-09

Etie S. Moghissi , Mary T. Korytkowski , Monica M. DiNardo +7 more

4. Does inpatient management of hyperglycemia represent a safety concern? 5. What systems need to be in place to achieve these recommendations?6.Is treatment of inpatient hyperglycemia cost-effective?7. What are the … 4. Does inpatient management of hyperglycemia represent a safety concern? 5. What systems need to be in place to achieve these recommendations?6.Is treatment of inpatient hyperglycemia cost-effective?7. What are the optimal strategies for transition to outpatient care? 8. What are areas for future research? QUESTION 1: DOES IMPROVING GLYCEMIC CONTROL IMPROVE CLINICAL OUTCOMES FOR INPATIENTS WITHHYPERGLYCEMIA? -Hyperglycemia in hospitalized patients, irrespective of its cause, is unequivocally associated with adverse outcomes (5,6,18 -25).Hyperglycemia occurs in patients with known or undiagnosed diabetes, or it occurs during acute illness in those with previously normal glucose tolerance (termed "stress hyperglycemia") (8,26).Intervention directed at reducing blood glucose (BG) levels has resulted in improved outcomes in some, but not all, studies (5,18 -25).Several recent clinical trials in critically ill patients have reported no reduction in mortality from intensive treatment targeting near-euglycemia versus conventional management targeting BG Ͻ180 mg/dl (Ͻ10.0 mmol/l).Of considerable concern are reports of harm, with higher rates of severe hypoglycemia and even increased mortality (14) resulting from intensive glycemic control (12)(13)(14)16,27,28).This variability in results may be attributable to several factors, including differences in intravenous (IV) insulin treatment protocols and their implementation, glycemic targets, patient populations, methods for glucose monitoring, and insulin adjustment (12,29).The following section focuses primarily on results of recent studies with an RCT design that investigated patient outcomes with protocols targeting nearnormalization of BG levels.Readers are referred to a previous ACE position statement (9), an ACE/ADA consensus statement (11), and a technical review (8) for details related to earlier studies supporting inpatient glycemic management.

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Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data

2009-03-24

Donald Griesdale , Russell J. de Souza , Rob M. van Dam +7 more

Background: Hyperglycemia is associated with increased mortality in critically ill patients. Randomized trials of intensive insulin therapy have reported inconsistent effects on mortality and increased rates of severe hypoglycemia. We … Background: Hyperglycemia is associated with increased mortality in critically ill patients. Randomized trials of intensive insulin therapy have reported inconsistent effects on mortality and increased rates of severe hypoglycemia. We conducted a meta-analysis to update the totality of evidence regarding the influence of intensive insulin therapy compared with conventional insulin therapy on mortality and severe hypoglycemia in the intensive care unit (ICU). Methods: We conducted searches of electronic databases, abstracts from scientific conferences and bibliographies of relevant articles. We included published randomized controlled trials conducted in the ICU that directly compared intensive insulin therapy with conventional glucose management and that documented mortality. We included in our meta-analysis the data from the recent NICE-SUGAR (Normoglycemia in Intensive Care Evaluation — Survival Using Glucose Algorithm Regulation) study. Results: We included 26 trials involving a total of 13 567 patients in our meta-analysis. Among the 26 trials that reported mortality, the pooled relative risk (RR) of death with intensive insulin therapy compared with conventional therapy was 0.93 (95% confidence interval [CI] 0.83–1.04). Among the 14 trials that reported hypoglycemia, the pooled RR with intensive insulin therapy was 6.0 (95% CI 4.5–8.0). The ICU setting was a contributing factor, with patients in surgical ICUs appearing to benefit from intensive insulin therapy (RR 0.63, 95% CI 0.44–0.91); patients in the other ICU settings did not (medical ICU: RR 1.0, 95% CI 0.78–1.28; mixed ICU: RR 0.99, 95% CI 0.86–1.12). The different targets of intensive insulin therapy (glucose level ≤ 6.1 mmol/L v. ≤ 8.3 mmol/L) did not influence either mortality or risk of hypoglycemia. Interpretation: Intensive insulin therapy significantly increased the risk of hypoglycemia and conferred no overall mortality benefit among critically ill patients. However, this therapy may be beneficial to patients admitted to a surgical ICU.

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Prevalence and Clinical Outcome of Hyperglycemia in the Perioperative Period in Noncardiac Surgery

2010-04-30

Anna Frisch , Chandra Prakash , Dawn Smiley +7 more

OBJECTIVE Hospital hyperglycemia, in individuals with and without diabetes, has been identified as a marker of poor clinical outcome in cardiac surgery patients. However, the impact of perioperative hyperglycemia on … OBJECTIVE Hospital hyperglycemia, in individuals with and without diabetes, has been identified as a marker of poor clinical outcome in cardiac surgery patients. However, the impact of perioperative hyperglycemia on clinical outcome in general and noncardiac surgery patients is not known. RESEARCH DESIGN AND METHODS This was an observational study with the aim of determining the relationship between pre- and postsurgery blood glucose levels and hospital length of stay (LOS), complications, and mortality in 3,184 noncardiac surgery patients consecutively admitted to Emory University Hospital (Atlanta, GA) between 1 January 2007 and 30 June 2007. RESULTS The overall 30-day mortality was 2.3%, with nonsurvivors having significantly higher blood glucose levels before and after surgery (both P &lt; 0.01) than survivors. Perioperative hyperglycemia was associated with increased hospital and intensive care unit LOS (P &lt; 0.001) as well as higher numbers of postoperative cases of pneumonia (P &lt; 0.001), systemic blood infection (P &lt; 0.001), urinary tract infection (P &lt; 0.001), acute renal failure (P = 0.005), and acute myocardial infarction (P = 0.005). In multivariate analysis (adjusted for age, sex, race, and surgery severity), the risk of death increased in proportion to perioperative glucose levels; however, this association was significant only for patients without a history of diabetes (P = 0.008) compared with patients with known diabetes (P = 0.748). CONCLUSIONS Perioperative hyperglycemia is associated with increased LOS, hospital complications, and mortality after noncardiac general surgery. Randomized controlled trials are needed to determine whether perioperative diabetes management improves clinical outcome in noncardiac surgery patients.

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Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control*

2003-02-01

Greet Van den Berghe , Pieter Wouters , Roger Bouillon +6 more

Maintenance of normoglycemia with insulin reduces mortality and morbidity of critically ill patients. Here we report the factors determining insulin requirements and the impact of insulin dose vs. blood glucose … Maintenance of normoglycemia with insulin reduces mortality and morbidity of critically ill patients. Here we report the factors determining insulin requirements and the impact of insulin dose vs. blood glucose control on the observed outcome benefits.A prospective, randomized, controlled trial.A 56-bed predominantly surgical intensive care unit in a tertiary teaching hospital.A total of 1,548 patients were randomly assigned to either strict normalization of blood glucose (80-110 mg/dL) with insulin infusion or the conventional approach, in which insulin is only given to maintain blood glucose levels at 180-200 mg/dL.It was feasible and safe to achieve and maintain blood glucose levels at <110 mg/dL by using a titration algorithm. Stepwise linear regression analysis identified body mass index, history of diabetes, reason for intensive care unit admission, at-admission hyperglycemia, caloric intake, and time in intensive care unit as independent determinants of insulin requirements, together explaining 36% of its variation. With nutritional intake increasing from a mean of 550 to 1600 calories/day during the first 7 days of intensive care, normoglycemia was reached within 24 hrs, with a mean daily insulin dose of 77 IU and maintained with 94 IU on day 7. Insulin requirements were highest and most variable during the first 6 hrs of intensive care (mean, 7 IU/hr; 10% of patients required >20 IU/hr). Between day 7 and 12, insulin requirements decreased by 40% on stable caloric intake. Brief, clinically harmless hypoglycemia occurred in 5.2% of intensive insulin-treated patients on median day 6 (2-14) vs. 0.8% of conventionally treated patients on day 11 (2-10). The outcome benefits of intensive insulin therapy were equally present regardless of whether patients received enteral feeding. Multivariate logistic regression analysis indicated that the lowered blood glucose level rather than the insulin dose was related to reduced mortality (p <.0001), critical illness polyneuropathy (p <.0001), bacteremia (p =.02), and inflammation (p =.0006) but not to prevention of acute renal failure, for which the insulin dose was an independent determinant (p =.03). As compared with normoglycemia, an intermediate blood glucose level (110-150 mg/dL) was associated with worse outcome.Normoglycemia was safely reached within 24 hrs and maintained during intensive care by using insulin titration guidelines. Metabolic control, as reflected by normoglycemia, rather than the infused insulin dose, was related to the beneficial effects of intensive insulin therapy.

Benefits and Risks of Tight Glucose Control in Critically Ill Adults

2008-08-26

Renda Soylemez Wiener , Daniel Wiener , Robin J. Larson

PUBlished a randomized controlled trial of critically ill surgical patients showing that tight glucose control reduced hospital mortality by onethird.Since the greatest decrease in deaths occurred in the subgroup of … PUBlished a randomized controlled trial of critically ill surgical patients showing that tight glucose control reduced hospital mortality by onethird.Since the greatest decrease in deaths occurred in the subgroup of patients with sepsis and multisystem organ failure, some speculated that the benefits of tight glucose control might extend to medical intensive care unit (ICU) patients as well. 2 Because few interventions in critically ill adult patients reduce mortality to this extent, the results of this trial were enthusiastically received and rapidly incorporated into guidelines.In 2004, the Surviving Sepsis Campaign 3 recommended glucose control for all patients with sepsis and explicitly stated, "There is no reason to think that these data are not generalizable to all severely septic patients."This recommendation persists in the 2008 update, now endorsed internationally by 16 professional societies. 4In addition, the Institute for Healthcare Improvement, 5 the Volunteer Hospital Association, 6 the Michigan Health and Safety Coalition, 7 the American Association of Clinical Endo-

Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients

2004-08-01

James S. Krinsley

Controversies Regarding Definition of Neonatal Hypoglycemia: Suggested Operational Thresholds

2000-05-01

Marvin Cornblath , Jane Hawdon , Anthony F. Williams +4 more

The definition of clinically significant hypoglycemia remains one of the most confused and contentious issues in contemporary neonatology. In this article, some of the reasons for these contentions are discussed. … The definition of clinically significant hypoglycemia remains one of the most confused and contentious issues in contemporary neonatology. In this article, some of the reasons for these contentions are discussed. Pragmatic recommendations for operational thresholds, ie, blood glucose levels at which clinical interventions should be considered, are offered in light of current knowledge to aid health care providers in neonatal medicine. Future areas of research to resolve some of these issues are also presented.

Correlation of Glucose Regulation and Hemoglobin AIcin Diabetes Mellitus

1976-08-19

Ronald J. Koenig , Charles M. Peterson , Robert L. Jones +3 more

We studied the increased levels of hemoglobins AIa+Ib and AIc in five hospitalized diabetic patients to determine whether changes in diabetic control would cause parallel changes in the levels of … We studied the increased levels of hemoglobins AIa+Ib and AIc in five hospitalized diabetic patients to determine whether changes in diabetic control would cause parallel changes in the levels of these hemoglobins. Before control of diabetes the mean fasting blood sugar for all patients was 343 mg per deciliter (range, 280 to 450), and hemoglobin AIc concentration 9.8 per cent (range, 6.8 to 12.1). During optimal diabetic control the blood sugar concentration was 84 mg per deciliter (range, 70 to 100), and hemoglobin AIc concentration 5.8 per cent (range, 4.2 to 7.6). Hemoglobin AIc concentration appears to reflect the mean blood sugar concentration best over previous weeks to months. The periodic monitoring of hemoglobin AIc levels provides a useful way of documenting the degree of control of glucose metabolism in diabetic patients and provides a means whereby the relation of carbohydrate control to the development of sequelae can be assessed.

Hyperinsulinism and Hyperammonemia in Infants with Regulatory Mutations of the Glutamate Dehydrogenase Gene

1998-05-07

Charles A. Stanley , Yen K. Lieu , Betty Y.L. Hsu +7 more

A new form of congenital hyperinsulinism characterized by hypoglycemia and hyperammonemia was described recently. We hypothesized that this syndrome of hyperinsulinism and hyperammonemia was caused by excessive activity of glutamate … A new form of congenital hyperinsulinism characterized by hypoglycemia and hyperammonemia was described recently. We hypothesized that this syndrome of hyperinsulinism and hyperammonemia was caused by excessive activity of glutamate dehydrogenase, which oxidizes glutamate to α-ketoglutarate and which is a potential regulator of insulin secretion in pancreatic beta cells and of ureagenesis in the liver.

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Lactic Dehydrogenase Activity in Blood.

1955-10-01

Felix Wróblewski , John S. LaDue

1. Lactic dehydrogenase activity is present in the venous serum of normal human adults. Normal activity ranges from 260 to 850 units per ml with a mean value of470 ± … 1. Lactic dehydrogenase activity is present in the venous serum of normal human adults. Normal activity ranges from 260 to 850 units per ml with a mean value of470 ± 130 units per ml. 2. Venous whole blood hemolysates of normal adults have a lactic dehydrogenase activity varying between 16,000 to 67,000 units per ml with a mean value of 34,000 ± 12,000 units per ml. 3. Alterations in serum lactic dehydrogenase have been studied in a selected group of disease states. 4. Experimental and clinical myocardial infarction are associated with a rise in serum lactic dehydrogenase activity. 5. Lactic dehydrogenase like serum glutamic oxaloacetic transaminase rises in a characteristic fashion following myocardial infarction.

Standards of Medical Care in Diabetes—2009

2008-12-31

C. Diagnosis of pre-diabetesHyperglycemia not sufficient to meet the diagnostic criteria for diabetes is catego-• • C. Diagnosis of pre-diabetesHyperglycemia not sufficient to meet the diagnostic criteria for diabetes is catego-• •

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Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

2020-05-09

Bruce W. Bode , Valerie Garrett , Jordan Messler +4 more

Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes … Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia.This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C ≥6.5%. Uncontrolled hyperglycemia was defined as ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec's data warehouse.Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia (P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001).Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated.

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2022

2021-12-16

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment … The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Standards of Medical Care in Diabetes–2006

2006-01-01

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Stress hyperglycaemia

2009-05-01

Kathleen Dungan , Susan S. Braithwaite , Jean‐Charles Preiser

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Standards of Medical Care in Diabetes—2008

2007-12-28

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2020

2019-12-16

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment … The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee (https://doi.org/10.2337/dc20-SPPC), a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2021

2020-12-04

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment … The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2019

2018-12-07

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals … The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2018

2017-11-24

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals … The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024

2023-12-11

Nuha A. ElSayed , Grazia Aleppo , Raveendhara R. Bannuru +7 more

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals … The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Implementation of an Evidence‐Based Protocol for Blood Glucose Management in Critically Ill Adult Patients: A Pilot Study

2025-06-25

Miao Huang , Dongxue Li , C. Zhang +3 more | Nursing in Critical Care

ABSTRACT Background Critically ill patients are prone to stress hyperglycaemia, which can negatively impact clinical outcomes at high blood glucose levels. Evidence‐based blood glucose management practices to improve patient outcomes … ABSTRACT Background Critically ill patients are prone to stress hyperglycaemia, which can negatively impact clinical outcomes at high blood glucose levels. Evidence‐based blood glucose management practices to improve patient outcomes should be explored. Aim This pilot study aimed to implement an evidence‐based glycaemic management protocol for critically ill adults and assess its impact on ICU nurses' knowledge, attitudes, behaviours as well as healthcare professionals' adherence and patient outcomes. Study Design This quasi‐experimental study included a controlled pre‐post pilot study that was conducted from April to June 2023 in a general ICU. An evidence‐based glycaemic management protocol was developed for critically ill adults using the Rosswurm and Larrabee model for evidence‐based practice change. The study cohort ultimately comprised 48 ICU nurses who completed both pre‐ and post‐implementation surveys and 61 patients (control group, 34; intervention group, 27). ICU nurses' knowledge, attitudes and behaviours; healthcare providers' compliance; and patients' clinical outcomes were measured to assess the effectiveness of the intervention. Results After implementing the intervention, ICU nurses' knowledge, attitudes and behaviours toward glycaemic management significantly improved. Among the 38 indicators of healthcare providers' compliance, 12 showed a 0%–100% improvement rate post‐implementation and 8 showed a compliance rate increase of 5.9%–66.7%. Statistically significant improvements were found in the duration of hyperglycaemia ( t = 2.841, p < 0.05, 95% CI [4.15, 24.46]), time to reach target glucose levels ( t = −2.215, p < 0.05, 95% CI [−12.02, −0.61]) and rate of complications ( χ 2 = 4.325, p < 0.05) among patients. Conclusions The evidence‐based glycaemic management protocol for critically ill adults is feasible and effective for clinical use. The Rosswurm and Larrabee model was useful for guiding the implementation of the protocol in mainland China. Relevance to Clinical Practice This pilot study provides a reference for blood glucose management in critically ill patients. Through structured training and procedural refinements, it facilitated the optimization of clinical workflows for glycaemic control, promoting a paradigm shift from experience‐based to evidence‐driven nursing practices among ICU nurses.

Improving blood glucose in late preterm and small for gestational age infants: the use of dextrose 40% gel

2025-06-24

Paola Polo Perucchin , Elena Aldera , Maria Grazia Calevo +5 more | Frontiers in Pediatrics

Introduction Limited evidence exists on whether administering oral dextrose gel immediately after birth reduces the risk of hypoglycemia in the early hours of life. The primary objective of this study … Introduction Limited evidence exists on whether administering oral dextrose gel immediately after birth reduces the risk of hypoglycemia in the early hours of life. The primary objective of this study was to assess whether early administration of 40% dextrose gel in infants with risk factors could reduce the incidence of hypoglycemia during the first few hours after birth. A secondary aim was to evaluate the impact of early dextrose gel administration on breastfeeding outcomes. Methods This was a double-arm, randomized trial conducted in two phases that included a total of 297 patients. In the first phase, 200 infants at risk for hypoglycemia were recruited including those who were small for gestational age (SGA), late preterm (LP, born between 34 + 0 and 36 + 6 weeks), large for gestational age (LGA), and infants of diabetic mothers: 100 infants were assigned to the “Dextrose group” and received 40% dextrose oral gel 15 minutes after birth, 100 infants in the “Control group” did not receive any dextrose. Capillary blood glucose was measured at 2 and 4 hours of life. Based on the preliminary findings, the second phase of the study randomized an additional 97 LP infants: 50 in the dextrose group and 47 in the control group, following the same intervention protocol. Results In the first phase, no significant differences in blood glucose levels were found at 2 and 4 hours of life in infants of diabetic mothers or those who were LGA. In SGA infants blood glucose levels tended to decrease significantly between 2 and 4 hours in the control group. In the second phase, LP infants who received dextrose had significantly higher blood glucose at 2 hours compared to those in the control group. Additionally, LP infants in the dextrose group who were breastfed within the first two hours showed significantly higher blood glucose at two hours than those in the control group. Discussion Early administration of 40% dextrose gel may be beneficial in maintaining higher blood glucose levels during the first hours of life in LP and SGA infants; our findings suggest that only in LP and SGA patients early intervention with dextrose gel could support glucose homeostasis and potentially improve breastfeeding outcomes.

Association of Chronic Diabetes with 42-Day Readmission after Delivery Hospitalization

2025-06-24

M.E. Boyd , Dominique Dubois , J. Mick Tilford +3 more | Maternal and Child Health Journal

Effects of Continuous Versus Intermittent Glucose Monitoring in Intensive Care Unit Patients: Protocol for a Systematic Review With Meta‐Analysis

2025-06-23

Christian Gantzel Nielsen , Milda Grigonyte‐Daraskeviciene , Mathias Maagaard Blem +7 more | Acta Anaesthesiologica Scandinavica

Glucose management in intensive care unit (ICU) patients is challenging, and dysglycemia is associated with increased morbidity and mortality. Continuous glucose monitoring (CGM) could be a potential tool to improve … Glucose management in intensive care unit (ICU) patients is challenging, and dysglycemia is associated with increased morbidity and mortality. Continuous glucose monitoring (CGM) could be a potential tool to improve clinical and glycemic outcomes compared with current practice which relies on intermittent glucose measurements. The aim of this systematic review and meta-analysis is to assess the effects of CGM compared with point of care (POC) glucose measurements on clinical patient-important and glycemic outcomes in ICU patients. This protocol is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. We will include all randomized clinical trials in ICU patients. The primary outcome is mortality at the longest follow-up, and the main-secondary outcome is the number of hypoglycemic events. Additional outcomes include both patient-important and glycemic outcomes. We will systematically search: PubMed, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection. We will assess risk of bias using the Cochrane Risk of Bias 2 tool and conduct a Trial Sequential Analysis for the primary and main-secondary outcome. Clinical heterogeneity will be assessed using the Clinical Diversity in meta-analyses tool, and the certainty of evidence will be assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach. This systematic review with meta-analysis will provide an updated overview and synthesis of the effect of CGM versus POC glucose monitoring to inform clinical practice and future trials.

Association between insulin dose and hyperglycemia in hospitalized adults with ischemic stroke receiving continuous enteral nutrition: A retrospective cohort study

2025-06-23

Heather M. Wallhauser , Leslie A. Hamilton , Skyler Brown +5 more | Journal of Parenteral and Enteral Nutrition

Abstract Background Hyperglycemia following an acute ischemic stroke has been linked to increased morbidity and mortality. Because of changes in a hospital‐wide sliding‐scale insulin protocol to incorporate half‐doses at midnight … Abstract Background Hyperglycemia following an acute ischemic stroke has been linked to increased morbidity and mortality. Because of changes in a hospital‐wide sliding‐scale insulin protocol to incorporate half‐doses at midnight due to hypoglycemia risk, we aimed to evaluate the safety and efficacy of half‐dose sliding‐scale insulin at midnight compared with full doses in patients with acute ischemic stroke receiving enteral nutrition. Methods This single‐center, retrospective cohort study involved 151 patients with acute ischemic stroke and receiving enteral nutrition in a neurocritical care unit between January 1, 2014, and December 31, 2021. The exposure of interest was half‐dose sliding‐scale insulin at midnight compared with full‐dose sliding‐scale insulin at midnight. The primary outcome was the incidence of hyperglycemia for a 48‐h period after stability while receiving enteral nutrition. Secondary outcomes were new infections, incidence of hypoglycemia, and incidence of delirium. Results In the full‐dose group, 52 patients experienced hyperglycemia compared with 60 patients in the half‐dose group; however, after propensity matching for carbohydrate content in enteral nutrition and hemoglobin A1c, the results are not noninferior (risk difference, 3.9%; 95% CI, −21.2% to 13.3%; P = 0.1041). Delirium was significantly higher in the full‐dose group, whereas the half‐dose group had a higher rate of suspected bacterial infections. Conclusion The study indicates that administering half‐dose sliding‐scale insulin at midnight in patients with acute ischemic stroke receiving enteral nutrition is not noninferior to full doses in controlling hyperglycemia. However, differences in delirium and infection rates suggest that glycemic changes may influence other outcomes.

Changes in Insulin Resistance and Gastrointestinal Microbiology in Patients with Traumatic Syndrome

2025-06-23

Е. V. Kryukov , S. P. Salikova , В. Б. Гриневич +7 more | Bulletin of the Russian Military Medical Academy

BACKGROUND: It is known that one of the basic processes developing in response to injury is insulin resistance. The mechanisms of development of insulin resistance at the present stage are … BACKGROUND: It is known that one of the basic processes developing in response to injury is insulin resistance. The mechanisms of development of insulin resistance at the present stage are not fully disclosed. There is an increasing amount of evidence indicating the role of the gastrointestinal microbiota in the development of insulin resistance. AIM: Was to evaluate the dynamics of the triglyceride-glucose index in relation to the taxonomic composition of the microbiota of the gastrointestinal tract and blood in patients with combined musculoskeletal injury. METHODS: 44 wounded with combined injury of the musculoskeletal system who were being treated at the clinic of military field surgery of the Military Medical Academy named after S.M. Kirov were examined. The patients underwent a standard examination with the calculation of an indirect indicator of insulin resistance, the triglyceride-glucose index. The microbiota of feces and blood was studied by sequencing 16S ribosomal ribonucleic acid. RESULTS: The average value of the triglyceride-glucose index in the victims was 4.61 ± 0.22 units. In 79.5% of patients, the value of the triglyceride-glucose index exceeded 4.49 units, which indicates the presence of signs of insulin resistance. There were direct correlations of the triglyceride-glucose index with the level of total cholesterol, serum amylase, the presence of chronic pancreatitis, and a number of ultrasound parameters of the liver, gallbladder, and pancreas. The most significant direct links of the triglyceride-glucose index were established with the presence of Pseudoscardovia, Pyramidobacter, and Pediococcus in the intestinal microbiota, and with bacteria of the genera Bacillus and Pseudomonas in the blood serum. Moderate inverse associations of the triglyceride-glucose index with the presence of bacteria of the genera Scardovia, Actinomyces, and Allofournierella (synonym: Fournierella) in the feces were revealed, Butyricicoccaceae UCG-009, Lactobacillus crispatus wiggsiae not Scardovia species, In. blood serum — bacteria Bifidobacterium Rodova, Phascolarctobacterium, Hydrogenophilus, the type of Escherichia is not Phascolarctobacterium albertii faecium. CONCLUSION: The established trends in the nature of changes in insulin resistance, depending on the timing of combat injury, indicate the dynamics of insulin resistance associated with the course of traumatic illness. Insulin resistance in the early period of traumatic illness, which develops in response to stress, blood loss, and tissue damage, can be considered as a compensatory and adaptive response within the framework of the concept of general adaptation syndrome, aimed primarily at eliminating energy deficiency. Therefore, it is necessary to conduct further research that can expand the understanding of the role of the bacterial microbiota as an important component of the gastrointestinal tract biotech complex in the development of metabolic changes in patients with injuries, as well as methods for their correction.

Insulin-aspart/insulin-glargine

2025-06-21

| Reactions Weekly

Bundled Care to Prevent Neonatal Hypoglycemia: Promise and Remaining Gaps

2025-06-21

Deepak Chawla | The Indian Journal of Pediatrics

The association between stress hyperglycemia and poor outcome in critically ill children is modulated by hyperlactatemia

2025-06-18

Wenjun Liu , milan dong , Jing Li +7 more | Frontiers in Endocrinology

Background The available evidence on tight glycemic control is conflicting, while the interaction between glucose and lactate in critically ill children remains unclear. Objective To explore the potential role of … Background The available evidence on tight glycemic control is conflicting, while the interaction between glucose and lactate in critically ill children remains unclear. Objective To explore the potential role of hyperlactatemia (HL) in modulating the relationship between stress hyperglycemia (SHG) and poor outcomes, aiming to establish tailored glucose targets in critically ill children. Methods This was a secondary analysis of a prospective observational cohort study conducted in five Pediatric Intensive Care Units (PICU) in southwestern China (ChiCTR2000030846). The interaction effect between glucose and lactate metrics concerning outcomes and subsequent subgroup regression analysis was conducted. SHG was defined as glucose &gt; 150 mg/dL(8.3mmol/L) and HL as lactate &gt; 2 mmol/L. Results A cohort of 433 pediatric patients with 4885 arterial blood gas measurements were finally enrolled. 90 (20.8%) cases died within 28 days of PICU admission. Significant interaction effects between SHG and HL on outcomes were observed (p &lt; 0.05). In the non-HL group, SHG was not an independent predictor of 28-day mortality (p = 0.656) and was not correlated with either 28-day ventilator-free days (p = 0.916) or 28-day ICU-free days (p = 0.914). In contrast, in the HL group, SHG was independently associated with 28-day mortality (OR 3.55, 95% CI 1.62~7.80, p = 0.002) and correlated with a reduction of 5.04 28-day ventilator-free days (p = 0.003) and 4.10 28-day ICU-free days (p = 0.004). Conclusions HL potentially modulates the correlation between SHG and poor outcomes in pediatric critically ill patients. Combined SHG and HL are associated with poor outcomes, whereas SHG without HL is not.

Association between admission hyperglycemia and prognosis in patients with acute myocardial infarction complicated with cardiogenic shock (AMI-CS): a systematic review, meta-analysis, and meta-regression of cohort study

2025-06-18

Dennis Ievan Hakim , Faqrizal Ria Qhabibi , Muhammad Yusuf +2 more | Next research.

Effect of focused ultrasound neuromodulation of the superior mesenteric plexus on insulin sensitivity and post-operative hyperglycemia in a swine model of surgical stress

2025-06-17

Weiguo Song , Khaled Qanud , Dane Thompson +2 more | Bioelectronic Medicine

Abstract Metabolic stress during major surgery increases insulin resistance and causes post-operative hyperglycemia (POHG), which may in turn contribute to post-operative morbidity and mortality. Intensive insulin therapy for POHG is … Abstract Metabolic stress during major surgery increases insulin resistance and causes post-operative hyperglycemia (POHG), which may in turn contribute to post-operative morbidity and mortality. Intensive insulin therapy for POHG is often ineffective and may even worsen patient outcomes. Non-invasive focused ultrasound stimulation (FUS) of glucose-sensing abdominal neurons improves glucose metabolism in animal models of diabetes, but its potential role in treating POHG remains unknown. In this study, we explored whether FUS of the superior mesenteric plexus (SMP) alters insulin sensitivity and post-operative fasting blood glucose (FBG) in a swine model of surgical stress-induced POHG. In each of 3 anesthetized animals, FUS targeting the porta hepatis (PH) of the liver or the SMP was delivered and insulin sensitivity was assessed in each case. In another series of experiments, 4 animals received SMP-FUS and 3 sham stimulation, after which surgical stress was induced via small bowel resection. In the 7 surgically operated animals, insulin sensitivity was measured before and after SMP-FUS (or sham), and fasting blood glucose (FBG) was measured before and 16 h after surgery. In all animals, insulin sensitivity was assessed using the hyperinsulinemic-euglycemic clamp (HEC) method. Results: SMP-FUS elicits a greater increase in insulin sensitivity than PH-FUS. On the day of surgery, SMP-FUS increases insulin sensitivity, compared to sham treatment. The day after surgery, surgically operated animals develop mild hyperglycemia. SMP-FUS-treated animals have higher FBG than sham-FUS-treated animals. No clear relationship is observed between FUS-induced changes in insulin sensitivity and next-day FBG. Conclusion: While SMP-FUS improves insulin sensitivity during surgery, it may exacerbate POHG.

Comment on “Adverse Impacts of PEGylated Protein Therapeutics: A Targeted Literature Review”

2025-06-17

João Gonçalves , Paolo Caliceti | BioDrugs

Neonatal Hypoglycemia and Long-Term Pediatric Neurodevelopmental Outcomes: A Systematic Review

2025-06-17

Rasha Fawzy Abdelmonem Mahrous , Sally Hassan Ali Hassanin , Raheeq Elssammani Elemam Elbashir +3 more | Cureus

Simulation‐based training significantly improved confidence and clinical skills of resident doctors in acute diabetes management

2025-06-17

Kalyaani Persad , Aqeelah Khatoon , Aashritha Buchipudi +6 more | Diabetic Medicine

Abstract Aims The joint consensus of the American Diabetes Association and the European Association for the Study of Diabetes highlights the need for practical, up‐to‐date training in acute diabetes care. … Abstract Aims The joint consensus of the American Diabetes Association and the European Association for the Study of Diabetes highlights the need for practical, up‐to‐date training in acute diabetes care. Therefore, this session aimed to develop an applied learning intervention that identifies key gaps in acute diabetes training, assesses participants' change in confidence in managing these scenarios following the intervention and evaluates participants' satisfaction and the intervention's relevance to practice. Methods To design the programme, we adopted Kern's six‐step curriculum development framework. Clinical experts were interviewed to assess general needs, and students and resident doctors were interviewed to assess targeted needs. The SIMBA (Simulation via Instant Messaging for Bedside Application) model was adopted to develop cases alongside generative AI and expert input. Pre‐ and post‐session surveys assessed participants' confidence, while the latter also assessed satisfaction and relevance to practice. Results 33 participants attended the session. 17 participants completed both pre‐ and post‐session surveys and were included in the study. Simulation performance scores averaged 4.0/5 for history taking, interpretation and clinical judgement; 3.9/5 for physical examination and investigations; and 3.6/5 for management. Confidence in managing acute diabetes scenarios improved significantly (pre vs. post: 33.3% vs. 78.4%, p < 0.001). 94.1% strongly agreed the cases were relevant, and 82.3% preferred this teaching method over traditional approaches. Conclusion The model identified the need for targeted education on physical examination, investigations and management specific to acute diabetes scenarios. Simulation‐based education significantly enhances confidence and is perceived as highly relevant for training in acute diabetes management.

Evaluation of circulating ApoL1 in diabetes mellitus patients attending Aminu Kano teaching Hospital

2025-06-16

Abdurrahman Hassan Jibril , Muhammad Yalwa Gwarzo , Hadiza Abdullahi +7 more | Sokoto Journal of Medical Laboratory Science

Apolipoprotein L1 (ApoL1) was originally recognized as a component of human high-density lipoprotein (HDL) particles. Subsequent research uncovered several highly homologous apolipoprotein L proteins encoded by genes clustered at the … Apolipoprotein L1 (ApoL1) was originally recognized as a component of human high-density lipoprotein (HDL) particles. Subsequent research uncovered several highly homologous apolipoprotein L proteins encoded by genes clustered at the long arm of chromosome 22 (22q12.1–13.1). Data suggests that ApoL1 may be associated with lipid and glucose metabolisms or may exert an antioxidative effect as a distinct HDL subspecies in certain dyslipidaemia subjects. The present study aimed to evaluate the circulating APOL1 in diabetes mellitus patients attending Aminu Kano teaching Hospital. Two hundred study participants were recruited out of which 100 were Type Diabetes mellitus patients and 100 were apparently healthy individuals. Fasting plasma glucose, Glycated haemoglobin, lipid profile and serum Apolipoprotein L1 were measured in the blood samples collected from each study participants. Student t- test and Pearson correlation were employed for mean comparison and correlation of the data collected respectively. Results shows significant difference in the BMI, FPG, HbA1c, Lipid Profile and APOL1 between the T2DM and the control group (p≤ 0.005). Pearson's correlation shows no significant association between APOL1 and T2DM markers (FPG and HbA1c) as well as lipid profile.

Administration of high-dose intravenous vitamin C in healthy dogs transiently leads to a false increase in portable blood glucose monitor and interstitial glucose monitor readings

2025-06-16

JAYLENE LUM , Ana Rosa Rincón‐Sánchez , Elizabeth J. Thomovsky +3 more | American Journal of Veterinary Research

Abstract Objective To investigate the effects of high-dose IV vitamin C (HDIVC) on handheld portable blood glucose monitor (PBGM) and interstitial glucose monitor (IGM) readings in dogs. Methods 6 client-owned … Abstract Objective To investigate the effects of high-dose IV vitamin C (HDIVC) on handheld portable blood glucose monitor (PBGM) and interstitial glucose monitor (IGM) readings in dogs. Methods 6 client-owned Border Collies with normal physical examinations and baseline bloodwork were enrolled in this prospective experimental study from November through December 2024. Glucose was measured via an IGM, PBGM, and laboratory blood glucose analyzer (LG) at time (T)-0, T1, T2, T3, T6, T12, T18, and T24 hours after HDIVC (200 mg/kg; ascorbic acid 500 mg/mL diluted 1:10 with sterile water, given over 30 minutes, IV). Results The median PBGM (T1, 189 mg/dL; T2, 138 mg/dL) and IGM (T1, high; T2, 321 mg/dL) readings were significantly higher than LG (T1, 76.5 mg/dL; T2, 93.5 mg/dL) at T1 and T2. The median IGM (183 mg/dL) readings were significantly higher than LG (99 mg/dL) at T3. There was no significant difference between modalities at T0 nor from T6 on. On consensus error grid analysis, all PBGM readings at T1 and 1 of 6 readings at T2 were clinically unacceptable. All IGM readings at T1 and T2 and 2 of 6 readings at T3 were clinically unacceptable. Conclusions A 200-mg/kg, IV, bolus of vitamin C in healthy dogs causes clinically significant elevations in PBGM and IGM glucose readings that normalize within 3 and 6 hours, respectively. Clinical Relevance Avoid the use of PBGM and IGM until 3 and 6 hours, respectively, after HDIVC in healthy dogs.

Nomogram-based risk prediction model employing serum biomarkers to assess intestinal injury risk in patients with metabolic syndrome

2025-06-16

Yongqing Chen , Guangxu Wen , Hongmei Wang +5 more | Frontiers in Endocrinology

Objective Patients with metabolic syndrome (MetS) are more likely to have intestinal injury that may accelerate the disease process. We developed a risk prediction model for the non-invasive, rapid, and … Objective Patients with metabolic syndrome (MetS) are more likely to have intestinal injury that may accelerate the disease process. We developed a risk prediction model for the non-invasive, rapid, and accurate assessment of intestinal injury in patients with MetS based on serum biomarkers. Methods Patients with MetS who underwent colonoscopy were enrolled in this study. Based on the results of the colonoscopy, the participants were divided into the intestinal injury and non-intestinal injury groups. Blood samples were collected to detect laboratory indicators and quantify serum biomarkers. Univariate and multivariate logistic regression analyses were employed to identify predictors of intestinal injury in patients with MetS and to construct a nomogram-based risk prediction model. We employed bootstrapping and 5-fold cross-validation to validate the model internally, with the area under the curve (AUC) used to assess the predictive efficacy, the calibration curve utilized to evaluate the calibration degree, and decision curve analysis (DCA) used to evaluate the clinical practicability of the model. Results The study included 263 participants. Our multivariate logistic regression analysis indicated that clinical features such as age, body mass index, neutrophil percentage, as well as serum biomarkers including diamine oxidase and lipopolysaccharide, were predictive factors for intestinal injury in patients with MetS. The model had strong repeatability (bootstrap method: precision: 0.873, 5-fold cross-validation: AUC: 0.948 ± 0.012), differentiation (AUC: 0.957), and accuracy (Hosmer-Lemeshow χ 2 = 3.985, P = 0.858), while DCA results confirmed the clinical utility of the nomogram. Conclusions Serum biomarkers are effective variables to assess intestinal injury in patients with MetS via our nomogram-based risk prediction model. Clinical trial registration https://www.chictr.org.cn/ , identifier ChiCTR2400088476.

The Role of Kidney Injury Molecule-1(KIM-1) In Early Location Nephropathy of Iraqi Diabetic Patients

2025-06-15

Ahmed Abed Kadhem , Qutaiba Samir Sabea , Anmar Jabbar Maftool +1 more | Osol journal for medical sciences.

Background: Serum KIM1 is the most effective diagnostic method for type 2 diabetes with microalbuminuria (increasing the level of albumin in urine). About 50% of diabetics develop diabetic nephropathy, which … Background: Serum KIM1 is the most effective diagnostic method for type 2 diabetes with microalbuminuria (increasing the level of albumin in urine). About 50% of diabetics develop diabetic nephropathy, which is another typical consequence of hyperglycemia. Objective: This study evaluates the impact of serum renal damage in the initial stages of diabetic nephropathy. Study design: The current study was conducted at the Department of Medical Laboratories at Osol AL- Elm University and Baghdad Hospital in the Medical City between December 2023 and June 2024. There were 90 participants in the trial, 60 of whom had type 2 diabetes and 30 of whom were controls. The participants, who vary in age from 51 to 53, were split into three groups: 30 individuals with microalbuminuria from type 2 diabetes, 30 individuals with macroalbuminuria from type 2 diabetes, and 30 healthy controls. Results: There was no difference significant in body mass index (BMI) and age between the study groups (p > 0.05), correlation analysis of the study analysis in diabetic patients with microalbuminuria, the serum KIM 1 shows a significant positive correlation with 0.708 of HbA1c% (r), P value ≤ 0.001) and urinary albumin (r = 0.893, P value ≤ 0.05). Serum KIM-1 shows a significant positive correlation with serum creatinine (r = 0.792, p-value ≤ 0.001) but a significant negative correlation with the GFR amount (r = - 0.338, p-value ≤ 0.001).Conclusion: Serum KIM-1 increases significantly as eGFR decreases. Serum KIM-1 is a kidney damage marker related to the decline of kidney function in type 2 diabetes mellitus.

Stress hyperglycemia ratio and the risk of new-onset chronic diseases: results of a national prospective longitudinal study

2025-06-14

Zhuang Ma , Lanlan Wu , Zheng Huang | Cardiovascular Diabetology

The stress hyperglycemia ratio (SHR), a dynamic biomarker of acute glucose dysregulation, has been established as a predictor of adverse acute outcomes. However, its longitudinal associations with chronic disease development, … The stress hyperglycemia ratio (SHR), a dynamic biomarker of acute glucose dysregulation, has been established as a predictor of adverse acute outcomes. However, its longitudinal associations with chronic disease development, particularly in middle-aged and older populations, remain insufficiently characterized. This nationwide prospective cohort study analyzed data from 8942 adults aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). We established 14 disease-specific cohorts to the relationship between SHR and new-onset chronic conditions. Multivariable-adjusted Cox proportional hazards models with restricted cubic splines were utilized to estimate hazard ratios (HRs) per standard deviation (SD) increase in SHR, supported by comprehensive sensitivity analyses and subgroup stratifications. Elevated SHR levels were significantly associated with increased risks of incident hypertension (HR = 1.30, 95% CI: 1.06-1.60; P < 0.001), dyslipidemia (HR = 1.43, 95% CI: 1.17-1.74; P < 0.001), diabetes (HR = 2.30, 95% CI: 1.82-2.91; P < 0.001), and liver disease (HR = 1.65, 95% CI: 1.21-2.26; P = 0.002). Conversely, elevated SHR levels correlated with a lower risk of lung disease (HR = 0.67, 95% CI: 0.50-0.89; P = 0.006). Restricted cubic spline analyses revealed a nonlinear relationship between SHR and diabetes risk (P-nonlinear = 0.02), while linear associations were observed for other outcomes. Subgroup analyses demonstrated consistency across demographic strata (P-interaction > 0.05). SHR demonstrates disease-specific associations with chronic disease development, indicating its potential value as a predictive marker for clinical risk assessment.

1662-P: Hyperglucagonemia and Glucose Tolerance in Humans with and without Gastric Bypass Surgery

2025-06-13

Amalia Gastaldelli , AZAM ALAMARI , SAMANTHA PEZZICA +1 more | Diabetes

Introduction and Objective: Glucagon influences glucose tolerance by increasing nutrient-induced insulin secretion. After gastric bypass (GB), prandial glucagon levels rise, independent of the nutrient composition, and remain elevated in the … Introduction and Objective: Glucagon influences glucose tolerance by increasing nutrient-induced insulin secretion. After gastric bypass (GB), prandial glucagon levels rise, independent of the nutrient composition, and remain elevated in the latter phase of the meal, when glycemia dips below fasting level. Here, we investigated the effect of hyperglucagonemia (100-150 pg/ml), created by ‘exogenous glucagon infusion’, on prandial insulin secretion, clearance and glucose fluxes. Methods: Nine non-diabetic subjects with prior history of GB and seven healthy non-operated controls (CN), matched for age, BMI, FFM, A1C, were studied twice, with and without intravenous glucagon infusion (2ng/kg/min) during a 3-hr liquid mixed meal test (50-gram whey protein + 50-gram glucose). Results: Fasting levels of glucose and islet hormones were similar between the 2 studies and among groups. As expected, prandial glucose and insulin secretion shifted to the left and upward in GB compared to CN. Prandial glucagon levels in GB were 1.5 times as high as in CN. Glucagon infusion further increased plasma concentrations by 1.5-fold in each group but had no effect on prandial β-cell secretory response or insulin clearance. Endogenous glucose production, insulin action (metabolic clearance of glucose/ insulin) and glucose tolerance were unaffected by glucagon infusion, but systemic appearance of ingested glucose (RaOral) was significantly reduced (p&lt;0.05) by glucagon infusion in both GB and CN. Conclusion: Our findings indicate that increasing systemic glucagon concentrations within physiological levels has no effect on the overall prandial glucose or insulin secretory response in subjects with normal glucose tolerance with or without bariatric surgery. Whether the excess post-meal ‘endogenous glucagon’ response after GB contribute to glucose metabolism needs further studies. Disclosure A. Gastaldelli: Advisory Panel; Boehringer-Ingelheim. Consultant; Boehringer-Ingelheim, Novo Nordisk, Merck Sharp & Dohme Corp, Regeneron Pharmaceuticals. Other Relationship; Pfizer Inc, Madrigal Pharmaceuticals, Inc, Echosens, Eli Lilly and Company. Speaker's Bureau; Merck Sharp & Dohme Corp, Eli Lilly and Company, Novo Nordisk. A. Alamari: None. S. Pezzica: None. M. Salehi: Advisory Panel; Vognex, Amylyx. Funding National Institutes of Health DK105379 (MS)

2024-LB: Dexcom G7 rtCGM Shows Improved Accuracy and Glycemia Compared with Dexcom G6 in Critically Ill Inpatient Adults

2025-06-13

ERIN R. GIOVANNETTI , RACHAEL O. LEE , Robert L. Thomas +2 more | Diabetes

Introduction and Objective: This study compared accuracy and glycemic control using Dexcom G6 and G7 real-time continuous glucose monitors (rtCGM) integrated into an insulin infusion computer calculator (IICC) workflow for … Introduction and Objective: This study compared accuracy and glycemic control using Dexcom G6 and G7 real-time continuous glucose monitors (rtCGM) integrated into an insulin infusion computer calculator (IICC) workflow for critically ill adult inpatients. Methods: A retrospective analysis evaluated 13 ICU patients using Dexcom G6 and 35 using G7, integrated into an institution-developed IICC workflow using a validation protocol. Accuracy was assessed by comparing matched rtCGM and point-of-care (POC) glucose values using mean absolute relative difference (MARD) and Surveillance Error Grid (SEG) analysis. Results: A total of 1,291 matched glucose pairs were analyzed for G7 and 758 for G6. G7 sensors demonstrated lower MARD (12.5% vs. 15.2%) and a higher percentage of values in SEG Zone A (86% vs. 76%). Both sensors showed high SEG accuracy, with 99.6% (G7) and 99.2% (G6) in the clinically acceptable Zone A+B (Figure). A lower mean glucose (142 vs. 151 mg/dL) and higher time in range (82.8% vs 79.3%) was achieved using G7 compared to G6. The G7 workflow also demonstrated lower time above range &gt;180 mg/dL (14.5% vs. 20.5%). Despite low overall hypoglycemia rates, G7 workflow exhibited slightly higher time below range &lt;70 mg/dL (0.5% vs. 0.18%) and marginally increased time &lt;54 mg/dL (0.1% vs. 0.05%). Conclusion: G7 sensors demonstrated improved accuracy and glycemic performance compared to G6, with the exception of a slight increase in time spent below range. Disclosure E.R. Giovannetti: Advisory Panel; Eli Lilly and Company, Sanofi. R.O. Lee: None. R.L. Thomas: Research Support; REMD Therapeutics, Carmot Therapeutics. S.C. Boeder: Consultant; Cecelia Health. Advisory Panel; Novo Nordisk. Consultant; Lexicon Pharmaceuticals, Inc, Persperion Diagnostics. Research Support; Eli Lilly and Company, Carmot Therapeutics, Inc, REMD Therapeutics, Dexcom, Inc., Lexicon Pharmaceuticals, Inc. K. Kulasa: None. Funding Dexcom provided CGM sensors free of charge for this study.

448-P: Dynamic Shifts in Metabolic Pathways Linked to Hyperglycemia under Surgical Stress

2025-06-13

DOHYUN KU , J. Bartelt , Sobha Kollipara +5 more | Diabetes

Introduction and Objective: Stress hyperglycemia (SH) commonly occurs after coronary artery bypass surgery (CABG), but its underlying metabolic perturbations remain unclear. Methods: We studied 48 participants (12.5% female, mean age … Introduction and Objective: Stress hyperglycemia (SH) commonly occurs after coronary artery bypass surgery (CABG), but its underlying metabolic perturbations remain unclear. Methods: We studied 48 participants (12.5% female, mean age 64±10 years) undergoing CABG. SH was defined as three glucose measurements &gt;140 mg/dL or one &gt;180 mg/dL within 4-28 hours post-surgery. High-resolution metabolomics (HRM) analyses were performed at four timepoints: pre-surgery baseline, 2-hours after surgery start, and 24- and 72-hours post-surgery [8,631 metabolites (C18 column)]. Two non-linear mixed-effects models were compared, one incorporating interaction terms for SH status and one without, to identify significant metabolite features. Pathway enrichment analysis was performed using Mummichog V2. Results: Twenty-eight participants developed SH. Seven significant pathways emerged, highlighting alterations in amino acid, pyrimidine, lipid, and microbiome metabolism. As shown in the Figure, key metabolites with the lowest p-values included imidazolelactic acid (histidine breakdown), orotidine (pyrimidine catabolism), sphingosine-1-phosphate (lipid signaling), and dihydroxybutyric acid (propanoate metabolism). Conclusion: Distinct metabolic changes were associated with SH in CABG patients, suggesting potential targets for monitoring, prevention, and therapeutic intervention during perioperative stress. Disclosure D. Ku: None. J. Bartelt: None. S. Kollipara: None. J. Feeley: None. H. Huneault: None. M.R. Smith: None. J. Li: None. F.J. Pasquel: Consultant; Insulet Corporation. Research Support; Novo Nordisk, Dexcom, Inc., Ideal Medical Technologies, Tandem Diabetes Care, Inc, Insulet Corporation. Consultant; Dexcom, Inc. Funding National Institutes of Health (K23GM128221)

1391-P: The Usefulness of Biomarkers and the Glycemic Gap in Predicting Mortality in Patients with Sepsis

2025-06-13

Chandni Radhakrishnan , ANJANA SURESH , BIPENTHUNG N. JAMI +3 more | Diabetes

Introduction and Objective: Sepsis remains the leading cause of ICU mortality. Key biomarkers widely studied ESR, lactate, procalcitonin and CRP, and the less-explored entity of hyperglycemia, particularly the glycemic gap, … Introduction and Objective: Sepsis remains the leading cause of ICU mortality. Key biomarkers widely studied ESR, lactate, procalcitonin and CRP, and the less-explored entity of hyperglycemia, particularly the glycemic gap, are crucial in predicting the outcomes of critically ill patients. This prospective, single-centred observational study combined the glycemic gap along with the biomarkers to predict 7th and 28th day mortality in patients with sepsis. Methods: Conducted at the Emergency Department, Government Medical College Kozhikode, in 105 patients with sepsis as per the 3rd International Consensus definition. The relationship between biomarkers, glycemic gap and mortality on the 7th and 28th day were analyzed. Results: The majority (50.5%) belonged to the 51-70 yrs of age, male-to-female ratio of 1.5:1. Table 1 shows the relationship between the glycemic gap and the mortality on the 7th and the 28th day. The extreme positive and negative values of the glycemic gap were significantly associated with higher mortality. The glycemic gap was compared with the need for ventilator and inotrope support and was found to be statistically significant (p=&lt;0.001). All subjects had elevated biomarkers irrespective of the mortality. Conclusion: While biomarkers remain proven indicators, the glycemic gap emerges as a novel and easily accessible tool for predicting mortality in sepsis-diagnosed patients. Disclosure C. Radhakrishnan: None. A. Suresh: None. B.N. Jami: None. G. Mohan: None. M. Ajmal KP: None. A.P. Moorkoth: None.

1011-P: Refined Time-in-Range Analysis for Continuous Glucose Monitoring—Mitigating Bias from Missing Data in Inpatient Glycemic Control

2025-06-13

Yu Qi , Guillermo E. Umpierrez , GEORGIA M. DAVIS +2 more | Diabetes

Introduction and Objective: Continuous glucose monitoring (CGM) is increasingly used in US hospitals for diabetes management, with Time in Range (TIR) as a key glycemic control metric. However, routine TIR … Introduction and Objective: Continuous glucose monitoring (CGM) is increasingly used in US hospitals for diabetes management, with Time in Range (TIR) as a key glycemic control metric. However, routine TIR analyses overlook missing data in inpatient CGM studies, such as insufficient CGM sampling due to short hospital stays. To address this, a refined TIR analysis approach was developed to mitigate biases from missing data. Methods: We applied the new method to data from 249 subjects in two prospective inpatient CGM studies. We compared TIR outcomes between patients undergoing CGM-guided insulin adjustment and those with capillary point-of-care glucose monitoring. Results: The analyses revealed differences between the new refined mean TIR analysis, which accounts for missing data, and the standard method, which does not (see Table 1). Group comparisons based on the refined analysis showed a notable reduction in the percent time spent in hypoglycemia of &lt;70 mg/dL (0.34 ± 0.14% vs. 0.84 ± 0.15%, p=0.01) while maintaining comparable mean TIR in the target range of 70-180 mg/dL (60.43 ± 3.92% vs. 61.06 ± 2.12%, p=0.89). Conclusion: The refined TIR analyses confirmed significant reductions in hypoglycemia with CGM-guided insulin adjustments. This supports the ongoing integration of CGM into clinical practice to enhance glycemic control while minimizing the risk of hypoglycemia. Disclosure Q. Yu: None. G. Umpierrez: Research Support; Abbott, Dexcom, Inc., Bayer Pharmaceuticals, Inc, Corcept Therapeutics. Advisory Panel; Dexcom, Inc., GlyCare Health. G.M. Davis: Research Support; Insulet Corporation. M. Fayfman: Research Support; Abbott, Dexcom, Inc. Funding National Institutes of Health (R01DK136023)

724-P: High One-Hour Post-load Plasma Glucose Is an Intermediate Condition between NGR and IGR

2025-06-13

ARVID SANDFORTH , REINER JUMPERTZ VON SCHWARTZENBERG , Leontine Sandforth +7 more | Diabetes

Introduction and Objective: Lifestyle intervention (LI) is recommended in people with prediabetes. High 1-hour post-load plasma glucose (1h-PG) predicts T2D risk earlier than current criteria. We hypothesized that high 1h-PG … Introduction and Objective: Lifestyle intervention (LI) is recommended in people with prediabetes. High 1-hour post-load plasma glucose (1h-PG) predicts T2D risk earlier than current criteria. We hypothesized that high 1h-PG represents an intermediate state between normal glucose regulation (NGR) and impaired glucose regulation (IGR) and that LI is more effective in high 1h-PG. Methods: 318 people from the Tübingen Lifestyle Intervention Program with NGR, IGR [fasting PG≥ 5.6 mmol/L and &lt;7.0 mmol/l or 2-h PG ≥ 7.8 mmol/L and &lt; 11.1 mmol/l]) or high 1h-PG (NGR and 1h-PG ≥ 8.6 mmol/L)) underwent LI (monthly dietary counseling to achieve ≥ 5% weight loss; increased physical activity) for 9 months. Results: At baseline (Table), insulin sensitivity (IS) and beta cell function (BCF) declined progressively from NGR (n=106), to the high1h-PG (n=93) and IGR (n=119) groups. Numerically, liver fat content and visceral adipose tissue volume (VAT) increased from NGT to high 1h-PG and to IGR. Risk of T2D during 12-years follow-up was reduced by 80% (37 - 96 %, p = 0.005) in the high 1h-PG group compared to the IGR group. The odds of remission to NGR were two-fold higher in the high 1h-PG group compared to the IGR group (2.18 [1.13 - 4.28], p = 0.021). Conclusion: High 1h-PG is an intermediate pathophysiological state between NGR and IGR. LI reduces ectopic fat deposition, improves IS and BCF and reduces the risk of incident T2D more in high 1h-PG than in IGR. Disclosure A. Sandforth: None. R. Jumpertz von Schwartzenberg: None. L. Sandforth: None. S. Katzenstein: None. H. Preissl: None. J. Machann: None. F. Schick: None. A. Fritsche: Advisory Panel; Abbott. Speaker's Bureau; AstraZeneca. N. Stefan: Speaker's Bureau; AstraZeneca, Boehringer-Ingelheim. Consultant; Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Consultant; Pfizer Inc. Speaker's Bureau; Sanofi. Research Support; Sanofi. Speaker's Bureau; Novo Nordisk, GlaxoSmithKline plc. Consultant; GlaxoSmithKline plc. M. Bergman: None. A.L. Birkenfeld: None. Funding German Federal Ministry for Education and Research (01GI0925) via the German Center for Diabetes Research (DZD e.V.)

1347-P: Glycated Hemoglobin (A1C) Testing—Ineffectiveness Due to Hematological Alterations

2025-06-13

Maria Rita Leite Monteiro Hasbun , R. Magalhães , Delanie B. Macedo +3 more | Diabetes

Introduction and Objective: Glycated hemoglobin (A1C) is widely used in the screening and follow-up of patients with diabetes mellitus (DM), making its accuracy critical for patient care. However, A1C results … Introduction and Objective: Glycated hemoglobin (A1C) is widely used in the screening and follow-up of patients with diabetes mellitus (DM), making its accuracy critical for patient care. However, A1C results can be influenced by various factors, including alterations in blood cell counts. This study aimed to evaluate the correlation between hematological abnormalities and inaccuracies in A1C measurement. Methods: Cross-sectional study was conducted using data from a laboratory database in Northeast Brazil, involving patients who underwent A1C by High-Performance Liquid Chromatography (HPLC) from 2019 to 2024. Out of 767,514 samples, A1C results for 194 (0.02%) patients were not released. Seven cases were excluded due to missing fasting blood glucose (FBG) and complete blood count (CBC) data, leaving 187 samples for analysis. High red cell distribution width (RDW &gt;16%) and severe anemia (Hb &lt;8 g/dL) were considered as hematological abnormalities. Results: Of the 187 patients, 96% were adults (mean age 59.2 ± 21.5 years; 74.3% women). Mean hemoglobin (Hb) level was 11.16 ± 2.21 g/dL, and mean FBG level, 95.5 ± 16 mg/dL. Red blood cell morphological abnormalities were found in 83.9% (157/187) of CBCs. High RDW was present in 38.5% (72/187) of tests. Severe anemia (mean Hb 6.9 ± 1.3 g/dL) occurred in 7.5% (14/187) of patients, most of whom had macrocytic red blood cells (12/14). Sickle cell anemia was found in 4 patients. Children made up 4.3% (8/187) of the cohort, with mean age of 10 ± 3.5 years. All were female, with mean Hb of 10 ± 1.7 g/dL and mean FBG of 81 ± 7 mg/dL. High RDW was found in 25% (2/8), and severe anemia in 1 child. Hemolytic characteristics were found in 3 children, with sickle cell anemia in 2. Conclusion: Although A1C by HPLC is a reliable method for DM diagnosis and monitoring, this study shows that unreleased A1C results may occur due to hematological abnormalities, such as red blood cell morphological changes, high RDW and severe anemia. These findings underscore the need for alternative methods to assess mean blood glucose levels in affected patients. Disclosure M.R. Hasbun: None. R.A. Magalhaes: None. D.B. Macedo: None. C.M. Figueirêdo: None. R. Petrola: None. M.G. Teles: None. Funding Emilio Ribas Medicina Diagnostica

1360-P: CGM Sensors Improve the Estimation of Glycemic Outcomes in Newborns at Risk of Neonatal Hypoglycemia

2025-06-13

Carmen Monthé‐Drèze , SARA CHERKERZIAN , Francesco Prendin +6 more | Diabetes

Introduction and Objective: Neonatal hypoglycemia (NH) is associated with later adverse neurodevelopment, particularly in children exposed to severe, recurrent or clinically undetected (blinded interstitial episodes) NH. Continuous glucose monitoring (CGM) … Introduction and Objective: Neonatal hypoglycemia (NH) is associated with later adverse neurodevelopment, particularly in children exposed to severe, recurrent or clinically undetected (blinded interstitial episodes) NH. Continuous glucose monitoring (CGM) may improve the management of NH that is undetected with intermittent blood glucose (iBG) testing. Here, we aimed to compare glycemic outcomes derived from CGM vs. iBG sampling methods, which has not previously been examined in a US population of well newborns. Methods: We included n=21 neonates ≥ 35 weeks gestational age at risk for NH enrolled in the ongoing observational prospective longitudinal LAMMBS study. Blinded CGM was performed from delivery to discharge with Dexcom G6 sensors. CGM traces were retrocalibrated using a validated adjustment algorithm to reconcile for known CGM inaccuracy in this population. Neonates were also screened for NH via capillary point-of-care (POC) testing with the Abbott Freestyle Precision Pro glucometer and treated per institutional protocol. We used the McNemar’s Chi2 and the Wilcoxon signed rank tests to test differences in glycemic outcomes between CGM and POC methods. Results: Median (IQR) for POC BG count and sampling duration of CGM was 3 (2,7) measures and 13.4 (3.3, 20.3) hours (h), respectively. Among neonates with NH (by POC), 40% experienced &gt;5h of low BG despite medical management. Twenty-five % of neonates had low BG concentrations not detected by iBG testing. Detection rates of NH (23.8 vs 42.9%; p = 0.046) and recurrent NH (4.7 vs 28.6%; p = 0.025), but not severe NH (0 vs 4.7%), differed between POC vs CGM methods. Number of NH (p = 0.03) but not severe NH (p = 0.32) episodes also differed between the two methods. Conclusion: CGM may increase the detection rates of NH in neonates at risk compared to iBG. Although its application in newborn clinical care requires further investigation, these preliminary data underscore the importance of adapting this technology for this vulnerable population to improve neurodevelopmental outcomes. Disclosure C. Monthe-Dreze: None. S. Cherkerzian: None. F. Prendin: None. A. Coburn-Sanderson: None. R. Abdel-Rahman: None. S. DelFavero: Research Support; Dexcom, Inc. Other Relationship; Dexcom, Inc. A. Galderisi: None. A. Facchinetti: None. S. Sen: Other Relationship; Dexcom, Inc., nova. Funding CRICO Risk Management Foundation Grant

93-OR: Early Defects of Beta-Cell Function Are Associated with Disrupted BAG3-Insulin Colocalization in Humans Islets

2025-06-13

Gea Ciccarelli , Gianfranco Di Giuseppe , Verena Damiani +7 more | Diabetes

Introduction and Objective: Alterations in first-phase insulin secretion are pivotal in the early development of type 2 diabetes mellitus (T2DM). The multifunctional protein BAG3 has been implicated in regulating insulin … Introduction and Objective: Alterations in first-phase insulin secretion are pivotal in the early development of type 2 diabetes mellitus (T2DM). The multifunctional protein BAG3 has been implicated in regulating insulin secretion in murine models, but its role in humans remains unexplored. This study investigates the expression of BAG3 in human pancreatic islets and its relationship with β-cell functionality in a cohort of non-diabetic subjects. Methods: Pancreatic tissue samples were obtained from 12 non-diabetic patients enrolled for partial pancreatectomy. Patients underwent deep metabolic evaluation, including oral glucose tolerance test (OGTT), hyperglycemic clamp and euglycemic hyperinsulinemic clamp. Immunofluorescence and confocal microscopy were used to assess BAG3-insulin colocalization in islets. Metabolic and histological findings were correlated with BAG3 expression, categorizing subjects into LOW and HIGH BAG3 groups based on Pearson’s correlation coefficient of BAG3-insulin colocalization. Results: Patients with HIGH BAG3 expression exhibited significantly impaired first-phase insulin secretion, evidenced by reduced rate sensitivity during OGTT and higher plasma glucose levels at 30 and 60 minutes post-glucose challenge. Islets from HIGH BAG3 patients showed increased size but no differences in insulin/glucagon ratios or insulin sensitivity, suggesting a specific disruption in the insulin secretory machinery rather than β-cell mass or insulin resistance. Conclusion: BAG3 appears to modulate first-phase insulin secretion in humans by influencing the insulin granule exocytosis process. Targeting BAG3-related pathways could represent a novel therapeutic approach to prevent or delay β-cell dysfunction and the onset of T2DM. Disclosure G. Ciccarelli: None. G. Di Giuseppe: None. V. Damiani: None. M. Brunetti: None. G. Gliozzo: None. L. Soldovieri: None. F. Cinti: None. A. Giaccari: Board Member; Novo Nordisk A/S. Speaker's Bureau; AstraZeneca, Sanofi. Advisory Panel; Sanofi. Speaker's Bureau; Guidotti. V. De Laurenzi: None. T. Mezza: None.

990-P: Impact of Early Continuous Glucose Monitor Placement in Pediatric Patients

2025-06-13

SARAH GIGER , Joshua Courter , Lindsey Hornung +2 more | Diabetes

Introduction and Objective: Continuous glucose monitors (CGM) improve diabetes control. Obtaining approval at diagnosis can be challenging. We evaluated the impact of CGM initiation at diabetes diagnosis on change in … Introduction and Objective: Continuous glucose monitors (CGM) improve diabetes control. Obtaining approval at diagnosis can be challenging. We evaluated the impact of CGM initiation at diabetes diagnosis on change in hemoglobin A1c (HbA1c) at follow up in pediatric patients. Methods: Patients with newly diagnosed diabetes were enrolled in a prospective cohort study at a pediatric hospital September 2023-March 2024. Patients starting CGM within several days of diagnosis were included in the ‘early CGM’ group. For the ‘late CGM’ comparison group, we used retrospective data (September 2022-March 2023); patients were not offered CGM at diagnosis but could start CGM later. All patients started injection basal bolus insulin therapy and had follow up scheduled per American Diabetes Association guidelines. Change in HbA1c from diagnosis to follow up was compared between groups. Results: 93 patients started a CGM at diagnosis, 105 patients did not start CGM at diagnosis. Mean age (early CGM: 10.9 years vs late CGM: 11.0 years) and HbA1c at diagnosis (early CGM: 11.4% vs late CGM: 11.7%) did not significantly differ between groups. There was no significant difference in change in HbA1c between groups (Figure 1). Conclusion: Starting a CGM at diabetes diagnosis did not significantly impact early changes in HbA1c. Further research is needed to assess the impact of early CGM initiation on other metrics, including hypoglycemia. Disclosure S. Giger: None. J.D. Courter: None. L. Hornung: None. A.L. Poetker: None. S. Lawson: None.

178-OR: Sensitivity of Different Screening Approaches for Early Hyperglycemia in Pregnancy

2025-06-13

David Simmons , Christopher J. Nolan , JINCY IMMANUEL +7 more | Diabetes

Introduction and Objective: The 2025 ADA standards recognize early pregnancy dysglycemia is associated with worse outcomes, and recommend detection with either fasting glucose (FG) or A1C. This study compared different … Introduction and Objective: The 2025 ADA standards recognize early pregnancy dysglycemia is associated with worse outcomes, and recommend detection with either fasting glucose (FG) or A1C. This study compared different early glycemic screening strategies for overt diabetes (ODIP) and GDM prediction. Methods: Pregnant women with GDM risk factors enrolled in a multicenter early GDM RCT had a 75g OGTT and A1C &lt;20 wks using ADA ODIP and GDM criteria. Repeat OGTT occurred at 24-28 wks if untreated (normal OGTT and randomized 50% early GDM). Area under the receiver operator curve (AUROC) with 95%CI was used for ODIP and late GDM prediction. The proportion of late OGTTs avoided included those with an A1C or FG &lt;90% sensitivity thresholds or reaching the ADA early screening thresholds (A1C≥5.9%; FG≥110 mg/dL). Results: Among 3515 women, mean age was 31±5 yrs, BMI 29.9±7.4 kg/m2, OGTT gestation 16±3 wks, 40.6% were European. A1C and FG had similar AUROCs for ODIP and similar, but lower, AUROCs for GDM. The ADA-recommended A1C and FG thresholds were&lt;50% sensitive for ODIP and &lt;5% sensitive for GDM. An early FG threshold of 92 mg/dL was &lt;70% sensitive for ODIP and persistent GDM. An early A1C threshold of 4.8% or FG of 76 mg/dL (@90% sensitivity for GDM) could avoid 22.7% of 24-28 week OGTTs (Table 1). Conclusion: The 2025 ADA recommended early pregnancy A1C and FG thresholds are insensitive tests for detecting women with ODIP and later pregnancy GDM. Disclosure D. Simmons: Research Support; Novo Nordisk, AMSL. Other Relationship; Abbott, Abbott, Boehringer-Ingelheim. Speaker's Bureau; Ascensia Diabetes Care. C.J. Nolan: None. J. Immanuel: None. H. Teede: None. J.R. Flack: None. V.W.M. Wong: None. E. Hibbert: None. M. McLean: Advisory Panel; Recordati Rare Diseases. A. Kautzky-Willer: None. J. Harreiter: None. H.E. Backman: None. E.J. Gianatti: None. A. Sweeting: None. V. Mohan: Speaker's Bureau; Novo Nordisk. Advisory Panel; Abbott. Research Support; Servier Laboratories. Speaker's Bureau; USV Private Limited, Sanofi, Medtronic, Eli Lilly and Company. W. Hague: None. Funding NHMRC (grants 1104231 and 2009326); Region ?rebro Research Committee Dnr OLL-970566, OLL-942177; Medical Scientific Fund of the Mayor of Vienna, project 15205; South Western Sydney Local Health District Academic Unit grant 2016; Western Sydney University Ainsworth Trust grant 2019

2109-LB: Unknown Dysglycemia before Surgery and Impact on Post-surgical Stress Hyperglycemia by Continuous Glucose Monitoring

2025-06-13

OMOLADE OLADEJO , LIZDA I. GUERRERO ARROYO , Limin Peng +5 more | Diabetes

Introduction and Objective: Approximately 30% of patients without diabetes (DM) undergoing non-cardiac surgery develop postoperative stress hyperglycemia (SH). SH is linked to higher rates of complications and mortality compared to … Introduction and Objective: Approximately 30% of patients without diabetes (DM) undergoing non-cardiac surgery develop postoperative stress hyperglycemia (SH). SH is linked to higher rates of complications and mortality compared to patients maintaining normoglycemia. The true prevalence of SH is not known, and it is unclear how underlying preoperative dysglycemia may impact the development of SH. This observational study examined the incidence of SH using continuous glucose monitoring (CGM) and the association between pre-surgical glycemia profiles and development of SH. Methods: High-risk patients (age ≥45 years, BMI ≥28 kg/m2) without known DM undergoing non-cardiac surgery were enrolled from a large urban hospital. Participants underwent 75g OGTT and HbA1c testing preoperatively. Dysglycemia categories were defined using standard diagnostic criteria for HbA1c and OGTT. A blinded CGM was placed preoperatively and worn during surgical hospitalization. CGM data ≥48 hours postoperatively were considered adequate for analysis. Sensor glucose &gt;140 and 180 mg/dL were used to define varying degrees of SH. Logistic regression was used to determine the association between preoperative dysglycemia and SH adjusting for age, sex, BMI and steroid exposure. Results: Overall age and BMI were 58.4±7.8 yrs and 34.9±4.9 kg/m2 respectively (n=59). The frequency of preoperative dysglycemia by OGTT or HbA1c testing was 62%. Postoperatively, 66% of participants developed SH with sensor glucose &gt;140 mg/dL while 20% developed glucose &gt;180 mg/dL. Dysglycemia status was associated with significantly increased odds of SH for glucose &gt;140 mg/dL (OR 3.72 95% CI [1.06, 13.10]) and &gt; 180 mg/dL (OR 15.24 [1.53,151.62]) after adjusting for age, BMI and preoperative steroid exposure. Conclusion: SH is frequent among high-risk patients without DM. Underlying dysglycemia is common and associated with the development of SH after accounting for other potential risk factors. Disclosure O. Oladejo: None. L.I. Guerrero Arroyo: None. L. Peng: None. L. Chadalawada: None. R. Parab: None. S. Usman: None. F.J. Pasquel: Consultant; Insulet Corporation. Research Support; Novo Nordisk, Dexcom, Inc., Ideal Medical Technologies, Tandem Diabetes Care, Inc, Insulet Corporation. Consultant; Dexcom, Inc. G.M. Davis: Research Support; Insulet Corporation. Funding National Institutes of Health (NIDDK 5K23DK122199)

1215-P: Utility and Accuracy of Blood Glucose Control Using RT-CGM in Type 1 Diabetes Summer Camp

2025-06-13

Tatsuya Kondo , Takafumi Senokuchi , Naoto Kubota | Diabetes

Introduction and Objective: The 54th Kumamoto Prefecture Pediatric Type 1 Diabetes Summer Camp (SC) was a 3-day camp in 2024. The overnight SC in 2023, we used the Dexcom G6 … Introduction and Objective: The 54th Kumamoto Prefecture Pediatric Type 1 Diabetes Summer Camp (SC) was a 3-day camp in 2024. The overnight SC in 2023, we used the Dexcom G6 for real-time glucose management, which showed high usefulness, but accuracy remained unsatisfactory. Methods: The Dexcom G7 (G7) can remotely and continuously measure subcutaneous glucose concentration (SG). SG by G7 were measured for one week prior to SC, and a questionnaire was administered to assess the usefulness and recommendation of G7. Twenty-one type 1campers and 52 healthcare provides (HCP) were participated. MARD, which evaluates the accuracy of rt-CGM, and TIR, TAR, TBR were measured during the week prior to camp (off camp) and during SC (on camp). Results: G7 was highly evaluated for its sensor insertion, visualization of SG variation, and convenience during camp. On the other hand, SG deviation from BG and accuracy of SG values were scored relatively low. Compared to G6 conducted last year, the usefulness and recommendation of G7 among campers were significantly higher than those of G6.In terms of usefulness and recommendation, what was significantly lower for campers at G6 was almost equally high for campers and HCPs at G7 (campers vs. HCPs: usefulness 4.50 v.s. 4.35, recommendation 4.38 v.s. 4.29).MARD was 11.3% (G6: 16.0%) on camp and 11.0% (G6: 19.7%) off camp. The coefficient of variation (CV) was 34.4% (G6: 60.3% on camp and 35.9% (G6: 63.1%) off camp, while the glucose management indicator (GMI) was 7.44% for G7 and 8.04% for G6. TIR and TAR on camp and off camp showed better glycemic control in on camp. Single regression analysis of BG-SG showed good linearity and Bland-Altman plot and error grid analysis also showed sufficient accuracy. Conclusion: Compared to G6, which was used last year, G7 was rated higher in terms of usefulness and recommendation among campers. G7 was also found to have improved accuracy, and was considered to be a useful rt-CGM in SC. Disclosure T. Kondo: None. T. Senokuchi: None. N. Kubota: None. Funding Japan Diabetes Foundation/Costco Research Grant

1031-P: Accuracy of Dexcom One+ in Patients with Hyperglycemia Hospitalized in Cardiac Intensive Care Unit

2025-06-13

Jerzy Hohendorff , Barbara Zawiślak , Maciej Bagieński +3 more | Diabetes

Introduction and Objective: CGM systems may support glucose control in patients in cardiac intensive care unit (CICU). We aimed to assess the accuracy, feasibility and tolerability of Dexcom One+ against … Introduction and Objective: CGM systems may support glucose control in patients in cardiac intensive care unit (CICU). We aimed to assess the accuracy, feasibility and tolerability of Dexcom One+ against standard blood glucose measurements. Methods: From September to December 2024, we included patients with known diabetes or hyperglycemia at admission &gt;140 mg/dl hospitalized in the CICU due to acute coronary syndrome and/or heart failure. The accuracy was assessed by the mean absolute relative difference (MARD). Clinical performance was assessed using Consensus Error Grid (CEG) analysis. Feasibility outcome included number of early sensor detachment and sensor failure. Safety outcomes included skin reactions. Results: We obtained 567 paired samples from 27 patients (15 males), aged 72.3 ± 11.4 years. Among participants there were 22 patients with previously diagnosed T2DM. The mean HbA1c was 7.3 ± 1.4%. Overall, 419 paired samples were obtained during oxygen therapy, while 199 during vasopressor infusion. CGM use duration was 4.4 ± 3.2 days. The were 2 reference readings &lt;70 mg/dl, 352 within 70-180 mg/dl range, and 213 &gt;180 mg/dl. Overall MARD was 12.3%. Clinical accuracy is summarized in Table 1. We observed 1 mild hematoma at insertion site, 1 sensor failure and 2 early detachments. Conclusion: In patients in CICU Dexcom One+ demonstrated acceptable accuracy and could facilitate glucose monitoring. Disclosure J. Hohendorff: None. B. Zawislak: None. M. Bagienski: None. M.M. Adamczyk-Hohendorff: None. T. Klupa: Speaker's Bureau; Lilly Diabetes, Novo Nordisk, AstraZeneca, Boehringer-Ingelheim, Sanofi. Research Support; Medtronic. Speaker's Bureau; Medtronic, Abbott, Dexcom, Inc. M. Malecki: Speaker's Bureau; Novo Nordisk, Lilly Diabetes, Sanofi, Boehringer-Ingelheim, AstraZeneca, Berlin-Chemie AG. Advisory Panel; Abbott, Dexcom, Inc. Speaker's Bureau; Servier Laboratories. Other Relationship; Amryt Pharma. Funding Jagiellonian University Medical College Grant awarded to JH

1320-P: Diagnosing Diabetes and Assessing Its Prevalence in Patients Attending A&E in an Acute Hospital in England

2025-06-13

Edward B. Jude , Adrian Heald , S. G. Anderson | Diabetes

Introduction and Objective: Uptake for community-based screening for T2D is inadequate with delays in diagnosis. Patients attending hospital can be screened for diabetes for early treatment. The aim of this … Introduction and Objective: Uptake for community-based screening for T2D is inadequate with delays in diagnosis. Patients attending hospital can be screened for diabetes for early treatment. The aim of this study was to identify people with undiagnosed diabetes attending an Accident and Emergency (A&E) department Methods: Screening was undertaken using HbA1c. Prediabetes was defined as HbA1c 39-47 and T2D ≥48 mmol/mol. The Finnish Diabetes Risk Score (FINDRISC) score was calculated for all patients. Results: 4620 patients (mean age 52.1 years, 41.8% males) were included. Normal glucose tolerance was seen in 2749 (59.5%), pre-DM in 1534 (33.2%) and T2D in 337 (7.3%); mean (SE) age: 49.3 (0.27), 56.3 (0.34) and 56.0 (0.76) years; HbA1c: 33.9 (0.09), 41.5 (0.12), 56.8 (0.25) mmol/mol; BMI: 28.2(0.13), 29.1 (0.17) and 31.5 (0.37); FINDRISC score: 8.3 (0.1), 10.0 (0.1), 11.6 (0.2), respectively (all p&lt;0.0001). Relative risk ratios (RRR) indicated that each unit increase in the FINDRISC score was associated with a 9% increased risk for pre-DM (RRR (95% CI) 1.09 (1.07, 1.11) and a 17% increased risk for T2D (1.17 (1.14, 1.20) compared to normoglycaemia. After adjusting for age (13% (7-18%), sex (45% lower in women), ethnicity and smoking, there was little effect modification for diabetes risk at 16% (1.16 (1.13-2.72). Ethnic minorities had higher incidence of Pre-DM and T2D compared to Whites (42.65% vs 37.8%) and twice as likely to have Pre-DM (2.17 (1.72-2.76) or T2D (3.21 (2.21-4.64). Comparing different age groups, individuals over 45 years had higher prevalence of pre-DM and T2D and higher CVD risk factors. Conclusion: Individuals attending A&E have a high incidence of unknown glucose intolerance. HbA1c is a valid and simple method to diagnose diabetes and can be a simple test to identify those with diabetes so that treatment can be instituted early. The FINDRISC score can be used to identify those at risk. Patients admitted to hospital should be screened for diabetes using the HbA1c test. Older age had greater risk of being diagnosed with T2D/Pre-DM. Disclosure E.B. Jude: Research Support; Abbott Diagnostics. Speaker's Bureau; AstraZeneca, A. Menarini Diagnostics, Novo Nordisk. Research Support; Sanofi. A.H. Heald: None. S.G. Anderson: None.

1547-P: Effects of Histone Modifications in Diabetes-Complicated Periodontal Tissues

2025-06-13

KENTO KOJIMA , Nobuhisa Nakamura , Megumi Miyabe +7 more | Diabetes

Introduction and Objective: Periodontitis is a chronic inflammatory disease characterized by periodontal tissue destruction by bacterial factors. Periodontal disease is considered one of the complications of diabetes due to the … Introduction and Objective: Periodontitis is a chronic inflammatory disease characterized by periodontal tissue destruction by bacterial factors. Periodontal disease is considered one of the complications of diabetes due to the high prevalence and severity of periodontal disease. However, the detailed mechanism by which diabetes aggravates periodontitis is unclear. In this study, we focused on histone modifications from the viewpoint of metabolic memory. Methods: We examined the effects of histone modifications on the gums in diabetes. Diabetes was induced by administering streptozotocin (STZ; 60 mg/kg) intraperitoneally in 6-week-old male Sprague-Dawley rats. To determine the involvement of histone modifications in gene expression changes in hyperglycemic conditions, human gingival fibroblasts (hGFs) were cultured for 1 week in high glucose conditions (27.5 mM) with sinefungin, a SET-type histone methyltransferase (HMT) inhibitor. Results: Induction of diabetes significantly increased the expression of trimethylation of histone H3 lysine 4 (H3K4me3) and Su (var) 3-9, enhancer-of-zeste, and trithorax domain 1A (SETD1A), a component of a histone methyltransferase, in the gums. High glucose significantly increased the expression of H3K4me3 and SETD1A proteins in hGF, and sinefungin suppressed these protein expressions. High glucose also significantly increased matrix metalloproteinase 1 (MMP1) and MMP13 gene expressions in hGF, which were suppressed by sinefungin in high glucose conditions. Although gene expression of tissue inhibitor metalloproteinase 1 (TIMP1) was unchanged under all conditions, the MMP/TIMP ratio was significantly higher in high glucose condition. Sinefungin canceled the increase of MMP/TIMP ratio in high glucose condition. Conclusion: In summary, we found that diabetes induces histone modification of H3K4me3 via upregulation of SETD1A in gingival tissue. These histone modifications may increase the susceptibility of diabetes to periodontal disease. Disclosure K. Kojima: None. N. Nakamura: None. M. Miyabe: None. T. Kikuchi: None. S. Kondo: None. N. Sawada: None. A. Hayashi: None. T. Minato: None. T. Saiki: None. S. Sasajima: None. R. Ozaki: None. A. Mitani: None. K. Naruse: None.

1602-P: Delayed Insulin Secretion in Early Postpartum Is Associated with Future Abnormal Glucose Metabolism among Women with a History of Gestational Diabetes Mellitus

2025-06-13

Shuhui Liang , CHANGLIU XU , Fenghua Lai +2 more | Diabetes

Introduction and Objective: The present study aims to determine the relationship between insulin secretion pattern after glucose load in the early postpartum period (&lt; 6 months) and the incidence of … Introduction and Objective: The present study aims to determine the relationship between insulin secretion pattern after glucose load in the early postpartum period (&lt; 6 months) and the incidence of abnormal glucose metabolism (AGM) in the future among women with a history of gestational diabetes mellitus (GDM). Methods: This is a prospective cohort study that conducted survival analysis on the medical records of 308 women with prior GDM. All eligible subjects underwent a 75g oral glucose tolerance test (OGTT) within 6 months postpartum and insulin levels were measured before, 30 minutes and 2 hours after glucose load..Participants were divided into two groups: delayed insulin secretion group: 2h insulin levels ≥ 30min insulin levels (In 2h ≥ In 30min) (n=196), and control group (In2h &lt; In30min) (n=112). Multiple imputation was used to handle missing values. Results: Of the 308 women, 153 occurred AGM (49.7%) within a mean follow-up time of 32.7 months. Women in In2h ≥ In30min group had a 52.5% increased risk of developing AGM (adjusted hazard ratio [HR] 1.525 [95% CI 1.044-2.227], P=0.029). Other risk factors included: fasting blood glucose during pregnancy, triglycerides and AGM within 6 months postpartum (adjusted HR 1.580 [95% CI 1.232-2.027], 1.395 [95% CI 1.048-1.855], and 1.559 [95% CI 1.045-2.337], respectively, all P&lt;0.05) Conclusion: In women with a history of GDM, delayed insulin secretion after glucose load within 6 months postpartum were associated with an increased incidence of future AGM. Disclosure S. Liang: None. C. Xu: None. F. Lai: None. Y. Li: None. X. Cao: None. Funding the 5010 Project Foundation of Sun Yat-sen University (No. 2017001).

181-OR: Time in Range (TIR) Extrapolated from Self-Monitoring of Blood Glucose (SMBG) and Risk for Adverse Perinatal Outcomes in Pregnancies Complicated by T1DM

2025-06-13

Emily Santos , Tatiana Assunção Zaccara , Fernanda Cristina Ferreira Mikami +4 more | Diabetes

Introduction and Objective: Type 1 diabetes mellitus (T1DM) is associated with increased risks of adverse pregnancy outcomes. While Continuous Glucose Monitoring Systems (CGMS) improve glycemic monitoring, self-monitoring of blood glucose … Introduction and Objective: Type 1 diabetes mellitus (T1DM) is associated with increased risks of adverse pregnancy outcomes. While Continuous Glucose Monitoring Systems (CGMS) improve glycemic monitoring, self-monitoring of blood glucose (SMBG) remains the primary method for most pregnant women due to accessibility and cost barriers. This study aimed to evaluate the association between time-in-range (TIR) extrapolated from SMBG and adverse perinatal outcomes in T1DM pregnancies. Methods: A retrospective cohort study included singleton pregnancies with live births and no malformations, starting prenatal care before 20 weeks (2010-2019). Glycemic data were categorized into TIR (63-140 mg/dL), time below range (TBR), and time above range (TAR) and stratified as TIR &lt;50%, 50-70%, and &gt;70%. Logistic regression analyzed independent predictors of adverse outcomes, including prematurity, LGA, and neonatal respiratory distress. Results: Among 140 participants that provided 142,997 capillary blood measurements, 20% had TIR &lt;50%, 53.6% had TIR 50-70%, and 26.4% had TIR &gt;70%. Higher TIR was inversely associated with adverse outcomes. Compared to TIR &lt;50%, TIR 50-70% and TIR&gt;70% were associated with lower risks of prematurity (OR 0.271, 95%CI 0.094-0.786; OR 0.219, 95%CI 0.058-0.826), neonatal respiratory distress (OR 0.341, 95%CI 0.124-0.936; OR 0.122, 95%CI 0.029-0.516), and LGA (OR 0.246, 95%CI 0.084-0.719; OR 0.115, 95%CI 0.028-0.469). Conclusion: Achieving glucose targets during pregnancy is particularly challenging for women with T1DM. Nonetheless, this study demonstrates that even modest achievements such as &gt;50% TIR, extrapolated from SMBG, significantly reduces the risks of prematurity, LGA, and neonatal respiratory distress. These findings highlight the importance of supporting pregnant women with T1DM in achieving individualized glycemic goals to optimize maternal and neonatal outcomes. Disclosure E.A.M. Santos: None. T. Assuncao Zaccara: None. F.C.F. Mikami: None. M.D. Bernardi: None. C. de Freitas Paganoti: None. R.P.V. Francisco: None. R.A. Costa: None.

423-P: Three Decades of Glucose-Lowering Therapy in Patients with Established Coronary Artery Disease—A Real-World Analysis

2025-06-13

MAGDALENA NEYER , Johannes Vogel , PASCAL ELSNER +7 more | Diabetes

Introduction and Objective: We aimed to assess long-term trends in glucose-lowering therapy (GLT) among patients with type 2 diabetes (T2DM) with proven coronary artery disease (CAD). Methods: We investigated T2DM … Introduction and Objective: We aimed to assess long-term trends in glucose-lowering therapy (GLT) among patients with type 2 diabetes (T2DM) with proven coronary artery disease (CAD). Methods: We investigated T2DM patients (n=590) referred to elective coronary angiography and diagnosed with CAD in one of three observational cohort studies (OS): OS1: 1999-2000 (n=190); OS2: 2005-2008 (n=241); OS3: 2022-2023 (n=159). These studies were conducted in a tertiary care hospital in central Europe. Results: From patients with T2DM, 43.2% in OS1, 27.8% in OS2 and 28.3% in OS3 were newly diagnosed at admission and had no GLT (ptrend=0.002). Patients with known T2DM (OS1: n=108, OS2: n=174, OS3: n=114) had a median diabetes duration of 5 years (IQR:1-13), 4 years (IQR:2-8) and 4 years (IQR:&lt;1-17) in OS1, OS2 and OS3, respectively (p=0.343). These patients reported to have some oral GLT in 50.0% (OS1), 72.4% (OS2) and 77.2% (OS3) of cases (ptrend&lt;0.001). A wider array of glucose-lowering drugs was used over time (OS1: 11, OS2: 21, OS3: 24). SGLT2 inhibitors were the most frequently reported class in OS3 (34.0% of reported glucose-lowering drugs) while not available in OS1 and OS2. Sulfonylureas were largely replaced (OS1: 32.1%, OS2: 26.8%, OS3: 2.0%, ptrend&lt;0.001), while metformin remained a key component of therapy (OS1: 31.2%, OS2: 42.1%, OS3: 31.0%). The use of incretin mimetics remained low in OS3: 4.6%; they were not used in OS1 and OS2. The proportion of patients on insulin showed no significant trend through the OS (OS1: 28.7%, OS2: 26.4%, OS3: 17.5%; ptrend&gt;0.05). Achievement of an HbA1c target &lt;7.0% was higher in OS3 (67.9%) than in OS1 (49.2%, p&lt;0.001) and in OS2 (53.9%, p=0.005); ptrend&lt;0.001. Conclusion: Our data show an upward trend in GLT intensity and complexity in T2DM patients with CAD. Significantly more patients reached HbA1c targets in the most recent cohort. However, the use of incretin mimetics remained very low, despite current guideline recommendations. Disclosure M. Neyer: None. J. Vogel: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. B. Larcher: None. A. Mader: None. L. Schnetzer: None. A. Leiherer: None. M. Frick: None. A. Muendlein: None. A. Festa: None. H. Drexel: None. C.H. Saely: None.

1077-P: Improving Glycemic Control in Surgical Patients—Outcomes of an Endocrinology Perioperative Referral Pathway

2025-06-13

Jennifer J. Iyengar , NADA FANOUS , Daniyeh Khurram +7 more | Diabetes

Introduction and Objective: Uncontrolled hyperglycemia increases the risk of surgical site infections (SSIs) and other perioperative complications. The Periprocedural Safety and Quality Improvement Program (PSQIP) at Michigan Medicine (MM) aims … Introduction and Objective: Uncontrolled hyperglycemia increases the risk of surgical site infections (SSIs) and other perioperative complications. The Periprocedural Safety and Quality Improvement Program (PSQIP) at Michigan Medicine (MM) aims to improve perioperative safety through quality improvement (QI) implementation of evidence-based interventions, including SSI reduction via enhanced glycemic control. Here we evaluate outcomes from a “fast track” endocrinology referral pathway established to optimize pre-operative diabetes management. Methods: Patients undergoing surgery at MM with T2DM (if not established with a MM PCP) or T1DM (regardless of PCP) and HbA1c &gt;/=8.5% were eligible for referral. We reviewed referral data from Jan 1st, 2023-Oct 31, 2024 and compared the pre-referral HbA1c to the post-referral (pre-surgery) HbA1c or 14-day GMI for patients who newly established with endocrinology as part of the referral pathway. Results: Thirty-one of the 83 patients referred for pre-operative DM management were seen by endocrinology prior to surgery with average referral HbA1c of 10.6±1.6%. Mean time from referral to appointment was 27 days and the top referring services were cardiac surgery (n=12), ENT (n=4), and GYN (n=4). Three of 31 had an SSI. Nineteen of the 31 have undergone surgery and have both pre- and post-referral HbA1c (6 pending surgery, 3 missing HbA1c, 2 passed, 1 excluded due to discordant fructosamine), HbA1c improved from 10.7±1.6% to 8.1±0.8% (p&lt;0.01, paired t-test) with an average 156 days between measurements. All patients had some improvement in HbA1c (range 0.4-4.7%). Conclusion: Implementation of a “fast track” pre-operative referral pathway to endocrinology demonstrated significant improvement in glycemic control among surgical patients with uncontrolled diabetes. These findings highlight the beneficial effects of multidisciplinary QI approaches to improve pre-operative diabetes management. Disclosure J.J. Iyengar: None. N. Fanous: None. D. Khurram: None. H.A. Fazio: None. J. Neeluru: None. S. Ponnaluri-Wears: None. A. DuKatz: None. A. Thompson: None. J. Wyckoff: None. R. Gianchandani: None. J. Lawton: Consultant; Innomed Savannah, Georgia.

1351-P: New-Onset Hyperglycemia in COVID-19—An Indian Perspective on Clinical Outcomes and Management

2025-06-13

Shiven Bhandari , Sudhir Bhandari , Shashank Joshi +3 more | Diabetes

Introduction and Objective: Hyperglycaemia has emerged as a significant complication in COVID-19, particularly in India, where the prevalence of diabetes is high. The objective of this study was to determine … Introduction and Objective: Hyperglycaemia has emerged as a significant complication in COVID-19, particularly in India, where the prevalence of diabetes is high. The objective of this study was to determine the prevalence, clinical manifestations, severity, and outcomes of new-onset hyperglycaemia in COVID-19 patients without pre-existing diabetes. Methods: A retrospective observational study was conducted on 2750 hospitalised COVID-19 patients, stratified into Group 1 (fasting blood glucose [FBG] ≥126 mg/dL) and Group 2 (FBG &lt;126 mg/dL). Demographic data, inflammatory markers (NLR, CRP, IL-6, D-dimer), imaging, and treatment modalities were analysed. Chi-square and z-score test were used to compare parameters between groups, and logistic regression assessed the association between hyperglycaemia and in-hospital mortality at statistical significance (p &lt; 0.05). Results: Among the cohort, 910 (33.09%) patients had raised FBG, with 64.72% males and 35.28% females. Group 1 exhibited higher rates of fever (31.64% vs. 25.86%), cough (29.46% vs. 26.08%), and dyspnoea (26.38% vs. 19.14%; p &lt; 0.05). Raised FBG correlated with elevated inflammatory markers and severe lung involvement. Group 1 showed higher ICU admissions (p = 0.003), non-invasive ventilation (p = 0.0323) and invasive ventilation (p = 0.0455), longer hospital stays (p = 0.0008), and increased mortality (OR 2.8, 95% CI 1.8-4.2, p &lt; 0.001). Glycaemic control with insulin was achieved in 80% of survivors. Conclusion: New-onset hyperglycaemia is a prevalent and severe complication of COVID-19, associated with worse clinical outcomes and higher mortality. Early detection and targeted glycaemic control are essential to improving prognosis in high-risk populations. Disclosure S. Bhandari: None. S. Bhandari: None. S. Joshi: None. B.D. Saboo: None. G. Rankawat: None. L. Wadhawan: None.

43-PUB: The Risk of Developing Type 1 and Type 2 Diabetes with Preterm Birth—A Systematic Review and Meta-analysis

2025-06-13

Rachel Wine , Jennifer Fu , George Tomlinson +1 more | Diabetes

Introduction and Objective: Preterm birth has been increasingly recognized as a risk factor for chronic conditions including diabetes. This systematic review and meta-analysis assessed the risk of developing type 1 … Introduction and Objective: Preterm birth has been increasingly recognized as a risk factor for chronic conditions including diabetes. This systematic review and meta-analysis assessed the risk of developing type 1 diabetes (T1DM) and type 2 diabetes (T2DM) among individuals born preterm using updated data from recent large cohorts. Methods: We systematically searched MEDLINE and Embase from 1946 to 2024. Case control, cross sectional and cohort studies were included. The primary outcomes were crude and pooled adjusted odds ratio (OR) or hazard ratio (HR) of developing T1DM and T2DM after preterm birth. Results: After screening 2,985 records, 48 full texts were evaluated resulting in 27 records included. The pooled crude OR from 20 studies found a significant increased risk of T1DM in preterm birth with OR 1.13 (95% CI 1.08-1.19). The pooled adjusted HR found a similar estimate with low heterogeneity with HR (95% CI) 1.17 (1.11-1.24). The pooled crude OR of 4 studies on T2DM found OR 1.35 (95% CI 1.24-1.47). The pooled adjusted HR (95% CI) for T2DM was 1.41 (1.20-1.64) whereas the pooled adjusted OR for T2DM was OR (95% CI) 1.31 (0.84-2.04) with high heterogeneity. Conclusion: Our results suggest that preterm birth is associated with a 10-15% increased risk of T1DM. There is also an increased risk of T2DM in those born preterm however data are heterogenous with fewer reports. Disclosure R. Wine: None. J. Fu: None. G.A. Tomlinson: None. D. Feig: Other Relationship; Novo Nordisk. Consultant; Ypsomed.

258-OR: Perioperative Glucose Management and Amputation Outcomes

2025-06-13

Christopher Girgis , Stephanie Behme , Irina Gaynanova +1 more | Diabetes

Introduction and Objective: Patients with diabetes have a 15-34% lifetime risk of foot ulcerations and complications from these ulcers are a leading cause of nontraumatic amputations in the United States. … Introduction and Objective: Patients with diabetes have a 15-34% lifetime risk of foot ulcerations and complications from these ulcers are a leading cause of nontraumatic amputations in the United States. Elevated perioperative glucose (&gt;140 mg/dL or A1c ≥8%) is associated with complications in elective surgeries, but limited data exists on its impact on nonelective amputations. This study aims to assess the effect of perioperative glucose levels on outcomes in patients with diabetes undergoing lower extremity amputations after infectious cases. Methods: This two-year retrospective chart review at a large tertiary health system identified 186 patients who underwent lower extremity amputations between January 1, 2021, and December 31, 2022. Glucose levels were measured preoperatively (120-30 minutes before incision), intraoperatively, and postoperatively (30-120 minutes after surgery). Non-eligible patients included non-diabetic related amputations, incomplete follow-up (&lt;6 months), and missing glucose measurements. Outcomes such as healing time, postoperative infection, and hospital readmissions were assessed. Results: 65 patients met eligibility. Postoperative glucose &gt;180 mg/dL significantly delayed healing by ~ 1.6 weeks (p= 0.0255). Healing time was also influenced by amputation level, with transmetatarsal amputations delaying healing by ~ 2.9 weeks (p&lt;0.001). Postoperative infection and peripheral arterial disease (PAD) added ~2.1 weeks (p &lt;0.001) and ~ 1.6 weeks (p = 0.0046) respectively to the average healing time. A1c levels and preoperative glucose levels were non-significant. Conclusion: Postoperative glucose levels &gt;180 mg/dL delayed healing in diabetic patients undergoing amputations. Healing time was also influenced by amputation level, post operative infection, and PAD. These findings emphasize tight perioperative glucose control and lay the groundwork for future research to optimize glucose management in high-risk procedures. Disclosure C. Girgis: None. S. Behme: None. I. Gaynanova: None. B.M. Schmidt: None.

1185-P: Determining Accuracy of Continuous Glucose Monitoring in Pediatric Patients in the Inpatient Setting

2025-06-13

Eleanor Allen , Laya Ekhlaspour , Eda Cengiz +3 more | Diabetes

Introduction and Objective: Continuous glucose monitoring (CGM) has revolutionized diabetes care in the outpatient setting, though data on CGM accuracy in the pediatric inpatient setting remains lacking. We aim to … Introduction and Objective: Continuous glucose monitoring (CGM) has revolutionized diabetes care in the outpatient setting, though data on CGM accuracy in the pediatric inpatient setting remains lacking. We aim to see whether CGM values in this population, compared to standard hospital point of care blood glucose (POC BG) checks, fall within an acceptable range according to established CGM accuracy analyses. Methods: We conducted a retrospective chart review of pediatric patients aged 1-18 years using CGM devices who were admitted to a children’s hospital system from June 2022 to June 2024. CGM readings were compared with POC BG values within a 5 minute window. We excluded CGM values ≥400 mg/dL or ≤40 mg/dL. We used Surveillance Error Grid (SEG), MARD, and percentage of CGM values within 15%/20%/30% of POC value to determine CGM accuracy. Results: We collected 802 unique POC BG/CGM paired measurements (89 patients). CGM values were within 5% of POC BG values for 20% of pairs, and within 20% of POC BG values for 67% of pairs. In the SEG, 67%, 30%, 1.7%, 0.9% and 0.5% fell in zones A through E respectively. MARD for all device data was 17%. Conclusion: Investigating factors that impact inpatient CGM accuracy by future prospective studies is essential to integrate CGMs into standard inpatient protocols, enhancing real-time decision-making and reducing healthcare costs while prioritizing patient safety and comfort. Disclosure E. Allen: None. L. Ekhlaspour: Other Relationship; Medtronic. Advisory Panel; Abbott, Medtronic. Consultant; Jaeb Center for Health Research. Research Support; MannKind Corporation. Speaker's Bureau; Insulet Corporation. Advisory Panel; Sequel Med Tech. Other Relationship; Tandem Diabetes Care, Inc. Research Support; Abbott. Other Relationship; Sanofi. E. Cengiz: Advisory Panel; Novo Nordisk, Arecor Therapeutics, Eli Lilly and Company, Tandem Diabetes Care, Inc, Portal Insulin, MannKind Corporation. J.C. Wong: Research Support; Abbott, Dexcom, Inc., Tandem Diabetes Care, Inc. Z.D. Perez: None. N.A. Sears: None.

44-PUB: Screening for Postpartum Hyperglycemia after GDM—A Strategy Tailoring Either FBG or OGTT as the Diagnostic Test

2025-06-13

Rafaela Alkmin da Costa , Tatiana Assunção Zaccara , Fernanda Cristina Ferreira Mikami +3 more | Diabetes

Introduction and Objective: Up to one-third of women with GDM develop T2DM postpartum. Despite the importance of early detection, adherence to the postpartum OGTT remains low due to logistical and … Introduction and Objective: Up to one-third of women with GDM develop T2DM postpartum. Despite the importance of early detection, adherence to the postpartum OGTT remains low due to logistical and discomfort challenges. While FBG is a better-tolerated test, it lacks sensitivity in detecting hyperglycemia that only manifests after glucose ingestion. This study aimed to identify factors associated with postpartum hyperglycemia in women with GDM and to propose an optimized screening strategy using FBG or OGTT. Methods: Retrospective cohort of 893 women with GDM who underwent postpartum OGTT between 28 and 180 days after delivery. Clinical and laboratory characteristics were compared between those with normal and abnormal OGTT results and between women with normal and abnormal FBG during OGTT. Multivariate logistic regression identified independent predictors of abnormal results, and ROC curve analysis was used to define optimal cutoff points for FBG and maternal age. Results: Of the 893 women, 168 (18.8%) presented postpartum hyperglycemia. Among them, 90 (54%) had abnormal FBG, and 78 (46%) had abnormal results only after glucose ingestion. Predictors of abnormal OGTT included maternal age (OR 1.04, 95%CI 1.00-1.07), chronic arterial hypertension (OR 1.70, 95%CI 1.14-2.55), and baseline FBG during prenatal care (OR 1.05, 95%CI 1.02-1.08). Predictors of abnormal FBG were baseline FBG (OR 1.06, 95%CI 1.02-1.09) and insulin use during pregnancy (OR 2.75, 95%CI 1.70-4.45). Since insulin use indication varies largely in clinical practice, it was excluded from the algorithm. Targeting OGTT for women with baseline FBG &lt; 97 mg/dL and maternal age ≥ 32 years and/or chronic arterial hypertension, and addressing only FBG for the remaining, reduced the need for OGTT by 49%, achieving 80% sensitivity and 96% accuracy for detecting postpartum hyperglycemia. Conclusion: It is possible to rationalize OGTT use, optimizing postpartum hyperglycemia screening in women that had GDM. Disclosure R. Costa: None. T. Assuncao Zaccara: None. F.C.F. Mikami: None. M.D. Bernardi: None. C. de Freitas Paganoti: None. R.P.V. Francisco: None.

2031-LB: Correlation between Fructosamine and Continuous Glucose Monitoring in the Preoperative Setting

2025-06-13

Hannah Lee , A Behrens , VICTORIA NELSON +4 more | Diabetes

Introduction and Objective: Fructosamine reflects glycemic control over 2-3 weeks via albumin turnover, offering a short-term alternative to HbA1c. Its perioperative use has increased, but no consensus exists on the … Introduction and Objective: Fructosamine reflects glycemic control over 2-3 weeks via albumin turnover, offering a short-term alternative to HbA1c. Its perioperative use has increased, but no consensus exists on the best formula for estimating average glucose from fructosamine. This study assessed the correlation between CGM and fructosamine and identified the best-aligned formula preoperatively. Methods: This retrospective analysis included 30 adult surgical patients with paired preoperative CGM and fructosamine data. Pearson correlations evaluated relationships between fructosamine, CGM-derived mean blood glucose (BG), and estimated A1c using three available formulas. Results: Fructosamine correlated significantly with CGM-derived mean BG (r(28) = 0.39, p = 0.04). Pearson correlations comparing CGM-derived mean BG with estimates from three fructosamine-to-HbA1c conversion formulas showed moderate, significant correlations across all models (r(28) = 0.39, p = 0.03). The Alarcon formula exhibited the strongest correlation, though all three showed similarly significant results. Conclusion: The significant correlation between fructosamine and CGM-derived mean BG supports its role as a short-term glycemic marker in the preoperative setting. The Alarcon formula appears most suitable for estimating glucose and HbA1c from fructosamine, aiding in pre-surgical glycemic assessment. Disclosure H. Lee: None. A. Behrens: None. V. Nelson: None. T. Adel: None. A. Thorgerson: None. A.Z. Dawson: None. C.E. Mendez: Consultant; Siemens Healthcare Diagnostics.

444-P: Protein and mRNA Comparison in Complications of Type 2 Diabetes—Integrating Proteomics with Transcriptomics

2025-06-13

HABIB FRANCIS , Andrzej S. Januszewski , Matthew B. O’Rourke +7 more | Diabetes

Introduction and Objective: We have previously identified 50 proteins associated with T2D vascular complications (CX). We now measured their mRNA expression in T2D patients with and without CX. Methods: RNA … Introduction and Objective: We have previously identified 50 proteins associated with T2D vascular complications (CX). We now measured their mRNA expression in T2D patients with and without CX. Methods: RNA was extracted from citrate plasma samples of 542 people with T2D from the Fenofibrate Intervention and Event Lowering in Diabetes trial (Age: 62±7 yrs; T2D duration: 6±6 yrs; HbA1c: 6.8±1.3%). There were n=179 participants with CX at baseline, n=142 developing first CX during follow-up (FUP) and n=221 who had no CX. OpenArray was used to measure mRNA with normalisation using housekeeping gene (MT-ATP6). For differences between groups ΔΔCT values were used. Results: Seven genes had circulating mRNA levels below the detection limit in all samples, 32 were detected in &lt; 20% of samples. The remaining 11 genes were detected in 23-90% of samples. Genes differentially expressed between T2D patients with and without CX were involved in vascular repair and extracellular matrix remodeling. E.g. FERMT3 mRNA was 1.8-fold higher in those developing macroCX during FUP vs. no CX group. Clusterin mRNA was 1.1-1.5-fold higher with CX during FUP and 1.3-1.7-fold higher with baseline CX vs. no CX. Comparisons of proteomic and mRNA levels across the study groups revealed that in 32% of cases differences in mRNA levels were paralleled in protein level differences. E.g. TLN1 exhibited reduced mRNA and protein expression in subjects who developed both micro- and/or macroCX during FUP. In contrast, in 45% of instances, differences in mRNA were not paralleled by the same differences in protein expression, suggesting potential post-transcriptional regulation in those pathways. Conclusion: These findings underscore the importance of integrating transcriptomic and proteomic analyses to better understand the molecular mechanisms driving vascular complications in T2D and to identify potential therapeutic targets. Disclosure H. Francis: None. A.S. Januszewski: None. M. O'Rourke: None. M.L. Huang: None. F. Ema: None. A.A. Hardikar: None. M.V. Joglekar: None. D. Sullivan: Other Relationship; Amgen Inc. Research Support; Arrowhead Pharmaceuticals, Inc. Other Relationship; Novartis Pharmaceuticals Corporation, Merck Sharp & Dohme Corp. Research Support; Ionis Pharmaceuticals. R.S. Scott: None. A. Jenkins: Advisory Panel; Abbott. Speaker's Bureau; GlaxoSmithKline plc. Research Support; Abbott, Metronics, Ypsomed AG, Insulet Corporation, Jaeb Center for Health Research, Endogenex, Hemsley Charitable Trust. Speaker's Bureau; CSL Seqirus. Research Support; AbbVie Inc, National Institutes of Health, Juvenile Diabetes Research Foundation (JDRF). M.P. Molloy: None. A.C. Keech: Research Support; Abbott, Amgen Inc, ASPEN Australia, Mylan. Speaker's Bureau; Novartis AG, Pfizer Inc. Research Support; Kowa Company, Ltd. Speaker's Bureau; Sanofi. Research Support; AbbVie Inc, Viatris Inc. Funding National Health and Medical Research Council of Australia (GNT1147879)

165-OR: Improving A1C and CGM Average Glucose Alignment—The Updated Glucose Management Indicator (GMI)

2025-06-13

Richard M. Bergenstal , Yongjin Xu , Timothy C. Dunn +2 more | Diabetes

Introduction and Objective: The not-infrequently observed disconnect between A1C and GMI, particularly at low and high A1C levels, can create clinical management difficulties. Our aim was to evaluate the agreement … Introduction and Objective: The not-infrequently observed disconnect between A1C and GMI, particularly at low and high A1C levels, can create clinical management difficulties. Our aim was to evaluate the agreement of an updated GMI metric (uGMI) with A1C and potential use in diabetes management. Methods: The GDAC study (n=257) collected CGM data and bi-monthly A1C for 26 weeks for those with diabetes across different race groups. GMI was calculated by an empirical known formula employing average glucose (AG) levels, GMI(%)=0.02392*AG+3.31, while the uGMI formula accounts for population-based red blood cell factors, uGMI(%) = (15.36/AG+0.0426)-1. Analysis was replicated in a real-world dataset (n=2,074). Results: GDAC showed a disconnect between original GMI and A1C with regression slope value up to 25% outside unity, a difference more pronounced in the Black group at 40%. Using uGMI, regression slopes improved to within 2 and 6% of unity in the non-Black and Black groups, respectively. For the same AG, the Black group displayed higher A1C values than the non-Black group, at all HbA1c ranges.The misalignment between GMI and A1C was more pronounced in real-world data with values up to 50% outside unity, improving to within 3% of unity with uGMI. Conclusion: The uGMI metric is superior to the original GMI at reflecting A1C, promising to refine interpretation of CGM data and improve clinical decision-making. Disclosure R.M. Bergenstal: Advisory Panel; Abbott. Research Support; Abbott. Consultant; Abbott. Research Support; Dexcom, Inc. Consultant; Dexcom, Inc., Eli Lilly and Company. Research Support; Eli Lilly and Company. Consultant; Novo Nordisk. Research Support; Novo Nordisk. Consultant; Roche Diabetes Care, Sanofi, Medtronic. Research Support; Medtronic, Insulet Corporation, Hemsley Charitable Trust. Other Relationship; MannKind Corporation. Consultant; Medscape. Research Support; National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc, UnitedHealth Group. Consultant; Vertex Pharmaceuticals Incorporated, Ascensia Diabetes Care, American Diabetes Association, Hygieia, embecta, Senseonics, Zealand Pharma A/S. Y. Xu: Employee; Abbott. T. Dunn: Employee; Abbott. Other Relationship; Omada Health. P. Choudhary: Speaker's Bureau; Abbott. Advisory Panel; Dexcom, Inc. Consultant; Insulet Corporation. Advisory Panel; Ypsomed AG, embecta, Sanofi. Speaker's Bureau; Lilly Diabetes, Medtronic. Advisory Panel; Roche Diabetes Care. Consultant; Cambridge Mechatronics. R. Ajjan: Research Support; Abbott. Speaker's Bureau; Abbott, Boehringer-Ingelheim. Advisory Panel; AstraZeneca, Novo Nordisk.

2040-LB: Testing a Continuous Glucose Monitoring Assessment Tool for Congenital Hyperinsulinism

2025-06-13

Kristen Rohli , Katherine Lord , Tai L.S. Pasquini +2 more | Diabetes

Introduction and Objective: The purpose of this project was to generate and test a tool to determine whether individuals with congenital hyperinsulinism (HI) may confer benefit from a continuous glucose … Introduction and Objective: The purpose of this project was to generate and test a tool to determine whether individuals with congenital hyperinsulinism (HI) may confer benefit from a continuous glucose monitor (CGM) as part of their glucose management plan. Unlike diabetes, where CGMs are integrated into closed-loop systems to manage hypo- and hyperglycemia, the primary concern in HI is hypoglycemia. While CGMs are not approved for use in HI, they are increasingly being used off-label. In the HI Global Registry, 51% of participants reported using CGM (n=255). Methods: The Congenital Hyperinsulinism International Collaborative Research Network glucose monitoring workgroup developed a mutual decision-making tool for physicians and families to evaluate nine factors of life with HI. The tool generates a score to facilitate conversations about the value of adding CGM to glucometer use for each individual. Results: Six HI Centers of Excellence retrospectively assessed up to 20 HI patients at each center. The tool’s assessment was compared to the physician’s real-world assessment for each individual, and agreement was found in 87/89 (88%) cases. This included instances where both the tool and physician agreed the patient would and would not benefit from CGM. Five tool questions were significantly associated with CGM benefit. Of those scored as “may confer benefit” by the tool, 5/13 (38%) received CGM from their physician. Conclusion: This is the first structured framework to assess the potential benefits of CGM use for people with HI. This tool should be used to facilitate clinician-family discussions about CGM use to improve HI management for families with HI. Disclosure K. Rohli: Other Relationship; European Union, Rezolute Bio, Zealand Pharma A/S, Hanmi Pharm. Co., Ltd, Rhythm Pharmaceuticals, Inc. K. Lord: None. T. Pasquini: Other Relationship; European Union, Hanmi Pharm. Co., Ltd, Rezolute Bio, Zealand Pharma A/S, Rhythym. J. Raskin: Other Relationship; European Union, Rezolute Bio, Hanmi Pharm. Co., Ltd, Zealand Pharma A/S, Rhythm Pharmaceuticals, Inc. P.S. Thornton: Advisory Panel; neurocrine. Research Support; Spruce Biosciences, Zealand Pharma A/S. Consultant; Rezolute Bio, Crinetics Pharmaceuticals, Inc.

1456-P: Clinical Course of Incident Diabetes in American Indian and Alaska Native People following COVID-19 Illness

2025-06-13

JAMES KECK , Sara Bressler , MARY E. LACY | Diabetes

Introduction and Objective: Studies report that COVID-19 illness increases diabetes risk, but the clinical course of incident diabetes following COVID-19 illness is unknown. We compared the course of new onset … Introduction and Objective: Studies report that COVID-19 illness increases diabetes risk, but the clinical course of incident diabetes following COVID-19 illness is unknown. We compared the course of new onset diabetes in American Indian and Alaska Native people with and without evidence of prior COVID-19 illness. Methods: We used de-identified patient data from the Indian Health Service’s National Patient Information Reporting System to identify individuals with new onset diabetes from 3/1/2020-12/31/2021. We created cohorts with and without documented COVID-19 infection (diagnosis codes and labs) preceding diabetes diagnosis. We excluded individuals with prevalent diabetes (diagnosis codes, labs, and medication data) from three years prior to cohort entry. We compared baseline characteristics and glycemic control (A1c and severe glycemic events) and diabetes medication use over one year of follow up between cohorts. Results: We identified new diabetes diagnoses in 3,164 people with and 24,218 people without antecedent COVID-19 infection. Baseline characteristics and A1c values at diagnosis and one year were similar across cohorts. A greater percentage of the COVID-19 cohort received diabetes medication. Conclusion: Individuals diagnosed with diabetes following COVID-19 illness had A1c levels similar to the no-COVID-19 cohort but were more likely to receive diabetes medication. Disclosure J. Keck: None. S. Bressler: None. M.E. Lacy: None. Funding National Institutes of Health (R34DK132548-01S1)

1107-P: Assessment of Barriers to Pediatric Diabetes Camp

2025-06-13

Erica R. Gumkowski , Noor Alicezah Mohd Kasim , GQ Zhou | Diabetes

Introduction and Objective: This project will identify the prevalence of barriers to attending pediatric diabetes camp for families of children with diabetes, in order to identify areas of change and … Introduction and Objective: This project will identify the prevalence of barriers to attending pediatric diabetes camp for families of children with diabetes, in order to identify areas of change and increase attendance, specifically minority youth attendance, to improve overall diabetes management and long term health outcomes in pediatric populations. Methods: A cross-sectional survey was conducted on 124 parents/caregivers of children with diabetes at the Corewell Health West Pediatric Endocrinology Clinic in Grand Rapids, Michigan (Feb 7 - Jun 6, 2024). Every parent and/or legal guardian with a child that has diabetes at our institution was eligible. A multiple correspondence analysis (MCA) with the MCA() function in the FactoMineR R package was applied to all 28 potential barriers. All results from the MCA() function were visualized with the factoextra R package. Survey results were also analyzed for frequency. Results: The top two percentages of variance that can be explained by the first two MCA dimensions were 39.4% for dimension 1 and 12.6% for dimension 2. The categories that contributed the most to both dimensions were: concerns for high blood sugars, accommodation of child’s emotional and/or social well being, and satisfactory diabetes care while at camp. The cost of attendance and transportation to/from camp were the most frequently reported barriers. Conclusion: Pediatric diabetes camps remain underutilized, particularly by racial/ethnic minority families, due to barriers like cost, transportation, and diabetes management concerns. Limited awareness of scholarships and the burden of transportation costs compound these issues, while psychosocial factors like mental health and identity concerns further hinder access. Addressing these challenges through better communication, financial aid, and inclusive support systems can improve camp accessibility. Expanding research across diverse populations is crucial to fostering equitable participation and improving outcomes for children with diabetes. Disclosure E. Gumkowski: None. N. Kasim: None. G. Zhou: None.