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Reducing glycemic excursion is of great importance to the successful practice for diabetes intervention and complication prevention. This is also an advantage of traditional Chinese medicine (TCM) in the treatment of diabetes. More and more studies have shown that the dysfunction of islet microcirculation is the key pathological link for glycemic excursion caused by decrease of islet function. The over-activation of local renin-angiotensin system (RAS) in islet microcirculation is a key ring to the islet decompensation, intimately related to the functionality of islet endocrine cells, and has gradually become the focus in the study of islet functionality. In TCM, it is believed that glycemic excursion in diabetes mellitus is closely related to the incapability of "spleen Qi to dispersing essence". If spleen fails to disperse essence, the essence will be accumulated in the body and become harmful stuffs. The stuffs further break the blood glucose homeostasis, acting as the key pathogenesis of diabetes. By supplementing the "spleen" Qi and promoting the dispersion of nutrient substance (hormone) in "pancreas", the balance between sugar-regulated hormones can be restored and therefore glycemic excursion can be reduced. However, the regulation mechanism of "spleen Qi to dispersing essence" on glycemic excursion remains unclear at present. Based on the previous clinical and scientific work, the following ideas were proposed by the authors:the effects of "spleen Qi to dispersing essence" on the improvement of islet function and the regulation of glycemic excursion may be achieved by promoting islet microcirculation, and its mechanism may be related to inhibiting the activation status of local RAS in islet microcirculation. It is important to note that the mutual antagonistic relationship between the signal pathways of RAS in islet microcirculation is similar to the antagonistic relationship between "spleen Qi to dispersing essence" and spermatozoa in TCM. Thus, the mechanism of "spleen Qi to dispersing essence" on the regulation mechanism of blood glucose fluctuations needs to be further explored from the perspective of the overall regulation of RAS in islet microcirculation, so as to reveal the scientific connotation of TCM on regulating the body's environmental homeostasis and reducing glycemic excursion in diabetic patients.
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Objective To explore the clinical role and value of detailed target management on patients with diabetic ketoacidosis (DKA) complicated with acute pancreatitis (AP).Methods The clinical data of patients with DKA complicated with AP admitted to the Department of Emergency of Linyi City People's Hospital from January 2013 toDecember 2016 were retrospectively analyzed. The patients managed by detailed target management (from January 2015 to December 2016) were served as the observation group (detailed target management group), and those managed by routine management (from January 2013 to December 2014) were set as the control group (traditional management group). The gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Ranson score, underlying disease, blood glucose, glycemic excursion [including: standard deviation of blood glucose (SDBG) level, the largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursion (MAGE), and absolute means of daily difference (MODD) in blood glucose], remission time of DKA, the incidence of MODS and mortality were compared between two groups.Results There were no significant differences in sex, age, APACHE Ⅱ score, Ranson score, blood glucose and the distribution of underlying disease between the two groups (allP > 0.05). Compared with the traditional management group, the level of blood glucose in the detailed target management group was decreased steadily, blood glucose excursions of within-day and day-to-day were significantly reduced on the 2nd and 3rd day (the 2nd day: SDBG was 3.01±1.38 vs. 4.27±1.89, LAGE was 4.14±1.52 vs. 5.62±2.54, MAGE was 0.61±0.35 vs. 1.01±0.57, the 3rd day: SDBG was 2.94±0.91 vs. 3.83±1.29, LAGE was 3.81±1.05 vs. 5.02±2.13, MAGE was 0.58±0.32 vs. 0.96±0.52), MODD: 0.82±0.81 vs. 1.59±1.12, allP < 0.05]. Remission time of DKA and the staying time at emergency department after the implementation of the detailed target management was significantly reduced [remission time of DKA (days): 1.73±0.88 vs. 2.57±1.09, the staying time at emergency department (days): 6.13±0.99 vs. 7.29±1.38, bothP < 0.05], and no hypoglycemic events occurred. There was no significant difference in the incidence of MODS and mortality between the two groups (bothP > 0.05).Conclusions Detailed target management can help the salvage and treatment of patients with diabetic ketoacidosis complicated with acute pancreatitis, control the blood glucose steadily, and significantly shorten the remission time of DKA and the stay time at emergency department.
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Objective To explore the influencing factors of glycemic variability in 217 cases of hospitalized patients with type 2 diabetes. Meth-ods A total of 217 cases of hospitalized patients with type 2 diabetes,whom received continuous glucose monitoring from January 2013 to Janu-ary 2016,were enrolled for the study. The evaluation variables of glycemic variability included mean amplitude of glycemic excursion(MAGE) and standard deviation of blood glucose(SDBG). Results The difference of glycemic variability was compared by gender,age,diabetic duration, HbA1c,BMI. The values of MAGE and SDBG in females were higher than those in males(P<0.05). There was no significant difference between various age groups and various diabetic duration. The level of glycemic variability increased gradually with the extension of HbA 1c(P<0.05). The level of glycemic variability increased gradually with the extension of body mass index(BMI)(P<0.05). Logistic regression analysis showed that gender(OR=0.67,P=0.02),HbA1c(OR=0.8,P=0.02),diastolic blood pressure(OR=0.9,P=0.03),triglycerides(OR=4.6,P=0.007),cholesterol(OR=0.6,P=0.007). HDL-C(OR=0.09,P=0.006)were significant influencing factors of glycemic variability in hospital-ized patients with type 2 diabetes. Conclusion Gender,HbA1c,BMI,and blood fat are significant influencing factors of glycemic variability while age and duration are not related to the glycemic variability in hospitalized patients with type 2 diabetes.
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BACKGROUND: Management of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET) for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM) by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration. METHODS: Twenty diabetic inpatients wearing a CGM system were enrolled. For MIET measurement, a plastic microneedle array was applied to the skin as pretreatment, and hydrogels were placed on the pretreated area to collect interstitial fluid. Hydrogels were replaced every 2 or 4 hours and AUC was predicted on the basis of glucose and sodium ion levels. RESULTS: AUC predicted by MIET correlated well with that measured by CGM (r=0.93). Good performances of both consecutive 2- and 4-hour measurements were observed (measurement error: 11.7%±10.2% for 2 hours and 11.1%±7.9% for 4 hours), indicating the possibility of repetitive measurements up to 8 hours. The influence of neither glucose fluctuation nor average glucose level over the measurement accuracy was observed through 8 hours. CONCLUSION: Our system showed good relationship with AUC values from CGM up to 8 hours, indicating that single pretreatment can cover a large portion of glucose excursion in a day. These results indicated possibility of our system to contribute to convenient monitoring of glucose excursions for a long duration.
Subject(s)
Humans , Area Under Curve , Extracellular Fluid , Glucose , Hydrogels , Hydrogels , Hyperglycemia , Inpatients , Plastics , Skin , SodiumABSTRACT
Objective To observe the characteristics of glycemic excursion and to evaluate the therapeutic effects on blood glucose in new dignosed type 2 diabetes mellitus after being given continuous subcutaneous insulin infusion(CS Ⅱ).Methods Thirty-eight new dignosed type 2 diabetes mellitus patients were randomly divided into group CS Ⅱ(n=18) and group many-times subcutaneous insulin infusion(MS Ⅱ,n=20).The blood glucose lasted for three days were monitored by continuous glucose monitoring system(CGMS).Results The abnormal glucose metabolism in two groups were markedly released after two weeks treatment,the mean blood glycemic(MBG),mean amphtude of glycemic excursions(MAGE),means of daily differences(MODD) and the percentage of blood glucose beyond 7.8 mmol/L and 11.1 mmol/L after therapy were all significantly decreased compared with those of before therapy (P＜0.001);the average levels of blood glucose before and after diet were decreased obviously as well(P＜0.05,P＜0.01).All index in group CS Ⅱ were lower than that of group MS Ⅱ (P＜0.01,P＜0.001).Conclusion Continuous glucose monitoring system can assess the changes characteristics of blood glucose effectively,continuous subcutaneous insulin infusion was an effective means of controlling blood glucose.
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Thirty-eight individuals with normal glucose regulation and thirty-nine newly diagnosed type 2 diabetic patients were observed by continuous glucose monitoring system(CGMS)for three days.The mean blood glucose,mean amplitude of glycemic excursions(MAGE),and absolute means of daily differences(MODD)were calculated in each subject.The results suggested that the amplitude of glyeemic excursions revealed by CGMS could be used to evaluate the quality of glycemic control in type 2 diabetic patients.