Assessment of Capillary Blood Glucose Levels as a Prognostic Indicator in Acute Ischemic Stroke

Acute Stroke is an abrupt onset of a neurological deficit attributable to a focal vascular cause. The diagnosis of stroke is based on clinical examination, and brain imaging. Cerebral ischemia is caused by a reduction in blood flow lasting longer than several seconds with manifestation of neurologic symptoms due to infarction or death of brain tissue because neurons utilise only glucose and lack glycogen stores, so energy failure is rapid. Neurologic signs and symptoms lasting for >24 hours or brain infarction demonstrated on brain imaging is known as Acute Stroke.[1] Abnormal blood glucose at the time of acute stroke is associated with poor clinical outcomes, longer in-hospital stay and mortality. We wanted to evaluate the influence of abnormal capillary glucose levels on functional outcomes by grading the Acute Ischemic Stroke patient on modified Rankin scale.METHODSThis cross sectional study was conducted for a period of 6 months in the medicine and neurology wards, ICU in a tertiary care rural hospital in central India and included a total of 35 patients after obtaining institutional ethical committee clearance. The capillary blood glucose samples were taken using a standard glucometer. Capillary blood glucose was determined at the time of admission, each day within the first 72 hrs. Two values of blood glucose were considered; admission value and max. value within the 1st 72 hrs. Functional prognosis was assessed on Modified Rankin scale at the time of discharge or 1 month. The categorical variables were assessed using chi-square test and odd’s ratio and p-value were calculated and assessed. The association of altered capillary glucose levels with functional outcomes on modified Rankin scale were analysed. The data were entered in excel spreadsheet and all the statistical analysis was conducted using STATA version 14.2 software.RESULTSA significant correlation between the higher admission capillary blood glucose levels with the outcomes on modified Rankin scale after 1 month or after discharge was found (p-0.0032). Hyperglycaemia at the time of admission with poor prognosis on mRS (p-value 0.007) was also found.CONCLUSIONSThe results of the study reveal that the patients with admission hyperglycaemia have poor prognosis as compared to the normoglycemic patients. There is a significantly positive correlation between the altered capillary blood glucose levels at the onset of stroke and functional prognosis of the patients with stroke after treatment.

Cambios en el perfil proteómico de preadipocitos con diferentes condiciones metabólicas / Changes in the proteomic pro/ile of preadipocytes with different metabolic status

Resumen Introducción y objetivos: El tejido adiposo subcutáneo se considera un depósito con un papel protector desde un punto de vista metabólico. El exceso de tejido adiposo desencadena en obesidad, la cual, está acompañada típicamente por resistencia a insulina, dislipidemia, e hipertensión arterial. No obstante, se conoce que existe un subgrupo de obesos que parecen estar protegidos de dichas complicaciones. Estos individuos son definidos como obesos sanos metabólicamente. A pesar de los avances en el conocimiento de las alteraciones que suceden en el tejido adiposo en obesidad, aún se desconocen los mecanismos que subyacen en el desarrollo de resistencia a insulina. Por lo tanto, en este trabajo, se estudió la asociación entre obesidad y desarrollo de enfermedad metabólica identificando factores y procesos que determinan la transición desde el fenotipo obeso sano y no sano, empleando preadipocitos provenientes de tejido adiposo subcutáneo. Metodología: Se emplearon datos de un estudio de proteómica comparada de preadipocitos de tejido subcutáneo obtenidos de pacientes obesos normoglucémicos no resistentes a insulina y de pacientes obesos con diabetes mellitus de tipo 2. El estudio proteómico, se llevó a cabo utilizando la técnica de iTRAQ combinada con LC-MSMS. Resultados y conclusiones: Las diferencias entre preadipocitos de tejido adiposo subcutáneo en sujetos normoglucémicos y con diabetes, afectan sobre todo a proteínas citosólicas y, en particular, a proteínas relacionadas con procesos metabólicos mientras que, las membranales no cambian entre fenotipos obesos. En el estudio se identificaron importantes diferencias en el perfil proteómico de los preadipocitos de tejido adiposo subcutáneo en obesidad, tanto en sujetos normoglucémicos como diabéticos, apoyando la importancia de estas células en el mantenimiento de la identidad del depósito graso. También se encontró que, la transición desde el fenotipo obeso sano hacia el no sano conlleva un mayor desarrollo de estrés oxidativo e inflamación en las células precursoras adipocitarias.

Abstract Introduction and objectives: The subcutaneous adipose tissue is considered as a depot with a protective role from a metabolic point of view. An excess of adipose tissue is triggered in obesity, which is accompanied by insulin resistance, dyslipidemia and arterial hypertension. However, it is known that, there is a subgroup of obese people who seem to be protected from obese complications. These individuals are defined as metabolically healthy obese. Despite the advances in the knowledge of the alterations that occur in adipose tissue during obesity, the mechanisms underlying the development of insulin resistance are still unknown. Therefore, in this work, we studied the association between obesity and the development of metabolic disease, we identified factors and processes that determined the transition of healthy and unhealthy obesity phenotype, using preadipocytes from subcutaneous adipose tissue. Methods: Data obtained from a comparative proteomics study of subcutaneous adipose tissue preadipocytes from normoglycemic obese patients-not resistant to insulin and from obese patients with type 2 diabetes mellitus were used. The proteomic study was carried out using the iTRAQ combined with LC -MSMS. Results and conclusions: The differences between pre-adipocytes of subcutaneous adipose tissue in normoglycemic subjects and with diabetes affect mainly cytosolic proteins and, in particular, proteins related to metabolic processes while, membrane proteins do not change between obese phenotypes. In this study, we identified significant differences in the proteomic profile of preadipocytes from subcutaneous adipose tissue in obesity in both, normoglycemic and diabetic subjects, supporting the importance of these cells in the maintenance of the fat depot identity. We also found that, the transition from unhealthy to healthy phenotype in obesity, leads to further development of oxidative stress and inflammation in adipocyte precursor cells.

Achieving triple treatment goals in multi-ethnic Asian patients with type 2 diabetes mellitus in primary care

@#Introduction: Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDLCholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines. Methods: A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore. The demographic and clinical data for this sub-population with both T2DM and dyslipidemia were collated with laboratory and treatment information retrieved from their electronic health records. The combined data was then analyzed to determine the proportion of patients who attained triple treatment goals, and logistic regression analysis was used to identify factors associated with this outcome. Results: 665 eligible patients [60.5% female, 30.5% Chinese, 35% Malays, and 34.4% Indians] with a mean age of 60.6 years were recruited. Of these patients, 71% achieved LDL-C ≤2.6 mmol/L, 70.4% had BP <140/90 mmHg, and 40.9% attained HbA1c ≤7%. Overall, 22% achieved the triple treatment goals for glycemia, BP, and LDL-C control. The major determinants were the number of diabetic medications and intensity of statin therapy. Conclusion: Eight in ten patients with T2DM failed to achieve concurrent glycemic, BP, and LDL-C treatment goals, subjecting them to risks of vascular complications. Primary healthcare professionals can mitigate these risks by optimizing therapeutic treatment to maximize glycemia, dyslipidemia, and BP control.

Short-term treatment with metformin improves the cardiovascular risk profile in first-degree relatives of subjects with type 2 diabetes mellitus who have a metabolic syndrome and normal glucose tolerance without changes in C-reactive protein or fibrinogen

OBJECTIVE: To study if metformin, when administered to first-degree relatives of type 2 diabetes mellitus subjects who have metabolic syndrome and normal glucose tolerance, could improve the cardiovascular risk profile and reduce the levels of both C-reactive protein and fibrinogen. INTRODUCTION: Metabolic syndrome is associated with higher cardiovascular morbidity and mortality. Metformin has vasculo-protective effects even in normoglycemic subjects, and C-reactive protein and fibrinogen are considered markers of endothelial injury and inflammation. METHODS: Thirty-one non-diabetic first-degree relatives of type 2 diabetes mellitus subjects with metabolic syndrome were randomized (1:1) and double-blinded for placement in the placebo and metformin groups (850mg bid/±90days); 16 subjects were administered metformin (mean age 40.0 [33.5-50] years; 13 females) and 15 subjects were in the placebo group (mean age 37.0 [32-42] years; 9 females). Blood samples were collected at baseline and at the end of treatment for biochemical analyses, including an assessment of C-reactive protein and fibrinogen levels. RESULTS: Metformin improved the lipid profile and decreased fasting plasma glucose, systolic blood pressure, weight and body mass index without changing body composition. For those in the placebo we identified no changes in fibrinogen (282.2 [220.4-323.7] mg/L vs. 286.7 [249.6-295.1] mg/L; NS) or in C-reactive protein levels (0.68 [0.3-1.2] vs. 0.64 [0.3-1.0] mg/L; NS). The same was also observed for the levels of fibrinogen (303.9 [217.6-347.6] mg/L vs. 290.9 [251.5-301.9] mg/L; NS) and C-reactive proteins (0.78 [0.3-1.1] vs. 0.80 [0.4-0.9] mg/L; NS) in the metformin group. CONCLUSIONS: Metformin treatment in first-degree relatives of type 2 diabetes mellitus sufferers who have metabolic syndrome and normal glucose tolerance improved the cardiovascular risk profile without changing the levels of C-reactive protein and fibrinogen.