Xiaofeng Lv

The Effects of Glucose Fluctuation on the Severity of Coronary Artery Disease in Type 2 Diabetes Mellitus

Objectives. To explore the difference of glucose fluctuations between the normal subjects and diabetes mellitus (DM) patients and explore their impact on the development of CAD in type 2 DM patients. Methods. The subjects were divided into 3 groups: normal control (group A, n = 40), type 2 DM patients without cardiovascular complications (group B, n = 56), and type 2 DM patients with cardiovascular complications (group C, n = 92). The SYNTAX scores were collected in group C. CGMS for 72 h was applied on all the subjects. The indexes such as MBG and the LAGE were calculated. Glycemic excursions were compared between groups A, B, and C, respectively. Results. The tested indexes had significant differences among the three groups. SYNTAX scores are related to systolic blood pressure, CRP, MAGE, and HbA1c and are significantly correlated at 6:00–8:00 and 11:00–13:00 time points in group C. Conclusions. Compared with normal subjects, T2DM patients have greater blood glucose fluctuations; T2DM patients with CAD have larger glucose fluctuations than T2DM patients without CAD. Blood glucose fluctuations are positively correlated with carotid artery intima-media thickness in T2DM patients and have a significant influence on the development of coronary artery.

Investigating the role of backward walking therapy in alleviating plantar pressure of patients with diabetic peripheral neuropathy.

OBJECTIVE To investigate the effect of combination therapy of backward walking training and alpha-lipoic acid (ALA) treatment on the distribution of plantar pressure in patients with diabetic peripheral neuropathy (DPN). DESIGN This study is a double-blinded, randomized controlled trial. The test group was treated with combination therapy of backward walking exercise and ALA (ALA for 2wk, backward walking exercise for 12wk), and the control group only received ALA treatment. SETTING Clinical and laboratory setting. PARTICIPANTS Patients with DPN (N=60) were divided into the test group (n=30) or control group (n=30). INTERVENTIONS Backward walking exercise with ALA treatment for the test group; lipoic acid treatment for the control group. MAIN OUTCOME MEASURE Plantar pressure before and after treatment was tested and analyzed with the flatbed plantar pressure measurement system. RESULTS After treatment, peak plantar pressure in the forefoot dropped for both the test and control groups; peak plantar pressure for the test group dropped significantly. Peak plantar pressure in the medial foot slightly increased for the test group, suggesting a more even distribution of plantar pressure in the test group after treatment. CONCLUSIONS The combination therapy of ALA and backward walking proved to be more effective than ALA monotherapy. Backward walking also proved to have an ameliorating effect on balance ability and muscle strength of patients with DPN.

The Accuracy and Efficacy of Real-Time Continuous Glucose Monitoring Sensor in Chinese Diabetes Patients: A Multicenter Study

BACKGROUND The purpose of this multicenter study was to investigate the accuracy of a real-time continuous glucose monitoring sensor in Chinese diabetes patients. SUBJECTS AND METHODS In total, 48 patients with type 1 or 2 diabetes from three centers in China were included in the study. The MiniMed Paradigm(®) 722 insulin pump (Medtronic, Northridge, CA) was used to monitor the real-time continuous changes of blood glucose levels for three successive days. Venous blood of the subjects was randomly collected every 15 min for seven consecutive hours on the day when the subjects were wearing the sensor. Reference values were provided by the YSI(®) 2300 STAT PLUS™ glucose and lactate analyzer (YSI Life Sciences, Yellow Springs, OH). RESULTS In total, 1,317 paired YSI-sensor values were collected from the 48 patients. Of the sensor readings, 88.3% (95% confidence interval, 0.84-0.92) were within±20% of the YSI values, and 95.7% were within±30% of the YSI values. Clarke and consensus error grid analyses showed that the ratios of the YSI-sensor values in Zone A to the values in Zone B were 99.1% and 99.9%, respectively. Continuous error grid analysis showed that the ratios of the YSI-sensor values in the region of accurate reading, benign errors, and erroneous reading were 96.4%, 1.8%, and 1.8%, respectively. The mean absolute relative difference (ARD) for all subjects was 10.4%, and the median ARD was 7.8%. Bland-Altman analysis detected a mean blood glucose level of 3.84 mg/dL. Trend analysis revealed that 86.1% of the difference of the rates of change between the YSI values and the sensor readings occurred within the range of 1 mg/dL/min. CONCLUSIONS The Paradigm insulin pump has high accuracy in both monitoring the real-time continuous changes and predicting the trend of changes in blood glucose level. However, actual clinical manifestations should be taken into account for diagnosis of hypoglycemia.

Metformin Alleviated Aβ-Induced Apoptosis via the Suppression of JNK MAPK Signaling Pathway in Cultured Hippocampal Neurons.

Both diabetes and hyperinsulinemia are confirmed risk factors for Alzheimers disease. Some researchers proposed that antidiabetic drugs may be used as disease-modifying therapies, such as metformin and thiazolidinediones, although more evidence was poorly supported. The aim of the current study is to investigate the role of metformin in Aβ-induced cytotoxicity and explore the underlying mechanisms. First, the experimental results show that metformin salvaged the neurons exposed to Aβ in a concentration-dependent manner with MTT and LDH assay. Further, the phosphorylation levels of JNK, ERK1/2, and p38 MAPK were measured with western blot analysis. It was investigated that Aβ increased phospho-JNK significantly but had no effect on phospho-p38 MAPK and phospho-ERK1/2. Metformin decreased hyperphosphorylated JNK induced by Aβ; however, the protection of metformin against Aβ was blocked when anisomycin, the activator of JNK, was added to the medium, indicating that metformin performed its protection against Aβ in a JNK-dependent way. In addition, it was observed that metformin protected the neurons via the suppression of apoptosis. Taken together, our findings demonstrate that metformin may have a positive effect on Aβ-induced cytotoxicity, which provides a preclinical strategy against AD for elders with diabetes.

Hypoglycemia and Blood Glucose Fluctuations in the Application of a Sensor-Augmented Insulin Pump

BACKGROUND The purpose of this study was to understand the effect of sensor-augmented insulin pump (SAP) use on hypoglycemia and blood glucose (BG) fluctuations. SUBJECTS AND METHODS Sixty patients with type 2 diabetes mellitus were randomly assigned to three groups of treatment with SAP, continuous subcutaneous insulin infusion (CSII), or multiple daily injection (MDI) therapy for 6 days. Parameters of glycemic control that were determined included mean BG concentration (MBG), SD of BG (SDBG), mean amplitude of glycemic excursions (MAGE), absolute means of daily differences (MODD), 24-h area under the curve at 10 h (AUC10), 24-h area under the curve at 3.9 h (AUC3.9), and Low Blood Glucose Index (LBGI). RESULTS No significant differences were observed among the three groups in terms of MBG, SDBG, MAGE, or MODD at the beginning of treatment. The MBG, SDBG, MAGE, MODD, and total AUC10 of the SAP group improved over the 4 days of the intervention compared with the CSII and MDI groups; however, no significant differences were observed among the three groups in terms of total AUC3.9 and LBGI. CONCLUSIONS Compared with CSII and MDI therapy, SAP therapy was able to rapidly lower mean BG and reduce BG level fluctuations with no increased risks of hypoglycemia.

Impact of glucose fluctuation on acute cerebral infarction in type 2 diabetes.

OBJECTIVE This study aimed to describe the frequency and temporal profile of acute cerebral infarction (ACI) using a continuous glucose monitoring system (CGMS) in patients with and without type 2 diabetes mellitus (T2DM) and explore the impact of blood glucose fluctuations on the short-term prognosis of ACI. METHODS The subjects were divided into four groups: T2DM with acute cerebral infarction (DMCI, Group A, n=56); T2DM without acute cerebral infarction (DM-NCI, Group B, n=36); Acute cerebral infarction patients without T2DM (NDM-CI, Group C, n=54); Healthy control group (NG, Group D, n=36). The National Institutes of Health Stoke Scale (NIHSS) and modified Rankin scale (mRs) were collected in Group A and C. All subjects were monitored for 72 hours using the CGMS. Indices such as fasting blood glucose (FBG) and mean amplitude of glycemic excursions (MAGE) were calculated. Glycemic excursions were compared between Group A, B, C and Group D, respectively. Multiple linear regression analysis and logistic analysis was applied. RESULTS MAGE is related to NIHSS, homocysteine (HCY), HOMA-IR, FBG, CRP and IMT, while NIHSS is related to CRP, HCY, HOMA-IR, IMT. The factors impacting the short-term prognosis of ACI were NIHSS, HBA1C and MAGE. CONCLUSION Larger glucose fluctuations are associated with more stroke risk factors and are associated with a poorer short-term prognosis. More attention should be paid to glucose fluctuations in patients with ACI and a history of T2DM.

Bone loss in Gorham's disease: A case study.

In this study, a rare disease with characteristics of spontaneous osteolysis of the bone is reported. The patient was an eight-year-old male, who was admitted with shortness of breath. The absence of the right clavicle was identified by radiography. However, the change to the right clavicle was not malignant, as indicated by bone scanography. The biopsy of the right cervical rib revealed a number of vascular fibrous tissues and vessels distending and shunting together; however, no cell proliferation was observed. In addition, no acid-fast bacillia or malignant cells were detected in the sample of pleural effusion from the patient. Low hemoglobin (93 g/l) and a slight elevation of alkaline phosphatase levels (133 U/l) were observed; however, the other laboratory examination results were normal. The follow-up investigation and radiotherapy results indicated that the osteolysis of the skull and the other portion of bone had not worsened. Although it has been reported that >15% of patients succumb to this disease, the patient reported in the current study was in a relatively stable condition.