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Diabetes mellitus (DM) is the condition represented by persistent hyperglycaemia, owing to the altered glucose metabolism. The current research aims to assess the capabilities of strains of lactic acid bacteria (LAB) that were obtained from fermented Ananas comosus (A. comosus) and Carica papaya (C. papaya) (non-dairy sources) as probiotics for the prevention of DM. The capacity of the strains to endure or survive extreme conditions was evaluated using bile tolerance using oxgall at varying concentrations, hydrophobicity, coaggregation ability, adhesion ability, and hemolytic activity, and their survival rate in gastric and intestinal juices. The LAB strains demonstrated the following results: phenol (>7 Log CFU/mL), acid-bile conditions (6.53–7.11 Log CFU/mL), gastric and intestinal juice tolerance (6.18–7.33 Log CFU/mL), thereby fulfilling the requirements to be a prospective probiotic agent. The LAB strains showed characteristics of cell surface hydrophobicity (≥ 40 %), autoaggregation (≥ 70 %), and coaggregation (≤ 48 %). Furthermore, they demonstrated antioxidant activity (≥ 59 %) as well as the ability to lower blood sugar levels by inhibiting α-glucosidase (≤ 57 %) and α-amylase (≤ 64 %). The development of antidiabetic probiotics from fermented papaya and pineapple has several potential uses. These probiotics may be used as functional foods or supplements to improve glycemic control in individuals with DM. They may also be used as adjunct therapies to conventional diabetes treatments to enhance their efficacy. The results of this research may pave way for creating probiotic products that function as food additives or supplements, with the aim of enhancing health and preventing long-term illnesses like diabetes. Additionally, probiotics have been proven to boost intestinal health, regulate the immune system, and decrease inflammation. [Display omitted] • LAB from fermented pineapple and papaya show antidiabetic potential. • LAB exhibit resilience to gastrointestinal conditions, meeting probiotic norms. • Strains display notable probiotic traits like hydrophobicity and adhesion. • Antioxidant activity and α-glucosidase & α-amylase inhibition suggest blood sugar reduction. • Pineapple and papaya offer promising non-dairy sources for functional foods. [ABSTRACT FROM AUTHOR]

The standard of care for burned patients experiencing hyperglycemia associated with the hypermetabolic response is insulin therapy. Insulin treatment predisposes burn patients to hypoglycemia, which increases morbidity and mortality. Metformin has been suggested as an alternative to insulin therapy for glycemic control in burn patients given its safety profile, but further research is warranted. This study investigated whether metformin use in burn patients is associated with improved glycemic control and morbidity/mortality outcomes compared to insulin use alone. Using the TriNetX database, we conducted a retrospective study of burned patients who were administered insulin, metformin, or both within one week of injury. Demographic, comorbidity, and burn severity information were collected. Patients were categorized by treatment type, propensity score-matched, and compared for the following outcomes within 3 months: hyperglycemia, hypoglycemia, sepsis, lactic acidosis, and death. Statistical significance was set a priori at p ≤ 0.05. The insulin cohort was at increased risk for all outcomes (all p < 0.0001) compared to the metformin cohort, and an increased risk for sepsis, lactic acidosis, and death (all p ≤ 0.0002) compared to the insulin/metformin combination cohort. When compared to the metformin cohort, the combination cohort was at increased risk for all outcomes (all p ≤ 0.0107) except death. Treatment with metformin after burn is associated with a reduced risk of morbidity and mortality compared to insulin. The combination of insulin and metformin is no more effective in reducing the risk of hyperglycemia and hypoglycemia than insulin alone but is less effective than metformin alone. • Uncontrolled hyperglycemia in burned patients increases morbidity and mortality. • Insulin predisposes to hypoglycemia, which increases mortality in burned patients. • Morbidity and mortality are reduced in patients treated with metformin vs. insulin. • Metformin may serve as a viable alternative to insulin in these patients. [ABSTRACT FROM AUTHOR]

To investigate the prevalence and associated outcomes of glucose abnormalities in infants with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Glucose values were reviewed in all HIE infants. Pearson's correlation was used to assess the association of hypo- and hyperglycemic episodes with neonatal brain MRI and neurodevelopmental outcomes (NDO) at 12 & 24 months. Of 153 infants included, 31, 56 and 43 had episodes of hypo-, hyperglycemia and combined, respectively. Hyperglycemia and combined hypo/hyper had higher mortality (p = 0.035), seizures (p = 0.009), and longer hospitalization (p = 0.023). Hypo- and hyperglycemia were associated with parenchymal hemorrhages (p = 0.028 & p = 0.027, respectively). Hypoglycemia was associated with restricted diffusion (p = 0.014), while hyperglycemia was associated with cortical injuries (p = 0.045). Each hour of hyper- or hypoglycemia was associated with 5.2–5.8 times unfavorable outcomes (p < 0.001). Blood glucose aberrations were detrimental in HIE infants treated with TH. Optimizing glucose management is crucial in this setting. [ABSTRACT FROM AUTHOR]

• Weight Reduction: Cinnamon supplementation significantly reduces body weight in women with PCOS. • Improved Insulin Resistance: Cinnamon helps lower insulin resistance, as indicated by decreased HOMA-IR scores. • Lower Fasting Blood Sugar: Cinnamon intake significantly reduces fasting blood sugar levels. • Cholesterol Benefits: Cinnamon supplementation lowers total cholesterol and LDL levels. Polycystic Ovary Syndrome (PCOS) is a hormonal disorder in women associated with increased cardiovascular risk. Cinnamon, a Chinese herbal medicine, is known for its anti-inflammatory and insulin-sensitizing properties, making it a potential therapeutic agent for PCOS-related cardiovascular complications. This systematic review and meta -analysis aimed to assess the impact of cinnamon supplementation on cardiovascular risk markers in women diagnosed with PCOS. Twelve randomized controlled trials (RCTs) were included in the analysis. The primary outcomes assessed were body weight, insulin resistance measured by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and fasting blood sugar (FBS). The meta -analysis revealed a statistically significant effect of cinnamon on reducing weight. Under the random-effects model, the pooled weighted mean difference (WMD) was −0.47 kg (95 % CI: −0.80 to −0.15, p < 0.001; I2 = 0.0 %). There was also a beneficial impact on insulin resistance, with reduced HOMA-IR scores following cinnamon supplementation (SMD=0.5015, 95 % CI: 0.2496 to 0.7533, p < 0.0001). Additionally, there was a significant improvement in FBS levels (pooled WMD: −7.72 mg/dL, 95 % CI: −12.33 to −3.12, p < 0.001; I2 = 91.3 %). The meta -analysis indicated a tendency towards reduced total cholesterol (WMD: −11.12 mg/dL, 95 % CI: −19.06 to −3.18, p = 0.01; I2 = 0.0 %) and LDL levels (WMD: −11.11 mg/dL, 95 % CI: −18.22 to −4.00, p < 0.01; I2 = 0.0 %) following cinnamon intervention. Substantial heterogeneity was observed among the studies, indicating the need for further research with larger sample sizes and standardized methodologies. Cinnamon supplementation demonstrates promising effects on body weight, blood sugar, total cholesterol, LDL, and insulin resistance in women with PCOS, indicating its potential in mitigating cardiovascular risk factors associated with this condition. [ABSTRACT FROM AUTHOR]

• Breath samples from patients with type 1 diabetes can be used to train dogs. • Odours used by glycaemic alert dogs are preserved during sampling and storage. • Volatile organic compound profiles differ with blood glucose concentration. • Collection material, day of collection and storage length all affect VOC profiles. Tight control of blood glucose can reduce the risk of severe health consequences of type 1 diabetes. For individuals with impaired awareness of hypoglycemia, glycemic control can be especially challenging. Fear of hypoglycemic events can lead individuals to adjust their glucose management resulting in poor glycemic control. Glycemic alert dogs trained on breath odor have been shown to accurately alert to changes in blood glucose in individuals with type 1 diabetes, providing them with an opportunity to intervene before dangerous fluctuations occur. By analyzing the volatile organic compounds (VOCs) of breath samples used during glycemic alert dog training, the aim of this study is to see if we, too, can detect differences in odor associated with blood glucose in type 1 diabetes. Breath samples from an individual with type 1 diabetes were collected during euglycemia, hypoglycemia, and hyperglycemia and analyzed using thermal desorption gas-chromatography time-of-flight mass-spectrometry. Statistical analysis with permutational multivariate analysis of variance, canonical analysis of principal coordinates, and random forest found significant differences in VOC profiles at different blood glucose concentrations. In addition, factors such as collection material, day of sample collection, and storage length had significant effects on the VOC profiles of samples. These findings show the complexity of the samples glycemic alert dogs are presented with and can direct future sample collection, storage, and training protocols. Despite variations associated with collection methods, differences associated with blood glucose remained detectable, suggesting the odors used by glycemic alert dogs to detect hypoglycemia are preserved in training samples. [ABSTRACT FROM AUTHOR]

Low-carbohydrate-diets (LCDs) are gaining popularity in individuals with type 1 diabetes (T1D). However, the impact of such diets on glycemia and cardiovascular risk factors is debated. This study aims to evaluate associations between low-carbohydrate intakes using LCD score with glycemia and cardiovascular risk factors (lipid profile) in adults with T1D or LADA in Québec, Canada. This is a cross-sectional study using data collected in the BETTER registry (02/2019 and 04/2021) including self-reported 24-h dietary recalls to calculate LCD scores, waist circumference, level-2 and level-3 hypoglycemic episodes and measured biochemical data (HbA1c, LDL-cholesterol and non-HDL-cholesterol). Participants were divided into quartiles (Q) based on LCD scores. Two hundred eighty-five adults (aged 48.2 ± 15.0 years; T1D duration 25.9 ± 16.2 years) were included. Categorical variables underwent Chi-squared/Fisher's Exact tests, while continuous variables underwent ANOVA tests. Mean carbohydrate intake ranged from 31.2 ± 6.9% (Q1) to 56.5 ± 6.8% (Q4) of total daily energy. Compared to Q4, more people in Q1 reported HbA1c ≤ 7% [≤53.0 mmol/mol] (Q1: 53.4% vs. Q4: 29.4%; P = 0.011). The same results were found in the models adjusted for age, sex and T1D duration. A greater proportion of participants in Q1 never experienced level-3 hypoglycemia compared to Q3 (Q1: 60.0% vs. Q3: 31.0%; P = 0.004). There were no differences across quartiles for frequency of level-2 hypoglycemia events and lipid profile (LDL-cholesterol and non-HDL-cholesterol). Low-carbohydrate intakes are associated with higher probabilities of reaching HbA1c target and of never having experienced level-3 hypoglycemia. No associations with level-2 hypoglycemia frequency, nor cardiovascular risk factors were observed. • Low-carb intakes are associated with higher probabilities of reaching HbA1c target. • Patients with lowest carb intakes were less likely to report history of severe hypoglycemia. • Low-carb intakes were not associated with adverse cardiovascular risk factors. • Cross-sectional study of baseline data extracted from the BETTER registry in Québec. [ABSTRACT FROM AUTHOR]

Documented symptomatic hypoglycemia is defined as "event during which typical symptoms of hypoglycemia are accompanied by measured blood glucose of ≤70 mg/dL. Most of the studies and recommendations for the unconscious hypoglycemic adult advocate the use of 25 g of glucose as 50 mL of 50% dextrose solution intravenous or 1 mg of intramuscular glucagon. To compare the efficacy and safety of 5 g boluses of 10%, 25% and 50% dextrose in the treatment of hypoglycemic patients presenting to our emergency department. This was a randomized controlled single blinded study. Hypoglycemic patients in altered mental status were randomized into three treatment arms to be administered 10%, 25% or 50% dextrose. 5 g aliquots of intravenous 10%,25% or 50% dextrose were administered over 1 min. Time taken to achieve a Glasgow Coma Scale (GCS) of 15 and median total doses (g) were the primary outcomes. Data of 204 patients were analysed in the study. There was no difference in the median time to achieve a GCS of 15 in all three treatment arms (6 min). Total median dose administered in the 10% and 25% groups was lower than 50% (10 g vs 15 g). Proportion of patients who received the maximum dose of 25 g was higher in the 50% group as compared to 10% and 25% groups (12%, 3%, 4%). There was no difference in 10% dextrose and 25% dextrose as compared to 50% dextrose in achieving the baseline mental status (or GCS 15) in the treatment of hypoglycemia in the ED. [ABSTRACT FROM AUTHOR]

• The EEG profile of neonates with encephalopathy was characterized during post-rewarming and 2-month follow-up. • Lower global delta power post-rewarming was associated with higher odds of moderate/severe neurodevelopmental outcome. • Combining EEG markers of spectral power post-rewarming with dysglycemia (0–48 h of life) improved prediction of outcomes. We investigated how electroencephalography (EEG) quantitative measures and dysglycemia relate to neurodevelopmental outcomes following neonatal encephalopathy (NE). This retrospective study included 90 neonates with encephalopathy who received therapeutic hypothermia. EEG absolute spectral power was calculated during post-rewarming and 2-month follow-up. Measures of dysglycemia (hypoglycemia, hyperglycemia, and glycemic lability) and glucose variability were computed for the first 48 h of life. We evaluated the ability of EEG and glucose measures to predict neurodevelopmental outcomes at ≥ 18 months, using logistic regressions (with area under the receiver operating characteristic [AUROC] curves). The post-rewarming global delta power (average all electrodes), hyperglycemia and glycemic lability predicted moderate/severe neurodevelopmental outcome separately (AUROC = 0.8, 95%CI [0.7,0.9], p <.001) and even more so when combined (AUROC = 0.9, 95%CI [0.8,0.9], p <.001). After adjusting for NE severity and magnetic resonance imaging (MRI) brain injury, only global delta power remained significantly associated with moderate/severe neurodevelopmental outcome (odds ratio [OR] = 0.9, 95%CI [0.8,1.0], p =.04), gross motor delay (OR = 0.9, 95%CI [0.8,1.0], p =.04), global developmental delay (OR = 0.9, 95%CI [0.8,1.0], p =.04), and auditory deficits (OR = 0.9, 95%CI [0.8,1.0], p =.03). In NE, global delta power post-rewarming was predictive of outcomes at ≥ 18 months. EEG markers post-rewarming can aid prediction of neurodevelopmental outcomes following NE. [ABSTRACT FROM AUTHOR]

Artificial pancreas systems should be designed considering different patient profiles, which is challenging from a control theory perspective. In this paper, a flexible-hybrid dual-hormone control algorithm for an artificial pancreas is proposed. The algorithm handles announced/unannounced meals by means of a non-interacting feedforward scheme that safely incorporates prandial boluses. Also, a coordination strategy is employed to distribute the counter-regulatory actions, which can be delivered as a continuous glucagon infusion via an automated pump, as an oral rescue carbohydrate recommendation, or as a rescue glucagon dose recommendation to be administrated through a glucagon pen. The different configurations of the proposed controller were evaluated in silico using a 14-day virtual scenario with random meal intakes and exercise sessions, achieving above 80% time-in-range and low time spent in hypoglycemia. [ABSTRACT FROM AUTHOR]

• Polypharmacy use was associated with the risk of severe hypoglycemia. • Good adherence and receiving home healthcare services were associated with a decreased odds of severe hypoglycemic events in elderly diabetic patients. To assess how medication adherence and home healthcare support influence the role of polypharmacy in induced hypoglycemia events among elderly diabetic patients. This case-crossover study retrieved records on diabetic patients >=65 years with severe hypoglycemia from 2002 to 2012 in Taiwan. Case period defined as 1–3 days before severe hypoglycemia was compared with a preceding control period of the same length, with an all-washout period of 30 days. Moreover, the modifiable effects of medication adherence and home healthcare service use were evaluated by stratified analysis. Totally 2,237 patients were identified. Polypharmacy use was associated with the risk of severe hypoglycemia. Patients receiving polypharmacy without home healthcare services (aOR: 1.34; 95 % CI: 1.16–1.54) and those with poor adherence to anti-diabetic medications (aOR: 1.48; 95 % CI: 1.24–1.77) were significantly associated with an elevated risk of severe hypoglycemia. In patients with good adherence, non-home healthcare users being prescribed with polypharmacy had a higher risk of severe hypoglycemia. In the group that received home healthcare services, patients with poor adherence using polypharmacy had a higher risk of severe hypoglycemia. Good adherence and receiving home healthcare services were associated with a decreased odds of severe hypoglycemic events in elderly diabetic patients, regardless of the fact whether they were prescribed with polypharmacy. [ABSTRACT FROM AUTHOR]

To investigate the efficacy of raw corn starch (RCS) in clinical management of insulinoma-induced hypoglycemia. We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively, and analyzed the therapeutic effects of the RCS intervention on blood glucose control, weight change, and its adverse events. The study population consisted of 24 cases of insulinoma patients, 7 males and 17 females, aged 46.08±14.15 years. Before RCS-supplemented diet, all patients had frequent hypoglycemic episodes (2.51±3.88 times/week), concurrent with neuroglycopenia (in 83.3% of patients) and autonomic manifestations (in 75.0% of patients), with the median fasting blood glucose (FBG) of 2.70 (interquartile range [IQR]: 2.50–2.90) mmol/L. The patients' weight increased by 0.38 (IQR: 0.05 – 0.65) kg per month, with 8 (33.3%) cases developing overweight and 7 (29.2%) cases developing obesity. All patients maintained the RCS-supplemented diet until they underwent tumor resection (23 cases) and transarterial chemoembolization for liver metastases (1 case). For 19 patients receiving RCS throughout the day, the median FBG within one week of nutritional management was 4.30 (IQR: 3.30–5.70) mmol/L, which was a significant increase compared to pre-nutritional level [2.25 (IQR: 1.60–2.90) mmol/L; P < 0.001]. Of them, 10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment [3.20 (IQR: 2.60–3.95) mmol/L vs. 2.15 (IQR: 1.83 – 2.33) mmol/L; P < 0.001). Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management [3.50 (IQR: 2.50–3.65) mmol/L vs. 2.20 (IQR: 1.80–2.60) mmol/L; P < 0.001], but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG. No improvement in weight gain was observed upon RCS supplementation. Mild diarrhea (2 cases) and flatulence (1 case) occurred, and were relieved by reduction of RCS dose. The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the impact of enteral glyburide on cerebral edema formation and hypoglycemia when used to treat patients diagnosed with acute ischemic stroke (AIS). This study was a single-center, retrospective medical record review that included all patients aged ≥18 years diagnosed with AIS who received ≥1 dose of enteral glyburide for the prevention of cerebral edema from January 1, 2018 to March 31, 2022. The primary outcome was the percentage of patients requiring intervention for cerebral edema management after glyburide initiation, and the safety outcome was the occurrence of hypoglycemia in this patient population. The final evaluation included 44 patients, with 6 patients (14%) requiring intervention for cerebral edema after glyburide initiation. The average baseline National Institutes of Health stroke scale score was 19. Overall, in-hospital mortality was 36% (n = 17), and hypoglycemia occurred in 7 patients (15%). Of the 44 patients, 20 (45%) received a partial duration of enteral glyburide (1–4 doses) and 24 (55%) received a full duration of enteral glyburide (5–7 doses). The rate of intervention for cerebral edema (10% vs. 17%) and the incidence of hypoglycemia (5% vs. 23%) were lower in the partial duration than in the full duration group. The in-hospital all-cause mortality rate was higher in the partial duration group than in the full duration group (43% vs. 31%). Despite the relatively low rates of intervention for cerebral edema, hypoglycemia was common, especially for patients receiving 5–7 doses of enteral glyburide for the prevention of cerebral edema after moderate-to-severe AIS. [ABSTRACT FROM AUTHOR]

Neonatal hypoglycemia is a common disease in newborns, which can precipitate energy shortage and follow by irreversible brain and neurological injury. Herein, we present a novel approach for treating neonatal hypoglycemia involving an adhesive polyvinylpyrrolidone/gallic acid (PVP/GA) film loading glucose. The PVP/GA film with loose cross-linking can be obtained by mixing their ethanol solution and drying complex. When depositing this soft film onto wet tissue, it can absorb interfacial water to form a hydrogel with a rough surface, which facilitates tight contact between the hydrogel and tissue. Meanwhile, the functional groups in the hydrogels and tissues establish both covalent and non-covalent bonds, leading to robust bioadhesion. Moreover, the adhered PVP/GA hydrogel can be detached without damaging tissue as needed. Furthermore, the PVP/GA films exhibit excellent antibacterial properties and biocompatibility. Notably, these films effectively load glucose and deliver it to the sublingual tissue of newborn rabbits, showcasing a compelling therapeutic effect against neonatal hypoglycemia. The strengths of the PVP/GA film encompass excellent wet adhesion in the wet and highly dynamic environment of the oral cavity, on-demand detachment, antibacterial efficacy, biocompatibility, and straightforward preparation. Consequently, this innovative film holds promise for diverse biomedical applications, including but not limited to wearable devices, sealants, and drug delivery systems. [Display omitted] [ABSTRACT FROM AUTHOR]

Although the discovery of insulin 100 years ago revolutionized the treatment of diabetes, its therapeutic potential is compromised by its short half-life and narrow therapeutic index. Current long-acting insulin analogs, such as insulin-polymer conjugates, are mainly used to improve pharmacokinetics by reducing renal clearance. However, these conjugates are synthesized without sacrificing the bioactivity of insulin, thus retaining the narrow therapeutic index of native insulin, and exceeding the efficacious dose still leads to hypoglycemia. Here, we report a kind of di-PEGylated insulin that can simultaneously reduce renal clearance and receptor-mediated clearance. By impairing the binding affinity to the receptor and the activation of the receptor, di-PEGylated insulin not only further prolongs the half-life of insulin compared to classical mono-PEGylated insulin but most importantly, increases its maximum tolerated dose 10-fold. The target of long-term glycemic management in vivo has been achieved through improved pharmacokinetics and a high dose. This work represents an essential step towards long-acting insulin medication with superior safety in reducing hypoglycemic events. Distinct from conventional mono-PEGylated insulin, this work developed a kind of di-PEGylated insulin that could simultaneously reduce renal clearance and receptor-mediated clearance. [Display omitted] [ABSTRACT FROM AUTHOR]

We evaluated the acute effects of yoga compared to cycling on glucose change and variability, and the occurrence of hypoglycemia in adults with type 1 diabetes. Fifteen participants performed 50 min of cycling or yoga. Glucose values were collected before and after exercise. Coefficient of variation (CV) and hypoglycemic episodes were evaluated from the start up to 12 h after exercise. Cycling and yoga significantly reduced glucose values during exercise, and CV was lower after yoga. One hypoglycemic episode occurred with yoga and seven with cycling. Yoga is a safe exercise that acutely reduces glucose values, but with lower risk of hypoglycemia compared to cycling. [ABSTRACT FROM AUTHOR]

Hyperkalemia is a common electrolyte abnormality that requires urgent treatment. Insulin is an effective treatment for hyperkalemia, but risk factors for developing insulin-induced hypoglycemia exist (e.g., low pretreatment glucose or renal impairment). This study evaluated the impact of a hyperkalemia protocol tailored to glucose concentration and renal function on insulin-induced hypoglycemia. This was a retrospective cohort study of emergency department patients with glucose ≤ 100 mg/dL treated with insulin for hyperkalemia. The primary outcome was incidence of hypoglycemia in patients treated prior to (July 1, 2018–June 30, 2019) vs. after (January 1, 2020–December 31, 2020) the protocol update, which individualized insulin and dextrose doses by glucose concentration and renal function. Secondary outcomes included change in potassium and protocol safety. We assessed factors associated with hypoglycemia using multiple logistic regression. We included 202 total patients (preimplementation: 114, postimplementation: 88). Initial insulin dose was lower in the postimplementation group (p < 0.001). We found a nonsignificant reduction in hypoglycemia in the postimplementation group (42.1% vs. 30.7%, p = 0.10). Degree of potassium reduction was similar in patients who received insulin 5 units vs. 10 units (p = 0.72). Higher pretreatment glucose (log odds ratio [OR] −0.05, 95% confidence interval [CI] −0.08 to −0.02) and additional insulin administration (log OR −1.55, 95% CI −3.01 to −0.25) were associated with reduced risk of developing hypoglycemia. A hyperkalemia protocol update was not associated with a significant reduction in hypoglycemia, and the incidence of hypoglycemia remained higher than anticipated. Future studies attempting to optimize treatment in this high-risk population are warranted. [ABSTRACT FROM AUTHOR]

To characterize sliding-scale insulin (SSI) use in US nursing homes (NHs) before and after the COVID-19 pandemic. Cross-sectional study. A total of 129,829 US NH residents on SSI (01/2018-06/2022) across 12 NH chains with a common electronic health record system. Among all residents with at least 1 administration of SSI documented in the electronic medication administration record, we described resident demographics, frequency of SSI monotherapy vs combination therapy with another diabetes medication, number of daily capillary blood glucose readings ("fingersticks"), and hypoglycemia (capillary blood glucose <70 mg/dL) and hyperglycemia after first SSI use. We used interrupted time series analysis (ITS) with segmented linear regression models to examine whether the monthly prevalence of SSI use changed at and after the onset of the COVID-19 pandemic (March 2020). There were 129,829 unique NH residents with SSI use [51% women, average age 71.3 (SD 11.7) years]. Of these, 36% of residents received SSI monotherapy and 64% received SSI combination therapy. Residents on SSI received an average of 3.96 (SD 1.41) fingersticks per day. Overall, 26% of SSI users experienced a hypoglycemic event within 30 days of the first SSI dose. The ITS analysis identified a step decrease in the rate of SSI use following the onset of the COVID-19 pandemic (43 fewer SSI users per 1000 insulin users) but no change in overall trend over time from before the onset of the pandemic. SSI use and fingerstick burden are high in NH residents. Hypoglycemia occurred commonly among residents on SSI. Future research should compare the safety and effectiveness of SSI monotherapy vs other diabetes medication regimens to guide person-centered prescribing decisions in NHs. [ABSTRACT FROM AUTHOR]

• Whole-Exome sequencing is an excellent tool for genetic screening in individuals with suspected epilepsy. • Seizures in epilepsy suspected patients might be directly caused, or influenced by hypoglycemia due to pathogenic variants in the GYS2 gene. • Loss of phosphorylation site in glycogen synthase enzyme due to deletions can have disastrous effects on its normal functioning. Adequate glucose supply is essential for brain function, therefore hypoglycemic states may lead to seizures. Since blood glucose supply for brain is buffered by liver glycogen, an impairment of liver glycogen synthesis by mutations in the liver glycogen synthase gene (GYS2) might result in a substantial neurological involvement. Here, we describe the phenotypes of affected siblings of two families harboring biallelic mutations in GYS2. Two suspected families - a multiplex Pakistani family (family A) with three affected siblings and a family of Moroccan origin (family B) with a single affected child who presented with seizures and reduced fasting blood glucose levels were genetically characterized. Whole exome sequencing (WES) was performed on the index patients, followed by Sanger sequencing-based segregation analyses on all available members of both families. The variant prioritization of WES and later Sanger sequencing confirmed three mutations in the GYS2 gene (12p12.1) consistent with an autosomal recessive pattern of inheritance. A homozygous splice acceptor site variant (NM_021957.3, c. 1646 -2A>G) segregated in family A. Two novel compound heterozygous variants (NM_021957.3: c.343G>A; p.Val115Met and NM_021957.3: c.875A>T; p.Glu292Val) were detected in family B, suggesting glycogen storage disorder. A special diet designed to avoid hypoglycemia, in addition to change of the anti-seizure medication led to reduction in seizure frequency. This study suggests that the seizures in patients initially diagnosed with epilepsy might be directly caused, or influenced by hypoglycemia due to pathogenic variants in the GYS2 gene. [ABSTRACT FROM AUTHOR]

Hypoglycemia is a common symptom in pediatrics that can lead to neurological sequelae. The etiologies are mostly benign, but hypoglycemia can be a symptom of severe underlying disease. To streamline the etiological investigations, a "hypoglycemia kit," containing supplies needed to perform specific analyses quickly, was made available in the pediatric emergency department of the Rouen University Hospital in 2011. Since its introduction, this kit has been used to explore all cases of hypoglycemia regardless of the context. However, although very useful, these analyses are expensive. The objective of our study was to examine the cost-effectiveness of this kit and to refine its indications if necessary. This was a non-interventional and retrospective single-center study. Digital records of patients for whom a hypoglycemia kit was used from September 2011 to August 2019 at the pediatric emergency department of Rouen University Hospital were used to retrieve clinical characteristics, laboratory results, and the causes of hypoglycemia. The study included 82 patients. The etiologic investigation concluded that 74 patients had functional hypoglycemia, and eight cases were attributed to other etiologies. In two cases, the kit led to a diagnosis, i.e., 2.4 % efficiency. A history of congenital malformations or previous hypoglycemia was significantly associated with severe etiologies. However, there was no significant association between hypoglycemia severity, age, sex, and these etiologies. Our study reveals that the cost-effectiveness of the hypoglycemia kit is low in pediatric emergencies (2.4 %) at Rouen University Hospital, where functional hypoglycemia remains the leading cause of hypoglycemia. However, our results allow us to suggest a decision tree for refining the usability of this kit, which would considerably increase its efficiency. [ABSTRACT FROM AUTHOR]

To evaluate the effect of a single intravenous injection of branched chain amino acids (BCAAs) on body temperature in cats undergoing general anesthesia. Prospective, blinded, randomized, crossover, experimental study. A total of 10 healthy adult cats (five female and five male). Cats were anesthetized three times with three different treatments in a random order: 3 mL kg–1 lactated Ringer's solution (LRS), 100 mg kg–1 BCAAs (B100) or 200 mg kg–1 BCAAs (B200) solution immediately before induction of anesthesia. After induction, rectal temperature was measured every 5 minutes. Blood samples were collected for the measurement of blood glucose (BG) just before induction, at the end of the 90 minute period of anesthesia, and 24 hours after anesthesia induction. The differences between baseline and each subsequent rectal temperature, and BG measurements were analyzed. Areas under the curve (AUCs) for temperature differences were calculated for each animal for the anesthetic period (AUC T0–90). Parametric or nonparametric data were analyzed by one-way repeated measures anova or Friedman test. A value of p < 0.05 was considered significant. There were no significant differences in AUC T0–90 between groups: 41.6 ± 7.7 for LRS, 43.4 ± 6.9 for B100 and 42.9 ± 7.5 for B200 (p = 0.368). No significant differences were observed in BG between groups at 90 minutes and 24 hours after anesthesia induction (p = 0.283 and p = 0.089, respectively). The incidence of hypoglycemia [BG ≤ 3.17 mmol L–1 (57 mg dL–1)] after anesthesia tended to be higher in both B100 (4/10 cats) and B200 groups (3/10 cats) than in LRS group (1/10 cats). A single, preanesthetic intravenous injection of BCAAs did not attenuate heat loss during anesthesia. More cats were hypoglycemic in the BCAA groups than in the LRS group. [ABSTRACT FROM AUTHOR]

Abdominal pain and postbariatric hypoglycemia (PBH) are common after bariatric surgery. This study aimed to explore the potential relationship between abdominal pain, gastrointestinal symptoms, and PBH more than a decade after Roux-en-Y gastric bypass (RYGB) and whether continuous glucose monitoring (CGM) with dietary intervention has an educational role in reducing symptoms. At two public hospitals in Norway (one University Hospital) 22 of 46 invited patients who reported abdominal pain more than weekly took part. Recruited from a prospective follow-up study of 546 patients 14.5 years after RYGB. They used a CGM for two 14-day periods, with a dietary intervention between periods. The Gastrointestinal Symptom Rating Scale (GSRS) and the Dumping Severity Score (DSS) questionnaires were completed at the start and end of the study. The 22 women had preoperative age 39.6 ± 7.7 years and body mass index (BMI) 42.0 ± 4.0 kg/m2, present age 54.6 ± 7.7 years and BMI 29.8 ± 4.8 kg/m2. The total GSRS score and DSS of early dumping decreased after the diet intervention. The number of events with Level 1 (<3.9 mmol/L) or Level 2 (<3.0 mmol/L) hypoglycemia did not change in the second period. Half of the patients had fewer, three had unchanged, and eight had more frequent events with Level 1 hypoglycemia after the intervention. Ten patients had Level 2 hypoglycemia. Though inconclusive findings, a personalized dietary intervention reduces GSRS. This intervention was accompanied by lower mean absolute glucose in patients with recurrent abdominal pain after bariatric surgery. However, further studies are needed to explore the benefits of CGM in this setting. [Display omitted] • CGM may be a first step to evaluating glycemic fluctuations and abdominal pain. • Half of the patients with abdominal pain more than weekly also suffered from PBH. • Patients had lower total GSRS and score of indigestion after diet intervention. • DSS score of early dumping was lower after diet intervention. • CGM adds value to patient involvement to comply with the recommended dietary advice. [ABSTRACT FROM AUTHOR]

Diabetes and hyperglycemic events in cardiac surgical patients are associated with postoperative morbidity and mortality. The causes of dysglycemia, the abnormal fluctuations in blood glucose concentrations, in the perioperative period include surgical stress, surgical techniques, medications administered perioperatively, and patient factors. Both hyperglycemia and hypoglycemia lead to poor outcomes after cardiac surgery. While trying to control blood glucose concentration tightly for better postoperative outcomes, hypoglycemia is the main adverse event. Currently, there is no definite consensus on the optimum perioperative blood glucose concentration to be maintained in cardiac surgical patients. This review provides an overview of perioperative glucose homeostasis, the pathophysiology of dysglycemia, factors that affect glycemic control in cardiac surgery, and current practices for glycemic control in cardiac surgery. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) lead to lower fasting glucose concentrations, but might cause higher glycemic variability (GV) and increased risk of hypoglycemia. However, it has been sparsely studied in patients without preoperative diabetes under normal living conditions. To study 24-hour interstitial glucose (IG) concentrations, GV, the occurrence of hypoglycemia and dietary intake before and after laparoscopic RYGB and SG in females without diabetes. Outpatient bariatric units at a community and a university hospital. Continuous glucose monitoring and open-ended food recording over 4 days in 4 study periods: at baseline, during the preoperative low-energy diet (LED) regimen, and at 6 and 12 months postoperatively. Of 47 patients included at baseline, 83%, 81%, and 79% completed the remaining 3 study periods. The mean 24-hour IG concentration was similar during the preoperative LED regimen and after surgery and significantly lower compared to baseline in both surgical groups. GV was significantly increased 6 and 12 months after surgery compared to baseline. The self-reported carbohydrate intake was positively associated with GV after surgery. IG concentrations below 3.9 mmol/L were observed in 14/25 (56%) of RYGB- and 9/12 (75%) of SG-treated patients 12 months after surgery. About 70% of patients with low IG concentrations also reported hypoglycemic symptoms. The lower IG concentration in combination with the higher GV after surgery, might create a lower margin to hypoglycemia. This could help explain the increased occurrence of hypoglycemic episodes after RYGB and SG. • Mean glucose levels were similarly lowered by low-energy diet as by RYGB and SG. • However, the glycemic variability increased after RYGB and SG surgery. • Postoperatively, carbohydrate intake was positively related to glycemic variability. • 56% of RYGB and 75% of SG had episodes of hypoglycemia 1 year after surgery. [ABSTRACT FROM AUTHOR]

Burn survivors undergoing complex glycemic derangements in the acute period after burn are at significantly increased risk of worse outcomes. Although most critical care investigations recommend intensive glycemic control to prevent morbidity and mortality, conflicting recommendations exist. To date, no literature review has studied outcomes associated with intensive glucose control in the burn intensive care unit (ICU) population. This review addresses this gap to improve practice guidelines and support further research regarding glycemic control. This is a narrative review of literature utilizing PubMed for articles published at any time. Inclusion criteria were English studies describing glucose management in ICU adult burn patients. Studies involving pediatric patients, non-human subjects, care non-ICU care, case reports, editorials, and position pieces were excluded. Our literature search identified 2154 articles. Full text review of 61 articles identified eight meeting inclusion criteria. Two studies reported mortality benefit of intensive glucose control (mg/dL) compared to controls (mg/dL), while two studies showed no mortality differences. Three studies reported reduced infectious complications such as pneumonia, urinary tract infection, sepsis, and bacteremia. A majority of the studies (6/8) reported higher risk for hypoglycemia with tight glucose control, but few reported instances of adverse sequela associated with hypoglycemia. Intensive glucose control may provide benefit to burn patients, but complications associated with hypoglycemia must be considered. This review recommends an individualized patient-centered approach factoring comorbidities, burn injury characteristics, and risk factors when determining whether to employ intensive glucose control. • Conflicted recommendations regarding intensive glucose control for burn intensive care unit patients. • Higher risk for hypoglycemic episodes with intensive glucose control, but few reported adverse events. • Reduction in infectious complications with intensive glucose control. • Recommend individual approach that factors comorbidities and burn characteristics forglucose control. [ABSTRACT FROM AUTHOR]

As diabetes prevalence has continued to increase in the United States, as well as globally, utilization of disease management techniques has also improved. The evolution in disease management for diabetes has adapted greatly from the initial dipstix method. Continuous glucose monitors have grown in popularity with its introduction to the market. After introduction of CGMs as part of DM management, various advancements have been made to the current models to promote the usage CGMs to promote glycemic control. The main competitors in the CGM market is Medtronic, Dexcom, Freestyle, and Eversense. Information was primarily gathered by employing various PubMed scholarly articles for real-world examples in addition to data extraction from supplementary manuscripts. Articles were evaluated from over the past 20 years. Clinically improvement of disease management of blood glucose levels, specifically with regards to mean absolute relative difference (MARD) was utilized to highlight effectiveness of continuous glucose monitors. Of the four key continuous glucose monitors device on the market in the US, all have demonstrated to have similar beneficial qualities which can be utilized in both T1DM and T2DM patients. The best device for an individual would be based on their specific diabetes management goal (maintain TIR, decreasing TBR/TAR, decrease A1c). • Continuous Glucose Monitors have become critical for diabetes management. • Within the USA, there are four key manufacturers of CGMs. • Utilization of MARD has highlighted the effectiveness of these devices. [ABSTRACT FROM AUTHOR]

Patients 80 years or older with HbA1c <7.0% (53 mmol/mol) treated with multiple daily insulin injections had low rates of rapid-acting insulin deprescription and initiation of diabetes medications with lower risk of hypoglycemia. Further investigation is needed to elucidate factors contributing to potentially inappropriately aggressive treatment of these patients. • Most older adults with well-controlled T2DM do not have prandial insulin stopped. • Contraindications to all alternative diabetes medications are uncommon. • Nevertheless alternative glucose-lowering medications are infrequently discussed. [ABSTRACT FROM AUTHOR]

Inpatient hypoglycemia is associated with increased morbidity and mortality. After a hypoglycemic event, the likelihood of additional episodes increases. The Joint Commission recommends evaluating all episodes of hypoglycemia for root-cause analysis. Studies have shown that pharmacists' involvement with glycemic control protocols can prevent hypoglycemia. This study aimed to assess whether the implementation of pharmacists' real-time assessment of hypoglycemic events using an electronic alert messaging system contributes to the reduction of the number of recurrent hypoglycemia during hospitalization. A community hospital that provides a wide range of health care services. The pharmacy department provides fully decentralized clinical services and team-based specialist services. The pharmacist-led hypoglycemia stewardship initiative included a comprehensive review of hypoglycemic alerts received via an automated message. The alerts generated in the electronic health record (EHR) every time a patient's blood glucose resulted in less than 70 mg/dL if there was a documented administration of a hypoglycemic agent 48 hours before the hypoglycemia event. Once the alert was received by the pharmacists via an EHR in-basket, a real-time review was conducted to identify the potential causes of the event and opportunities for therapy modification. A single-center retrospective observational study including a pre- and post-implementation phase from January 1 to June 3, 2020, and January 1 to June 30, 2021, respectively. Continuous data were analyzed using paired and equal variance t test. Noncontinuous data were analyzed using Fisher exact and chi-square test. Descriptive statistics were used to describe distribution and frequency of data. There was a 5.1% absolute reduction in recurrent hypoglycemic events (P < 0.001) and a 0.6% reduction of severe hypoglycemic days (P = 0.269) in the postimplementation group. The average time to pharmacist intervention was 4 (± 3.5) hours with a 92% acceptance rate. This study demonstrated the utility of pharmacist-led hypoglycemia reviews in the reduction of recurrent hypoglycemic events in the inpatient setting. [ABSTRACT FROM AUTHOR]

• A nomogram for predicting hypoglycemia risk in critically ill patients with sepsis. • An online individualized predictive tool was developed. • Predictive model was validated externally in external validation cohort. Few studies have reported the risk factors or developed a risk predictive model of hypoglycemia patients with sepsis. To develop a predictive model to assess the hypoglycemia risk in critically ill patients with sepsis. For this retrospective study, we collected the data from the Medical Information Mart for Intensive Care III and IV (MIMIC-III and MIMIC-IV). All eligible patients from the MIMIC-III were randomly divided into the training set for development of predictive model and testing set for internal validation of the predictive model at a ratio of 8:2. Patients from the MIMIC-IV database were used as the external validation set. The primary endpoint was the occurrence of hypoglycemia. Univariate and multivariate logistic model was used to screen predictors. Adopted receiver operating characteristics (ROC) and calibration curves to estimate the performance of the nomogram. The median follow-up time was 5.13 (2.61–9.79) days. Diabetes, dyslipidemia, mean arterial pressure, anion gap, hematocrit, albumin, sequential organ failure assessment, vasopressors, mechanical ventilation and insulin were identified as the predictors for hypoglycemia risk in critically ill patients with sepsis. We constructed a nomogram for predicting hypoglycemia risk in critically ill patients with sepsis based on these predictors. An online individualized predictive tool: https://ghongyang.shinyapps.io/DynNomapp/. The established nomogram had a good predictive ability by ROC and calibration curves in the training set, testing set and external validation cohort. A predictive model of hypoglycemia risk was constructed, with a good ability in predicting the risk of hypoglycemia in critically ill patients with sepsis. [ABSTRACT FROM AUTHOR]

Reducing hypoglycemic episodes in type 1 diabetic (T1DM) patients remains a challenge during and several hours after traditional aerobic sessions. Alternatively, active video games (AVG) or exergames, may offer higher enjoyment levels, although their effects on capillary blood glucose (CBG) and hypoglycemias are unknown. To investigate an AVG session on 24-h CBG levels and hypoglycemic episodes in comparison to traditional aerobic exercise in T1DM patients under real-life settings. This crossover study consisted of three conditions: resting (control, CON), AVG, and running (RUN). First, volunteers (7 men and 3 women) performed CON, and CBG was measured immediately before, and immediately after, 30 min, 6 h, 12 h, 18 h, and 24 h after. Hypoglycemic episodes (daytime and nighttime) were also recorded. Then, AVG and RUN sessions were performed in a randomized order. CBG was measured at the same time points and procedures. Statistical differences were seen in CBG concerning AVG and RUN sessions in comparison to CON, immediately and 30 min after. CBG values were similar between active conditions. However, six hypoglycemic episodes were found after RUN, and only one after AVG (p = 0.022; X 2 (1) = 7.342). Similar reductions in 24-h CBG concerning AVG and RUN were found, although exergames led to fewer hypoglycemic episodes (daytime and nighttime) than intensity- and duration-matched traditional aerobic exercise. These findings corroborate that Kinect Adventure-exergame may be an interesting and effective exercise tool for T1DM treatment, mainly for hypoglycemia mitigation, which is the main barrier for this population. [ABSTRACT FROM AUTHOR]

Birth asphyxia causes hypoxia or inadequate perfusion to the organs of newborns, leading to metabolism dysfunctions including blood glucose disorders. Neonates with and without birth asphyxia were retrospectively recruited from 53 hospitals in Hubei Province from January 1 to December 31, 2018. In summary, 875, 1139, and 180 cases in the control group, the mild asphyxia group, and the severe asphyxia group were recruited, respectively. Neonatal blood glucose values at postnatal 1, 2, 6, and 12 h (time error within 0.5 h was allowed) were gathered from the medical records. The incidence rates of hyperglycemia in the control group, the mild asphyxia group and the severe asphyxia group were 2.97%, 7.90%, and 23.33%, respectively (p < 0.001). Additionally, the incidence rates of hypoglycemia in the three groups above were 3.66%, 4.13%, and 7.78%, respectively (p = 0.042). The blood glucose values of neonates with hypoglycemia in the asphyxia group were lower than in the control group (p = 0.003). Furthermore, the blood glucose values of neonates with hyperglycemia were highest in the severe asphyxia group (p < 0.001). There were 778 and 117 cases with blood glucose records at four predefined time points in the mild and severe asphyxia group, respectively. The incidence of blood glucose disorders in the mild asphyxia group significantly decreased from postnatal 6 h (p＜0.05). However, we found no obvious changes of the incidence of glucose disorders within postnatal 12 h in the severe asphyxia group (p = 0.589). Birth asphyxia is likely to cause neonatal blood glucose disorders, both hypoglycemia and hyperglycemia, during the early postnatal life. The neonates with severe asphyxia have higher incidence, worse severity and longer duration of blood glucose disorders than neonates with mild asphyxia. [ABSTRACT FROM AUTHOR]

Neonatal hypoglycemia is a common metabolic occurrence among small for gestational age (SGA) neonates. This study aims to determine the incidence of early neonatal hypoglycemia and confirms the potential risk factors among term and late preterm SGA neonates in a well-baby newborn nursery of a tertiary medical center in Southern Taiwan. We performed a retrospective medical record review of term and late preterm SGA (birth weight <10 percentile) neonates, born between January 1, 2012 and December 31, 2020, in the well-baby newborn nursery, of a tertiary medical center in Southern Taiwan. Blood glucose monitoring was routinely performed at 0.5, 1, 2, and 4 h of life. Antenatal and postnatal risk factors were recorded. Mean blood glucose level, age of occurrence, symptomatic hypoglycemia, and need for intravenous glucose treatment of early hypoglycemia in SGA neonates were documented. 690 SGA neonates in the nursery met the criteria and were retrospectively enrolled in the study, 358 of whom (51.80%) were male and 332 (48.10%) female. Of 690 enrolled SGA neonates, 134(19.42%) SGA neonates developed hypoglycemia during a well-baby nursery stay. Among these neonates, 97% of early hypoglycemic episodes occur during the first 2 h of life. The lowest blood glucose level was 46.78 ± 11.13 mg/dL, recorded in the first hour of life. Among the hypoglycemic 134 neonates, 26 (19.40%) neonates had to be transferred from the nursery to the neonatal ward and they required intravenous glucose treatment to achieve euglycemia. 14 (10.40%) neonates had symptomatic hypoglycemia. A multivariate logistic regression analysis revealed that cesarean delivery, small head circumference, small chest circumference, and low 1-min Apgar score were significant risk factors for early hypoglycemia in these neonates. Periodic routine blood glucose level monitoring within the first 4 h of life in term and late preterm SGA neonates is required, especially those with cesarean delivery and low Apgar score. [ABSTRACT FROM AUTHOR]

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Congenital hyperinsulinism of infancy (CHI) can be caused by a deficiency of the ubiquitously expressed enzyme shortchain 3-hydroxyacyl-CoA dehydrogenase (SCHAD). To test the hypothesis that SCHAD-CHI arises from a specific defect in pancreatic β-cells, we created genetically engineered β-cellspecific (β-SKO) or hepatocyte-specific (L-SKO) SCHAD knockout mice. While L-SKO mice were normoglycemic, plasma glucose in β-SKO animals was significantly reduced in the random-fed state, after overnight fasting, and following refeeding. The hypoglycemic phenotype was exacerbated when the mice were fed a diet enriched in leucine, glutamine, and alanine. Intraperitoneal injection of these three amino acids led to a rapid elevation in insulin levels in β-SKO mice compared to controls. Consistently, treating isolated β-SKO islets with the amino acid mixture potently enhanced insulin secretion compared to controls in a low-glucose environment. RNA sequencing of β-SKO islets revealed reduced transcription of βcell identity genes and upregulation of genes involved in oxidative phosphorylation, protein metabolism, and Ca2+ handling. The β-SKO mouse offers a useful model to interrogate the intra-islet heterogeneity of amino acid sensing given the very variable expression levels of SCHAD within different hormonal cells, with high levels in β- and δ-cells and virtually absent α-cell expression. We conclude that the lack of SCHAD protein in β-cells results in a hypoglycemic phenotype characterized by increased sensitivity to amino acid-stimulated insulin secretion and loss of β-cell identity. [ABSTRACT FROM AUTHOR]

Introduction: To prevent hypoglycemic episodes, the management of insulin therapy against post-transplant diabetes mellitus (PTDM) is important. We compared glargine (long-acting insulin) versus NPH isophane (intermediate-acting insulin) as an armamentarium against PTDM. Indeed, the study evaluated PTDM patients with hypoglycemic episodes treated with isophane or glargine. Material and methods: We evaluated a total number of 231 living-donor renal transplant recipients with PTDM of age > 18 years admitted to the hospital between January 2017 and September 2021. However, patients taking hypoglycemic agents before transplantation were excluded from this study. Out of 231 patients, 52 (22.15%) suffered from PTDM out of whom 26 were treated with glargine or isophane. Results; After applying exclusion criteria, out of 52 PTDM patients 23 were included in the study: 13 PTDM patients were treated with glargine, whereas 10 PTDM patients with isophane. Our analysis revealed 12 episodes of hypoglycemia in glargine-treated PTDM patients compared to 3 in isophane-treated PTDM patients (p = 0.056). Clinically, 9 out of 15 hypoglycemic episodes were nocturnal (60%). Furthermore, no other risk factors were observed in our study population. Detailed analysis showed that both groups had equivalent doses of immunosuppressants and oral hypoglycemic agents. The odds ratio for hypoglycemia in the group treated with isophane compared to that treated with glargine was 0.224 (95% CI, 0.032-1.559). Glargine users recorded significantly lower blood sugar levels before lunch, dinner and at bedtime with p-values of 0.001, 0.009 and 0.001 respectively. A better hemoglobin Ale (HbAlc) level was seen in the glargine vs. isophane group (6.98 ± 0.52 vs. 7.45 ± 0.49, p-value 0.03). Conclusion: The study shows better blood sugar control with long-acting insulin analog, glargine, than with intermedlate-actin analog, isophane. Overall, a higher number of hypoglycemic episodes was nocturnal. Long term safety of long-acting insulin analogs needs to be further studied. [ABSTRACT FROM AUTHOR]

Hypoglycemia has been reported in patients with LAMA2-CMD, but the frequency, risk factors, and correlation to genotype/phenotype have not been systematically assessed to date. A retrospective cohort study was performed on 48 patients with LAMA2-CMD. Patients were divided into two groups: a hypoglycemic group, with at least one episode of hypoglycemia, and a nonhypoglycemic group. The groups were compared according to gait function, epilepsy, intellectual disability, constipation, gastroesophageal reflux, gastrostomy, weight percentile, scoliosis, the use of a ventilator device, the use of a feeding device, neuromuscular disease swallowing status scale, and type of mutation. Fifteen patients (31.2%) presented with at least one episode of symptomatic hypoglycemia and eight (16.6% of the cohort) had two or more episodes. All patients who had hypoglycemia were in the nonambulant group. We observed a correlation between gait, the use of ventilator and feeding devices, and swallow function with hypoglycemia. Patients with extremely low weight were five times more likely to have recurrent episodes of hypoglycemia. The presence of at least one missense variant appears to be associated with a lower risk of hypoglycemia. Patients with LAMA2-CMD are at risk of hypoglycemia. The risk is more relevant in patients with severe phenotype and patients with loss-of-function variants. For patients with extremely low weight, the risk is higher. Blood glucose should be actively measured in patients who are fasting or have infections, and health care providers should be prepared to identify and treat these patients. [ABSTRACT FROM AUTHOR]

Type 2 Diabetes Mellitus (T2DM) patients are exposed to a 7.5 times higher risk of hypoglycemia while fasting during Ramadan. Relevant diabetes guidelines prioritize the use of SGLT2 inhibitors over other classes. There is a great need to enrich data on their safe and effective use by fasting patients at greater risk of hypoglycemia. Therefore, this study aims to assess the safety and tolerability of Empagliflozin in T2DM Muslim patients during Ramadan. A prospective cohort study was conducted for adult Muslim T2DM patients. Patients who met the inclusion criteria were categorized into two sub-cohorts based on Empagliflozin use during Ramadan (Control versus Empagliflozin). The primary outcomes were the incidence of hypoglycemia symptoms and confirmed hypoglycemia. Other outcomes were secondary. All patients were followed up to eight weeks post-Ramadan. A propensity score (PS) matching and Risk Ratio (RR) were used to report the outcomes. Among 1104 patients with T2DM who were screened, 220 patients were included, and Empagliflozin was given to 89 patients as an add-on to OHDs. After matching with PS (1:1 ratio), the two groups were comparable. The use of other OHDs, such as sulfonylurea, DPP4 inhibitors, and Biguanides, was not statistically different between the two groups. The risk of hypoglycemia symptoms during Ramadan was lower in patients who received Empagliflozin than in the control group (RR 0.48 CI 0.26, 0.89; p-value = 0.02). Additionally, the risk of confirmed hypoglycemia was not statistically significant between the two groups (RR 1.09 CI 0.37, 3.22; p-value = 0.89). Empagliflozin use during Ramadan fasting was associated with a lower risk of hypoglycemia symptoms and higher tolerability. Further randomized control trials are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Diabetes is one of the most dangerous diseases humanity faces. What is surprising is how widespread diabetes is among children, even those very young. Many of those children are admitted to hospitals and underlay intensive diabetic therapy. The goal of that therapy is to normalize and stabilize the patient's blood glucose level (BGL). This should be done as soon as possible by proper adjustment of insulin injections. It is worth noting that the problem is especially tough while dealing with children, those admitted to a hospital for the first time. At diabetes onset, the individual reaction of the human body to insulin is not known, therefore, establishing insulin therapy must be done very carefully. In that period, the decision support system for physicians is much appreciated. The research presented in this paper addresses that problem. Specifically, to complement our previous works, we develop a graphical model representing the nocturnal diabetic therapy which, due to the patient rest state, is very specific and requires special attention from the physicians. The proposed model helps to avoid excessive fluctuations of BGL during nocturnal periods, namely hypoglycemia and hyperglycemia. The model has been validated by a diabetology expert. The results of that validation reveal that the proposed graph-based approach is a valuable tool assisting physicians in their clinical practice. [ABSTRACT FROM AUTHOR]

Diabetes is present in approximately 10% of people living with schizophrenia and substantially contributes to early mortality, but some aspects of diabetes care among those with schizophrenia have been inadequately investigated to date. We assessed diabetes care and comorbidity management among people with and without schizophrenia. We conducted a cohort study with data obtained from primary care electronic medical records stored in the Diabetes Action Canada (DAC) National Repository from Alberta, Ontario, and Quebec, Canada. The population studied included patients with diabetes, with and without schizophrenia, who had at least 3 primary care visits in a 2 year period between July 2017 and June 2019. Outcomes included glycemia; diabetes complication screening and monitoring; antihyperglycemic and cardioprotective medication prescription; health service use. We identified 69,512 patients with diabetes; 911 (1.3%) of whom also had schizophrenia. Prevalence of high HbA1C (>8.5%) (9083/68601; 13.2% vs. 137/911; 15.0%) and high blood pressure (>130/80 mmHg) (4248/68601; 6.2% vs. 73/911; 8.0%) was similar between the two groups. Half (50.0%) of patients with schizophrenia (n = 455) had 11 or more primary care visits in the past year, compared with 27.8% of people without schizophrenia. (p < 0.0001). Patients with schizophrenia had lower odds of ever having blood pressure recorded (OR = 0.81, 95% CI 0.71–0.94) and fewer of those with chronic kidney disease (CKD) were prescribed renin-angiotensin aldosterone system inhibitors, compared to patients without schizophrenia (10.3% vs 15.8%, p = 0.0005). Patients with diabetes and schizophrenia achieved similar blood glucose and blood pressure levels to those without schizophrenia, and had more primary care visits. However, they had fewer blood pressure readings and lower prescription of recommended medications among those who also had CKD. These results are both encouraging and represent opportunities for improvement in care. [ABSTRACT FROM AUTHOR]

Despite the increasing prevalence of postbariatric hypoglycemia (PBH), a late metabolic complication of bariatric surgery, our understanding of its diverse manifestations remains incomplete. To contrast parameters of glucose-insulin homeostasis in 2 distinct phenotypes of PBH (mild versus moderate hypoglycemia) based on nadir plasma glucose. University Hospital (Bern, Switzerland). Twenty-five subjects with PBH following gastric bypass surgery (age, 41 ± 12 years; body mass index, 28.1 ± 6.1kg/m2) received 75g of glucose with frequent blood sampling for glucose, insulin, C-peptide, and glucagon-like peptide 1 (GLP)-1. Based on nadir plasma glucose (-9∗min-1; P =.003). Despite an increased GLP-1 exposure in L2 compared to L1 PBH (50.7 versus 31.9pmol∗L-1∗min∗102; P =.021), no significant difference in PI was observed (P =.204). No significant differences were observed for HE, Ra, and SI. Our results suggest that higher insulin exposure in PBH patients with lower postprandial nadir glucose values mainly relate to a higher responsiveness to glucose, rather than GLP-1. [Display omitted] • Heterogeneity of postbariatric hypoglycemia in terms of its clinical manifestation is high. • Postbariatric hypoglycemia patients with low postprandial glucose levels display higher insulin exposure. • Differences in glucose, rather than GLP-1 β-cell stimulation is associated with higher insulin levels. [ABSTRACT FROM AUTHOR]

Aggregation represents a significant challenge for the long-term formulation stability of insulin therapeutics. The supramolecular PEGylation of insulin with conjugates of cucurbit[7]uril and polyethylene glycol (CB[7]‒PEG) has been shown to stabilize insulin formulations by reducing aggregation propensity. Yet prolonged in vivo duration of action, arising from sustained complex formation in the subcutaneous depot, limits the application scope for meal-time insulin uses and could increase hypoglycemic risk several hours after a meal. Supramolecular affinity of CB[7] in binding the B1-Phe residue on insulin is central to supramolecular PEGylation using this approach. Accordingly, here we synthesized N-terminal acid-modified insulin analogs to reduce CB[7] interaction affinity at physiological pH and reduce the duration of action by decreasing the subcutaneous depot effect of the formulation. These insulin analogs show weak to no interaction with CB[7]‒PEG at physiological pH but demonstrate high formulation stability at reduced pH. Accordingly, N-terminal modified analogs have in vitro and in vivo bioactivity comparable to native insulin. Furthermore, in a rat model of diabetes, the acid-modified insulin formulated with CB[7]‒PEG offers a reduced duration of action compared to native insulin formulated with CB[7]‒PEG. This work extends the application of supramolecular PEGylation of insulin to achieve enhanced stability while reducing the risks arising from a subcutaneous depot effect prolonging in vivo duration of action. The supramolecular PEGylation of N-terminal acid-modified insulin derivatives produces a stable formulation with a shorter duration of in vivo action, reducing the risk of hypoglycemia arising from subcutaneous depot. [Display omitted] [ABSTRACT FROM AUTHOR]

Neonates at risk of hypoglycemia are often roomed in with mothers, but there is paucity of literature on the occurrence of hypoglycemia in these exclusively breastfed high-risk neonates. The primary objective was to estimate the incidence of hypoglycaemia in high-risk neonates on exclusive breastfeeding. The secondary objectives were to study the time of presentation, symptoms of hypoglycaemia, and the various maternal and neonatal risk factors. This prospective observational study was carried out in a tertiary care teaching hospital of eastern India between January 2017 and June 2018. All neonates roomed in with mothers with high-risk factors such as low birth weight, preterm, small for gestational age, large for gestational age and infants of diabetic mothers were included. All included neonates were exclusive breastfed and underwent blood glucose monitoring at 2, 6, 12, 24, 48 and 72 h of life using glucometer strips and also whenever clinical features suggested hypoglycaemia. Hypoglycemia was defined as the blood glucose level ≤46 mg/dL. Of a total of 250 neonates studied, 52 (20.8%) developed hypoglycaemia in first 72 h. Hypoglycaemia was detected in most at 2 h with the second peak at 48 h of age. Only 8 (3.2%) neonates had symptomatic hypoglycaemia with jitteriness being the commonest symptom, followed by lethargy and poor feeding. There is a need to closely monitor the blood glucose levels for at least first 48 h in high-risk neonates roomed in with mothers on exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

A pharmacist-led, individualised, educational intervention (SUGAR) was formulated to prevent hypoglycaemia among elderly patients with type 2 diabetes mellitus (T2DM) in Jordan. To evaluate the effectiveness of the SUGAR intervention added to usual care compared with usual care only in preventing hypoglycaemic attacks in elderly patients with T2DM in Jordan. A single-centre, pragmatic, open-label, randomised controlled trial with embedded process evaluation was conducted at the outpatient clinics of a hospital in Jordan. Elderly patients (≥65 years) with T2DM and on sulfonylurea, insulin, or at least three anti-diabetic medications were recruited and parallelly randomised to the SUGAR intervention with usual care or the control (usual care) groups. The primary outcome was the rate of total hypoglycaemic attacks per patient after 3 months from randomisation. Secondary outcomes included rate of hypoglycaemia subtypes, the incidence of any and subtypes of hypoglycaemia, hypoglycaemia-free survival probability, and incidence of fasting hyperglycaemia necessitating therapy modification. Outcomes were measured through glucose meters and diaries, assessed at 3 months, and analysed by intention to treat. A total of 212 participants (mean age 68.98 years, 58.96% men) were randomly allocated (106 in each group), with 190 (89.62%) participants completing the study. The mean of total hypoglycaemic attacks was less in the intervention group compared with the control group (3.91 [SD 7.65] vs. 6.87 [SD 11.99]; p < 0.0001) at three months. The intervention significantly reduced the rate of hypoglycaemia subtypes; the odds to experience any, severe, and symptomatic hypoglycaemia; and increased hypoglycaemia-free survival probability compared with the control group at three months. Incidence of fasting hyperglycaemia necessitating therapy modification was similar between groups. The SUGAR intervention can prevent hypoglycaemia without increasing the risk of fasting hyperglycaemia warranting therapy adjustment in elderly Jordanians with T2DM. • The SUGAR intervention is an individualised, pharmacist-led, educational intervention. • The SUGAR intervention can reduce rate and incidence of hypoglycaemia in the elderly. • The SUGAR intervention can increase hypoglycaemia-free survival probability. • The SUGAR intervention does not increase the risk of fasting hyperglycaemia. [ABSTRACT FROM AUTHOR]

In this paper, we reported an excellent hypoglycemic effect of a Ganoderma lucidium polysaccharide F31 with efficacies between 45 and 54 %, approaching to that of liraglutide (52 %). Significantly, F31 reduced the body weight gains and food intakes. F31 decreased 4 key compounds, consisting of adenosine, adenosine, galactitol and glycerophosphocholine and elevated 8 key compounds, including arginine, proline, arachidonic acid, creatine, aspartic acid, leucine, phenylalanine and ornithine, which protected kidney function. Also, apoptosis was promoted by F31 in epididymal fat through increasing Caspase-3, Caspase-6 and Bax and decreasing Bcl-2. On 3 T3-L1 preadipocyte cells, F31 induced early apoptosis through reducing mitochondrial membrane potential. Finally, a molecular docking was performed to reveal a plausible cross-talk between kidney and epididymal fat through glycerophosphorylcholine-Bax axis. Overall, F31 alleviated hyperglycemia through kidney protection and adipocyte apoptosis in db/db mice. This work may provide novel insights into the hypoglycemic activity of polysaccharides. • F31 reduced fast blood glucose significantly, showing efficacies between 45 and 54 %. • F31 reduced the body weight gains and food intakes of the diabetic mice. • F31 demonstrated alleviation against the inflammation and chronic injury of kidney. • F31 promoted the apoptosis of adipocytes in epididymal fat. • F31 elevated Caspase-3 and Bax and reduced the mitochondrial membrane potential. [ABSTRACT FROM AUTHOR]

• UQCRC2 deficiency is characterised by hypoglycaemia with hyperlactatemia and recurrent episodes of severe hepatic failure. • Decompensations are frequent in infancy, in contrast with a satisfactory clinical condition between acute events. • Glucose fluid infusion quickly improves decompensations, which is a remarkable feature for a mitochondrial disorder. • UQCRC2 deficiency should be discussed as a differential diagnosis of neoglucogenesis defect. Isolated complex III defect is a relatively rare cause of mitochondrial disorder. New genes involved were identified in the last two decades, with only a few cases described for each deficiency. UQCRC2 , which encodes ubiquinol-cytochrome c reductase core protein 2, is one of the eleven structural subunits of complex III. We report seven French patients with UQCRC2 deficiency to complete the phenotype reported so far. We highlight the similarities with neoglucogenesis defect during decompensations - hypoglycaemias, liver failure and lactic acidosis - and point out the rapid improvement with glucose fluid infusion, which is a remarkable feature for a mitochondrial disorder. Finally, we discuss the relevance of coenzyme Q10 supplementation in this defect. [ABSTRACT FROM AUTHOR]

Treatment of hyperkalemia using intravenous insulin can result in severe hypoglycemia, but regular blood glucose monitoring is not standardized. This study aimed to (i) explore the demographics of adult patients receiving hyperkalemia treatment and (ii) identify the incidence rate of hypoglycemia and associated demographic or clinical characteristics. A descriptive design with prospective data collection was used. This study recruited 135 patients who received hyperkalemia treatment in the emergency department. Structured blood glucose monitoring was conducted at 1, 2, 4, and 6 hours after receiving intravenous insulin. Univariate analyses of association between demographic and clinical variables and hypoglycemia outcome were performed. There were 31 hypoglycemic events, with 11.9%, 7.4%, 2.2%, and 1.5% occurring at the 1, 2, 4, and 6 hours after treatment. The logit regression showed no significantly increased risk of hypoglycemia in terms of the demographic and clinical variables. The variation in blood glucose response observed in this study combined with the high incidences of hypolycaemia indicated the need for frequent and longer duration of monitoring for patients who were being treated for hyperkalaemia with IDT. [ABSTRACT FROM AUTHOR]

L'hypotrophie néonatale est responsable d'une morbidité et mortalité néonatale surtout dans les pays en développement. L'objectif de cette étude était de déterminer les facteurs associés dans le contexte de ressources limitées. Il s'agissait d'une étude de type cas-témoins réalisée de mars à novembre 2021 au service de néonatologie de la maternité Issaka Gazoby de Niamey. Les nouveau-nés hospitalisés au service, ainsi que leurs mères ont été étudiés. Les caractéristiques des mères, les données relatives aux nouveau-nés ont été étudiées. Les données ont été analysées grâce au logiciel Sphinx Plus2 version 5.0.0.82. Le test de Chi2 de Pearson et le test exact de Fisher ont été utilisés (p < 0,05). Sur 5310 nouveau-nés, 116 cas d'hypotrophie néonatale ont été retrouvés (2,2 %). Les cas étaient plus observés chez les mères qui n'ont pas d'activité professionnelle (66,38 %) [ p > 0,05]. Les principaux facteurs de risque significatifs étaient l'âge maternel (OR = 1,93; p = 0,02), la dénutrition maternelle (OR = 120,97; p < 0,01) et l'insuffisance du suivi des grossesses (OR = 1,64 et p = 0,01). Pour les caractéristiques des nouveau-nés, la prématurité a été retrouvée comme facteur de risque (OR = 7,57; p < 0,01). L'hypoglycémie, l'hypothermie et les décès étaient plus observés chez les nouveau-nés hypotrophes (p < 0,01). Les principaux déterminants maternels de l'hypotrophie néonatale étaient l'âge avancé, la dénutrition et l'insuffisance de suivi de la grossesse. Chez les nouveau-nés, il s'agissait de la prématurité. Les complications néonatales associées étaient l'hypoglycémie, l'hypothermie et les décès. Neonatal hypotrophy is responsible for neonatal morbidity and mortality especially in developing countries. The objective of this study was to determine the associated factors in the context of limited resources. This was a case-control study conducted from March to November 2021 in the neonatology department of Issaka Gazoby maternity hospital in Niamey. Newborns hospitalized in the department, as well as their mothers were studied. The characteristics of mothers and the data on the newborns were studied. Data were analyzed using the Sphinx Plus2 software version 5.0.0.82. Pearson's Chi2 test and Fisher's exact test were used (P < 0.05). Out of 5310 newborns, 116 cases of neonatal hypotrophy were found (2.2 %). The cases were more observed in mothers without professional activity (66.38 %) [ P > 0.05]. The significant risk factors were maternal age over 20 years (OR = 1.93; P = 0.02), maternal undernutrition (OR = 120.97; P < 0.01) and inadequate pregnancy follow-up (OR = 1.64 and P = 0.01). For newborn characteristics, prematurity was found to be a risk factor (OR = 7.57; P < 0.01). Hypoglycemia, hypothermia and death were more observed in hypotrophic newborns (P < 0.01). The main maternal determinants of neonatal hypotrophy were advanced age, undernutrition and inadequate pregnancy follow-up. In neonates, it was prematurity. Associated neonatal complications were hypoglycemia, hypothermia and death. [ABSTRACT FROM AUTHOR]

Aim: To study the effect of real time continuous glucose monitor (RT-CGM) use on glycemic parameters in patients with diabetes mellitus (DM) in real world practice.Methods: We retrospectively studied 91 adult subjects with DM who had been using Dexcom™ RT-CGM. Two consecutive hemoglobin A1c (HbA1c), both prior to and after at least 3 months of RT-CGM initiation, were collected. A total of 31 subjects completed a 5-14 day user blinded CGM using a Freestyle Libre™ prior to RT-CGM initiation. The first two week period following at least 3 months use of RT-CGM was analyzed for CGM metrics.Results: A total of 51.6 % of subjects had T1DM, 34.1 % used continuous subcutaneous insulin infusion (CSII), and 62.6 % had DM for > 10 years. Both HbA1c obtained following RT-CGM initiation decreased significantly compared to baseline (8.11 + 1.47% vs 7.69 + 1.25 %; P = 0.002 & 8.16 + 1.51 % vs 7.62 + 1.06 %; P = 0.001). Subjects with baseline HbA1c > 7.0 % showed even more robust reduction in both HbA1c after RT-CGM initiation (8.74 + 1.24 % vs 7.99 + 1.22 %; P = 0.000 & 8.74 + 1.32 % vs 7.85 + 1.07 %; P = 0.001). On comparison of CGM metrics, there was a significant reduction in time spent in hypoglycemia (sugars < 70 mg/dl) including severe hypoglycemia (sugars < 54 mg/dl) after initiation of the RT-CGM (9.16 + 8.68 % vs 1.29 + 2.21 %; P = <0.001 & 4.58 + 5.43 % vs 0.28 + 0.58 %; P = <0.001). CoV of glucose was also decreased significantly (39.61 + 9.36 % vs 31.06 + 6.74 %; P = <0.001) with RT- CGM use.Conclusion: RT-CGM use for at least 3 months in patients with DM results in meaningful HbA1c reductions with stable glycemic control without increasing the risk of hypoglycemia. [ABSTRACT FROM AUTHOR]