scholarly journals Glucocorticoid pulse therapy аnd carbohydrate metabolism in rheumatic diseases

2013 ◽  
Vol 94 (6) ◽  
pp. 920-923
Author(s):  
G I Nurullina
Keyword(s):  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Pulse Therapy ◽  
Serum Glucose ◽  
Peripheral Tissues ◽  
Family History Of Diabetes ◽  
Glucose Levels ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
High Doses

Glucocorticoids are used in clinical practice for more than 50 years and are a great advance in the treatment of systemic inflammatory diseases. High doses of intravenous glucocorticoids (pulse therapy) are effective in conditions requiring rapid immunosuppression and antiinflammatory effect, such as systemic lupus erythematosus, rheumatoid arthritis, glomerulonephritis and systemic vasculitides. The advantage of this method are increased efficacy and lower rate of complications associated with prolonged administration of glucocorticoids. At the same time, glucocorticoid pulse therapy is associated with increased risk of hyperglycemia or even can be a cause of steroid-induced diabetes in patients without known hyperglycemia, as well as worsen glycemia control in patients with diabetes. Increased hepatic gluconeogenesis, inhibition of glucose uptake and metabolism in peripheral tissues and altered both receptor and post-receptor insulin action can lead to an increased serum glucose levels. In patients with inadequate compensatory reserves of pancreas, a clinical picture of diabetus mellitus can develop while treated with glucocorticoids. Blood glucose levels begin to rise 6-12 hours after the infusion of high doses of glucocorticoids. Risk factors for developing glucose intolerance and diabetes include advanced age, obesity, family history of diabetes and high cumulative doses of glucocorticoids. Glucocorticoid-induced diabetes is a common complication of pulse therapy, but exact causes are still not elucidated yet, current literature data on glucocorticoid-induced hyperglycemia are scarce.

scholarly journals Glycemic variability and cardiovascular disease in patients with type 2 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002032
Author(s):  
Marcela Martinez ◽  
Jimena Santamarina ◽  
Adrian Pavesi ◽  
Carla Musso ◽  
Guillermo E Umpierrez
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycated Hemoglobin ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Cardiovascular Complications ◽  
Glucose Levels ◽  
Increased Risk ◽  
Patients With Diabetes

Glycated hemoglobin is currently the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes. Glycated hemoglobin, however, does not address fluctuations in blood glucose. Glycemic variability (GV) refers to fluctuations in blood glucose levels. Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level. The use of continuous glucose monitoring devices has markedly improved the assessment of GV in clinical practice and facilitated the assessment of GV as well as hypoglycemia and hyperglycemia events in patients with diabetes. We review current concepts on the definition and assessment of GV and its association with cardiovascular complications in patients with type 2 diabetes.

scholarly journals Dexamethasone Administration in Mice Leads to Less Body Weight Gain over Time, Lower Serum Glucose, and Higher Insulin Levels Independently of NRF2

Antioxidants ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 4
Author(s):  
Fotini Filippopoulou ◽  
George I. Habeos ◽  
Vagelis Rinotas ◽  
Antonia Sophocleous ◽  
Gerasimos P. Sykiotis ◽  
...  
Keyword(s):  
Body Weight ◽  
Weight Gain ◽  
Molecular Mechanisms ◽  
Inflammatory Diseases ◽  
Body Weight Gain ◽  
Serum Glucose ◽  
Dexamethasone Treatment ◽  
Insulin Levels ◽  
Glucose Levels ◽  
High Insulin

Glucocorticoids are used widely on a long-term basis in autoimmune and inflammatory diseases. Their adverse effects include the development of hyperglycemia and osteoporosis, whose molecular mechanisms have been only partially studied in preclinical models. Both these glucocorticoid-induced pathologies have been shown to be mediated at least in part by oxidative stress. The transcription factor nuclear erythroid factor 2-like 2 (NRF2) is a central regulator of antioxidant and cytoprotective responses. Thus, we hypothesized that NRF2 may play a role in glucocorticoid-induced metabolic disease and osteoporosis. To this end, WT and Nrf2 knockout (Nrf2KO) mice of both genders were treated with 2 mg/kg dexamethasone or vehicle 3 times per week for 13 weeks. Dexamethasone treatment led to less weight gain during the treatment period without affecting food consumption, as well as to lower glucose levels and high insulin levels compared to vehicle-treated mice. Dexamethasone also reduced cortical bone volume and density. All these effects of dexamethasone were similar between male and female mice, as well as between WT and Nrf2KO mice. Hepatic NRF2 signaling and gluconeogenic gene expression were not affected by dexamethasone. A 2-day dexamethasone treatment was also sufficient to increase insulin levels without affecting body weight and glucose levels. Hence, dexamethasone induces hyperinsulinemia, which potentially leads to decreased glucose levels, as well as osteoporosis, both independently of NRF2.

scholarly journals Assessment of Candidal carriage in patients with Type II Diabetes Mellitus

2015 ◽  
Vol 5 (9) ◽  
pp. 733-738 ◽  
Author(s):  
RS Lamichhane ◽  
K Boaz ◽  
S Natarajan ◽  
M Shrestha
Keyword(s):  
Diabetes Mellitus ◽  
Fungal Infections ◽  
Surrogate Marker ◽  
Salivary Flow ◽  
Type Ii Diabetes Mellitus ◽  
Serum Glucose ◽  
Denture Stomatitis ◽  
Oral Rinse ◽  
Increased Risk ◽  
Patients With Diabetes

Background: It is generally acknowledged that patients with diabetes mellitus are more susceptible to fungal infections, particularly with Candida albicans. Oral infection by Candida can result in a number of clinical lesions, including median rhomboid glossitis (central papillary atrophy), denture stomatitis, squamous cell carcinoma, Radiation therapy, immunocompromised status, etc. Different studies have shown that patients with diabetes mellitus have increased frequency of oral candidal carriage and increased risk of candidiasis, which is related to poor metabolic control, neutrophil dysfunction, reduced salivary flow, high glucose concentration in blood and saliva and in medications.Materials and Methods: Subjects of both the groups were given 10 ml of sterile normal saline and asked to rinse the mouth for one minute. The subjects were then asked to return the oral rinse in a sterile clean, broad-mouthed container which was capped, labelled and taken to the laboratory. The samples were then inoculated onto the culture medium (Sabouraud’s dextrose agar with Chloramphenicol) with minimal delay (within 6-8 hours of collection of oral rinse). Candidal colonies were counted and compared with non-diabetics.Results: Statistically significant increase in colony forming units (p=0.0324) were obtainedin patients with diabetes mellitus.Conclusion: The results indicate significant increase in colonization and carriage of candida in the oral cavity among diabetics when compared with non-diabetics. However, further research using larger samples is required which may lend credibility to the suggestion of increased candidal CFUs in diabetics serving as a surrogate marker of serum glucose levels.Journal of Pathology of Nepal (2015) Vol. 5, 733-738

scholarly journals Metabolic syndrome increases COVID-19-related mortality in the UK Biobank sample

2020 ◽  
Author(s):  
Filip Morys ◽  
Alain Dagher
Keyword(s):  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Serum Glucose ◽  
Uk Biobank ◽  
Glucose Levels ◽  
Increased Risk ◽  
Confounding Variables ◽  
Specific Factors ◽  
The Uk ◽  
Related Mortality

AbstractPrevious studies link obesity and individual components of metabolic syndrome to increased hospitalisations and death rates of patients with COVID-19. Here, in two overlapping samples of over 1,000 individuals from the UK Biobank we investigate whether metabolic syndrome, and its constituent components, increased waist circumference, dyslipidaemia, hypertension, diabetes, and systemic inflammation, are related to increased COVID-19 infection and mortality rates. Using logistic regression and controlling for confounding variables such as socioeconomic status, age, sex or ethnicity, we find that individuals with pre-existing metabolic syndrome (measured on average eleven years prior to 2020) have an increased risk for COVID-19-related death (odds ratio 1.67). We also find that specific factors contributing to increased mortality are serum glucose levels, systolic blood pressure and waist circumference.

scholarly journals Remote continuous glucose monitoring during the COVID-19 pandemic in quarantined hospitalized patients in Denmark: A structured summary of a study protocol for a randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Carina Kirstine Klarskov ◽  
Birgitte Lindegaard ◽  
Ulrik Pedersen-Bjergaard ◽  
Peter Lommer Kristensen
Keyword(s):  
Blood Glucose ◽  
Sample Size ◽  
Primary Endpoint ◽  
Controlled Trial ◽  
Glucose Monitoring ◽  
Glucose Levels ◽  
Increased Risk ◽  
Finger Prick ◽  
Patients With Diabetes ◽  
Full Protocol

Abstract Objectives Patients with diabetes are - compared to people without diabetes - at increased risk of worse outcomes from COVID-19 related pneumonia during hospitalization. We aim to investigate whether telemetric continuous glucose monitoring (CGM) in quarantined hospitalized patients with diabetes and confirmed SARS-CoV-2 infection or another contagious infection can be successfully implemented and is associated with better glycaemic control than usual blood glucose monitoring (finger prick method) and fewer patient-health care worker contacts. Furthermore, we will assess whether glucose variables are associated with the clinical outcome. The hypothesis is that by using remote CGM to monitor glucose levels of COVID-19 infected patients and patients with other contagious infections with diabetes, we can still provide satisfactory (and maybe even better) in-hospital diabetes management despite patients being quarantined. Furthermore, the number of patient-personnel contacts can be lowered compared to standard monitoring with finger-prick glucose. This could potentially reduce the risk of transmitting contagious diseases from the patient to other people and reduces the use of PPE’s. Improved glucose control may reduce the increased risk of poor clinical outcomes associated with combined diabetes and infection. Trial Design This is a single centre, open label, exploratory, randomised, controlled, 2-arm parallel group (1:1 ratio), controlled trial. Participants The trial population is patients with diabetes (both type 1 diabetes, type 2 diabetes, newly discovered diabetes that is not classified yet, and all other forms of diabetes) admitted to Nordsjællands Hospital that are quarantined due to COVID-19 infection or another infection. Inclusion criteria: 1. Hospitalized with confirmed COVID-19 infection by real-time PCR or another validated method OR hospitalized with a non-COVID-19 diagnosis and quarantined at time of inclusion. 2. A documented clinically relevant history of diabetes or newly discovered during hospitalization as defined by The World Health Organizations diagnostic criteria for diabetes. 3. Written informed consent obtained before any trial related procedures are performed. 4. Male or female aged over 18 years of age. 5. Must be able to communicate with the study personnel. 6. The subject must be willing and able to comply with trial protocol. Exclusion criteria: 1. Known hypersensitivity to the band-aid of the Dexcom G6 sensors Intervention and comparator Participants will be randomized to either real-time CGM with the Dexcom G6, a CGM system that does not need to be calibrated, or finger-prick glucose monitoring. Blinded CGM will be mounted in the finger-prick group. In the open CGM group, the glucose values will be transmitted to a Smartdevice in the nurse office where glucose levels can be monitored remotely. Main Outcomes The primary endpoint is the difference between groups in distribution of glucose values being in time in range (TIR), defined as 3.9 to 10 mmol/l. In addition, the primary endpoint is reported as the percentage of days of the whole admission, the patient reaches TIR. Secondary endpoints are the estimated number of saved patient-personnel contacts related to blood glucose measurements, incl. time healthcare providers spent on diabetes related tasks and PPE related tasks, during the patients’ hospitalization. Furthermore, we will assess additional glucose outcomes and associations of glucose variables and patient outcomes (As specified in the protocol). Randomisation The service used for generating the randomization lists is www.random.org. Randomization is stratified by COVID-19 status and an allocation ratio of 1:1 to either CGM or finger-prick groups. Blinding (Masking) The design of the trial is open, however blinded CGM is recorded in the finger-prick group. Numbers to be randomized (sample size) A sample size of N=72 is required for the primary endpoint analysis based on 80% power to detect a 10% difference between groups in TIR and to allow for a 15% dropout. The 72 participants will be randomized 1:1 to open CGM or finger-prick with 36 in each group. Trial status This structured protocol summary is based on the CGM-ISO protocol version 1.3, dated 13.05.2020. Date of first patient enrolled: 25.05.2020. Expected last recruiting is May 2021. Patients enrolled to date: 20 in total. 8 with confirmed COVID-19 infection and 12 with other infections. Trial registration ClinicalTrials.gov Identifier: NCT04430608. Registered 12.06.2020 Full protocol The full protocol is attached as an additional file from the Trial website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; This Letter serves as a summary of the key elements of the full protocol.

scholarly journals Rowell syndrome – a clinical entity that must not be forgotten

2016 ◽  
Vol 63 (4) ◽  
pp. 331-333
Author(s):  
Maria Daniela Tănăsescu ◽  
◽  
Mihai Ovidiu Comşa ◽  
Alexandru Mincă ◽  
Alexandru Cristian Diaconescu ◽  
...  
Keyword(s):  
Erythema Multiforme ◽  
Lupus Erythematosus ◽  
Rare Condition ◽  
Skin Lesions ◽  
Pulse Therapy ◽  
Therapeutic Regimen ◽  
Discoid Lupus Erythematosus ◽  
Cutaneous Lesions ◽  
High Doses ◽  
Minor Criteria

Objective. Rowell Syndrome represents a rare condition, characterised by the existence of erythema multiforme with lupus erythematosus. The diagnosis is made in patients which present both the major criteria (coexistence of discoid lupus erythematosus with erythema multiforme lesions and positivity for speckled - pattern antinuclear antibodies) and at least one of the minor criteria (frostbites-like lesions, positive anti-La or anti-Ro antibodies and reactive rheumatoid factor). The main objective of this article is to evidence a rare case of Rowell Syndrome and the optimal diagnostic and therapeutic management involved for resolving this case. Material and method. This article presents the case of a 47-year-old patient diagnosed with Rowell Syndrome, which met the diagnostic criteria. In her case, we used a therapeutic regimen comprising Hydroxychloroquine 400 mg/day and pulse-therapy with methylprednisolone 1 gram/day, for 3 days. Results. The decremental titration of prednisone resulted in reoccurrence of cutaneous lesions, prompting the return to the high doses, with normalisation of skin lesions. Conclusions. The presented case highlights the importance of keeping in mind the diagnosis of Rowell Syndrome in all the situations of patients with serologic profile of lupus and erythema multiforme lesions. Discussion. The therapeutic regimen and evolution under treatment may have a variable course, imposing the monitoring of patients a course for preventing the disease relapse.

scholarly journals Lupus Disease with Lupus Nephritis - 14 Years of Clinical-Biological Observations

2020 ◽  
Vol 17 (3) ◽  
pp. 61-69
Author(s):  
Cristina Buhoară ◽  
Nicoleta Petre ◽  
Mircea Penescu
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Nitrogen Retention ◽  
Pulse Therapy ◽  
Reduced Dose ◽  
Clinical Evolution ◽  
Azathioprine Treatment ◽  
Increased Risk ◽  
Dsdna Antibodies

AbstractWe present the case of a female patient diagnosed in 2004 with systemic lupus erythematosus, initially with joint and hematological damage complaint, for which she was treated with Methylprednisolone for 6 months. Subsequently, symptomatology and paraclinical screening raised the suspicion of renal impairment, a pulse therapy with Solumedrol and Cyclophosphamide was initiated, a total of 6 pulses. She is in the database of our Clinic since March 2008, when a renal biopsy was performed, revealing a class IV lupus nephritis, initiating treatment with Mycophenolate mofetil and Prednisone until 2010, when the dose of Prednisone is progressively reduced until cessation at the time of remission. Subsequently she presented two relapse episodes, recovered by pulse therapy with Methylprednisolone and Cyclophosphamide, followed by maintenance therapy with Mycophenolate mofetil and Prednisone with a good clinical evolution. In 2017 the patient has a pregnancy with favorable evolution (under treatment with Azathioprine), presenting normal values of cDNA, C3, C4 during the 9 months, but with a persistent nephrotic-range proteinuria; in these conditions gives birth physiologically at 37 weeks. During 2019 apparent remission is maintained (stationary nitrogen retention, anti-dsDNA antibodies within normal range), but with moderate anaemia and persistent, but diminished proteinuria (being under treatment with reduced dose Prednisolone and Mycophenolate mofetil); along the way proteinuria is accentuated again and it is decided to return to reduced dose Azathioprine treatment, with good clinical evolution.Conclusion. The presented case reinforces the idea of systematic monitoring of patients with SLE and the need for permanent adaptation of treatment especially when there is an increased risk of relapse. Pregnancy, paradoxically well tolerated, increases subsequently the risk of reactivation of lupus nephritis.

scholarly journals Robust Neutralizing Antibodies to SARS-CoV-2 Develop and Persist in Subjects with Diabetes and COVID-19 Pneumonia

2021 ◽  
Author(s):  
Stefania Dispinseri ◽  
Vito Lampasona ◽  
Massimiliano Secchi ◽  
Andrea Cara ◽  
Elena Bazzigaluppi ◽  
...  
Keyword(s):  
Antibody Response ◽  
Neutralizing Antibodies ◽  
Vaccine Development ◽  
Lentiviral Vector ◽  
Vaccination Campaign ◽  
Humoral Response ◽  
Neutralizing Antibody ◽  
Glucose Levels ◽  
Increased Risk ◽  
Patients With Diabetes

Abstract Context Demonstrating the ability to mount a neutralizing antibody response to SARS-CoV-2 in the presence of diabetes is crucial to understand COVID-19 pathogenesis, reinfection potential, and vaccine development. Objective The aim of this study was to characterize the kinetics and durability of neutralizing antibody (Nab) response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the presence of hyperglycemia. Methods Using a lentiviral vector–based SARS-CoV-2 neutralization assay to measure Nabs, we characterized 150 patients randomly selected from a cohort of 509 patients with confirmed COVID-19 pneumonia. We analyzed Nab response according to the presence of diabetes or hyperglycemia, at the time of hospitalization and during the postdischarge follow-up: 1-, 3-, and 6-month outpatient visits. Results Among 150 randomly selected patients 40 (26.6%) had diabetes. Diabetes (hazard ratio [HR] 8.9, P < .001), glucose levels (HR 1.25 × 1.1 mmol/L, P < .001), and glucose variability (HR 1.17 × 0.6 mmol/L, P < .001) were independently associated with an increased risk of mortality. The neutralizing activity of SARS-CoV-2 antibodies in patients with diabetes was superimposable, as for kinetics and extent, to that of patients without diabetes. It was similar across glucose levels and correlated with the humoral response against the SARS-CoV-2 spike protein. Positivity for Nabs at the time of hospital admission conferred protection on mortality, both in the presence (HR 0.28, P = .046) or absence of diabetes (HR 0.26, P = .030). The longevity of the Nab response was not affected by diabetes. Conclusion Diabetes and hyperglycemia do not affect the kinetics and durability of the neutralizing antibody response to SARS-CoV-2. These findings provide the rational to include patients with diabetes in the early phase of the vaccination campaign against SARS-CoV-2.

Elevated Preoperative Fasting Serum Glucose Levels Increase the Risk of Postoperative Mediastinitis in Patients Undergoing Open Heart Surgery

2003 ◽  
Vol 24 (10) ◽  
pp. 776-778 ◽  
Author(s):  
Stephen J. Wilson ◽  
Daniel J. Sexton
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Serum Glucose ◽  
Open Heart ◽  
Preoperative Fasting ◽  
Fasting Serum ◽  
Fasting Serum Glucose ◽  
Glucose Levels ◽  
Increased Risk ◽  
The Relationship

AbstractWe conducted a case-control study to investigate the relationship between preoperative fasting serum glucose and postoperative mediastinitis in patients undergoing open heart surgery. Multivariate analysis revealed that a glucose level of 126 mg/dL or greater was associated with a significantly increased risk of mediastinitis (OR, 5.25; P = .002).

Management of Diabetes in People Undergoing Dental Treatment in Primary Care

2020 ◽  
Vol 9 (2) ◽  
pp. 38-46
Author(s):  
Samina Nayani ◽  
Omar G. Mustafa
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Dental Treatment ◽  
Rapid Progression ◽  
High Blood Glucose ◽  
Glucose Levels ◽  
Dental Management ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Microvascular And Macrovascular Complications

Diabetes mellitus is a condition resulting from loss of production of insulin, or insufficient production/insulin resistance leading to high blood glucose levels. Management of the condition can be provided in a variety of settings and is tailored to the person’s requirements. The condition has a lifelong, systemic impact due to microvascular and macrovascular complications. Diabetes mellitus has dental implications due to increased risk of infections, poor wound healing, rapid progression of periapical pathology, xerostomia, burning mouth syndrome, and a bidirectional link with periodontal disease. Two clinical cases of patients with diabetes are discussed and their dental management described. Many people with diabetes can be treated in primary care, however, some with suboptimal glycaemic control may require specialist input and liaison with the patient’s diabetes team.

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