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Lancet (London, England) Jun 2012Prediabetes (intermediate hyperglycaemia) is a high-risk state for diabetes that is defined by glycaemic variables that are higher than normal, but lower than diabetes... (Review)
Review
Prediabetes (intermediate hyperglycaemia) is a high-risk state for diabetes that is defined by glycaemic variables that are higher than normal, but lower than diabetes thresholds. 5-10% of people per year with prediabetes will progress to diabetes, with the same proportion converting back to normoglycaemia. Prevalence of prediabetes is increasing worldwide and experts have projected that more than 470 million people will have prediabetes by 2030. Prediabetes is associated with the simultaneous presence of insulin resistance and β-cell dysfunction-abnormalities that start before glucose changes are detectable. Observational evidence shows associations between prediabetes and early forms of nephropathy, chronic kidney disease, small fibre neuropathy, diabetic retinopathy, and increased risk of macrovascular disease. Multifactorial risk scores using non-invasive measures and blood-based metabolic traits, in addition to glycaemic values, could optimise estimation of diabetes risk. For prediabetic individuals, lifestyle modification is the cornerstone of diabetes prevention, with evidence of a 40-70% relative-risk reduction. Accumulating data also show potential benefits from pharmacotherapy.
Topics: Adult; Blood Glucose; Diabetes Complications; Disease Progression; Global Health; Glycated Hemoglobin; Humans; Hyperglycemia; Hypoglycemic Agents; Life Style; Microcirculation; Prediabetic State; Risk Reduction Behavior
PubMed: 22683128
DOI: 10.1016/S0140-6736(12)60283-9 -
Anesthesiology Mar 2017An association between perioperative hyperglycemia and adverse outcomes has been established in surgical patients, with morbidity being reduced in those treated with... (Review)
Review
An association between perioperative hyperglycemia and adverse outcomes has been established in surgical patients, with morbidity being reduced in those treated with insulin. A practical treatment algorithm and literature summary is provided for surgical patients with diabetes and hyperglycemia.
Topics: Humans; Hyperglycemia; Hypoglycemic Agents; Insulin; Perioperative Care
PubMed: 28121636
DOI: 10.1097/ALN.0000000000001515 -
Diabetologia Jan 2018Diabetic cardiomyopathy is characterised in its early stages by diastolic relaxation abnormalities and later by clinical heart failure in the absence of dyslipidaemia,... (Review)
Review
Diabetic cardiomyopathy is characterised in its early stages by diastolic relaxation abnormalities and later by clinical heart failure in the absence of dyslipidaemia, hypertension and coronary artery disease. Insulin resistance, hyperinsulinaemia and hyperglycaemia are each independent risk factors for the development of diabetic cardiomyopathy. The pathophysiological factors in diabetes that drive the development of cardiomyopathy include systemic metabolic disorders, inappropriate activation of the renin-angiotensin-aldosterone system, subcellular component abnormalities, oxidative stress, inflammation and dysfunctional immune modulation. These abnormalities collectively promote cardiac tissue interstitial fibrosis, cardiac stiffness/diastolic dysfunction and, later, systolic dysfunction, precipitating the syndrome of clinical heart failure. Recent evidence has revealed that dysregulation of coronary endothelial cells and exosomes also contributes to the pathology behind diabetic cardiomyopathy. Herein, we review the relationships among insulin resistance/hyperinsulinaemia, hyperglycaemia and the development of cardiac dysfunction. We summarise the current understanding of the pathophysiological mechanisms in diabetic cardiomyopathy and explore potential preventative and therapeutic strategies.
Topics: Animals; Diabetic Cardiomyopathies; Heart Diseases; Humans; Hyperglycemia; Insulin Resistance
PubMed: 28776083
DOI: 10.1007/s00125-017-4390-4 -
Lancet (London, England) May 2009Results of randomised controlled trials of tight glycaemic control in hospital inpatients might vary with population and disease state. Individualised therapy for... (Review)
Review
Results of randomised controlled trials of tight glycaemic control in hospital inpatients might vary with population and disease state. Individualised therapy for different hospital inpatient populations and identification of patients at risk of hyperglycaemia might be needed. One risk factor that has received much attention is the presence of pre-existing diabetes. So-called stress hyperglycaemia is usually defined as hyperglycaemia resolving spontaneously after dissipation of acute illness. The term generally refers to patients without known diabetes, although patients with diabetes might also develop stress hyperglycaemia-a fact overlooked in many studies comparing hospital inpatients with or without diabetes. Investigators of several studies have suggested that patients with stress hyperglycaemia are at higher risk of adverse consequences than are those with pre-existing diabetes. We describe classification of stress hyperglycaemia, mechanisms of harm, and management strategies.
Topics: Acute Disease; Blood Glucose; Cardiovascular Diseases; Critical Illness; Early Diagnosis; Glucose Tolerance Test; Humans; Hyperglycemia; Monitoring, Physiologic; Prediabetic State; Prevalence; Research Design; Risk Factors; Risk Reduction Behavior; Severity of Illness Index; Stress, Physiological; Stroke; Surgical Procedures, Operative; Treatment Outcome
PubMed: 19465235
DOI: 10.1016/S0140-6736(09)60553-5 -
BMJ (Clinical Research Ed.) Sep 2016To assess the association between maternal glucose concentrations and adverse perinatal outcomes in women without gestational or existing diabetes and to determine... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the association between maternal glucose concentrations and adverse perinatal outcomes in women without gestational or existing diabetes and to determine whether clear thresholds for identifying women at risk of perinatal outcomes can be identified.
DESIGN
Systematic review and meta-analysis of prospective cohort studies and control arms of randomised trials.
DATA SOURCES
Databases including Medline and Embase were searched up to October 2014 and combined with individual participant data from two additional birth cohorts.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Studies including pregnant women with oral glucose tolerance (OGTT) or challenge (OGCT) test results, with data on at least one adverse perinatal outcome.
APPRAISAL AND DATA EXTRACTION
Glucose test results were extracted for OGCT (50 g) and OGTT (75 g and 100 g) at fasting and one and two hour post-load timings. Data were extracted on induction of labour; caesarean and instrumental delivery; pregnancy induced hypertension; pre-eclampsia; macrosomia; large for gestational age; preterm birth; birth injury; and neonatal hypoglycaemia. Risk of bias was assessed with a modified version of the critical appraisal skills programme and quality in prognostic studies tools.
RESULTS
25 reports from 23 published studies and two individual participant data cohorts were included, with up to 207 172 women (numbers varied by the test and outcome analysed in the meta-analyses). Overall most studies were judged as having a low risk of bias. There were positive linear associations with caesarean section, induction of labour, large for gestational age, macrosomia, and shoulder dystocia for all glucose exposures across the distribution of glucose concentrations. There was no clear evidence of a threshold effect. In general, associations were stronger for fasting concentration than for post-load concentration. For example, the odds ratios for large for gestational age per 1 mmol/L increase of fasting and two hour post-load glucose concentrations (after a 75 g OGTT) were 2.15 (95% confidence interval 1.60 to 2.91) and 1.20 (1.13 to 1.28), respectively. Heterogeneity was low between studies in all analyses.
CONCLUSIONS
This review and meta-analysis identified a large number of studies in various countries. There was a graded linear association between fasting and post-load glucose concentration across the whole glucose distribution and most adverse perinatal outcomes in women without pre-existing or gestational diabetes. The lack of a clear threshold at which risk increases means that decisions regarding thresholds for diagnosing gestational diabetes are somewhat arbitrary. Research should now investigate the clinical and cost-effectiveness of applying different glucose thresholds for diagnosis of gestational diabetes on perinatal and longer term outcomes.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42013004608.
Topics: Birth Weight; Diabetes, Gestational; Dystocia; Evidence-Based Medicine; Female; Fetal Macrosomia; Glucose Tolerance Test; Humans; Hyperglycemia; Infant, Newborn; Pregnancy; Pregnancy Outcome; Premature Birth; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 27624087
DOI: 10.1136/bmj.i4694 -
The Journal of Clinical Endocrinology... Mar 2023Graves orbitopathy (GO) or thyroid eye disease is a potentially sight-threatening and disfiguring autoimmune disease. Teprotumumab is a monoclonal antibody against the... (Observational Study)
Observational Study
CONTEXT
Graves orbitopathy (GO) or thyroid eye disease is a potentially sight-threatening and disfiguring autoimmune disease. Teprotumumab is a monoclonal antibody against the insulin-like growth factor-I receptor that was recently approved for GO treatment. Hyperglycemia is a recognized adverse event of teprotumumab, occurring in 10% of patients in 2 recent randomized controlled trials.
OBJECTIVE
Our study aimed to report the incidence, severity, management, and longitudinal glycemic changes in patients treated with teprotumumab in an academic practice cohort.
METHODS
This longitudinal, observational study included all consecutive patients treated with teprotumumab between March 2020 and May 2022 at 1 institution. Hemoglobin A1c (HbA1c) was measured every 3 months.
RESULTS
Forty-two patients with baseline normoglycemia (n = 22), prediabetes (n = 10), and diabetes (n = 10) were followed for a mean of 47.5 weeks. Overall, HbA1c increased by 0.5% at 3 months. Least-squares mean changes in HbA1c at 3 months were 1.3 (P < .001), 0.7 (P = .01), and 0.1 (P = .41) in patients with diabetes, prediabetes, and normoglycemia, respectively. Twenty-two patients (52%) had hyperglycemia, which was graded as mild, moderate, and life-threatening in 55% (12/22), 41% (9/22), and 5% (1/22) of cases, respectively. Age, pre-existing diabetes, and Hispanic and Asian race/ethnicity were significant risk factors for hyperglycemia. Among patients with hyperglycemia, 36.4% (8/22) returned to baseline glycemic status at last follow-up.
CONCLUSION
While effective, teprotumumab carries a significant risk of hyperglycemia, especially in patients with diabetes. Hyperglycemia may persist after stopping teprotumumab. These findings underscore the importance of guidelines for screening and management of teprotumumab-related hyperglycemia.
Topics: Humans; Graves Ophthalmopathy; Glycated Hemoglobin; Prediabetic State; Hyperglycemia
PubMed: 36300333
DOI: 10.1210/clinem/dgac627 -
The Lancet. Child & Adolescent Health Apr 2021Hyperglycaemia and hypoglycaemia are common in preterm infants and have been associated with increased risk of mortality and morbidity. Interventions to reduce risk... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Hyperglycaemia and hypoglycaemia are common in preterm infants and have been associated with increased risk of mortality and morbidity. Interventions to reduce risk associated with these exposures are particularly challenging due to the infrequent measurement of blood glucose concentrations, with the potential of causing more harm instead of improving outcomes for these infants. Continuous glucose monitoring (CGM) is widely used in adults and children with diabetes to improve glucose control, but has not been approved for use in neonates. The REACT trial aimed to evaluate the efficacy and safety of CGM in preterm infants requiring intensive care.
METHODS
This international, open-label, randomised controlled trial was done in 13 neonatal intensive care units in the UK, Spain, and the Netherlands. Infants were included if they were within 24 h of birth, had a birthweight of 1200 g or less, had a gestational age up to 33 weeks plus 6 days, and had parental written informed consent. Infants were randomly assigned (1:1) to real-time CGM or standard care (with masked CGM for comparison) using a central web randomisation system, stratified by recruiting centre and gestational age (<26 or ≥26 weeks). The primary efficacy outcome was the proportion of time sensor glucose concentration was 2·6-10 mmol/L for the first week of life. Safety outcomes related to hypoglycaemia (glucose concentrations <2·6 mmol/L) in the first 7 days of life. All outcomes were assessed on the basis of intention to treat in the full analysis set with available data. The study is registered with the International Standard Randomised Control Trials Registry, ISRCTN12793535.
FINDINGS
Between July 4, 2016, and Jan 27, 2019, 182 infants were enrolled, 180 of whom were randomly assigned (85 to real-time CGM, 95 to standard care). 70 infants in the real-time CGM intervention group and 85 in the standard care group had CGM data and were included in the primary analysis. Compared with infants in the standard care group, infants managed using CGM had more time in the 2·6-10 mmol/L glucose concentration target range (mean proportion of time 84% [SD 22] vs 94% [11]; adjusted mean difference 8·9% [95% CI 3·4-14·4]), equivalent to 13 h (95% CI 5-21). More infants in the standard care group were exposed to at least one episode of sensor glucose concentration of less than 2·6 mmol/L for more than 1 h than those in the intervention group (13 [15%] of 85 vs four [6%] of 70). There were no serious adverse events related to the use of the device or episodes of infection.
INTERPRETATION
Real-time CGM can reduce exposure to prolonged or severe hyperglycaemia and hypoglycaemia. Further studies using CGM are required to determine optimal glucose targets, strategies to obtain them, and the potential effect on long-term health outcomes.
FUNDING
National Institute for Health Research Efficacy and Mechanisms Evaluation Programme.
Topics: Blood Glucose; Female; Glucose; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemic Agents; Infant, Extremely Premature; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Insulin; Intensive Care Units, Neonatal; Male; Monitoring, Physiologic; Netherlands; Spain; Time Factors; United Kingdom
PubMed: 33577770
DOI: 10.1016/S2352-4642(20)30367-9 -
Clinical Medicine (London, England) Sep 2019Post-transplant diabetes mellitus (PTDM) is common following solid organ transplantation, and is a risk factor for graft failure and patient mortality. In addition to... (Review)
Review
Post-transplant diabetes mellitus (PTDM) is common following solid organ transplantation, and is a risk factor for graft failure and patient mortality. In addition to standard diabetes risk factors such as obesity and ethnicity, patients undergoing transplantation also have the additional risk factors of immunosuppressive agents and infections such as hepatitis C. Patients undergoing transplant assessment should be screened for diabetes. If non-diabetic, but deemed at high risk, they should be offered careful lifestyle advice to reduce risk of post-transplant weight gain and therefore reduce risk of PTDM. Hyperglycaemia in the early post-operative period should be managed ideally with insulin therapy. Once clinically stable, there may be an opportunity to reduce or stop insulin, and consider oral hypoglycaemic agents. Despite lack of evidence from randomised trials, PTDM should be actively screened for in all transplant recipients, and actively managed with structured education, screening for complications, cardiovascular risk reduction and anti-hyperglycaemic therapy.
Topics: Diabetes Mellitus; Humans; Hyperglycemia; Organ Transplantation; Postoperative Complications; Risk Factors
PubMed: 31530687
DOI: 10.7861/clinmed.2019-0195 -
Pediatric Endocrinology, Diabetes, and... 2016Stress hyperglycemia remains a significant and unsolved medical condition in critically ill children. Treatment for hyperglycemia is controversial and, to date, no... (Review)
Review
Stress hyperglycemia remains a significant and unsolved medical condition in critically ill children. Treatment for hyperglycemia is controversial and, to date, no recommendations exist from pediatric professional society regarding the management of hyperglycemia in critically ill children. This review summarizes recent work investigating the pathogenesis of stress hyperglycemia, the importance of hypoglycemic episodes and glycemic variability among critically ill patients.
Topics: Adolescent; Child; Child, Preschool; Critical Illness; Female; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemic Agents; Infant; Infant, Newborn; Insulin; Male; Stress, Psychological
PubMed: 28132069
DOI: 10.18544/PEDM-22.01.0046 -
Oncology Nursing Forum Jul 2019Hyperglycemia can increase the risk for adverse events and outcomes in patients undergoing treatment for cancer. The purposes of this state-of-the-science review were to...
PROBLEM IDENTIFICATION
Hyperglycemia can increase the risk for adverse events and outcomes in patients undergoing treatment for cancer. The purposes of this state-of-the-science review were to explore the complexity of hyperglycemia in patients with cancer and to analyze physiologic mechanisms and outcomes in individuals with or at risk for cancer.
LITERATURE SEARCH
PubMed® and the Cochrane Library databases were searched, and 95 articles were included. Findings were evaluated for their methods and analyses. Studies assessed as methodologically flawed were not included.
DATA EVALUATION
The synthesis of the articles provided the evidence for describing normal and glycemic pathways. Hyperglycemia in patients with cancer was explored through chronic inflammatory mechanisms that lead to increased risks for adverse events and outcomes.
SYNTHESIS
This article discusses normal glucose regulation and hyperglycemic pathways, hyperglycemia in patients with cancer, hyperglycemia and cancer-related inflammation, and outcomes (e.g., infections, mortality, symptoms).
IMPLICATIONS FOR RESEARCH
Understanding the contributors to and consequences of hyperglycemia can guide the development of screening tools to predict which individuals are at the greatest risk for hyperglycemic episodes prior to starting cancer therapies. Research can lead to glycemic guidelines specific to patients with cancer for better outcomes.
Topics: Adult; Aged; Aged, 80 and over; Comorbidity; Female; Humans; Hyperglycemia; Male; Middle Aged; Neoplasms
PubMed: 31225836
DOI: 10.1188/19.ONF.459-472