Objective:
The objective was to investigate glycemic variability indices in relation to demographic factors and common environmental lifestyles in a general adult population.
Methods:
The A Estrada ...Glycation and Inflammation Study is a cross-sectional study covering 1516 participants selected by sampling of the population aged 18 years and over. A subsample of 622 individuals participated in the Glycation project, which included continuous glucose monitoring procedures. Five glycemic variability indices were analyzed, that is, SD, MAGE, MAG, CONGA1, and MODD.
Results:
Participants had a mean age of 48 years, 62% were females, and 12% had been previously diagnosed with diabetes. In the population without diabetes, index distributions were not normal but skewed to the right. Distributional regression models that adjusted for age, gender, BMI, alcohol intake, smoking status, and physical activity confirmed that all indices were positively and independently associated with fasting glucose levels and negatively with heavy drinking. SD, MAGE, and CONGA1 were positively associated with aging, and MAG was negatively associated with BMI. None of the GVI studied were influenced by physical activity. Age-group-specific reference values are given for the indices.
Conclusions:
This study yielded age-specific reference values for glucose variability indices in a general adult population. Significant increases were observed with aging. Heavy drinking of more than 140 g/week was associated with significant decreases in variability indices. No differences were found between males and females. These normative ranges provide a guide for clinical care, and may offer an alternative treatment target among persons with diabetes.
Blood donors are key in meeting the ever-increasing blood requirements worldwide. The Spanish and Portuguese donation systems are based on altruism and voluntariness. However, nursing students may ...not be fully aware of the importance of this social responsibility and their professional skills in this field.
This study aimed to identify differences regarding attitudes towards and knowledge about blood donation among Spanish and Portuguese undergraduate Nursing students (1st to 8th semester), as well as to analyse how different variables account for them.
A multicentre cross-sectional study was carried out.
The participants of the study were 1038 nursing students from four Schools of Nursing in two countries, Spain and Portugal.
The web-based CADS-19 questionnaire to measure attitudes and knowledge was used during the academic years 2018-2019 and 2019-2020. Additionally, sociodemographic data were collected.
The mean knowledge score was 3.079 out of 10 (SD = 1.429). The level of knowledge differed significantly by gender, where females scored higher, along with older students and previous donors. The highest mean attitude score corresponded to the “external incentives” dimension, significant differences were found between countries. In barriers and incentives, some differences were found depending on gender or sexual orientation, among others, with slightly better attitudes in Spanish participants.
The level of knowledge was lower than expected, considering participants were nursing students. The attitude's comparative analysis between both countries showed significant differences, especially in the pretext dimension. As for greater donation rates found in Spanish students, nurse-led international partnerships could be designed to enhance health literacy and sensitivity among nursing undergraduates. Interventions should focus on specific theoretical and practical training programs and educative actions should contribute to a greater awareness, motivation, and sensitise students to blood donation.
•The knowledge level about blood donation in nursing students from Spain and Portugal was low.•Age, previous donors and females were associated with a greater level of knowledge.•Knowledge and attitudes were greater in Spanish students.•Nurse-led international partnerships might help to raise awareness among nursing students.•Education targeted strategies involving nursing students could improve donation attitudes.
Recent investigations highlight how important it is to identify the key factors involved in the design of strategies to promote blood donation among undergraduates as a public health concern. The ...study aims to investigate attitudes and knowledge towards blood donation in university students with health education roles and examine the way sociodemographic and educational characteristics play a part in it.
A cross-sectional and multi-center design was used. A structured questionnaire was answered by 1128 Spanish university students (Schools of Health Sciences and Education Sciences).
The knowledge test indicated a low score (M = 4.2 out of 10), being Me = 3.00 in the case of Education Sciences and Me = 5.00 in Health Sciences students. The greatest degree of importance is found in the “external incentives” dimension (M = 3.7 out of 5). Health science students and participants with relatives who needed a donation showed fewer “fears” (p ≤ 0.001) and “pretexts” (p ≤ 0.01).
The low knowledge score stresses the need to develop valuable health education-related strategies in the curriculum of studies related with health education; showing room for improvement particularly in Education Science students. Health education interventions aimed at increasing donors in the university environment should be designed while considering differences among undergraduates. Based on their better attitudes, health science students might play a relevant role in promoting blood donation.
•We present a unique set of CGM, fasting glucose and HbA1C data from 322 non-diabetic members under everyday-life conditions.•Dysglycaemic behaviour was observed in 73% of participants who were ...normoglycaemic (by FPG and HbA1C).•The glycaemic variability of participants with normal glycaemia (by FPG and HbA1C) was similar to that of prediabetic participants.•Glycaemic variability did not correlate with BMI.
To investigate whether continuous glucose monitoring (CGM) reveals patterns of glycaemic behaviour, the detection of which might improve early diagnosis of dysglycaemia.
A total 1521 complete days of valid CGM data were recorded under real-life conditions from a healthy sample of a Spanish community, as were matching FPG and HbA1C data. No participant was pregnant, had a history of kidney or liver disease, or was taking drugs known to affect glycaemia.
CGM and fingerstick measurements showed a mean relative absolute difference of 6.9 ± 2.2%. All subjects were normoglycaemic according to FPG and HbA1C except 21% who were prediabetic. The normoglycaemic subjects had a 24-hour mean blood glucose concentration (MBG) of 5.7 ± 0.4 mmol/L, spending a median of 97% of their time within the target range (3.9–7.8 mmol/L). 73% of them experienced episodes with blood glucose levels above the threshold for impaired glucose tolerance, and 5% levels above the threshold for diabetes. These normoglycaemic participants with episodes of high glycaemia had glycaemic variabilities similar to those of prediabetic subjects with episodes of similar intensity or combined duration.
CGM is a better indicator of possible early dysglycaemia than either FPG or HbA1c.
AIMTo analyze the clinical impact of the Flash glucose monitoring system in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). METHODSA ...24-week retrospective cohort study in CSII-treated T1DM patients exposed (1:1) to the Flash glucose monitoring system vs. self-monitoring of capillary blood glucose (SMBG). The primary outcome was the difference in hemoglobin A1c (HbA1c) levels between both groups at the end of the study. RESULTSThirty-six patients with a mean age of 38.2 years (range 22-55) and a mean T1DM duration of 20.9±7.8 years, treated with CSII for 7.1±5.4 years, were enrolled into the study. At the end of the study, mean HbA1c levels improved in patients in the Flash group (7.1±0.7 vs. 7.8±1.0, p=0.04). Only the Flash group showed a significant decrease in HbA1c levels of -0.4% (95% CI, -0.6, -0.2; p=0.004) during follow-up. Flash patients captured 93.9% of data through 17.8±9.9 scans daily. In fact, the Flash cohort showed a three-fold increase in daily self-monitoring of glucose, while daily frequency of SMBG decreased during the study (-1.8 tests/24h (95% CI -3, -0.7; p=0.01). No safety issues related to Flash use were recorded. CONCLUSIONSThe Flash glucose monitoring system is a novel approach to improve blood glucose control in CSII-treated T1DM patients. Randomized controlled trials are needed to assess the effectiveness of this system in CSII-treated T1DM patients.
Concerning continuous subcutaneous insulin infusion (CSII), there are controversial results related to changes in glycemic response according to the meal composition and bolus design. Our aim is to ...determine whether the presence of protein and fat in a meal could involve a different postprandial glycemic response than that obtained with only carbohydrates (CHs).
This was a crossover, randomized clinical trial. Seventeen type 1 diabetes (T1D) patients on CSII wore a blinded continuous glucose monitoring system sensor for 3 days. They ingested two meals (meal 1 vs. meal 2) with the same CH content (50 g) but different fat (8.9 g vs. 37.4 g) and protein (3.3 g vs. 28.9 g) contents. A single-wave insulin bolus was used, and the interstitial glucose values were measured every 30 min for 3 h. We evaluated the different postprandial glycemic response between meal 1 and meal 2 by using mixed-effects models.
The postmeal glucose increase was 22 mg/dL for meal 1 and 31 mg/dL for meal 2. In univariate analysis, at different times not statistically significant differences in glucose levels between meals occurred. In mixed-model analysis, a time×meal interaction was found, indicating a different response between treatments along the time. However, most of the patients remained in the normoglycemic range (70-180 mg/dL) during the 3-h postmeal period (84.4% for meal 1 and 93.1% for meal 2).
The presence of balanced amounts of protein and fat determined a different glycemic response from that obtained with only CH up to 3 h after eating. The clinical relevance of this finding remains to be elucidated.
Abstract Aim To analyze the clinical impact of the Flash glucose monitoring system in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). ...Methods A 24-week retrospective cohort study in CSII-treated T1DM patients exposed (1:1) to the Flash glucose monitoring system vs. self-monitoring of capillary blood glucose (SMBG). The primary outcome was the difference in hemoglobin A1c (HbA1c) levels between both groups at the end of the study. Results Thirty-six patients with a mean age of 38.2 years (range 22–55) and a mean T1DM duration of 20.9 ± 7.8 years, treated with CSII for 7.1 ± 5.4 years, were enrolled into the study. At the end of the study, mean HbA1c levels improved in patients in the Flash group (7.1 ± 0.7 vs. 7.8 ± 1.0, p = 0.04). Only the Flash group showed a significant decrease in HbA1c levels of −0.4% (95% CI, −0.6, −0.2; p = 0.004) during follow-up. Flash patients captured 93.9% of data through 17.8 ± 9.9 scans daily. In fact, the Flash cohort showed a three-fold increase in daily self-monitoring of glucose, while daily frequency of SMBG decreased during the study (−1.8 tests/24 h (95% CI −3, −0.7; p = 0.01). No safety issues related to Flash use were recorded. Conclusions The Flash glucose monitoring system is a novel approach to improve blood glucose control in CSII-treated T1DM patients. Randomized controlled trials are needed to assess the effectiveness of this system in CSII-treated T1DM patients.
To investigate, in a sample of nondiabetic adults from a Spanish community, the differences between prediabetes as defined by HbA
("H-prediabetes") and by fasting plasma glucose (FPG) ...("F-prediabetes") in regard to prevalence and the influence of potential risk factors, adjusting the latter for confounders.
A total of 1328 nondiabetic participants aged ≥ 18 years were classified as normoglycemic, H-prediabetic HbA
5.7-6.4% (39-47 mmol/mol) or F-prediabetic (FPG 5.6-6.9 mmol/L). Multivariable analyses were used to compare the impacts of risk factors on the prevalence of H-prediabetes, F-prediabetes and their conjunctive and disjunctive combinations ("HaF-prediabetes" and "HoF-prediabetes," respectively).
Some 29.9% of participants were HoF-prediabetic, 21.7% H-prediabetic, 16.3% F-prediabetic and only 8.1% HaF-prediabetic. Whatever the definition of prediabetes, increasing age, fasting insulin and LDL cholesterol were each a risk factor after adjustment for all other variables. Increasing BMI and decreasing mean corpuscular hemoglobin (MCH) were additional risk factors for H-prediabetes; male sex and increasing uric acid for F-prediabetes and increasing BMI for HaF-prediabetes. The participants satisfying the compound condition "hypertension or hyperlipidemia or obesity or hyperuricemia" (59.9% of the whole study group) included 83.1% of all subjects with HoF-prediabetes.
In this population, the most sensitive risk factor for detection of prediabetes was age, followed by fasting insulin, LDL cholesterol, BMI, MCH, male sex and uric acid, with differences depending on the definition of prediabetes. MCH, an indirect measure of erythrocyte survival, significantly influences the prevalence of HbA
-defined prediabetes. This study suggests that screening of individuals with selected risk factors may identify a high proportion of prediabetic persons.
Resumen Introducción La hipoglucemia limita la eficacia de la terapia insulínica intensiva, principalmente en pacientes con gran variabilidad glucémica. Nuestro objetivo fue determinar si la terapia ...con infusión subcutánea contínua de insulina (ISCI) es útil y si logra disminuir la variabilidad glucémica e hipoglucemias, principalmente en los pacientes con mayor variabilidad. Método Se realizó una monitorización continua de glucosa de 3 días de duración a 24 pacientes con diabetes mellitus tipo 1 (DM1) en 2 ocasiones diferentes: antes de iniciar la terapia con ISCI y 6 meses después de su implantación. Se comparó la variabilidad glucémica con distintas medidas de variabilidad (desviación estándar SD, amplitud media de las excursiones glucémicas MAGE, valor M) y el área bajo la curva (AUC) <70 mg/dl de forma global en todos los pacientes y en aquellos con mayor variabilidad inicial (MAGE en mayor cuartil) Resultados A los 6 meses, se observó un descenso de la variabilidad glucémica medida como MAGE (mediana:-28 mg/dl rango interquartílico {RI}, -48 a 1, p = 0,03); valor M (-22 -40 a 0, p = 0,04) y SD (-11-23 a 0, p = 0,009) en todos los pacientes. Los pacientes con mayor variabilidad glucémica inicial (MAGE cuartil 4) mostraron un mayor descenso de MAGE (-47 mg/dl -103 a -34 vs -20 -36 a 17, p = 0,01) y de AUC<70 (-10,7 mg/dlxdía -15 a 0 vs -1,1-4,7 a 3,8, p = 0,03), que el resto. Los pacientes con más tiempo en hipoglucemia inicial (AUC cuartil 4) lograron una mayor reducción del AUC<70 (-9,7 mg/dlxdía -15 a -6,5 vs -0,08 -2,9 a 3,8, p = 0,003. Se halló una correlación entre ΔMAGE-ΔAUC r 0,4, p = 0,03. Conclusiones Durante el tratamiento con ISCI, la variabilidad glucémica descendió significativamente, principalmente en aquellos pacientes con mayor variabilidad inicial. El tiempo en hipoglucemia también fue menor en aquellos con una mayor variabilidad. Los pacientes con más hipoglucemias iniciales experimentaron un mayor descenso de estas con ISCI.
Abstract Background Hypoglycemia limits the efficacy of intensive insulin therapy, especially in patients with great glucose variability. The extent to which continuous subcutaneous insulin infusion ...(CSII) overcomes this limitation is unclear. Our aim was to determine whether CSII is helpful for decreasing glucose variability and hypoglycemia, mainly in patients with the greatest variability. Method Twenty-four patients with type 1 diabetes wore a continuous glucose monitoring system sensor for 3 days before starting therapy with CSII and 6 months later. Glucose variability (SD, MAGE, M) and hypoglycemia duration (area under the curve (AUC) <70 mg/dL) were compared in all patients and in those with the greatest MAGE (highest quartile). Results At 6 months, a decreased glucose variability was seen, as measured by MAGE, M, and SD (median: −28 mg/dL (interquartile range, −48 to 1), p = 0.03; −22 (−40 to 0), p = 0.04; −11 (−23 to 0), p = 0.009; respectively). Patients with the greatest initial glucose variability (MAGE quartile 4) showed a greater decrease in both MAGE (−47 mg/dL (−103 to −34) vs −20 (−36 to 17), p = 0.01) and AUC <70 (−10.7 mg/dL × day (−15 to 0) vs −1.1 (−4.7 to 3.8), p = 0.03) as compared to all others. Patients with longer initial hypoglycemia (AUC quartile 4) achieved a greater reduction in AUC <70 (−9.7 mg/dL × day (−15 to −6.5) vs −0.08 (−2.9 to 3.8), p = 0.003). A correlation was found between ΔMAGE–ΔAUC (r 0.4, p = 0.03). Conclusions During CSII, glucose variability significantly decreased, especially in patients with the greatest initial variability. Hypoglycemia was also markedly less in patients with greater variability, with the greatest reduction occurring in those who experienced more marked hypoglycemia with CSII.
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