The role of exercise testing in the assessment of GH deficiency (GHD) in adult patients is currently unclear. This study aimed at evaluating the diagnostic value of exercise-induced GH levels in the ...detection of severe GHD in adult patients.
Fourteen patients confirmed to have severe GHD according to current guidelines and 20 healthy control individuals (CI) exercised for 120 min at 50-60% of their individual VO2(max). GH was measured before and every 30 min throughout exercise. The diagnostic value of predicting GHD was assessed by performing receiver operating characteristics (ROC) analysis for each time point of GH assessment. To optimise comparability within the study population a sub-analysis with ten individuals specifically matched for gender, age, body mass index and waist was performed.
Exercise-induced GH secretion was significantly lower in patients with GHD than in CI (P<0.001). Area under the ROC curve (AUC(ROC)) was 0.954±0.033, 0.993±0.009, 0.989±0.012 and 0.992±0.009 for the overall population and 0.870±0.086, 0.980±0.024, 0.970±0.034 and 0.978±0.027 for the matched individuals at 30, 60, 90 and 120 min of exercise respectively. At 60 min of exercise a cut off GH value of 2.4 ng/ml translates into a sensitivity of 100% and a specificity of 95 and 90% in the diagnosis of GHD for the overall population and matched individuals respectively.
GH assessment during a standardised aerobic exercise of moderate intensity is a reliable test with high diagnostic accuracy in predicting severe GHD in adult individuals. Based on the current findings exercise duration of 60 min appears to be sufficient for diagnostic purposes.
The primary focus of this review is threefold: first, to summarize available knowledge on exercise-associated glucose metabolism in individuals with type 1 diabetes mellitus (T1DM); second, to ...elucidate physiological mechanisms predisposing to glycemic variations in patients in T1DM; and third, to describe novel approaches derived from physiological perceptions applicable to stabilize exercise-related glycemia in individuals with T1DM.
Recent studies corroborate the concept that despite partial differences in counter-regulatory mechanisms individuals with T1DM do not fundamentally differ in their glucose response to exercise when compared with healthy individuals if studies are performed under standardized conditions with insulin and glucose levels held close to physiological ranges. Novel approaches derived from a better understanding of exercise-associated glucose metabolism (e.g., the concept of intermittent high-intensity exercise) may provide alternative ways to master the challenges imposed by exercise to individuals with T1DM.
Exercise still imposes high demands on patients with T1DM and increases risks for hypoglycemia and hyperglycemia. Deeper insight into the associated metabolic pathways has revealed novel options to stabilize exercise-associated glucose levels in these patients.
Blood lactate measurements are common as a marker of skeletal muscle metabolism in sport medicine. Due to the close equilibrium between the extracellular and intramyocellular space, plasma lactate is ...a more accurate estimate of muscle lactate. However, whole blood-based lactate measurements are more convenient in field use. The purpose of this investigation was therefore (1) to establish a plasma-converting lactate formula for field use, and (2) to validate the computed plasma lactate levels by comparison to a laboratory standard method.
A total of 91 venous samples were taken from 6 individuals with type 1 diabetes during resting and exercise conditions and assessed for whole blood and plasma lactate using the YSI 2300 analyzer. A linear model was applied to establish a formula for converting whole blood lactate to plasma lactate. The validity of computed plasma lactate values was assessed by comparison to a laboratory standard method.
Whole blood YSI lactate could be converted to plasma YSI values (slope 1.66, intercept 0.12) for samples with normal hematocrit. Computed plasma levels compared to values determined by the laboratory standard method using Passing-Bablok regression yielded a slope of 1.03 (95%CI:0.99:1.08) with an intercept of -0.11 (95%CI:-0.18:-0.06).
Whole blood YSI lactate values can be reliably converted into plasma values which are in line with laboratory determined plasma measurements.
Neuroendocrine neoplasms (NENs) are difficult to diagnose. We used SwissNET data to characterise NEN patients followed in the two academic centres of western Switzerland (WS), and to compare them ...with patients followed in eastern Switzerland (ES) as well as with international guidelines.
SwissNET is a prospective database covering data from 522 consecutive patients (285 men, 237 women) from WS (n = 99) and ES (n = 423).
Mean ± SD age at diagnosis was 59.0 ± 15.7 years. Overall, 76/522 experienced a functional syndrome, with a median interval of 1.0 (IQR: 1.0-3.0) year between symptoms onset and diagnosis. A total of 51/522 of these tumours were incidental. The primary tumour site was the small intestine (29%), pancreas (21%), appendix (18%) and lung (11%) in both regions combined. In all, 513 functional imaging studies were obtained (139 in WS, 374 in ES). Of these, 381 were 111In-pentetreotide scintigraphies and 20 were 68Ga-DOTATOC PET. First line therapy was surgery in 87% of patients, medical therapy (biotherapy or chemotherapy) in 9% and irradiation in 3% for both regions together.
Swiss NEN patients appear similar to what has been described in the literature. Imaging by somatostatin receptor scintigraphy (SRS) is widely used in both regions of Switzerland. In good accordance with published guidelines, data on first line therapy demonstrate the crucial role of surgery. The low incidence of biotherapy suggests that long-acting somatostatin analogues are not yet widely used for their anti-proliferative effects. The SwissNET initiative should help improve compliance with ENETS guidelines in the workup and care of NEN patients.
Open source artificial pancreas systems (OpenAPS) have gained considerable interest in the diabetes community. We analyzed continuous glucose monitoring (CGM) records of 80 OpenAPS users with type 1 ...diabetes (T1D). A total of 19 495 days (53.4 years) of CGM records were available. Mean glucose was 7.6 ± 1.1 mmol/L, time in range 3.9–10 mmol/L was 77.5 ± 10.5%, <3.9 mmol/L was 4.3 ± 3.6%, <3.0 mmol/L was 1.3 ± 1.9%, >10 mmol/L was 18.2 ± 11.0% and > 13.9 mmol/L was 4.1 ± 4.0%, respectively. In 34 OpenAPS users, additional CGM records were obtained while using sensor‐augmented pump therapy (SAP). After changing from SAP to OpenAPS, lower mean glucose (−0.6 ± 0.7; P < 0.0001), lower estimated HbA1c (−0.4 ± 0.5%; P < 0.0001), higher time in range 3.9–10 mmol/L (+9.3 ± 9.5%; P < 0.0001), less time < 3.0 mmol/L (−0.7 ± 2.2%; P = 0.0171), lower coefficient of variation (−2.4 ± 5.8; P = 0.0198) and lower mean of daily differences (−0.6 ± 0.9 mmol/L; P = 0.0005) was observed. Glycaemic control using OpenAPS was comparable with results of more rigorously developed and tested AP systems. However, OpenAPS was used by a highly selective, motivated and technology‐adept cohort, despite not being approved for the treatment of individuals with T1D.
In patients with diabetes, hospitalization can complicate the achievement of recommended glycemic targets. There is increasing evidence that a closed-loop delivery system (artificial pancreas) can ...improve glucose control in patients with type 1 diabetes. We wanted to investigate whether a closed-loop system could also improve glycemic control in patients with type 2 diabetes who were receiving noncritical care.
In this randomized, open-label trial conducted on general wards in two tertiary hospitals located in the United Kingdom and Switzerland, we assigned 136 adults with type 2 diabetes who required subcutaneous insulin therapy to receive either closed-loop insulin delivery (70 patients) or conventional subcutaneous insulin therapy, according to local clinical practice (66 patients). The primary end point was the percentage of time that the sensor glucose measurement was within the target range of 100 to 180 mg per deciliter (5.6 to 10.0 mmol per liter) for up to 15 days or until hospital discharge.
The mean (±SD) percentage of time that the sensor glucose measurement was in the target range was 65.8±16.8% in the closed-loop group and 41.5±16.9% in the control group, a difference of 24.3±2.9 percentage points (95% confidence interval CI, 18.6 to 30.0; P<0.001); values above the target range were found in 23.6±16.6% and 49.5±22.8% of the patients, respectively, a difference of 25.9±3.4 percentage points (95% CI, 19.2 to 32.7; P<0.001). The mean glucose level was 154 mg per deciliter (8.5 mmol per liter) in the closed-loop group and 188 mg per deciliter (10.4 mmol per liter) in the control group (P<0.001). There was no significant between-group difference in the duration of hypoglycemia (as defined by a sensor glucose measurement of <54 mg per deciliter; P=0.80) or in the amount of insulin that was delivered (median dose, 44.4 U and 40.2 U, respectively; P=0.50). No episode of severe hypoglycemia or clinically significant hyperglycemia with ketonemia occurred in either trial group.
Among inpatients with type 2 diabetes receiving noncritical care, the use of an automated, closed-loop insulin-delivery system resulted in significantly better glycemic control than conventional subcutaneous insulin therapy, without a higher risk of hypoglycemia. (Funded by Diabetes UK and others; ClinicalTrials.gov number, NCT01774565 .).
Although the benefits of regular exercise on cardiovascular risk factors are well established for people with type 1 diabetes (T1D), glycemic control remains a challenge during exercise. Carbohydrate ...consumption to fuel the exercise bout and/or for hypoglycemia prevention is an important cornerstone to maintain performance and avoid hypoglycemia. The main strategies pertinent to carbohydrate supplementation in the context of exercise cover three aspects: the amount of carbohydrates ingested (i.e., quantity in relation to demands to fuel exercise and avoid hypoglycemia), the timing of the intake (before, during and after the exercise, as well as circadian factors), and the quality of the carbohydrates (encompassing differing carbohydrate types, as well as the context within a meal and the associated macronutrients). The aim of this review is to comprehensively summarize the literature on carbohydrate intake in the context of exercise in people with T1D.
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