OBJECTIVE: The relative contribution of fasting and post-prandial glucose to glycated hemoglobin (HbA1c) is controversial. In the present study, we assessed the relationship with HbA1c of fasting and post-prandial glucose measured in a more naturalistic setting, through home glucose self-monitoring or with a continuous glucose monitoring system (CGM). MATERIALS AND METHODS: A consecutive series of 300 patients with Type 2 diabetes were enrolled in the study, provided that they performed blood glucose self-monitoring. HbA1c and fasting plasma glucose (FPG) were measured at enrolment. RESULTS: Both fasting plasma and capillary glucose showed a significant correlation with HbA1c (r=0.66 and 0.61, respectively; p<0.001). When home glucose monitoring was considered, both mean fasting and post-prandial glucose showed a significant correlation with HbA1c (r=0.71 and 0.73, respectively). In patients in the lower tertile of body mass index (BMI), HbA1c showed a significant correlation at multivariate analysis with post-prandial glucose, but not with fasting glucose. In patients with HbA1c >7%, both fasting and post-prandial glucose showed a significant correlation, after adjustment for age and BMI, with HbA1c (both p<0.01); conversely, in those with HbA1c < or =7%, such a correlation could be observed for fasting (p<0.01), but not for post-prandial glucose. CONCLUSION: In conclusion, both fasting and post-prandial glucose contribute to the determination of HbA1c . Home glucose self-monitoring appears to provide a more accurate assessment of metabolic control than a single plasma glucose measurement in experimental conditions. Fasting glucose could provide a greater contribution to HbA1c in patients with lower HbA1c, while post-prandial glucose seems to play a major role in leaner Type 2 diabetic subjects.

Aged↗

PubMedDate not supplied

Cardiac effects of botulinal toxin.

Crystalline type A botulinal toxin rapidly caused temporary bradycardia and electrocardiographic (ECG) changes in mice, rats, rabbits and dogs. In addition, in the dog the force of contraction was measured and found to be depressed. The ECG changes were indicative of conduction defects. The hemagglutinin present in the toxin played no role in the effects on the heart, since a derivative toxin without hemagglutinin also caused these phenomena. The cardiac effects were spontaneously reversible in the intact animal without removal of the toxin. On the other hand, in the in vitro isolated heart of the rat, recovery from the cardiac effects occurred only after the toxin was washed out of the preparation. The findings are consistent with, but do not prove, a physical rather than a chemical mechanism for the effects of toxin on the heart.

Animals↗

PubMedDate not supplied

[A peculiar anomaly of the main biliary duct: choledochal cystic dilatation].

The Authors report a case of choledochal cystic dilatation and examine this particular anomaly of the main biliary duct analysing the complex classification. After a brief review of the embryology of the hepato-pancreatic ring, etiopathogenetic theories, clinic characteristics, as well as diagnostic and therapeutic possibilities for this affection are taken into account. It is concluded that the best therapeutic choice should be always based on an accurate evaluation of the anatomo-pathological conditions in each single case.

Adult↗