The proposed computerized calculation of MAGE is a practicable method that may provide an efficient tool for assessing glycemic variability.
MAG change represents a valid GV index if closely spaced sensor glucose measurements are used, but does not provide any advantage over variability indices already used for assessing diabetes control.
Background: The decisive factor in successful intensive insulin therapy is the ability to deliver need-based-adjusted nutrition-independent insulin dosages at the closest possible approximation to the physiological insulin level. Because this basal insulin requirement is strongly influenced by the patient’s lifestyle, its subtlety is of great importance. This challenge is very different between patients with type 1 diabetes and those with insulin-dependent type 2 diabetes. Furthermore, it is more difficult to finetune a basal insulin dosage with intensified conventional insulin therapy (ICT), due to delayed insulin delivery, compared to insulin pump therapy, which provides continuous delivery of small doses of exclusively short-acting insulin. In all cases, the goal is to achieve an optimal basal delivery rate. Method: We hypothesized that this goal could be achieved with a modeling tool that determined the optimal basal insulin supply based on the patient’s anamnestic data and monitored glucose values. This type of modeling tool has been used in health insurance programs in Germany to improve insulin control in patients that receive ICT. Results: Our retrospective data analysis showed that this modeling tool provided a significant improvement in metabolic control, significant reductions in HbA1c and Q scores, and improved time-in-range values, with reduced daily insulin levels. Conclusion: The model-based basal rate test could provide additional data of the actual effect of the basal insulin adjustment in intensified insulin treated diabetes to the physician or treatment team.
Mit Hilfe einer radioimmunologischen Methode zur Messung von Angiotensin I wurden die Reninaktivität und die Reninsubstratkonzentration im Plasma bei zehn bzw. vier gesunden jungen Frauen unter der Einnahme eines oralen Contraceptivurns-während eines ganzen Cyclus bestimmt. Die Blutentnahmen erfolgten in zweitägigen Abständen morgens vor dem Aufstehen. Die verwendeten oralen Contraceptiva enthielten als Östrogenkomponente in neun Fällen 17 a-Äthinylöstradiol-17/3; die Gestagenkomportente war bei jeweils vier Versuchspersonen Lynestrenol bzw. Norgestrel. Die Reninaktivität im Plasma zeigte bei sieben Versuchspersonen wenige Tage nach Beginn der Einnahme des Östrogen-Gestagen-Kombinationspräparates einen signifikanten Anstieg; allerdings stieg die Reninaktivität im Plasma nur bei einer Frau auf pathologisch erhöhte Werte an. Während des Einnahmecyclus blieb die Reninaktivität im Plasma nicht auf einem konstanten Niveau, sondern zeigte deutliche Schwankungen; diese dürften vor allem auf rcnale Regulationsvorgänge zurückzuführen sein. Die Reninsubstratkonzentration im Plasma war ebenfalls bei drei Versuchspersonen erheblichen Veränderungen nicht nur zu Beginn, sondern auch im Verlaufe der Behandlung mit oralen Contraceptiva unterworfen. Dies deutet daraufhin, daß im Renin-Angiotensm-Aldosteron-System ein Rückkopp-lungsmechanismus besteht, der die Synthese von Reninsubstrat in der Leber beeinflußt. Bei keiner der untersuchten Frauen bestand oder entwickelte sich eine Hypertonie; somit bleibt offen, ob Verlaufskontrollen der Reninaktivität im Plasma Rückschlüsse auf eine mögliche Disposition zur Hypertonie nach Behandlung mit oralen Contraceptiva gestatten. The effect of oral contraceptives on plasma renin activity and plasma renin substrate concentrationDuring one cycle of oral contraceptive treatment, blood was taken every second day from ten healthy young women before rising from bed. Plasma renin activity was determined by means of a sensitive radioimmunoassay of angiotensin I; in four subjects, plasma renin substrate concentration was estimated using the same radioimmunoassay. In nine experiments the oral contraceptive contained 17 aê thynyloestradiol-170 as the oestrogenic component; either norgestrel and lynestrenol were used as progestagens in four cases. A few days after starting the administration of the oral contraceptive, there was a significant rise in plasma renin activity in seven subjects. However, values of plasma renin activity above the normal range were only detected in one subject. Plasma renin activity did not remain at a constant level during the administration period, but showed characteristic variations; these were possibly due to some regulation mechanisms in the kidney. In three of the four subjects examined, plasma renin substrate concentration also showed distinct changes at the beginning and during the course of the treatment. From these results it may be concluded that feedback mechanisms whithin the renin-angiotensin-aldosterone system may influence renin substrate synthesis in the live...
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