Studies on Austrobilharzia terrigalensis (Trematoda: Schistosomatidae) in the Swan Estuary, Western Australia: infection in the definitive host, Larus novaehollandiae

The prevalence of Austrobilharzia terrigalensis infection in the Silver Gull (Larus novaehollandiae) population of the Swan Estuary, Western Australia was shown from autopsies to be 80.7% with a median worm load of five pairs. Maximum egg-output was recorded about 3 weeks after the first eggs were voided in the faeces of experimentally-infected birds. Few worms were thought to live longer than 2–3 months. Egg-output from naturally infected L. novaehollandiae was generally low, with a median rate of 24 eggs/g for birds living within 125 km radius of Perth. The liver, duodenum and small intestine were the organs most heavily involved in A. terrigalensis infection.     

Austrobilharzia terrigalensis: A schistosome dominant in interspecific interactions in the molluscan host

Walker J. C. 1979. Austrobilharzia terrigalensis: a schistosome dominant in interspecific interactions in the molluscan host. International Journal for Parasitology9: 137–140. In the estuarine prosobranch Velacumantus australis the avian schistosome Austrobilharzia terrigalensis is always associated with the germinal sacs of other trematodes. In this association the schistosome retards the development of the other trematode, thereby reducing the intensity of interspecific competition for the limited resource, the host's tissues.     

Studies on Austrobilharzia terrigalensis (Trematoda: Schistosomatidae) in the Swan Estuary, Western Australia: observations on the biology of the cercaria

The emergence of Austrobilharzia terrigalensis cercariae from the snail Velacumantus australis decreased with decreasing salinity and temperature. This was most marked between 23 and 25 and between 24 and 19°C. Very few cercariae were shed below 23 regardless of temperature. The decrease in cercarial emergence was associated with the decreasing metabolic activity of the intermediate host. The emergence pattern of A. terrigalensis cercariae from V. australis was diurnal. There was a major peak between 08h00 and 10h00 and a minor second one between 16h00 and 18h00. No cercariae were shed between 22h00 and 04h00. Cercariae survived in sea water (35) for up to 48h, with a half-life of 30h. There was evidence that the prevalence of A. terrigalensis infection in the intermediate host population in the Swan estuary was higher during the summer than during the winter. The production of cercariae in the sporocyst also appeared to be a seasonal phenomenon. Mature cercariae were rare in sporocysts examined during the winter months (May–October) and absent altogether from those examined in September.     

Phytochemical study on the leaves of Wollemia nobilis

In this work, a phytochemical study performed on the leaves of the rare species, Wollemia nobilis W.G. Jones, K.D. Hill & J.M. Allen, is reported. By means of classical column chromatography and NMR Spectroscopy and Mass Spectrometry, nine compounds were evidenced. These were: pheophorbide a (1), isocupressic acid (2), acetyl-isocupressic acid (3), sandaracopimaric acid (4), agathic acid (5), 7–4′-4‴-tri-O-methyl-agathisflavone (6), 7–4′-7″-4‴-tetra-O-methyl-agathisflavone (7), caffeic acid (8) and shikimic acid (9). Compared to our previous phytochemical analysis on the male cones, some further compounds were identified i.e. compounds 1, 5, 6, 7 and 8. This confirmed the previous chemotaxonomic considerations of the species but also added new ones which were discussed within the text. In addition, a possible different accumulation of secondary metabolites in the tissues and organs of this plant was even noticed.     

A zigzag chain coordination polymer consisting of silver(I) ion having square planar geometry

Silver(I) complexes of hexakis(tolylsulfanyl)benzene (htsb), [Ag(htsb)](PF₆) (1), have been prepared and their molecular structures were determined by X-ray crystallography. In 1, the silver ion prefers a square planar coordination geometry comprized of four S atoms from two different htsb molecules and producing a zigzag chain structure of AgS in the silver coordination polymer. Based on the thermo-gravimetry analysis results, two tolylsulfanyl groups were easily eliminated at approximately 211 °C. However, [Ag(htsb)(2-butanone)] (PF₆) (2), which were obtained by the reactions in different solvents, showed a different colors and thermal degradation behaviors.     

Ring A rearranged limonoids from the fruits of Aphanamixis grandifolia and their cytotoxicity evaluation

Two new limonoids aphanamolides C (1) and D (2), together with two known limonoids aphanamolide A (3) and aphapolynin A (4), were isolated from the fruits of Aphanamixis grandifolia. Their structures were assigned on the basis of spectroscopic data, with the absolute configurations of 1 and 2 being established by electronic circular dichroism (ECD) spectroscopic analyses. Those limonoids varied in the ring A: aphanamolide C featured two oxygenated bridges, and aphanamolide D was the second example containing β-hydroxy-α,β:γ,δ-dienoate moiety. The cytotoxic activities were also evaluated in vitro against four human cancer cell lines (MCF-7, A549, SMMC-7721, and HL-60).     

Xanthine oxidase inhibitory effects of the constituents of Chrysanthemum morifolium stems

The flowers of Chrysanthemum morifolium Ramat. (family: Asteraceae) are used in Traditional Chinese Medicine to treat fever, cold and swelling. However the aerial part is considered as agriculture waste and the chemical and pharmacological information is scanty. From the stems of this plant, four new compounds named as morineoliganosides A (1), B (2), C (3) and heterophyllol-1-O-β-d-glucopyranoside A (4) together with 27 known isolates (5–31), including flavonoids and caffeoylquinic acids were isolated. Their structures were elucidated by chemical and spectroscopic methods The inhibitory effects on xanthine oxidase of these compounds have been determined. This research provided a scientific development and utilization of C. morifolium stems.     

Comparison of commercially available antibody reagents for the cytomegalovirus pp65 antigenemia assay

Background: The Argene Biosoft 1C3 and the Biotest C10,C11 monoclonal antibodies are two of the most commonly used commercially available antibody reagents for the cytomegalovirus (CMV) pp65 antigenemia assay.Objectives: The sensitivities of these two reagents were compared in peripheral blood specimens received for CMV antigenemia testing.Study design: A total of 1149 peripheral blood specimens were processed for CMV antigenemia testing. Duplicate slides were stained with the Biosoft 1C3 and Biotest C10,C11 monoclonal antibodies.Results: A total of 158 specimens gave a positive result by one or both antibodies. One hundred and forty five were positive by the Biosoft antibody and 130 were positive by the Biotest antibody. Positive cell counts were significantly higher on cell preparations stained by the Biosoft antibody (Wilcoxon signed rank, P < 0.001) and the Biosoft antibody detected twice as many low-level positive specimens as the Biotest.Conclusions: The Biosoft antibody reagent was superior to the Biotest reagent for the detection of CMV antigenemia. This is an important factor since early detection is essential for appropriate initiation of preemptive antiviral therapy, particularly in transplant recipients at high risk of CMV disease.     

Tetrameric 1:1 and monomeric 1:3 complexes of silver(I) halides with tri(p-tolyl)-phosphine: A structural and biological study

Silver(I) halides react with tri(p-tolyl)phosphine (tptp, C₂₁H₂₁P) in MeOH/MeCN solutions in 1:1 or 1:3 molar ratios to give complexes of formulae {[AgCl(tptp)]₄} (1) or [AgX(tptp)₃] (X = Cl (2), Br (3), I (4)), respectively. The complexes were characterized by elemental analyses, and FT-IR far-IR, FT-Raman, TG and ¹H, ¹³C, ³¹P NMR spectroscopic techniques. Crystal structures of complexes 2-4 were determined by X-ray diffraction at room temperature (rt). The crystal structure of 1 and 4 was also determined at 100(1) and 140(2) K (lt), respectively. In complex 1 four μ3-Cl ions are bonded with four Ag(I) ions forming a cubane while the coordination sphere of silver(I) ions is completed by one P atom from a terminal tri(p-tolyl)phosphine ligand. In complexes 2-3 one terminal halogen and three P atoms from phosphine ligands form a tetrahedral arrangement around the metal ion. Complexes 1-4 were tested for in vitro cytostatic activity against sarcoma cancer cells (mesenchymal tissue) from the Wistar rat, polycyclic aromatic hydrocarbons (PAH, benzo[a]pyrene) carcinogenesis and against murine leukemia (L1210) and human T-lymphocyte (Molt4/C8 and CEM) cells. The silver(I) complexes 1-4 show strong activity.     

Impact Of Ethnic Background On Clinical Characteristics And Cardiovascular Risk Factors Among Patients With Primary Hyperparathyroidism

Objective: To compare initial laboratory values and cardiovascular risk factors (CRF) among patients with primary hyperparathyroidism (PHPT) of different ethnic backgrounds.Methods: In this retrospective study, we reviewed 500 charts of PHPT patients who presented at Robert Wood Johnson University Hospital from January 2000 to December 2013. Among these patients were 46 African Americans (AA), 31 Asians (A), 19 Hispanics (H), and 404 Caucasians (C). The following characteristics were compared between the groups: age; body mass index (BMI); levels of serum calcium, intact parathyroid hormone (iPTH), 25-OH vitamin D, and 24-hour urine calcium; and parathyroid adenoma weight. Presence of CRF including BMI, diabetes mellitus, hypertension, and hyperlipidemia were also recorded for comparison. Associations of adenoma weight and several other parameters were also assessed.Results: Among different ethnic groups, AA patients with PHPT had higher iPTH levels compared to the A and C groups (P<.05), while 25-OHD levels were lower in the AA compared to the A and C groups (P<.05). Adenoma weight was significantly greater in AA than in C and A PHPT patients (P<.01). Adenoma weight was positively correlated with iPTH levels (r = 0.493, P <.001) and serum calcium levels (r = 0.255, P<.01). The group BMIs were C: 29.5 ± 6.9, AA: 33.8 ± 10, A: 24.7 ± 3.3, and H: 30.2 ± 6.6. AA patients had a lower rate of renal stones (9%) compared to other groups (21–29%, P<.05).Conclusion: The results of our study indicate that AA patients with PHPT presented with a more severe PHPT profile but had lower 24-hour urine calcium and fewer renal stones. AA patients with PHPT also had higher prevalence of CRF when compared to A and C.Abbreviations:A = AsianAA = African AmericanC = CaucasianCRF = cardiovascular risk factorsH = HispaniciPTH = intact parathyroid hormonePHPT = primary hyperparathyroidismPTH = parathyroid hormone     

Clinical and Cost-Effectiveness of Insulin Delivery with V-GO® Disposable Insulin Delivery Device Versus Multiple Daily Injections in Patients with Type 2 Diabetes Inadequately Controlled on Basal Insulin

Objective: To compare two methods of delivering intensified insulin therapy (IIT) in patients with type 2 diabetes inadequately controlled on basal insulin ± concomitant antihyperglycemic agents in a real-world clinical setting.Methods: Data for this retrospective study were obtained using electronic medical records from a large multicenter diabetes system. Records were queried to identify patients transitioned to V-Go® disposable insulin delivery device (V-Go) or multiple daily injections (MDI) using an insulin pen to add prandial insulin when A1C was >7% on basal insulin therapy. The primary endpoint was the difference in A1C change using follow-up A1C results.Results: A total of 116 patients were evaluated (56 V-Go, 60 MDI). Both groups experienced significant glycemic improvement from similar mean baselines. By 27 weeks, A1C least squares mean change from baseline was -1.98% (-21.6 mmol/mol) with V-Go and -1.34% (-14.6 mmol/mol) with MDI, for a treatment difference of -0.64% (-7.0 mmol/mol; P = .020). Patients using V-Go administered less mean ± SD insulin compared to patients using MDI, 56 ± 17 units/day versus 78 ± 40 units/day (P<.001), respectively. Diabetes-related direct pharmacy costs were lower with V-Go, and the cost inferential from baseline per 1% reduction in A1C was significantly less with V-Go ($118.84 ± $158.55 per patient/month compared to $217.16 ± $251.66 per patient/month with MDI; P = .013).Conclusion: Progression to IIT resulted in significant glycemic improvement. Insulin delivery with V-Go was associated with a greater reduction in A1C, required less insulin, and proved more cost-effective than administering IIT with MDI.Abbreviations:A1C = glycated hemoglobinANCOVA = analysis of covarianceCI = confidence intervalCSII = continuous subcutaneous insulin infusionFPG = fasting plasma glucoseIIT = intensified insulin therapyLSM = least squares meanMDI = multiple daily injectionsT2DM = type 2 diabetes mellitusTDD = total daily dose     

Milk fatty acids as indicators of negative energy balance of dairy cows in early lactation

Most dairy cows experience negative energy balance (NEB) in early lactation because energy demand for milk synthesis is not met by energy intake. Excessive NEB may lead to metabolic disorders and impaired fertility. To optimize herd management, it is useful to detect cows in NEB in early lactation, but direct calculation of NEB is not feasible in commercial herds. Alternative methods rely on fat-to-protein ratio in milk or on concentrations of non-esterified fatty acids (NEFA) and β-hydroxybutyrate (BHB) in blood. Here, we considered methods to assess energy balance (EB) of dairy cows based on the fatty acid (FA) composition in milk. Short- and medium-chain FAs (primarily, C14:0) are typically synthesized de novo in the mammary gland and their proportions in milk fat decrease during NEB. Long-chain FAs C18:0 and C18:1 cis-9 are typically released from body fat depots during NEB, and their proportions increase. In this study, these FAs were routinely determined by Fourier-transform infrared spectroscopy (FTIR) of individual milk samples. We performed an experiment on 85 dairy cows in early lactation, fed the same concentrate ration of up to 5 kg per day and forage ad libitum. Daily milk yield and feed intake were automatically recorded. During lactation weeks 2, 4, and 6 after calving, two milk samples were collected for FTIR spectroscopy, Tuesday evening and Wednesday morning, blood plasma samples were collected Thursday morning. Net energy content in feed and net energy required for maintenance and lactation were estimated to derive EB, which was used to compare alternative indicators of severe NEB. Linear univariate models for EB based on NEFA concentration (deviance explained = 0.13) and other metabolites in blood plasma were outperformed by models based on concentrations of metabolites in milk: fat (0.27), fat-to-protein ratio (0.18), BHB (0.20), and especially C18:0 (0.28) and C18:1 cis-9 (0.39). Analysis of generalized additive models (GAM) revealed that models based on milk variables performed better than those based on blood plasma (deviance explained 0.46 vs. 0.21). C18:0 and C18:1 cis-9 also performed better in severe NEB prediction for EB cut-off values ranging from −50 to 0 MJ NEL/d. Overall, concentrations of C18:0 and C18:1 cis-9 in milk, milk fat, and milk BHB were the best variables for early detection of cows in severe NEB. Thus, milk FA concentrations in whole milk can be useful to identify NEB in early-lactation cows.     

Efficacy and Safety of Iglarlixi in Hispanics and Non-Hispanic Whites with Type 2 Diabetes

Objective: Type 2 diabetes (T2D) is more common in Hispanic than non-Hispanic white (NHW) populations worldwide, and ethnicity, among other factors, may affect response to therapy. The efficacy and safety of insulin glargine 100 units/mL (iGlar) and the fixed-ratio combination of iGlar and the glucagon-like peptide 1 receptor agonist lixisenatide (iGlarLixi) was assessed in Hispanic and NHW patients with T2D from 25 countries.Methods: In this post hoc analysis, data from two 30-week randomized controlled trials comparing iGlar and iGlarLixi in patients with T2D uncontrolled on basal insulin ± oral antidiabetes drugs (OADs; LixiLan-L: NCT02058160) or uncontrolled on metformin ± OADs (LixiLan-O: NCT02058147) were evaluated.Results: Of the 1,512 patients included across trials, 301 were Hispanic and 1,211 NHW. Compared with iGlar, iGlarLixi resulted in greater reductions in glycated hemoglobin (A1C) and 2-hour postprandial glucose and a higher proportion of patients at target A1C <7.0% (<53 mmol/mol), regardless of ethnicity. Among NHWs from the LixiLan-L trial, documented symptomatic hypoglycemia (plasma glucose ≤70 mg/dL) rates were higher with iGlar compared with iGlarLixi (P = .06), whereas this trend was reversed among Hispanics (P = .07). Nevertheless, in both trials, a greater proportion of patients taking iGlarLixi than iGlar reached the composite efficacy endpoints of target A1C without hypoglycemia and target A1C without weight gain, regardless of ethnicity.Conclusion: These results indicate that iGlarLixi is a viable therapeutic option for both Hispanic and NHW patients with T2D, as it is efficacious without a significant increase in hypoglycemia, irrespective of ethnicity.Abbreviations: A1C = glycated hemoglobin; BMI = body mass index; FPG = fasting plasma glucose; FRC = fixed-ratio combination; GLP-1 RA = glucagon-like peptide 1 receptor agonist; HDL-C = high-density-lipoprotein cholesterol; iGlar = insulin glargine; iGlarLixi = insulin glargine + lixisenatide; LDL-C = low-density-lipoprotein cholesterol; NHW = non-Hispanic white; OAD = oral antidiabetes drug; PPG = postprandial glucose; T2D = type 2 diabetes     

Glycated Albumin at 4 Weeks Correlates with A1C Levels at 12 Weeks and Reflects Short-Term Glucose Fluctuations

Objective: Evaluate the performance of glycated albumin (GA) monitoring by comparing it to other measures of glycemic control during intensification of antidiabetic therapy.Methods: This 12-week, prospective, multicenter study compared the diagnostic clinical performance of GA to glycated hemoglobin A1C (A1C), fructosamine corrected for albumin (FRA), fasting plasma glucose (FPG), and mean blood glucose (MBG) estimated from self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) in 30 patients with suboptimally controlled type 1 or 2 diabetes.Results: Mean A1C decreased from 9.5% to 8.1%. Mean SMBG correlated closely with CGM (Pearson r = 0.783 for daily estimates and r = 0.746 for weekly estimates, P<.0001). Both GA and FRA levels significantly correlated with changes from baseline in A1C and mean weekly SMBG (P<.001). The lowest observed median GA occurred at 4 weeks, followed by a small increase and then a slight reduction, mirroring changes in overall mean SMBG values. The median A1C fell throughout the treatment period, failing to reflect short-term changes in SMBG. A ≥1% reduction in GA at 4 weeks was significantly associated with a ≥0.5% change in A1C at 12 weeks (odds ratio &lsqb;OR] = 19.0, 95% confidence interval &lsqb;CI]: 1.4, 944, P = .018).Conclusion: In patients receiving glucose-lowering therapy, changes in GA at 4 weeks were concordant with changes in A1C at 12 weeks, and both GA and FRA more accurately reflected short-term blood glucose fluctuations than A1C.Abbreviations: A1C = glycated hemoglobin A1C ARIC = Atherosclerosis Risk in Communities CGM = continuous glucose monitoring FPG = fasting plasma glucose FRA = fructosamine corrected for albumin GA = glycated albumin MBG = mean blood glucose OR = odds ratio SMBG = self-monitoring of blood glucose     

Biosynthesis of chondroitin sulfate. Purification of UDP-D-xylose:core protein beta-D-xylosyltransferase by affinity chromatography

Silver carbonate on Celite (the Fetizon reagent) was shown to be selective as an oxidizing agent, and convenient for the preparation of various aldonolactones. Whereas substituted aldoses having the 1-hydroxyl group free were readily converted into the corresponding lactones, partially protected 2-acetamido-2-deoxypyranoses having more than one free hydroxyl group were selectively oxidized at C-1. The oxidation was carrried out in boiling benzene or 1,4-dioxane. A series of partially protected 2-acetamido-2-deoxy-1,5-aldonolactones [2-acetamido-4,6-O-benzylidene-2-deoxy-D-mannono-1,5-lactone (13),2-acetamido-4,6-O-benzylidene-2-deoxy-D-glucono-1,5-lactone (15), 2-acetamido-2-deoxy-4,6-O-isopropylidene-D-glucono-1,5-lactone (18), 2-acetamido-2-deoxy-4,6-O-isopropylidene-D-mannono-1,5-lactone (20), 2-acetamido-2-deoxy-3,4-di-O-methyl-D-mannono-1,5-lactone (24), and 2-acetamido-2-deoxy-3,4-di-O-methyl-D-glucono-1,5-lactone (25)] was thus prepared; for these, the oxidation was accompanied by two side-reactions: (a) an elimination (dehydration) that gave the unsaturated lactones [2-acetamido-4,6-O-benzylidene-2,3-dideoxy-D-erythro-hex-2-enono-1,5-lactone (12), 2-acetamido-2,3-dideoxy-4,6-O-isopropylidene-D-erythro-hex-2-enono-1,5-lactone (17), and 2-acetamido-2,3-dideoxy-4-O-methyl-D-erythro-hex-2-enono-1,5-lactone (23)], and (b) partial gluco-to-manno epimerization occurring during the oxidation of 2-acetamido-4,6-O-benzylidene-2-deoxy-D-glucopyranose (14), 2-acetamido-2-deoxy-4,6-O-isopropylidene-D-glucopyranose (16), and 2-acetamido-2-deoxy-3,4-di-O-methyl-D-glucopyranose (22).The free unsaturated lactone, 2-acetamido-2,3-dideoxy-D-erythro-hex-2-enono-1,5-lactone (26), was obtained on hydrolysis of the isopropylidene group in lactone 17.     

Alterations of the fatty acid composition and lipid metabolome of breast muscle in chickens exposed to dietary mixed edible oils

The fatty acid composition of chicken’s meat is largely influenced by dietary lipids, which are often used as supplements to increase dietary caloric density. The underlying key metabolites and pathways influenced by dietary oils remain poorly known in chickens. The objective of this study was to explore the underlying metabolic mechanisms of how diets supplemented with mixed or a single oil with distinct fatty acid composition influence the fatty acid profile in breast muscle of Qingyuan chickens. Birds were fed a corn-soybean meal diet supplemented with either soybean oil (control, CON) or equal amounts of mixed edible oils (MEO; soybean oil : lard : fish oil : coconut oil = 1 : 1 : 0.5 : 0.5) from 1 to 120 days of age. Growth performance and fatty acid composition of muscle lipids were analysed. LC-MS was applied to investigate the effects of CON v. MEO diets on lipid-related metabolites in the muscle of chickens at day 120. Compared with the CON diet, chickens fed the MEO diet had a lower feed conversion ratio (P < 0.05), higher proportions of lauric acid (C12:0), myristic acid (C14:0), palmitoleic acid (C16:1n-7), oleic acid (C18:1n-9), EPA (C20:5n-3) and DHA (C22:6n-3), and a lower linoleic acid (C18:2n-6) content in breast muscle (P < 0.05). Muscle metabolome profiling showed that the most differentially abundant metabolites are phospholipids, including phosphatidylcholines (PC) and phosphatidylethanolamines (PE), which enriched the glycerophospholipid metabolism (P < 0.05). These key differentially abundant metabolites – PC (14:0/20:4), PC (18:1/14:1), PC (18:0/14:1), PC (18:0/18:4), PC (20:0/18:4), PE (22:0/P-16:0), PE (24:0/20:5), PE (22:2/P-18:1), PE (24:0/18:4) – were closely associated with the contents of C12:0, C14:0, DHA and C18:2n-6 in muscle lipids (P < 0.05). The content of glutathione metabolite was higher with MEO than CON diet (P < 0.05). Based on these results, it can be concluded that the diet supplemented with MEO reduced the feed conversion ratio, enriched the content of n-3 fatty acids and modified the related metabolites (including PC, PE and glutathione) in breast muscle of chickens.     

Evaluation of Insulin Glargine and Exenatide Alone and in Combination: a Randomized Clinical Trial with Continuous Glucose Monitoring and Ambulatory Glucose Profile Analysis

Objective: Characterize the effectiveness of insulin glargine alone, exenatide alone, or combined in subjects taking stable doses of metformin and evaluate their impact on hemoglobin A1C, hypoglycemia, weight, and glucose variability.Methods: Open-label, randomized, parallel-arm study of adults with type 2 diabetes naïve to both insulin and glucagon-like peptide 1 (GLP-1) agonist who were not at A1C goal despite treatment with metformin. This prospective interventional study employed blinded continuous glucose monitoring ambulatory glucose profile (AGP) reports over 32 weeks. Subjects were randomized to treatment with glargine (Iglar), exenatide (GLP-1), or combination of glargine and exenatide (Iglar + GLP-1). At midpoint, those not at A1C target had the second medication added; those on Iglar + GLP-1 continued therapy optimization.Results: Decreases in A1C were: 7.6 to 6.2% for Iglar + GLP-1, 7.5 to 6.6% for Iglar, and 7.5 to 6.4% for GLP-1. Iglar + GLP-1 achieved A1C targets faster (14 to 16 weeks) but had more hypoglycemia. Hypoglycemia rates increased slightly for all arms. Weight loss was achieved in all regimens including GLP-1. Glucose variability was not reduced to the same extent in the Iglar arm as the GLP-1 arm.Conclusion: Addition of Iglar and/or GLP-1 to metformin for patients not at treatment goal was safe and effective. The order of medication addition needs to consider individualized AGP patterns and goals. Iglar + GLP-1 resulted in rapid A1C lowering, whereas GLP-1 was noted to have less hypoglycemia. Weight loss was most pronounced in GLP-1 monotherapy, suggesting that GLP-1 may mitigate the weight gain of Iglar. Any treatment with GLP-1 showed significant decreases in glucose variability.Abbreviations: A1C = hemoglobin A1c; AGP = ambulatory glucose profile; CGM = continuous glucose monitoring; GLM = general linear model; GLP-1 = glucagon-like peptide 1 (exenatide); Iglar = insulin glargine; SGLT2 = sodium-glucose cotransporter 2; SMBG = self-monitoring blood glucose; SU = sulfonylurea; T2D = type 2 diabetes mellitus     

Glycemic Effects Of Sglt-2 Inhibitor Canagliflozin In Type 1 Diabetes Patients Using The Dexcom G4 Platinum Cgm

Objective: Limited information is available on chronic use of sodium glucose cotransporter 2 inhibitors in type 1 diabetes (T1D). We conducted a retrospective review of T1D patients on Dexcom G4Platinum continuous glucose monitors (DCGMs) >1 year (mean, 4.6 years) who were prescribed canagliflozin (CANA) 100 mg daily and had a baseline DCGM 30-day download prior to and a second download after at least 1 month (mean, 3.7 months) taking CANA 100 mg daily. The glycemic, weight, and systolic blood pressure (SBP) effects are reported.Methods: We identified 27 patients meeting the selection criteria: 14 men; 25 white; 22 on pump; average T1D duration, 34 years (range, 12 to 48 years); average hemoglobin A1C (A1C), 7.6% (range, 6.1 to 9.8%); 22 with baseline A1C 7.0% or higher. All patients had an estimated glomerular filtration rate (eGFR) at baseline of 60 mL/min/1.73 m² or higher and were normotensive or on stable therapy. On average, 29 days of CGM data was reviewed. Total daily insulin dose (TDD) was available in 21 patients. We identified 27 patients who were judged to be candidates for CANA but did not have any change in glycemic therapy other than insulin adjustment as controls.Results: CANA resulted in significant reductions in mean blood glucose, CGM standard deviation, time in hyperglycemia, A1C, weight, SBP, and TDD, with increased time in target, with minimal increase in hypoglycemia and no significant change in eGFR. Three females developed genital mycotic infections but continued therapy, 2 developed ketoacidosis from insulin interruption.Conclusion: CANA offers promise as adjunct therapy in T1D, though caution is advised.Abbreviations:A1C = hemoglobin A1CCANA = canagliflozinCGM = continuous glucose monitorCSII = continuous subcutaneous insulin infusionDCGM = Dexcom G4Platinum CGMDKA = diabetic ketoacidosisGMI = genital mycotic infectionMG = mean glucosePCGM = personal continuous glucose monitoringSBP = systolic blood pressureSGLT-2i = sodium-glucose cotransporter 2 inhibitorSH = severe hypoglycemiaT2D = type 2 diabetesT1D = type 1 diabetes