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Randomized cross-over trial comparing the diagnosis of gestational diabetes by oral glucose tolerance test and a designed breakfast glucose profile.
Marais, C, Hall, DR, van Wyk, L, Conradie, M
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2018;(1):85-90
Abstract
OBJECTIVE To compare a glucose test based on a standardized, designed breakfast to the 75-g oral glucose tolerance test (OGTT), comparing venous and capillary glucose values for the diagnosis of gestational diabetes mellitus (GDM). METHODS The present prospective, randomized, cross-over trial enrolled patients at high risk of developing GDM who were attending the High-Risk Antenatal Clinic of Tygerberg Hospital, Cape Town, South Africa, between March 1 and December 31, 2015. Patients were randomized to initial testing with either the OGTT or a designed breakfast glucose profile (DBGP) glucose test before the alternate test was performed 1 week later; no dietary or other interventions were applied in the intervening period. Venous and capillary fasting and 2-hour glucose values were measured and were compared between the OGTT and DBGP, and between OGTT and laboratory venous samples. RESULTS There were 51 patients included in the study. The fasting and 2-hour capillary glucose values from the OGTT correlated significantly with the laboratory venous samples (P<0.001 at both time intervals). The 2-hour capillary glucose values from the DBGP demonstrated a satisfactory correlation with those from the OGTT (P<0.001). CONCLUSIONS The DBGP provided a sufficiently accurate alternate test for the diagnosis of GDM; it warrants further investigation.
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Reducing Cholesterol and Fat Intake Improves Glucose Tolerance by Enhancing β Cell Function in Nondiabetic Subjects.
Tricò, D, Trifirò, S, Mengozzi, A, Morgantini, C, Baldi, S, Mari, A, Natali, A
The Journal of clinical endocrinology and metabolism. 2018;(2):622-631
Abstract
CONTEXT A diet low in cholesterol and fat is commonly recommended to prevent metabolic and cardiovascular diseases; however, its effect on glucose tolerance is largely unknown. OBJECTIVE We examined whether and by which mechanisms a chronic reduction of cholesterol and fat intake affects glucose tolerance in nondiabetic individuals, independently of weight changes. DESIGN AND PARTICIPANTS In this crossover, randomized clinical trial, 30 healthy subjects, including 15 with family history of type 2 diabetes (T2D) (T2D offspring), underwent a 75-g oral glucose tolerance test (OGTT) after two 14-day isocaloric high-cholesterol, high-fat (HChF) or low-cholesterol, and low-fat (LChF) diets. MAIN OUTCOME MEASURES We evaluated changes in glucose tolerance, β cell function, insulin clearance, and insulin sensitivity by modeling plasma glucose, insulin, and C-peptide levels during the OGTT. RESULTS The shift from the HChF to the LChF diet was neutral on body weight but increased glucose tolerance (mean glucose -5%, P = 0.01) and three components of β cell function: glucose sensitivity (+17%, P = 0.01), insulin secretion at fasting glucose (+20%, P = 0.02), and potentiation (+19%, P = 0.03). The LChF diet improved insulin sensitivity (+7%, P = 0.048) only in T2D offspring, who tended to be more susceptible to the positive effect of the diet on glucose tolerance. CONCLUSIONS A chronic and isocaloric decrease in dietary cholesterol and fat intake improves glucose tolerance by diffusely ameliorating β cell function in nondiabetic subjects. Individuals genetically predisposed to develop T2D tend to be more susceptible to the positive effect of this dietary intervention on glucose tolerance and insulin sensitivity.
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The relationship of insulin resistance estimated by triglyceride glucose index and coronary plaque characteristics.
Won, KB, Kim, YS, Lee, BK, Heo, R, Han, D, Lee, JH, Lee, SE, Sung, JM, Cho, I, Park, HB, et al
Medicine. 2018;(21):e10726
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Abstract
The triglyceride glucose (TyG) index is a useful surrogate marker for insulin resistance, which is an important risk factor for coronary artery disease (CAD). However, data on the relationship of the TyG index and coronary plaque characteristics are limited.This study included 2840 participants with near-normal renal function who underwent coronary computed tomography angiography. CAD was defined as the presence of any plaques, and obstructive CAD was defined as the presence of plaques with ≥50% stenosis. The relationship between the TyG index and noncalcified plaque (NCP), calcified or mixed plaque (CMP), and coronary artery calcium score (CACS) was evaluated.All participants were stratified into 4 groups based on the quartiles of the TyG index. The prevalence of CAD and obstructive CAD significantly increased with increasing quartiles. The risk for NCP and obstructive NCP was not different among all groups. However, compared with group I (lowest quartile), the risk for CMP was higher in groups III (odds ratio [OR]: 1.438) and IV (highest quartile) (OR: 1.895) (P < .05), and that for obstructive CMP was higher in groups II (OR: 1.469), III (OR: 1.595), and IV (OR: 2.168) (P < .05). Multivariate regression analysis showed that the TyG index was associated with an increased risk for CAD (OR: 1.700), obstructive CAD (OR: 1.692), and CACS >400 (OR: 1.448) (P < .05).The TyG index was independently associated with the presence and severity of CAD due to an increased risk for CMP.
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Avocado Fruit on Postprandial Markers of Cardio-Metabolic Risk: A Randomized Controlled Dose Response Trial in Overweight and Obese Men and Women.
Park, E, Edirisinghe, I, Burton-Freeman, B
Nutrients. 2018;(9)
Abstract
Avocados are distinctive fruits having both fats and fibers along with various micronutrients and bioactive phytochemicals. This study aimed to assess the effects of replacing carbohydrate energy in meals with half or whole avocado on postprandial indices of metabolic and vascular health. A single-center, randomized, controlled, 3-arm, 6 h, crossover study was conducted in overweight/obese middle-aged adults (n = 31). Participants consumed energy-matched breakfast meals containing 0 g (Control), 68 g (Half-A) or 136 g (Whole-A) fresh Hass avocado on 3 separate occasions. Post-meal glycemic (p < 0.0001), insulinemic (p < 0.0001) and flow mediated vasodilation (FMD) responses were reduced compared to Control meal (p < 0.01), independent of dose. Nuclear magnetic resonance analyses indicated lower concentrations of triglyceride-rich lipoproteins and higher concentrations of larger high-density lipoprotein (HDL) particles after the Whole-A vs. the Control meal (p = 0.02, p < 0.05, respectively). Race/ethnicity influenced sub-class lipoprotein concentrations (p < 0.05). Oxidized low-density-lipoproteins, monocyte chemoattractant protein-1, and interleukin-6 were not different among meals. Tumor necrosis factor-α tended to be lower after Whole-A vs. Control meal (p = 0.07). Replacing carbohydrate components with avocados in a meal improved FMD, a measure of endothelial function, and improved glycemic and lipoprotein profiles in overweight/obese adults. The study provides insight on the acute cardio-metabolic benefits of incorporating avocados into a meal.
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Early worsening of diabetic retinopathy after rapid improvement of blood glucose control in patients with diabetes.
Feldman-Billard, S, Larger, É, Massin, P, ,
Diabetes & metabolism. 2018;(1):4-14
Abstract
AIM: To review the frequency, importance of and risk factors for "early worsening of diabetic retinopathy" (EWDR) after rapid improvement of blood glucose in patients with diabetes. METHODS This was a systematic review of key references (PubMed 1980-2016) and the current international recommendations for the above-mentioned topics. RESULTS EWDR has been described during intensive treatment (IT) in patients with uncontrolled type 1 or 2 diabetes, and after pancreas transplantation or bariatric surgery. EWDR arises in 10-20% of patients within 3-6 months after abrupt improvement of glucose control, and in nearly two times that proportion in patients with advanced baseline diabetic retinopathy (DR). While EWDR is often transient and predominantly driven by the development of cotton-wool spots and intraretinal microvascular abnormalities in patients with no or minimal DR, it can lead to irreversible retinal damage in patients with advanced DR before IT. Its identified risk factors include higher baseline levels and larger magnitudes of reduction of HbA1c, longer diabetes durations and previous severity of DR. CONCLUSION Intensive diabetes treatment inducing a rapid fall in glucose should prompt vigilance and caution, particularly in patients with long-term and uncontrolled diabetes and DR prior to IT. Careful retinal examination should be performed in all patients before initiating IT; however, in patients with severe non-proliferative or proliferative DR, panretinal photocoagulation therapy should be performed promptly. During the year following IT, quarterly eye monitoring is required in patients at high risk of EWDR (long-term uncontrolled diabetes, previous advanced DR), whereas follow-up every 6 months can be applied in patients with short-term diabetes and no/minimal DR before IT. To date, there is no evidence that controlling the speed or magnitude of HbA1c decreases will reduce the risk of EWDR in patients with diabetes.
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Consumption of a drink containing extruded sorghum reduces glycaemic response of the subsequent meal.
Anunciação, PC, Cardoso, LM, Queiroz, VAV, de Menezes, CB, de Carvalho, CWP, Pinheiro-Sant'Ana, HM, Alfenas, RCG
European journal of nutrition. 2018;(1):251-257
Abstract
PURPOSE Glycaemic control is essential to prevent the manifestation of diabetes in predisposed individuals and the development of associated comorbidities. It is believed that sorghum may modulate the glucose response. In this study, we investigated the effect of extruded sorghum consumption, and the profile of bioactive compounds, on postprandial glycaemia of a subsequent meal in normal weight and normoglycaemic subjects. METHODS This was a randomized, single-blind, crossover designed study. After a 12 h overnight fasting, ten subjects reported to the laboratory to participate in four experimental sessions, and consumed one of three sorghum test drinks: sorghum P 3-DXAs (with proanthocyanidins-P and rich in 3-deoxyanthocyanidins-3-DXAs); 3-DXAs (without proanthocyanidins and rich in 3-DXAs); and control (low in 3-DXAs and without proanthocyanidins); or a non-sorghum drink. 30 min later, the subjects consumed a glucose solution (25 g glucose). Glycaemic response was monitored at times 0 (before glucose solution), 15, 30, 45, 60, 90, 120 min (after glucose solution consumption). The incremental areas under the glycaemic curve (iAUC) were calculated by the trapezoidal method. RESULTS Intake of P 3-DXAs drink before the glucose solution resulted in a postprandial iAUC lower than the other sorghum test drinks. Sorghum drinks minimized the postprandial glycaemia peak. CONCLUSION Sorghum drinks consumption, especially the P 3-DXAs drink, 30 min before the glucose solution resulted in lower iAUC compared to the non-sorghum drink, leading to a lower glycaemic response.
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[Update on Diabetic Kidney Disease 2018].
Venzin, RM, Fehr, T
Therapeutische Umschau. Revue therapeutique. 2018;(6):355-357
Abstract
Update on Diabetic Kidney Disease 2018 Abstract. The first descriptions of diabetes mellitus are known as "sweet honey urine". Interestingly, the new therapy of diabetic kidney disease, namely SGLT-2-inhibitor, enhances glucosuria, leading to the historical description of sweet urine. This not only leads to a better control of glycemia itself, but it also leads to a better renal prognosis by reducing glomerular hyperfiltration. So far, this effect has been proven for diabetic kidney disease in type 2 diabetic patients. Whether this effect could also lead to a better renal prognosis in other kidney diseases with hyperfiltration (independent of hyperglycemia), is still object of ongoing studies.
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Effect of Preexercise Ingestion of Modified Amylomaize Starch on Glycemic Response While Cycling.
Parks, RB, Angus, HF, King, DS, Sharp, RL
International journal of sport nutrition and exercise metabolism. 2018;(1):82-89
Abstract
Amylomaize-7 is classified as a resistant corn starch and is 68% digestible. When modified by partial hydrolysis in ethanol and hydrochloric acid its digestibility is 92%, yet retains its low glycemic and insulinemic properties. The purpose of this study was to characterize the metabolic response when modified amylomaize-7 or dextrose is consumed in the hour before exercise, and to compare the effect on performance of a brief high-intensity cycling trial. Ten male, trained cyclists were given 1 g/kg body mass of dextrose (DEX) or modified amylomaize-7 (AMY-7) or a flavored water placebo (PL) 45 min prior to exercise on a cycle ergometer. A 15-min ride at 60% Wmax was immediately followed by a self-paced time trial (TT) equivalent to 15 min at 80% Wmax. When cyclists consumed DEX, mean serum glucose concentration increased by 3.3 ± 2.1 mmol/L before exercise, compared to stable serum glucose observed for AMY-7 or PL. Glucose concentrations returned to baseline by pre-TT in all treatments. However, the mean post-TT glucose concentration of the DEX group was significantly lower than baseline, AMY-7, or PL. Serum insulin concentration increased nine-fold from baseline to preexercise in the DEX trial, whereas PL or AMY-7 remained unchanged. Time required to complete the performance trial was not significantly different between DEX, AMY-7 or PL. Preexercise ingestion of modified amylomaize-7 compared to dextrose resulted in a more stable serum glucose concentration, but did not offer a performance advantage in this high-intensity cycling trial.
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Alpha-glucosidase inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus.
Moelands, SV, Lucassen, PL, Akkermans, RP, De Grauw, WJ, Van de Laar, FA
The Cochrane database of systematic reviews. 2018;(12):CD005061
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Abstract
BACKGROUND Alpha-glucosidase inhibitors (AGI) reduce blood glucose levels and may thus prevent or delay type 2 diabetes mellitus (T2DM) and its associated complications in people at risk of developing of T2DM. OBJECTIVES To assess the effects of AGI in people with impaired glucose tolerance (IGT), impaired fasting blood glucose (IFG), moderately elevated glycosylated haemoglobin A1c (HbA1c) or any combination of these. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of systematic reviews, articles and health technology assessment reports. The date of the last search of all databases was December 2017. SELECTION CRITERIA We included randomised controlled trials (RCTs), with a duration of one year or more, comparing AGI with any pharmacological glucose-lowering intervention, behaviour-changing intervention, placebo or no intervention in people with IFG, IGT, moderately elevated HbA1c or combinations of these. DATA COLLECTION AND ANALYSIS Two review authors read all abstracts and full-text articles or records, assessed quality and extracted outcome data independently. One review author extracted data, which were checked by a second review author. We resolved discrepancies by consensus or involvement of a third review author. For meta-analyses we used a random-effects model with assessment of risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs) for effect estimates. We assessed the overall quality of the evidence by using the GRADE instrument. MAIN RESULTS For this update of the Cochrane Review (first published 2006, Issue 4) we included 10 RCTs (11,814 participants), eight investigating acarbose and two investigating voglibose, that included people with IGT or people "at increased risk for diabetes". The trial duration ranged from one to six years. Most trials compared AGI with placebo (N = 4) or no intervention (N = 4).Acarbose reduced the incidence of T2DM compared to placebo: 670 out of 4014 people (16.7%) in the acarbose groups developed T2DM, compared to 812 out of 3994 people (20.3%) in the placebo groups (RR 0.82, 95% CI 0.75 to 0.89; P < 0.0001; 3 trials; 8008 participants; moderate-certainty evidence). One trial including participants with coronary heart disease and IGT contributed 64% of cases for this outcome. Acarbose reduced the risk of T2DM compared to no intervention: 7 out 75 people (9.3%) in the acarbose groups developed T2DM, compared to 18 out of 65 people (27.7%) in the no-intervention groups (RR 0.31, 95% CI 0.14 to 0.69; P = 0.004; 2 trials; 140 participants; very low-certainty evidence).Acarbose compared to placebo did not reduce or increase the risk of all-cause mortality (RR 0.98, 95% CI 0.82 to 1.18; P = 0.86; 3 trials; 8069 participants; very low-certainty evidence), cardiovascular mortality (RR 0.88; 95% CI 0.71 to 1.10; P = 0.26; 3 trials; 8069 participants; very low-certainty evidence), serious adverse events (RR 1.12, 95% CI 0.97 to 1.29; P = 0.13; 2 trials; 6625 participants; low-certainty evidence), non-fatal stroke (RR 0.50, 95% CI 0.09 to 2.74; P = 0.43; 1 trial; 1368 participants; very low-certainty evidence) or congestive heart failure (RR of 0.87; 95% CI 0.63 to 1.12; P = 0.40; 2 trials; 7890 participants; low-certainty evidence). Acarbose compared to placebo reduced non-fatal myocardial infarction: one out of 742 participants (0.1%) in the acarbose groups had a non-fatal myocardial infarction compared to 15 out of 744 participants (2%) in the placebo groups (RR 0.10, 95% CI 0.02 to 0.53; P = 0.007; 2 trials; 1486 participants; very low-certainty evidence). Acarbose treatment showed an increased risk of non-serious adverse events (mainly gastro-intestinal events), compared to placebo: 751 of 775 people (96.9%) in the acarbose groups experienced an event, compared to 723 of 775 people (93.3%) in the placebo groups (RR 1.04; 95% CI 1.01 to 1.06; P = 0.0008; 2 trials; 1550 participants). Acarbose compared to no intervention showed no advantage or disadvantage for any of these outcome measures (very low-certainty evidence).One trial each compared voglibose with placebo (1780 participants) or diet and exercise (870 participants). Voglibose compared to placebo reduced the incidence of T2DM: 50 out of 897 participants (5.6%) developed T2DM, compared to 106 out of 881 participants (12%) in the placebo group (RR 0.46, 95% CI 0.34 to 0.64; P < 0.0001; 1 trial; 1778 participants; low-certainty evidence). For all other reported outcome measures there were no clear differences between voglibose and comparator groups. One trial with 90 participants compared acarbose with diet and exercise and another trial with 98 participants reported data on acarbose versus metformin. There were no clear differences for any outcome measure between these two acarbose interventions and the associated comparator groups.None of the trials reported amputation of lower extremity, blindness or severe vision loss, end-stage renal disease, health-related quality of life, time to progression to T2DM, or socioeconomic effects. AUTHORS' CONCLUSIONS AGI may prevent or delay the development of T2DM in people with IGT. There is no firm evidence that AGI have a beneficial effect on cardiovascular mortality or cardiovascular events.
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The Effects of Synbiotic Supplementation on Glucose Metabolism and Lipid Profiles in Patients with Diabetes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Tabrizi, R, Moosazadeh, M, Lankarani, KB, Akbari, M, Heydari, ST, Kolahdooz, F, Asemi, Z
Probiotics and antimicrobial proteins. 2018;(2):329-342
Abstract
Although several studies have evaluated the effect of synbiotic intake on metabolic profiles in patients with diabetes, findings are inconsistent. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the evidence on the effect of synbiotic intake on metabolic profiles in patients with diabetes. The PubMed, EMBASE, Web of Science, and Cochrane Library databases were systematically searched. All RCTs published up to 12 November 2016 were included. Two review authors independently assessed study eligibility, extracted data, and evaluated risk of bias of included studies. Heterogeneity was measured with a Q test and with I 2 statistics. Data were pooled by using the fix or random-effect model based on the heterogeneity test results and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). A total of seven randomized controlled trials were included. Synbiotic consumption significantly changed glucose metabolism, including fasting plasma glucose (FPG) (SMD = -0.29; 95% CI, -0.47, -0.10), insulin concentrations (SMD = -0.84; 95% CI, -1.61, -0.06), homeostasis model assessment of insulin resistance (HOMA-IR) (SMD = -0.80; 95% CI, -1.58, -0.03), homeostatic model assessment-B cell function (HOMA-B) (SMD = -0.36; 95% CI, -0.71, -0.01), quantitative insulin sensitivity check index (QUICKI) (SMD = 0.46; 95% CI, 0.09, 0.82), and significantly improved lipid profiles, such as triglycerides (SMD = -0.36; 95% CI, -0.55, -0.17), very low density lipoprotein-cholesterol (SMD = -0.31; 95% CI, -0.55, -0.08), and total cholesterol (SMD = -0.32; 95% CI, -0.67, -0.03), but had no effect on low density lipoprotein-cholesterol (SMD = -0.07; 95% CI, -0.58, 0.43) and high density lipoprotein-cholesterol concentrations (SMD = -0.25; 95% CI, -0.81, 0.31). Synbiotic may result in an improvement in FPG, insulin, HOMA-IR, HOMA-B, QUICKI, triglycerides, and total cholesterol.