How should postprandial glycemia be treated?

Macroalgae of Izmir Gulf: Cystoseira barbata, Cystoseira compressa and Cystoseira crinita species have high α-glucosidase and Moderate Pancreatic Lipase Inhibition Activities

Hyperglycemia and hyperlipidemia have been symptoms of many serious diseases such as diabetes and atherosclerosis overall the world. Thus, drug researchers have focused on new, natural and healthy drug alternatives. Marine macroalgae is a great source of hypoglycemic, hypolipidemic or hypocholesterolemic agents. In this study, we investigated that hypoglycemic, hypolipidemic and cytotoxic potentials of 22 marine macroalgae from the Gulf of Izmir. According to our results, the cold methanol extract of Polysiphonia denudata exhibited the highest antioxidant activity (93.6%) compared to BHA (95.3%). Three Cystoseira species, Cystoseria crinita (91.9%), Cystoseria barbata (90.7%), Cystoseria compressa (89.8%) showed higher α-glucosidase inhibition rates than oral antidiabetic acarbose (79.5%). It has also been observed that same species are potent inhibitors of pancreatic lipase. Cytotoxicity test revealed that these extracts did not cause viability inhibition on MCF-7. The results of maltose- glucose assay indirectly displayed that Cystoseira cold methanolic extracts inhibited maltose consumption better than acarbose on HT29. The results of this screening study show that these Cystoseira species may provide non- toxic bioactive agents to control non-communicable diseases (NCDs) such as cardiovascular disease and diabetes mellitus.

Safety of intravenous insulin aspart compared to regular human insulin in patients undergoing ICU monitoring post cardiac surgery: an Indian experience

BACKGROUND

Poor perioperative glycemic control increases risk of infection, cardiovascular accidents and mortality in patients undergoing surgery. Tight glycemic control by insulin therapy is known to yield better outcomes in such patients. Intravenous (IV) insulin therapy with or without adjunctive subcutaneous insulin therapy is the mainstay of managing hyperglycemia in perioperative period. This observational study assessed the safety of IV Insulin Aspart (IAsp) as compared to Regular Human Insulin (RHI) in patients undergone cardiac surgery at a tertiary care hospital.

METHODS

203 patients received IV IAsp (n = 103) and RHI (n = 100) respectively. Safety was assessed by frequency and severity of adverse events (AEs) & serious adverse events (SAEs) during hospitalization.

RESULTS

IAsp effectively controlled mean blood glucose levels to 159.87 ± 41.41 mg/dl similar to RHI (160.77 ± 44.39 mg/dl). No serious adverse event was reported. The incidence of hypoglycemia was similar in both the groups. The insulin infusion rate, time for which insulin infusion was withheld and mean blood glucose during hypoglycemia was significantly high in RHI group.

CONCLUSION

This study has shown similar safety of IV IAsp as compared to IV RHI in the post cardiac surgery patients. However physicians preferred IAsp as it offers advantage during transition. IV IAsp offers an effective and safe option for managing hyperglycemia in patients in ICU post cardiac procedures.

Foot care practice - the key to prevent diabetic foot ulcers in India

BACKGROUND

The magnitude of diabetic foot ulcers (DFUs) and the amputation rates due to DFUs remain high even in developing and developed countries. Yet, the influence of knowledge, attitude, and practice (KAP) of diabetic foot care (DFC) on DFU incidence is not studied much.

OBJECTIVE

To study causal relationship between knowledge, attitude and practice (KAP) on DFC between diabetic patients with and without DFUs; and the risk factors associated with DFUs.

METHODS

A consecutive of 203 diabetic patients (103 with DFU and 100 without DFU) were included in the study. Their demographic details, medical history, and personal habits were recorded. KAP on DFC was assessed using a questionnaire. Responses were recorded, scored, and analyzed.

RESULTS

Of the cohort, 67.5% were males, mean age: 59.9 ± 11.4 years. Patients without DFU had good knowledge on DFC compared to those with DFU (86% versus 69.9%) (p<0.001). Incidence of DFU was 9% and 39.8% (p<0.001) among patients who practiced and not practiced DFC respectively. 88% patients with and without DFUs; showed favorable attitude toward adopting DFC. Risk factors - diabetic peripheral neuropathy, peripheral vascular disease, retinopathy, nephropathy, smoking, tobacco chewing and alcohol consumption were significantly (p<0.001) associated with DFUs.

CONCLUSIONS

An inverse relationship between DFU and foot care knowledge as well as practice was observed. Apart from tight glycemic control, diabetic patients must be educated and motivated on proper foot care practice and life style modifications for preventing DFUs.

dGlucose is linked to renal function changes in diabetes

AIMS

This study examines if dglucose, two-hour postprandial (2 hPP) minus fasting glucose (F), predicts glycemic control better than F or 2 hPPglucose.

METHODS

F and 2 hPPglucose, and renal function variables; BUN, serum creatinine (Scr), and estimated GFR (eGFR), were obtained from 56 insulin treated diabetic adults. 2 hPP-F(d) was calculated. Variables were compared when 2 hPPglucose was <200 (n=23) or >200 mg/dL (n=33). Correlation coefficients were calculated for F, 2 hPP or 2 hPP-F(d) renal function variables versus those for glucose.

RESULTS

Variables differed significantly between F and 2 hPP (t-test, p<0.05) for all patients and when 2 hPPglucose was < or >200 mg/dL, except dBUN at <200 mg/dL. When F, 2 hPP or 2 hPP-F(d) variables between 2 hPPglucose< and >200 mg/dL were compared, dScr was significant (p=0.0327). Correlation coefficients between dglucose and dScr or deGFR, were significant for all patients (r=0.420, p=0.0013, and r=-0.434, p=0.0008, respectively) and for 2 hPPglucose >200 mg/dL (r=0.523, p=0.0018 and r=-0.513, p=0.0023, respectively) but not 2 hPPglucose <200 mg/dL. When dglucose increased by 100 mg/dL, dScr increased by 0.08 and 0.11 mg/dL, and deGFR decreased by 2.73 and 3.73 mL/min for all patients and >200 mg/dL, respectively.

CONCLUSIONS

dGlucose better predicts renal function changes than F or 2 hPPglucose. Postprandial hyperglycemia (<200 mg/dL) control is crucial for renal protection in diabetes.

The growth hormone receptor gene-disrupted mouse fails to respond to an intermittent fasting diet

The interaction of longevity-conferring genes with longevity-conferring diets is poorly understood. The growth hormone receptor gene-disrupted (GHR-KO) mouse is long lived; and this longevity is not responsive to 30% caloric restriction, in contrast to wild-type animals from the same strain. To determine whether this may have been limited to a particular level of dietary restriction, we subjected GHR-KO mice to a different dietary restriction regimen, an intermittent fasting diet. The intermittent fasting diet increased the survivorship and improved insulin sensitivity of normal males, but failed to affect either parameter in GHR-KO mice. From the results of two paradigms of dietary restriction, we postulate that GHR-KO mice would be resistant to any manner of dietary restriction; potentially due to their inability to further enhance insulin sensitivity. Insulin sensitivity may be a mechanism and/or a marker of the lifespan extending potential of an intervention.

Importance of postprandial glucose levels as a target for glycemic control in type 2 diabetes

Increasing evidence supports the importance of postprandial glucose (PPG) in glycemic control with regard to the development of complications in patients with diabetes. PPG plays a critical role in determining overall glycemic control, particularly in patients who are close to their glycemic goals. Data also indicate that postprandial hyperglycemia may have a greater effect on the development of cardiovascular complications compared with elevated fasting plasma glucose. Several antidiabetic agents that specifically target PPG are currently available, including glinides, glucagon-like peptide-1 mimetics, dipeptidyl peptidase-4 inhibitors, and rapid-acting insulin analogs. A more intensive approach to managing PPG may improve the care of patients with diabetes and, ultimately, the outcome of these patients.