Association between β‐cell function estimated by HOMA ‐β and prognosis of non‐diabetic patients with ischaemic stroke

Distinct microbiome of tongue coating and gut in type 2 diabetes with yellow tongue coating

The gut microbiome plays a critical role in the pathogenesis of type 2 diabetes mellitus (T2DM). However, the inconvenience of obtaining fecal samples hinders the clinical application of gut microbiome analysis. In this study, we hypothesized that tongue coating color is associated with the severity of T2DM. Therefore, we aimed to compare tongue coating, gut microbiomes, and various clinical parameters between patients with T2DM with yellow (YC) and non-yellow tongue coatings (NYC). Tongue coating and gut microbiomes of 27 patients with T2DM (13 with YC and 14 with NYC) were analyzed using 16S rDNA gene sequencing technology. Additionally, we measured glycated hemoglobin (HbA1c), random blood glucose (RBG), fasting blood glucose (FBG), postprandial blood glucose (PBG), insulin (INS), glucagon (GC), body mass index (BMI), and homeostasis model assessment of β-cell function (HOMA-β) levels for each patient. The correlation between tongue coating and the gut microbiomes was also analyzed. Our findings provide evidence that the levels of Lactobacillus spp. are significantly higher in both the tongue coating and the gut microbiomes of patients with YC. Additionally, we observed that elevated INS and GC levels, along with decreased BMI and HOMA-β levels, were indicative of a more severe condition in patients with T2DM with YC. Moreover, our results suggest that the composition of the tongue coating may reflect the presence of Lactobacillus spp. in the gut. These results provide insights regarding the potential relationship between tongue coating color, the gut microbiome, and T2DM.

Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients

BACKGROUND

Estimated glucose disposal rate (eGDR), a simple and noninvasive measure of insulin resistance, has been proven to be an independent risk factor for first-time stroke and all-cause mortality. In this study, we aimed to investigate the associations between eGDR and the stroke outcome in patients with first-time acute ischemic stroke (AIS).

METHODS

We included first-time AIS patients with available data on eGDR in the China National Stroke Registry III (CNSR-III), and divided the subjects into lower eGDR group (eGDR ≤ 6 mg/kg/min) and higher eGDR group (eGDR > 6 mg/kg/min). The primary outcome was excellent functional outcome (modified Rankin Scale score 0-1) at 3 months. Secondary outcomes included stroke recurrence and favorable functional outcome (modified Rankin Scale score 0-2) at 3 months, and functional outcome and combined vascular event at one year. Univariate and multivariate analyses were performed to evaluate the association between eGDR and outcomes.

RESULTS

A total of 6,271 patients with AIS were included in this study. The median values of eGDR in lower and higher eGDR group were 5.0 mg/kg/min (interquartile range, 4.2-5.6) and 7.6 mg/kg/min (interquartile range, 6.8-9.6), respectively. Patients with higher eGDR were significantly associated with higher incidence of excellent functional outcome (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.45; P < 0.01) at 3 months and favorable (adjusted odds ratio, 1.55; 95% confidence interval, 1.24-1.93; P < 0.01) and excellent (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51; P < 0.01) functional outcome at one year. However, there was no significant difference in stroke recurrence between these two groups at 3 months (adjusted odds ratio, 0.81; 95% confidence interval, 0.61-1.06; P = 0.12) and one year (adjusted odds ratio, 0.91; 95% confidence interval, 0.73-1.14; P = 0.41).

CONCLUSION

eGDR is a predictor of functional outcome in patients with AIS, independent of traditional cardiovascular predictors.

Pre-diabetes, Diabetes, Hyperglycemia, and Stroke: Bittersweet Therapeutic Opportunities

PURPOSEOF REVIEW

Diabetes mellitus (DM) causes systemic vascular complications. Chronic hyperglycemia is a hallmark of DM and appears to be at least partially responsible for the vascular complications. In addition, hyperglycemia during acute tissue injury has been postulated to augment the injury. This review addresses the potential therapeutic benefits related to ischemic stroke from lowering hyperglycemia in two settings, in chronic hyperglycemia and during acute ischemic stroke.

RECENT FINDINGS

A recent efficacy trial to lower hyperglycemia during acute ischemic stroke showed no significant benefit overall as well as in patient subgroups. This finding helps to establish good clinical practice protocols for patients with acute ischemic stroke and hyperglycemia. Hyperglycemia appears to be a key mediator of the systemic vascular complications of DM. Despite current lack of evidence that lowering hyperglycemia during acute ischemic stroke improves functional outcome, unanswered questions remain in specific acute ischemic stroke settings that warrant additional research.

Comparison between distinct insulin resistance indices in measuring the development of hypertension: The China Health and Nutrition Survey

Aim

Our aim was to identify the relationship between several surrogate insulin resistance (IR) indices based on lipid products and the development of hypertension.

Materials and methods

A total of 3,281 participants aged ≥ 18 years enrolled in the China Health and Nutrition Survey from 2009 to 2015 and who were followed up for 6 years were included in the final analysis. Logistic regression was used to analyze the association between different IR indices and incident hypertension.

Results

There were 882 (28.9%) hypertensive participants in 2015. With regard to the homeostasis model assessment of insulin resistance (HOMA-IR) based on insulin level, subjects in the highest quartile of HOMA-IR values were more likely to develop hypertension [RR = 1.58 (1.26–1.98), P < 0.001] after being adjusted by sex and age, smoke habits, alcohol consumption, community type, married status, and education years in 2009. Subjects in the highest quartile of the triglyceride-glucose index (TyG) combined with body mass index (BMI) and waist circumference (WC) had more than two times the risk of hypertension after full adjustment compared with individuals in the lowest quartile (both P < 0.001), and the trend continued when adjusted for the HOMA-IR. Compared with those in the lowest quartile of TyG-BMI values, females in the highest quartile had a higher risk of developing hypertension than males [2.82 (2.01–3.97) vs. 2.56 (1.80–3.64)] after the full adjustment, and the trend existed independent of IR. Young participants in the highest quartile of the HOMA-IR had significantly higher risks of hypertension compared with subjects in the lowest quartile [1.67 (1.31–2.14), P < 0.005], and this trend was not significant in the elderly participants.

Conclusion

The results from our large-scale study elucidate the superiority of the TyG-BMI and TyG-WC compared with the HOMA-IR in the prediction of hypertension, which may be related to lipid deposition. The sex-specific predictive value is distinct for different IR indicators.

Association of β-cell function and cognitive impairment in patients with abnormal glucose metabolism

Background

Insulin has been demonstrated to play an important role in the occurrence and development of Alzheimer’s disease, especially in those with diabetes. β cells are important insulin-producing cells in human pancreas. This study aimed to investigate the association between β-cell dysfunction and cognitive impairment among patients over 40-year-old with abnormal glucose metabolism in Chinese rural communities.

Methods

A sample of 592 participants aged 40 years or older from the China National Stroke Prevention Project (CSPP) between 2015 and 2017 were enrolled in this study. Abnormal glucose metabolism was defined when hemoglobin Alc ≥ 5.7%. Cognitive function was assessed by the Beijing edition of the Montreal Cognitive Assessment scale. Homeostasis assessment of β-cell function was performed and classified into 4 groups according to the quartiles. A lower value of HOMA-β indicated a worse condition of β-cell function. Multivariate logistic regression was used to analyze the association between β-cell function and cognitive impairment.

Results

In a total of 592 patients with abnormal glucose metabolism, the average age was 60.20 ± 7.63 years and 60.1% patients had cognitive impairment. After adjusting for all potential risk factors, we found the first quartile of β-cell function was significantly associated with cognitive impairment (OR: 2.27, 95%CI: 1.32–3.92), especially at the domains of language (OR: 1.64, 95%CI: 1.01–2.65) and abstraction (OR: 2.29, 95%CI: 1.46–3.58).

Conclusions

Our study showed that worse β-cell function is associated with cognitive impairment of people over 40-year-old with abnormal glucose metabolism in Chinese rural communities, especially in the cognitive domains of abstraction and language.

Dietary Magnesium Intake Affects the Vitamin D Effects on HOMA-β and Risk of Pancreatic β-Cell Dysfunction: A Cross-Sectional Study

Background

Some studies have shown that, the circulating vitamin D (Vit D) concentration in the body exerts a crucial role in regulating the pancreatic β-cell function. Meanwhile, the role of magnesium is important in the synthesis of Vit D, since it is an essential element for activating Vit D. Nevertheless, there remains insufficient studies concerning whether dietary Magnesium intake influences the association between Vit D and risk of pancreatic β-cell dysfunction. Hence, this cross-sectional study aimed to assess the effect of Magnesium intake alterations on the association between serum Vit D levels and the risk of pancreatic β-cell dysfunction.

Methods

This large-scale cross-sectional study involves four cycles of National Health and Nutrition Examination Survey (NHANES) (2007–2014), with totally 4,878 participants. Groups were divided depending on the median daily intake of Magnesium, namely, the low intake group (Magnesium intake <267 Magnesium/d) and the high intake group (Magnesium intake ≥ 267 Magnesium/d). By constructing multiple multivariate linear and logistics regression models, the associations between serum Vit D levels and HOMA-β, as well as between serum Vit D levels and the risk of pancreatic β-cell dysfunction were explored at different Magnesium intakes.

Results

In this cross-sectional study, the serum Vit D level is independently correlated with the HOMA-β index [β: 0.65 (0.40–0.90)] and the risk of pancreatic β-cell dysfunction [OR: 0.95 (0.92–0.98)]. Moreover, such correlations are affected by different dietary Magnesium intakes (P for interaction < 0.001).

Conclusion

According to the results of this study, the dietary Magnesium intake influences the associations of serum Vit D levels with HOMA-β index and pancreatic β-cell dysfunction. Besides, the finding requires validation through more RCT or cohort studies.

Efficacy of the Synbiotic Supplementation on the Metabolic Factors in Patients with Metabolic Syndrome: A Randomized, Triple-Blind, Placebo-Controlled Trial

BACKGROUND

Metabolic syndrome is overwhelmingly increasing and is a significant risk factor for cardiovascular disorder, so effective treatment strategies are considered high priority. This study aimed to determine the effects of synbiotic supplementation on metabolic factors in patients with metabolic syndrome.

METHODS

In this triple-blind, randomized, placebo-controlled, clinical trial, 108 participants were divided into two groups to receive synbiotic supplementation or placebo for 12 weeks. All participants were also educated about maintaining a healthy lifestyle and consuming low-calorie nutritious meals, along with dietary intake and physical activity monitoring. Anthropometric measures, blood pressure, glycemic indices, lipid profile, hepatic enzymes, and hs-CRP were evaluated at the baseline and end of the trial.

RESULTS

Synbiotic supplementation significantly reduces fasting blood glucose (FBG) levels in the intervention group versus placebo group [-14.69 ± 15.11 mg/dl vs. -8.23 ± 7.90 mg/dl; p=0.007], but there was no difference between groups in other metabolic factors.

CONCLUSIONS

These findings suggest that synbiotic supplementation while following a healthy lifestyle and nutrition improved FBG in patients with metabolic syndrome.

Impact of Pancreatic β-Cell Function on Clopidogrel Responsiveness and Outcomes in Chinese Nondiabetic Patients Undergoing Elective Percutaneous Coronary Intervention

PURPOSE

Insulin resistance and β-cell dysfunction are fundamental defects contributing to type 2 diabetes development. Prior studies indicated that insulin resistance may be correlated with low responsiveness to clopidogrel. This study aimed to investigate the effects of β-cell function on clopidogrel-induced platelet P2Y12 inhibition and the clinical outcomes of nondiabetic patients undergoing elective percutaneous coronary intervention (PCI).

METHODS

Patients scheduled to undergo elective PCI and receive clopidogrel in addition to aspirin were recruited for this study. Homeostatic model assessment 2 of β-cell function (HOMA2-β%) was used to classify participants into quartiles. Thromboelastography (TEG) was used to calculate the quantitative platelet inhibition rate to assess clopidogrel-induced antiplatelet reactivity. The clinical outcome was major adverse cardiovascular and cerebrovascular events (MACCEs).

RESULTS

Of the 784 participants evaluated, 21.3% of them (169 of 784) had low responsiveness to clopidogrel. According to multivariate linear regression analysis, the first quartile of HOMA2-β% (19.9-78.1), indicating greater β-cell dysfunction, was independently associated with low responsiveness to clopidogrel compared with the fourth quartile (126.8-326.2) after adjustment for potential covariates [odds ratio 2.140, 95% confidence interval (CI) (1.336 to 3.570), P = 0.038]. In addition, at one year, the first quartile of HOMA2-β% was associated with an increased risk of 1-year MACCE occurrence compared with the fourth quartile [adjusted hazard ratio 4.989, 95% CI (1.571 to 15.845), P = 0.006].

CONCLUSION

Increased β-cell dysfunction, indicated by a low HOMA2-β%, was associated with low responsiveness to clopidogrel and an increased risk of one-year MACCEs in nondiabetic patients undergoing elective PCI.

β-Cell Function and Clinical Outcome in Nondiabetic Patients With Acute Ischemic Stroke

[Figure: see text].

Improvements in health parameters of a diabetic and hypertensive patient with only 40 minutes of exercise per week: a case study

Purpose: The present study aimed to report the effects of 15 weeks of a minimal dose resistance training on blood glucose levels, blood pressure, heart rate, physical capacity, and quality of life of a 67 old woman with type 2 diabetes mellitus, cardiopathy and hypertension.Method: The Patient was sedentary with a family history of heart failure and coronary artery disease. She suffered a heart attack in 2013 and was submitted to six cardiac catheterizations and one angioplasty between the 2015 and 2017. On April 2017, she was initially untrained in resistance training and was followed for 15 weeks with the performance of 31 resistance training sessions. Resistance training followed a minimal dose approach with 4 exercises performed with 2 sets to muscle failure, twice a week.Results: After follow up, the Patient presented a reduction in blood glucose, systolic and diastolic blood pressure, and heart rate at rest. There were also improvements on body mass index, cardiorespiratory fitness and quality of life. These results were accompanied by a reduction in the amount of antihypertensive and anti-diabetic medications.Conclusions: These results suggest that only 40 min of resistance training per week might help to improve general health and quality of life in a patient with hypertension and type 2 diabetes mellitus.Implications for RehabilitationMinimal dose resistance training improved health parameters in a diabetic and hypertensive patient.Resistance training promoted a reduction in the drugs used to control blood pressure and blood glucose levels.

Testing for HbA1c, in addition to the oral glucose tolerance test, in screening for abnormal glucose regulation helps to reveal patients with early β-cell function impairment

Background:

The oral glucose tolerance test (OGTT) is recommended to screen for diabetes in patients with coronary artery disease. We hypothesized that testing for glycated hemoglobin (HbA1c), in addition to the OGTT, in screening for abnormal glucose regulation may help to reveal patients with β-cell function impairment.

Methods:

Patients with no history of diabetes who were admitted for coronary angiography were recruited to undergo an OGTT and HbA1c test 2–4 weeks after hospital discharge. β-cell function and insulin resistance were assessed using the homeostasis model assessment (HOMA-β and HOMA-IR, respectively). For patients with normal glucose tolerance (NGT) based on the OGTT, we compared HOMA-β between two subgroups of patients using an HbA1c cutoff of 39 mmol/mol or 42 mmol/mol. For patients with prediabetes based on an OGTT, we compared the HOMA-β between two subgroups of patients using an HbA1c cutoff of 48 mmol/mol.

Results:

A total of 1044 patients were analyzed. In patients with NGT by OGTT (n=432), those with an HbA1c ≥42 mmol/mol had a lower HOMA-β compared to those with an HbA1c <42 mmol/mol (107±82 vs. 132±96, p=0.018). In patients with prediabetes by OGTT (n=423), those with an HbA1c ≥48 mmol/mol had a lower HOMA-β compared to those with an HbA1c <48 mmol/mol (91±52 vs. 120±88, p=0.003). No significant between-group difference in HOMA-IR was noted.

Conclusions:

The use of HbA1c in addition to the OGTT in screening for abnormal glucose regulation helped to reveal patients with early β-cell function impairment.