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Yadav Y, Romeres D, Cobelli C, Dalla Man C, Carter R, Basu A, Basu R. Impaired Diurnal Pattern of Meal Tolerance and Insulin Sensitivity in Type 2 Diabetes: Implications for Therapy. Diabetes 2023; 72:223-232. [PMID: 36346619 PMCID: PMC9871193 DOI: 10.2337/db22-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
To assess the diurnal patterns of postprandial glucose tolerance and insulin sensitivity, 19 subjects with type 2 diabetes (8 women; 60 ± 11 years; BMI 32 ± 5 kg/m2) and 19 anthropometrically matched subjects with no diabetes (ND; 11 women; 53 ± 12 years; BMI 29 ± 5 kg/m2) were studied during breakfast (B), lunch (L), and dinner (D) with identical mixed meals (75 g carbohydrates) on 3 consecutive days in a randomized Latin square design. Three stable isotopes of glucose were ustilized to estimate meal fluxes, and mathematical models were used in estimating indices of insulin action and β-cell function. Postmeal glucose excursions were higher at D versus B and at D versus L in type 2 diabetes (P < 0.05), while in ND they were higher at D versus B (P = 0.025) and at L versus B (P = 0.04). The insulin area under the curve was highest at B compared with L and D in type 2 diabetes, while no differences were observed in ND. Disposition index (DI) was higher at B than at L (P < 0.01) and at D (P < 0.001) in ND subjects, whereas DI was low with unchanging pattern across B-L-D in individuals with type 2 diabetes. Furthermore, between-meal differences in β-cell responsivity to glucose (F) and insulin sensitivity (SI) were concurrent with changes in the DI within groups. Fasting and postmeal glucose, insulin, and C-peptide concentrations, along with estimates of endogenous glucose production (EGP), Rd, SI, F, hepatic extraction of insulin, insulin secretion rate, extracted insulin, and DI, were altered in type 2 diabetes compared with ND (P < 0.011 for all). The data show a diurnal pattern of postprandial glucose tolerance in overweight otherwise glucose-tolerant ND individuals that differs from overweight individuals with type 2 diabetes. The results not only provide valuable insight into management strategies for better glycemic control in people with type 2 diabetes, but also improved understanding of daytime glucose metabolism in overweight individuals without impaired glucose tolerance or overt diabetes.
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Affiliation(s)
- Yogesh Yadav
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Davide Romeres
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Claudio Cobelli
- Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Ananda Basu
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Rita Basu
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
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Eichenlaub MM, Khovanova NA, Gannon MC, Nuttall FQ, Hattersley JG. A Glucose-Only Model to Extract Physiological Information from Postprandial Glucose Profiles in Subjects with Normal Glucose Tolerance. J Diabetes Sci Technol 2022; 16:1532-1540. [PMID: 34225468 PMCID: PMC9631515 DOI: 10.1177/19322968211026978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Current mathematical models of postprandial glucose metabolism in people with normal and impaired glucose tolerance rely on insulin measurements and are therefore not applicable in clinical practice. This research aims to develop a model that only requires glucose data for parameter estimation while also providing useful information on insulin sensitivity, insulin dynamics and the meal-related glucose appearance (GA). METHODS The proposed glucose-only model (GOM) is based on the oral minimal model (OMM) of glucose dynamics and substitutes the insulin dynamics with a novel function dependant on glucose levels and GA. A Bayesian method and glucose data from 22 subjects with normal glucose tolerance are utilised for parameter estimation. To validate the results of the GOM, a comparison to the results of the OMM, obtained by using glucose and insulin data from the same subjects is carried out. RESULTS The proposed GOM describes the glucose dynamics with comparable precision to the OMM with an RMSE of 5.1 ± 2.3 mg/dL and 5.3 ± 2.4 mg/dL, respectively and contains a parameter that is significantly correlated to the insulin sensitivity estimated by the OMM (r = 0.7) Furthermore, the dynamic properties of the time profiles of GA and insulin dynamics inferred by the GOM show high similarity to the corresponding results of the OMM. CONCLUSIONS The proposed GOM can be used to extract useful physiological information on glucose metabolism in subjects with normal glucose tolerance. The model can be further developed for clinical applications to patients with impaired glucose tolerance under the use of continuous glucose monitoring data.
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Affiliation(s)
- Manuel M. Eichenlaub
- School of Engineering, University of
Warwick, Coventry, UK
- Coventry NIHR CRF Human Metabolic
Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry,
UK
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm,
Germany
| | - Natasha A. Khovanova
- School of Engineering, University of
Warwick, Coventry, UK
- University Hospitals Coventry and
Warwickshire NHS Trust, Coventry, UK
- Natasha Khovanova, PhD, School of
Engineering, University of Warwick, Library Road, Coventry CV4 7AL, UK.
| | - Mary C. Gannon
- Department of Medicine, Minneapolis
Veterans Affairs Health Care System / University of Minnesota, Minneapolis, MN,
USA
| | - Frank Q. Nuttall
- Department of Medicine, Minneapolis
Veterans Affairs Health Care System / University of Minnesota, Minneapolis, MN,
USA
| | - John G. Hattersley
- School of Engineering, University of
Warwick, Coventry, UK
- Coventry NIHR CRF Human Metabolic
Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry,
UK
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Circadian clock, diurnal glucose metabolic rhythm, and dawn phenomenon. Trends Neurosci 2022; 45:471-482. [PMID: 35466006 PMCID: PMC9117496 DOI: 10.1016/j.tins.2022.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 01/28/2023]
Abstract
The circadian clock provides cue-independent anticipatory signals for diurnal rhythms of baseline glucose levels and glucose tolerance. The central circadian clock is located in the hypothalamic suprachiasmatic nucleus (SCN), which comprises primarily GABAergic neurons. The SCN clock regulates physiological diurnal rhythms of endogenous glucose production (EGP) and hepatic insulin sensitivity through neurohumoral mechanisms. Disruption of the molecular circadian clock is associated with the extended dawn phenomenon (DP) in type 2 diabetes (T2D), referring to hyperglycemia in the early morning without nocturnal hypoglycemia. The DP affects nearly half of patients with diabetes, with poorly defined etiology and a lack of targeted therapy. Here we review neural and secreted factors in physiological diurnal rhythms of glucose metabolism and their pathological implications for the DP.
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Protein and carbohydrate distribution among the meals: effect on metabolic parameters of patients with type 2 diabetes: a single-blinded randomised controlled trial. Br J Nutr 2021; 125:1007-1016. [PMID: 32493523 DOI: 10.1017/s0007114520001944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Studies have revealed that the timing of macronutrient ingestion may influence body weight and glucose tolerance. We aimed to examine the effect of high protein v. high carbohydrate intake at the evening meal on metabolic parameters of patients with type 2 diabetes. This is a single-blinded, parallel, randomised controlled trial. Ninety-six patients with type 2 diabetes, aged 32-65 years with a mean BMI of 28·5 (sd 3·4) kg/m2, were randomly assigned into one of these three groups: standard evening meal (ST), high-carbohydrate evening meal (HC) and high-protein evening meal (HP). Then, the patients were followed for 10 weeks. HbA1c, fasting blood glucose, fasting insulin, insulin resistance, TAG, LDL-cholesterol, VLDL-cholesterol, diastolic blood pressure, body weight, body fat percentage and waist circumference decreased significantly in all three groups (P < 0·05). HbA1c showed more improvement in the ST compared with the HP group (-0·45 (sd 0·36) v. -0·26 (sd 0·36)). Reductions in BMI and body weight were significantly higher in the ST compared with the HP group (P < 0·05). Reductions in total cholesterol, non-HDL-cholesterol and systolic blood pressure were significant in all groups, except for the HP group. Non-HDL-cholesterol:HDL-cholesterol remained unchanged in all groups. The results of the present study revealed that even distribution of carbohydrates and protein among meals compared with reducing carbohydrates and increasing protein at dinner may have a more beneficial effect on glycaemic control of patients with type 2 diabetes.
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Eichenlaub MM, Hattersley JG, Gannon MC, Nuttall FQ, Khovanova NA. Bayesian parameter estimation in the oral minimal model of glucose dynamics from non-fasting conditions using a new function of glucose appearance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105911. [PMID: 33485076 DOI: 10.1016/j.cmpb.2020.105911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The oral minimal model (OMM) of glucose dynamics is a prominent method for assessing postprandial glucose metabolism. The model yields estimates of insulin sensitivity and the meal-related appearance of glucose from insulin and glucose data after an oral glucose challenge. Despite its success, the OMM approach has several weaknesses that this paper addresses. METHODS A novel procedure introducing three methodological adaptations to the OMM approach is proposed. These are: (1) the use of a fully Bayesian and efficient method for parameter estimation, (2) the model identification from non-fasting conditions using a generalised model formulation and (3) the introduction of a novel function to represent the meal-related glucose appearance based on two superimposed components utilising a modified structure of the log-normal distribution. The proposed modelling procedure is applied to glucose and insulin data from subjects with normal glucose tolerance consuming three consecutive meals in intervals of four hours. RESULTS It is shown that the glucose effectiveness parameter of the OMM is, contrary to previous results, structurally globally identifiable. In comparison to results from existing studies that use the conventional identification procedure, the proposed approach yields an equivalent level of model fit and a similar precision of insulin sensitivity estimates. Furthermore, the new procedure shows no deterioration of model fit when data from non-fasting conditions are used. In comparison to the conventional, piecewise linear function of glucose appearance, the novel log-normally based function provides an improved model fit in the first 30 min of the response and thus a more realistic estimation of glucose appearance during this period. The identification procedure is implemented in freely accesible MATLAB and Python software packages. CONCLUSIONS We propose an improved and freely available method for the identification of the OMM which could become the future standardard for the oral minimal modelling method of glucose dynamics.
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Affiliation(s)
- Manuel M Eichenlaub
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; Coventry NIHR CRF Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - John G Hattersley
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; Coventry NIHR CRF Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Mary C Gannon
- Veterans Affairs Medical Center/University of Minnesota Medical School, Minneapolis, MN, USA
| | - Frank Q Nuttall
- Veterans Affairs Medical Center/University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natasha A Khovanova
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
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Banholzer N, Herzig D, Piazza C, Álvarez-Martínez M, Nakas CT, Kosinski C, Feuerriegel S, Hovorka R, Bally L. Effect of nutrition on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully automated closed-loop insulin therapy. Diabetes Obes Metab 2021; 23:234-239. [PMID: 32885596 DOI: 10.1111/dom.14187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/06/2020] [Accepted: 08/23/2020] [Indexed: 02/05/2023]
Abstract
Fully automated closed-loop insulin delivery may offer a novel way to manage diabetes in hospital. However, postprandial glycaemic control remains challenging. We aimed to assess the effect of nutritional intake on postprandial glucose control in hospitalized patients with type 2 diabetes receiving fully closed-loop insulin therapy. The effects of different meal types and macronutrient composition on sensor glucose time-in-target (TIT, 3.9-10.0 mmol/L) and mean sensor glucose were assessed with hierarchical linear models using a Bayesian estimation approach. TIT was lower and the mean sensor glucose slightly higher, after breakfast compared with lunch and dinner, whereas the insulin dose was higher. Across meals, when carbohydrates were replaced by fat, or to a lesser extent by protein, postprandial glucose control improved. For breakfast, a 3.9% improvement in TIT was observed when 10% of the energy from carbohydrates was replaced by fat. Improvements were slightly lower during lunch and dinner (3.2% and 3.4%) or when carbohydrates were replaced by protein (2.2 and 2.7%, respectively). We suggest that reducing carbohydrate at the expense of fat or protein, could further improve glucose control during fully closed-loop insulin therapy in hospital.
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Affiliation(s)
| | - David Herzig
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Camillo Piazza
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mario Álvarez-Martínez
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Edinburgh, UK
| | - Christos T Nakas
- Laboratory of Biometry, School of Agriculture, University of Thessaly, Nea Ionia, Greece
- University Institute of Clinical Chemistry, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Christophe Kosinski
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Oosterman JE, Wopereis S, Kalsbeek A. The Circadian Clock, Shift Work, and Tissue-Specific Insulin Resistance. Endocrinology 2020; 161:5916887. [PMID: 33142318 DOI: 10.1210/endocr/bqaa180] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/25/2020] [Indexed: 01/02/2023]
Abstract
Obesity and type 2 diabetes (T2D) have become a global health concern. The prevalence of obesity and T2D is significantly higher in shift workers compared to people working regular hours. An accepted hypothesis is that the increased risk for metabolic health problems arises from aberrantly timed eating behavior, that is, eating out of synchrony with the biological clock. The biological clock is part of the internal circadian timing system, which controls not only the sleep/wake and feeding/fasting cycle, but also many metabolic processes in the body, including the timing of our eating behavior, and processes involved in glucose homeostasis. Rodent studies have shown that eating out of phase with the endogenous clock results in desynchronization between rhythms of the central and peripheral clock systems and between rhythms of different tissue clocks (eg, liver and muscle clock). Glucose homeostasis is a complex process that involves multiple organs. In the healthiest situation, functional rhythms of these organs are synchronized. We hypothesize that desynchronization between different metabolically active organs contributes to alterations in glucose homeostasis. Here we summarize the most recent information on desynchronization between organs due to shift work and shifted food intake patterns and introduce the concept of phenotypic flexibility, a validated test to assess the contribution of each organ to insulin resistance (IR) in humans. We propose this test as a way to provide further insight into the possible desynchronization between tissue clocks. Because different types of IR benefit from different therapeutic approaches, we also describe different chronotherapeutic strategies to promote synchrony within and between metabolically active organs.
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Affiliation(s)
- Johanneke E Oosterman
- Department of Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), HE Zeist, the Netherlands
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, AZ Amsterdam, the Netherlands
| | - Suzan Wopereis
- Department of Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), HE Zeist, the Netherlands
| | - Andries Kalsbeek
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, AZ Amsterdam, the Netherlands
- Hypothalamic Integration Mechanisms, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), BA Amsterdam, the Netherlands
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Moore MC, Smith MS, Swift LL, Cincotta AH, Ezrokhi M, Cominos N, Zhang Y, Farmer B, Cherrington AD. Bromocriptine mesylate improves glucose tolerance and disposal in a high-fat-fed canine model. Am J Physiol Endocrinol Metab 2020; 319:E133-E145. [PMID: 32459527 PMCID: PMC7468784 DOI: 10.1152/ajpendo.00479.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bromocriptine mesylate treatment was examined in dogs fed a high fat diet (HFD) for 8 wk. After 4 wk on HFD, daily bromocriptine (Bromo; n = 6) or vehicle (CTR; n = 5) injections were administered. Oral glucose tolerance tests were performed before beginning HFD (OGTT1), 4 wk after HFD began (Bromo only), and after 7.5 wk on HFD (OGTT3). After 8 wk on HFD, clamp studies were performed, with infusion of somatostatin and intraportal replacement of insulin (4× basal) and glucagon (basal). From 0 to 90 min (P1), glucose was infused via peripheral vein to double the hepatic glucose load; and from 90 to 180 min (P2), glucose was infused via the hepatic portal vein at 4 mg·kg-1·min-1, with the HGL maintained at 2× basal. Bromo decreased the OGTT glucose ΔAUC0-30 and ΔAUC0-120 by 62 and 27%, respectively, P < 0.05 for both) without significantly altering the insulin response. Bromo dogs exhibited enhanced net hepatic glucose uptake (NHGU) compared with CTR (~33 and 21% greater, P1 and P2, respectively, P < 0.05). Nonhepatic glucose uptake (non-HGU) was increased ~38% in Bromo in P2 (P < 0.05). Bromo vs. CTR had higher (P < 0.05) rates of glucose infusion (36 and 30%) and non-HGU (~40 and 27%) than CTR during P1 and P2, respectively. In Bromo vs. CTR, hepatic 18:0/16:0 and 16:1/16:0 ratios tended to be elevated in triglycerides and were higher (P < 0.05) in phospholipids, consistent with a beneficial effect of bromocriptine on liver fat accumulation. Thus, bromocriptine treatment improved glucose disposal in a glucose-intolerant model, enhancing both NHGU and non-HGU.
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Affiliation(s)
- Mary Courtney Moore
- Department of Metabolic Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marta S Smith
- Department of Metabolic Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Larry L Swift
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | - Ben Farmer
- Department of Metabolic Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan D Cherrington
- Department of Metabolic Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Henry CJ, Kaur B, Quek RYC. Chrononutrition in the management of diabetes. Nutr Diabetes 2020; 10:6. [PMID: 32075959 PMCID: PMC7031264 DOI: 10.1038/s41387-020-0109-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 12/28/2022] Open
Abstract
Circadian rhythms are 24-h cycles regulated by endogeneous molecular oscillators called the circadian clock. The effects of diet on circadian rhythmicity clearly involves a relationship between factors such as meal timings and nutrients, known as chrononutrition. Chrononutrition is influenced by an individual's "chronotype", whereby "evening chronotypes" or also termed "later chronotype" who are biologically driven to consume foods later in the day. Research in this area has suggested that time of day is indicative of having an influence on the postprandial glucose response to a meal, therefore having a major effect on type 2 diabetes. Cross-sectional and experimental studies have shown the benefits of consuming meals early in the day than in the evening on postprandial glycaemia. Modifying the macronutrient composition of night meals, by increasing protein and fat content, has shown to be a simple strategy to improve postprandial glycaemia. Low glycaemic index (GI) foods eaten in the morning improves glycaemic response to a greater effect than when consumed at night. Timing of fat and protein (including amino acids) co-ingested with carbohydrate foods, such as bread and rice, can reduce glycaemic response. The order of food presentation also has considerable potential in reducing postprandial blood glucose (consuming vegetables first, followed by meat and then lastly rice). These practical recommendations could be considered as strategies to improve glycaemic control, rather than focusing on the nutritional value of a meal alone, to optimize dietary patterns of diabetics. It is necessary to further elucidate this fascinating area of research to understand the circadian system and its implications on nutrition that may ultimately reduce the burden of type 2 diabetes.
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Affiliation(s)
- Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, 14 Medical Drive, #07-02, Singapore, 117599, Singapore. .,National University of Singapore, Department of Biochemistry, 8 Medical Drive, Singapore, 117596, Singapore.
| | - Bhupinder Kaur
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, 14 Medical Drive, #07-02, Singapore, 117599, Singapore
| | - Rina Yu Chin Quek
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, 14 Medical Drive, #07-02, Singapore, 117599, Singapore
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Takao T, Takahashi K, Suka M, Suzuki N, Yanagisawa H. Association between postprandial hyperglycemia at clinic visits and all-cause and cancer mortality in patients with type 2 diabetes: A long-term historical cohort study in Japan. Diabetes Res Clin Pract 2019; 148:152-159. [PMID: 30641172 DOI: 10.1016/j.diabres.2019.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/13/2018] [Accepted: 01/04/2019] [Indexed: 01/09/2023]
Abstract
AIMS To evaluate the effect of postprandial hyperglycemia at clinic visits on all-cause and cancer mortality independent of glycated hemoglobin (HbA1c) levels in a real-world setting in Japanese patients with type 2 diabetes. We also investigated age at death. METHODS This historical cohort study included 1582 patients with type 2 diabetes who first visited our clinic from 1995 to 1998 and continued visiting for at least 1 year. The patients were followed up through 2017. Blood glucose levels at 2 h ± 30 min post-breakfast (2h-PBBG) were measured in 926 patients during the first year. The first measurements of 2h-PBBG levels were used as a measure of postprandial hyperglycemia. RESULTS A total of 233 patients died. The average age at death (men/women) was 75.6/80.8 years. A total of 139 patients who had 2h-PBBG levels measured died, including 46 deaths from cancer. Multivariate Cox regression analysis showed that 2h-PBBG levels significantly predicted all-cause and cancer mortality independent of HbA1c levels. CONCLUSIONS Postprandial hyperglycemia at clinic visits may be associated with all-cause and cancer mortality in patients with type 2 diabetes independent of HbA1c levels. As this is a small observational study, further studies are warranted to confirm our findings.
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Affiliation(s)
- Toshiko Takao
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
| | - Kazuyuki Takahashi
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobumi Suzuki
- Division of Gastroenterology, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
| | - Hiroyuki Yanagisawa
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Impact of First Meal Size during Prolonged Sitting on Postprandial Glycaemia in Individuals with Prediabetes: A Randomised, Crossover Study. Nutrients 2018; 10:nu10060733. [PMID: 29882811 PMCID: PMC6024819 DOI: 10.3390/nu10060733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 12/30/2022] Open
Abstract
We compared the impact of a high versus low energy intake first meal on glucose and insulin responses during prolonged sitting in individuals with prediabetes. Thirteen adults with overweight/obesity and prediabetes (mean ± SD age: 60 ± 6 years, BMI: 33 ± 4 kg/m²; 2 h OGTT: 8.9 ± 1.1 mmol/L) completed two randomised trials: 10 h uninterrupted sitting, incorporating three meals with matching macronutrient compositions but different energy distributions: High-Energy Breakfast (HE-BF; breakfast: 50%, lunch: 30%, dinner: 20% energy intake), Low-Energy Breakfast (LE-BF: 20%/30%/50% energy intake). Venous blood was sampled from 08:00⁻18:00 h for determination of plasma glucose and insulin concentrations, with 24 h continuous glucose monitoring (CGM). Total glucose area under the curve (AUC; +5.7 mmol/L/h, p = 0.019) and mean plasma glucose concentrations (+0.5 mmol/L, p = 0.014) were greater after HE-BF compared to LE-BF. In the HE-BF condition, compared to LE-BF, there was a greater incremental area under the curve (iAUC) for plasma glucose post-breakfast (+44 ± 59%, p = 0.007), but lower iAUC post-lunch (−55 ± 36%, p < 0.001). Total insulin AUC was greater (+480 mIU/mL/h, p < 0.01) after HE-BF compared to LE-BF. Twenty-four-hour (24 h) CGM revealed no differences in mean glucose and total AUC between conditions. Compared to a low-energy first meal, a high-energy first meal elicited exaggerated plasma insulin and glucose responses until lunch but had little effect on 24 h glycaemia. During periods of prolonged sitting, adults with prediabetes may have more beneficial postprandial insulin responses to a low-energy first meal.
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12
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Takao T, Suka M, Yanagisawa H, Iwamoto Y. Impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular events and all-cause mortality in patients with type 2 diabetes. J Diabetes Investig 2017; 8:600-608. [PMID: 27978599 PMCID: PMC5497051 DOI: 10.1111/jdi.12610] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/27/2016] [Accepted: 12/06/2016] [Indexed: 12/24/2022] Open
Abstract
AIMS/INTRODUCTION We evaluated the impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular diseases (CVD) and all-cause mortality independently of mean glycosylated hemoglobin in type 2 diabetes patients in a real-world setting. MATERIALS AND METHODS The present retrospective observational cohort study included 646 type 2 diabetes patients. All of the participants had their initial consultations at the Institute for Diabetes Care and Research, Asahi Life Foundation affiliated Marunouchi Hospital, Tokyo, Japan, during the period from 1995 to 1996, visited the clinic ≥4 times, had their 2-h post-breakfast blood glucose (2h-PBBG) levels measured and were followed up for ≥1 year. The 646 patients were followed up for survival. Of the 646 patients, 618 had no history of CVD at the first visit and had measured 2h-PBBG until the first CVD onset or censorings. These two cohorts were followed up through June 2012, and subsequently questionnaires were mailed. Multivariate Cox proportional hazard models were used to evaluate the risk of CVD incidence and death. RESULTS CVD occurred in 78 patients, and 56 patients died. The median follow-up periods of the CVD cohort and the mortality cohort were 15.6 and 15.9 years, respectively. The mean 2h-PBBG is a significant predictor of the CVD incidence and all-cause mortality after adjusting for the mean glycosylated hemoglobin, the number of 2h-PBBG measurements, age, sex and classical risk factors. CONCLUSIONS Postprandial hyperglycemia represented by the mean level of 2h-PBBG at clinic visits is associated with CVD incidence and all-cause mortality independently of the mean glycosylated hemoglobin level in type 2 diabetes patients. Prospective interventional trials are warranted to confirm the present findings.
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Affiliation(s)
- Toshiko Takao
- Division of Diabetes and MetabolismThe Institute for Adult DiseasesAsahi Life FoundationTokyoJapan
| | - Machi Suka
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hiroyuki Yanagisawa
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yasuhiko Iwamoto
- Division of Diabetes and MetabolismThe Institute for Adult DiseasesAsahi Life FoundationTokyoJapan
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13
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Moore MC, Smith MS, Farmer B, Kraft G, Shiota M, Williams PE, Cherrington AD. Priming Effect of a Morning Meal on Hepatic Glucose Disposition Later in the Day. Diabetes 2017; 66:1136-1145. [PMID: 28174290 PMCID: PMC5399607 DOI: 10.2337/db16-1308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/28/2017] [Indexed: 01/15/2023]
Abstract
We used hepatic balance and tracer ([3H]glucose) techniques to examine the impact of "breakfast" on hepatic glucose metabolism later in the same day. From 0-240 min, 2 groups of conscious dogs (n = 9 dogs/group) received a duodenal infusion of glucose (GLC) or saline (SAL), then were fasted from 240-360 min. Three dogs from each group were euthanized and tissue collected at 360 min. From 360-600 min, the remaining dogs underwent a hyperinsulinemic (4× basal) hyperglycemic clamp (arterial blood glucose 146 ± 2 mg/dL) with portal GLC infusion. The total GLC infusion rate was 14% greater in dogs infused with GLC than in those receiving SAL (AUC360-600min 2,979 ± 296 vs. 2,597 ± 277 mg/kg, respectively). The rates of hepatic glucose uptake (5.8 ± 0.8 vs. 3.2 ± 0.3 mg ⋅ kg-1 ⋅ min-1) and glycogen storage (4.7 ± 0.6 vs. 2.9 ± 0.3 mg ⋅ kg-1 ⋅ min-1) during the clamp were markedly greater in dogs receiving GLC compared with those receiving SAL. Hepatic glycogen content was ∼50% greater, glycogen synthase activity was ∼50% greater, glycogen phosphorylase activity was ∼50% lower, and the amount of phosphorylated glycogen synthase was 34% lower, indicating activation of the enzyme, in dogs receiving GLC compared with those receiving SAL. Thus, morning GLC primed the liver to extract and store more glucose in the presence of hyperinsulinemic hyperglycemia later in the same day, indicating that breakfast enhances the liver's role in glucose disposal in subsequent same-day meals.
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Affiliation(s)
- Mary Courtney Moore
- Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Marta S Smith
- Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Ben Farmer
- Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Guillaume Kraft
- Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Masakazu Shiota
- Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Phillip E Williams
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Alan D Cherrington
- Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
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14
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Kessler K, Hornemann S, Petzke KJ, Kemper M, Kramer A, Pfeiffer AFH, Pivovarova O, Rudovich N. The effect of diurnal distribution of carbohydrates and fat on glycaemic control in humans: a randomized controlled trial. Sci Rep 2017; 7:44170. [PMID: 28272464 PMCID: PMC5341154 DOI: 10.1038/srep44170] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/02/2017] [Indexed: 12/17/2022] Open
Abstract
Diurnal carbohydrate and fat distribution modulates glycaemic control in rodents. In humans, the optimal timing of both macronutrients and its effects on glycaemic control after prolonged consumption are not studied in detail. In this cross-over trial, 29 non-obese men were randomized to two four-week diets: (1) carbohydrate-rich meals until 13.30 and fat-rich meals between 16.30 and 22.00 (HC/HF) versus (2) inverse sequence of meals (HF/HC). After each trial period two meal tolerance tests were performed, at 09.00 and 15.40, respectively, according to the previous intervention. On the HF/HC diet, whole-day glucose level was increased by 7.9% (p = 0.026) in subjects with impaired fasting glucose and/or impaired glucose tolerance (IFG/IGT, n = 11), and GLP-1 by 10.2% (p = 0.041) in normal glucose-tolerant subjects (NGT, n = 18). Diet effects on fasting GLP-1 (p = 0.009) and PYY (p = 0.034) levels were observed in IFG/IGT, but not in NGT. Afternoon decline of glucose tolerance was more pronounced in IFG/IGT and associated with a stronger decrease of postprandial GLP-1 and PYY levels, but not with changes of cortisol rhythm. In conclusion, the HF/HC diet shows an unfavourable effect on glycaemic control in IFG/IGT, but not in NGT subjects. Consequently, large, carbohydrate-rich dinners should be avoided, primarily by subjects with impaired glucose metabolism.
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Affiliation(s)
- Katharina Kessler
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.,German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany.,Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, 12203 Berlin, Germany
| | - Silke Hornemann
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.,German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
| | - Klaus J Petzke
- Research Group Physiology of Energy Metabolism, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
| | - Margrit Kemper
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.,German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany.,Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, 12203 Berlin, Germany
| | - Achim Kramer
- Laboratory of Chronobiology, Institute for Medical Immunology, Charité University of Medicine, 10117 Berlin, Germany
| | - Andreas F H Pfeiffer
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.,German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany.,Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, 12203 Berlin, Germany
| | - Olga Pivovarova
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.,German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany.,Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, 12203 Berlin, Germany
| | - Natalia Rudovich
- Dept. of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.,German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany.,Dept. of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, 12203 Berlin, Germany.,Division of Endocrinology and Diabetes, Department of Internal Medicine, Spital Bülach, 8180 Bülach, Switzerland
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15
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Bosley JR, Maurer TS, Musante CJ. Systems Pharmacology Modeling in Type 2 Diabetes Mellitus. SYSTEMS PHARMACOLOGY AND PHARMACODYNAMICS 2016. [DOI: 10.1007/978-3-319-44534-2_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes: a randomised clinical trial. Br J Nutr 2014; 112:504-12. [DOI: 10.1017/s0007114514001123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Low-glycaemic index diets reduce glycated Hb (HbA1c) in patients with type 2 diabetes, but require intensive dietary support. Using a liquid meal replacement with a low glycaemic response (GR) may be an alternative dietary approach. In the present study, we investigated whether breakfast replacement with a low-GR liquid meal would reduce postprandial glycaemia and/or improve long-term glycaemia. In the present randomised, controlled, cross-over design, twenty patients with type 2 diabetes consumed either a breakfast replacement consisting of an isoenergetic amount of Glucerna SR or a free-choice breakfast for 3 months. Postprandial AUC levels were measured using continuous glucose measurement at home. After the 3-month dietary period, meal profiles and oral glucose tolerance were assessed in the clinical setting. The low-GR liquid meal replacement reduced the AUC of postprandial glucose excursions at home compared with a free-choice control breakfast (estimated marginal mean 141 (95 % CI 114, 174) v. estimated marginal mean 259 (95 % CI 211, 318) mmol × min/l; P= 0·0002). The low-GR liquid meal replacement also reduced glucose AUC levels in the clinical setting compared with an isoenergetic control breakfast (low GR: median 97 (interquartile range (IQR) 60–188) mmol × min/l; control: median 253 (IQR 162–386) mmol × min/l; P< 0·001). However, the 3-month low-GR liquid meal replacement did not affect fasting plasma glucose, HbA1c or lipid levels, and even slightly reduced oral glucose tolerance. In conclusion, the low-GR liquid meal replacement is a potential dietary approach to reduce postprandial glycaemia in patients with type 2 diabetes. However, clinical trials into the effects of replacing multiple meals on long-term glycaemia in poorly controlled patients are required before a low-GR liquid meal replacement can be adopted as a dietary approach to the treatment of type 2 diabetes.
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17
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Hinshaw L, Dalla Man C, Nandy DK, Saad A, Bharucha AE, Levine JA, Rizza RA, Basu R, Carter RE, Cobelli C, Kudva YC, Basu A. Diurnal pattern of insulin action in type 1 diabetes: implications for a closed-loop system. Diabetes 2013; 62:2223-9. [PMID: 23447123 PMCID: PMC3712033 DOI: 10.2337/db12-1759] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We recently demonstrated a diurnal pattern to insulin action (i.e., insulin sensitivity [SI]) in healthy individuals with higher SI at breakfast than at dinner. To determine whether such a pattern exists in type 1 diabetes, we studied 19 subjects with C-peptide-negative diabetes (HbA1c 7.1 ± 0.6%) on insulin pump therapy with normal gastric emptying. Identical mixed meals were ingested during breakfast, lunch, and dinner at 0700, 1300, and 1900 h in randomized Latin square of order on 3 consecutive days when measured daily physical activity was equal. The triple tracer technique enabled measurement of glucose fluxes. Insulin was administered according to the customary insulin:carbohydrate ratio for each participant. Although postprandial glucose excursions did not differ among meals, insulin concentration was higher (P < 0.01) and endogenous glucose production less suppressed (P < 0.049) at breakfast than at lunch. There were no differences in meal glucose appearance or in glucose disappearance between meals. Although there was no statistical difference (P = 0.34) in SI between meals in type 1 diabetic subjects, the diurnal pattern of SI taken across the three meals in its entirety differed (P = 0.016) from that of healthy subjects. Although the pattern in healthy subjects showed decreasing SI between breakfast and lunch, the reverse SI pattern was observed in type 1 diabetic subjects. The results suggest that in contrast to healthy subjects, SI diurnal pattern in type 1 diabetes is specific to the individual and cannot be extrapolated to the type 1 diabetic population as a whole, implying that artificial pancreas algorithms may need to be personalized.
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Affiliation(s)
- Ling Hinshaw
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Ahmed Saad
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Adil E. Bharucha
- Division of Gastroenterology, Mayo Medical School, Rochester, Minnesota
| | - James A. Levine
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Robert A. Rizza
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Rita Basu
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Medical School, Rochester, Minnesota
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Yogish C. Kudva
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Ananda Basu
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
- Corresponding author: Ananda Basu,
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18
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Hannon TS, Mather KJ. Measuring the transition to diabetes. J Diabetes Complications 2013; 27:101-2. [PMID: 23164632 DOI: 10.1016/j.jdiacomp.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/02/2012] [Indexed: 12/17/2022]
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19
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Stenvers DJ, Jonkers CF, Fliers E, Bisschop PHLT, Kalsbeek A. Nutrition and the circadian timing system. PROGRESS IN BRAIN RESEARCH 2013; 199:359-376. [PMID: 22877675 DOI: 10.1016/b978-0-444-59427-3.00020-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Life on earth has evolved under the daily rhythm of light and dark. Consequently, most creatures experience a daily rhythm in food availability. In this review, we first introduce the mammalian circadian timing system, consisting of a central clock in the suprachiasmatic nucleus (SCN) and peripheral clocks in various metabolic tissues including liver, pancreas, and intestine. We describe how peripheral clocks are synchronized by the SCN and metabolic signals. Second, we review the influence of the circadian timing system on food intake behavior, activity of the gastrointestinal system, and several aspects of glucose and lipid metabolism. Third, the circadian control of digestion and metabolism may have important implications for several aspects of food intake in humans. Therefore, we review the human literature on health aspects of meal timing, meal frequency, and breakfast consumption, and we describe the potential implications of the clock system for the timing of enteral tube feeding and parenteral nutrition. Finally, we explore the connection between type 2 diabetes and the circadian timing system. Although the past decade has provided exciting knowledge about the reciprocal relation between biological clocks and feeding/energy metabolism, future research is necessary to further elucidate this fascinating relationship in order to improve human health.
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Affiliation(s)
- Dirk Jan Stenvers
- Department of Endocrinology and Metabolism, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.
| | - Cora F Jonkers
- Department of Nutrition, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Peter H L T Bisschop
- Department of Endocrinology and Metabolism, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Andries Kalsbeek
- Department of Endocrinology and Metabolism, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands; Hypothalamic Integration Mechanisms, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, The Netherlands
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20
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Saad A, Dalla Man C, Nandy DK, Levine JA, Bharucha AE, Rizza RA, Basu R, Carter RE, Cobelli C, Kudva YC, Basu A. Diurnal pattern to insulin secretion and insulin action in healthy individuals. Diabetes 2012; 61:2691-700. [PMID: 22751690 PMCID: PMC3478548 DOI: 10.2337/db11-1478] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Evaluation of the existence of a diurnal pattern of glucose tolerance after mixed meals is important to inform a closed-loop system of treatment for insulin requiring diabetes. We studied 20 healthy volunteers with normal fasting glucose (4.8 ± 0.1 mmol/L) and HbA(1c) (5.2 ± 0.0%) to determine such a pattern in nondiabetic individuals. Identical mixed meals were ingested during breakfast, lunch, or dinner at 0700, 1300, and 1900 h in randomized Latin square order on 3 consecutive days. Physical activity was the same on all days. Postprandial glucose turnover was measured using the triple tracer technique. Postprandial glucose excursion was significantly lower (P < 0.01) at breakfast than lunch and dinner. β-Cell responsivity to glucose and disposition index was higher (P < 0.01) at breakfast than lunch and dinner. Hepatic insulin extraction was lower (P < 0.01) at breakfast than dinner. Although meal glucose appearance did not differ between meals, suppression of endogenous glucose production tended to be lower (P < 0.01) and insulin sensitivity tended to be higher (P < 0.01) at breakfast than at lunch or dinner. Our results suggest a diurnal pattern to glucose tolerance in healthy humans, and if present in type 1 diabetes, it will need to be incorporated into artificial pancreas systems.
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Affiliation(s)
- Ahmed Saad
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Via Gradenigo 6B, Padova, Italy
| | - Debashis K. Nandy
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - James A. Levine
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Adil E. Bharucha
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Robert A. Rizza
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Rita Basu
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo College of Medicine, Rochester, Minnesota
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Via Gradenigo 6B, Padova, Italy
| | - Yogish C. Kudva
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
| | - Ananda Basu
- Division of Endocrinology and Metabolism, Mayo College of Medicine, Rochester, Minnesota
- Corresponding author: Ananda Basu,
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