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Urbanschitz T, Huber L, Tichy A, Burgener IA, Zeugswetter FK. Short-term glycemic variability in non-diabetic, non-obese dogs assessed by common glycemic variability indices. Res Vet Sci 2024; 169:105156. [PMID: 38340380 DOI: 10.1016/j.rvsc.2024.105156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Glycemic variability (GV) refers to swings in blood glucose levels and is an emerging measure of glycemic control in clinical practice. It is associated with micro- and macrovascular complications and poor clinical outcomes in diabetic humans. Although an integral part of patient assessment in human patients, it is to a large extent neglected in insulin-treated diabetic dogs. This prospective pilot study was performed to describe canine within-day GV in non-diabetic dogs with the aim to provide a basis for the interpretation of daily glucose profiles, and to promote GV as an accessible tool for future studies in veterinary medicine. Interstitial glucose concentrations of ten non-diabetic, non-obese beagles were continuously measured over a 48-h period using a flash glucose monitoring system. GV was assessed using the common indices MAGE (mean amplitude of glycemic excursion), GVP (Glycemic variability percentage) and CV (coefficient of variation). A total of 2260 sensor measurements were obtained, ranging from 3.7 mmol/L (67 mg/dL) to 8.5 mmol/L (153 mg/dL). Glucose profiles suggested a meal-dependent circadian rhythmicity with small but significant surges during the feeding periods. No differences in GV indices were observed between day and night periods (p > 0.05). The MAGE (mmol/L), GVP (%) and CV (%) were 0.86 (± 0.19), 7.37 (± 1.65), 6.72 (± 0.89) on day one, and 0.83 (± 0.18), 6.95 (± 1.52), 6.72 (± 1.53) on day two, respectively. The results of this study suggest that GV is low in non-diabetic dogs and that glucose concentrations are kept within narrow ranges.
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Affiliation(s)
- Tobias Urbanschitz
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Lukas Huber
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Alexander Tichy
- University of Veterinary Medicine Vienna Platform for Bioinformatics and Biostatistics Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Iwan Anton Burgener
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Florian Karl Zeugswetter
- University of Veterinary Medicine Vienna Department of Small Animals and Horses Division of Small Animal Internal Medicine Veterinaerplatz 1, 1210 Vienna, Austria.
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Lazar S, Ionita I, Reurean-Pintilei D, Timar B. How to Measure Glycemic Variability? A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:61. [PMID: 38256322 PMCID: PMC10818970 DOI: 10.3390/medicina60010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Optimal glycemic control without the presence of diabetes-related complications is the primary goal for adequate diabetes management. Recent studies have shown that hemoglobin A1c level cannot fully evaluate diabetes management as glycemic fluctuations are demonstrated to have a major impact on the occurrence of diabetes-related micro- and macroangiopathic comorbidities. The use of continuous glycemic monitoring systems allowed the quantification of glycemic fluctuations, providing valuable information about the patients' glycemic control through various indicators that evaluate the magnitude of glycemic fluctuations in different time intervals. This review highlights the significance of glycemic variability by describing and providing a better understanding of common and alternative indicators available for use in clinical practice.
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Affiliation(s)
- Sandra Lazar
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital Timisoara, 300041 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
| | - Ioana Ionita
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital Timisoara, 300041 Timisoara, Romania
| | - Delia Reurean-Pintilei
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases, Consultmed Medical Centre, 700544 Iasi, Romania
| | - Bogdan Timar
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
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Li M, Wan Y, Zhu Z, Luo P, Yu H, Su J, Hang D, Lu Y, Tao R, Wu M, Zhou J, Fan X. Association between glycated haemoglobin and the risk of chronic obstructive pulmonary disease: A prospective cohort study in UK biobank. Diabetes Obes Metab 2023; 25:3599-3610. [PMID: 37643990 DOI: 10.1111/dom.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
AIMS To investigate the association between glycated haemoglobin (HbA1c) levels and chronic obstructive pulmonary disease (COPD) incidents in the general population, and the association between HbA1c levels and mortality in patients with COPD. MATERIALS AND METHODS We investigated the association of HbA1c levels with COPD risk in the general population in the UK Biobank, using data from 420 065 participants. Survival analysis was conducted for 18 854 patients with COPD. We used restricted cubic spline analysis to assess the dose-response relationship between HbA1c levels and COPD risk and survival. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS During a median follow-up of 12.3 years, 11 556 COPD cases were recorded. HbA1c had a non-linear relationship with COPD risk (p for non-linearity < .05). Compared with the quintile 2 (32.2-<34.3 mmol/mol), those with HbA1c levels above 38.7 mmol/mol (quintile 5) had a 22% (HR, 1.22, 95% CI: 1.15-1.30) higher risk of COPD. Compared with the HbA1c decile 2 (30.5-<32.2 mmol/mol), the HRs (95% CI) of COPD risk were 1.16 (1.03-1.30) and 1.36 (1.24-1.50) in the lowest HbA1c decile (<30.5 mmol/mol) and highest decile (≥41.0 mmol/mol), respectively. The increased COPD risk associated with HbA1c was more pronounced in younger, current smokers, passive smokers, and participants with a higher Townsend deprivation index (all p for interaction < .05). Among patients with COPD, 4569 COPD cases died (488 because of COPD) during a median follow-up of 5.4 years. Regarding COPD survival, HbA1c had a non-linear relationship with all-cause death (p for non-linearity < .05). Those with HbA1c quintile 5 (≥38.7 mmol/mol) had a 23% (HR, 1.23, 95% CI: 1.10-1.37) higher risk of all-cause death compared with the quintile 2 (32.2-<34.3 mmol/mol). Compared with the HbA1c decile 4 (33.3-<34.3 mmol/mol), those in the lowest HbA1c decile (<30.5 mmol/mol) and highest HbA1c decile (≥41.0 mmol/mol) had 22% (HR, 1.22; 95% CI: 1.01-1.47) and 28% (HR, 1.28; 95% CI: 1.11-1.48) higher risk for overall death. However, no significant association was observed between HbA1c levels and the risk of COPD-specific death. CONCLUSIONS Our findings indicated that lower and higher HbA1c levels were associated with a higher risk of COPD. In COPD cases, lower and higher HbA1c levels were associated with a higher COPD all-cause death risk.
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Affiliation(s)
- Mengyao Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yanan Wan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Zheng Zhu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Pengfei Luo
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Hao Yu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Dong Hang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yan Lu
- Department of Chronic Disease Prevention and Control, Suzhou City Centre for Disease Control and Prevention, Suzhou, China
| | - Ran Tao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Ming Wu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Xikang Fan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
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Zhang Y, Chu L, Zhou X, Xu T, Shen Q, Li T, Wu Y. Vitamin B12-Induced Autophagy Alleviates High Glucose-Mediated Apoptosis of Islet β Cells. Int J Mol Sci 2023; 24:15217. [PMID: 37894898 PMCID: PMC10607738 DOI: 10.3390/ijms242015217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
High glucose levels can lead to the apoptosis of islet β cells, while autophagy can provide cytoprotection and promote autophagic cell death. Vitamin B12, a water-soluble B vitamin, has been shown to regulate insulin secretion and increase insulin sensitivity. However, the precise mechanism of action remains unclear. In this study, we investigated the influence of vitamin B12 on high glucose-induced apoptosis and autophagy in RIN-m5F cells to elucidate how vitamin B12 modulates insulin release. Our results demonstrate that exposure to 45 mM glucose led to a significant increase in the apoptosis rate of RIN-m5F cells. The treatment with vitamin B12 reduced the apoptosis rate and increased the number of autophagosomes. Moreover, vitamin B12 increased the ratio of microtubule-associated protein 1 light chain 3 beta to microtubule-associated protein 1 light chain 3 alpha (LC3-II/LC3-I), while decreasing the amount of sequestosome 1 (p62) and inhibiting the phosphorylation of p70 ribosomal protein S6 kinase (p70S6K) under both normal- and high-glucose conditions. The additional experiments revealed that vitamin B12 inhibited high glucose-induced apoptosis. Notably, this protective effect was attenuated when the autophagy inhibitor 3-methyladenine was introduced. Our findings suggest that vitamin B12 protects islet β cells against apoptosis induced by high glucose levels, possibly by inducing autophagy.
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Affiliation(s)
- Yu Zhang
- Key Laboratory for Food Science and Biotechnology of Hunan Province, College of Food Science and Technology, Hunan Agricultural University, Changsha 410128, China; (Y.Z.); (L.C.); (X.Z.); (T.X.); (Q.S.)
| | - Ling Chu
- Key Laboratory for Food Science and Biotechnology of Hunan Province, College of Food Science and Technology, Hunan Agricultural University, Changsha 410128, China; (Y.Z.); (L.C.); (X.Z.); (T.X.); (Q.S.)
| | - Xi’an Zhou
- Key Laboratory for Food Science and Biotechnology of Hunan Province, College of Food Science and Technology, Hunan Agricultural University, Changsha 410128, China; (Y.Z.); (L.C.); (X.Z.); (T.X.); (Q.S.)
| | - Tingxia Xu
- Key Laboratory for Food Science and Biotechnology of Hunan Province, College of Food Science and Technology, Hunan Agricultural University, Changsha 410128, China; (Y.Z.); (L.C.); (X.Z.); (T.X.); (Q.S.)
| | - Qingwu Shen
- Key Laboratory for Food Science and Biotechnology of Hunan Province, College of Food Science and Technology, Hunan Agricultural University, Changsha 410128, China; (Y.Z.); (L.C.); (X.Z.); (T.X.); (Q.S.)
| | - Tao Li
- Hunan Agricultural Product Processing Institute, Hunan Academy of Agricultural Sciences, Changsha 410125, China
| | - Yanyang Wu
- Key Laboratory for Food Science and Biotechnology of Hunan Province, College of Food Science and Technology, Hunan Agricultural University, Changsha 410128, China; (Y.Z.); (L.C.); (X.Z.); (T.X.); (Q.S.)
- Horticulture and Landscape College, Hunan Agricultural University, Changsha 410128, China
- Hunan Co-Innovation Center for Utilization of Botanical Functional Ingredients, Changsha 410128, China
- State Key Laboratory of Subhealth Intervention Technology, Changsha 410128, China
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Pappe CL, Peters B, Dommisch H, Woelber JP, Pivovarova-Ramich O. Effects of reducing free sugars on 24-hour glucose profiles and glycemic variability in subjects without diabetes. Front Nutr 2023; 10:1213661. [PMID: 37850088 PMCID: PMC10577299 DOI: 10.3389/fnut.2023.1213661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
Background The Western diet, especially beverages and high processed food products, is high in sugars which are associated with the development of obesity and diabetes. The reduction of refined carbohydrates including free and added sugars improves glycemic control in individuals with diabetes, but the data regarding effects in subjects without diabetes are limited. Objective This study aimed to evaluate the effects of reducing free sugar intake on 24-h glucose profiles and glycemic variability using continuous glucose monitoring (CGM). Methods In the randomized controlled study, 21 normal weight and overweight/obese subjects (BMI 18-40 kg/m2) without diabetes were assigned to a 4-week reduced-sugar (RS) diet or control diet after a 2-week baseline phase. During the baseline phase, all participants were advised not to change their habitual diet. During the intervention phase, RS participants were asked to avoid added sugar and white flour products, whereas participants of the control group were requested to proceed their habitual diet. Anthropometric parameters and HbA1c were assessed before and at the end of the intervention phase. Interstitial glucose was measured using continuous glucose monitoring (CGM), and the food intake was documented by dietary records for 14 consecutive days during the baseline phase and for the first 14 consecutive days during the intervention phase. Mean 24-h glucose as well as intra- and inter-day indices of glucose variability, i.e., standard deviation (SD) around the sensor glucose level, coefficient of variation in percent (CV), mean amplitude of glucose excursions (MAGE), continuous overlapping net glycemic action (CONGA), and mean absolute glucose (MAG), were calculated for the baseline and intervention phases. Results During the intervention, the RS group decreased the daily intake of sugar (i.e., -22.4 ± 20.2 g, -3.28 ± 3.61 EN %), total carbohydrates (-6.22 ± 6.92 EN %), and total energy intake (-216 ± 108 kcal) and increased the protein intake (+2.51 ± 1.56 EN %) compared to the baseline values, whereby this intervention-induced dietary changes differed from the control group. The RS group slightly reduced body weight (-1.58 ± 1.33 kg), BMI, total fat, and visceral fat content and increased muscle mass compared to the baseline phase, but these intervention-induced changes showed no differences in comparison with the control group. The RS diet affected neither the 24-h mean glucose levels nor intra- and inter-day indices of glucose variability, HbA1c, or diurnal glucose pattern in the within- and between-group comparisons. Conclusion The dietary reduction of free sugars decreases body weight and body fat which may be associated with reduced total energy intake but does not affect the daily mean glucose and glycemic variability in individuals without diabetes. Clinical trial registration German Clinical Trials Register (DRKS); identifier: DRKS00026699.
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Affiliation(s)
- Christina Laeticia Pappe
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Beeke Peters
- Research Group Molecular Nutritional Medicine and Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Oberschleißheim, Germany
| | - Henrik Dommisch
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Periodontology, Health Science Center, University of Washington, Seattle, WA, United States
| | - Johan Peter Woelber
- Policlinic of Operative Dentistry, Periodontology, and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Olga Pivovarova-Ramich
- Research Group Molecular Nutritional Medicine and Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Oberschleißheim, Germany
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Di Giuseppe G, Ciccarelli G, Soldovieri L, Capece U, Cefalo CMA, Moffa S, Nista EC, Brunetti M, Cinti F, Gasbarrini A, Pontecorvi A, Giaccari A, Mezza T. First-phase insulin secretion: can its evaluation direct therapeutic approaches? Trends Endocrinol Metab 2023; 34:216-230. [PMID: 36858875 DOI: 10.1016/j.tem.2023.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 03/03/2023]
Abstract
Our work is aimed at unraveling the role of the first-phase insulin secretion in the natural history of type 2 diabetes mellitus (T2DM) and its interrelationship with insulin resistance and with β cell function and mass. Starting from pathophysiology, we investigate the impact of impaired secretion on glucose homeostasis and explore postmeal hyperglycemia as the main clinical feature, underlining its relevance in the management of the disease. We also review dietary and pharmacological approaches aimed at improving early secretory defects and restoring residual β cell function. Furthermore, we discuss possible approaches to detect early secretory defects in clinical practice. By providing a journey through human and animal data, we attempt a unification of the recent evidence in an effort to offer a new outlook on β cell secretion.
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Affiliation(s)
- Gianfranco Di Giuseppe
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Gea Ciccarelli
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Soldovieri
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Capece
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara M A Cefalo
- Department of Clinical and Molecular Medicine, University of Rome - Sapienza, Rome, Italy
| | - Simona Moffa
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico C Nista
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michela Brunetti
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Cinti
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Giaccari
- Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Teresa Mezza
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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Liu AS, Fan ZH, Lu XJ, Wu YX, Zhao WQ, Lou XL, Hu JH, Peng XYH. The characteristics of postprandial glycemic response patterns to white rice and glucose in healthy adults: Identifying subgroups by clustering analysis. Front Nutr 2022; 9:977278. [PMID: 36386904 PMCID: PMC9659901 DOI: 10.3389/fnut.2022.977278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/03/2022] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES Large interpersonal variability in postprandial glycemic response (PGR) to white rice has been reported, and differences in the PGR patterns during the oral glucose tolerance test (OGTT) have been documented. However, there is scant study on the PGR patterns of white rice. We examined the typical PGR patterns of white rice and glucose and the association between them. MATERIALS AND METHODS We analyzed the data of 3-h PGRs to white rice (WR) and glucose (G) of 114 normoglycemic female subjects of similar age, weight status, and same ethnic group. Diverse glycemic parameters, based on the discrete blood glucose values, were calculated over 120 and 180 min. K-means clustering based on glycemic parameters calculated over 180 min was applied to identify subgroups and representative PGR patterns. Principal factor analysis based on the parameters used in the cluster analysis was applied to characterize PGR patterns. Simple correspondence analysis was performed on the clustering categories of WR and G. RESULTS More distinct differences were found in glycemic parameters calculated over 180 min compared with that calculated over 120 min, especially in the negative area under the curve and Nadir. We identified four distinct PGR patterns to WR (WR1, WR2, WR3, and WR4) and G (G1, G2, G3, and G4), respectively. There were significant differences among the patterns regard to postprandial hyperglycemia, hypoglycemic, and glycemic variability. The WR1 clusters had significantly lower glycemic index (59 ± 19), while no difference was found among the glycemic index based on the other three clusters. Each given G subgroup presented multiple patterns of PGR to WR, especially in the largest G subgroup (G1), and in subgroup with the greatest glycemic variability (G3). CONCLUSION Multiple subgroups could be classified based on the PGR patterns to white rice and glucose even in seemingly homogeneous subjects. Extending the monitoring time to 180 min was conducive to more effective discrimination of PGR patterns. It may not be reliable to extrapolate the patterns of PGR to rice from that to glucose, suggesting a need of combining OGTT and meal tolerance test for individualized glycemic management.
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Affiliation(s)
- An-shu Liu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Zhi-hong Fan
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Xue-jiao Lu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yi-xue Wu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Wen-qi Zhao
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xin-ling Lou
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Jia-hui Hu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xi-yi-he Peng
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
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Liu Y, Jiang H, Ruan B, Liu Y, Le S, Fu X, Wang S. Effect of high-protein vs. high-fat snacks before lunch on glycemic variability in prediabetes: A study protocol for a randomized controlled trial. Front Nutr 2022; 9:925870. [PMID: 35928840 PMCID: PMC9344043 DOI: 10.3389/fnut.2022.925870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background China has the largest number of patients with Type 2 Diabetes Mellitus (T2DM), and it tends to increasingly grow in the future, putting an enormous burden on disease control and prevention in China. While glycemic variability (GV) came to be an important indicator of blood glucose control in diabetic patients, studies suggested that premeal snacks may help blood glucose control, but there are still some problems to be researched. Therefore, we designed this trial to evaluate which kind of premeal snacks would lead to better effects on GV under two diet patterns in pre-diabetes subjects and to evaluate assessments of acceptability and compliance, behavior, and metabolism changes in individuals will be described. Methods and analysis The study is a single-center, open-label, multiparallel group, randomized controlled trial. A total of 32 male and female volunteers will be randomized into 4 groups in a single allocated ratio of soy milk (powder) snack, milk (powder) snack, almonds snack, and placebo control with 250 ml of water taken 30 min before lunch, respectively. The study consists of two intervention periods over 11 days. The first intervention period under habitual diet conditions from D3 to D6 (4 days), during which all subjects are asked to maintain their habitual eating and daily activities similar to the run-in period. The second intervention consists of prelunch snacks with standard meals. We will examine both the effect of GV and various metabolic and behavioral outcomes potentially associated with the interventions. At the end of this study, we will assess the acceptability and maintainability of the intervention through interviews. Clinical trial registration Chinese Clinical Trial Registry, identifier ChiCTR2200058935.
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Affiliation(s)
- Yupeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Huinan Jiang
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Binye Ruan
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Yi Liu
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Siyu Le
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyi Fu
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Xiaoyi Fu
| | - Shuran Wang
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
- Shuran Wang
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9
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Luo Y, Wang J, Sun L, Gu W, Zong G, Song B, Shen C, Zhou P, Chen Y, Wu Y, Lin H, Zheng H, Ni M, Yang X, Chen Y, Xu X, Zhang J, Shi J, Zhang R, Hu J, Hou H, Lu L, Xu X, Liang L, Liu R, Liu X, Li H, Hong J, Wang W, Lin X, Ning G. Isocaloric-restricted Mediterranean Diet and Chinese Diets High or Low in Plants in Adults With Prediabetes. J Clin Endocrinol Metab 2022; 107:2216-2227. [PMID: 35579171 PMCID: PMC9282247 DOI: 10.1210/clinem/dgac303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Indexed: 12/02/2022]
Abstract
CONTEXT Calorie restriction plus dietary advice is suggested as a preventive strategy for individuals with obesity and prediabetes; however, optimal diet is still debatable. We aimed to compare the effects of Mediterranean diet (MD) and Chinese diets high or low in plants on body weight and glucose homeostasis among high-risk Chinese. SUBJECTS AND METHODS In this parallel-arm randomized controlled trial, 253 Chinese adults aged 25 to 60 years with a body mass index ≥ 24.0 kg/m2 and fasting blood glucose ≥ 5.6 mmol/L were randomly assigned to 3 isocaloric-restricted diets: MD (n = 84), a traditional Jiangnan diet high in plants (TJD, n = 85), or a control diet low in plants (CD, n = 84). During the 6-month trial, a 5-weekday full-feeding regimen was followed, along with mobile app-based monitoring. Abdominal fat measurement (magnetic resonance imaging), oral glucose tolerance test (OGTT), and continuous glucose monitoring (CGM) were conducted at baseline and 3 and 6 months. RESULTS With a 25% calorie restriction for 6 months, weight deduction was 5.72 kg (95% confidence interval, 5.03-6.40) for MD, 5.05 kg (4.38-5.73) for TJD, and 5.38 kg (4.70-6.06) for CD (Ptime < 0.0001). No between-group differences were found for fasting glucose, insulin, and the Matsuda index from OGTT. Notably, CD had significantly longer time below range (glucose < 3.9 mmol/L) than MD (0.81% [0.21-1.40], P = 0.024) and marginally longer time than TJD (0.56% [-0.03 to 1.15], P = 0.065), as measured by CGM. CONCLUSIONS With the 6-month isocaloric-restricted feeding, TJD and MD achieved comparable weight deduction and improved glucose homeostasis, whereas CD showed a higher risk for hypoglycemia.
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Affiliation(s)
| | - Jiqiu Wang
- Jiqiu Wang, MD, PhD, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Rui-Jin 2nd Rd, Shanghai, 200025, China.
| | | | | | - Geng Zong
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Boyu Song
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Chongrong Shen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Puchen Zhou
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Yufei Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yanpu Wu
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Huibin Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - He Zheng
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Mengshan Ni
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaowei Yang
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Yanru Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xinming Xu
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Juan Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Juan Shi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ru Zhang
- SAIC Volkswagen Automotive Company Limited, Shanghai, 201805, China
| | - Jinfen Hu
- SAIC Volkswagen Automotive Company Limited, Shanghai, 201805, China
| | - Hong Hou
- SAIC Volkswagen Automotive Company Limited, Shanghai, 201805, China
| | - Ling Lu
- Key Laboratory of Systems Health Science of Zhejiang Province, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, 310024, China
- Key Laboratory of Systems Biology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Hangzhou, 310024, China
| | | | - Liming Liang
- Department of Epidemiology and Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, 02115, USA
| | - Ruixin Liu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaoran Liu
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Huaixing Li
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Jie Hong
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xu Lin
- Xu Lin, MD, PhD, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, 320 Yue-yang Rd., Shanghai, 200031, China.
| | - Guang Ning
- Correspondence: Guang Ning, MD, PhD, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Rui-Jin 2nd Rd, Shanghai, 200025, China.
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10
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Association of Visit-to-Visit Variability in Fasting Plasma Glucose with Digestive Cancer Risk. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:4530894. [PMID: 35873802 PMCID: PMC9301759 DOI: 10.1155/2022/4530894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
Background and Aims. The aim of this study is to investigate the association between visit-to-visit variability in fasting plasma glucose (FPG) and the risk of digestive cancers among individuals with and without diabetes. Methods. Using data from Kailuan cohort, a prospective population-based study, individuals who had at least two measurements of FPG between 2006 and 2012 without prior cancer were included in this study. Four indexes of variability were used, including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average successive variability (ARV). Cox regression was used to evaluate the relationship between the quartiles of FPG variability and digestive cancers. Results. A total of 98,161 individuals were studied. Over a mean follow-up of
years, 1103 individuals developed incident digestive cancer (1.21 per 1000 person-years). Compared to the individuals in the lowest quartile, those in the highest quartile of FPG variability by SD had 38.7% higher risk of developing overall digestive cancers after adjusting for the significant confounders (hazard ratio, 1.387; 95% confidence interval, 1.160-1.659;
). Higher FPG variability was associated with significantly higher risks of colorectal cancer (fully adjusted HR 1.432, 95% CI [1.073-1.912],
) and pancreatic cancer (fully adjusted HR 2.105, 95% CI [1.024-4.329],
), but not liver cancer (fully adjusted HR 1.427, 95% CI [0.973-2.092],
) or esophageal and gastric cancer (fully adjusted HR 1.139, 95% CI [0.776-1.670],
). Subgroup analyses showed that individuals who were younger (<65 years), male, and those without diabetes experienced a predominantly higher risk of developing digestive cancers. Similar results were observed when using CV, VIM, and ARV. Conclusions. FPG variability was significantly associated with increasing risk of digestive cancers, especially for pancreatic and colorectal cancer. Our study suggested a potential role of FPG variability in risk stratification of digestive cancers. Approaches that reduce FPG variability may lower the risks of incident digestive cancers among the general population. This trial is registered with ChiCTR-TNRC-11001489.
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11
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Wang Y, Yu L, Wang Y, Zhou J, Wu Y, Liu T, Wang N, Fu C. Postload Plasma Glucose but Not Fasting Plasma Glucose Had a Greater Predictive Value for Cardiovascular Disease in a Large Prospective Cohort Study in Southwest China. Front Cardiovasc Med 2022; 8:815357. [PMID: 35141297 PMCID: PMC8818731 DOI: 10.3389/fcvm.2021.815357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Uncertainty remains regarding the relevance of glycemia, though below the threshold for diabetes, for the risk of cardiovascular disease (CVD) among the Southwest Chinese. We aimed to examine the associations of the first-onset CVD with fasting plasma glucose (FPG) and 2-h postload glucose (2h-PG) in Southwest China. METHODS The current study examined data from the Guizhou Population Health Cohort Study (GPHCS) of 9,280 participants aged 18 to 95 years recruited from 12 areas since 2010 in Guizhou Province, Southwest China. Participants were followed-up until December, 2020. Primary outcomes were the first onset of a composite of or one of major CVD events, including ischaemic stroke, haemorrhagic stroke and myocardial infarction. FPG, 2h-PG, other metabolic factors and some demographic factors were collected at baseline. Cox proportional hazards models were used to estimate the risk of CVD associated with FPG and 2h-PG. Sensitive analysis and stratified analysis were conducted among participants across different modifiable risk factors and demographic features. RESULTS During a median of 6.58 years of follow-up, of 7,593 participants with available data for analysis, 174 experienced at least one CVD events, 158 developed stroke (including 126 ischemic stroke and 39 Ischemic stroke events), and 24 developed myocardial infarction. The risk of major CVD events was significantly increased with elevated 2h-PG but not FPG. Compared with participants in the lowest tertile of 2h-PG, those in the highest tertile had a 1.87-fold (95%CI: 1.26-2.77) increased risk for overall CVD, a 1.82-fold (95%CI: 1.20-2.75) increased risk for overall Stroke, and a 1.82-fold (95%CI: 1.20-2.75) increased risk for ischemic stroke, respectively, after adjustment for age, sex, smoking, ethnic group, education level, systolic blood pressure (SBP), triglycerides (TG), body mass index (BMI) and waist circumference (WC). However, there was no relation of glycemia of haemorrhagic stroke or myocardial infarction (P > 0.05). The effect sizes in the associations of CVD with 2h-PG become enhanced among those within normal range of glycemia, SBP, TG, BMI, as well as those without hypertension, dyslipidemia.and obesity. CONCLUSIONS 2h-PG, in contrast to FPG, is a significant indicator in predication of CVD in Southwest Chinese. Elevated 2h-PG, though below the below the threshold for diabetes, remains independently increased the risk of CVD.
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Affiliation(s)
- Yingying Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Lisha Yu
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Yiying Wang
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Jie Zhou
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Yanli Wu
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Tao Liu
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Na Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Chaowei Fu
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
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12
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Yong G, Jing Q, Yao Q, Yang K, Ye X. Changing Meal Sequence Affects Glucose Excursions in Gestational Diabetes Mellitus. J Diabetes Res 2022; 2022:7083106. [PMID: 35915720 PMCID: PMC9338731 DOI: 10.1155/2022/7083106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/06/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
Studies on nutrient sequences during meals suggest that consuming carbohydrates last lowers postprandial glucose excursions more than consuming carbohydrates first. However, this phenomenon has not been studied in gestational diabetes mellitus (GDM). Ten women with GDM consumed the same caloric foods in different sequences over five successive days: (A) dish first, followed by carbohydrate and soup last; (B) carbohydrate first, followed by dish and soup last; (C) soup first, followed by dish and carbohydrate last; (D) three meals a day ad libitum; and (E) six meals a day as ad libitum. Continuous glucose monitoring (CGM) was used to assess diurnal glycemia. Decreases in mean glucose levels and the largest glucose levels in A were similar to group C. The peak glucose of breakfast and lunch in group B was more significant than in groups A and C. The B meal pattern showed more marked glycemic excursions than groups A and C. Increasing the number of meals reduced the peak glucose level and the glycemic excursions with the same total calories. Changing meal sequences or increasing the number of meals may reduce glycemic excursions in GDM. Our trial was registered retrospectively and the trial registration number is ChiCTR2200057044.
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Affiliation(s)
- Guangjin Yong
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, China
| | - Qian Jing
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, China
| | - Qing Yao
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, China
| | - Kechun Yang
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, China
| | - Xinhua Ye
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, China
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13
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Shao D, Wang SS, Sun JW, Wang HP, Sun Q. Association Between Long-Term HbA1c Variability and Functional Limitation in Individuals Aged Over 50 Years: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:847348. [PMID: 35574024 PMCID: PMC9099190 DOI: 10.3389/fendo.2022.847348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As mean HbA1c provides incomplete information regarding glycemic variability, there has been considerable interest in the emerging association between glycemic variability and macrovascular events and with microvascular complications and mortality in adults with and without diabetes. However, the association between long-term glycemic variability, represented by visit-to-visit HbA1c variability, and functional limitations has not been clarified in previous literature. The present study aimed to explore the longitudinal association between long-term glycemic variability, represented by visit-to-visit HbA1c variability and functional limitations. METHODS This cohort study included adults aged over 50 years who participated in the 2006 to 2016 waves of the Health and Retirement Study. Physical functions, including mobility, large muscle function, activities of daily living (ADLs), and instrumental ADLs (IADLs), were assessed at baseline and every 2 years, and HbA1c levels were assessed at baseline and every 4 years. Visit-to-visit HbA1c variability was calculated using the HbA1c variability score (HVS) during the follow-up period. Generalized estimating equation models were used to evaluate the longitudinal association between HbA1c variability and functional limitations with adjustment for a series of confounders. RESULTS A total of 5,544 participants having three HbA1c measurements from 2006 to 2016, having two or more physical function measures (including one at baseline), and age over 50 years were included in this analysis. The mean age at baseline was 66.13 ± 8.39 years. A total of 916 (16.5%) participants had an HVS = 100, and 35.1% had an HVS = 50. The highest HVS category (HVS =100) was associated with increased functional status score (β = 0.093, 95% CI: 0.021-0.165) in comparison with the lowest HVS category (HVS = 0). Sensitivity analyses using the CV and SD of HbA1c as measures of variability showed similar associations between HbA1c variability and functional limitation. An incremental increase in HbA1c-CV (β = 0.630, 95% CI: 0.127-1.132) or HbA1c-SD (β = 0.078, 95% CI: 0.006-0.150) was associated with an increase in functional limitation in the fully adjusted model. CONCLUSIONS HbA1c variability was associated with heightened difficulty in performing functional activities over time after adjusting for mean HbA1c levels and multiple demographics and comorbidities. This study provides further evidence regarding the detrimental effect of HbA1c variability and highlights the significance of steady glycemic control.
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Affiliation(s)
- Di Shao
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuang-Shuang Wang
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ji-Wei Sun
- Center for Reproductive Medicine, School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
| | - Hai-Peng Wang
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Qiang Sun,
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14
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Resistant Starch Consumption Effects on Glycemic Control and Glycemic Variability in Patients with Type 2 Diabetes: A Randomized Crossover Study. Nutrients 2021; 13:nu13114052. [PMID: 34836304 PMCID: PMC8621288 DOI: 10.3390/nu13114052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 01/02/2023] Open
Abstract
We previously observed beneficial effects of native banana starch (NBS) with a high resistant starch (RS) content on glycemic response in lean and obese participants. Here, we aimed to determine the effects of NBS and high-amylose maize starch (HMS) on glycemic control (GC) and glycemic variability (GV) in patients with type 2 diabetes (T2D) when treatments were matched for digestible starch content. In a randomized, crossover study, continuous glucose monitoring (CGM) was performed in 17 participants (aged 28-65 years, BMI ≥ 25 kg/m2, both genders) consuming HMS, NBS, or digestible maize starch (DMS) for 4 days. HMS and NBS induced an increase in 24 h mean blood glucose during days 2 to 4 (p < 0.05). CONGA, GRADE, and J-index values were higher in HMS compared with DMS only at day 4 (p < 0.05). Yet, NBS intake provoked a reduction in fasting glycemia changes from baseline compared with DMS (p = 0.0074). In conclusion, under the experimental conditions, RS from two sources did not improve GC or GV. Future longer studies are needed to determine whether these findings were affected by a different baseline microbiota or other environmental factors.
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15
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Liu D, Tang Y, Zhang Q. Admission Hyperglycemia Predicts Long-Term Mortality in Critically Ill Patients With Subarachnoid Hemorrhage: A Retrospective Analysis of the MIMIC-III Database. Front Neurol 2021; 12:678998. [PMID: 34675863 PMCID: PMC8525327 DOI: 10.3389/fneur.2021.678998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a severe subtype of stroke with high mortality. Hyperglycemia is a common phenomenon in critically ill patients and associated with poor clinical outcome. However, the predictive value of admission hyperglycemia for 30 and 90-day all-cause mortality in critically ill patients with SAH remains controversial. All SAH patients between 2001 and 2012 were included based on the MIMIC-III database and were further classified according to the tertiles of blood glucose (BG) measured on intensive care unit (ICU) admission. Clinical information including demographic data, comorbidities, and laboratory indicators were exacted and analyzed. The primary outcomes were 30- and 90-day all-cause mortality. A total of 1,298 SAH patients were included. The 30 and 90-day mortality rates were 19.80% and 22.73%, respectively. Subjects in the high glucose tertile were older, were overweight, had higher sequential organ failure assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scores, and presented higher mortality rate. Generalized additive model revealed a U-shaped relationship between BG and 30 and 90-day all-cause mortality. Furthermore, Kaplan-Meier (K-M) survival curve also illustrated that subjects with admission hyperglycemia presented lower survival rate and shorter survival time. In Cox analysis, after adjustment for potential confounders, admission hyperglycemia was related to an increase in 30- and 90-day all-cause mortality in SAH patients. In subgroup analysis, the association between admission hyperglycemia and all-cause mortality was consistent. In conclusion, admission hyperglycemia is associated with significantly increased 30- and 90-day all-cause mortality in critically ill patients with SAH.
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Affiliation(s)
- Dongliang Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yiyang Tang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
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16
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Graph Convolutional Network Enabled Two-Stream Learning Architecture for Diabetes Classification based on Flash Glucose Monitoring Data. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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17
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Sun Z, Chai Q, Zhang Z, Lu D, Meng Z, Wu W. Inhibition of SGLT1 protects against glycemic variability-induced cardiac damage and pyroptosis of cardiomyocytes in diabetic mice. Life Sci 2021; 271:119116. [PMID: 33508297 DOI: 10.1016/j.lfs.2021.119116] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022]
Abstract
AIMS Glycemic variability has been shown to be more harmful in the development of diabetic complication than sustained chronic hyperglycemia. In this present study, we tried to reveal the effects of glycemic variability on cardiac damage in diabetic mice and investigate whether sodium-glucose cotransporter 1 (SGLT1), an important cardiac glucose transporter, functions as an important mediator in the process. MATERIALS AND METHODS Type 2 diabetes mellitus (DM) mice were induced by a high-fat diet and intraperitoneal injection of streptozotocin (STZ), and then glycemic variability in type 2 diabetes mellitus (GVDM) was induced by alternately injecting insulin and glucose to DM mice. In order to determine the roles of SGLT1 in GVDM mice, SGLT1 inhibition was performed using shRNA against SGLT1. The blood glucose level, the cardiac function and myocardial injury were assessed. And the expressions of SGLT1 and the activations of NLRP3/caspase-1 pathway and NF-κB in left ventricular tissues were measured. KEY FINDINGS The results showed that SGLT1 was highly expressed in heart of GVDM mice compared to control and DM groups, and knockdown of SGLT1 reduced glycemic variability in GVDM mice. Moreover, glycemic variability impaired cardiac function, aggravated cardiac injury and induced NLRP3/caspase-1-mediated inflammatory response and pyroptosis. And knockdown of SGLT1 significantly attenuated the cardiac damages that induced by glycemic variability. SIGNIFICANCE The results indicated that glycemic variability could cause cardiac damage and induce inflammatory response and pyroptosis of cardiomyocytes in diabetic mice, which could be partially blocked by SGLT1 silence.
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Affiliation(s)
- Zhenjie Sun
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Qian Chai
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Ziying Zhang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Dexue Lu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Ziang Meng
- Department of Urology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Weihua Wu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China.
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Kamruzzaman M, Horowitz M, Jones KL, Marathe CS. Gut-Based Strategies to Reduce Postprandial Glycaemia in Type 2 Diabetes. Front Endocrinol (Lausanne) 2021; 12:661877. [PMID: 33897622 PMCID: PMC8062751 DOI: 10.3389/fendo.2021.661877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Postprandial glycemic control is an important target for optimal type 2 diabetes management, but is often difficult to achieve. The gastrointestinal tract plays a major role in modulating postprandial glycaemia in both health and diabetes. The various strategies that have been proposed to modulate gastrointestinal function, particularly by slowing gastric emptying and/or stimulating incretin hormone GLP-1, are summarized in this review.
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Affiliation(s)
- Md Kamruzzaman
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Karen L. Jones
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Chinmay S. Marathe
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- *Correspondence: Chinmay S. Marathe,
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Kenđel Jovanović G, Mrakovcic-Sutic I, Pavičić Žeželj S, Šuša B, Rahelić D, Klobučar Majanović S. The Efficacy of an Energy-Restricted Anti-Inflammatory Diet for the Management of Obesity in Younger Adults. Nutrients 2020; 12:nu12113583. [PMID: 33266499 PMCID: PMC7700374 DOI: 10.3390/nu12113583] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
There is growing evidence of the dietary impact on obesity-induced low-grade chronic inflammation and the associated chronic non-communicable diseases modification. We determined changes in body composition and cardiometabolic and inflammatory status of participants with obesity after 24 weeks of a dietary intervention based on an energy-reduced anti-inflammatory diet and examined the relationship of these changes with changes in the inflammatory potential of the diet. The anthropometric and body composition parameters of 81 participants (average age of 43 years, 74 women) were assessed. Metabolic status was determined using the glycemic and lipid statuses, and the cardiometabolic index and inflammatory status were determined using the concentration of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α). The inflammatory potential of the diet was assessed using the Dietary Inflammatory Index (DII®). Intervention with an anti-inflammatory diet resulted in a significant reduction in body weight and visceral adipose tissue and caused improvements in the participants’ cardiometabolic and inflammatory statuses. The anti-inflammatory diet was shown to be effective regarding obesity management. The study data could advance current scientific knowledge in the field of inflammation and diet, provide guidelines for obesity management, and find its application in routine clinical practice.
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Affiliation(s)
- Gordana Kenđel Jovanović
- Department of Health Ecology, Teaching Institute of Public Health of Primorsko-goranska County, Krešimirova 52a, 51000 Rijeka, Croatia;
- Correspondence: ; Tel.: +358-51-358-751
| | - Ines Mrakovcic-Sutic
- Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia;
| | - Sandra Pavičić Žeželj
- Department of Health Ecology, Teaching Institute of Public Health of Primorsko-goranska County, Krešimirova 52a, 51000 Rijeka, Croatia;
- Department of Health Ecology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Branislav Šuša
- General Hospital Pula, Santoriova 24a, 52100 Pula, Croatia;
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, Šalata ul. 2, 10000 Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Sanja Klobučar Majanović
- Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia;
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
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Bozbulut R, Şanlıer N, Döğer E, Bideci A, Çamurdan O, Cinaz P. The effect of beta-glucan supplementation on glycemic control and variability in adolescents with type 1 diabetes mellitus. Diabetes Res Clin Pract 2020; 169:108464. [PMID: 32971156 DOI: 10.1016/j.diabres.2020.108464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
AIMS This study aimed to investigate whether supplemental soluble fiber, oat β-glucan, has any effect on glycemic control and variability of adolescents with type 1 diabetes mellitus. METHODS This study was conducted in 30 adolescents with type 1 diabetes mellitus and it consisted of three phases lasting one week. At Phase I, all subjects followed a standard diet program. For Phase II and Phase III, the subjects continued their standard diet program and added natural oat flakes containing 3 g/day and 6 g/day β-glucan, respectively. Glucose levels were monitored by continuous glucose monitoring (CGM). The maximal, minimal, mean and daytime and night blood glucose levels, percentages of glucose values in a target range and below and above a target values were calculated for each of the phases. Premeal, postmeal, peak blood glucose values and peak times of meals were evaluated for each of the phases. Glycemic variability was measured via SD, CV, MAGE, IQR, MODD, LBGI, HBGI, and CONGA parameters. RESULTS The maximal, mean and daytime and night blood glucose levels were the lowest at Phase III (p < 0.05). Minimal blood glucose levels were the highest at Phase III (p < 0.05). Phase I, II, and III showed similar durations elapsed for Level 2 and Level 1 hypoglycemia, euglycemia, Level 1 and Level 2 hyperglycemia (p > 0.05). Premeal and postmeal blood glucose levels were lowest at Phase III for breakfast, lunch, and overall (p < 0.05). The lowest peak blood glucose levels were detected at Phase III for breakfast, lunch, dinner and overall (p < 0.05). Phase III also showed delayed peaks for all time-points (p < 0.05 for each) compared to other phases. Phase III had significantly lower levels of SD, CV, LBGI, and CONGA levels than those in either Phase I or Phase II (p < 0.05 for each). CONCLUSION 6 g/day oat β-glucan have favorable outcomes in glycemic control and variability in adolescents with type 1 diabetes mellitus.
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Affiliation(s)
- Rukiye Bozbulut
- Gazi University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey.
| | - Nevin Şanlıer
- Ankara Medipol University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Esra Döğer
- Gazi University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Aysun Bideci
- Gazi University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Orhun Çamurdan
- Gazi University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Peyami Cinaz
- Gazi University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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21
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Zeugswetter FK, Sellner A. Flash glucose monitoring in diabetic dogs: a feasible method for evaluating glycemic control. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2020; 48:330-338. [PMID: 33086409 DOI: 10.1055/a-1239-4739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To alleviate clinical signs and avoid life-threatening complications in dogs with diabetes mellitus, individualized treatment plans and frequent reassessments are necessary. Performing blood glucose profiles every 7-14 days following insulin adjustments and monthly thereafter, is recommended. In 2016, a factory calibrated continuous blood glucose monitoring system was presented as a possible alternative to glucometer readings. The objectives of this study were to summarize the experiences with this new technology and to show, that in combination with simple rules, already the first measurement period can improve glycemic control. MATERIAL AND METHODS The electronic database of the endocrine unit of the clinic was retrospectively searched for diabetic dogs with flash glucose monitoring. In case of repeated sensor implantations, only the first sensor was considered. The recordings of day A (starting at midnight after sensor placement) were compared to the measurements of day B (day before sensor failure) and all owners were contacted to fill in a standardized questionnaire. RESULTS The final study population consisted of 24 dogs weighing 3.4 to 36 kg. Although the clicking noise during sensor placement irritated most dogs, the application was considered easy and painless. Waiting for disinfectant evaporation and fixation of the sensor disc with forceps helped to avoid sensor detachment when removing the application device. Although transient mild to moderate skin irritations were observed in 80 % of the dogs, 95 % of the owners were highly satisfied with this new monitoring technology. Mean and maximum glucose (p = 0.043, p = 0.003) as well as glucose readings ≥ 11.1 mmol/l (p = 0.032) decreased from day A to B, whereas markers of glycemic variability did not change. CONCLUSION AND CLINICAL RELEVANCE Flash glucose monitoring is a feasible, safe method with high user satisfaction and offers a possibility to improve glycemic control in diabetic dogs.
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Affiliation(s)
- Florian K Zeugswetter
- Diabetes mellitus, sensorbasiertes Glukosemonitoring, glykämische Variabilität, MAGE
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22
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Thomsen MN, Skytte MJ, Astrup A, Deacon CF, Holst JJ, Madsbad S, Krarup T, Haugaard SB, Samkani A. The clinical effects of a carbohydrate-reduced high-protein diet on glycaemic variability in metformin-treated patients with type 2 diabetes mellitus: A randomised controlled study. Clin Nutr ESPEN 2020; 39:46-52. [PMID: 32859328 DOI: 10.1016/j.clnesp.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/01/2020] [Accepted: 07/03/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND & AIMS High glycaemic variability (GV) is associated with late complications in type 2 diabetes (T2D). We hypothesised that a carbohydrate-reduced high-protein (CRHP) diet would reduce GV acutely in patients with T2D compared with a conventional diabetes (CD) diet. METHODS In this controlled, randomised crossover study, 16 patients with metformin-treated T2D (median (IQR) age: 64.0 (58.8-68.0) years; HbA1c: 47 (43-57) mmol/mol; duration of T2D: 5.5 (2.8-10.3) years) were assigned to an energy-matched CRHP diet and CD diet (31E%/54E% carbohydrate, 29E%/16E% protein and 40E%/30E% fat, respectively) for two separate 48-h intervention periods. Interstitial continuous glucose monitoring (CGM) was performed to assess accepted measures of glycaemic variability, i.e. standard deviation (SD) around the sensor glucose level; coefficient of variation in percent (CV); mean amplitude of glucose excursions (MAGE); continuous overlapping net glycaemic action (CONGA1, CONGA4) of observations 1 and 4 h apart; and mean absolute glucose (MAG) change. RESULTS All indices of glycaemic variability (mean ± SD) were significantly reduced during CRHP diet compared with CD diet; including SD (1.0 ± 0.3 (CRHP) vs 1.6 ± 0.5 mmol/L (CD)), CV (12.3 ± 3.8 vs 19.3 ± 5.5%), MAGE (2.3 ± 0.9 vs 4.2 ± 1.3 mmol/L), CONGA1 (0.8 ± 0.3 vs 1.5 ± 0.4 mmol/L), CONGA4 (1.4 ± 0.5 vs 2.5 ± 0.8 mmol/L), and MAG change (0.9 ± 0.3 vs 1.4 ± 0.4 mmol/L/h) (p < 0.001 for all). Compared with the CD diet, the CRHP diet improved the diurnal glucose profile by reducing 24-h mean sensor glucose (7.7 ± 1.6 vs 8.6 ± 2.0 mmol/L). CONCLUSIONS In T2D patients treated with diet and metformin, two days of iso-energetic replacement of dietary carbohydrates by protein and fat reduced all indices of glycaemic variability by 36%-45% when compared with a conventional diabetes diet. These data may support reduction of carbohydrates as dietary advice for T2D patients. CLINICALTRIALS. GOV IDENTIFIER NCT02472951.
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Affiliation(s)
- Mads N Thomsen
- Dept. of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
| | - Mads J Skytte
- Dept. of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Arne Astrup
- Dept. of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Carolyn F Deacon
- Endocrinology Research Section, Dept. of Biomedical Sciences, University of Copenhagen, Denmark; Section for Translational Physiology, NNF Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Jens J Holst
- Endocrinology Research Section, Dept. of Biomedical Sciences, University of Copenhagen, Denmark; Section for Translational Physiology, NNF Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Sten Madsbad
- Dept. of Endocrinology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | - Thure Krarup
- Dept. of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Steen B Haugaard
- Dept. of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Dept. of Internal Medicine, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | - Amirsalar Samkani
- Dept. of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Peabody J, Paculdo D, Acelajado MC, Burgon T, Dahlen JR. Finding the clinical utility of 1,5-anhydroglucitol among primary care practitioners. J Clin Transl Endocrinol 2020; 20:100224. [PMID: 32368501 PMCID: PMC7184171 DOI: 10.1016/j.jcte.2020.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/07/2022] Open
Abstract
Background HbA1c is widely used as the standard measure to track glycemic control in patients with diabetes and pre-diabetes but measures average levels of glycated hemoglobin over two to three months, with limited utility in the presence of recent and/or short-term fluctuations in glycemic control, which are correlated with worse patient outcomes. Methods We examined the clinical utility of 1-5-anhydroglucitol (1,5-AG) in six different, but common, case types of diabetes patients with short-term glycemic variability. We conducted a randomized controlled trial of simulated patients to examine the clinical practice patterns of primary care physicians before and after introducing 1,5-AG. The 145 participants were randomly assigned into standard care or standard care + 1,5-AG arms. Provider care was reviewed against explicit evidence-based care standards. Results At baseline, we saw no difference between the two study arms in clinical quality of care provided (p = 0.997). After introduction of 1,5-AG, standard care + 1,5-AG providers performed 3.2% better than controls (p = 0.025. In diagnosis and treatment, there was a slight, but nonsignificant trend toward better care (+1.1%, p = 0.507) for intervention providers. Upon disaggregation by case, almost all the improvement occurred in the medication-induced hyperglycemia patients (+8.1%, p = 0.047). Conclusions A nationally representative sample of primary care physicians demonstrated that of six different cases used in this study, 1,5-AG was found to be most effective increasing awareness of poor glucose control in medication-induced hyperglycemia. If 1,5-AG is used in this particular circumstance, the overall savings to the healthcare system is estimated to be $28 million.
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Rangasamy V, Xu X, Susheela AT, Subramaniam B. Comparison of Glycemic Variability Indices: Blood Glucose, Risk Index, and Coefficient of Variation in Predicting Adverse Outcomes for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:1794-1802. [PMID: 32033891 DOI: 10.1053/j.jvca.2019.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/26/2019] [Accepted: 12/31/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Fluctuations in blood glucose (glycemic variability) increase the risk of adverse outcomes. No universally accepted tool for glycemic variability exists during the perioperative period. The authors compared 2 measures of glycemic variability-(1) coefficient of variation (CV) and (2) the Blood Glucose Risk Index (BGRI)-in predicting adverse outcomes after cardiac surgery. DESIGN Prospective, observational study. SETTING Single-center, teaching hospital. PARTICIPANTS A total of 1,963 adult patients undergoing cardiac surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Postoperative blood glucose levels were measured hourly for the first 24 hours and averaged every 4 hours (4, 8, 12, 16, 20, and 24 hours). Glycemic variability was measured by CV and the BGRI. The primary outcome, major adverse events (MAEs), was a predefined composite of postoperative complications (death, reoperation, deep sternal infection, stroke, pneumonia, renal failure, tamponade, and myocardial infarction). Logistic regression models were constructed to evaluate the association. Predictive ability was measured using C-statistics. Major adverse events were seen in 170 (8.7%) patients. Only the fourth quartile of CV showed association (odds ratio [OR] 1.91; 95% confidence interval [CI] [1.19-3.14]; p = 0.01), whereas BGRI was related significantly to MAE (OR 1.20; 95% CI [1.10-1.32]; p < 0.0001). The predictive ability of CV and BGRI increased on adding the standard Society of Thoracic Surgeons (STS) risk index. The C-statistic for STS was 0.68, whereas STS + CV was 0.70 (p = 0.012) and STS + BGRI was 0.70 (p = 0.012). CONCLUSION Both CV and the BGRI had good predictive ability. The BGRI being a continuous variable could be a preferred measure of glycemic variability in predicting adverse outcomes (cutoff value 2.24) after cardiac surgery.
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Affiliation(s)
- Valluvan Rangasamy
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Xinling Xu
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ammu Thampi Susheela
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Balachundhar Subramaniam
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Peabody JW, de Belen E, Dahlen JR, Acelajado MC, Tran MT, Paculdo DR. Variation in Diabetes Management: A National Assessment of Primary Care Providers. J Diabetes Sci Technol 2020; 14:70-76. [PMID: 31282183 PMCID: PMC7189162 DOI: 10.1177/1932296819861662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Glucose control is monitored primarily through ordering HbA1c levels, which is problematic in patients with glycemic variability. Herein, we report on the management of these patients by board-certified primary care providers (PCPs) in the United States. METHODS We measured provider practice in a representative sample of 156 PCPs. All providers cared for simulated patients with diabetes presenting with symptoms of glycemic variability. Provider responses were reviewed by trained clinicians against evidence-based care standards and accepted standard of care protocols. RESULTS Care varied widely-overall quality of care averaged 51.3%±10.6%-with providers performing just over half the evidence-based practices necessary for their cases. More worryingly, provider identified the underlying etiology of the poor glycemic control only 36.3% of the time. HbA1c was routinely ordered in 91.3% of all cases but often (59.5%) inappropriately. Ordering other tests of glycemic control (done in 15% of cases) led to significant increases in identifying the etiology of the hyperglycemia. Correctly modifying their patient's treatment was more likely to occur if doctors first identified the underlying etiology (65.9% vs 49.0%, P<0.001). We conservatively estimated a US $65/patient/visit in unnecessary testing and US $389 annually in additional care costs when the etiology was missed, translating potentially into millions of dollars of wasteful spending. CONCLUSION Despite established evidence that HbA1c misses short-term changes in diabetes, we found PCPs consistently ordered HbA1c, rarely using other available blood tests. However, if the factors leading to poor glycemic control were recognized, PCPs were more likely to correctly alter their patient's hypoglycemic therapy.
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Affiliation(s)
- John W. Peabody
- University of California San Francisco,
CA, USA
- QURE Healthcare, San Francisco, CA,
USA
- John Peabody, MD PhD, QURE Healthcare, 450
Pacific Ave, Suite 200, San Francisco, CA 94133, USA.
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Lin YH, Huang YY, Chen HY, Hsieh SH, Sun JH, Chen ST, Lin CH. Impact of Carbohydrate on Glucose Variability in Patients with Type 1 Diabetes Assessed Through Professional Continuous Glucose Monitoring: A Retrospective Study. Diabetes Ther 2019; 10:2289-2304. [PMID: 31659627 PMCID: PMC6848334 DOI: 10.1007/s13300-019-00707-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this study was to objectively analyze the correlation between dietary components and blood glucose variation by means of continuous glucose monitoring (CGM). METHODS Patients with type 1 diabetes mellitus (T1DM) who received CGM to manage their blood glucose levels were enrolled into the study, and the components of their total caloric intake were analyzed. Glycemic variation parameters were calculated, and dietary components, including percentages of carbohydrate, protein and fat in the total dietary intake, were analyzed by a dietitian. The interaction between parameters of glycemic variability and dietary components was analyzed. RESULTS Sixty-one patients with T1DM (33 females, 28 males) were enrolled. The mean age of the participants was 34.7 years, and the average duration of diabetes was 14 years. Glycated hemoglobin before CGM was 8.54%. Participants with a carbohydrate intake that accounted for < 50% of their total caloric intake had a longer DM duration and a higher protein and fat intake than did those with a carbohydrate intake that accounted for ≥ 50% of total caloric intake, but there was no between-group difference in total caloric intake per day. The group with a carbohydrate intake that accounted for < 50% of their total caloric intake also had lower nocturnal continuous overlapping net glycemic action (CONGA) 1, - 2 and - 4 values. The percentage of protein intake had a slightly negative correlation with mean amplitude of glycemic excursions (MAGE) (r = - 0.286, p < 0.05) and a moderately negative correlation with coefficient of variation (CV) (r = 0.289, p < 0.05). One additional percentage of protein calories of total calories per day decreased the MAGE to 4.25 mg/dL and CV to 0.012 (p < 0.05). The optimal dietary protein percentage for MAGE < 140 mg/dL was 15.13%. The performance of predictive models revealed the beneficial effect of adequate carbohydrate intake on glucose variation when combined with protein consumption. CONCLUSIONS Adequate carbohydrate consumption-but not more than half the daily total calories-combined with protein calories that amount to approximately 15% of the daily caloric intake is important for glucose stability and beneficial for patients with T1DM.
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Affiliation(s)
- Yi-Hsuan Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Yun Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sheng-Hwu Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Ch'ng LZ, Barakatun-Nisak MY, Wan Zukiman WZH, Abas F, Wahab NA. Nutritional strategies in managing postmeal glucose for type 2 diabetes: A narrative review. Diabetes Metab Syndr 2019; 13:2339-2345. [PMID: 31405640 DOI: 10.1016/j.dsx.2019.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
Medical Nutrition Therapy (MNT) plays an essential role in overall glycemic management. Less focus is given on managing postmeal hyperglycemia despite the facts that, it is a common feature of Type 2 Diabetes (T2D). The purpose of this narrative review is to provide a comprehensive understanding of the existing literature on the nutritional approaches to improve postmeal hyperglycemia in patients with T2D. We searched multiple databases for the studies examining the nutritional approaches to manage postmeal glucose in patients with T2D. We included studies that involve human trials that were published in English for the past 10 years. Our review of the current literature indicates that the postmeal hyperglycemia can be improved with four nutritional approaches. These approaches include (i) utilizing the appropriate amount and selecting the right type of carbohydrates, (ii) using specific types of dietary protein, (iii) manipulating the meal timing and orders and (iv) others (promoting postmeal physical activity, incorporating diabetes-specific formula and certain functional foods). The potential mechanisms underlying these approaches are discussed and the identified gaps warranted further research. This array of nutritional strategies provide a set of options for healthcare professionals to facilitate patients with T2D in achieving the optimal level of postmeal glucose.
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Affiliation(s)
- Lau Zhi Ch'ng
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia
| | - Mohd Yusof Barakatun-Nisak
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia; Research Centre of Excellent for Nutrition and Noncommunicable Diseases (NNCD), Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia.
| | | | - Faridah Abas
- Department of Food Science, Faculty of Food Science and Technology, Universiti Putra, Malaysia
| | - Norasyikin A Wahab
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan, Malaysia
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Taylor PJ, Thompson CH, Luscombe-Marsh ND, Wycherley TP, Wittert G, Brinkworth GD. Efficacy of Real-Time Continuous Glucose Monitoring to Improve Effects of a Prescriptive Lifestyle Intervention in Type 2 Diabetes: A Pilot Study. Diabetes Ther 2019; 10:509-522. [PMID: 30706365 PMCID: PMC6437235 DOI: 10.1007/s13300-019-0572-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Optimising patient adherence to prescribed lifestyle interventions to achieve improved blood glucose control remains a challenge. Combined use of real-time continuous glucose monitoring systems (RT-CGM) may promote improved glycaemic control. This pilot study examines the effects of a prescriptive lifestyle modification programme when combined with RT-CGM on blood glucose control and cardiovascular disease risk markers. METHODS Twenty adults (10 men, 10 women) with obesity and type-2 diabetes (T2D) (age 60.55 ± 8.38 years, BMI 34.22 ± 4.67 kg/m2) were randomised to a prescriptive low-carbohydrate diet and lifestyle plan whilst continuously wearing either an RT-CGM or an 'offline-blinded' monitor (control) for 12 weeks. Outcomes were glycaemic control (HbA1c, fasting glucose, glycaemic variability [GV]), diabetes medication (MeS), weight, blood pressure and lipids assessed pre- and post-intervention. RESULTS Both groups experienced reductions in body weight (RT-CGM - 7.4 ± 4.5 kg vs. control - 5.5 ± 4.0 kg), HbA1c (- 0.67 ± 0.82% vs. - 0.68 ± 0.74%), fasting blood glucose (- 1.2 ± 1.9 mmol/L vs. - 1.0 ± 2.2 mmol/L), LDL-C (- 0.07 ± 0.34 mmol/L vs. - 0.26 ± 0.42 mmol/L) and triglycerides (- 0.32 ± 0.46 mmol/L vs. - 0.36 ± 0.53 mmol/L); with no differential effect between groups (P ≥ 0.10). At week 12, GV indices were consistently lower by at least sixfold in RT-CGM compared to control (CONGA-1 - 0.27 ± 0.36 mmol/L vs. 0.06 ± 0.19 mmol/L; CONGA-2 - 0.36 ± 0.54 mmol/L vs. 0.05 ± 2.88 mmol/L; CONGA-4 - 0.44 ± 0.67 mmol/L vs. - 0.02 ± 0.42 mmol/L; CONGA-8 - 0.36 ± 0.61 vs. 0.02 ± 0.52 mmol/L; MAGE - 0.69 ± 1.14 vs. - 0.09 ± 0.08 mmol/L, although there was insufficient power to achieve statistical significance (P ≥ 0.11). Overall, there was an approximately 40% greater reduction in blood glucose-lowering medication (MeS) in RT-CGM (- 0.30 ± 0.59) compared to control (0.02 ± 0.23). CONCLUSION This study provides preliminary evidence that RT-CGM may be an effective strategy to optimise glucose control whilst following a low-carbohydrate lifestyle programme that targets improved glycaemic control, with minimal professional support. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry identifier, ANZTR: 372898. FUNDING Grant funding was received for the delivery of the clinical trial only, by the Diabetes Australia Research Trust (DART).
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Affiliation(s)
- Penelope J Taylor
- Commonwealth Scientific and Industrial Research Organisation, Health and Biosecurity, Adelaide, Australia.
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
- Nutrition and Metabolism, South Australian Health and Medical Research Institute (SAHRMI), Adelaide, Australia.
| | - Campbell H Thompson
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation, Health and Biosecurity, Adelaide, Australia
- Nutrition and Metabolism, South Australian Health and Medical Research Institute (SAHRMI), Adelaide, Australia
| | - Thomas P Wycherley
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Gary Wittert
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Nutrition and Metabolism, South Australian Health and Medical Research Institute (SAHRMI), Adelaide, Australia
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation, Health and Biosecurity, Sydney, Australia
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Carvalho FMC, Lima VCO, Costa IS, Luz ABS, Ladd FVL, Serquiz AC, Bortolin RH, Silbiger VN, Maciel BLL, Santos EA, Morais AHA. Anti-TNF-α Agent Tamarind Kunitz Trypsin Inhibitor Improves Lipid Profile of Wistar Rats Presenting Dyslipidemia and Diet-induced Obesity Regardless of PPAR-γ Induction. Nutrients 2019; 11:nu11030512. [PMID: 30818882 PMCID: PMC6470745 DOI: 10.3390/nu11030512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 01/07/2023] Open
Abstract
The increasing prevalence of obesity and, consequently, chronic inflammation and its complications has increased the search for new treatment methods. The effect of the purified tamarind seed trypsin inhibitor (TTIp) on metabolic alterations in Wistar rats with obesity and dyslipidemia was evaluated. Three groups of animals with obesity and dyslipidemia were formed, consuming a high glycemic index and glycemic load (HGLI) diet, for 10 days: Obese/HGLI diet; Obese/standard diet; Obese/HGLI diet + TTIp (730 μg/kg); and one eutrophic group of animals was fed a standard diet. Rats were evaluated daily for food intake and weight gain. On the 11th day, animals were anesthetized and sacrificed for blood and visceral adipose tissue collection. TTIp treated animals presented significantly lower food intake than the untreated group (p = 0.0065), TG (76.20 ± 18.73 mg/dL) and VLDL-C (15.24 ± 3.75 mg/dL). Plasma concentrations and TNF-α mRNA expression in visceral adipose tissue also decreased in obese animals treated with TTIp (p < 0.05 and p = 0.025, respectively) with a negative immunostaining. We conclude that TTIp presented anti-TNF-α activity and an improved lipid profile of Wistar rats with dyslipidemia and obesity induced by a high glycemic index and load diet regardless of PPAR-γ induction.
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Affiliation(s)
- Fabiana M C Carvalho
- Biochemistry Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Vanessa C O Lima
- Biochemistry Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Izael S Costa
- Biochemistry Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Anna B S Luz
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Fernando V L Ladd
- Department of Morphology, Biosciences Center, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Alexandre C Serquiz
- Course of Nutrition, Center University of Rio Grande do Norte, Natal, RN 59014-545, Brazil.
| | - Raul H Bortolin
- Pharmaceutical Sciences Post Graduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Vivian N Silbiger
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
- Pharmaceutical Sciences Post Graduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
- Department of Clinical and Toxicological Analysis, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Bruna L L Maciel
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Elizeu A Santos
- Biochemistry Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
- Department of Biochemistry, Center for Biosciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
| | - Ana H A Morais
- Biochemistry Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN 59078-970, Brazil.
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Nsr-Allah AAEM, Kamar M, Sharawy A, Raafat N. Assessment of blood glucose variability by continuous monitoring as a therapy guide for patients with diabetic nephropathy on hemodialysis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_26_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Xia J, Yin C. Glucose Variability and Coronary Artery Disease. Heart Lung Circ 2018; 28:553-559. [PMID: 30527849 DOI: 10.1016/j.hlc.2018.10.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/29/2018] [Accepted: 10/08/2018] [Indexed: 02/08/2023]
Abstract
Fasting blood glucose, postprandial blood glucose and glycated haemoglobin are considered three important indicators for diabetes treatment. There is increasing evidence that glucose variability has more detrimental effects on the coronary arteries than does chronic sustained hyperglycaemia. This overview summarises recent findings in the field of glucose variability and its possible relationship with coronary artery disease. Glucose variability may be a marker of increased progression of coronary disease and plaque vulnerability. It might be a potential new therapeutic target for secondary prevention of coronary artery disease. Future studies will focus on the early detection and control of glucose variability to improve the clinical outcomes in patients with coronary artery disease.
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Affiliation(s)
- Jinggang Xia
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Chunlin Yin
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Su Q, Liu J, Li P, Qian L, Yang W. Relative Contribution of Fasting and Postprandial Blood Glucose in Overall Glycemic Control: Post Hoc Analysis of a Phase IV Randomized Trial. Diabetes Ther 2018; 9:987-999. [PMID: 29574635 PMCID: PMC5984909 DOI: 10.1007/s13300-018-0403-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Few prospective clinical trials have investigated the role of fasting blood glucose (FBG) and/or postprandial glucose (PPG) in assessing overall glycemic control by using different insulin regimens. In the present post hoc analysis, we assessed the contribution of FBG and/or PPG in overall glycemic control in Chinese patients under insulin treatment. METHODS CLASSIFY is a phase IV, randomized, open-label, 26-week, parallel-arm, treat-to-target, multinational, controlled study in patients with type 2 diabetes mellitus to compare the efficacy and safety of insulin lispro mix 25 (LM25) and insulin lispro mix 50 (LM50) as starter insulins. Insulin was titrated with an aim to target pre-meal blood glucose (BG) levels at > 3.9 and ≤ 6.1 mmol/L before breakfast and dinner. The primary outcome assessed was the change in HbA1c from baseline. RESULTS Chinese patients contributed 38.7% (N = 156) of the total population. The majority of patients were male (52.6%). The mean (SD) body mass index was 24.54 (3.04) kg/m2 and mean (SD) HbA1c was 8.54 (1.10) % at baseline. At week 26, LM50 showed a significantly greater reduction from baseline in HbA1c (- 2.03% vs - 1.55%, P < 0.001), average daily BG (- 3.21 vs - 2.34 mmol/L, P < 0.001), average post-meal BG (- 3.58 vs - 2.39 mmol/L, P < 0.001), and average prandial BG excursion (- 1.01 vs - 0.22 mmol/L, P = 0.006) than the LM25 group. The reductions in average pre-meal BG (- 2.59 vs - 2.28 mmol/L, P = 0.137) were not significantly different between the groups. The proportion of patients achieving HbA1c targets (< 7% or ≤ 6.5%) without nocturnal hypoglycemia or weight gain was greater (P < 0.05) with LM50 compared with LM25. CONCLUSION LM50 achieved better overall glycemic control than LM25 as a starter insulin in Chinese patients, which may be due to greater improvement in PPG levels. TRIAL REGISTRATION Clinicaltrials.gov identification number: NCT01773473. FUNDING Eli Lilly and Company, Shanghai, China.
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Affiliation(s)
- Qing Su
- Department of Endocrinology and Metabolism, Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Endocrinology and Metabolism, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Pengfei Li
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Lei Qian
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
- Medical Science Department, Shanghai Haihe Pharmaceutical Co. Ltd, Shanghai, China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
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Tong L, Chi C, Zhang Z. Association of various glycemic variability indices and vascular outcomes in type-2 diabetes patients: A retrospective study. Medicine (Baltimore) 2018; 97:e10860. [PMID: 29794785 PMCID: PMC6392700 DOI: 10.1097/md.0000000000010860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Both blood glucose (BG) level and glycemic variability (GV) significantly associate with diabetes-related complications. However, the criterion standard in GV assessment is absent. We aimed to compare different GV indices in association of vascular outcomes.Ten commonly used GV indices based on self-monitored BG data were calculated, and their associations of vascular outcomes including coronary artery disease (CAD), stroke, and chronic kidney disease (CKD) were compared.In total, 288 type 2 diabetes patients (66.5 ± 11.1 years old) were included in present analysis. Spearman correlation analysis showed that only mean amplitude of glycemic excursions (MAGE) significantly correlated with both estimated glomerular filtration rate and urinary albumin creatinine ratio (P ≤ .03). In Cochran-Armitage trend test, vascular outcomes were significantly associated with the increment of BG risk index and MAGE (P ≤ .03). After adjustment for potential confounders, multiple logistic regression results suggested that BG risk index and MAGE still significantly associated with these three vascular outcomes (P ≤ .01), whereas the other GV indices did not. Receiver operating characteristic curve analysis showed that the abilities of BG risk index and MAGE were similar in identifying CAD, stroke, or CKD.BG risk index and MAGE were better associated with vascular outcomes than other GV indices in type 2 diabetes patients.
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Affiliation(s)
- Lei Tong
- Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, State Key Laboratory of Medical, Economics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Chen Chi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiguo Zhang
- Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, State Key Laboratory of Medical, Economics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
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Tay J, Thompson CH, Luscombe-Marsh ND, Wycherley TP, Noakes M, Buckley JD, Wittert GA, Yancy WS, Brinkworth GD. Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Diabetes Obes Metab 2018; 20:858-871. [PMID: 29178536 DOI: 10.1111/dom.13164] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 12/20/2022]
Abstract
AIM To examine whether a low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) improves glycaemic control and cardiovascular disease (CVD) risk factors in overweight and obese patients with type 2 diabetes (T2D). METHODS A total of 115 adults with T2D (mean [SD]; BMI, 34.6 [4.3] kg/m2 ; age, 58 [7] years; HbA1c, 7.3 [1.1]%) were randomized to 1 of 2 planned energy-matched, hypocaloric diets combined with aerobic/resistance exercise (1 hour, 3 days/week) for 2 years: LC: 14% energy as carbohydrate, 28% as protein, 58% as fat (<10% saturated fat); or low-fat, high-carbohydrate, low-glycaemic index diet (HC): 53% as CHO, 17% as protein, 30% as fat (<10% saturated fat). HbA1c, glycaemic variability (GV), anti-glycaemic medication effect score (MES, calculated based on the potency and dosage of diabetes medication), weight, body composition, CVD and renal risk markers were assessed before and after intervention. RESULTS A total of 61 (LC = 33, HC = 28) participants completed the study (trial registration: http://www.anzctr.org.au/, ANZCTR No. ACTRN12612000369820). Reductions in weight (estimated marginal mean [95% CI]; LC, -6.8 [-8.8,-4.7], HC, -6.6 [-8.8, -4.5] kg), body fat (LC, -4.3 [-6.2, -2.4], HC, -4.6 [-6.6, -2.7] kg), blood pressure (LC, -2.0 [-5.9, 1.8]/ -1.2 [-3.6, 1.2], HC, -3.2 [-7.3, 0.9]/ -2.0 [-4.5, 0.5] mmHg), HbA1c (LC, -0.6 [-0.9, -0.3], HC, -0.9 [-1.2, -0.5] %) and fasting glucose (LC, 0.3 [-0.4, 1.0], HC, -0.4 [-1.1, 0.4] mmol/L) were similar between groups (P ≥ 0.09). Compared to HC, the LC achieved greater reductions in diabetes medication use (MES; LC, -0.5 [-0.6, -0.3], HC, -0.2 [-0.4, -0.02] units; P = 0.03), GV (Continuous Overall Net Glycemic Action calculated every 1 hour (LC, -0.4 [-0.6, -0.3], HC, -0.1 [-0.1, 0.2] mmol/L; P = 0.001), and 4 hours (LC, -0.9 [-1.3, -0.6], HC, -0.2 [-0.6, 0.1] mmol/L; P = 0.02)); triglycerides (LC, -0.1 [-0.3, 0.2], HC, 0.1 [-0.2, 0.3] mmol/L; P = 0.001), and maintained HDL-C levels (LC, 0.02 [-0.05, 0.1], HC, -0.1 [-0.1, 0.01] mmol/L; P = 0.004), but had similar changes in LDL-C (LC, 0.2 [-0.1, 0.5], HC, 0.1 [-0.2, 0.4] mmol/L; P = 0.85), brachial artery flow mediated dilatation (LC, -0.5 [-1.5, 0.5], HC, -0.4 [-1.4, 0.7] %; P = 0.73), eGFR and albuminuria. CONCLUSIONS Both diets achieved comparable weight loss and HbA1c reductions. The LC sustained greater reductions in diabetes medication requirements, and in improvements in diurnal blood glucose stability and blood lipid profile, with no adverse renal effects, suggesting greater optimization of T2D management.
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Affiliation(s)
- Jeannie Tay
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
- Agency for Science, Technology and Research (A-STAR), Singapore
| | | | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Thomas P Wycherley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
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Longato E, Acciaroli G, Facchinetti A, Hakaste L, Tuomi T, Maran A, Sparacino G. Glycaemic variability-based classification of impaired glucose tolerance vs. type 2 diabetes using continuous glucose monitoring data. Comput Biol Med 2018; 96:141-146. [PMID: 29573667 DOI: 10.1016/j.compbiomed.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/10/2018] [Accepted: 03/10/2018] [Indexed: 11/17/2022]
Abstract
Many glycaemic variability (GV) indices extracted from continuous glucose monitoring systems data have been proposed for the characterisation of various aspects of glucose concentration profile dynamics in both healthy and non-healthy individuals. However, the inter-index correlations have made it difficult to reach a consensus regarding the best applications or a subset of indices for clinical scenarios, such as distinguishing subjects according to diabetes progression stage. Recently, a logistic regression-based method was used to address the basic problem of differentiating between healthy subjects and those affected by impaired glucose tolerance (IGT) or type 2 diabetes (T2D) in a pool of 25 GV-based indices. Whereas healthy subjects were classified accurately, the distinction between patients with IGT and T2D remained critical. In the present work, by using a dataset of CGM time-series collected in 62 subjects, we developed a polynomial-kernel support vector machine-based approach and demonstrated the ability to distinguish between subjects affected by IGT and T2D based on a pool of 37 GV indices complemented by four basic parameters-age, sex, BMI, and waist circumference-with an accuracy of 87.1%.
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Affiliation(s)
- Enrico Longato
- Department of Information Engineering, University of Padova, Via Gradenigo 6/B, 35131, Padova, Italy.
| | - Giada Acciaroli
- Department of Information Engineering, University of Padova, Via Gradenigo 6/B, 35131, Padova, Italy.
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Via Gradenigo 6/B, 35131, Padova, Italy.
| | - Liisa Hakaste
- Endocrinology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, FI-00014, Helsinki, Finland; Folkhälsan Research Center and Research Program for Diabetes and Obesity, University of Helsinki, Haartmaninkatu 8, FI-00014, Helsinki, Finland.
| | - Tiinamaija Tuomi
- Endocrinology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, FI-00014, Helsinki, Finland; Folkhälsan Research Center and Research Program for Diabetes and Obesity, University of Helsinki, Haartmaninkatu 8, FI-00014, Helsinki, Finland; Finnish Institute for Molecular Medicine, University of Helsinki, Tukholmankatu 8, FI-00014, Helsinki, Finland.
| | - Alberto Maran
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Via Gradenigo 6/B, 35131, Padova, Italy.
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Mihai BM, Mihai C, Cijevschi-Prelipcean C, Grigorescu ED, Dranga M, Drug V, Sporea I, Lăcătușu CM. Bidirectional Relationship between Gastric Emptying and Plasma Glucose Control in Normoglycemic Individuals and Diabetic Patients. J Diabetes Res 2018; 2018:1736959. [PMID: 30402500 PMCID: PMC6192082 DOI: 10.1155/2018/1736959] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/14/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022] Open
Abstract
Gastric emptying and glycemic control pathways are closely interrelated processes. Gastric chyme is transferred into the duodenum with velocities depending on its solid or liquid state, as well as on its caloric and nutritional composition. Once nutrients enter the intestine, the secretion of incretins (hormonal products of intestinal cells) is stimulated. Among incretins, glucagon-like peptide-1 (GLP-1) has multiple glycemic-regulatory effects that include delayed gastric emptying, thus triggering a feedback loop lowering postprandial serum glucose levels. Glycemic values also influence gastric emptying; hyperglycemia slows it down, and hypoglycemia accelerates it, both limiting glycemic fluctuations. Disordered gastric emptying in diabetes mellitus is understood today as a complex pathophysiological condition, with both irreversible and reversible components and high intra- and interindividual variability of time span and clinical features. While limited delays may be useful for reducing postprandial hyperglycemias, severely hindered gastric emptying may be associated with higher glycemic variability and worsened long-term glycemic control. Therapeutic approaches for both gastric emptying and glycemic control include dietary modifications of meal structure or content and drugs acting as GLP-1 receptor agonists. In the foreseeable future, we will probably witness a wider range of dietary interventions and more incretin-based medications used for restoring both gastric emptying and glycemic levels to nearly physiological levels.
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Affiliation(s)
- Bogdan Mircea Mihai
- “Grigore T. Popa” University of Medicine and Pharmacy, Clinical Centre of Diabetes, Nutrition and Metabolic Diseases, “Sf. Spiridon” Clinical Hospital, Iași, Romania
| | - Cătălina Mihai
- “Grigore T. Popa” University of Medicine and Pharmacy, Institute of Gastroenterology and Hepatology, “Sf. Spiridon” Clinical Hospital, Iași, Romania
| | - Cristina Cijevschi-Prelipcean
- “Grigore T. Popa” University of Medicine and Pharmacy, Institute of Gastroenterology and Hepatology, “Sf. Spiridon” Clinical Hospital, Iași, Romania
| | - Elena-Daniela Grigorescu
- “Grigore T. Popa” University of Medicine and Pharmacy, Clinical Centre of Diabetes, Nutrition and Metabolic Diseases, “Sf. Spiridon” Clinical Hospital, Iași, Romania
| | - Mihaela Dranga
- “Grigore T. Popa” University of Medicine and Pharmacy, Institute of Gastroenterology and Hepatology, “Sf. Spiridon” Clinical Hospital, Iași, Romania
| | - Vasile Drug
- “Grigore T. Popa” University of Medicine and Pharmacy, Institute of Gastroenterology and Hepatology, “Sf. Spiridon” Clinical Hospital, Iași, Romania
| | - Ioan Sporea
- Gastroenterology, “Victor Babes” University of Medicine and Pharmacy Timișoara, Romania
| | - Cristina Mihaela Lăcătușu
- “Grigore T. Popa” University of Medicine and Pharmacy, Clinical Centre of Diabetes, Nutrition and Metabolic Diseases, “Sf. Spiridon” Clinical Hospital, Iași, Romania
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Uncoupling Protein 2 Inhibition Exacerbates Glucose Fluctuation-Mediated Neuronal Effects. Neurotox Res 2017; 33:388-401. [PMID: 28875237 DOI: 10.1007/s12640-017-9805-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 01/10/2023]
Abstract
Though glucose fluctuations have been considered as an adverse factor for the development of several diabetes-related complications, their impact in the central nervous system is still not fully elucidated. This study was conducted to evaluate the responses of neuronal cells to different glycemic exposures alongside to elucidate the role of uncoupling protein 2 (UCP2) in regulating such responses. To achieve our goals, primary cortical neurons were submitted to constant high (HG)/low (LG) or glucose level variations (GVs), and the pharmacological inhibition of UCP2 activity was performed using genipin. Results obtained show that GV decreased neuronal cells' viability, mitochondrial membrane potential, and manganese superoxide dismutase activity and increased reactive oxygen species (ROS) production. GV also caused an increase in the glutathione/glutathione disulfide ratio and in the protein expression levels of nuclear factor E2-related factor 2 (NRF2), UCP2, NADH-ubiquinone oxidoreductase chain 1 (ND1), and mitochondrially encoded cytochrome c oxidase I (MTCO1), both mitochondrial DNA encoded subunits of the electron transport chain. Contrariwise, genipin abrogated all those compensations and increased the levels of caspase 3-like activity, potentiated mitochondrial ROS levels, and the loss of neuronal synaptic integrity, decreased the protein expression levels of NRF1, and increased the protein expression levels of UCP5. Further, in the control and LG conditions, genipin increased mitochondrial ROS and the protein expression levels of UCP4, postsynaptic density protein 95 (PSD95), ND1, and MTCO1. Overall, these observations suggest that UCP2 is in the core of neuronal cell protection and/or adaptation against GV-mediated effects and that other isoforms of neuronal UCPs can be upregulated to compensate the inhibition of UCP2 activity.
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Chiu HT, Li TC, Li CI, Liu CS, Lin WY, Lin CC. Visit-to-visit glycemic variability is a strong predictor of chronic obstructive pulmonary disease in patients with type 2 diabetes mellitus: Competing risk analysis using a national cohort from the Taiwan diabetes study. PLoS One 2017; 12:e0177184. [PMID: 28489885 PMCID: PMC5425194 DOI: 10.1371/journal.pone.0177184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 04/23/2017] [Indexed: 01/08/2023] Open
Abstract
Background This study aims to examine the association between visit-to-visit glucose variability, which was measured by coefficient of variation (CV) of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), and risk of chronic obstructive pulmonary disease (COPD) in a large number of patients with type 2 diabetes with an average follow-up of 7.58 years. Methods We conducted a retrospective cohort study on 27,257 patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. Visit-to-visit variability in HbA1c and FPG at baseline and the incidence of COPD were analyzed using a modified Cox proportional hazards model considering competing risks. Results A total of 2,346 incident cases of COPD. Patients were grouped into tertiles of FPG-CV and HbA1c-CV. The incidence rates in the first, second, and third tertiles were 9.87, 11.06, and 13.19, respectively, for FPG-CV and 10.2, 11.81, and 12.07, for HbA1c-CV per 1000 person-years. After adjusting for age, gender, diabetes duration, treatment type, smoking, hypertension, hyperlipidemia, baseline FPG and HbA1c levels, and complications, both FPG-CV and HbA1c-CV were independently associated with COPD. The hazard ratios of COPD for the third terile compared with the first tertile of FPG-CV were 1.26 (95% confidence interval [CI]: 1.13–1.40). Moreover, the hazard ratios of COPD for the third and second tertiles compared with the first tertile of HbA1c-CV were 1.13 (1.02–1.25) and 1.13 (1.02–1.26), respectively. Conclusions Patients with FPG-CV higher than 34.6% or HbA1c-CV higher than 8.4% exhibited an increased risk of COPD. This finding confirmed the linear relationship of FPG-CV and HbA1c-CV to COPD. Visit-to-visit variability in FPG and HbA1c levels are strong predictors of COPD in patients with type 2 diabetes. Future studies should focus on lung dysfunction in diabetes, and adequate glucose control strategy in regular clinical practices must be established for COPD prevention.
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Affiliation(s)
- Hsien-Tsai Chiu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Clinical Research Outcome and Training Center, Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Schwingshackl L, Lampousi AM, Portillo MP, Romaguera D, Hoffmann G, Boeing H. Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials. Nutr Diabetes 2017; 7:e262. [PMID: 28394365 PMCID: PMC5436092 DOI: 10.1038/nutd.2017.12] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/25/2017] [Accepted: 02/02/2017] [Indexed: 02/08/2023] Open
Abstract
Background/Objectives: Olive oil (OO) as food is composed mainly of fatty acids and bioactive compounds depending from the extraction method. Both had been discussed as health promoting with still open questions. Thus, we conducted a meta-analysis to illustrate the impact of this food on type 2 diabetes (T2D) by investigating the association between OO intake and risk of T2D, and the effect of OO intake in the management of T2D. Subjects/Methods: Searches were performed in PubMed, Cochrane Library and google scholar. First, we conducted a random effect meta-analysis of prospective cohort studies and trials investigating the association between OO and risk of T2D. Second, a meta-analysis was performed to detect the effects of olive oil on glycemic control in patients with T2D. Results: Four cohort studies including 15 784 T2D cases and 29 trials were included in the meta-analysis. The highest OO intake category showed a 16% reduced risk of T2D (RR: 0.84; 95% CI: 0.77, 0.92) compared with the lowest. However, we observed evidence for a nonlinear relationship. In T2D patients OO supplementation resulted in a significantly more pronounced reduction in HbA1c (MD: −0.27% 95% CI: −0.37, −0.17) and fasting plasma glucose (MD: −0.44 mmol l−1; 95% CI −0.66, −0.22) as compared with the control groups. Conclusions: This meta-analysis provides evidence that the intake of OO could be beneficial for the prevention and management of T2D. This conclusion regards OO as food, and might not been valid for single components comprising this food.
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Affiliation(s)
- L Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
| | - A-M Lampousi
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
| | - M P Portillo
- Nutrition and Obesity Group, Department of Nutrition and Food Sciences, University of Basque Country (UPV/EHU) and Lucio Lascaray Research Center, Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - D Romaguera
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain.,Health Research Institute of Palma (IdISPa), University Hospital Son Espases, Palma de Mallorca, Spain
| | - G Hoffmann
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
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Vuksan V, Choleva L, Jovanovski E, Jenkins AL, Au-Yeung F, Dias AG, Ho HVT, Zurbau A, Duvnjak L. Comparison of flax (Linum usitatissimum) and Salba-chia (Salvia hispanica L.) seeds on postprandial glycemia and satiety in healthy individuals: a randomized, controlled, crossover study. Eur J Clin Nutr 2016; 71:234-238. [DOI: 10.1038/ejcn.2016.148] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/14/2016] [Accepted: 06/24/2016] [Indexed: 11/09/2022]
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Lodi A, Karsten B, Bosco G, Gómez-López M, Brandão PP, Bianco A, Paoli A. The Effects of Different High-Protein Low-Carbohydrates Proprietary Foods on Blood Sugar in Healthy Subjects. J Med Food 2016; 19:1085-1095. [PMID: 27754766 DOI: 10.1089/jmf.2016.0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to analyze the effects on blood sugar concentrations through the calculation of the glycemic score (GS) of 10 different high-protein low-carbohydrates (CHOs) proprietary foods that are commonly used as meals during very low-CHO ketogenic diets or during low-CHO diets. Fourteen healthy females were tested for their glycemic response curve elicited by 1000 kJ of glucose three times within a 3-week period (one test each week) compared with one of 10 test foods once on separate days twice a week. After determining the GS of each food in each individual, the mean GS of each test food was calculated. All test foods, compared with glucose, produced a significantly lower glycemic response. The GS of all test food resulted in being lower than 25 and the difference between the mean glycemia after the intake of glucose (mean 122 ± 15 mg/dL) and after the intake of the sweet test foods (mean 89 ± 7 mg/dL) was 33 mg/dL (P < .001), whereas the difference between the mean glycemia after the intake of glucose and after the intake of savory test foods (mean 91 ± 8 mg/dL) was of 31 mg/dL (P < .001). CONCLUSIONS The reformulation of ultraprocessed ready-to-consume foods in a low-CHO, high-protein version can produce a significantly lower glycemic response whilst maintaining the valued ready-to-use format and high palatability demanded by consumers. The low impact on postprandial glycemia and the nutritional characteristics of these proprietary foods makes them useful in both weight control management strategies and in the care management of diabetes.
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Affiliation(s)
- Alessandra Lodi
- 1 Department of Biomedical Sciences, University of Padova , Padova, Italy
| | - Bettina Karsten
- 2 Department of Life and Sports Sciences, University of Greenwich , Medway, United Kingdom
| | - Gerardo Bosco
- 1 Department of Biomedical Sciences, University of Padova , Padova, Italy
| | - Manuel Gómez-López
- 3 Department of Physical Activity and Sport, University of Murcia , Murcia, Spain
| | - Paula Paraguassú Brandão
- 4 Human Kinetics Laboratory of the Federal University of the State of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Antonino Bianco
- 5 Sport and Exercise Sciences Research Unit, University of Palermo , Palermo, Italy
| | - Antonio Paoli
- 1 Department of Biomedical Sciences, University of Padova , Padova, Italy
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Yang YF, Li TC, Li CI, Liu CS, Lin WY, Yang SY, Chiang JH, Huang CC, Sung FC, Lin CC. Visit-to-Visit Glucose Variability Predicts the Development of End-Stage Renal Disease in Type 2 Diabetes: 10-Year Follow-Up of Taiwan Diabetes Study. Medicine (Baltimore) 2015; 94:e1804. [PMID: 26554779 PMCID: PMC4915880 DOI: 10.1097/md.0000000000001804] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study was to examine the association of glucose variability using coefficient of variation of fasting plasma glucose (FPG-CV) and coefficient of variation of glycated hemoglobin (HbA1c-CV) to end-stage renal disease (ESRD) in 31,841 Chinese patients with type 2 diabetes.Patients with type 2 diabetes enrolled in National Diabetes Care Management Program, aged ≧30 years, and free of ESRD (n = 31,841) in January 1, 2002 to December 31, 2004 were included. Extended Cox proportional hazards regression models with competing risk of all-cause mortality were used to evaluate risk factors on ESRD incidence. Patients were followed till 2012.After a median follow-up period of 8.23 years, 1642 patients developed ESRD, giving a crude incidence rate of 6.27/1000 person-years (6.36 for men, 6.19 for women). After the multivariate adjustment, both FPG-CV and HbA1c-CV were independent predictors of ESRD with corresponding hazard ratios of 1.20 (95% confidence interval [CI] 1.01, 1.41), 1.24 (95% CI 1.05, 1.46) in HbA1c-CV from fourth to fifth quintile and 1.23 (95% CI 1.03, 1.47) in FPG-CV from fifth quintile.One-year visit-to-visit glucose variability expressed by FPG-CV and HbA1c-CV predicted development of ESRD in patients with type 2 diabetes, suggesting therapeutic strategies toward a goal to minimize glucose fluctuation.
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Affiliation(s)
- Ya-Fei Yang
- From the Division of Nephrology (Y-FY, C-CH), China Medical University Hospital; School of Medicine (Y-FY, C-IL, C-SL, W-YL, C-CH, C-CL), College of Medicine, China Medical University; Department of Public Health (Y-FY, F-CS), China Medical University; Institute of Biostatistics (T-CL, S-YY), College of Public Health, China Medical University; Department of Healthcare Administration (T-CL), College of Medical and Health Science, Asia University; Department of Medical Research (C-IL, C-SL, C-CL), China Medical University Hospital; Department of Family Medicine (C-SL, W-YL, C-CL), China Medical University Hospital; Management Office for Health Data (J-HC, F-CS), China Medical University Hospital; and Research Center for Chinese Medicine & Accupuncture (J-HC), China Medical University, Taichung, Taiwan
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