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Miller V, Jenkins DA, Dehghan M, Srichaikul K, Rangarajan S, Mente A, Mohan V, Swaminathan S, Ismail R, Luz Diaz M, Ravindran RM, Zatonska K, Bahonar A, Altuntas Y, Khatib R, Lopez-Jaramillo P, Yusufali A, Yeates K, Chifamba J, Iqbal R, Yusuf R, Catherina Swart E, Bo H, Han G, Li X, Alhabib KF, Rosengren A, Avezum A, Lanas F, Yusuf S. Associations of the glycaemic index and the glycaemic load with risk of type 2 diabetes in 127 594 people from 20 countries (PURE): a prospective cohort study. Lancet Diabetes Endocrinol 2024; 12:330-338. [PMID: 38588684 DOI: 10.1016/s2213-8587(24)00069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The association between the glycaemic index and the glycaemic load with type 2 diabetes incidence is controversial. We aimed to evaluate this association in an international cohort with diverse glycaemic index and glycaemic load diets. METHODS The PURE study is a prospective cohort study of 127 594 adults aged 35-70 years from 20 high-income, middle-income, and low-income countries. Diet was assessed at baseline using country-specific validated food frequency questionnaires. The glycaemic index and the glycaemic load were estimated on the basis of the intake of seven categories of carbohydrate-containing foods. Participants were categorised into quintiles of glycaemic index and glycaemic load. The primary outcome was incident type 2 diabetes. Multivariable Cox Frailty models with random intercepts for study centre were used to calculate hazard ratios (HRs). FINDINGS During a median follow-up of 11·8 years (IQR 9·0-13·0), 7326 (5·7%) incident cases of type 2 diabetes occurred. In multivariable adjusted analyses, a diet with a higher glycaemic index was significantly associated with a higher risk of diabetes (quintile 5 vs quintile 1; HR 1·15 [95% CI 1·03-1·29]). Participants in the highest quintile of the glycaemic load had a higher risk of incident type 2 diabetes compared with those in the lowest quintile (HR 1·21, 95% CI 1·06-1·37). The glycaemic index was more strongly associated with diabetes among individuals with a higher BMI (quintile 5 vs quintile 1; HR 1·23 [95% CI 1·08-1·41]) than those with a lower BMI (quintile 5 vs quintile 1; 1·10 [0·87-1·39]; p interaction=0·030). INTERPRETATION Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes. FUNDING Full funding sources are listed at the end of the Article.
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Affiliation(s)
- Victoria Miller
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - David A Jenkins
- Department of Nutritional Sciences and Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; Clinical Nutrition Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Kristie Srichaikul
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Sumathi Swaminathan
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - Rosnah Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur, Malaysia
| | | | - Rekha M Ravindran
- Department of Health Sciences, Government of Kerala, Kerala, India; Health Action by People, Trivandrum, Kerala, India
| | | | - Ahmad Bahonar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yuksel Altuntas
- University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training Research Hospital, Clinic of Endocrinology and Metabolism, Sisli/Istabul, Türkiye
| | - Rasha Khatib
- Advocate Aurora Research Institute, Milwaukee, WI, USA; Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | | | | | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- Center for Health, Population and Development, Independent University, Dhaka, Bangladesh
| | | | - Hu Bo
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guoliang Han
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaocong Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyaadh, Saudi Arabia
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alvaro Avezum
- International Research Center, Hospital Alemão-Oswaldo Cruz & UNISA, São Paulo, SP Brazil
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Yin J, Cheng L, Hong Y, Li Z, Li C, Ban X, Zhu L, Gu Z. A Comprehensive Review of the Effects of Glycemic Carbohydrates on the Neurocognitive Functions Based on Gut Microenvironment Regulation and Glycemic Fluctuation Control. Nutrients 2023; 15:5080. [PMID: 38140339 PMCID: PMC10745758 DOI: 10.3390/nu15245080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Improper glycemic carbohydrates (GCs) consumption can be a potential risk factor for metabolic diseases such as obesity and diabetes, which may lead to cognitive impairment. Although several potential mechanisms have been studied, the biological relationship between carbohydrate consumption and neurocognitive impairment is still uncertain. In this review, the main effects and mechanisms of GCs' digestive characteristics on cognitive functions are comprehensively elucidated. Additionally, healthier carbohydrate selection, a reliable research model, and future directions are discussed. Individuals in their early and late lives and patients with metabolic diseases are highly susceptible to dietary-induced cognitive impairment. It is well known that gut function is closely related to dietary patterns. Unhealthy carbohydrate diet-induced gut microenvironment disorders negatively impact cognitive functions through the gut-brain axis. Moreover, severe glycemic fluctuations, due to rapidly digestible carbohydrate consumption or metabolic diseases, can impair neurocognitive functions by disrupting glucose metabolism, dysregulating calcium homeostasis, oxidative stress, inflammatory responses, and accumulating advanced glycation end products. Unstable glycemic status can lead to more severe neurological impairment than persistent hyperglycemia. Slow-digested or resistant carbohydrates might contribute to better neurocognitive functions due to stable glycemic response and healthier gut functions than fully gelatinized starch and nutritive sugars.
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Affiliation(s)
- Jian Yin
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
| | - Li Cheng
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Yan Hong
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Zhaofeng Li
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Caiming Li
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Xiaofeng Ban
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Ling Zhu
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Zhengbiao Gu
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (J.Y.); (Y.H.); (Z.L.); (C.L.); (X.B.); (L.Z.)
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
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Ott R, Stein R, Hauta-Alus HH, Ronkainen J, Fernández-Barrés S, Spielau U, Kirsten H, Poulain T, Melton PE, Küpers LK, Azaryah H, Colombo M, Landgraf K, Tobi EW, O'Sullivan T, Huang RC, Campoy C, Winkler C, Vioque J, Vrijheid M, Kiess W, Körner A, Sebert S, Jarvelin MR, Ziegler AG, Hummel S. Epigenome-Wide Meta-analysis Reveals Associations Between Dietary Glycemic Index and Glycemic Load and DNA Methylation in Children and Adolescents of Different Body Sizes. Diabetes Care 2023; 46:2067-2075. [PMID: 37756535 DOI: 10.2337/dc23-0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Dietary glycemic index (GI) and glycemic load (GL) are associated with cardiometabolic health in children and adolescents, with potential distinct effects in people with increased BMI. DNA methylation (DNAm) may mediate these effects. Thus, we conducted meta-analyses of epigenome-wide association studies (EWAS) between dietary GI and GL and blood DNAm of children and adolescents. RESEARCH DESIGN AND METHODS We calculated dietary GI and GL and performed EWAS in children and adolescents (age range: 4.5-17 years) from six cohorts (N = 1,187). We performed stratified analyses of participants with normal weight (n = 801) or overweight or obesity (n = 386). We performed look-ups for the identified cytosine-phosphate-guanine (CpG) sites (false discovery rate [FDR] <0.05) with tissue-specific gene expression of 832 blood and 223 subcutaneous adipose tissue samples from children and adolescents. RESULTS Dietary GL was positively associated with DNAm of cg20274553 (FDR <0.05), annotated to WDR27. Several CpGs were identified in the normal-weight (GI: 85; GL: 17) and overweight or obese (GI: 136; GL: 298; FDR <0.05) strata, and none overlapped between strata. In participants with overweight or obesity, identified CpGs were related to RNA expression of genes associated with impaired metabolism (e.g., FRAT1, CSF3). CONCLUSIONS We identified 537 associations between dietary GI and GL and blood DNAm, mainly in children and adolescents with overweight or obesity. High-GI and/or -GL diets may influence epigenetic gene regulation and thereby promote metabolic derangements in young people with increased BMI.
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Affiliation(s)
- Raffael Ott
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Robert Stein
- Medical Faculty, University of Leipzig, University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Helena H Hauta-Alus
- PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Justiina Ronkainen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sílvia Fernández-Barrés
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Institute, Madrid, Spain
| | - Ulrike Spielau
- Medical Faculty, University of Leipzig, University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Tanja Poulain
- LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Phillip E Melton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- University of Western Australia, School of Population and Global Health, Perth, Western Australia, Australia
| | - Leanne K Küpers
- The Generation R Study Group, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hatim Azaryah
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Marco Colombo
- Medical Faculty, University of Leipzig, University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
| | - Kathrin Landgraf
- Medical Faculty, University of Leipzig, University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
| | - Elmar W Tobi
- Periconceptional Epidemiology, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Therese O'Sullivan
- Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Rae-Chi Huang
- Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Cristina Campoy
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Institute, Madrid, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs-Granada), Granada, Spain
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- Forschergruppe Diabetes, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jesus Vioque
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Institute, Madrid, Spain
- Alicante Institute for Health and Biomedical Research, University Miguel Hernandez, Alicante, Spain
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Carlos III Institute, Madrid, Spain
| | - Wieland Kiess
- Medical Faculty, University of Leipzig, University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
- LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Antje Körner
- Medical Faculty, University of Leipzig, University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
- LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Sylvain Sebert
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Marjo-Riitta Jarvelin
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, U.K
- Medical Research Council-Public Health England Centre for Environment and Health, School of Public Health, Imperial College, London, U.K
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Middlesex, U.K
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- Forschergruppe Diabetes, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- Forschergruppe Diabetes, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Kashima H, Endo MY, Kanda M, Miura A, Fukuba Y, Mizuno M. High-glycemic index meal acutely potentiates blood pressure response to static handgrip exercise in healthy humans. J Appl Physiol (1985) 2023; 135:609-620. [PMID: 37471212 PMCID: PMC10538994 DOI: 10.1152/japplphysiol.00703.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
Blood glucose levels acutely increase postprandially depending on the type of meal consumed. However, it remains unclear whether postprandial hyperglycemia temporally affects cardiovascular responses to static handgrip exercise (SHG-ex). Thus, this study aimed to examine whether increased blood glucose induced by consumption of a high-glycemic index (HGI) meal affects pressor response to SHG-ex. A total of 14 healthy participants (7 women and 7 men) consumed an HGI meal, a low-glycemic index (LGI) meal, or no meal (control). Participants performed 30% maximal voluntary contraction SHG-ex followed by a postexercise muscle ischemia (PEMI) test before the meal and 60 min after consuming the meal. Blood glucose, plasma insulin, and plasma triglyceride levels were measured, and the area under the curve until 60 min (AUC0-60 min) after meal consumption was calculated. The HGI and LGI groups showed higher blood glucose and insulin AUC0-60 min than the control group (P < 0.001). At 60 min after the meal, the changes in blood pressure during SHG-ex were significantly greater in the HGI group, but not in the LGI group, than in the control group. The changes in blood pressure at the onset and end of SHG-ex 60 min after the meal were positively correlated with blood glucose AUC0-60 min (r = 0.321, P = 0.038; r = 0.402, P = 0.008, respectively) and plasma insulin AUC0-60 min (r = 0.339, P = 0.028; r = 0.302, P = 0.052, respectively). However, no association was observed during PEMI. These data suggest that postprandial hyperglycemia and hyperinsulinemia acutely exaggerate pressor response during SHG-ex in healthy young adults.NEW & NOTEWORTHY Postprandial hyperglycemia following consumption of a high-glycemic index (HGI) meal potentiated blood pressure response to static handgrip exercise (SHG-ex) in healthy young adults. These findings provide important insight into the role of the diet on acute circulatory response to exercise in healthy adults.
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Affiliation(s)
- Hideaki Kashima
- Department of Exercise Science and Physiology, School of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Masako Yamaoka Endo
- Department of Exercise Science and Physiology, School of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Masako Kanda
- Department of Exercise Science and Physiology, School of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Akira Miura
- Department of Exercise Science and Physiology, School of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Yoshiyuki Fukuba
- Department of Exercise Science and Physiology, School of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
- Faculty of Health and Sports Sciences, Hiroshima International University, Hiroshima, Japan
| | - Masaki Mizuno
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Monro J. Accuracy in Determining the Glycaemic Impact of Meals by Adding Individual Food Values Is Affected by Food Number, Homeostasis and Glucose Reference Dose. Nutrients 2023; 15:3296. [PMID: 37571234 PMCID: PMC10421172 DOI: 10.3390/nu15153296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Summing glycaemic glucose equivalent (GGE) values of foods in a meal would be a practical way to predict the relative glycaemic impact (RGI) of the meal, without measuring the whole meal postprandial effect. However, as glycaemic response is non-linear, and glycaemic responsiveness per gram of glucose decreases with dose, addition accumulates inaccuracy. This research described determined inaccuracies accruing during addition of GGE values of foods and identifies approaches to reduce inaccuracy. By combining five published glucose dose-glycaemic response curves, the relationship between GGE dose and response was shown to be nearly quadratic (R2 = 0.98). This curve allowed determination of the divergence between the theoretically true glycaemic glucose equivalence of food intakes and estimates obtained by extrapolating linearly from zero through responses to glucose reference doses of 10, 20, 30, 40, 50 and 60 g. For each reference, the disparity between the linearly determined sum of GGE values of foods in 20 realistic meals, and true homeostasis-adjusted glucose equivalence for each whole meal, was calculated. Summation of the GGE values of individual foods could lead to inaccurate (>5 g GGE) estimates of the RGI of meals, depending on the GGE total, the number of foods, and the size of the glucose reference. Inaccuracy that accumulates during linear addition of GGE values of foods limits the range in which they can be used linearly in dietary management, public health and epidemiology. However, the steps discussed herein may be taken to allow for non-linearity.
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Affiliation(s)
- John Monro
- New Zealand Institute for Plant & Food Research, Palmerston North 4442, New Zealand
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Khodarahmi M, Siri G, Erahimzadeh F, Farhangi MA, Shanehbandi D. Dietary glycemic index and glycemic load mediate the effect of CARTPT rs2239670 gene polymorphism on metabolic syndrome and metabolic risk factors among adults with obesity. BMC Endocr Disord 2022; 22:288. [PMID: 36404325 PMCID: PMC9677654 DOI: 10.1186/s12902-022-01188-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The importance of genetic and dietary factors in occurrence and progression of chronic diseases such as metabolic syndrome (MetS) has been established. However, complex interrelationships, including direct and indirect effects of these variables are yet to be clarified. So, our aim was to investigate the mediating role of glycemic indices in the relationship between CARTPT rs2239670 polymorphism, socio-demographic and psychological factors and metabolic risk factors and the presence of MetS in adults with obesity. METHODS In a cross-sectional study of 288 apparently healthy adults with obesity aged 20-50 years, dietary glycemic index (GI) and glycemic load (GL) were measured using a validated semi-quantitative food frequency questionnaire (FFQ). Biochemical parameters, blood pressure and anthropometric indicators were assayed by standard methods. Genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Structural equation modeling (SEM) was used in the statistical analysis. RESULTS CARTPT rs2239670 had a positive direct effect on MetS (B = 0.037 ± 0.022; P = 0.043) and, on the other hand, this variant was found to be indirectly associated with MetS presence through mediation of GI (B = 0.039 ± 0.017; P = 0.009). CARTPT was a significant predictor of both dietary GI and GL (B = 1.647 ± 0.080 and B = 3.339 ± 0.242, respectively). Additionally, glycemic indicators appeared to mediate the association of age and gender with LDL-C (B = 0.917 ± 0.332; P = 0.006) and HDL (B = 1.047 ± 0.484; P = 0.031), respectively. GI showed a positive relationship with LDL-C (P = 0.024) in men and similar relationships were found between GL and LDL-C (P = 0.050) and cholesterol (P = 0.022) levels in women. CONCLUSION The SEM findings suggest a hypothesis of the mediating effect of glycemic indices in the relationship between genetic susceptibility to obesity and MetS presence. Our findings need to be confirmed with large prospective studies.
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Affiliation(s)
- Mahdieh Khodarahmi
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Goli Siri
- Department of Internal Medicine, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Erahimzadeh
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Dariush Shanehbandi
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Monnard C, Rytz A, Tudorica CM, Fiore GL, Do TAL, Bhaskaran K, Macé K, Shahkhalili Y. Nutritional Composition of Infant Cereal Prototypes Can Precisely Predict Their Glycemic Index. Nutrients 2022; 14:nu14183702. [PMID: 36145078 PMCID: PMC9504606 DOI: 10.3390/nu14183702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Designing cereal-based products with appropriate metabolic responses is of high interest to the food industry in view of the potential health impact of the product. The objective of this study was to test whether a model that used the nutrient composition of breakfast cereals to predict their glycemic index (GI) and glycemic load (GL) could also accurately predict the GI and GL for complete (containing protein, reconstituted in water) infant cereal prototypes. Four independent studies measured the postprandial glucose response of 20 complete infant cereal prototypes (51−76 g/100 g glycemic carbohydrates) in healthy adults. The predictions were strongly correlated with the measured values for both the GI (r = 0.93, p-value < 0.01) and GL (r = 0.98, p-value < 0.01). The in vivo incremental area under the curve (iAUC) for glucose showed a strong linear relationship with the predicted GL (r = 0.99, p < 0.01). In summary, the model previously developed to predict the GI and GL of breakfast cereals was both accurate and precise for infant cereals and could be considered a simple tool to support nutritionally responsible product development.
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Affiliation(s)
- Cathriona Monnard
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., 1015 Lausanne, Switzerland
- Correspondence:
| | - Andreas Rytz
- Nestlé Research Center, 1000 Lausanne, Switzerland
| | | | | | - Tram Anh Line Do
- Nestlé Product Technology Center, Société des Produits Nestlé S.A., Route de Chavornay 3, 1350 Orbe, Switzerland
| | - Kalpana Bhaskaran
- Centre for Applied Nutrition Services, Glycemic Index Research Unit, School of Applied Science, Temasek Polytechnic, Singapore 529757, Singapore
| | | | - Yasaman Shahkhalili
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., 1015 Lausanne, Switzerland
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8
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Raczkowska E, Bienkiewicz M, Gajda R, Bronkowska M, Piotrowska E, Habánová M. Do Body Composition and Values of Selected Nutritional Status Indices Influence the Glycaemic Index Values of Vegetarian Dishes? A Pilot Study in a Group of Older Women. Int J Environ Res Public Health 2022; 19:9918. [PMID: 36011551 PMCID: PMC9408484 DOI: 10.3390/ijerph19169918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
An ageing population brings with it the need for public policy to respond to the demands and health needs of this group of people. The ageing process has been shown to be associated with changes in body composition. These mainly concern a decrease in muscle mass and an increase in body fat. Body composition and other indicators of nutritional status are important factors differentiating carbohydrate management. Glycaemic index (GI) values may be affected by differences resulting from individual metabolism. The rate of carbohydrate digestion is also influenced by a number of factors, including the degree to which the product is processed, the structure of the starch, and the presence of protein, fat and dietary fibre. Available studies do not provide information on the glycaemic response following the consumption of specific products by older people with varying BMI and body composition. Therefore, the aim of this study was to evaluate the effect of the body mass index (BMI) values of women aged 50-80 years on the glycaemic response after eating vegetarian meals and the influence of selected indices of nutritional status on their GI values. It has been shown that the areas under the glycaemic curves after the consumption of the tested foods, both traditional and modified, are higher in the group of overweight and obese women. Nevertheless, the GI of meals consumed by those with a BMI ≥ 25.0 kg/m2 is lower than that of foods consumed by women with normal values of this index. In the group of women with BMI 18.5-24.9 kg/m2, on the basis of an analysis of the obtained correlations, it was observed that the GI value of modified products depends on the percentage of body fat (FM%) (p = 0.0363) and the percentage of fat free mass (FFM%) (p = 0.0363), and, in the case of traditional products, also on the percentage of total body water (%) (p = 0.0133). In the group of women with a BMI ≥ 25.0 kg/m2, significant correlations were only found between the GI of modified foods and the waist-to-hip ratio (WHR) (p = 0.0363) and the ratio of waist circumference to height (WHtR) (p = 0.0369) indices. The GI values of food set solely with the participation of young, healthy people should not be the basis for the nutrition planning of all groups of people.
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Affiliation(s)
- Ewa Raczkowska
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Maciej Bienkiewicz
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Monika Bronkowska
- Institute of Health Sciences, University of Opole, Katowicka 68, 45-060 Opole, Poland
| | - Ewa Piotrowska
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Marta Habánová
- Institute of Nutrition and Genomics, Faculty of Agrobiology and Food Resources, Slovak University of Agriculture in Nitra, 949 01 Nitra, Slovakia
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9
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Papakonstantinou E, Xaidara M, Siopi V, Giannoglou M, Katsaros G, Theodorou G, Maratou E, Poulia KA, Dimitriadis GD, Skandamis PN. Effects of Spaghetti Differing in Soluble Fiber and Protein Content on Glycemic Responses in Humans: A Randomized Clinical Trial in Healthy Subjects. Int J Environ Res Public Health 2022; 19:ijerph19053001. [PMID: 35270698 PMCID: PMC8909947 DOI: 10.3390/ijerph19053001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
This randomized, single blind, cross-over study investigated the glycemic responses to three spaghetti No 7 types differing in dietary protein and soluble fiber content. Fourteen clinically and metabolically healthy, fasting individuals (25 ± 1 years; ten women; BMI 23 ± 1 kg/m2) received isoglucidic test meals (50 g available carbohydrate) and 50 g glucose reference, in random order. GI was calculated using the FAO/WHO method. Capillary blood glucose and salivary insulin samples were collected at 0, 15, 30, 45, 60, and 120 min. Subjective appetite ratings (hunger, fullness, and desire to eat) were assessed by visual analogue scales (VAS, 100 mm) at baseline and 120 min. All three spaghetti types (regular, whole wheat, and high soluble fiber–low carbohydrates) provided low GI values (33, 38, and 41, respectively, on glucose scale) and lower peak glucose values compared to glucose or white bread. No differences were observed between spaghetti No 7 types for fasting glucose, fasting and post-test-meal insulin concentrations, blood pressure (systolic and diastolic), and subjective appetite. Conclusions: all spaghetti No 7 types, regardless of soluble fiber and/or protein content, attenuated postprandial glycemic response, which may offer advantages to glycemic control.
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Affiliation(s)
- Emilia Papakonstantinou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
- Correspondence: ; Tel.: +30-2105294967
| | - Marina Xaidara
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
| | - Vassiliki Siopi
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
| | - Marianna Giannoglou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DEMETER”, 14123 Athens, Greece; (M.G.); (G.K.)
| | - George Katsaros
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DEMETER”, 14123 Athens, Greece; (M.G.); (G.K.)
| | - Georgios Theodorou
- Laboratory of Animal Breeding and Husbandry, Department of Animal Science, School of Animal Biosciences, Agricultural University of Athens, 11855 Athens, Greece;
| | - Eirini Maratou
- Department of Clinical Biochemistry, “Attikon” University General Hospital, National and Kapodistrian University of Athens, Haidari, 12462 Athens, Greece;
| | - Kalliopi-Anna Poulia
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
| | - George D. Dimitriadis
- Sector of Medicine, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Panagiotis N. Skandamis
- Laboratory of Food Quality Control and Hygiene, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece;
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10
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Sun J, Liu X, Xu Q, Zong M, Zhang Y, Xiao F, Zhao H, Ma Y. Acute effect of flaxseed-enriched snack bars on glycemic responses and satiety in healthy individuals. Asia Pac J Clin Nutr 2022; 31:371-377. [PMID: 36173209 DOI: 10.6133/apjcn.202209_31(3).0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The dietary glycemic index (GI) and glycemic load (GL) have garnered scholarly attention for their roles in weight management and glycemic control. Flaxseed is a good source of fiber, lignans, and omega-3 fatty acids. This study evaluated healthy individuals' acute glycemic response and satiety following the consumption of flaxseed-enriched snack bars. METHODS AND STUDY DESIGN Nineteen healthy men and women consumed flaxseed bars or a glucose solution containing 50 g of available carbohydrates. Capillary blood glucose concentrations were obtained through the finger-prick test. The GI and GL values of the flaxseed bars were calculated using incremental area under the glucose response curve. Over 2 h, subjective satiety was examined at 0 (fasting), 15, 30, 45, 60, 90 and 120min following the consumption of flaxseed bars or saltine crackers containing 300 kcal by using a visual analogue scale (VAS). RESULTS Compared with that of the glucose solution, the glucose concentrations of the flaxseed bars (15-90 min) were significantly lower (p<0.001). The GI and GL values of the flaxseed bars were 30.0±23.0 and 2.3±0.2, respectively. Compared with saltine cracker consumption, flaxseed bars consumption resulted in lower hunger and higher satiety. The satiety index score of the flaxseed bars was 1.6 times higher than that of the saltine crackers. CONCLUSIONS Although further studies are warranted to evaluate the long-term effects of flaxseed-enriched snacks on glycemia and energy balance, our findings suggest that the incorporation of flaxseed into snack bars is a viable strategy for the management of obesity and diabetes.
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Affiliation(s)
- Jianqin Sun
- Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Xia Liu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qi Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Zong
- Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yali Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Xiao
- Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hailei Zhao
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Ma
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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11
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Amoah I, Cairncross C, Merien F, Rush E. Glycaemic and Appetite Suppression Effect of a Vegetable-Enriched Bread. Nutrients 2021; 13:nu13124277. [PMID: 34959829 PMCID: PMC8707846 DOI: 10.3390/nu13124277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 01/04/2023] Open
Abstract
Bread, a frequently consumed food, is an ideal vehicle for addition of ingredients that increase nutrient density and add health benefits. This experimental cross-over study sought to test the effect of a vegetable-enriched bread (VB) in comparison to commercial white bread (WB) and wheatmeal bread (WMB) on serum glucose, insulin response and subjective appetite suppression. On three separate occasions, 10 participants (23 ± 7 years) visited the laboratory and consumed after an overnight fast, in random order, a 75 g serve of WB, WMB or VB. Venous blood samples drawn twice before (0 min) and at 15, 30, 45, 60, 90 and 120 min after consumption of the bread were analysed for glucose and insulin. Participants rated their subjective feelings of hunger, fullness, satisfaction and desire to eat on a 150 mm Likert scale. The mean glucose iAUC over 120 min was not different among the breads. The mean insulin iAUC for the VB was significantly lower than the WB and WMB; difference VB and WB 12,415 pmol/L*minutes (95% CI 1918, 22,912 pmol/L*minutes, p = 0.025) and difference VB and WMB 13,800 pmol/L*minutes (95% CI 1623, 25,976 pmol/L*minutes p = 0.031). The VB was associated with a higher fullness feeling in the participants over the 120-min period. The consumption of VB was associated with less insulin release and higher satiety over 120 min which may be related to the higher fibre content and texture of VB. The role of vegetable and fruit fibres such as pectin in bread and insulin response should also be further explored.
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Affiliation(s)
- Isaac Amoah
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand;
- Centre of Research Excellence, Riddet Institute, Palmerston North 4474, New Zealand
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi 0023351, Ghana
- Correspondence: or (I.A.); (E.R.); Tel.: +233-24-918-3185 (I.A.); +64-21-624-077 (E.R.)
| | - Carolyn Cairncross
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand;
| | - Fabrice Merien
- AUT Roche Diagnostics Laboratory, Auckland University of Technology, Auckland 1010, New Zealand;
| | - Elaine Rush
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand;
- Centre of Research Excellence, Riddet Institute, Palmerston North 4474, New Zealand
- Correspondence: or (I.A.); (E.R.); Tel.: +233-24-918-3185 (I.A.); +64-21-624-077 (E.R.)
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12
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Sünram-Lea SI, Gentile-Rapinett G, Macé K, Rytz A. Assessment of Glycemic Response to Model Breakfasts Varying in Glycemic Index (GI) in 5-7-Year-Old School Children. Nutrients 2021; 13:nu13124246. [PMID: 34959798 PMCID: PMC8707352 DOI: 10.3390/nu13124246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Reduced Glycemic Index (GI) of breakfast has been linked to improved cognitive performance in both children and adult populations across the morning. However, few studies have profiled the post-prandial glycemic response (PPGR) in younger children. The aim of this study was to assess PPGR to breakfast interventions differing in GI in healthy children aged 5-7 years. Eleven subjects completed an open-label, randomized, cross-over trial, receiving three equicaloric test beverages (260 kcal) consisting of 125 mL semi-skimmed milk and 50 g sugar (either glucose, sucrose, or isomaltulose). On a fourth occasion, the sucrose beverage was delivered as intermittent supply. PPGR was measured over 180 min using Continuous Glucose Monitoring (CGM). The incremental area under the curve (3h-iAUC) was highest for the glucose beverage, followed by intermittent sucrose (-21%, p = 0.288), sucrose (-27%, p = 0.139), and isomaltulose (-48%, p = 0.018). The isomaltulose beverage induced the smallest Cmax (7.8 mmol/L vs. >9.2 mmol/L for others) and the longest duration with moderate glucose level, between baseline value and 7.8 mmol/L (150 vs. <115 min for others). These results confirm that substituting mid-high GI sugars (e.g., sucrose and glucose) with low GI sugars (e.g., isomaltulose) during breakfast are a viable strategy for sustained energy release and glycemic response during the morning even in younger children.
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Affiliation(s)
- Sandra I. Sünram-Lea
- Department of Psychology, Lancaster University, Lancaster LA1 4YF, UK
- Correspondence:
| | | | - Katherine Macé
- Nestlé Research Center, 1000 Lausanne, Switzerland; (G.G.-R.); (K.M.); (A.R.)
| | - Andreas Rytz
- Nestlé Research Center, 1000 Lausanne, Switzerland; (G.G.-R.); (K.M.); (A.R.)
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13
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Heimbürger SMN, Hoe B, Nielsen CN, Bergmann NC, Hartmann B, Holst JJ, Vilsbøll T, Dejgaard TF, Christensen MB, Knop FK. The effect of 6-day subcutaneous glucose-dependent insulinotropic polypeptide infusion on time in glycaemic range in patients with type 1 diabetes: a randomised, double-blind, placebo-controlled crossover trial. Diabetologia 2021; 64:2425-2431. [PMID: 34405256 DOI: 10.1007/s00125-021-05547-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes is characterised by reduced glucagon response to hypoglycaemia, increasing the risk of insulin treatment-associated hypoglycaemia known to hamper glycaemic control. We previously reported a glucagonotropic effect of exogenous glucose-dependent insulinotropic polypeptide (GIP) during insulin-induced hypoglycaemia in individuals with type 1 diabetes. Here we investigate the effect of a 6-day s.c. GIP infusion on time in glycaemic range as assessed by continuous glucose monitoring (CGM) in individuals with type 1 diabetes. METHODS In a randomised, placebo-controlled, double-blind crossover study, time in glycaemic range (assessed by double-blinded CGM) was evaluated in 20 men with type 1 diabetes (18-75 years, stable insulin treatment ≥3 months, diabetes duration 2-15 years, fasting plasma C-peptide below 200 pmol/l, BMI 20-27 kg/m2, HbA1c <69 mmol/mol [8.5%]) during two × 6 days of continuous s.c. GIP (6 pmol kg-1 min-1) and placebo (saline [154 mmol/l NaCl]) infusion, respectively, with an interposed 7-day washout period. The primary outcome was glycaemic time below range, time in range and time above range. RESULTS There were no significant differences in time below range (<3.9 mmol/l, p = 0.53) or above range (>10 mmol/l, p = 0.32) during night-time or daytime, in mean glucose, or in hypoglycaemic events as assessed by CGM. GIP altered neither self-reported hypoglycaemia nor safety measures. Compared with placebo, GIP significantly increased time in tight range (3.9-7.8 mmol/l) during daytime (06:00-23:59 hours) by [mean ± SEM] 11.2 ± 5.1% [95% CI 0.41, 21.9] (p = 0.02). CONCLUSIONS/INTERPRETATION Six-day s.c. GIP infusion in men with type 1 diabetes did not procure convincing effect on overall time in range, but increased time in tight glycaemic range during daytime by ~2 h per day. TRIAL REGISTRATION ClinicalTrials.gov NCT03734718. FUNDING The study was funded by grants from The Leona M. and Harry B. Helmsley Charitable Trust and Aase og Ejnar Danielsens Fond.
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Affiliation(s)
- Sebastian M N Heimbürger
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn Hoe
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Chris N Nielsen
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Natasha C Bergmann
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Bolette Hartmann
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas F Dejgaard
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Mikkel B Christensen
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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14
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Lipscombe L, Butalia S, Dasgupta K, Eurich DT, MacCallum L, Shah BR, Simpson S, Senior PA. Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update. Can J Diabetes 2021; 44:575-591. [PMID: 32972640 DOI: 10.1016/j.jcjd.2020.08.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Lorraine Lipscombe
- Division of Endocrinology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Butalia
- Division of Endocrinology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism, Department of Medicine; Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Lori MacCallum
- Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Scot Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter A Senior
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
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15
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Chen C, Gallagher JR, Tarlton J, van Aalten L, Bray SE, Ashford MLJ, McCrimmon RJ, Pearson ER, McNeilly AD, Sutherland C. The genetic association of the transcription factor NPAT with glycemic response to metformin involves regulation of fuel selection. PLoS One 2021; 16:e0253533. [PMID: 34197485 PMCID: PMC8248654 DOI: 10.1371/journal.pone.0253533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Abstract
The biguanide, metformin, is the first-choice therapeutic agent for type-2 diabetes, although the mechanisms that underpin metformin clinical efficacy remain the subject of much debate, partly due to the considerable variation in patient response to metformin. Identification of poor responders by genotype could avoid unnecessary treatment and provide clues to the underlying mechanism of action. GWAS identified SNPs associated with metformin treatment success at a locus containing the NPAT (nuclear protein, ataxia-telangiectasia locus) and ATM (ataxia-telangiectasia mutated) genes. This implies that gene sequence dictates a subsequent biological function to influence metformin action. Hence, we modified expression of NPAT in immortalized cell lines, primary mouse hepatocytes and mouse tissues, and analysed the outcomes on metformin action using confocal microscopy, immunoblotting and immunocytochemistry. In addition, we characterised the metabolic phenotype of npat heterozygous knockout mice and established the metformin response following development of insulin resistance. NPAT protein was localised in the nucleus at discrete loci in several cell types, but over-expression or depletion of NPAT in immortalised cell models did not change cellular responses to biguanides. In contrast, metformin regulation of respiratory exchange ratio (RER) was completely lost in animals lacking one allele of npat. There was also a reduction in metformin correction of impaired glucose tolerance, however no other metabolic abnormalities, or response to metformin, were found in the npat heterozygous mice. In summary, we provide methodological advancements for the detection of NPAT, demonstrate that minor reductions in NPAT mRNA levels (20–40%) influence metformin regulation of RER, and propose that the association between NPAT SNPs and metformin response observed in GWAS, could be due to loss of metformin modification of cellular fuel usage.
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Affiliation(s)
- Changwei Chen
- Division of Cellular Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Jennifer R. Gallagher
- Division of Systems Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Jamie Tarlton
- Division of Systems Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Lidy van Aalten
- Division of Cellular Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Susan E. Bray
- Tayside Tissue Bank, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Michael L. J. Ashford
- Division of Systems Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Rory J. McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Ewan R. Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Alison D. McNeilly
- Division of Systems Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
| | - Calum Sutherland
- Division of Cellular Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, James Arnott Drive, Dundee, United Kingdom
- * E-mail:
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16
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Wahab RJ, Jaddoe VWV, Gaillard R. Associations of maternal early-pregnancy dietary glycemic index with childhood general, abdominal and ectopic fat accumulation. Clin Nutr 2021; 40:1628-1636. [PMID: 33752151 PMCID: PMC7613756 DOI: 10.1016/j.clnu.2021.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
Background & aims Maternal hyperglycemia during pregnancy is an important risk factor for childhood adiposity. Maternal dietary glycemic index during pregnancy directly influences maternal and fetal glucose concentrations. We examined the associations of maternal early-pregnancy dietary glycemic index with offspring general, abdominal and ectopic fat accumulation among normal weight and overweight or obese pregnant women and their offspring. Methods In a population-based cohort study among 2488 Dutch pregnant women and their children, we assessed maternal dietary glycemic index by food frequency questionnaire at median 13.4 (95% range 10.7; 21.1) weeks gestation. Dietary glycemic index was used continuously and categorized into low (≤55), normal (56–69) and high (≥70) glycemic index diet. We measured offspring BMI, total fat mass and android/gynoid fat mass ratio by DXA, and visceral fat mass and liver fat fraction by MRI at 10 years. Results No associations of maternal early-pregnancy dietary glycemic index with offspring adiposity were present among normal weight women and their children. Among overweight and obese women and their children, 1-Standard Deviation Score (SDS) increase in maternal early-pregnancy dietary glycemic index was associated with higher childhood BMI (0.10 SDS, 95% Confidence Interval (CI) 0.01; 0.19), total fat mass index (0.13 SDS, 95% CI 0.05; 0.22), visceral fat mass index (0.19 SDS, 95% CI 0.07; 0.32) and tended to be associated with a higher android/gynoid fat mass ratio (0.09 SDS, 95% CI −0.01; 0.19) and higher risk of childhood overweight (Odds Ratio (OR) 1.20, 95% CI 0.97; 1.48). Overweight and obese women consuming an early-pregnancy low-glycemic index diet, as compared to an early-pregnancy normal-glycemic index diet, had children with lower BMI, total fat mass index, visceral fat mass index and android/gynoid fat mass ratio at 10 years (p-values<0.05). No women consumed a high-glycemic index diet. No associations were explained by maternal socio-economic, lifestyle and dietary characteristics, birth or childhood characteristics. No associations with liver fat fraction were present. Conclusions In overweight or obese women and their children, a higher maternal early-pregnancy dietary glycemic index is associated with childhood general, abdominal and visceral fat accumulation, but not with liver fat. Intervention studies among overweight and obese pregnant women may need to target the dietary glycemic index to prevent childhood adiposity.
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Affiliation(s)
- Rama J Wahab
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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17
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Erdal B, Caferoglu Z, Hatipoglu N. The comparison of two mealtime insulin dosing algorithms for high and low glycaemic index meals in adolescents with type 1 diabetes. Diabet Med 2021; 38:e14444. [PMID: 33119135 DOI: 10.1111/dme.14444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
AIMS Postprandial glycaemic variability carries on being a clinical challenge in optimizing glucose control in type 1 diabetes. The aim of this study was to compare the postprandial glycaemic effects of carbohydrate counting and food insulin index algorithms following the consumption of protein-rich, high-fat meals with different glycaemic index (GI) in adolescents with type 1 diabetes. METHODS A randomized, single-blind and crossover trial included 15 adolescents aged 14-18 years with type 1 diabetes. Participants consumed two different test meals with similar energy, macronutrients and food insulin index but the approximately twofold difference in GI, in random order on four consecutive mornings at their home. Insulin dose for high- and low-GI test meals was determined by using the carbohydrate counting and food insulin index algorithms. Four-hour postprandial glycaemia was assessed by the continuous glucose monitoring system. RESULTS Compared with carbohydrate counting, the food insulin index algorithm significantly decreased peak glucose excursion (-57%, p = 0.02), incremental area under the curve (-65%, p = 0.02) and coefficient variation of blood glucose (-37%, p = 0.03) in the high-GI meal, though there was no difference between the two algorithms in the low-GI meal. The occurrence of hypoglycaemia did not significantly differ between insulin dosing algorithms for the high-GI (p = 0.58) and low-GI (p = 0.20) meals. CONCLUSIONS The food insulin index algorithm may be beneficial for postprandial glycaemic control after the consumption of high-GI meals in adolescents with type 1 diabetes.
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Affiliation(s)
- Busra Erdal
- Institute of Health Sciences, Department of Nutrition and Dietetics, Erciyes University, Kayseri, Turkey
| | - Zeynep Caferoglu
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Erciyes University, Kayseri, Turkey
| | - Nihal Hatipoglu
- Faculty of Medicine, Department of Paediatric Endocrinology, Erciyes University, Kayseri, Turkey
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18
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Ravi R, Balasubramaniam V, Kuppusamy G, Ponnusankar S. Current concepts and clinical importance of glycemic variability. Diabetes Metab Syndr 2021; 15:627-636. [PMID: 33743360 DOI: 10.1016/j.dsx.2021.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Evolving evidence indicate that variations in blood glucose levels are likely to be an important factor in developing diabetic complications. Monitoring glucose fluctuations in patients remains as a therapeutic challenge and more evidence needs to be created in order to bring GV into limelight. This review encapsulates the most important findings conducted and discusses on them to provide readers a better understanding on this emerging subject. METHODS Keyword-based comprehensive desktop search was conducted to gather the relevant literature. Triple-stage cascade type content analysis of the literature was conducted to draw relevant themes of discussions. RESULTS High glycemic variability is associated with an increased risk of development of diabetic complications especially in cardiac conditions. The widely used and accepted metrics to determine the variations in blood glucose are Standard deviation (SD), MAGE (Mean amplitude of glycemic excursions) and MODD (Mean of daily differences). Occurrence of blood glucose variations affects at a molecular level thereby causing more harm than the occurrence of hyperglycemia alone. CONCLUSION Available data suggest that Glycemic Variability should be used as an additional marker of glycemia. Additional research globally, and in India are required.
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Affiliation(s)
- Ramya Ravi
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Udhagamandalam, The Nilgiris, Tamil Nadu, India
| | - V Balasubramaniam
- Department of Surgery, Govt. Medical College Hospital, Udhagamandalam, The Nilgiris, Tamil Nadu, India
| | - Gowthamarajan Kuppusamy
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Udhagamandalam, The Nilgiris, Tamil Nadu, India
| | - Sivasankaran Ponnusankar
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Udhagamandalam, The Nilgiris, Tamil Nadu, India.
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Jamshidi S, Moradi Y, Nameni G, Mohsenpour MA, Vafa M. Effects of cashew nut consumption on body composition and glycemic indices: A meta-analysis and systematic review of randomized controlled trials. Diabetes Metab Syndr 2021; 15:605-613. [PMID: 33725628 DOI: 10.1016/j.dsx.2021.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Present meta-analysis and systematic review was conducted to synthesis a definitive conclusion from previous randomized controlled clinical trials (RCTs). METHODS A comprehensive search was done up to July 2020, in order to extract RCTs which investigated the effect of cashew nut on weight, body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), insulin, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Weighted mean difference (WMD) and 95% confidence interval (CI) were used to estimate effect size. Meta regression analysis was done to identify probable sources of heterogeneity. RESULTS Six clinical trials with 521 participants were included. Combined effect sizes demonstrated no effect of cashew consumption on weight (WMD): 0.02, 95% CI: -1.04, 1.09, P > 0.05), BMI (WMD: 0.1, 95% CI: -0.72, 0.74, P > 0.05), and WC (WMD: -0.13, 95% CI: -1.97, 1.70, P > 0.05). Results were also not significant for FBS (WMD: 3.58, 95% CI: -3.92, 11.08, P > 0.05), insulin (WMD: -0.19, 95% CI: -1.63, 1.25, P > 0.05), and HOMA-IR (WMD: 0.25, 95% CI: -0.55, 1.06, P > 0.05). CONCLUSION The sum up, incorporating cashew into the diet has no significant effect on body composition or modifying glycemic indices.
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Affiliation(s)
- Sanaz Jamshidi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghazaleh Nameni
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohsenpour
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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20
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Alkhormi AH, Alshahrani NZ, Mahmood SE. Khat chewing leads to increase in glycaemic parameters in patients with type 2 diabetes mellitus in Jazan region, Saudi Arabia and Yemen. Diabetes Metab Syndr 2021; 15:565-568. [PMID: 33689938 DOI: 10.1016/j.dsx.2021.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Khat is known to have a stimulating effect on the sympathetic nervous system by producing a temporary sensation of activeness and happiness, along with mood disturbance and anxiety. Despite growing evidence of the association between khat chewing and glycaemic control in patients with diabetes, the position of khat chewing in DM is not fully recognised. AIM To evaluate the association of khat chewing with the risk of elevated blood glucose levels among patients with type 2 diabetes mellitus. METHOD A web-based literature search was performed using the electronic databases PubMed, EMBASE and Google Scholar. Databases were searched for studies published about khat chewing and diabetes mellitus in the Jazan region, Saudi Arabia and Yemen. RESULT Twenty-five published articles studying the relation between khat chewing and diabetes mellitus were identified, but only 10 studies reported an association between khat chewing and blood glucose levels and were included. CONCLUSION Khat chewing increases fasting blood glucose, post-prandial blood glucose and HbA1c levels in patients with diabetes in the Jazan region, Saudi Arabia and Yemen.
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Affiliation(s)
- Abdulrahman H Alkhormi
- Departement of Preventive Medicine, King Fahd Central Hospital, Ministry of Health, Jazan 84211, Saudi Arabia
| | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah 21589, Saudi Arabia.
| | - Syed Esam Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
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21
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Metwally M, Cheung TO, Smith R, Bell KJ. Insulin pump dosing strategies for meals varying in fat, protein or glycaemic index or grazing-style meals in type 1 diabetes: A systematic review. Diabetes Res Clin Pract 2021; 172:108516. [PMID: 33096184 DOI: 10.1016/j.diabres.2020.108516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nutritional composition and food patterns influence postprandial glycaemia in type 1 diabetes (T1D). For optimal glycaemic control, insulin dose and delivery pattern must be matched accordingly. This systematic review aimed to compare insulin dosing strategies for meals varying in fat, protein and glycaemic index (GI), and prolonged meals in T1D. METHODS Studies in adults and/or children with T1D on insulin pump therapy comparing the glycaemic effects of different insulin pump bolus types for these meal types were identified from biomedical databases (MEDLINE, PREMEDLINE, Embase, CINAHL and Cochrane Central Register of Controlled Trials; March 1995-April 2020) and systematically reviewed. RESULTS All eleven publications investigating high-fat meals (234 participants) and all seven studies investigating high-protein meals (129 participants) showed a dual-wave bolus was superior. Additional insulin further improved postprandial glycaemia, although increasing risk of hypoglycaemia in 5 of 14 studies. One study investigating GI found a dual-wave bolus reduced postprandial glycaemia and risk of hypoglycaemia. No studies were identified for grazing/degustation-style meals. Due to heterogeneity, meta-analysis was not possible. CONCLUSION Dual-wave boluses improve postprandial glycaemia in high-fat, high-protein and low-GI meals. Further research is needed to identify optimal bolus delivery split, duration and optimal total dose adjustment.
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Affiliation(s)
- Mariam Metwally
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Tin Oi Cheung
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | | | - Kirstine J Bell
- Charles Perkins Centre, University of Sydney, Sydney, Australia.
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22
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Camps SG, Lim J, Koh MXN, Henry CJ. The Glycaemic and Insulinaemic Response of Pasta in Chinese and Indians Compared to Asian Carbohydrate Staples: Taking Spaghetti Back to Asia. Nutrients 2021; 13:451. [PMID: 33572918 PMCID: PMC7911001 DOI: 10.3390/nu13020451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/08/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
In this study, we compared the metabolic properties of the Asian staples rice and noodles, which are typically high in glycaemic index (GI), to two types of spaghetti. It is hypothesised that pasta can be a healthy replacement, particularly amongst the Asian population. Thirty Chinese and Indian subjects (17 men, 13 women; BMI: 18.5-25 kg/m2) participated in this randomised crossover trial. On seven occasions, they consumed a glucose reference drink (3 times), white rice, wheat-based mee pok noodles, semolina spaghetti and wholegrain spaghetti. Blood samples were taken to measure glucose and insulin response over a period of 3 h. The current evaluation showed that semolina spaghetti and wholegrain spaghetti can be classified as low GI products, with a GI of 53 and 54, respectively, significantly lower than wheat based mee pok noodles (74) and rice (80) (p < 0.005). In addition, both spaghettis had a lower insulin response compared to rice (p < 0.05). Furthermore, there was no difference in glucose or insulin response between semolina and wholegrain spaghetti. After controlling for gender, ethnicity, fat and fat free mass (kg), the glucose and insulin results did not change. In conclusion, wheat-based pasta can be helpful to modify the carbohydrate-rich Asian diet. Notably, there was no effect of gender, ethnicity and body composition on the glycaemic and insulinaemic response. We speculate that the starch-protein structure as a result of the spaghetti production process is a major driver of its favourable metabolic properties.
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Affiliation(s)
- Stefan Gerardus Camps
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive #07-02, MD 6 Building, Singapore 117599, Singapore; (J.L.); (M.X.N.K.)
| | - Joseph Lim
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive #07-02, MD 6 Building, Singapore 117599, Singapore; (J.L.); (M.X.N.K.)
| | - Melvin Xu Nian Koh
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive #07-02, MD 6 Building, Singapore 117599, Singapore; (J.L.); (M.X.N.K.)
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive #07-02, MD 6 Building, Singapore 117599, Singapore; (J.L.); (M.X.N.K.)
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, S14 Level 5, Science Drive 2, Singapore 117543, Singapore
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Ashraf H, Faraz A, Ahmad J. Achievement of guideline targets of glycemic and non-glycemic parameters in North Indian type 2 diabetes mellitus patients: A retrospective analysis. Diabetes Metab Syndr 2021; 15:425-431. [PMID: 33588199 DOI: 10.1016/j.dsx.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/26/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS Though, the prevalence of diabetes is increasing in the worldwide, achievement of glycemic and non-glycemic targets remain suboptimal. We conducted this retrospective cross-sectional study at two endocrine clinics of Aligarh (Uttar Pradesh) in north India. MATERIALS AND METHODS After screening the records of 13800 patients, 12140 patients of type 2 diabetes mellitus who were attending the clinic regularly every three to four months, were included in the final analysis. The data regarding patient's height, weight, body mass index, blood pressure, blood glucose, HbA1c, lipid profile and complications were obtained. RESULTS Mean age was 49.7 ± 11.3 years; males and females were almost equal in number. 2891 (23.8%) subjects were of age less than 40 years. 9614 (80%) patients had diabetes duration of less than 5 years. 3311 (27.3%) subjects were having an HbA1c of <7%, HbA1c 7-8% in 3711 (30.5%), HbA1c 8-9% in 2653 (21.9%) whereas HbA1c of >9% in 2465 (20.3%) subjects. The microvascular complications; diabetic nephropathy, diabetic neuropathy and diabetic retinopathy were present in 7.5%, 14.9% and 16.2% respectively. Hypertension was present in 25.8% and coronary artery disease was present in 15.5% of patients. Overall 27.3%, 41.7%, 44.1%, 45.3% and 67.7% of patients achieved their HbA1c, triglyceride, HDL, LDL and hypertension targets respectively, as per American Diabetes Association 2020 guidelines. CONCLUSION Despite availability of multiple drugs and guidelines, the attainment rates of glycemic and non-glycemic targets remain suboptimal. A more aggressive approach in the treatment of type 2 diabetes is required.
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Affiliation(s)
- Hamid Ashraf
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, UP, India.
| | - Ahmad Faraz
- Department of Physiology, Aligarh Muslim University, Aligarh, UP, India.
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, UP, India
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Ghosh A, Anjana RM, Shanthi Rani CS, Jeba Rani S, Gupta R, Jha A, Gupta V, Kuchay MS, Luthra A, Durrani S, Dutta K, Tyagi K, Unnikrishnan R, Srivastava BK, Ramu M, Sastry NG, Gupta PK, Umasankari G, Jayashri R, Mohan V, Misra A. Glycemic parameters in patients with new-onset diabetes during COVID-19 pandemic are more severe than in patients with new-onset diabetes before the pandemic: NOD COVID India Study. Diabetes Metab Syndr 2021; 15:215-220. [PMID: 33450530 PMCID: PMC7771314 DOI: 10.1016/j.dsx.2020.12.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS It is not known if new onset diabetes during Coronavirus-19 disease (COVID-19; NOD COVID) is phenotypically or biochemically different than new onset diabetes before COVID-19 (NOD). METHODS All adults diagnosed with new onset diabetes from during the time of COVID-19 were compared with new onset diabetes prior to COVID-19 from two tertiary care hospitals in Chennai and Delhi. RTPCR test for SARS-CoV-2 virus was done as appropriate, and COVID-19 antibody test was done in all other NOD COVID patients. RESULT A total of 555 patients with new onset diabetes were included in the study (282 NOD and 273 NOD COVID patients). Patients with NOD COVID had higher fasting and post prandial blood glucose and glycated hemoglobin levels vs. NOD patients. Both the groups had high average body mass index; ∼28 kg/m2. Interestingly, fasting C-peptide levels were significantly higher in the NOD COVID group vs. NOD group. There was no difference in C-peptide levels or glycemic parameters between the COVID-19 antibody positive and negative NOD COVID cases. CONCLUSION Individuals who were diagnosed with diabetes during COVID-19 epidemic (NOD COVID) do not significantly differ from those diagnosed before COVID-19 in symptomatology, phenotype, and C-peptide levels but they had more severe glycemia.
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Affiliation(s)
- Amerta Ghosh
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Saravanan Jeba Rani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ritesh Gupta
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India
| | - Alka Jha
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India
| | - Vimal Gupta
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India
| | | | - Atul Luthra
- Fortis CDOC Center for Diabetes, Fortis Memorial Institute, Gurgaon, India
| | - Suhail Durrani
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India
| | - Koel Dutta
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India
| | - Kanika Tyagi
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Muthu Ramu
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Prasanna Kumar Gupta
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ganesan Umasankari
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ramamoorthy Jayashri
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
| | - Anoop Misra
- Fortis CDOC Centre for Diabetes and Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India.
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Geraghty AA, Sexton-Oates A, O’Brien EC, Saffery R, McAuliffe FM. Epigenetic Patterns in Five-Year-Old Children Exposed to a Low Glycemic Index Dietary Intervention during Pregnancy: Results from the ROLO Kids Study. Nutrients 2020; 12:nu12123602. [PMID: 33255249 PMCID: PMC7760894 DOI: 10.3390/nu12123602] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022] Open
Abstract
A range of in utero and early-life factors can influence offspring epigenetics, particularly DNA methylation patterns. This study aimed to investigate the influence of a dietary intervention and factors in pregnancy on offspring epigenetic profile at five years of age. We also explored associations between body composition and methylation profile in a cross-sectional analysis. Sixty-three five-year-olds were selected from the ROLO Kids Study, a Randomized controlled trial Of a LOw glycemic index dietary intervention from the second trimester of pregnancy. DNA methylation was investigated in 780,501 CpG sites in DNA isolated from saliva. Principal component analysis identified no association between maternal age, weight, or body mass index (BMI) during pregnancy and offspring DNA methylation (p > 0.01). There was no association with the dietary intervention during pregnancy, however, gene pathway analysis identified functional clusters involved in insulin secretion and resistance that differed between the intervention and control. There were no associations with child weight or adiposity at five years of age; however, change in weight from six months was associated with variation in methylation. We identified no evidence of long-lasting influences of maternal diet or factors on DNA methylation at age five years. However, changes in child weight were associated with the methylome in childhood.
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Affiliation(s)
- Aisling A. Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin 2, Ireland; (A.A.G.); (E.C.O.)
| | - Alex Sexton-Oates
- Cancer and Disease Epigenetics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia; (A.S.-O.); (R.S.)
| | - Eileen C. O’Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin 2, Ireland; (A.A.G.); (E.C.O.)
| | - Richard Saffery
- Cancer and Disease Epigenetics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia; (A.S.-O.); (R.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin 2, Ireland; (A.A.G.); (E.C.O.)
- Correspondence:
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Olickal JJ, Chinnakali P, Suryanarayana BS, Ulaganeethi R, Kumar SS, Saya GK. Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India. Diabetes Metab Syndr 2020; 14:1967-1972. [PMID: 33059300 PMCID: PMC7548067 DOI: 10.1016/j.dsx.2020.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS COVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care. METHODS This cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity. RESULTS A total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress. CONCLUSIONS Majority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.
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Affiliation(s)
- Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - B S Suryanarayana
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Revathi Ulaganeethi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Swetha S Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Önmez A, Gamsızkan Z, Özdemir Ş, Kesikbaş E, Gökosmanoğlu F, Torun S, Cinemre H. The effect of COVID-19 lockdown on glycemic control in patients with type 2 diabetes mellitus in Turkey. Diabetes Metab Syndr 2020; 14:1963-1966. [PMID: 33059299 PMCID: PMC7548075 DOI: 10.1016/j.dsx.2020.10.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS A national lockdown to prevent the spread of coronavirus disease (COVID-19) in Turkey was introduced in March 2020. We think that lockdowns may lead to weight gain and worsening of glycemic parameters in patients with type 2 diabetes mellitus (DM). The purpose of this study was to investigate how type 2 DM patients were affected by the lockdown. METHOD Type 2 DM patients unable to attend regular follow-ups due to lockdown over a 75-day period between March and June 2020 and who again attended polyclinic follow-up when the lockdown was lifted were included in the study. These patients' glycemic control and weight status were compared with the pre-lockdown period. In addition, patients' general habits, and adherence to diet and exercise were evaluated, while their general health was assessed using the Short-Form 36-item survey. RESULT The research involved 101 type 2 DM patients, 57 men (56.5%) and 44 women (44.5%), with a mean age of 55 ± 13. Patients' mean pre-lockdown weight was 84.7 ± 16.4 kg, rising to 85.5 ± 16.8 kg post-lockdown, although the increase was not statistically significant (p = 0.781). In terms of glycemic parameters, Hba1c rose from 7.67 ± 1.76 to 8.11 ± 2.48, and fasting glucose from 157.9 (83-645) mg/dl to 163.2 (84-550) mg/dl, none of which were statistically significant (p = 0.253, p = 0.079, respectively). CONCLUSION In addition to weight gain among type 2 DM patients during the Covid 19 lockdown, statistically insignificant increases were also observed in such glycemic parameters. This was a small sample and further studies with larger sample are needed.
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Affiliation(s)
- Attila Önmez
- Department of Internal Medicine, Duzce University Medical Faculty, Duzce, Turkey.
| | - Zerrin Gamsızkan
- Department of Family Medicine, Duzce University Medical Faculty, Duzce, Turkey.
| | - Şeyma Özdemir
- Department of Internal Medicine, Duzce University Medical Faculty, Duzce, Turkey.
| | - Enis Kesikbaş
- Department of Internal Medicine, Duzce University Medical Faculty, Duzce, Turkey.
| | | | - Serkan Torun
- Department of Internal Medicine, Duzce University Medical Faculty, Duzce, Turkey.
| | - Hakan Cinemre
- Department of Internal Medicine, Sakarya University Medical Faculty, Sakarya, Turkey.
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Lambadiari V, Korakas E, Tsimihodimos V. The Impact of Dietary Glycemic Index and Glycemic Load on Postprandial Lipid Kinetics, Dyslipidemia and Cardiovascular Risk. Nutrients 2020; 12:E2204. [PMID: 32722053 PMCID: PMC7468809 DOI: 10.3390/nu12082204] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
Many recent studies have acknowledged postprandial hypetriglyceridemia as a distinct risk factor for cardiovascular disease. This dysmetabolic state is the result of the hepatic overproduction of very low-density lipoproteins (VLDLs) and intestinal secretion of chylomicrons (CMs), which leads to highly atherogenic particles and endothelial inflammation. Postprandial lipid metabolism does not only depend on consumed fat but also on the other classes of nutrients that a meal contains. Various mechanisms through which carbohydrates exacerbate lipidemia have been identified, especially for fructose, which stimulates de novo lipogenesis. Glycemic index and glycemic load, despite their intrinsic limitations, have been used as markers of the postprandial glucose and insulin response, and their association with metabolic health and cardiovascular events has been extensively studied with contradictory results. This review aims to discuss the importance and pathogenesis of postprandial hypertriglyceridemia and its association with cardiovascular disease. Then, we describe the mechanisms through which carbohydrates influence lipidemia and, through a brief presentation of the available clinical studies on glycemic index/glycemic load, we discuss the association of these indices with atherogenic dyslipidemia and address possible concerns and implications for everyday practice.
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Affiliation(s)
- Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, 124 62 Haidari, Greece;
| | - Emmanouil Korakas
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, 124 62 Haidari, Greece;
| | - Vasilios Tsimihodimos
- Department of Internal Medicine, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece;
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Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, Lei F, Wang H, Xie J, Wang W, Li H, Zhang P, Song X, Chen X, Xiang M, Zhang C, Bai L, Xiang D, Chen MM, Liu Y, Yan Y, Liu M, Mao W, Zou J, Liu L, Chen G, Luo P, Xiao B, Zhang C, Zhang Z, Lu Z, Wang J, Lu H, Xia X, Wang D, Liao X, Peng G, Ye P, Yang J, Yuan Y, Huang X, Guo J, Zhang BH, Li H. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab 2020; 31:1068-1077.e3. [PMID: 32369736 PMCID: PMC7252168 DOI: 10.1016/j.cmet.2020.04.021] [Citation(s) in RCA: 1024] [Impact Index Per Article: 256.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023]
Abstract
Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.
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Affiliation(s)
- Lihua Zhu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Xu Cheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Juan-Juan Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Xiao-Jing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410000, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Haitao Wang
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430072, China
| | - Jing Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China
| | - Wenxin Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Haomiao Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Peng Zhang
- Institute of Model Animal, Wuhan University, Wuhan 430072, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430072, China
| | - Xiaohui Song
- Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Xi Chen
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430072, China
| | - Mei Xiang
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430072, China
| | - Chaozheng Zhang
- Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Liangjie Bai
- Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Da Xiang
- Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Ming-Ming Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Yanqiong Liu
- Institute of Model Animal, Wuhan University, Wuhan 430072, China
| | - Youqin Yan
- Wuhan Seventh Hospital, Wuhan 430072, China
| | - Mingyu Liu
- The Ninth Hospital of Wuhan City, Wuhan 430072, China
| | - Weiming Mao
- Department of General Surgery, Huanggang Central Hospital, Huanggang 438000, China
| | - Jinjing Zou
- Department of Pulmonary and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430072, China
| | - Liming Liu
- Department of General Surgery, Ezhou Central Hospital, Ezhou 436000, China
| | - Guohua Chen
- Department of Neurology, Wuhan First Hospital/Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan 430072, China
| | - Pengcheng Luo
- Department of Urology, Wuhan Third Hospital and Tongren Hospital of Wuhan University, Wuhan 430072, China
| | - Bing Xiao
- Department of Stomatology, Xiantao First People's Hospital, Xiantao 433000, China
| | - Changjiang Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China
| | - Zixiong Zhang
- The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China
| | - Zhigang Lu
- Department of Neurology, The First People's Hospital of Jingmen affiliated to Hubei Minzu University, Jingmen 448000, China
| | - Junhai Wang
- Department of Orthopedics, The First People's Hospital of Jingmen affiliated to Hubei Minzu University, Jingmen 448000 China
| | - Haofeng Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Changjiang University, Jingzhou 434000, China
| | - Xigang Xia
- Department of Hepatobiliary Surgery, Jingzhou Central Hospital, Jingzhou 434000, China
| | - Daihong Wang
- Department of Hepatobiliary and Pancreatic Surgery, Xianning Central Hospital, Xianning 437000, China
| | - Xiaofeng Liao
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - Gang Peng
- Department of Hepatobiliary and Pancreatic Surgery, Suizhou Central Hospital Affiliated to Hubei Medical College, Suizhou 441300, China
| | - Ping Ye
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430072, China
| | - Jun Yang
- Department of Cardiology, The First College of Clinical Medical Science, China Three Gorges University and Yichang Central People's Hospital and Institute of Cardiovascular Diseases, China Three Gorges University, Yichang 443000, China
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430072, China
| | - Xiaodong Huang
- Department of Gastroenterology, Wuhan Third Hospital and Tongren Hospital of Wuhan University, Wuhan 430072, China.
| | - Jiao Guo
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine & Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China and Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou 510006, China.
| | - Bing-Hong Zhang
- Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan 430072, China.
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430072, China; Basic Medical School, Wuhan University, Wuhan 430072, China.
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Zhang Y, Dai J, Han X, Zhao Y, Zhang H, Liu X, Li W, Ling H, Zhou X, Ying C. Glycemic variability indices determined by self-monitoring of blood glucose are associated with β-cell function in Chinese patients with type 2 diabetes. Diabetes Res Clin Pract 2020; 164:108152. [PMID: 32360707 DOI: 10.1016/j.diabres.2020.108152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Glycemic control plays an important role in diabetes management, and self-monitoring of blood glucose (SMBG) is critical to achieving good glycemic control. However, there are few studies about the relationship between SMBG-estimated glycemic indices and β-cell function. Here we investigated the association between glucose variation indices estimated by SMBG and β-cell function among Chinese patients with type 2 diabetes mellitus (T2DM). METHODS In this cross‑sectional study, 397 patients with T2DM were recruited from February 2015 to October 2016. β-cell function was monitored using the Homeostasis Model Assessment 2 (HOMA2)-%β index. The parameters evaluated by SMBG were the mean blood glucose (MBG), standard deviation of MBG (SDBG), largest amplitude of glycemic excursions (LAGE), and postprandial glucose excursion (PPGE). RESULTS HOMA2-%β was negatively correlated with SDBG, LAGE, PPGE, and MBG (r = -0.350, -0.346, -0.178, and -0.631, respectively; all p < 0.01). After adjusting for confounding characteristics (diabetic duration, triglyceride, total cholesterol, fasting C-peptide, HOMA2-insulin resistance index, hypoglycemia, and diabetic treatments) and glycated hemoglobin A1c on a continuous scale, odds ratios of SDBG, LAGE, PPGE, and MBG between the patients in the lowest and highest HOMA2-%β quartiles were 2.02 (1.14-3.57), 1.24 (1.04-1.49), 1.13 (0.86-1.51), and 2.26 (1.70-3.00). HOMA2-%β was independently associated with SDBG, LAGE, and MBG. CONCLUSIONS Increased SDBG and LAGE assessed by SMBG are associated with β-cell dysfunction in Chinese patients with T2DM.
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Affiliation(s)
- Yusheng Zhang
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Jiao Dai
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Xiao Han
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Yue Zhao
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Hui Zhang
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Xuan Liu
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Wei Li
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Hongwei Ling
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Xiaoyan Zhou
- Laboratory of Morphology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, PR China
| | - Changjiang Ying
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China.
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Taheri S, Zaghloul H, Chagoury O, Elhadad S, Ahmed SH, El Khatib N, Amona RA, El Nahas K, Suleiman N, Alnaama A, Al-Hamaq A, Charlson M, Wells MT, Al-Abdulla S, Abou-Samra AB. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol 2020; 8:477-489. [PMID: 32445735 DOI: 10.1016/s2213-8587(20)30117-0] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 2 diabetes is affecting people at an increasingly younger age, particularly in the Middle East and in north Africa. We aimed to assess whether an intensive lifestyle intervention would lead to significant weight loss and improved glycaemia in young individuals with early diabetes. METHODS This open-label, parallel-group, randomised controlled trial (DIADEM-I), done in primary care and community settings in Qatar, compared the effects of an intensive lifestyle intervention with usual medical care on weight loss and glycaemic outcomes in individuals with type 2 diabetes, aged 18-50 years, with a short diabetes duration (≤3 years), had a BMI of 27·0 kg/m2 or more, and who were from the Middle East and north Africa region. Participants were randomly allocated (1:1) either to the intensive lifestyle intervention group or the usual medical care control group by a computer-generated sequence and an online randomisation service. The intensive lifestyle intervention comprised a total diet replacement phase, in which participants were given formula low-energy diet meal replacement products followed by gradual food reintroduction combined with physical activity support, and a weight-loss maintenance phase, involving structured lifestyle support. Participants in the control group received usual diabetes care, which was based on clinical guidelines. The primary outcome was weight loss at 12 months after receiving the assigned intervention. Our analysis was based on the intention-to-treat principle. Key secondary outcomes included diabetes control and remission. The trial was registered with the ISRCTN registry, ISRCTN20754766, and ClinicalTrials.gov, NCT03225339. FINDINGS Between July 16, 2017, and Sept 30, 2018, we enrolled and randomly assigned 158 participants (n=79 in each group) to the study. 147 participants (70 in the intervention group and 77 in the control group) were included in the final intention-to-treat analysis population. Between baseline and 12 months, the mean bodyweight of participants in the intervention group reduced by 11·98 kg (95% CI 9·72 to 14·23) compared with 3·98 kg (2·78 to 5·18) in the control group (adjusted mean difference -6·08 kg [95% CI -8·37 to -3·79], p<0·0001). In the intervention group, 21% of participants achieved more than 15% weight loss between baseline and 12 months compared with 1% of participants in the control group (p<0·0001). Diabetes remission occurred in 61% of participants in the intervention group compared with 12% of those in the control group (odds ratio [OR] 12·03 [95% CI 5·17 to 28·03], p<0·0001). 33% of participants in the intervention group had normoglycaemia compared with 4% of participants in the control group (OR 12·07 [3·43 to 42·45], p<0·0001). Five serious adverse events were reported in four participants in the control group; four admissions to hospital because of unanticipated events (supraventricular tachycardia, abdominal pain, pneumonia, and epididymo-orchitis), and one admission to hospital for an anticipanted event (hyperglycaemia). INTERPRETATION Our findings show that the intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants. The provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and wellbeing. FUNDING Qatar National Research Fund.
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Affiliation(s)
- Shahrad Taheri
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, New York, NY, USA; Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Hadeel Zaghloul
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Odette Chagoury
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar
| | - Sara Elhadad
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar
| | - Salma Hayder Ahmed
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar
| | - Neda El Khatib
- Qatar Diabetes Association, Qatar Foundation, Doha, Qatar
| | | | - Katie El Nahas
- Qatar Diabetes Association, Qatar Foundation, Doha, Qatar
| | - Noor Suleiman
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar; Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mary Charlson
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Martin T Wells
- University Department of Statistics and Data Science, Cornell University, Ithaca, New York, NY, USA
| | | | - Abdul Badi Abou-Samra
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar; Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
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Abstract
There is no question that elevated postprandial glycemia is a significant driver of common chronic diseases globally [...].
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Affiliation(s)
- Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney 2006, Australia
- Correspondence:
| | - Anette E. Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany;
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Kim SY, Woo HW, Lee YH, Shin DH, Shin MH, Choi BY, Kim MK. Association of dietary glycaemic index, glycaemic load, and total carbohydrates with incidence of type-2 diabetes in adults aged ≥40 years: The Multi-Rural Communities Cohort (MRCohort). Diabetes Res Clin Pract 2020; 160:108007. [PMID: 31953108 DOI: 10.1016/j.diabres.2020.108007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/09/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022]
Abstract
AIMS To examine potential associations between the glycaemic index (GI), glycaemic load (GL), and carbohydrates and the incidence risk of type-2 diabetes (T2D) and the effect modification of obesity among Korean adults aged ≥40 years. METHOD Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2D were estimated in 8310 participants using a modified Poisson regression model. Dietary indices were averaged using repeated dietary assessments during follow-up. RESULT After adjusting for potential confounders, a positive association between GI and T2D was found among women (IRR = 1.63, 95% CI = 1.06-2.51 in the highest tertile (T3) vs. the lowest tertile (T1) for GI, p trend = 0.0310), but not for GL and carbohydrate intake. This positive association with GI was stronger in obese women (IRR = 1.91, 95% CI: 1.15-3.19 in T3 vs. T1, p trend = 0.0137 for body mass index ≥23 kg/m2; IRR = 2.35, 95% CI: 1.01-5.48, p trend = 0.0350 for waist circumference (WC) ≥ 85 cm). In men, there was no association before stratification by obesity, but IRRs of GI (T3 vs. T1) were significant and stronger with increased WCs (IRR = 2.26, 95% CI: 1.02-4.98, p trend = 0.0439 for WC ≥ 90 cm). CONCLUSION GI may be positively associated with the incidence of T2D in women, particularly in obese women. The association of GI with T2D incidence risk may also be positive even in men with high WC.
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Affiliation(s)
- Se Young Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Division of Cancer Registration & Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Hye Won Woo
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, South Korea
| | - Dong Hoon Shin
- Department of Preventive Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea.
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Abstract
Of all the novel glucoregulatory molecules discovered in the past 20 years, bile acids (BAs) are notable for the fact that they were hiding in plain sight. BAs were well known for their requirement in dietary lipid absorption and biliary cholesterol secretion, due to their micelle-forming properties. However, it was not until 1999 that BAs were discovered to be endogenous ligands for the nuclear receptor FXR. Since that time, BAs have been shown to act through multiple receptors (PXR, VDR, TGR5 and S1PR2), as well as to have receptor-independent mechanisms (membrane dynamics, allosteric modulation of N-acyl phosphatidylethanolamine phospholipase D). We now also have an appreciation of the range of physiological, pathophysiological and therapeutic conditions in which endogenous BAs are altered, raising the possibility that BAs contribute to the effects of these conditions on glycaemia. In this Review, we highlight the mechanisms by which BAs regulate glucose homeostasis and the settings in which endogenous BAs are altered, and provide suggestions for future research.
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Affiliation(s)
- Tiara R Ahmad
- Naomi Berrie Diabetes Center, Columbia University Medical Center, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Rebecca A Haeusler
- Naomi Berrie Diabetes Center, Columbia University Medical Center, New York, NY, USA.
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA.
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Stillman MD, Williams S. Guideline for the identification and management of cardiometabolic risk after spinal cord injury: a case of unsubstantiated recommendations. Spinal Cord Ser Cases 2019; 5:97. [PMID: 31798972 PMCID: PMC6881404 DOI: 10.1038/s41394-019-0240-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
The 2018 Guideline for the Identification and Management of Cardiometabolic Risk after Spinal Cord Injury (SCI) represented the first concerted effort to address a cluster of derangements and diseases that are claiming the lives of individuals living with injuries. Its contributors and authors scoured the literature, weighed the validity, importance, and clinical relevance of what data they found, and collaborated in an effort to meaningfully improve the health and lives of people with SCI. However, we are concerned that several of the guideline's central recommendations-particularly around screening for and detection of glycemic dysregulation and dyslipidemia-have been offered prematurely. In several instances, the authors cite data from studies of people without SCI and, in our opinion, inappropriately apply those findings to support their SCI-specific suggestions. In other instances, they recommend that we employ tests whose usefulness and clinical relevance have yet to be demonstrated among people living with injuries. In short, we fear that the authors have developed clinical guidelines that are inadequately supported by data. This guideline is an extraordinary show of collaboration, and is an important first step toward understanding and treating a number of secondary cardiometabolic effects of SCI. The lack of data underpinning several of its central recommendations-making them, in our opinion, unadoptable-underscores the inadequacy of research in this area and provides a roadmap for future investigative efforts.
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Affiliation(s)
- Michael D. Stillman
- Internal Medicine and Rehabilitation Medicine, Sydney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA
| | - Steve Williams
- Rehabilitation Medicine, Sydney Kimmel Medical College, Philadelphia, PA USA
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Abstract
Over the past 30 years, a significant increase in the prevalence of insulin resistance (IR) has been observed. It is associated with more frequent occurrence of impaired glucose tolerance, diabetes, excessive weight, cardiovascular diseases, and endocrine disorders. The results of current studies do not indicate a necessity to exclude dairy products from the diet of insulin-resistant individuals. In addition, it has been found that moderate amounts of alcohol as part of a balanced, low-energy diet do not have a negative effect on insulin sensitivity. The authors of recent studies emphasize the importance of reducing the intake of simple sugars, especially from sweet drinks, sweets and excessive fruit juice consuption. Many studies have demonstrated the beneficial effects of consuming complex, low-glycemic-index carbohydrates that are rich in dietary fiber. An insulin-resistant patient's diet should be rich in whole grains and high amounts of non-starchy vegetables and raw fruit. The beneficial effect of the Dietary Approaches to Stop Hypertension (DASH diet) and the Mediterranean diet has been confirmed. The positive correlation between low-carbohydrate and very-low-carbohydrate diets requires confirmation in long-term studies with the participation of insulin-resistant patients. Research shows the benefits of increased calorific intake during the first half of the day, especially from a high-energy and low-glycemic-index breakfast. Furthermore, many researchers indicate that slow and mindful eating is a significant component of an appropriate diet for insulin-resistant individuals.
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Affiliation(s)
| | - Bożena Regulska-Ilow
- Department of Dietetics, Faculty of Health Sciences, Wroclaw Medical University, Poland
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Raczkowska E, Bronkowska M. The Effect of the Body Mass Indexes of Young Healthy Individuals on the Glyacemic Indexes of Traditional and Modified Vegetarian Meals. Nutrients 2019; 11:nu11102546. [PMID: 31652553 PMCID: PMC6835997 DOI: 10.3390/nu11102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022] Open
Abstract
Blood glucose concentration increases after the consumption of any carbohydrate-containing meal. Several factors affect the course of glucose metabolism, including nutritional status. This study evaluated the effect of the nutritional statuses of adults on their glycaemic responses after the consumption of some vegetarian meals (dumplings with potato and curd cheese stuffing; curd cheese dumplings; pancakes with curd cheese), prepared according to the traditional recipe and a partly modified recipe. The 105 participants, aged 20-27 years, with different body mass indexes (BMI), took an oral glucose tolerance test after the intake of a standard glucose solution, and also after each meal (previously analysed for energy value and approximate composition). The consumption of each meal by participants with different nutritional statuses elicited different glycaemic responses, which were reflected in the diverse glycaemic indexes (GIs). The partial modification of the meal recipes contributed to lowering their GIs. Vast differences were observed in the glycaemic responses among the surveyed participants after the consumption of the same meals. The GIs of meals should be determined in different groups of people.
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Affiliation(s)
- Ewa Raczkowska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland.
| | - Monika Bronkowska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland.
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Akhtar S, Layla A, Sestili P, Ismail T, Afzal K, Rizvanov AA, Asad MHHB. Glycemic and Insulinemic Responses of Vegetables and Beans Powders Supplemented Chapattis in Healthy Humans: A Randomized, Crossover Trial. Biomed Res Int 2019; 2019:7425367. [PMID: 31737676 PMCID: PMC6817945 DOI: 10.1155/2019/7425367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/28/2022]
Abstract
Vegetables and beans are nutrient-dense foods with innate potential to mediate diabetes in a variety of cultures. The present study aims at evaluating vegetables and beans for assessing their glycemic index and response in raising glucose levels in human model. Powdered formulations of vegetables and beans were designed to modulate glycemic response of carbohydrate-rich staples. A randomized, crossover trial was conducted in healthy young adults (n = 24) who were challenged with vegetable powder-supplemented chapatti (VPSC), bean powder-supplemented chapatti (BPSC) and all-purpose wheat flour chapatti (APFC) to evaluate their postprandial glucose (PPG) and postprandial insulin (PPI) responses. In comparison with APFC, feeding VPSC and BPSC to healthy volunteers anticipated significant reduction in PPG (44% reduction in incremental area under the curve (AUC) for VPSC and 46% reduction in incremental AUC for BPSC, p = 0.005). Likewise, significant reduction in PPI levels was observed for VPSC (59%, p = 0.012) and BPSC (47%, p = 0.002) compared to APFC-treated group. The study concludes wheat flour enrichment with vegetables and beans powder as a viable approach to develop cost effective and culturally acceptable low glycemic foods bearing acceptable sensory attributes.
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Affiliation(s)
- Saeed Akhtar
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Anam Layla
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Piero Sestili
- Department of Biomolecular Sciences, Sports Science and Health Department, University of Urbino ‘‘Carlo Bo” Via ‘‘The Maggetti”, 2661029 Urbino, PU, Italy
| | - Tariq Ismail
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Khurram Afzal
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Albert A. Rizvanov
- Institute of Fundamental Medicine and Biology, Department of Genetics, Kazan Federal University, Kazan, Russia
| | - Muhammad Hassham Hassan Bin Asad
- Institute of Fundamental Medicine and Biology, Department of Genetics, Kazan Federal University, Kazan, Russia
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, 22060, Islamabad, Pakistan
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Yang Y, Zhang B, Nakata M, Nakae J, Mori M, Yada T. Islet β-cell-produced NUCB2/nesfatin-1 maintains insulin secretion and glycemia along with suppressing UCP-2 in β-cells. J Physiol Sci 2019; 69:733-739. [PMID: 31228099 PMCID: PMC10717817 DOI: 10.1007/s12576-019-00689-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/11/2019] [Indexed: 01/29/2023]
Abstract
Nesfatin-1 is a hypothalamic anorexigenic peptide processed from nucleobindin 2 (NUCB2). Central and peripheral administration of NUCB2/nesfatin-1 enhances glucose metabolism and insulin release. NUCB2/nesfatin-1 is also localized in pancreatic islets, while its function remains unknown. To explore the role of pancreatic β-cell-produced NUCB2/nesfatin-1, we developed pancreatic β-cell-specific NUCB2 knockout (βNUCB2 KO) mice and NUCB2 gene knockdown (shNUCB2) MIN6 β-cell line. In βNUCB2 KO mice, casual blood glucose was elevated from 12 weeks of age. In a glucose tolerance test at 12 weeks, insulin secretion at 15 min was reduced and blood glucose at 2 h increased in βNUCB2 KO mice fasted 8 h. In islets isolated from βNUCB2 KO mice, high glucose-stimulated insulin secretion (GSIS) was impaired. In shNUCB2 MIN6 cells, GSIS was reduced and UCP-2 mRNA expression was elevated. These results show impaired GSIS possibly associated with UCP-2 overexpression in NUCB2-silenced β-cells, suggesting that β-cell-produced NUCB2/nesfatin-1 maintains GSIS and thereby glycemia.
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Affiliation(s)
- Yifei Yang
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, 329-0498, Japan
- Division of Integrative Physiology, Kansai Electric Power Medical Research Institute, 1-5-6 Minatojimaminamimachi, Chuou-ku, Kobe, 650-0047, Japan
- Division of System Neuroscience, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Boyang Zhang
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, 329-0498, Japan
- Department of Physiology, Wakayama Medical University School of Medicine, Wakayama, 641-8509, Japan
| | - Masanori Nakata
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, 329-0498, Japan
- Department of Physiology, Wakayama Medical University School of Medicine, Wakayama, 641-8509, Japan
| | - Jun Nakae
- Center for Medical Science, International University of Health and Welfare, 2600-1 Kitakanemaru, Ohtawara, 324-8501, Japan
| | - Masatomo Mori
- Kitakanto Molecular Novel Research Institute for Obesity and Metabolism, Midori, Gunma, 379-2311, Japan
| | - Toshihiko Yada
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, 329-0498, Japan.
- Division of Integrative Physiology, Kansai Electric Power Medical Research Institute, 1-5-6 Minatojimaminamimachi, Chuou-ku, Kobe, 650-0047, Japan.
- Division of System Neuroscience, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.
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Afroz A, Ali L, Karim MN, Alramadan MJ, Alam K, Magliano DJ, Billah B. Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan. Sci Rep 2019; 9:10248. [PMID: 31308457 PMCID: PMC6629620 DOI: 10.1038/s41598-019-46766-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/28/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.
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Affiliation(s)
- Afsana Afroz
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Liaquat Ali
- Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mohammed J Alramadan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Khurshid Alam
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Dianna J Magliano
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- BakerIDI Heart and Diabetes Institute, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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Chen LW, Navarro P, Murrin CM, Mehegan J, Kelleher CC, Phillips CM. Maternal Dietary Glycemic and Insulinemic Indexes Are Not Associated with Birth Outcomes or Childhood Adiposity at 5 Years of Age in an Irish Cohort Study. J Nutr 2019; 149:1037-1046. [PMID: 31049568 DOI: 10.1093/jn/nxz025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/26/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High maternal dietary glycemic index (GI) and glycemic load (GL) may be associated with adverse offspring birth and postnatal adiposity outcomes through metabolic programming, but the evidence thus far, mainly from studies conducted in high-risk pregnant populations, has been inconclusive. No study has examined the influence of maternal insulin demand [measured by food insulinemic index (II) and insulinemic load (IL)] on offspring outcomes. OBJECTIVES We investigated associations between maternal GI, GL, II, and IL and offspring birth outcomes and postnatal adiposity in a general pregnant population. METHODS The study was based on data from 842 mother-child pairs from the Lifeways prospective cohort study in Ireland. Through the use of standard methodology, maternal GI, GL, II, and IL were derived from dietary information obtained via a validated food-frequency questionnaire in early pregnancy (12-16 wk). Birth outcomes were abstracted from hospital records. At 5-y follow-up, children's body mass index (BMI) and waist circumference were measured. Associations were assessed through the use of multivariable-adjusted regression analysis. RESULTS Mothers had a mean ± SD age of 30.3 ± 5.7 y and a mean BMI (kg/m2) of 23.9 ± 4.2. The mean ± SD for dietary glycemic and insulinemic indexes were: GI = 58.9 ± 4.4; GL = 152 ± 49; II = 57.4 ± 14.5; IL = 673 ± 267. After adjustment for confounders, no consistent associations were observed between maternal GI, GL, II, and IL and birth outcomes including birth weight, macrosomia, gestational age, and postterm births. Similarly, no association was observed with BMI and waist circumference z scores and childhood obesity (general and central) at 5-y follow-up. There was no evidence of a nonlinear relation between the studied indexes and outcomes. CONCLUSIONS We observed no clear relation between maternal GI, GL, II, and IL and offspring birth outcomes and childhood obesity in a general pregnant population.
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Affiliation(s)
- Ling-Wei Chen
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Pilar Navarro
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Celine M Murrin
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - John Mehegan
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Cecily C Kelleher
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
| | - Catherine M Phillips
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Republic of Ireland
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Nielsen LV, Nyby S, Klingenberg L, Ritz C, Sundekilde UK, Bertram HC, Westerterp-Plantenga MS, Liaset B, Kristiansen K, Madsen L, Raben A. Salmon in Combination with High Glycemic Index Carbohydrates Increases Diet-Induced Thermogenesis Compared with Salmon with Low Glycemic Index Carbohydrates⁻An Acute Randomized Cross-Over Meal Test Study. Nutrients 2019; 11:nu11020365. [PMID: 30744149 PMCID: PMC6412964 DOI: 10.3390/nu11020365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 11/16/2022] Open
Abstract
The study investigated the acute effects of meals containing either salmon or veal in combination with carbohydrates with high or low glycemic index (GI) on diet-induced thermogenesis (DIT) (primary endpoint), appetite sensations, and energy intake (EI). Twenty-five overweight men and women ingested four iso-caloric test meals: salmon with mashed potatoes (high GI) (SM), salmon with wholegrain pasta (low GI) (SP), veal with mashed potatoes (VM) and veal with wholegrain pasta (VP). Energy expenditure was measured in the fasting state and six times postprandially for 25 min with 5-min breaks between each measurement. Appetite sensations were measured every 30 min. Blood samples, from arterialized venous blood, were drawn every 20 min until an ad libitum buffet-style lunch was served 3.5 h later. DIT was 40% higher after the SM meal compared to the SP meal (p = 0.002). Prospective food consumption was lower after the SM meal compared with the VP meal (p = 0.01). There were no differences in satiety, hunger, fullness, or ad libitum EI between the test meals (all p > 0.05). In conclusion, salmon with high GI carbohydrates increased DIT compared to salmon with low GI carbohydrates. This indicates that DIT is sensitive to the GI of the carbohydrates after intake of salmon but not veal.
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Affiliation(s)
- Lone V Nielsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark.
| | - Signe Nyby
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark.
- Department of Biology, University of Copenhagen, 2200 København N, Denmark.
| | - Lars Klingenberg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark.
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark.
| | | | - Hanne C Bertram
- Department of Food Science, Aarhus University, 5792 Aarslev, Denmark.
| | - Margriet S Westerterp-Plantenga
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Bjørn Liaset
- Institute of Marine Research, 5005 Bergen, Norway.
| | | | - Lise Madsen
- Department of Biology, University of Copenhagen, 2200 København N, Denmark.
- Institute of Marine Research, 5005 Bergen, Norway.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark.
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Abstract
BACKGROUND Subclinical inflammation and presence of almost all indicators of systemic inflammation are found in type 2 diabetic patients. Such a systemic and subclinical inflammatory process can be characterized by elevated circulating levels of inflammatory markers. AIM To study the state of subclinical inflammation in patients with type 2 diabetes mellitus and establish a correlation between glycemic control and inflammatory markers. METHODS This research included 90 subjects divided into 2 groups; Group A: 70 patients with type 2 diabetes and Group B: 20 Age and sex matched people as the control group. All patients were clinically examined, had laboratory investigations including; fasting and 2 h postprandial blood sugar, HbA1c, serum ferritin., high sensitivity C-reactive protein hs-CRP, kidney functions tests, liver function tests, complete blood count and erythrocyte sedimentation rate and antinuclear antibody. RESULTS The estimated levels of ESR, FBS, serum ferritin, hs-CRP and HbA1c in T2DM were 10.69 ± 3.05, 186.01 ± 92.21, 6005.2 ± 2639.83, 155.75 ± 73.95, 7.5 ± 3.23, respectively. In a similar way, in control subject, the estimated levels for respective parameters were 12.4 ± 3.41, 83.25 ± 6.25, 45.088 ± 39.35, 19.97 ± 18.51, 4.555 ± 0.58, respectively. Mean values of all parameters, except ESR, were found to be significantly augmented in T2DM subjects when compared to control group. There is significant positive correlation between HbA1c and hs-CRP (r=0.761, p < 0.001). Moreover, serum ferritin has shown significant positive correlation with HbA1c (r = 0.853, p < 0.001). CONCLUSION Strong correlation between inflammation and glycemic control in patient with type 2 diabetes mellitus suggests that inflammation plays an important role in the pathogenesis of diabetes.
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Affiliation(s)
- Hanan Elimam
- Biochemistry Department, Faculty of Pharmacy, University of Sadat City, Sadat City, Egypt.
| | - Azza M Abdulla
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Egypt
| | - Inas Mohamed Taha
- Internal Medicine Department, Faculty of Medicine, Taibah University, Saudi Arabia
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Hokka M, Egi M, Mizobuchi S. Glycated hemoglobin A1c level on the day of emergency surgery is a marker of premorbid glycemic control: a retrospective observational study. BMC Anesthesiol 2018; 18:180. [PMID: 30501609 PMCID: PMC6267889 DOI: 10.1186/s12871-018-0641-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Current international guideline recommends to maintain blood glucose level ≤ 180 mg/dL in acute ill patients, irrespective of presence of premorbid diabetes. However, there are studies suggested that optimal acute glycemic control should be adjusted according to premorbid glycemic control in patients with chronic hyperglycemia. Accordingly, to obtain the information of premorbid glycemic control would be relevant. However, the HbA1c level on the day of the emergency operation (HbA1c-ope) might not be useful as a surrogate of premorbid chronic glycemic control, since glucose metabolism can be affected by inflammation, severity of illness and surgical invasion. METHODS We hypothesized that HbA1c-ope reflects pre-morbid glycemic control. To assess this hypothesis, we conducted a single-center retrospective observational study to assess the association between HbA1c-ope and HbA1c level measured within 30 days before the operation (HbA1c-pre). We screened patients who had been admitted to the ICU of our hospital after emergency surgery during the period from January 2008 to December 2016. Patients in whom both of HbA1c-ope and HbA1c-pre were measured were included in this study. We compared HbA1c-ope and HbA1c-pre using the paired t-test. The correlation between the two HbA1c measurements was assessed using Pearson's correlation coefficient. Its agreement was assessed using the Bland-Altman approach with 95% confidence intervals. RESULTS We included 48 patients in this study. The mean value of HbA1c-pre was 6.3%, which was not significantly different from the mean value of 6.2% for HbA1c-ope (p = 0.12). There was a significant correlation between HbA1c-pre and HbA1c-ope (r2 = 0.70, p < 0.001). The mean difference between two HbA1c measurements was 0.12% (95% CI: -0.03% to 0.27%). The limit of agreement ranged from - 0.9% to +1.1%. CONCLUSIONS We found that there was a significant correlation between HbA1c-ope and HbA1c-pre. Our findings suggest that HbA1c-ope can be used to estimate previous glycemic control with an acceptable degree of accuracy, enabling personalized glycemic control in the perioperative period.
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Affiliation(s)
- Mai Hokka
- Department of Anesthesiology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe City, 650-0017 Japan
| | - Moritoki Egi
- Department of Anesthesiology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe City, 650-0017 Japan
| | - Satoshi Mizobuchi
- Department of Anesthesiology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe City, 650-0017 Japan
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Chertok Shacham E, Kfir H, Schwartz N, Ishay A. Glycemic control with a basal-bolus insulin protocol in hospitalized diabetic patients treated with glucocorticoids: a retrospective cohort study. BMC Endocr Disord 2018; 18:75. [PMID: 30373567 PMCID: PMC6206674 DOI: 10.1186/s12902-018-0300-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/02/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Improved glycemic control is the desired outcome after the discharge of patients with diabetes. We aimed to determine the efficacy of a basal-bolus insulin protocol in hospitalized patients with diabetes treated with glucocorticoids. METHODS A retrospective cohort study compared the glycemic control of 150 hospitalized patients with diabetes and elevated inflammatory markers who were either treated with (n = 61) or without glucocorticoids (n = 89). All patients were treated with a basal-bolus regimen. RESULTS Glycosylated hemoglobin A1C (HbA1C) levels, mode of diabetes treatment before admission, length of hospitalization and inflammatory markers were similar in both groups of patients (treated and untreated with glucocorticoid). There was a trend toward female predominance in the glucocorticoid-treated group. Mean daily glucose levels were higher in patients taking glucocorticoids when compared with untreated patients (12.5 ± 2.7 mmol/l vs. 10.9 ± 2.4 mmol/l, p < .0001), and significantly higher at 5:00 PM (13.1 ± 3.4 vs. 10.2 ± 3 mmol/l, p < .0001), and 8:00 P.M. (13.9 ± 4.1 mmol/l vs. 11 ± 3.1 mmol/l, p < 0.001) . No difference was detected between the two groups in prandial and basal insulin doses during hospitalization. Overall, 64% of patients in the glucocorticoid-treated group versus 39% in the untreated group had inadequate glycemic control during hospitalization (p = 0.003). CONCLUSION A significantly higher percentage of patients with diabetes who were treated with glucocorticoids during hospitalization did not achieve glycemic control with a basal-bolus insulin protocol. These patients had significantly higher mean blood glucose levels due to elevated levels in the afternoon and evening. New basal-bolus protocols with appropriate adjustments of short acting insulin are needed to treat patients with diabetes on glucocorticoid therapy.
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Affiliation(s)
- Elena Chertok Shacham
- Endocrinology Unit, Haemek Medical Center, Rabin Ave 21, Afula, Israel, 18134, Afula, Israel.
| | - Hila Kfir
- Endocrinology Unit, Haemek Medical Center, Rabin Ave 21, Afula, Israel, 18134, Afula, Israel
| | - Naama Schwartz
- Statistics Department, Haemek Medical Center, Afula, Israel
| | - Avraham Ishay
- Endocrinology Unit, Haemek Medical Center, Rabin Ave 21, Afula, Israel, 18134, Afula, Israel
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Ballance S, Knutsen SH, Fosvold ØW, Fernandez AS, Monro J. Predicting mixed-meal measured glycaemic index in healthy subjects. Eur J Nutr 2018; 58:2657-2667. [PMID: 30218140 DOI: 10.1007/s00394-018-1813-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/06/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the influence of meal composition on the glycaemic impact of different carbohydrate staples, and the accuracy of "adjusted calculated meal GI" compared with "measured mixed-meal GI". METHODS In a non-blind randomized crossover trial fasted healthy subjects consumed four dinner-type mixed meals of realistic serving size comprising a carbohydrate staple of either mashed potato, pasta, rice or a glucose drink, combined with fixed portions of boiled carrots, poached salmon and herb sauce. Blood samples collected between 0 and 180 min were analysed for glucose and insulin concentrations. Adjusted calculated meal GI values were determined against a 50 g reference glucose drink, and compared to corresponding measured mixed-meal GIs, supplemented with data from four previous mixed-meal postprandial glycaemic response studies. RESULTS The common carbohydrate staples, and the glucose drink, ingested as part of the salmon mixed meal induced a significantly lower post-prandial relative glycaemic response (RGR) and concurrent higher relative insulin response than the same amount of staple eaten alone. Adjusted calculated mixed-meal GI closely predicted measured mixed-meal GI in healthy subjects for 15 out of 17 mixed meals examined, showing the need to account for effects of fat and protein when predicting measured mixed-meal GI. Further, we showed the validity of using customarily consumed food amounts in mixed-meal postprandial RGR study design. CONCLUSIONS Adjusted calculated mixed-meal GI appears a useful model to predict measured mixed-meal GI in healthy subjects and with further development and validation could aid nutrition research and rational design of healthy meals for personalized nutrition and particular consumer groups.
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Affiliation(s)
- Simon Ballance
- Nofima AS, Norwegian Institute of Food, Fisheries and Aquaculture Research, Osloveien 1, 1433, Ås, Norway.
| | - Svein Halvor Knutsen
- Nofima AS, Norwegian Institute of Food, Fisheries and Aquaculture Research, Osloveien 1, 1433, Ås, Norway
| | | | | | - John Monro
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
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Alramadan MJ, Magliano DJ, Almigbal TH, Batais MA, Afroz A, Alramadhan HJ, Mahfoud WF, Alragas AM, Billah B. Glycaemic control for people with type 2 diabetes in Saudi Arabia - an urgent need for a review of management plan. BMC Endocr Disord 2018; 18:62. [PMID: 30200959 PMCID: PMC6131885 DOI: 10.1186/s12902-018-0292-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/29/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The aim of this study was to assess inadequate glycaemic control and its associated factors among people with type 2 diabetes in Saudi Arabia. METHODS A cross-sectional study design was used. Adults with type 2 diabetes attending diabetes centres in Riyadh, Hofuf and Jeddah cities were interviewed and their anthropometrics were measured. Their medical records were also reviewed to collect information related to recent lab tests, medications, and documented comorbidities. Multivariable logistic regression were used for data analysis. RESULTS A total of 1111 participants were recruited in the study. Mean age was 57.6 (±11.1) years, 65.2% of the participants were females, and mean HbA1c was 8.5 ± 1.9%. About three-fourths of participants had inadequate glycaemic control (≥ 7%). Multivariable analysis showed that age ≤ 60 years, longer duration of diabetes, living in a remote location, low household income, low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, low adherence to medication, and using injectable medications were independent risk factors for inadequate glycaemic control. CONCLUSIONS Inadequate glycaemic control is prevalent among people with type 2 diabetes in Saudi Arabia. In order to improve glycaemic control diabetes management plan should aim at controlling the modifiable risk factors which include low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, and low adherence to medications.
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Affiliation(s)
- Mohammed J. Alramadan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dianna J. Magliano
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC Australia
| | | | | | - Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Cheung LTF, Ko GTC, Chow FCC, Kong APS. Association between hedonic hunger and glycemic control in non-obese and obese patients with type 2 diabetes. J Diabetes Investig 2018; 9:1135-1143. [PMID: 29328544 PMCID: PMC6123031 DOI: 10.1111/jdi.12800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/04/2017] [Accepted: 12/27/2017] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION Higher hedonic hunger has been observed in obese individuals compared with those without obesity, but little is known about its association with glycemic management. We aimed to examine the association between hedonic hunger and glycemic control in non-obese and obese patients with type 2 diabetes. MATERIALS AND METHODS Between April and November 2016, a total of 211 type 2 diabetes patients who underwent comprehensive diabetes assessments at a university-affiliated hospital were recruited into two groups according to body mass index: non-obese (body mass index 18.5-24.9 kg/m2 ) and obese (body mass index ≥30 kg/m2 ) groups. All participants completed the Chinese version of the Power of Food Scale (PFS) for assessment of hedonic hunger. Good glycemic control was defined as glycated hemoglobin <7.0%. RESULTS Compared with the non-obese group, the obese group showed higher PFS aggregated and subscale 'food available' scores (both P < 0.05). After adjustment for age, sex, disease duration of diabetes and insulin use, there were positive associations of glycated hemoglobin with PFS aggregated, subscale 'food available' and 'food present' scores in the obese group (all P for trend <0.05). The PFS aggregated score was negatively associated with good glycemic control in obese type 2 diabetes patients after adjustment using logistic regression analysis (adjusted odds ratio 0.42, 95% confidence interval 0.20-0.91, P = 0.027). By contrast, such associations were not observed in non-obese type 2 diabetes patients. CONCLUSIONS Hedonic hunger had an independent and inverse association with good glycemic control in obese Chinese patients with type 2 diabetes, but not in their counterparts without obesity.
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Affiliation(s)
- Lorena Tsui Fun Cheung
- Department of Medicine and TherapeuticsPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
| | - Gary Tin Choi Ko
- Department of Medicine and TherapeuticsPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
| | - Francis Chun Chung Chow
- Department of Medicine and TherapeuticsPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
| | - Alice Pik Shan Kong
- Department of Medicine and TherapeuticsPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
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El Toony LF, Hamad DA, Omar OM. Outcome of focused pre-Ramadan education on metabolic and glycaemic parameters in patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2018; 12:761-767. [PMID: 29729978 DOI: 10.1016/j.dsx.2018.04.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ramadan fasting is associated with the risk of acute complications including hypoglycaemia. Therefore, patients' education before Ramadan and follow up during Ramadan is essential for safe fasting. OBJECTIVES To evaluate the effect of pre-Ramadan education program on biochemical parameters and the risk of hypoglycaemia in patients with type 2 diabetes mellitus. METHODS A prospective interventional controlled design was carried out on 320 Muslim patients with type 2 diabetes. They were divided into 2 groups; the control group (n = 200) who received standard diabetic care and the intervention group (n = 120) who received focused individualized diabetic education sessions before Ramadan. The study was carried out on 3 phases (before, during and after Ramadan). Post-education change of hypoglycaemia risk and biochemical parameters during Ramadan fasting were the primary outcomes. RESULTS Fasting blood glucose decreased significantly during, and after Ramadan in both groups (P < 0.001). Hypoglycaemia during fasting occurred in 4.1% of patients in the intervention group vs. 19.5% in the control group. Post Ramadan reduction of HbA1c < 7% increased statistically significantly in the intervention group (from 20.8% of patients before Ramadan to 55.8% after Ramadan). Low-density lipoprotein cholesterol decreased in the intervention group (P = 0.024). The body weight of the patients did not significantly change in both groups. CONCLUSION There was a significant impact of pre-Ramadan educational program on reduction of hypoglycaemic risk and other acute complications, reduction of low-density lipoprotein cholesterol and improvement of high-density lipoprotein cholesterol. Therefore, it is recommended for the fasting patients especially those with high and very high risk during Ramadan.
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Affiliation(s)
- Lobna F El Toony
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt.
| | - Dina Ali Hamad
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt.
| | - Omar Mohammed Omar
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt.
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Handelsman Y, Wyne K, Cannon A, Shannon M, Schneider D. Glycemic Efficacy, Weight Effects, and Safety of Once-Weekly Glucagon-Like Peptide-1 Receptor Agonists. J Manag Care Spec Pharm 2018; 24:S14-S29. [PMID: 30156445 PMCID: PMC10408429 DOI: 10.18553/jmcp.2018.24.9-a.s14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED This article provides an overview of the efficacy and safety of once-weekly glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the treatment of type 2 diabetes mellitus (T2DM). GLP-1 RAs stimulate pancreatic GLP-1 receptors, which increases insulin secretion, delays gastric emptying, and increases satiety. As a class, GLP-1 RAs lower A1c levels and have been associated with reductions in weight and blood pressure and reduced fluctuations in glucose levels, and they have a low risk of hypoglycemia. Exenatide extended release (ER) and dulaglutide monotherapy have shown similar or superior reductions in A1c and weight compared with various oral antidiabetic drugs (OADs). Semaglutide has been shown to reduce both A1c and body weight compared with placebo and, in head-to-head studies versus both exenatide ER and dulaglutide, showed greater reductions in A1c and body weight. Once-weekly GLP-1 RAs have also been evaluated as add-on therapy in the continuum of care for the treatment of T2DM in combination with a variety of background medications, including 1 or more OADs (metformin, sulfonylureas, and/or thiazolidinediones), basal insulin, and prandial insulin. Gastrointestinal adverse events (e.g., nausea, vomiting, and diarrhea) are the most common side effects with once-weekly GLP-1 RAs. Rates of hypoglycemia, and especially major/severe hypoglycemia, are low with once-weekly GLP-1 RAs but, as expected, are higher when used in combination with sulfonylureas or insulin. These once-weekly GLP-1 RAs provide a safe and effective treatment option for patients with T2DM and may offer improved convenience and possibly greater adherence compared with daily GLP-1 RAs. DISCLOSURES This supplement was funded by Novo Nordisk. Handelsman reports research grants from Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Grifols, Janssen, Lexicon, Merck, Novo Nordisk, Regeneron, and Sanofi; speaker fees from Amarin, Amgen, AstraZeneca, Boehringer Ingelheim-Lilly, Janssen, Merck, Novo Nordisk, Regeneron, and Sanofi; and has served in advisory capacity to Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Intarcia, Janssen, Lilly, Merck, Merck-Pfizer, Novo Nordisk, Regeneron, and Sanofi. Cannon reports speaker fees and owns stock in Novo Nordisk. Shannon reports consultant and speaker fees from Novo Nordisk and Boehringer Ingelheim-Lilly Alliance. Schneider reports advisory board fees from Intarcia, Lilly, and Novo Nordisk. Wyne has nothing to disclose.
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Affiliation(s)
| | - Kathleen Wyne
- 2 The Ohio State University Wexner Medical Center, Columbus
| | | | | | - Doron Schneider
- 5 Jefferson Health at Abington Hospital, Abington, Pennsylvania
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