Applied physiology of glucose control

Reliability and diagnostic performance of a new blood ketone and glucose meter in humans

BACKGROUND

Accurate and reliable monitoring of blood ketone and glucose levels is useful for athletes adhering to a ketogenic diet who want to verify that they are in a state of ketosis and, therefore, accruing performance adaptations. However, the cost of devices and testing materials may prohibit their use. More affordable field testing systems are available, but their accuracy and reliability remain in question. The objectives of this study were to evaluate the agreement between a previously validated ketone and glucose meter (Meter 1 - Precision Xtra) and a more affordable meter that has not been validated (Meter 2 - Keto-Mojo), and also to assess the diagnostic performance of Meter 2 for identifying nutritional ketosis.

METHODS

Thirteen participants (7 females and 6 males; 21.6 ± 3.0 years old) visited the laboratory three times in this randomized, double-blind cross-over design study. Ketone and glucose levels were measured with Meter 1 and Meter 2 twice before and twice after ingestion of a racemic ketone, natural ketone, or maltodextrin supplement. Intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals were calculated to evaluate interrater reliability for Meter 1 and Meter 2. Bland-Altman plots were constructed to visually assess the agreement between devices. Area under the ROC curve analysis was performed to evaluate the diagnostic ability of Meter 2 to detect nutritional ketosis at a threshold ketone level of 0.5 mM as identified by Meter 1.

RESULTS

Reliability between the meters was excellent for measuring ketones (ICC = .968; .942-.981) and good for measuring glucose (ICC = .809; .642-.893), though the Bland-Altman plot revealed substantial differences in agreement for measuring glucose. Area under the ROC curve (Area = 0.913; 0.828-0.998) was excellent for diagnosing nutritional ketosis.

CONCLUSIONS

Both Meter 1 and Meter 2 displayed excellent agreement between each other for ketone measurement. Meter 2 also displayed an excellent level of accuracy for diagnosing nutritional ketosis at a threshold value of 0.5 mM, making it an effective and affordable alternative to more expensive testing devices.

Methanolic leaf exctract of Otostegia integrifolia Benth reduces blood glucose levels in diabetic, glucose loaded and normal rodents

Background

Although the leaves of Otostegia integrifolia traditionally claimed in Ethiopian folklore medicine for management of diabetes mellitus, it has not been validated. The aim of this study was therefore to investigate the antidiabetic activity of Otostegia integrifolia in rodents.

Methods

Male rats or mice were randomly divided into five groups for diabetic, hypoglycemic and glucose tolerance test (OGTT) studies. In all models, group I received Tween 80, 2% v/v, Group II (GL5) treated with 5 mg/kg of glibenclamide and the remaining group: III, IV and V were given the plant extract at doses of 100 mg/kg 200 mg/kg and 400 mg/kg respectively. Blood glucose levels (BGL) were measured by collecting blood samples at different time points. Data was analyzed using one way ANOVA followed by Dunnet’s post hoc test to carry out between and within group comparisons. P < 0.05 was considered as statistically significant.

Results

Inter-group analysis revealed that O. integrifolia at 100 mg/kg and 200 mg/kg reduced the 4^th hour fasting blood BGL significantly (p < 0.001) compared to the control group. The intra-group analysis result has shown O. integrifolia at 200 mg/kg produced a significant (p < 0.05) reduction in BGL at the 1^st, 2^nd, 3rd and 4th hours of post treatment compared to their respective initial levels. Moreover, in the hypoglycemic and OGTT models, O. integrifolia extract at 200 mg/kg, has shown a significant reduction in blood glucose levels compared to negative controls and across all time points.

Conclusion

The crude extract of O. integrifolia has shown significant antidiabetic, hypoglyceamic and oral glucose tolerating effects. The effective dose of the extract was found to be 200 mg/kg in time dependent manner.

Reduced insulin secretion and glucose intolerance are involved in the fasting susceptibility of common vampire bats

Susceptibility during fasting has been reported for the common vampire bat (Desmodus rotundus), to the point of untimely deaths after only 2-3 nights of fasting. To investigate the underlying physiology of this critical metabolic condition, we analyzed serum insulin levels, pancreatic islets morphometry and immunocytochemistry (ICC), static insulin secretion in pancreas fragments, and insulin signaling mechanism in male vampire bats. A glucose tolerance test (ipGTT) was also performed. Serum insulin was found to be lower in fed vampires compared to other mammals, and was significantly reduced after 24h fasting. Morphometrical analyses revealed small irregular pancreatic islets with reduced percentage of β-cell mass compared to other bats. Static insulin secretion analysis showed that glucose-stimulated insulin secretion was impaired, as insulin levels did not reach significance under high glucose concentrations, whereas the response to the amino acid leucin was preserved. Results from ipGTT showed a failure on glucose clearance, indicating glucose intolerance due to diminished pancreatic insulin secretion and/or decreased β-cell response to glucose. In conclusion, data presented here indicate lower insulinemia and impaired insulin secretion in D. rotundus, which is consistent with the limited ability to store body energy reserves, previously reported in these animals. Whether these metabolic and hormonal features are associated with their blood diet remains to be determined. The peculiar food sharing through blood regurgitation, reported to this species, might be an adaptive mechanism overcoming this metabolic susceptibility.

Evaluation of the effects of 80% methanolic leaf extract of Caylusea abyssinica (fresen.) fisch. & Mey. on glucose handling in normal, glucose loaded and diabetic rodents

BACKGROUND

The leaves of Caylusea abyssinica (fresen.) Fisch. & Mey. (Resedaceae), a plant widely distributed in East African countries, have been used for management of diabetes mellitus in Ethiopian folklore medicine. However, its use has not been scientifically validated. The present study was undertaken to investigate antidiabetic effects of the hydroalcoholic leaf extract of C. abyssinica extract in rodents.

MATERIALS AND METHOD

Male Animals were randomly divided into five groups for each diabetic, normoglycemic and oral glucose tolerance test (OGTT) studies. Group 1 served as controls and administered 2% Tween-80 in distilled water, (TW80); Group 2 received 5 mg/kg glibenclamide (GL5); Groups 3, 4 and 5 were given 100 (CA100), 200 (CA200) and 300 (CA300) mg/kg, respectively, of the hydroalcoholic extract of C. abyssinica. Blood samples were then collected at different time points to determine blood glucose levels (BGL). Data were analyzed using one way ANOVA followed by Dunnet's post hoc test and p < 0.05was considered as statistically significant.

RESULTS

In normal mice, CA200 and GL5 induced hypoglycemia starting from the 2nd h but the hypoglycemic effect of CA300 was delayed and appeared at the 4th h (p < 0.05 in all cases). In diabetic mice, BGL was significantly reduced by CA100 (p < 0.05) and CA300 (p < 0.01) starting from the 3rd h, whereas CA200 (p < 0.001) and GL5 (p < 0.05) attained this effect as early as the 2nd h. In OGTT, TW80 (p < 0.01) and CA100 (p < 0.01) brought down BGL significantly at 120 min, while CA200 (p < 0.001) and GL5 (p < 0.001) achieved this effect at 60 min indicating the oral glucose load improving activity of the extract. By contrast, CA300 was observed to have no effect on OGTT. Acute toxicity study revealed the safety of the extract even at a dose of 2000 mg/kg. Preliminary phytochemical study demonstrated the presence of various secondary metabolites, including, among others, saponins, flavonoids and alkaloids.

CONCLUSION

The results indicate that C. abyssinica is endowed with antidiabetic and oral glucose tolerance improving actions, particularly at the dose of 200 mg/kg in experimental animals. These activities of the plant extract may be related to the presence of secondary metabolites implicated in antidiabetic activities of plant extracts via different hepatic and extra-hepatic mechanisms. These results thus support the traditional use of the leaf extract for the management of diabetes mellitus.

A systematic review of the effect of breakfast on the cognitive performance of children and adolescents

Breakfast is recommended as part of a healthy diet because it is associated with healthier macro- and micronutrient intakes, BMI and lifestyle. Breakfast is also widely promoted to improve cognitive function and academic performance, leading to the provision of breakfast initiatives by public health bodies. Despite this positive and intuitive perception of cognitive benefits, there has been no systematic review of the evidence. Systematic review methodology was employed to evaluate the effects of breakfast on cognitive performance in well-nourished children and nutritionally at-risk or stunted children. Acute experimental studies, school feeding programmes and studies of habitual breakfast intake are reviewed. Comparisons of breakfast v. no breakfast and breakfasts differing in energy and macronutrient composition are discussed. Included are forty-five studies described in forty-one papers published between 1950 and 2008. The evidence indicates that breakfast consumption is more beneficial than skipping breakfast, but this effect is more apparent in children whose nutritional status is compromised. There is a lack of research comparing breakfast type, precluding recommendations for the size and composition of an optimal breakfast for children's cognitive function. Few studies examined adolescents. Studies of school breakfast programmes suggest that such interventions can have positive effects on academic performance, but this may be in part explained by the increased school attendance that programmes encourage. The present systematic review considers methodological issues in this field and makes recommendations for future research design and policy priorities.