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Huang WK, Jalleh RJ, Rayner CK, Wu TZ. Management of gestational diabetes mellitus via nutritional interventions: The relevance of gastric emptying. World J Diabetes 2024; 15:1394-1397. [DOI: 10.4239/wjd.v15.i7.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 07/08/2024] Open
Abstract
Gestational diabetes mellitus (GDM) represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term. Lifestyle intervention remains the mainstay for the management of GDM. The efficacy of nutritional approaches (e.g. calorie restriction and small frequent meals) to improving the maternal-neonatal outcomes of GDM was attested to by Chinese population data, discussed in two articles in recent issues of this journal. However, a specific focus on the relevance of postprandial glycaemic control was lacking. Postprandial rather than fasting hyperglycaemia often represents the predominant manifestation of disordered glucose homeostasis in Chinese women with GDM. There is now increasing appreciation that the rate of gastric emptying, which controls the delivery of nutrients for digestion and absorption in the small intestine, is a key determinant of postprandial glycaemia in both health, type 1 and 2 diabetes. It remains to be established whether gastric emptying is abnormally rapid in GDM, particularly among Chinese women, thus contributing to a predisposition to postprandial hyperglycaemia, and if so, how this influences the therapeutic response to nutritional interventions. It is essential that we understand the role of gastric emptying in the regulation of postprandial glycaemia during pregnancy and the potential for its modulation by nutritional strategies in order to improve post-prandial glycaemic control in GDM.
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Affiliation(s)
- Wei-Kun Huang
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5000, Australia
| | - Ryan J Jalleh
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5000, Australia
| | - Christopher K Rayner
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide and Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Tong-Zhi Wu
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5000, Australia
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Li C, Gao Y, Luo T, Qin S, Yao X, Wen Y, Wang X, Zhang J, Zhong Q, Shi H, Liu J. Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention. Front Nutr 2023; 10:1122102. [PMID: 37032785 PMCID: PMC10076760 DOI: 10.3389/fnut.2023.1122102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Background Increased post-prandial glycemic excursions contribute to the development of diabetes and have been observed in women with recent gestational diabetes mellitus (GDM) and with normal glucose tolerance at post-partum. As a convenient meal replacement, low-GI biscuits are helpful for improving glycemic excursions in patients with type 2 diabetes. However, it is unknown whether low-GI biscuits as pre-loads or mid-meal snacks have a better effect in diminishing post-prandial glycemic excursions from the individual level in women with recent GDM. Therefore, the aim of this trial is to tailor a better dietary strategy utilizing low-GI biscuits (Fitmeal) to improve post-prandial glycemic excursions through within-subject comparison in such a population and observe the long-term effect of a tailored dietary approach in glycemic control. Methods We have designed a two-phase trial including a randomized, crossover, non-blinded trial in the first phase, followed by a 4-week tailored intervention in the second phase. A total of 52 post-partum women with recent GDM will be allocated into four meal plans: (1) Fitmeal pre-load 30 min before standard lunch meal (P+L), (2) Fitmeal as a mid-meal snack 2 h before standard lunch meal (S+L), (3) isocaloric standard control with co-ingestion of Fitmeal and standard lunch meal (CL) at the same time, and (4) placebo control with 200 ml of water taken 30 min before standard lunch meal (W + L), on four consecutive days. Acute post-prandial glycemic response (PGR) measured by continuous glucose monitoring (CGM) will be compared among the four meals. In the second phase, all participants will receive a 4-week tailored intervention using Fitmeal as pre-loads or mid-meal snacks based on within-subject PGR results from the first phase. Glycemic metrics, dietary behaviors, and psychosocial factors (e.g., quality of life, self-efficacy, perceived stress, and depression) will be examined at baseline and end-point. Discussion This trial is expected to optimize the use of low-GI biscuits as pre-loads or mid-meal snacks in improving individual post-prandial glycemic excursions among women with recent GDM. Furthermore, the findings of this study will provide novel information on how to deliver an effective dietary intervention at the individual level and guide future clinical practice of medical nutrition therapy for diabetes prevention. Trial registration number Chinese clinical trial registry, ChiCTR2200060923.
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Affiliation(s)
- Chunrong Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Women Health Department, Chengdu Jintang District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Yan Gao
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Tongyong Luo
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Shiji Qin
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xue Yao
- Healthcare Department, Chengdu Jinjiang District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Ye Wen
- Chengdu Tianyi Cuisine Nutritional Food Co., Ltd., Chengdu, Sichuan, China
| | - Xue Wang
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jing Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiong Zhong
- Women Health Department, Chengdu Jintang District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Hao Shi
- Healthcare Department, Chengdu Jinniu District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Jing Liu
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- *Correspondence: Jing Liu
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Influence of Information-Based Continuous Care on Disease Control and Treatment Compliance of Elderly Diabetic Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4023123. [PMID: 36285157 PMCID: PMC9588350 DOI: 10.1155/2022/4023123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Background The incidence of diabetes is increasing year by year. For elderly diabetic patients, poor blood glucose control and worsening immune function greatly increase the risk of complications, which will seriously affect their quality of life. Purpose This paper primarily clarifies the influence of information-based continuous care on disease control and treatment compliance of elderly diabetic patients. Methods From December 2018 to December 2021, 106 elderly diabetic patients were selected, and their clinical data were retrospectively studied. Patients were grouped according to the type of care they received: an observation group (OG) comprising 56 cases receiving information-based continuous care and a control group (CG) including 50 cases treated with routine nursing. The two cohorts of patients were compared regarding disease control, treatment compliance, glucose and lipid metabolism (GLM), and self-management. Results After analysis, it was found that the disease control and treatment compliance were statistically higher in OG compared with CG. OG also showed significantly reduced fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), total cholesterol (TC), and triglyceride (TG) after nursing that were all lower compared with CG. In terms of self-management, OG outperformed CG in diet, exercise, blood glucose monitoring, and adherence to medical regimens. Conclusions Information-based continuous care has beneficial effects on disease control and treatment compliance of elderly diabetic patients and can help control blood sugar and optimize patients' self-management level, with high clinical promotion value.
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Khoshhali M, Ebrahimpour K, Shoshtari-Yeganeh B, Kelishadi R. Systematic review and meta-analysis on the association between seasonal variation and gestational diabetes mellitus. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:55915-55924. [PMID: 34490580 DOI: 10.1007/s11356-021-16230-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
Recently, there is growing evidence that ambient temperature and seasonal changes are related to the incidence of gestational diabetes mellitus (GDM). Thereby, this study was conducted to evaluate the association between seasonal changes and ambient temperature and GDM. We conducted a systematic search in PubMed, ISI Web of Science, Scopus, Google Scholar, and Cochrane Collaboration for human studies available until the end of 2020. We used the following keywords to identify relevant articles: "Diabetes, Gestational" (MeSH), "Glucose Tolerance Test" (MeSH), "Glucose intolerance" (MeSH), "Pregnancy outcome" (MeSH), "Birth outcome", "Seasons" (MeSH), "Weather" (MeSH), "Ambient Temperature," "Climate Change" (MeSH). Meta-analyses by using STATA software were conducted for analyzing data. Due to the high heterogeneity between included studies, a random-effects model was used. Subgroup analysis, meta-regression, and sensitivity analysis were used to define a source of heterogeneity. We found 13 studies related to the association between ambient temperature and season changes and GDM, which 11 of them were included in meta-analyses. Despite inconsistencies in outcome assessment across studies, we found a significant positive association between seasons of GDM screening and risk of GDM (pooled OR=1.12; 95% CI (1.03, 1.21)). The funnel plot and Egger's test showed that there was no significant publication bias among these studies (p=0.51). In general, season changes showed a significant positive relationship with prevalence of GDM. However, due to the unknown exact mechanism on this association, further studies should be conducted.
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Affiliation(s)
- Mehri Khoshhali
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Ebrahimpour
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahareh Shoshtari-Yeganeh
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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BAI Q, XU J, ZHU W, HUANG C, NI X, ZHAO H, FENG X, LI L, DU S, FAN R, WANG J. Effects of consumption of a low glycaemic index formula on glycaemic control in patients with type 2 diabetes managed by medical nutrition therapy. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.51320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - Jing XU
- Army Medical University, China
| | | | | | | | | | | | - Li LI
- Army Medical University, China
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Nesti L, Mengozzi A, Tricò D. Impact of Nutrient Type and Sequence on Glucose Tolerance: Physiological Insights and Therapeutic Implications. Front Endocrinol (Lausanne) 2019; 10:144. [PMID: 30906282 PMCID: PMC6418004 DOI: 10.3389/fendo.2019.00144] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/18/2019] [Indexed: 02/03/2023] Open
Abstract
Pharmacological and dietary interventions targeting postprandial glycemia have proved effective in reducing the risk for type 2 diabetes and its cardiovascular complications. Besides meal composition and size, the timing of macronutrient consumption during a meal has been recently recognized as a key regulator of postprandial glycemia. Emerging evidence suggests that premeal consumption of non-carbohydrate macronutrients (i.e., protein and fat "preloads") can markedly reduce postprandial glycemia by delaying gastric emptying, enhancing glucose-stimulated insulin release, and decreasing insulin clearance. The same improvement in glucose tolerance is achievable by optimal timing of carbohydrate ingestion during a meal (i.e., carbohydrate-last meal patterns), which minimizes the risk of body weight gain when compared with nutrient preloads. The magnitude of the glucose-lowering effect of preload-based nutritional strategies is greater in type 2 diabetes than healthy subjects, being comparable and additive to current glucose-lowering drugs, and appears sustained over time. This dietary approach has also shown promising results in pathological conditions characterized by postprandial hyperglycemia in which available pharmacological options are limited or not cost-effective, such as type 1 diabetes, gestational diabetes, and impaired glucose tolerance. Therefore, preload-based nutritional strategies, either alone or in combination with pharmacological treatments, may offer a simple, effective, safe, and inexpensive tool for the prevention and management of postprandial hyperglycemia. Here, we survey these novel physiological insights and their therapeutic implications for patients with diabetes mellitus and altered glucose tolerance.
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Affiliation(s)
- Lorenzo Nesti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Sant'Anna School of Advanced Studies, Institute of Life Sciences, Pisa, Italy
- *Correspondence: Domenico Tricò
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Shafaeizadeh S, Muhardi L, Henry CJ, van de Heijning BJM, van der Beek EM. Macronutrient Composition and Food Form Affect Glucose and Insulin Responses in Humans. Nutrients 2018; 10:E188. [PMID: 29419785 PMCID: PMC5852764 DOI: 10.3390/nu10020188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023] Open
Abstract
Glycaemic index (GI) is used as an indicator to guide consumers in making healthier food choices. We compared the GI, insulin index (II), and the area under the curve for blood glucose and insulin as glucose (GR) and insulin responses (IR) of a newly developed liquid nutritional formula with one commercially available liquid product with different types of carbohydrates. We then evaluated the glucose and insulin responses of two test foods with comparable energy density and protein percentage but presented in different food forms (liquid vs. solid). Fourteen healthy women participated in the study. GI, II, GR, and IR were assessed after (independent) consumption of two liquid products and a solid breakfast meal. The two liquid foods showed comparable GI, whilst the liquid form appeared to produce lower median GI (25 vs. 54), and II (52 vs. 98) values compared to the solid breakfast (p < 0.02). The median GR and IR for solid breakfast were respectively 44% and 45% higher compared to the liquid product (p < 0.02). Liquid formulas with different carbohydrate qualities produced comparable glucose responses, while foods with comparable energy density and protein percentage but different food form elicited differential effects on GI, II, GR, and IR. Nutrient quality and food form need to be taken into consideration when developing low GI products to manage glycaemic responses.
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Affiliation(s)
- Shila Shafaeizadeh
- Nutricia Research, Matrix Building #05-01b, 30 Biopolis Street, Singapore 138671, Singapore.
| | - Leilani Muhardi
- Danone Early Life Nutrition, Cyber 2 Tower, 15th Floor, Jl. HR. Rasuna Said #X-5 No. 13, South Jakarta 12950, Indonesia.
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), and National University Health System, Centre for Translational Medicine, 14 Medical Drive #07-02, MD 6 Building, Yong Loo Lin School of Medicine, Singapore 117599, Singapore.
- Department of Biochemistry, National University of Singapore, 8 Medical Drive, Singapore 117596, Singapore.
| | | | - Eline M van der Beek
- Nutricia Research, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands.
- Department of Pediatrics, University Medical Centre Groningen, CA84, Room Y2.115, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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