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Bjerkan KK, Sandvik J, Nymo S, Johnsen G, Hyldmo ÅA, Kulseng BE, Salater S, Høydal KL, Hoff DAL. Postbariatric hypoglycemia, abdominal pain and gastrointestinal symptoms after Roux-en-Y gastric bypass explored by continuous glucose monitoring. Obes Res Clin Pract 2024; 18:9-14. [PMID: 38402034 DOI: 10.1016/j.orcp.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Abdominal pain and postbariatric hypoglycemia (PBH) are common after bariatric surgery. OBJECTIVES This study aimed to explore the potential relationship between abdominal pain, gastrointestinal symptoms, and PBH more than a decade after Roux-en-Y gastric bypass (RYGB) and whether continuous glucose monitoring (CGM) with dietary intervention has an educational role in reducing symptoms. SUBJECTS At two public hospitals in Norway (one University Hospital) 22 of 46 invited patients who reported abdominal pain more than weekly took part. Recruited from a prospective follow-up study of 546 patients 14.5 years after RYGB. METHODS They used a CGM for two 14-day periods, with a dietary intervention between periods. The Gastrointestinal Symptom Rating Scale (GSRS) and the Dumping Severity Score (DSS) questionnaires were completed at the start and end of the study. RESULTS The 22 women had preoperative age 39.6 ± 7.7 years and body mass index (BMI) 42.0 ± 4.0 kg/m2, present age 54.6 ± 7.7 years and BMI 29.8 ± 4.8 kg/m2. The total GSRS score and DSS of early dumping decreased after the diet intervention. The number of events with Level 1 (<3.9 mmol/L) or Level 2 (<3.0 mmol/L) hypoglycemia did not change in the second period. Half of the patients had fewer, three had unchanged, and eight had more frequent events with Level 1 hypoglycemia after the intervention. Ten patients had Level 2 hypoglycemia. CONCLUSION Though inconclusive findings, a personalized dietary intervention reduces GSRS. This intervention was accompanied by lower mean absolute glucose in patients with recurrent abdominal pain after bariatric surgery. However, further studies are needed to explore the benefits of CGM in this setting.
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Affiliation(s)
- Kirsti K Bjerkan
- Faculty of Social Science and History, Volda University College, Volda, Norway; Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Jorunn Sandvik
- Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway; Centre for Obesity Research, Clinic of Surgery, St. Olav's University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siren Nymo
- Centre for Obesity Research, Clinic of Surgery, St. Olav's University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Norway
| | - Gjermund Johnsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St.Olav's University Hospital, Trondheim, Norway
| | - Åsne A Hyldmo
- Centre for Obesity Research, Clinic of Surgery, St. Olav's University Hospital, Trondheim, Norway; Department of Clinical Studies, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Bård Eirik Kulseng
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sissel Salater
- Centre for Obesity Research, Clinic of Surgery, St. Olav's University Hospital, Trondheim, Norway
| | - Kjetil Laurits Høydal
- Department of Physical Education, Faculty of Arts and Physical Education, Volda University College, Volda, Norway
| | - Dag Arne L Hoff
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Studies, Møre and Romsdal Hospital Trust, Ålesund, Norway; Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
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2
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Dubinski I, Bechtold-Dalla Pozza S, Debor B, Nowotny HF, Reisch N, Tschaidse L, Schmidt H. Continuous Glucose Monitoring in Children and Adolescents with Congenital Adrenal Hyperplasia. J Clin Res Pediatr Endocrinol 2023; 15:380-389. [PMID: 37218136 PMCID: PMC10683536 DOI: 10.4274/jcrpe.galenos.2023.2023-3-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Patients with congenital adrenal hyperplasia (CAH) require lifelong therapy with glucocorticoids to suppress androgen excess and substitute for deficient cortisol. An important aspect of care is the prevention of metabolic sequelae. In infants, potentially lethal nocturnal hypoglycaemia has been described. In adolescence, visceral obesity, hypertension, hyperinsulinism and insulin resistance are reported. To date, systematic studies of glucose profiles in this age group with CAH are lacking. Methods This was a monocentric, prospective, observational study to determine the glucose profiles under different treatment regimens in a cohort of young patients with CAH. The continuous glucose monitoring device used was the latest generation FreeStyle Libre 3® sensor in blinded mode. Therapeutic and auxological data were obtained. Results The cohort consisted of 10 children/adolescents with a mean age of 11 years. Three patients exhibited morning fasting hyperglycaemia. Overall, 6 out of 10 patients had unacceptably few total values in the desired range of 70-120 mg/dL. Tissue glucose values above 140-180 mg/dL were found in 5 of 10 patients. The mean value for glycosylated haemoglobin for the cohort was of 5.8%. All pubertal adolescents with reverse circadian regimens had significantly higher glucose levels at night. Two adolescents showed asymptomatic nocturnal hypoglycaemia. Conclusion Most of the patients exhibited abnormalities in glucose metabolism. Two-thirds had elevated total 24h glucose values outside the age-appropriate reference values. Thus, this aspect may need to be addressed early in life by adjusting the doses, treatment regimen or dietary measures. Consequently, reverse circadian therapy regimens should be critically indicated and closely monitored due to the potential metabolic risk.
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Affiliation(s)
- Ilja Dubinski
- Dr. von Hauner Children’s Hospital; Ludwig Maximilian University, Department of Paediatrics, Division of Paediatric Endocrinology, Munich, Germany
| | - Susanne Bechtold-Dalla Pozza
- Dr. von Hauner Children’s Hospital; Ludwig Maximilian University, Department of Paediatrics, Division of Paediatric Endocrinology, Munich, Germany
| | - Belana Debor
- Dr. von Hauner Children’s Hospital; Ludwig Maximilian University, Department of Paediatrics, Division of Paediatric Endocrinology, Munich, Germany
| | | | - Nicole Reisch
- Ludwig Maximilian University, Department of Medicine IV, Munich, Germany
| | - Lea Tschaidse
- Ludwig Maximilian University, Department of Medicine IV, Munich, Germany
| | - Heinrich Schmidt
- Dr. von Hauner Children’s Hospital; Ludwig Maximilian University, Department of Paediatrics, Division of Paediatric Endocrinology, Munich, Germany
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3
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Klonoff DC, Nguyen KT, Xu NY, Gutierrez A, Espinoza JC, Vidmar AP. Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come? J Diabetes Sci Technol 2023; 17:1686-1697. [PMID: 35856435 PMCID: PMC10658694 DOI: 10.1177/19322968221110830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Continuous glucose monitor (CGM) systems were originally intended only for people with diabetes. Recently, there has been interest in monitoring glucose concentrations in a variety of other situations. As data accumulate to support the use of CGM systems in additional states unrelated to diabetes, the use of CGM systems is likely to increase accordingly. METHODS PubMed and Google Scholar were searched for articles about the use of CGM in individuals without diabetes. Relevant articles that included sufficient details were queried to identify what cohorts of individuals were adopting CGM use and to define trends of use. RESULTS Four clinical user cases were identified: (1) metabolic diseases related to diabetes with a primary dysregulation of the insulin-glucose axis, (2) metabolic diseases without a primary pathophysiologic derangement of the insulin-glucose axis, (3) health and wellness, and (4) elite athletics. Seven trends in the use of CGM systems in people without diabetes were idenfitied which pertained to both FDA-cleared medical grade products as well as anticipated future products, which may be regulated differently based on intended populations and indications for use. CONCLUSIONS Wearing a CGM has been used not only for diabetes, but with a goal of improving glucose patterns to avoid diabetes, improving mental or physical performance, and promoting motivate healthy behavioral changes. We expect that clinicians will become increasingly aware of (1) glycemic patterns from CGM tracings that predict an increased risk of diabetes, (2) specific metabolic glucotypes from CGM tracings that predict an increased risk of diabetes, and (3) new genetic and genomic biomarkers in the future.
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Affiliation(s)
- David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Juan C. Espinoza
- University of Southern California, Los Angeles, CA, USA
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Alaina P. Vidmar
- University of Southern California, Los Angeles, CA, USA
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Arnoriaga-Rodríguez M, Leal Y, Mayneris-Perxachs J, Pérez-Brocal V, Moya A, Ricart W, Fernández-Balsells M, Fernández-Real JM. Gut Microbiota Composition and Functionality Are Associated With REM Sleep Duration and Continuous Glucose Levels. J Clin Endocrinol Metab 2023; 108:2931-2939. [PMID: 37159524 DOI: 10.1210/clinem/dgad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/11/2023]
Abstract
CONTEXT Sleep disruption is associated with worse glucose metabolic control and altered gut microbiota in animal models. OBJECTIVE We aimed to evaluate the possible links among rapid eye movement (REM) sleep duration, continuous glucose levels, and gut microbiota composition. METHODS This observational, prospective, real-life, cross-sectional case-control study included 118 (60 with obesity), middle-aged (39.1-54.8 years) healthy volunteers recruited at a tertiary hospital. Glucose variability and REM sleep duration were assessed by 10-day continuous glucose monitoring (CGM) (Dexcom G6) and wrist actigraphy (Fitbit Charge 3), respectively. The coefficient of variation (CV), interquartile range (IQR), and SD of glucose variability was assessed and the percentage of time in range (% TIR), at 126-139 mg/dL (TIR2), and 140-199 mg/dL (TIR3) were calculated. Shotgun metagenomics sequencing was applied to study gut microbiota taxonomy and functionality. RESULTS Increased glycemic variability (SD, CV, and IQR) was observed among subjects with obesity in parallel to increased % TIR2 and % TIR3. REM sleep duration was independently associated with % TIR3 (β = -.339; P < .001) and glucose variability (SD, β = -.350; P < .001). Microbial taxa from the Christensenellaceae family (Firmicutes phylum) were positively associated with REM sleep and negatively with CGM levels, while bacteria from Enterobacteriacea family and bacterial functions involved in iron metabolism showed opposite associations. CONCLUSION Decreased REM sleep duration was independently associated with a worse glucose profile. The associations of species from Christensenellaceae and Enterobacteriaceae families with REM sleep duration and continuous glucose values suggest an integrated picture of metabolic health.
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Affiliation(s)
- María Arnoriaga-Rodríguez
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, 17007 Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), 17007 Girona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, 17004 Girona, Spain
| | - Yenny Leal
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, 17007 Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), 17007 Girona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, 17004 Girona, Spain
| | - Jordi Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, 17007 Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), 17007 Girona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
| | - Vicente Pérez-Brocal
- Area of Genomics and Health, Foundation for the Promotion of Sanitary and Biomedical Research of Valencia Region (FISABIO-Public Health), 46020 Valencia, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Andrés Moya
- Area of Genomics and Health, Foundation for the Promotion of Sanitary and Biomedical Research of Valencia Region (FISABIO-Public Health), 46020 Valencia, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Institute for Integrative Systems Biology (I2SysBio), University of Valencia and Spanish National Research Council (CSIC), 46980 Valencia, Spain
| | - Wifredo Ricart
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, 17007 Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), 17007 Girona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, 17004 Girona, Spain
| | - Mercè Fernández-Balsells
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, 17007 Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), 17007 Girona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, 17004 Girona, Spain
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, 17007 Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), 17007 Girona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, 17004 Girona, Spain
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Yu Y, Nie W, Chu K, Wei X, Smith ZJ. Highly Sensitive, Portable Detection System for Multiplex Chemiluminescence Analysis. Anal Chem 2023; 95:14762-14769. [PMID: 37729474 DOI: 10.1021/acs.analchem.3c02920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Chemiluminescence (CL) has emerged as a critical tool for the sensing and quantification of various bioanalytes in virtually all clinical fields. However, the rapid nature of many CL reactions raises challenges for typical low-cost optical sensors such as cameras to achieve accurate and sensitive detection. Meanwhile, classic sensors such as photomultiplier tubes are highly sensitive but lack spatial multiplexing capabilities and are generally not suited for point-of-care applications outside a standard laboratory setting. To address this issue, in this paper, a miniaturized and versatile silicon-photomultiplier-based fiber-integrated CL device (SFCD) was designed for sensitive multiplex CL detection. The SFCD comprises a silicon photomultiplier array coupled to an array of high numerical aperture plastic optical fibers to achieve 16-plex detection. The optical fibers ensure efficient light collection while allowing the fixed detector to be mated with diverse sample geometries (e.g., circular or grid), simply by adjusting the fiber configuration. In a head-to-head comparison with a lens-based camera system featuring a cooled detector, the SFCD achieved a 14-fold improved limit of detection in both direct and enzyme-mediated CL reactions. The SFCD also features improved compactness and lower cost, as well as faster temporal resolution compared with camera-based systems while preserving spatial multiplexing and good environmental robustness. Thus, the SFCD has excellent potential for point-of-care biosensing applications.
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Affiliation(s)
- Yannan Yu
- Key Laboratory of Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, 96 JinZhai Road, Hefei 230026, China
| | - Wei Nie
- Department of Chemistry, University of Science and Technology of China, 96 JinZhai Road, Hefei 230026, China
| | - Kaiqin Chu
- Key Laboratory of Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, 96 JinZhai Road, Hefei 230026, China
| | - Xi Wei
- Department of Chemistry, University of Science and Technology of China, 96 JinZhai Road, Hefei 230026, China
| | - Zachary J Smith
- Key Laboratory of Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, 96 JinZhai Road, Hefei 230026, China
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Chekima K, Wong BTZ, Noor MI, Ooi YBH, Yan SW, Chekima B. Use of a Continuous Glucose Monitor to Determine the Glycaemic Index of Rice-Based Mixed Meals, Their Effect on a 24 h Glucose Profile and Its Influence on Overweight and Obese Young Adults' Meal Preferences. Foods 2022; 11:foods11070983. [PMID: 35407070 PMCID: PMC8997962 DOI: 10.3390/foods11070983] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/16/2022] Open
Abstract
Postprandial hyperglycaemia is associated with an increased risk of type-2 diabetes. This study aims to determine the glycaemic index (GI) of three varieties of rice-based mixed meals and their effects on glycaemic variability (GV), 24 h mean glucose levels and target ranges, and rice variety preferences among overweight and obese young adults using real-time continuous glucose monitoring (rtCGM). In a randomised controlled crossover design, 14 participants (22.8 ± 4.6 years, 32.9 ± 5.8 kg/m2) were randomly assigned to receive 3 rice-based mixed meals containing 50 g of available carbohydrates (white rice meal = WRM; brown rice meal = BRM; and parboiled basmati rice meal = PBRM) and 50 g of a glucose reference drink on alternate days. GI, GV, 24 h mean glucose levels and target ranges were measured. Rice variety preferences were compared with those of baseline data and determined at the end of the study period. Results: The analysis found that PBRM was low in GI (45.35 ± 2.06), BRM medium in GI (56.44 ± 2.34), and WRM high in GI (83.03 ± 2.19). PBRM had a significantly (p < 0.05) lower 24 h mean glucose level, higher in-target 24 h glucose level percentage and non-significantly (p > 0.05) lower GV compared to WRM. Prior to observing their postprandial glucose levels generated by rtCGM, the participants preferred WRM (64.3%) over other meals, whereas this preference changed significantly (p < 0.05) at the endpoint (PBRM, 71.4%). PBRM reduced 24 h glucose level and GV of overweight and obese young adults. The rtCGM is proven to be reliable in measuring GI, while providing robust continuous glycaemic information. This may serve as an educational tool that motivates eating behaviour changes among overweight and obese young adults.
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Affiliation(s)
- Khadidja Chekima
- Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Selangor, Malaysia; (K.C.); (S.W.Y.)
| | - Benjamin Tziak Ze Wong
- Faculty of Social Sciences & Leisure Management, Taylor’s University, Subang Jaya 47500, Selangor, Malaysia;
| | - Mohd Ismail Noor
- Faculty of Medicine and Health Sciences, The National University of Malaysia, Bangi 43600, Selangor, Malaysia;
| | - Yasmin Beng Houi Ooi
- Faculty of Food Science and Nutrition, University Malaysia Sabah, Kota Kinabalu 88450, Sabah, Malaysia;
| | - See Wan Yan
- Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Selangor, Malaysia; (K.C.); (S.W.Y.)
| | - Brahim Chekima
- Faculty of Business, Economics and Accountancy, University Malaysia Sabah, Kota Kinabalu 88450, Sabah, Malaysia
- Correspondence:
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Naguib MN, Hegedus E, Raymond JK, Goran MI, Salvy SJ, Wee CP, Durazo-Arvizu R, Moss L, Vidmar AP. Continuous Glucose Monitoring in Adolescents With Obesity: Monitoring of Glucose Profiles, Glycemic Excursions, and Adherence to Time Restricted Eating Programs. Front Endocrinol (Lausanne) 2022; 13:841838. [PMID: 35282464 PMCID: PMC8914373 DOI: 10.3389/fendo.2022.841838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 01/21/2023] Open
Abstract
Background Randomized controlled trials of time restricted eating (TRE) in adults have demonstrated improvements in glucose variability as captured by continuous glucose monitors (CGM). However, little is known about the feasibility of CGM use in TRE interventions in adolescents, or the expected changes in glycemic profiles in response to changes in meal-timing. As part of a pilot trial of TRE in adolescents with obesity, this study aimed to 1) assess the feasibility of CGM use, 2) describe baseline glycemic profiles in adolescents with obesity, without diabetes, and 3) compare the difference between glycemic profiles in groups practicing TRE versus control. Methods This study leverages data from a 12-week pilot trial (ClinicalTrials.gov Identifier: NCT03954223) of late TRE in adolescents with obesity compared to a prolonged eating window. Feasibility of CGM use was assessed by monitoring 1) the percent wear time of the CGM and 2) responses to satisfaction questionnaires. A computation of summary measures of all glycemic data prior to randomization was done using EasyGV and R. Repeat measures analysis was conducted to assess the change in glycemic variability over time between groups. Review of CGM tracings during periods of 24-hour dietary recall was utilized to describe glycemic excursions. Results Fifty participants were enrolled in the study and 43 had CGM and dietary recall data available (16.4 + 1.3 years, 64% female, 64% Hispanic, 74% public insurance). There was high adherence to daily CGM wear (96.4%) without negative impacts on daily functioning. There was no significant change in the glycemic variability as measured by standard deviation, mean amplitude glycemic excursion, and glucose area under the curve over the study period between groups. Conclusions CGM use appears to be a feasible and acceptable tool to monitor glycemic profiles in adolescents with obesity and may be a helpful strategy to confirm TRE dosage by capturing glycemic excursions compared to self-reported meal timing. There was no effect of TRE on glucose profiles in this study. Further research is needed to investigate how TRE impacts glycemic variability in this age group and to explore if timing of eating window effects these findings.
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Affiliation(s)
- Monica N. Naguib
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Hegedus
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Jennifer K. Raymond
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Michael I. Goran
- Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Sarah-Jeanne Salvy
- Department of Medicine, Research Center for Health Equity Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Choo Phei Wee
- Department of Preventive Medicine, Southern California Clinical and Translational Science Institute, Keck School of Medicine, Los Angeles, CA, United States
| | - Ramon Durazo-Arvizu
- Southern California Clinical and Translational Science Institute Biostatistics Core, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Lilith Moss
- Southern California Clinical and Translational Science Institute Biostatistics Core, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Alaina P. Vidmar
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, United States
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8
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Schembre SM, Jospe MR, Giles ED, Sears DD, Liao Y, Basen-Engquist KM, Thomson CA. A Low-Glucose Eating Pattern Improves Biomarkers of Postmenopausal Breast Cancer Risk: An Exploratory Secondary Analysis of a Randomized Feasibility Trial. Nutrients 2021; 13:nu13124508. [PMID: 34960058 PMCID: PMC8707938 DOI: 10.3390/nu13124508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Postmenopausal breast cancer is the most common obesity-related cancer death among women in the U.S. Insulin resistance, which worsens in the setting of obesity, is associated with higher breast cancer incidence and mortality. Maladaptive eating patterns driving insulin resistance represent a key modifiable risk factor for breast cancer. Emerging evidence suggests that time-restricted feeding paradigms (TRF) improve cancer-related metabolic risk factors; however, more flexible approaches could be more feasible and effective. In this exploratory, secondary analysis, we identified participants following a low-glucose eating pattern (LGEP), defined as consuming energy when glucose levels are at or below average fasting levels, as an alternative to TRF. Results show that following an LGEP regimen for at least 40% of reported eating events improves insulin resistance (HOMA-IR) and other cancer-related serum biomarkers. The magnitude of serum biomarkers changes observed here has previously been shown to favorably modulate benign breast tissue in women with overweight and obesity who are at risk for postmenopausal breast cancer. By comparison, the observed effects of LGEP were similar to results from previously published TRF studies in similar populations. These preliminary findings support further testing of LGEP as an alternative to TRF and a postmenopausal breast cancer prevention strategy. However, results should be interpreted with caution, given the exploratory nature of analyses.
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Affiliation(s)
- Susan M. Schembre
- Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA;
- Correspondence:
| | - Michelle R. Jospe
- Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA;
| | - Erin D. Giles
- Department of Nutrition, Texas A & M University, College Station, TX 77843, USA;
| | - Dorothy D. Sears
- College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA;
| | - Yue Liao
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Karen M. Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA;
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Færch K, Amadid H, Bruhn L, Clemmensen KKB, Hulman A, Ried-Larsen M, Blond MB, Jørgensen ME, Vistisen D. Discordance Between Glucose Levels Measured in Interstitial Fluid vs in Venous Plasma After Oral Glucose Administration: A Post-Hoc Analysis From the Randomised Controlled PRE-D Trial. Front Endocrinol (Lausanne) 2021; 12:753810. [PMID: 34675886 PMCID: PMC8525890 DOI: 10.3389/fendo.2021.753810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS The oral glucose tolerance test (OGTT) is together with haemoglobin A1c (HbA1c) gold standard for diagnosing prediabetes and diabetes. The objective of this study was to assess the concordance between glucose values obtained from venous plasma versus interstitial fluid after oral glucose administration in 120 individuals with prediabetes and overweight/obesity. METHODS 120 adults with prediabetes defined by HbA1c 39-47 mmol/mol and overweight or obesity who participated in the randomised controlled PRE-D trial were included in the study. Venous plasma glucose concentrations were measured at 0, 30, 60 and 120 minutes during a 75 g oral glucose tolerance test (OGTT) performed on three different occasions within a 26 weeks period. During the OGTT, the participants wore a CGM device (IPro2, Medtronic), which assessed glucose concentrations every five minutes. RESULTS A total of 306 OGTTs with simultaneous CGM measurements were obtained. Except in fasting, the CGM glucose values were below the OGTT values throughout the OGTT period with mean (SD) differences of 0.2 (0.7) mmol/L at time 0 min, -1.1 (1.3) at 30 min, -1.4 (1.8) at 60 min, and -0.5 (1.1) at 120 min). For measurements at 0 and 120 min, there was a proportional bias with an increasing mean difference between CGM and OGTT values with increasing mean of the two measurements. CONCLUSIONS Due to poor agreement between the OGTT and CGM with wide 95% limits of agreement and proportional bias at 0 and 120 min, the potential for assessing glucose tolerance in prediabetes using CGM is questionable.
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Affiliation(s)
- Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Kristine Færch,
| | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lea Bruhn
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin Bæk Blond
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Southern Denmark, Copenhagen, Denmark
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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