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Yuan L, Luo Y, Luo Y, Ding B, Zhang P, Ma J, Wu J. Ultra rapid lispro improves postprandial glucose control versus lispro in combination with basal insulin: a study based on CGM in type 2 diabetes in China. Front Endocrinol (Lausanne) 2024; 15:1364585. [PMID: 38774225 PMCID: PMC11106447 DOI: 10.3389/fendo.2024.1364585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Aim To evaluate the efficacy and safety of URLi (ultra rapid lispro insulin) compared to insulin lispro as bolus insulin with basal insulin using CGM in the individuals with type 2 diabetes(T2D) in China. Methods This was a double-blind, randomized, parallel, prospective, phase 3 study. Subjects with uncontrolled T2D were recruited and randomized 1:2 into the insulin lispro and URLi groups. Subjects received a consistent basal insulin regimen during the study and self-administered insulin lispro or URLi before each meal throughout the treatment period. Subjects underwent a 3-day continuous glucose monitoring (CGM) at the baseline and endpoint respectively, and then CGM data were analyzed. The primary endpoint was to compare the difference in postprandial glucose (PPG) control using CGM between the two groups. Results A total of 57 subjects with T2D completed the study. Our CGM data showed that postprandial glucose excursions after breakfast (BPPGE) in the URLi group was lower than that in the insulin lispro group (1.59 ± 1.57 mmol/L vs 2.51 ± 1.73 mmol/L, p = 0.046). 1-hour PPG was observed to decrease more in the URLi group than that in the insulin lispro group (-1.37 ± 3.28 mmol/L vs 0.24 ± 2.58 mmol/L, p = 0.047). 2-hour PPG was observed to decrease more in the URLi group than that in the insulin lispro group (-1.12 ± 4.00 mmol/L vs 1.22 ± 2.90 mmol/L, p = 0.021). The mean HbA1c level decreased by 1.1% in the URLi group and 0.99% in the insulin lispro group, with no treatment difference (p = 0.642). In the CGM profile, TBR was not significantly different between the two groups (p = 0.743). The weight gain also did not differ between the two groups (p = 0.303). Conclusion URLi can control breakfast PPG better than insulin lispro in adults with T2D in China, while it is non-inferior in improving HbA1c. The incidence of hypoglycemic and weight gain were similar between the two groups.
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Affiliation(s)
| | | | | | | | | | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jindan Wu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Hota D, Padhy BM, Maiti R, Bisoi D, Sahoo JP, Patro BK, Kumar P, Goel A, Banik SP, Chakraborty S, Rungta M, Bagchi M, Bagchi D. A Placebo-Controlled, Double-Blind Clinical Investigation to Evaluate the Efficacy of a Patented Trigonella foenum-graecum Seed Extract "Fenfuro®" in Type 2 Diabetics. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:147-156. [PMID: 37459747 DOI: 10.1080/27697061.2023.2233008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/30/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Trigonella foenum-graecum (Fenugreek) is an extensively researched phytotherapeutic for the management of Type 2 diabetes without any associated side effects. The major anti-diabetic bioactive constituents present in the plant are furostanolic saponins, which are more abundantly available in the seed of the plant. However, the bioavailability of these components depends on the method of extraction and hence formulation of the phytotherapeutic constitutes a critical step for its success. OBJECTIVE The present study reports the efficacy of a novel, patented fenugreek seed extract, Fenfuro®, containing significant amount of furostanolic saponins, in an open-labelled, two-armed, single centric study on a group of 204 patients with Type 2 diabetes mellitus over a period of twelve consecutive weeks. RESULTS Administration of Fenfuro® in the dosage of 500 mg twice daily along with metformin and/or sulfonylurea-based prescribed antidiabetic drug resulted in a reduction of post-prandial glucose by more than 33% along with significant reduction in fasting glucose, both of which were greater than what resulted for the patient group receiving only Metformin and/or Sulfonylurea therapy. Fenfuro® also resulted in reduction in mean baseline HOMA index from 4.27 to 3.765, indicating restoration of insulin sensitivity which was also supported by a significant decrease in serum insulin levels by >10% as well as slight reduction in the levels of C-peptide. However, in the case of the Metformin and/or Sulfonylurea group, insulin levels were found to increase by more than 14%, which clearly indicated that drug-induced suppression of glucose levels instead of restoration of glucose homeostasis. Administration of the formulation was also found to be free from any adverse side effects as there were no changes in hematological profile, liver function and renal function. CONCLUSION The study demonstrated the promising potential of this novel phytotherapeutic, Fenfuro®, in long-term holistic management of type-2 diabetes.
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Affiliation(s)
- Debasish Hota
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Orissa, India
| | - Biswa M Padhy
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Orissa, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Orissa, India
| | - Debasis Bisoi
- Department of Pharmacology, AIIMS, Bibinagar, Hyderabad, India
| | - Jyoti Prakash Sahoo
- Department of Pharmacology, SCB Medical College & Hospital, Cuttack, Orissa, India
| | - Binod K Patro
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Orissa, India
| | - Pawan Kumar
- R&D Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
| | - Apurva Goel
- Regulatory Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
| | - Samudra P Banik
- Department of Microbiology, Maulana Azad College, Kolkata, India
| | - Sanjoy Chakraborty
- Department of Biological Sciences, New York City College of Technology/CUNY, Brooklyn, New York, USA
| | - Mehul Rungta
- R&D Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
| | - Manashi Bagchi
- Department of R&D, Dr. Herbs LLC, Concord, California, USA
| | - Debasis Bagchi
- Department of Biology, College of Arts and Sciences, and Department of Psychology, Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
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Chen J, Yin D, Dou K. Intensified glycemic control by HbA1c for patients with coronary heart disease and Type 2 diabetes: a review of findings and conclusions. Cardiovasc Diabetol 2023; 22:146. [PMID: 37349787 PMCID: PMC10288803 DOI: 10.1186/s12933-023-01875-8] [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] [Received: 04/17/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
The occurrence and development of coronary heart disease (CHD) are closely linked to fluctuations in blood glucose levels. While the efficacy of intensified treatment guided by HbA1c levels remains uncertain for individuals with diabetes and CHD, this review summarizes the findings and conclusions regarding HbA1c in the context of CHD. Our review showed a curvilinear correlation between regulated level of HbA1c and therapeutic effectiveness of intensified glycemic control among patients with type 2 diabetes and coronary heart disease. It is necessary to optimize the dynamic monitoring indicators of HbA1c, combine genetic profiles, haptoglobin phenotypes for example and select more suitable hypoglycemic drugs to establish more appropriate glucose-controlling guideline for patients with CHD at different stage of diabetes.
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Affiliation(s)
- Jingyang Chen
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China
| | - Dong Yin
- Cardiometabolic Medicine Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China
| | - Kefei Dou
- Cardiometabolic Medicine Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China
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Lebovitz HE, Fleming A, Cherrington AD, Joshi S, Athalye SN, Loganathan S, Vishweswaramurthy A, Panda J, Marwah A. Efficacy and safety of Tregopil, a novel, ultra-rapid acting oral prandial insulin analog, as part of a basal-bolus regimen in type 2 diabetes: a randomized, active-controlled phase 2/3 study. Expert Opin Pharmacother 2022; 23:1855-1863. [DOI: 10.1080/14656566.2022.2141569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Harold E Lebovitz
- Department of Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, NY, USA
| | | | - Alan D Cherrington
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine-Basic Sciences, Nashville, TENN, USA
| | - Shashank Joshi
- Consultant Endocrinologist, Joshi Clinic and Lilavati Hospital, Mumbai, India
| | - Sandeep N Athalye
- Clinical Development and Medical Affairs, Biocon Biologics Limited, Bengaluru, Karnataka, India
| | - Subramanian Loganathan
- Clinical Development and Medical Affairs, Biocon Biologics Limited, Bengaluru, Karnataka, India
| | | | - Jayanti Panda
- Clinical Development and Medical Affairs, Biocon Biologics Limited, Bengaluru, Karnataka, India
| | - Ashwani Marwah
- Clinical Development and Medical Affairs, Biocon Biologics Limited, Bengaluru, Karnataka, India
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Moore JM, Vinoskey C, Salmons H, Hooshmand S, Kressler J. Sex differences in the acute effect of stair-climbing on postprandial blood glucose levels: A randomized controlled trial. Metabol Open 2022; 15:100200. [PMID: 35898575 PMCID: PMC9309661 DOI: 10.1016/j.metop.2022.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
Single, short stair climbing and descending (SCD) bouts of low to moderate intensity effectively lower postprandial blood glucose but previous reports have found conflicting results on interactions by sex during exercise. We hypothesize that SCD at a self-selected intensity will be equally effective at lowering postprandial blood glucose in males and females. Methods and Results: Thirty subjects (age: 23.8 (3.0) years) performed 0, 1, 3, and 10 min of SCD following consumption of a mixed meal. SCD was performed at a self-selected comfortable pace and all bouts ended at minute 28. Postprandial blood glucose was measured every 15 min for 1 h and analyzed as glucose over time, area under the curve (AUC), and incremental AUC (iAUC) using mixed-design ANOVAs with repeated measures. Although there was no interaction between sex and condition or time (p = .129 to .541) for glucose over time, AUC, or iAUC, there was a main effect for sex for glucose over time (p = .004) and AUC (p = .006), but not iAUC (p = .125). Females had higher blood glucose throughout each trial (22% (13 to 31%), p = .004) but both males' and females’ postprandial blood glucose was lowered following 10 min of SCD relative to the seated control condition. Conclusions: Males and females benefited equally from single, short SCD bouts of low to moderate intensity despite females having higher blood glucose at all time points. Previous findings of sex differences in the attenuating effect of exercise on postprandial blood glucose are likely due to the use of absolute workloads leading to varying relative intensities. SCD at a self-selected, comfortable pace for 3 min reduced postmeal blood glucose. Men and women benefit equally from SCD postprandial glucose attenuations. Previous sex differences were likely due to unequal relative intensity of exercise.
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Affiliation(s)
- Jeff M. Moore
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
- Corresponding author. School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA.
| | - Cameron Vinoskey
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
| | - Hannah Salmons
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
| | - Shirin Hooshmand
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
| | - Jochen Kressler
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
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Zhou Y, Wang R, Han F, Zhang J. Efficacy of epalrestat combined with alprostadil for diabetic nephropathy and its impacts on renal fibrosis and related factors of inflammation and oxidative stress. Am J Transl Res 2022; 14:3172-3179. [PMID: 35702110 PMCID: PMC9185026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the efficacy of epalrestat (Ep) combined with alprostadil (Alp) in the treatment of diabetic nephropathy (DN) and its impacts on renal fibrosis (RF) and inflammation and oxidative stress (OS)-related factors. METHODS In this retrospective study, 120 patients with DN treated in the Cangzhou Central Hospital from January 2020 to January 2021 were selected as the research subjects. Among them, 80 cases treated with Ep combined with Alp were assigned to group A, and the rest 40 patients treated with Alp only were assigned to group B. The two groups were compared with respect to the following items: serum OS indexes (malondialdehyde, MDA; superoxide dismutase, SOD; total antioxidant capacity, TAOC), inflammatory factors (tumor necrosis factor-α, TNF-α; interleukin-2, IL-2), RF index transforming growth factor-β1 (TGF-β1), urinary protein indexes (urinary albumin excretion, UAE; serum albumin, ALB), blood glucose (fasting blood glucose, FBG), fasting C-peptide, postprandial 2hC peptide levels, overall response rate (ORR) and incidence of adverse reactions. RESULTS Compared with group B, the levels of MDA, TNF-α, IL-2 and TGF-β1 were lower, while SOD and TAOC were higher in group A. In addition, ALB was higher, while UAE and FBG were lower in group A as compared with group B. Moreover, group A had a higher ORR and fewer adverse reactions as compared with group B. CONCLUSION The combined therapy of Ep and Alp is more effective in the treatment of DN. This combination can effectively reduce RF and better alleviate inflammation and OS.
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Affiliation(s)
- Yanan Zhou
- Endocrinology and Diabetes Department, Cangzhou Central HospitalCangzhou 061001, Hebei, China
| | - Rongrong Wang
- Endocrinology and Diabetes Department, Cangzhou Central HospitalCangzhou 061001, Hebei, China
| | - Fengmei Han
- Ophthalmology Department, Cangzhou Central HospitalCangzhou 061001, Hebei, China
| | - Jincheng Zhang
- Endocrinology and Diabetes Department, Cangzhou Central HospitalCangzhou 061001, Hebei, China
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Jiang Y, Du T. Relation of circulating lncRNA GAS5 and miR-21 with biochemical indexes, stenosis severity, and inflammatory cytokines in coronary heart disease patients. J Clin Lab Anal 2022; 36:e24202. [PMID: 34997773 PMCID: PMC8842157 DOI: 10.1002/jcla.24202] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 12/11/2022] Open
Abstract
Background Long noncoding RNA GAS5 (lnc‐GAS5) and its target microRNA‐21 (miR‐21) regulate blood lipid, macrophages, Th cells, vascular smooth muscle cells to participate in atherosclerosis, and related coronary heart disease (CHD). The study aimed to further explore the linkage of their circulating expressions with common biochemical indexes, stenosis severity and inflammatory cytokines in CHD patients. Methods Ninety‐eight CHD patients and 100 controls confirmed by coronary angiography were enrolled. Plasma samples were collected for lnc‐GAS5 and miR‐21 detection by reverse transcription‐quantitative polymerase chain reaction and inflammatory cytokines determination by enzyme‐linked immunosorbent assay. Results Lnc‐GAS5 was increased in CHD patients compared with controls (2.270 (interquartile range [IQR]: 1.676–3.389) vs. 0.999 ([IQR: 0.602–1.409], p < 0.001), whereas miR‐21 showed opposite tread (0.442 [IQR: 0.318–0.698] vs. 0.997 [IQR: 0.774–1.368], p < 0.001). In aspect of their intercorrelation, lnc‐GAS5 negatively linked with miR‐21 in CHD patients (p < 0.001) instead of controls (p = 0.211). Interestingly, among the common biochemical indexes, lnc‐GAS5 related to decreased high‐density lipoprotein cholesterol (p = 0.008) and increased C‐reactive protein (CRP) (p < 0.001), while miR‐21 correlated with lower total cholesterol (p = 0.024) and CRP (p < 0.001) in CHD patients. As stenosis degree, lnc‐GAS5 positively correlated with Gensini score (p < 0.001), but miR‐21 exhibited negative association (p = 0.003) in CHD patients. In terms of inflammatory cytokines, lnc‐GAS5 positively related to tumor necrosis factor α (TNF‐α) and interleukin (IL)‐17A, while miR‐21 negatively linked with TNF‐α, IL‐1β, IL‐6, and IL‐17 in CHD patients (all p < 0.05). Conclusion Circulating lnc‐GAS5 and its target miR‐21 exhibit potency to serve as biomarkers for CHD management.
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Affiliation(s)
- Yan Jiang
- Department of Nosocomial Infection Management, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Tian Du
- Department of Thoracic and Cardiovascular Surgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
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Postprandial plasma glucose excursion is associated with an atherogenic lipid profile in individuals with type 2 diabetes mellitus: A cross-sectional study. PLoS One 2021; 16:e0258771. [PMID: 34669756 PMCID: PMC8528281 DOI: 10.1371/journal.pone.0258771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Coronary heart disease (CHD) is a prevalent complication of type 2 diabetes mellitus (T2DM). The atherogenic low-density lipoprotein (LDL) cholesterol is an established risk factor of cardiovascular disease, and evidence also suggests that postprandial plasma glucose (PPG) levels closely delineate CHD mortality in diabetes. The investigators hypothesized that postprandial plasma glucose excursion (PPGE), defined as the difference between 2-hour PPG and fasting plasma glucose (FPG), may be associated with plasma LDL cholesterol levels in patients with T2DM. This study enrolled diabetic participants for whom FPG and lipid profile were sampled after a 12-hour fast, followed by PPG sampling two hours after consuming a standard meal with 75 grams of carbohydrates. The study enrolled 379 participants who were divided into PPGE tertiles according to the difference between their 2-hour PPG and FPG. Participants in the highest PPGE tertile had considerably greater plasma LDL cholesterol levels than patients in the lowest tertile (126.7 mg/dL vs. 99.5 mg/dL, P <0.001). Linear regression analysis also demonstrated that the PPGE was positively correlated with plasma LDL cholesterol levels (β coefficient: 0.165, P < 0.001). Postprandial glucose excursion positively correlated with plasma LDL cholesterol levels in individuals with T2DM. Participants with raised PPGE harbored greater LDL cholesterol levels than those with lower postprandial glucose fluctuations. Therefore, postprandial glucose excursion is associated with an atherogenic lipid profile and may be a modifiable risk factor of diabetic CHD.
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Malinska H, Klementová M, Kudlackova M, Veleba J, Hoskova E, Oliyarnyk O, Markova I, Thieme L, Hill M, Pelikanova T, Kahleova H. A plant-based meal reduces postprandial oxidative and dicarbonyl stress in men with diabetes or obesity compared with an energy- and macronutrient-matched conventional meal in a randomized crossover study. Nutr Metab (Lond) 2021; 18:84. [PMID: 34507586 PMCID: PMC8434736 DOI: 10.1186/s12986-021-00609-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Increased oxidative/dicarbonyl stress and chronic inflammation are considered key pathophysiological mediators in the progression of complications in obesity and type 2 diabetes (T2D). Lifestyle and diet composition have a major impact. In this study, we tested the effects of a vegan (V) and a conventional meat containg (M) meal, matched for energy and macronutrients, on postprandial oxidative and dicarbonyl stress, inflammatory markers and appetite hormones. METHODS A randomised crossover design was used to evaluate T2D, obese with normal glucose tolerance and control participants (n = 20 in each group), with serum concentrations of analytes determined at 0, 120 and 180 min. Repeated-measures ANOVA was used for statistical analysis. RESULTS In T2D subjects, we observed decreased postprandial concentrations of oxidised glutathione (p ˂ 0.001) and increased glutathione peroxidase activity (p = 0.045) after the V-meal consumption, compared with the M-meal. In obese participants, V-meal consumption increased postprandial concentrations of reduced glutathione (p = 0.041) and decreased methylglyoxal concentrations (p = 0.023). There were no differences in postprandial secretion of TNFα, MCP-1 or ghrelin in T2D or obese men, but we did observe higher postprandial secretion of leptin after the V-meal in T2D men (p = 0.002) compared with the M-meal. CONCLUSIONS The results show that a plant-based meal is efficient in ameliorating the postprandial oxidative and dicarbonyl stress compared to a conventional energy- and macronutrient-matched meal, indicating the therapeutic potential of plant-based nutrition in improving the progression of complications in T2D and obese patients. Registered under ClinicalTrials.gov Identifier No. NCT02474147.
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Affiliation(s)
- Hana Malinska
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marta Klementová
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Jiri Veleba
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Eva Hoskova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Olena Oliyarnyk
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Irena Markova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lenka Thieme
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Martin Hill
- Institute of Endocrinology, Prague, Czech Republic
| | - Terezie Pelikanova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hana Kahleova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic. .,Physicians Committee for Responsible Medicine, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC, 20016, USA.
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Cucuzzella M, Riley K, Isaacs D. Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet. Front Nutr 2021; 8:688540. [PMID: 34434951 PMCID: PMC8380766 DOI: 10.3389/fnut.2021.688540] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
Healthcare professionals in the primary care setting need to be competent to safely adapt diabetes medications when patients with Type 2 Diabetes (T2D) alter their diet. Safe prescribing practice is supported through an understanding of the clinical evidence, basic science, and pharmacology of medications. This review article supports clinicians in the practical application of this knowledge to achieve safe practice. Traditional medical training and clinical practice for chronic disease has long revolved around the teaching of intensifying therapy and evidenced based prescribing, a crucial skill when chronic disease progresses. Now that we are witnessing remission of Type 2 Diabetes through nutritional interventions specifically low carbohydrate diets (LCD) we must apply the same effort and thought to de-prescribing as the underlying metabolic condition improves. There is minimal guidance in the literature on how to actively de-prescribe. The American Diabetes Association in their Standards of Medical Care in Diabetes–2021 acknowledges low carbohydrate nutritional therapy (LCD) as a viable option in the management of Type 2 Diabetes (T2D). Thus, the goal of our paper is to help close the gap between the clinical evidence, basic science, and pharmacology of T2D medications to the practical application and teamwork needed to facilitate safe medication reduction in the primary care setting when applied to a LCD. The LCD is an increasingly popular and effective option for managing T2D and can lead to an improvement in the condition, reduced medication burden, and contribute to significant weight loss. Safe initiation of a LCD in patients on medications requires significant monitoring and medication adjustments to decrease and eliminate the risk of hypoglycemia and hypotension. The health care team including clinicians in primary care, nursing, pharmacy and nutrition need to be competent in adjusting diabetes and antihypertensive medications to achieve safe and effective care. The most immediate and important adjustments are to insulin, sulfonylureas, SGLT2 inhibitors, blood pressure medications and diuretics. Interdisciplinary care teams can individualize therapy while following the guidance, which includes monitoring blood glucose and blood pressure closely, decreasing medications that can cause hypoglycaemia and hypotension, evaluating blood glucose and blood pressure data responses regularly, and open access communication with the team. The article is an international consensus document on de-prescribing that was put together by a multidisciplinary team of clinicians.
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Affiliation(s)
- Mark Cucuzzella
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Karen Riley
- Institute for Personalized Therapeutic Nutrition, Vancouver, BC, Canada
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Cheng PC, Kao CH. Telemedicine assists in the management of proatherogenic dyslipidemia and postprandial glucose variability in patients with type 2 diabetes mellitus: a cross-sectional study. Endocr Connect 2021; 10:789-795. [PMID: 34137735 PMCID: PMC8346188 DOI: 10.1530/ec-21-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Coronary heart disease (CHD) is a prevalent complication of type 2 diabetes mellitus (T2DM). The proatherogenic low-density lipoprotein (LDL) cholesterol is an established risk factor of cardiovascular disease, and evidence also suggests that postprandial plasma glucose (PPG) levels closely delineate CHD mortality in diabetes. The investigators hypothesized that the addition of telehealth consultation to standard antidiabetic therapy may help to reduce postprandial glucose variability and plasma LDL cholesterol levels in patients with T2DM. METHODS This cross-sectional study enrolled patients with newly diagnosed T2DM who received standard antidiabetic therapy with or without additional telehealth consultation. Participants received blood tests for plasma lipid profile and glucose levels at the diagnosis of diabetes and after 1 month of therapeutic intervention. Laboratory results were compared between treatment groups to determine the efficacy of complementary telehealth consultation. RESULTS In this study, 375 participants were enrolled. The standard treatment group had considerably greater levels of plasma LDL cholesterol than recipients of telehealth consultation (110 mg/dL vs 93.1 mg/dL, P < 0.001). Moreover, patients receiving standard treatment had greater levels of fasting plasma glucose (104 mg/dL vs 98.5 mg/dL, P = 0.027), 2-h PPG (169 mg/dL vs 111 mg/dL, P < 0.001), and postprandial glucose variability (65.4 mg/dL vs 12.8 mg/dL, P < 0.001) than participants under telehealth consultation. CONCLUSIONS Telemedicine in addition to standard antidiabetic therapy helped to reduce plasma LDL cholesterol levels and postprandial glucose variability in patients with newly diagnosed T2DM. Therefore, telehealth consultation is a suitable complement to pharmacologic therapy for diabetic patients to assist in the management of proatherogenic dyslipidemia and postprandial glucose variability.
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Affiliation(s)
- Po-Chung Cheng
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Correspondence should be addressed to C-H Kao:
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Mohr AE, Minicucci O, Long D, Miller VJ, Keller A, Sheridan C, O’brien G, Ward E, Schuler B, Connelly S, Holst JJ, Astrup A, He F, Gentile CL, Arciero PJ. Resistant Starch Combined with Whey Protein Increases Postprandial Metabolism and Lowers Glucose and Insulin Responses in Healthy Adult Men. Foods 2021; 10:foods10030537. [PMID: 33807618 PMCID: PMC8000721 DOI: 10.3390/foods10030537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
Resistant starch (RS) and/or protein consumption favorably influence energy metabolism, substrate utilization, and weight management. The current study administered four different versions of a pancake breakfast containing waxy maize or RS with and without whey protein (WP) and measured postprandial thermogenesis (TEM), fuel utilization, and circulating satiation and appetite factors for 180 min in a group of healthy, adult men. On four separate visits to the laboratory, eight participants were administered four different pancake breakfast meal challenges using a single-blind, randomized crossover design: (1) waxy maize starch (WMS) control; (2) WMS and WP (WMS + WP); (3) RS; or (4) RS and WP (RS + WP). TEM (kcals/180 min) was significantly greater (p < 0.05) in RS + WP (45.11; confidence interval (CI), 33.81–56.41) compared to WMS (25.61; CI, 14.31–36.91), RS (29.44; CI, 18.14–40.74), and WMS + WP (24.64; CI, 13.34–35.94), respectively. Fat oxidation was enhanced (p < 0.05) after RS + WP compared to RS at 60 min (+23.10%), WMS at 120 min (+27.49%), and WMS and WMS + WP at 180 min (+35.76%; +17.31%, respectively), and RER was decreased with RS + WP versus the other three meals (mean differences: ≥−0.021). Insulin concentrations were decreased (p < 0.05) following RS + WP compared to WMS, whereas both RS (−46.19%) and RS + WP (−53.05%) insulin area under the curve (AUC) were greatly reduced (p < 0.01) compared to WMS. While limited by sample size, meals containing both RS and WP increased postprandial thermogenesis and fat oxidation, and lowered insulin response compared to isocaloric meals without this combination. Therefore, RS + WP may favorably impact energy metabolism and thus weight control and body composition under chronic feeding conditions.
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Affiliation(s)
- Alex E. Mohr
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Olivia Minicucci
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Dale Long
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Vincent J. Miller
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Allison Keller
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Caitlin Sheridan
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Gabriel O’brien
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Emery Ward
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Brad Schuler
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
| | - Scott Connelly
- Scott Connelly Foundation, Corona Del Mar, Newport Beach, CA 92625, USA;
| | - Jens J. Holst
- Department of Biomedical Sciences, University of Copenhagen, 1017 Copenhagen, Denmark;
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1017 Copenhagen, Denmark;
| | - Feng He
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
- Department of Kinesiology, California State University, Chico, CA 95929, USA
| | - Christopher L. Gentile
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA;
| | - Paul J. Arciero
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA; (A.E.M.); (O.M.); (D.L.J.); (V.J.M.); (A.K.); (C.S.); (G.O.); (E.W.); (B.S.); (F.H.)
- Correspondence: ; Tel.: +1-518-580-5366; Fax: +1-518-580-8356
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13
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Moore J, Salmons H, Vinoskey C, Kressler J. A single one-minute, comfortable paced, stair-climbing bout reduces postprandial glucose following a mixed meal. Nutr Metab Cardiovasc Dis 2020; 30:1967-1972. [PMID: 32811738 DOI: 10.1016/j.numecd.2020.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/26/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Postprandial blood glucose (PBG) is an independent predictor of disease and mortality risk. To date, the shortest, single, moderate-intensity exercise intervention to reduce PBG is a 1 min bout of stair stepping during an oral glucose tolerance test. Whether this effect translates to real meal consumption is unknown. METHODS AND RESULTS Subjects (N = 30) participated in a randomized controlled crossover trial performing 0 min (seated control), 1 min, 3 min or 10 min of stair climbing and descending bouts (SCD) at a self-selected pace after consumption of a mixed meal on four separate visits. Compared to control, all SCD reduced PBG at least one timepoint: at 30-min the 3 min (-10.8 (-18.7 to -2.8) mg/dL, p = 0.010) and 10 min (-36.3 (-46.4 to -26.3) mg/dL), p < .001), and at 45-min the 1 min (-7.3 (-13.9 to -0.7) mg/dL, p = 0.030, 3 min (-8.7 (-13.9 to -3.6) mg/dL, p = 0.002 and 10 min SCD (-12.2 (-18.2 to -6.1)mg/dL, p < 0.000) reduced PBG. The area under the curve (AUC) for PBG was lower following the 3 min (-4.4% (-7.5 to -1.4%), p = 0.006) and 10 min (-8.9% (-12.4 to -5.3%), p < 0.001), while the incremental AUC (iAUC) was reduced only following the 10 min (-38.0% (-63.7 to -12.3%), p = 0.005) SCD. All SCD were rated by subjects as very light to light intensity. CONCLUSIONS Single, subjectively "light" intensity stair climbing and descending bouts as short as 1 min in duration attenuate the postprandial glucose response in normal weight individuals following consumption of a mixed meal. More pronounced effects require longer bouts in a dose-dependent manner.
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Affiliation(s)
- Jeff Moore
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182-7251, USA.
| | - Hannah Salmons
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182-7251, USA
| | - Cameron Vinoskey
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182-7251, USA
| | - Jochen Kressler
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182-7251, USA
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14
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Hanssen NMJ, Kraakman MJ, Flynn MC, Nagareddy PR, Schalkwijk CG, Murphy AJ. Postprandial Glucose Spikes, an Important Contributor to Cardiovascular Disease in Diabetes? Front Cardiovasc Med 2020; 7:570553. [PMID: 33195459 PMCID: PMC7530333 DOI: 10.3389/fcvm.2020.570553] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022] Open
Abstract
Clinical trials investigating whether glucose lowering treatment reduces the risk of CVD in diabetes have thus far yielded mixed results. However, this doesn't rule out the possibility of hyperglycemia playing a major causal role in promoting CVD or elevating CVD risk. In fact, lowering glucose appears to promote some beneficial long-term effects, and continuous glucose monitoring devices have revealed that postprandial spikes of hyperglycemia occur frequently, and may be an important determinant of CVD risk. It is proposed that these short, intermittent bursts of hyperglycemia may have detrimental effects on several organ systems including the vasculature and the hematopoietic system collectively contributing to the state of elevated CVD risk in diabetes. In this review, we summarize the potential mechanisms through which hyperglycemic spikes may increase atherosclerosis and how new and emerging interventions may combat this.
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Affiliation(s)
- Nordin M J Hanssen
- Diabetes Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands.,Department of Internal Medicine, CARIM, School of Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Michael J Kraakman
- Haematopoiesis and Leukocyte Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Michelle C Flynn
- Haematopoiesis and Leukocyte Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Prabhakara R Nagareddy
- Division of Cardiac Surgery, Department of Surgery, Ohio State University, Columbus, OH, United States
| | - Casper G Schalkwijk
- Department of Internal Medicine, CARIM, School of Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Andrew J Murphy
- Haematopoiesis and Leukocyte Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Immunology, Monash University, Melbourne, VIC, Australia
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15
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Moore J, Kressler J, Buono MJ. Hand heating lowers postprandial blood glucose concentrations: A double-blind randomized controlled crossover trial. Complement Ther Med 2020; 49:102280. [PMID: 32147036 DOI: 10.1016/j.ctim.2019.102280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/30/2019] [Accepted: 12/11/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Examine effect of single hand heating with and without negative pressure on fasting blood glucose (FBG) and postprandial blood glucose (PBG). DESIGN Double-blind randomized controlled trial with crossover design. SUBJECTS FBG experiment: 17 healthy subjects (4 males). PBG experiment: 13 healthy subjects (1 males). INTERVENTIONS Devices included one providing heat only, one heat and negative pressure, and one acting as a sham. For the FBG experiment the devices were used for 30 min. For the PBG experiment the devices were used for one hour during an oral glucose tolerance test (OGTT). OUTCOME MEASURES Blood glucose measurements were used to determine change in FBG, peak PBG, area under the curve (AUC), and incremental AUC (iAUC). RESULTS Temperature: Change in tympanic temperature was ≤ 0.15 °C for all trials. FBG: There was no effect on FBG. PBG: Compared to the sham device the heat plus vacuum and heat only device lowered peak blood glucose by 16(31)mg/dL, p = 0.092 and 18(28)mg/dL, p = 0.039, respectively. AUC and iAUC: Compared to the sham device, the heat plus vacuum device and heat only device lowered the AUC by 5.1(15.0)%, p = 0.234 and 7.9(11.1)%, p = 0.024 respectively and iAUC by 17.2(43.4)%, p = 0.178 and 20.5(34.5)%, p = 0.054, respectively. CONCLUSIONS Heating a single hand lowers postprandial blood glucose in healthy subjects.
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Affiliation(s)
- Jeff Moore
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182-7251, United States.
| | - Jochen Kressler
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182-7251, United States.
| | - Michael J Buono
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182-7251, United States; Department of Biology, San Diego State University, San Diego, CA, 92182-7251, United States.
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16
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Yang J, Zhou Y, Zhang T, Lin X, Ma X, Wang Z, Liu Y, Shi D, Zhou Z, Zhao Y. Fasting Blood Glucose and HbA 1c Correlate With Severity of Coronary Artery Disease in Elective PCI Patients With HbA 1c 5.7% to 6.4. Angiology 2019; 71:167-174. [PMID: 31749367 DOI: 10.1177/0003319719887655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetes mellitus, and even prediabetes, has been shown to be independently associated with cardiovascular disease. Our study explored whether the combination of glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) can better assess the severity of coronary heart disease (CHD) in elective percutaneous coronary intervention (PCI) patients. We consecutively enrolled 1006 prediabetic patients with HbA1c 5.7% to 6.4% who underwent elective PCI. Patients were divided into 2 groups: a normal fasting glucose (NFG) group (FBG <6.1 mmol/L) and an impaired fasting glucose (IFG) group (6.1 ≤FBG<7.0 mmol/L) with defined values. Baseline characteristics and angiography data of the 2 groups were compared. The prevalence of 3-vessel disease (P = .002), the GENSINI (the score is named after a professor) score (P = .002), and the SYNTAX (SYNergy between PCI with TAXUS™ and Cardiac Surgery) score (P = .002) of the IFG group was significantly higher compared to the NFG group. After multiple regression analysis, FBG was found to be independently associated with prevalence of 3-vessel disease (adjusted odds ratio: 1.62; 95% confidence interval: 1.21-2.36; P = .013), the GENSINI score (standardized β = .138, P = .008), and the SYNTAX score (standardized β = .145, P = .005). In addition, HbA1 c was independently associated with the prevalence of 3-vessel disease, the GENSINI, score, and the SYNTAX score (P < .05). Both FBG and HbA1c are independently correlated with the severity of CHD in prediabetic patients with HbA1c 5.7% to 6.4%.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Tingyu Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Xuze Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yuyang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Zhiming Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
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17
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Paing AC, McMillan KA, Kirk AF, Collier A, Hewitt A, Chastin SFM. Impact of free-living pattern of sedentary behaviour on intra-day glucose regulation in type 2 diabetes. Eur J Appl Physiol 2019; 120:171-179. [PMID: 31705275 PMCID: PMC6969863 DOI: 10.1007/s00421-019-04261-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/05/2019] [Indexed: 12/14/2022]
Abstract
Purpose To investigate how the pattern of sedentary behaviour affects intra-day glucose regulation in type 2 diabetes. Methods This intensive longitudinal study was conducted in 37 participants with type 2 diabetes (age, 62.8 ± 10.5 years). Glucose and sedentary behaviour/physical activity were assessed with a continuous glucose monitoring (Abbott FreeStyle Libre) and an activity monitor (activPAL3) for 14 days. Multiple regression models with generalised estimating equations (GEEs) approach were used to assess the associations of sedentary time and breaks in sedentary time with pre-breakfast glucose, pre-lunch glucose, pre-dinner glucose, post-breakfast glucose, post-lunch glucose, post-dinner glucose, bedtime glucose, the dawn phenomenon, time in target glucose range (TIR, glucose 3.9–10 mmol/L) and time above target glucose range (TAR, glucose > 10 mmol/L). Results Sedentary time was associated with higher pre-breakfast glucose (p = 0.001), pre-dinner glucose (p < 0.001), post-lunch glucose (p = 0.005), post-dinner glucose (p = 0.013) and the dawn phenomenon (p < 0.001). Breaks in sedentary time were associated with lower pre-breakfast glucose (p = 0.023), pre-dinner glucose (p = 0.023), post-breakfast glucose (p < 0.001) and the dawn phenomenon (p = 0.004). The association between sedentary time and less TIR (p = 0.022) and the association between breaks in sedentary time and more TIR (p = 0.001) were also observed. Conclusions Reducing sedentary time and promoting breaks in sedentary time could be clinically relevant to improve intra-day glucose regulation in type 2 diabetes. Electronic supplementary material The online version of this article (10.1007/s00421-019-04261-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aye C Paing
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Kathryn A McMillan
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Alison F Kirk
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Andrew Collier
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Allan Hewitt
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Sebastien F M Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Department of Movement and Sports Science, Ghent University, Ghent, Belgium
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18
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Paing AC, Kirk AF, Collier A, Kubiak T, Chastin SFM. Are glucose profiles well-controlled within the targets recommended by the International diabetes Federation in type 2 diabetes? A meta-analysis of results from continuous glucose monitoring based studies. Diabetes Res Clin Pract 2018; 146:289-299. [PMID: 30399393 DOI: 10.1016/j.diabres.2018.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/05/2018] [Accepted: 10/16/2018] [Indexed: 12/13/2022]
Abstract
AIMS To assess continuous glucose monitoring (CGM) derived intra-day glucose profiles using global guideline for type 2 diabetes recommended by the International Diabetes Federation (IDF). METHODS The Cochrane Library, MEDLINE, PubMed, CINAHL and Science Direct were searched to identify observational studies reporting intra-day glucose profiles using CGM in people with type 2 diabetes on any anti-diabetes agents. Overall and subgroup analyses were conducted to summarise mean differences between reported glucose profiles (fasting glucose, pre-meal glucose, postprandial glucose and post-meal glucose spike/excursion) and the IDF targets. RESULTS Twelve observational studies totalling 731 people were included. Pooled fasting glucose (0.81 mmol/L, 95% CI, 0.53-1.09 mmol/L), postprandial glucose after breakfast (1.63 mmol/L, 95% CI, 0.79-2.48 mmol/L) and post-breakfast glucose spike (1.05 mmol/L, 95% CI, 0.13-1.96 mmol/L) were significantly higher than the IDF targets. Pre-lunch glucose, pre-dinner glucose and postprandial glucose after lunch and dinner were above the IDF targets but not significantly. Subgroup analysis showed significantly higher fasting glucose and postprandial glucose after breakfast in all groups: HbA1c <7% and ≥7% (53 mmol/mol) and duration of diabetes <10 years and ≥10 years. CONCLUSIONS Independent of HbA1c, fasting glucose and postprandial glucose after breakfast are not well-controlled in type 2 diabetes.
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Affiliation(s)
- Aye C Paing
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Alison F Kirk
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Andrew Collier
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Thomas Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Sebastien F M Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Department of Movement and Sports Science, Ghent University, Ghent, Belgium
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19
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Zhu Y, Wang X, Wang W, Wang H, Zhang F. Expression and influence of pentraxin-3, HbAlc and ApoA1/ApoB in serum of patients with acute myocardial infarction combined with diabetes mellitus type 2. Exp Ther Med 2018; 15:4395-4399. [PMID: 29731826 PMCID: PMC5920826 DOI: 10.3892/etm.2018.5930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/15/2018] [Indexed: 12/18/2022] Open
Abstract
The present study investigated the clinical significance of changes in levels of hypersensitive plasma pentraxin-3 (PTX3), hemoglobin A1c (HbAlc) and apolipoprotein A-I (ApoA1)/apolipoprotein B (ApoB) on patients with acute myocardial infarction (AMI) and diabetes mellitus type 2 (T2DM). After admission, 100 patients diagnosed with AMI combined with T2DM were selected as Group A. According to the level of fasting blood glucose (FBG), they were then subdivided into Group A1 (n=44) with FBG ≥13.0 mmol/l and Group A2 (n=56) with FBG <13.0 mmol/l. A total of 100 hospitalized patients with AMI in People's Hospital of Dongying (Dongying, China) were collected as Group B, and 100 healthy people receiving physical examination in the Physical Examination Center of People's Hospital of Dongying were selected as Group C. Serum PTX3, HbAlc and ApoA1/ApoB of all the study participants were tested, and diseased coronary artery vessels were divided into single-, double- and triple-vessel lesions according to their numbers. Logistic regression analysis was performed for the number of diseased coronary artery vessels and each index. The level of PTX3 in Group A1 was higher than that in Group A2; the level of ApoA1/ApoB in the former was lower than that in the latter (P<0.05); and the level of HbAlc in the former was significantly higher than that in the latter (P<0.01); the levels of PTX3 and HbA1c in Group A2 were higher than those in Group B, while the level of ApoA1/ApoB in the former was lower than that in the latter (P<0.05). Logistic regression analysis showed that the number of diseased coronary artery vessels was positively correlated with PTX3 and HbA1c, but negatively correlated with ApoA1/ApoB. PTX3, HbAlc and ApoA1/apoB have a certain clinical significance in assessing the severity of AMI combined with T2DM.
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Affiliation(s)
- Yanxia Zhu
- Department of Cardiology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Xiaofang Wang
- Department of Cardiology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Weihua Wang
- Department of Emergency, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Hongguang Wang
- Department of Cardiology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Fenglei Zhang
- Department of Cardiology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
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20
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Stewart ML, Wilcox ML, Bell M, Buggia MA, Maki KC. Type-4 Resistant Starch in Substitution for Available Carbohydrate Reduces Postprandial Glycemic Response and Hunger in Acute, Randomized, Double-Blind, Controlled Study. Nutrients 2018; 10:E129. [PMID: 29373530 PMCID: PMC5852705 DOI: 10.3390/nu10020129] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022] Open
Abstract
Resistant starch (RS) is a type of dietary fiber that has been acknowledged for multiple physiological benefits. Resistant starch type 4 (RS4) is a subcategory of RS that has been more intensively studied as new types of RS4 emerge in the food supply. The primary aim of this randomized, double-blind, controlled study was to characterize the postprandial glucose response in healthy adults after consuming a high fiber scone containing a novel RS4 or a low fiber control scone without RS4. Secondary aims included assessment of postprandial insulin response, postprandial satiety, and gastrointestinal tolerance. The fiber scone significantly reduced postprandial glucose and insulin incremental areas under the curves (43-45% reduction, 35-40% reduction, respectively) and postprandial glucose and insulin maximum concentrations (8-10% and 22% reduction, respectively). The fiber scone significantly reduced hunger and desire to eat during the 180 min following consumption and yielded no gastrointestinal side effects compared with the control scone. The results from this study demonstrate that a ready-to-eat baked-good, such as a scone, can be formulated with RS4 replacing refined wheat flour to yield statistically significant and clinically meaningful reductions in blood glucose and insulin excursions. This is the first study to report increased satiety after short-term RS4 intake, which warrants further investigation in long-term feeding studies.
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Affiliation(s)
- Maria L Stewart
- Global Nutrition R & D, Ingredion Incorporated, 10 Finderne Ave, Bridgewater, NJ 08807, USA.
| | - Meredith L Wilcox
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, 489 Taft Ave Suite 202, Glen Ellyn, IL 60137, USA.
| | - Marjorie Bell
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, 489 Taft Ave Suite 202, Glen Ellyn, IL 60137, USA.
| | - Mary A Buggia
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, 489 Taft Ave Suite 202, Glen Ellyn, IL 60137, USA.
| | - Kevin C Maki
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, 489 Taft Ave Suite 202, Glen Ellyn, IL 60137, USA.
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