1
|
Al-Ozairi E, Reem AA, El Samad A, Taghadom E, Al-Kandari J, Abdul-Ghani M, Oliver N, Whitcher B, Guess N. A randomised crossover trial: Exploring the dose-response effect of carbohydrate restriction on glycaemia in people with well-controlled type 2 diabetes. J Hum Nutr Diet 2023; 36:51-61. [PMID: 35560850 DOI: 10.1111/jhn.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/03/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Trials investigating the role of carbohydrate restriction in the management of glycaemia in type 2 diabetes (T2D) have been confounded by multiple factors, including degree of calorie restriction and dietary protein content, as well as by no clear definition of a low-carbohydrate diet. The present study aimed to provide insight into the relationship between carbohydrate restriction and glycaemia by testing the effect of varying doses of carbohydrate on continuous glucose concentrations within a range of intakes defined as low-carbohydrate at the same time as controlling for confounding factors. METHODS This was a randomised crossover trial in participants with T2D (HbA1c: 6.6 ± 0.6%, 49 ± 0.9 mmol mol-1 ) testing five different 6-day eucaloric dietary treatments with varying carbohydrate content (10%, 15%, 20%, 25%, and 30% kcal). Diets exchanged %kcal from carbohydrate with fat, keeping protein constant at 15% kcal. Daily self-weighing was employed to ensure weight stability throughout each treatment arm. Between dietary treatments, participants underwent a washout period of at least 7 days and were advised to maintain their habitual diet. Glycaemic control was assessed using a continuous glucose monitoring device. RESULTS Twelve participants completed the study. There were no differences in 24-h and post-prandial sensor glucose concentrations between the 30 and 10%kcal doses (7.4 ± 1.1 mmol L-1 vs. 7.6 ± 1.3 mmol L-1 [p = 0.28] and 8.1 ± 1.5 mmol L-1 vs. 8.5 ± 1.4 mmol L-1 [p = 0.28], respectively). In our exploratory analyses, we did not find any dose-response relationship between carbohydrate intake and glycaemia. A small amount of weight loss occurred in each treatment arm (range: 0.4-1.1 kg over the 6 days) but adjusting for these differences did not influence the primary or secondary outcomes. CONCLUSIONS Modest changes in dietary carbohydrate content in the absence of weight loss at the same time as keeping dietary protein intake constant do not appear to influence glucose concentrations in people with well-controlled T2D. SUMMARY This study randomised people with T2D to receive five different doses of carbohydrate from 10% to 30% of calories in random order to see what effect it had on their blood glucose.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Brandon Whitcher
- Department of Life Sciences, University of Westminster, London, UK
| | - Nicola Guess
- Dasman Diabetes Institute, Kuwait City, Kuwait.,Department of Life Sciences, University of Westminster, London, UK.,Department of Nutritional Sciences, King's College London, London, UK
| |
Collapse
|
2
|
Wang X, Wu G, Shen D, Zhang X, Yang W. Unmet Needs of Glycaemic Control and Risk Factors of Residual Hyperglycaemia in a Chinese Population with Type 2 Diabetes Initiating Basal Insulin: A Post Hoc Analysis of the FPG GOAL Study. Adv Ther 2022; 39:2820-2830. [PMID: 35430674 PMCID: PMC9123059 DOI: 10.1007/s12325-022-02128-y] [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: 12/27/2021] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
Introduction To aim of this analysis was to investigate the extent and evaluate risk factors of residual hyperglycaemia in Chinese individuals with type 2 diabetes (T2D) initiating basal insulin. Methods FPG GOAL was a 24-week, open-label, treat-to-target randomised controlled trial in Chinese individuals with T2D inadequately controlled with oral anti-hyperglycaemic drugs initiating treatment with basal insulin. This analysis categorised participants into the following glycaemic control categories: hyperglycaemia [glycated haemoglobin (HbA1c) ≥ 53 mmol/mol (≥ 7%), fasting plasma glucose (FPG) ≥ 7.0 mmol/L], residual hyperglycaemia [HbA1c ≥ 53 mmol/mol (≥ 7%), FPG < 7.0 mmol/L], discordant [HbA1c < 53 mmol/mol (< 7%), FPG ≥ 7.0 mmol/L] and at target [HbA1c < 53 mmol/mol (< 7%), FPG < 7.0 mmol/L]. The proportion of participants in each glycaemic control category was assessed at weeks 12 and 24. Multivariable regression analyses were conducted to evaluate risk factors for residual hyperglycaemia. Results Of the 914 participants included, 22.1% had residual hyperglycaemia, 31.9% had hyperglycaemia, 11.1% were discordant and 29.3% were at target at week 24. More participants who were randomised to a fasting blood glucose (FBG) target of > 3.9 to ≤ 5.6 mmol/L had residual hyperglycaemia compared with participants randomised to a FBG target of > 3.9 to ≤ 6.1 mmol/L or > 3.9 to ≤ 7.0 mmol/L. Multivariable analysis indicated that higher HbA1c and lower FPG levels at baseline were associated with greater proportion of residual hyperglycaemia. Conclusion Some Chinese individuals with T2D may have residual hyperglycaemia 3–6 months after initiating basal insulin treatment and require further intensified treatment. Higher HbA1c and lower FPG levels could be risk factors for residual hyperglycaemia. Trial Registration ClinicalTrials.gov identifier NCT02545842. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02128-y.
Collapse
Affiliation(s)
- Xin Wang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, 100029, China
| | | | - Dan Shen
- Sanofi Real-World Evidence, Shanghai, China
| | | | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, 100029, China.
| |
Collapse
|
3
|
Mori T, Yoshioka K, Tanno Y, Kasakura S. Independent factors affecting hemorrhagic and ischemic stroke in patients aged 40-69 years: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:189. [PMID: 35448966 PMCID: PMC9027078 DOI: 10.1186/s12872-022-02625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) have common vascular risk factors; however, ICH often occurs in adults aged < 70 years. Intracerebral hemorrhage and AIS in adults aged < 70 years should be preventable; however, it is unclear why different subtypes of ICH or AIS occur among adults aged < 70 years with vascular risk factors. This study aimed to identify independent variables for ICH or AIS onset in patients aged < 70 years. Methods We included patients aged 40–69 years who experienced ICH or AIS between August 2016 and July 2019. Patients aged < 40 years were excluded because other diseases, rather than vascular risk factors, are often associated with stroke etiology in this age group. Data on age, systolic blood pressure (SBP), serum lipids, and serum fatty acid levels were compared between patients with ICH and those with AIS. In addition, we conducted multivariable logistic regression analyses to identify independent factors among the variables, such as blood pressure or biomarkers, with significant differences between the two groups. Results Of the 1252 acute stroke patients screened, 74 patients with ICH and 149 patients with AIS met the inclusion criteria. After excluding variables with multicollinearity, SBP, glycated hemoglobin (HbA1c), and eicosapentaenoic acid (EPA) proportion (%) of total fatty acids were identified as independent factors affecting ICH and AIS. The SBP and EPA% threshold values for ICH compared to AIS were ≥ 158 mmHg and ≤ 2.3%, respectively. The HbA1c threshold value for AIS compared to ICH was ≥ 6.1%. Conclusions Systolic blood pressure, HbA1c, and EPA%, were independent factors between ICH and AIS. Patients aged 40–69 years with high SBP and low EPA% were at a higher risk of ICH than AIS, and those with a high HbA1c were at a higher risk of AIS than ICH. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02625-6.
Collapse
Affiliation(s)
- Takahisa Mori
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan.
| | - Kazuhiro Yoshioka
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Yuhei Tanno
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Shigen Kasakura
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| |
Collapse
|
4
|
Papakonstantinou E, Oikonomou C, Nychas G, Dimitriadis GD. Effects of Diet, Lifestyle, Chrononutrition and Alternative Dietary Interventions on Postprandial Glycemia and Insulin Resistance. Nutrients 2022; 14:823. [PMID: 35215472 PMCID: PMC8878449 DOI: 10.3390/nu14040823] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 02/08/2023] Open
Abstract
As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7-10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.
Collapse
Affiliation(s)
- Emilia Papakonstantinou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece;
| | - Christina Oikonomou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece;
| | - George Nychas
- Laboratory of Microbiology and Biotechnology of Foods, Agricultural University of Athens, 11855 Athens, Greece;
| | - George D. Dimitriadis
- Sector of Medicine, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| |
Collapse
|
5
|
Pei Y, Agner BR, Luo B, Dong X, Li D, Liu J, Liu L, Liu M, Lu Y, Nishida T, Xu X, Mu Y. DUAL II China: Superior HbA1c reductions and weight loss with insulin degludec/liraglutide (IDegLira) versus insulin degludec in a randomized trial of Chinese people with type 2 diabetes inadequately controlled on basal insulin. Diabetes Obes Metab 2021; 23:2687-2696. [PMID: 34387411 PMCID: PMC9291809 DOI: 10.1111/dom.14522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022]
Abstract
AIM To assess the efficacy and safety of insulin degludec/liraglutide (IDegLira) versus insulin degludec (degludec) in Chinese people with type 2 diabetes (T2D) treated with basal insulin. MATERIALS AND METHODS In DUAL II China, a randomized, double-blinded, multicentre, treat-to-target trial, Chinese adults with T2D and HbA1c of 7.5% or more on basal insulin and metformin, with or without other oral antidiabetic drugs (OADs), were randomized 2:1 to 26 weeks of treatment with either IDegLira (max. dose 50 U degludec/1.8 mg liraglutide) or degludec (max. 50 U/day), respectively, combined with metformin. At 26 weeks, superiority of IDegLira over degludec was assessed for change in HbA1c (primary endpoint), and body weight and number of severe or blood glucose (BG)-confirmed hypoglycaemic episodes (confirmatory secondary endpoints). RESULTS Overall, 453 participants were randomized to IDegLira (n = 302) or degludec (n = 151). Superiority was confirmed for IDegLira over degludec in HbA1c change (-1.9% vs. -1.0%, respectively, estimated treatment difference [ETD] [95% confidence interval]: -0.92% [-1.09; -0.75], P < .0001), body weight change (-0.7 vs. +0.4 kg, respectively, ETD [95% CI]: -1.08 kg [-1.63; -0.52], P = .0002) and severe or BG-confirmed hypoglycaemia (estimated rate ratio [95% CI]: 0.53 [0.30; 0.94], P = .0297). The odds of achieving HbA1c less than 7.0% without hypoglycaemia and/or weight gain were greater with IDegLira than degludec (P < .0001 for all). Daily insulin dose at 26 weeks was lower for IDegLira (34.3 U) than degludec (37.4 U) (P = .0014). No unexpected safety signals were observed. CONCLUSIONS IDegLira may be an efficacious and well-tolerated treatment intensification option for Chinese people with T2D uncontrolled on basal insulin and OADs.
Collapse
Affiliation(s)
- Yu Pei
- Department of EndocrinologyChinese People's Liberation Army General HospitalBeijingChina
| | | | - Bin Luo
- Novo Nordisk China PharmaceuticalsBeijingChina
| | - Xiaolin Dong
- Department of EndocrinologyJinan Central Hospital, Shandong UniversityJinanChina
| | - Dongmei Li
- Department of EndocrinologyInner Mongolia People's HospitalHohhotChina
| | - Jun Liu
- Department of EndocrinologyFifth People's Hospital of ShanghaiShanghaiChina
| | - Lei Liu
- Novo Nordisk A/SSøborgDenmark
| | - Ming Liu
- Department of Endocrinology and MetabolismTianjin Medical University General HospitalTianjinChina
| | - Yibing Lu
- Department of EndocrinologyThe Second Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | | | - Xiangjin Xu
- Department of EndocrinologyFuzhou General HospitalFuzhouChina
| | - Yiming Mu
- Department of EndocrinologyChinese People's Liberation Army General HospitalBeijingChina
| |
Collapse
|
6
|
Pafili Z, Dimosthenopoulos C. Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus-beyond dietary patterns: a narrative review. Hormones (Athens) 2021; 20:641-655. [PMID: 34455577 DOI: 10.1007/s42000-021-00314-1] [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: 02/09/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.
Collapse
Affiliation(s)
- Zoe Pafili
- Department of Nutrition and Dietetics, Evangelismos General Hospital, Athens, Greece.
| | | |
Collapse
|
7
|
Ma J, He H, Yang X, Chen D, Tan C, Zhong L, Du Q, Wu X, Gao Y, Liu G, Wang C, Ran X. A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1 C. Nutr Diabetes 2021; 11:14. [PMID: 34088897 PMCID: PMC8178390 DOI: 10.1038/s41387-021-00156-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/09/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023] Open
Abstract
To develop an accurate method for evaluating the relative contributions of basal glucose (BG) and postprandial glucose (PPG) to glycated haemoglobin (HbA1c) in subjects with hyperglycaemia using a Continuous Glucose Monitoring System (CGMS®). The subjects were divided into the normal glucose tolerance (NGT), impaired glucose tolerance (IGT), newly-diagnosed type 2 diabetes (NDDM), and drug-treated type 2 diabetes (T2DM) groups. We evaluated the relative contributions of BG and PPG to HbA1c in patients with hyperglycaemia according to three different baseline values. Subjects (n = 490) were grouped as follows: 92 NGT, 36 IGT, 131 NDDM, and 231 T2DM. The relative contributions of PPG to HbA1c were calculated using baseline values of 6.1 mmol/L, 5.6 mmol/L, and the 24-h glucose curve of the NGT group. The relative contribution of PPG to HbA1c decreased progressively from the IGT group to the T2DM group. Compared with the 24-h glucose curve as the baseline, the relative contribution of PPG was overestimated in 9.04% and 1.76% of the subjects when 6.1 mmol/L and 5.6 mmol/L were used as baselines, respectively (P < 0.01), in T2DM patients. The 24-h glucose curve of NGT is more suitable for studying the relative contributions of BG and PPG to HbA1c and it is more precise, as it considers physiological fluctuations in NGT after meals. However, 5.6 mmol/L can be used when the 24-h glucose curve for NGT is unavailable; using 6.1 mmol/L as a baseline value may overestimate the contribution to the HbA1c. There is no unified standard for assessing the contributions of basal glucose (BG) and postprandial glucose (PPG) to HbA1c. The 24-h glucose curve of NGT is more suitable for studying the relative contributions of BG and PPG to HbA1c, as it considers physiological fluctuations in NGT after meals. However, 5.6 mmol/L can be used when the 24-h glucose curve for NGT is unavailable; using 6.1 mmol/L as a baseline value may overestimate the contribution to the HbA1c.
Collapse
Affiliation(s)
- Jing Ma
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Hua He
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojie Yang
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Cuixia Tan
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhong
- Department of Endocrinology and Metabolism, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Qiling Du
- Wannian Community health center in Chenghua district, Chengdu, China
| | - Xiaohua Wu
- Shudu Community health center in Xindu district, Chengdu, China
| | - Yunyi Gao
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Guanjian Liu
- Chinese Cochrane Centre, Chinese EBM Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
- Wannian Community health center in Chenghua district, Chengdu, China.
| |
Collapse
|
8
|
Churuangsuk C, Lean MEJ, Combet E. Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008-2016. Eur J Nutr 2020; 59:2771-2782. [PMID: 31686204 PMCID: PMC7413867 DOI: 10.1007/s00394-019-02122-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Evidence of low-carbohydrate, high-fat diets (LCHF) for type 2 diabetes (T2DM) prevention is scarce. We investigated how carbohydrate intake relates to HbA1c and T2DM prevalence in a nationally representative survey dataset. METHODS We analyzed dietary information (4-day food diaries) from 3234 individuals aged ≥ 16 years, in eight waves of the UK National Diet and Nutrition Survey (2008-2016). We calculated LCHF scores (0-20, higher score indicating lower %food energy from carbohydrate, with reciprocal higher contribution from fat) and UK Dietary Reference Value (DRV) scores (0-16, based on UK dietary recommendations). Associations between macronutrients and diet scores and diabetes prevalence were analyzed (in the whole sample) using multivariate logistic regression. Among those without diabetes, analyses between exposures and %HbA1c (continuous) were analyzed using multivariate linear regression. All analyses were adjusted for age, sex, body mass index, ethnicity, smoking status, total energy intake, socioeconomic status and survey years. RESULTS In the overall study sample, 194 (6.0%) had diabetes. Mean intake was 48.0%E for carbohydrates, and 34.9%E for total fat. Every 5%E decrease in carbohydrate, and every 5%E increase in fat, was associated with 12% (95% CI 0.78-0.99; P = 0.03) and 17% (95% CI 1.02-1.33; P = 0.02) higher odds of diabetes, respectively. Each two-point increase in LCHF score is related to 8% (95% CI 1.02-1.14; P = 0.006) higher odds of diabetes, while there was no evidence for association between DRV score and diabetes. Among the participants without diagnosed diabetes (n = 3130), every 5%E decrease in carbohydrate was associated with higher %HbA1c by + 0.016% (95% CI 0.004-0.029; P = 0.012), whereas every 5%E increase in fat was associated with higher %HbA1c by + 0.029% (95% CI 0.015-0.043; P < 0.001). Each two-point increase in LCHF score is related to higher %HbA1c by + 0.010% (0.1 mmol/mol), while each two-point increase in the DRV score is related to lower %HbA1c by - 0.023% (0.23 mmol/mol). CONCLUSIONS Lower carbohydrate and higher fat intakes were associated with higher HbA1c and greater odds of having diabetes. These data do not support low(er) carbohydrate diets for diabetes prevention.
Collapse
Affiliation(s)
- Chaitong Churuangsuk
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Room 2.22, Level 2, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Room 2.22, Level 2, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK
| | - Emilie Combet
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Room 2.22, Level 2, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK.
| |
Collapse
|
9
|
Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2020; 12:nu12072005. [PMID: 32640608 PMCID: PMC7400909 DOI: 10.3390/nu12072005] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of this meta-analysis was to explore the efficacy of a ketogenic diet in metabolic control in patients with overweight or obesity and with or without type 2 diabetes. Embase, PubMed, and Cochrane Library were searched for randomized controlled trials that enrolled patients with overweight or obesity on a ketogenic diet for metabolic control. Fourteen studies were included in meta-analysis. The effects of ketogenic diets on glycemic control were greater for diabetic patients relative to those of low-fat diets, indicated by lower glycated hemoglobin (SMD, -0.62; p < 0.001) and homeostatic model assessment index (SMD, -0.29; p = 0.02), while comparable effects were observed for nondiabetic patients. Ketogenic diets led to substantial weight reduction (SMD, -0.46; p = 0.04) irrespective of patients' diabetes status at baseline and improved lipid profiles in terms of lower triglyceride (SMD, -0.45; p = 0.01) and greater high-density lipoprotein (SMD, 0.31; p = 0.005) for diabetic patients. Other risk markers showed no substantial between-group difference post intervention. Our study findings confirmed that ketogenic diets were more effective in improving metabolic parameters associated with glycemic, weight, and lipid controls in patients with overweight or obesity, especially those with preexisting diabetes, as compared to low-fat diets. This effect may contribute to improvements in metabolic dysfunction-related morbidity and mortality in these patient populations.
Collapse
|
10
|
Churuangsuk C, Lean MEJ, Combet E. Low and reduced carbohydrate diets: challenges and opportunities for type 2 diabetes management and prevention. Proc Nutr Soc 2020; 79:1-16. [PMID: 32131904 DOI: 10.1017/s0029665120000105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Low-carbohydrate diets (LCD) have been promoted for weight control and type 2 diabetes (T2D) management, based on an emerging body of evidence, including meta-analyses with an indication of publication bias. Proposed definitions vary between 50 and 130 g/d, or <10 and <40 % of energy from carbohydrate, with no consensus on LCD compositional criteria. LCD are usually followed with limited consideration for other macronutrients in the overall diet composition, introducing variance in the constituent foods and in metabolic responses. For weight management, extensive evidence supports LCD as a valid weight loss treatment, up to 1-2 years. Solely lowering carbohydrate intake does not, in the medium/long term, reduce HbA1c for T2D prevention or treatment, as many mechanisms interplay. Under controlled feeding conditions, LCD are not physiologically or clinically superior to diets with higher carbohydrates for weight-loss, fat loss, energy expenditure or glycaemic outcomes; indeed, all metabolic improvements require weight loss. Long-term evidence also links the LCD pattern to increased CVD risks and mortality. LCD can lead to micronutrient deficiencies and increased LDL-cholesterol, depending on food selection to replace carbohydrates. Evidence is limited but promising regarding food choices/sources to replace high-carbohydrate foods that may alleviate the negative effects of LCD, demanding further insight into the dietary practice of medium to long term LCD followers. Long-term, high-quality studies of LCD with different food sources (animal and/or plant origins) are needed, aiming for clinical endpoints (T2D incidence and remission, cardiovascular events, mortality). Ensuring micronutrient adequacy by food selection or supplementation should be considered for people who wish to pursue long-term LCD.
Collapse
Affiliation(s)
- Chaitong Churuangsuk
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, GlasgowG31 2ER, UK
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, GlasgowG31 2ER, UK
| | - Emilie Combet
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, GlasgowG31 2ER, UK
| |
Collapse
|
11
|
Kondo-Ando M, Seino Y, Morikawa R, Negi K, Todoroki H, Kawakami T, Asada Y, Yoshimoto R, Tanaka C, Okamoto K, Masuda A, Tomatsu E, Hiratsuka I, Yoshino Y, Maki W, Kakita A, Shibata M, Takayanagi T, Makino M, Sugimura Y, Asai S, Ito A, Ueno S, Fujiwara Y, Kuwata H, Yabe D, Suzuki A. Low-carbohydrate diet by staple change attenuates postprandial GIP and CPR levels in type 2 diabetes patients. J Diabetes Complications 2019; 33:107415. [PMID: 31466840 DOI: 10.1016/j.jdiacomp.2019.107415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Abstract
AIMS The aim of this study is to investigate the effects of a low-carbohydrate staple food (i.e., low-carbohydrate bread) on glucose and lipid metabolism and pancreatic and enteroendocrine hormone secretion in comparison with meals containing normal-carbohydrate bread, without consideration of the carbohydrate content of the side dishes. METHODS T2DM patients (n = 41) were provided meals containing low-carbohydrate bread (LB) together with side dishes or normal-carbohydrate bread (NB) together with side dishes every other day as a breakfast. Blood glucose levels were evaluated by using a continuous glucose monitoring system; blood samples were collected before and 1 and 2 h after the breakfast. RESULTS Postprandial blood glucose levels, plasma insulin, plasma glucose-dependent insulinotropic polypeptide (GIP) and plasma triglyceride were significantly lower and plasma glucagon levels were significantly higher in LB compared with those in NB. Plasma glucagon-like peptide-1 (GLP-1) levels did not differ in the LB and NB groups. CONCLUSIONS These results indicate that changing only the carbohydrate content of the staple food has benefits on glucose and lipid metabolism in T2DM patients concomitant with the decrease of insulin and GIP secretion, which ameliorate body weight gain and insulin resistance.
Collapse
Affiliation(s)
- Mizuho Kondo-Ando
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Yusuke Seino
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan.
| | - Risa Morikawa
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Kana Negi
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Hidechika Todoroki
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Tsukasa Kawakami
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Yohei Asada
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Ryo Yoshimoto
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Chika Tanaka
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Keiko Okamoto
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Atsushi Masuda
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Eisuke Tomatsu
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Izumi Hiratsuka
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Yasumasa Yoshino
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Wakako Maki
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Ayako Kakita
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Megumi Shibata
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Takeshi Takayanagi
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Masaki Makino
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Yoshihisa Sugimura
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| | - Shiho Asai
- Food and Nutrition Services Department, Fujita Health University Hospital, Japan
| | - Akemi Ito
- Food and Nutrition Services Department, Fujita Health University Hospital, Japan
| | - Shinji Ueno
- The Division of Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Japan
| | - Yuuka Fujiwara
- The Division of Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Japan
| | - Hitoshi Kuwata
- The Division of Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Japan
| | - Daisuke Yabe
- The Division of Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Japan
| | - Atsushi Suzuki
- Departments of Endocrinology and Metabolism, Fujita Health University, Japan
| |
Collapse
|
12
|
Association between breakfast skipping and postprandial hyperglycaemia after lunch in healthy young individuals. Br J Nutr 2019; 122:431-440. [DOI: 10.1017/s0007114519001235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractBreakfast skipping has become an increasing trend in the modern lifestyle and may play a role in obesity and type 2 diabetes. In our previous studies in healthy young individuals, a single incident of breakfast skipping increased the overall 24-h blood glucose and elevated the postprandial glycaemic response after lunch; however, it was difficult to determine whether this response was due to breakfast omission or the extra energy (i.e. lunch plus breakfast contents). The present study aimed to assess the postprandial glycaemic response and to measure their hormone levels when healthy young individuals had identical lunch and dinner, and the 24-h average blood glucose as a secondary outcome. Nine healthy young men (19−24 years) participated in two-meal trials: with breakfast (three-meal condition) or without breakfast (breakfast skipping condition). During the meals, each individual’s blood glucose was continuously monitored. Skipping breakfast resulted in a significantly higher (P < 0·001) glycaemic response after lunch as compared with the glycaemic response after an identical lunch when breakfast was consumed. Despite the difference in the total energy intake, the 24-h average blood glucose was similar between the two-meal conditions (P = 0·179). Plasma NEFA level was significantly higher (P < 0·05) after lunch when breakfast was omitted, and NEFA level positively correlated with the postprandial glycaemic response (r 0·631, P < 0·01). In conclusion, a single incident of breakfast skipping increases postprandial hyperglycaemia, and associated impaired insulin response, after lunch. The present study showed that skipping breakfast influences glucose regulation even in healthy young individuals.
Collapse
|
13
|
Bao Y, Chen L, Chen L, Dou J, Gao Z, Gao L, Guo L, Guo X, Ji L, Ji Q, Jia W, Kuang H, Li Q, Li Q, Li X, Li Y, Li L, Liu J, Ma J, Ran X, Shi L, Song G, Wang Y, Weng J, Xiao X, Xie Y, Xi G, Yang L, Zhao Z, Zhou J, Zhou Z, Zhu D, Zou D. Chinese clinical guidelines for continuous glucose monitoring (2018 edition). Diabetes Metab Res Rev 2019; 35:e3152. [PMID: 30884108 DOI: 10.1002/dmrr.3152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Abstract
Blood glucose monitoring is an important part of diabetes management. Continuous glucose monitoring (CGM) technology has become an effective complement to conventional blood glucose monitoring methods and has been widely applied in clinical practice. The indications for its use, the accuracy of the generated data, the interpretation of the CGM results, and the application of the results must be standardized. In December 2009, the Chinese Diabetes Society (CDS) drafted and published the first Chinese Clinical Guideline for Continuous Glucose Monitoring (2009 edition), providing a basis for the standardization of CGM in clinical application. Based on the updates of international guidelines and the increasing evidence of domestic studies, it is necessary to revise the latest CGM guidelines in China so that the recent clinical evidence can be effectively translated into clinical benefit for diabetic patients. To this end, the CDS revised the Chinese Clinical Guideline for Continuous Glucose Monitoring (2012 Edition) based on the most recent evidence from international and domestic studies.
Collapse
Affiliation(s)
- Yuqian Bao
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan City, Shandong Province, China
| | - Liming Chen
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Jingtao Dou
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Leili Gao
- Peking University People's Hospital, Beijing, China
| | - Lixin Guo
- Beijing Hospital of the Ministry of Health, Beijing, China
| | - Xiaohui Guo
- Peking University First Hospital, Beijing, China
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
| | - Qiuhe Ji
- Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shanxi Province, China
| | - Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyu Kuang
- The First Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Qifu Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Xiaoying Li
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yanbing Li
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Ling Li
- Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Jianhua Ma
- Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing City, Jiangsu Province, China
| | - Xingwu Ran
- West China Hospital of Sichuan University, Chengdu City, Sichuan Province, China
| | - Lixin Shi
- The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, China
| | - Guangyao Song
- Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Yufei Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianping Weng
- The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, Anhui Province, China
| | - Xinhua Xiao
- Peking Union Medical College Hospital, Beijing, China
| | - Yun Xie
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Guangxia Xi
- Shanxi Dayi Hospital, Taiyuan City, Shanxi Province, China
| | - Liyong Yang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Zhigang Zhao
- Zhengzhou Yihe Hospital Affiliated to Henan University, Zhengzhou City, Henan Province, China
| | - Jian Zhou
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhiguang Zhou
- The Second Xiangya Hospital of Central South University, Changsha City, Hunan Province, China
| | - Dalong Zhu
- Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing City, Jiangsu Province, China
| | - Dajin Zou
- Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| |
Collapse
|
14
|
Chang CR, Francois ME, Little JP. Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability. Am J Clin Nutr 2019; 109:1302-1309. [PMID: 30968140 PMCID: PMC6499564 DOI: 10.1093/ajcn/nqy261] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/29/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The breakfast meal often results in the largest postprandial hyperglycemic excursion in people with type 2 diabetes. OBJECTIVE Our purpose was to investigate whether restricting carbohydrates at breakfast would be a simple and feasible strategy to reduce daily exposure to postprandial hyperglycemia. DESIGN Adults with physician-diagnosed type 2 diabetes [n = 23; mean ± SD age: 59 ± 11 y; glycated hemoglobin: 6.7% ± 0.6%; body mass index (kg/m2): 31 ± 7] completed two 24-h isocaloric intervention periods in a random order. Participants consumed one of the following breakfasts: 1) a very-low-carbohydrate high-fat breakfast (LCBF; <10% of energy from carbohydrate, 85% of energy from fat, 15% of energy from protein) or 2) a breakfast with dietary guidelines-recommended nutrient profile (GLBF; 55% of energy from carbohydrate, 30% of energy from fat, 15% of energy from protein), with the same lunch and dinner provided. Continuous glucose monitoring was used to assess postprandial glucose responses over 24 h, and visual analog scales were used to assess ratings of hunger and fullness. RESULTS The LCBF significantly reduced postprandial hyperglycemia after breakfast (P < 0.01) and did not adversely affect glycemia after lunch or dinner. As such, overall postprandial hyperglycemia (24-h incremental area under the glucose curve) and glycemic variability (mean amplitude of glycemic excursions) were reduced with the LCBF (24-h incremental area under the glucose curve: -173 ± 361 mmol/L; P = 0.03; mean amplitude of glycemic excursions: -0.4 ± 0.8 mmol/L · 24 h; P = 0.03) compared with the GLBF. Premeal hunger was lower before dinner with the LCBF than with the GLBF (P-interaction = 0.03). CONCLUSIONS A very-low-carbohydrate high-fat breakfast lowers postbreakfast glucose excursions. The effects of this simple strategy appear to be sufficient to lower overall exposure to postprandial hyperglycemia and improve glycemic variability. Longer-term interventions are warranted. This trial was registered at clinicaltrials.gov as NCT02982330.
Collapse
Affiliation(s)
- Courtney R Chang
- School of Health and Exercise Sciences, University of British Columbia, Okanagan, Canada
| | - Monique E Francois
- School of Health and Exercise Sciences, University of British Columbia, Okanagan, Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia, Okanagan, Canada,Address correspondence to JPL (e-mail: )
| |
Collapse
|
15
|
Su Q, Liu J, Li P, Qian L, Yang W. Relative Contribution of Fasting and Postprandial Blood Glucose in Overall Glycemic Control: Post Hoc Analysis of a Phase IV Randomized Trial. Diabetes Ther 2018; 9:987-999. [PMID: 29574635 PMCID: PMC5984909 DOI: 10.1007/s13300-018-0403-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Few prospective clinical trials have investigated the role of fasting blood glucose (FBG) and/or postprandial glucose (PPG) in assessing overall glycemic control by using different insulin regimens. In the present post hoc analysis, we assessed the contribution of FBG and/or PPG in overall glycemic control in Chinese patients under insulin treatment. METHODS CLASSIFY is a phase IV, randomized, open-label, 26-week, parallel-arm, treat-to-target, multinational, controlled study in patients with type 2 diabetes mellitus to compare the efficacy and safety of insulin lispro mix 25 (LM25) and insulin lispro mix 50 (LM50) as starter insulins. Insulin was titrated with an aim to target pre-meal blood glucose (BG) levels at > 3.9 and ≤ 6.1 mmol/L before breakfast and dinner. The primary outcome assessed was the change in HbA1c from baseline. RESULTS Chinese patients contributed 38.7% (N = 156) of the total population. The majority of patients were male (52.6%). The mean (SD) body mass index was 24.54 (3.04) kg/m2 and mean (SD) HbA1c was 8.54 (1.10) % at baseline. At week 26, LM50 showed a significantly greater reduction from baseline in HbA1c (- 2.03% vs - 1.55%, P < 0.001), average daily BG (- 3.21 vs - 2.34 mmol/L, P < 0.001), average post-meal BG (- 3.58 vs - 2.39 mmol/L, P < 0.001), and average prandial BG excursion (- 1.01 vs - 0.22 mmol/L, P = 0.006) than the LM25 group. The reductions in average pre-meal BG (- 2.59 vs - 2.28 mmol/L, P = 0.137) were not significantly different between the groups. The proportion of patients achieving HbA1c targets (< 7% or ≤ 6.5%) without nocturnal hypoglycemia or weight gain was greater (P < 0.05) with LM50 compared with LM25. CONCLUSION LM50 achieved better overall glycemic control than LM25 as a starter insulin in Chinese patients, which may be due to greater improvement in PPG levels. TRIAL REGISTRATION Clinicaltrials.gov identification number: NCT01773473. FUNDING Eli Lilly and Company, Shanghai, China.
Collapse
Affiliation(s)
- Qing Su
- Department of Endocrinology and Metabolism, Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Endocrinology and Metabolism, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Pengfei Li
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Lei Qian
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
- Medical Science Department, Shanghai Haihe Pharmaceutical Co. Ltd, Shanghai, China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
| |
Collapse
|
16
|
Alyami J, Ladd N, Pritchard SE, Hoad CL, Sultan AA, Spiller RC, Gowland PA, Macdonald IA, Aithal GP, Marciani L, Taylor MA. Glycaemic, gastrointestinal and appetite responses to breakfast porridges from ancient cereal grains: A MRI pilot study in healthy humans. Food Res Int 2017; 118:49-57. [PMID: 30898352 DOI: 10.1016/j.foodres.2017.11.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/06/2017] [Accepted: 11/27/2017] [Indexed: 12/19/2022]
Abstract
Cereal grain based porridges are commonly consumed throughout the world. Whilst some data are available for varieties that are popular in the Western world such as oats and rye, other 'ancient' grains used in the East and in Africa such as millets are thought to have beneficial health effects, such as a suppression of post prandial hunger and circulating glucose levels. These grains, a sustainable food source due to their tolerance of extreme weather and growing conditions, are commonly found throughout Asia and Africa. However, knowledge of the physiological responses to these grain varieties is very limited. This study aimed to collect initial pilot data on the physiological and gastrointestinal responses to breakfast porridges made with two millet varieties and oats and rye grains. A total of n=15 completed the oats and rye, n=9 the finger millet n=12 the pearl millet meals. MRI scans were undertaken at baseline, immediately after consumption and then hourly postprandially. Blood glucose was measured at baseline, immediately after consumption and then every 15min until t=80min, then every 20min until t=120min, followed on each occasion by completion of VAS. Seven participants completed the entire protocol and were included in the final analysis. A subgroup analysis with the n=10 paired comparison between the same individuals that completed the oats, rye and pearl millet was also considered. The gastric volume AUC was higher for pearl millet than oats and rye (n=10, p<0.001). The incremental area under the curve (iAUC) for blood glucose was not significantly different between the meals although this showed a trend to be lower for pearl millet. Hunger was lower for pearl millet compared to oats and rye (n=10, p=0.01). There was a significant correlation between total gastric volume AUC and average appetite AUC r=-0.47, p<0.010. Isoenergetic breakfast porridges from 'ancient' varieties of millet grains showed physiological responses that were comparable with those from common Western varieties known to have beneficial health effects. Pearl millet appeared to induce lower postprandial blood glucose response and appetite scores though the differences were not conclusive compared with the other porridges and further work is needed. Improved knowledge of the effects of different cereal grains could help direct dietary advice and ultimately improve health outcomes in the general population worldwide.
Collapse
Affiliation(s)
- Jaber Alyami
- Deaprtment of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University(KAU), Jeddah, Saudi Arabia; Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Nidhi Ladd
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Susan E Pritchard
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Caroline L Hoad
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Alyshah Abdul Sultan
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Robin C Spiller
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Penny A Gowland
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Ian A Macdonald
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Luca Marciani
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Moira A Taylor
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham, UK.
| |
Collapse
|
17
|
Kang X, Wang C, Chen D, Lv L, Liu G, Xiao J, Yang Y, He L, Chen L, Li X, Tian H, Jia W, Ran X. Contributions of Basal Glucose and Postprandial Glucose Concentrations to Hemoglobin A1c in the Newly Diagnosed Patients with Type 2 Diabetes--the Preliminary Study. Diabetes Technol Ther 2015; 17:445-8. [PMID: 25826625 PMCID: PMC4504343 DOI: 10.1089/dia.2014.0327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this preliminary study is to investigate contributions of basal glucose (BG) and postprandial glucose (PPG) increments to overall hyperglycemia in newly diagnosed patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We evaluated the relative contributions of BG and PPG to overall hyperglycemia in 59 newly diagnosed T2DM patients according to BG baseline value of 6.1 mmol/L and 24-h glucose profiles of normal glucose tolerance (NGT) subjects obtained by continuous glucose monitoring as baseline, respectively. RESULTS When the baseline was 24-h glucose profiles of the NGT subjects, the relative contributions of PPG in the T2DM patients with hemoglobin A1c (HbA1c) levels of ≤ 7.0%, 7.0-9.0%, and >9.0% were 57.58%, 44.69%, and 21.56%, respectively. When the baseline value was equal to 6.1 mmol/L, the relative contributions of PPG in the T2DM patients with HbA1c levels of ≤ 7.0%, 7.0-9.0%, and >9.0% were 77.23%, 53.43%, and 22.78%, respectively. Compared with the 24-h glucose profiles of the NGT subjects as the baseline, the relative contribution of PPG was overestimated by about 10-20% in the T2DM patients with HbA1c levels of ≤ 9.0% when 6.1 mmol/L was chosen as the baseline. CONCLUSIONS In the newly diagnosed T2DM patients with mild hyperglycemia, PPG is a predominant contributor, whereas the relative contributions of BG gradually increase from mild to severe hyperglycemia and obviously exceed PPG in the T2DM patients with HbA1c levels of >9.0%. This finding implies that the initial pharmacotherapy may target PPG in those patients with mild hyperglycemia and target BG in those patients with severe hyperglycemia.
Collapse
Affiliation(s)
- Xin Kang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Chun Wang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Dawei Chen
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lifang Lv
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Guanjian Liu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jie Xiao
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yanzhi Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Liping He
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lihong Chen
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiujun Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
18
|
Tay J, Thompson CH, Brinkworth GD. Glycemic Variability: Assessing Glycemia Differently and the Implications for Dietary Management of Diabetes. Annu Rev Nutr 2015; 35:389-424. [PMID: 25974701 DOI: 10.1146/annurev-nutr-121214-104422] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The primary therapeutic target for diabetes management is the achievement of good glycemic control, of which glycated hemoglobin (HbA1c) remains the standard clinical marker. However, glycemic variability (GV; the amplitude, frequency, and duration of glycemic fluctuations around mean blood glucose) is an emerging target for blood glucose control. A growing body of evidence supports GV as an independent risk factor for diabetes complications. Several techniques have been developed to assess and quantify intraday and interday GV. Additionally, GV can be influenced by several nutritional factors, including carbohydrate quality, quantity; and distribution; protein intake; and fiber intake. These factors have important implications for clinical nutrition practice and for optimizing blood glucose control for diabetes management. This review discusses the available evidence for GV as a marker of glycemic control and risk factor for diabetes complications. GV quantification techniques and the influence of nutritional considerations for diabetes management are also discussed.
Collapse
Affiliation(s)
- Jeannie Tay
- Commonwealth Scientific and Industrial Research Organisation (CSIRO)-Food and Nutrition Flagship, Adelaide, South Australia 5000, Australia;
| | | | | |
Collapse
|