The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Inhibition of human starch digesting enzymes and intestinal glucose transport by walnut polyphenols

One approach to controlling type 2 diabetes (T2D) is to lower postprandialglucose spikesby slowing down the digestion of carbohydrates and the absorption of glucose in the small intestine. The consumption of walnuts is associated with a reduced risk of chronic diseases such as T2D, suggested to be partly due to the high content of (poly)phenols. This study evaluated, for the first time, the inhibitory effect of a (poly)phenol-rich walnut extract on human carbohydrate digesting enzymes (salivary and pancreatic α-amylases, brush border sucrase-isomaltase) and on glucose transport across fully differentiated human intestinal Caco-2/TC7 monolayers. The walnut extract was rich in multiple (poly)phenols (70 % w/w) as analysed by Folin-Ciocalteau and by LCMS. It exhibited potent inhibition of both human salivary (IC50: 32.2 ± 2.5 µg walnut (poly)phenols (WP)/mL) and pancreatic (IC50: 56.7 ± 1.7 µg WP/mL) α-amylases, with weaker effects on human sucrase (IC50: 990 ± 20 µg WP/mL), maltase (IC50: 1300 ± 80 µg WP/mL), and isomaltase (IC25: 830 ± 60 µg WP/mL) activities. Selected individual walnut (poly)phenols inhibited human salivary α-amylase in the order: 1,3,4,6-tetragalloylglucose > ellagic acid pentoside > 1,2,6-tri-O-galloyl-β-D-glucopyranose, with no inhibition by ellagic acid, gallic acid and 4-O-methylgallic acid. The (poly)phenol-rich walnut extract also attenuated (up to 59 %) the transfer of 2-deoxy-D-glucose across differentiated Caco-2/TC7 cell monolayers. This is the first report on the effect of (poly)phenol-rich extracts from any commonly-consumed nut kernel on any human starch-digesting enzyme, and suggests a mechanism through which walnut consumption may lower postprandial glucose spikes and contribute to their proposed health benefits.

Chinese Guidelines for Medical Nutrition Therapy for Patients with Diabetes (2022 Edition)

Medical nutrition therapy (MNT) is the foundation of the comprehensive treatment of patients with diabetes. In 2010, the Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association developed the first Chinese guideline on MNT for patients with diabetes, and it was updated in 2015. Since then, new evidence has emerged in the field of MNT and metabolic therapy in patients with diabetes. The Nutrition and Metabolic Management Branch of the China International Exchange and Promotive Association for Medical and Health Care organized a team of experts from related institutions, including the Clinical Nutrition Branch of the Chinese Nutrition Society, Chinese Diabetes Society, Chinese Society for Parenteral and Enteral Nutri-tion, and Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association. Their task was to develop the Chinese Guidelines of Medical Nutrition Therapy in Diabetes (2022 Edition) in accordance with the requirements of the Guidelines for the Formulation/Revision of Clinical Guidelines in China (2022 Edition) by combining the questions raised and evidence gathered in clinical practices in China, to guide and standardize the clinical MNT.

Beneficial glycaemic effects of high-amylose barley bread compared to wheat bread in type 2 diabetes

BACKGROUND

Cereals foods with a high content of dietary fibres or amylose have potential to lower postprandial glucose levels. Optimisation of cereal foods may improve management of type 2 diabetes (T2D).

METHODS

We investigated the impact on 4 h postprandial glucose responses given as incremental area under curve (iAUC) of bread made of either 50% RNAi-based (genetically modified) amylose-only barley flour (AmOn) (and 50% wheat flour), 50% hulless barley flour (and 50% wheat flour) or 75% hulless barley (and 25% wheat flour) in subjects with T2D compared with 100% wheat flour bread.

DESIGN

Twenty adults with T2D were randomly allocated to one of four breads at four separate visits. We measured fasting and 4 h postprandial responses of glucose, insulin, glucagon, triacylglycerol (TG), free fatty acids (FFA), glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP). Mixed model ANOVA was used to examine the differences.

RESULTS

Bread made from 50% AmOn lowered the 4 h postprandial glucose by 34%, 27%, 23% (P < 0.05) compared with 100% wheat, 50% or 75% hulless barley, respectively. Bread made from 75% hulless barley reduced the postprandial glucose response (iAUC) by 11% (P < 0.05) compared to 100% wheat bread. Postprandial insulin responses (iAUC) were reduced for 50% AmOn compared with 100% wheat and 50% hulless barley and for 75% hulless compared to 50% hulless barley bread (P < 0.05). 4 h postprandial glucagon (tAUC) did not differ between the four bread types (P > 0.05). Lower postprandial GIP (iAUC) was observed after all barley breads compared to 100% wheat (P < 0.05), whereas no difference was seen in postprandial GLP-1. Postprandial TG and FFA (tAUC) were difficult to judge due to differences in fasting values.

CONCLUSIONS

Bread made by replacing wheat flour with either 50% high-amylose or 75% hulless barley flour lowered postprandial glucose responses compared to 100% wheat bread indicating a beneficial impact on glucose regulation in T2D subjects. This trial was registered at clinicaltrials.gov as NCT04646746.

Effect of Alchornea cordifolia on Glycemic Indices of Varieties of Fufu Among Healthy Subjects

Background

Glycemic index (GI) is a measure of the ability of carbohydrate food to raise blood glucose concentration. The GI of a food and its negative effects has caused an adverse increase in the prevalence of diabetes and other metabolic diseases.

Objective

This study aimed to determine the effect of Alchornea cordifolia on glycemic indices of varieties of fufu.

Methods

The research was a crossover experimental study involving 10 healthy individuals. A 50-g measure of pure glucose was served on 2 separate occasions and, subsequently, a measured amount of the test foods containing 50 g of available carbohydrates. The GI values were determined by the measure of the blood glucose concentrations of the subjects at fasting and after ingestion of the glucose and the test foods (fufu) within 2 h. Collection of capillary blood for blood glucose measurement started 30 min after consumption and was subsequently taken at 60, 90, and 120 min for both noncomposited and composited fufu GI determination. The phytoconstituents of the A. cordifolia were also determined.

Results

For the noncomposited fufu, plantain fufu had the least glycemic response (46%), followed by cassava fufu (50%) and cassava-plantain fufu (53%); however, all were in the low-GI category. For the composited fufu, plantain fufu had the least response (12%), followed by cassava-plantain fufu (14%) and cassava fufu (14%), with all in the low-GI category. A multiple comparison of GI on the various foods by analysis of variance revealed a significant difference between the GI of cassava-plantain fufu and composite cassava-plantain fufu (P = 0.001); cassava fufu and composite cassava fufu (P = 0.004); and plantain fufu and composite plantain fufu (P = 0.006). The phytochemical screening of the A. cordifolia revealed the presence of flavonoids and tannins.

Conclusions

Composited A. cordifolia fufu affects the glycemic response.

Nutrition at the Intersection between Gut Microbiota Eubiosis and Effective Management of Type 2 Diabetes

Nutrition is one of the most influential environmental factors in both taxonomical shifts in gut microbiota as well as in the development of type 2 diabetes mellitus (T2DM). Emerging evidence has shown that the effects of nutrition on both these parameters is not mutually exclusive and that changes in gut microbiota and related metabolites such as short-chain fatty acids (SCFAs) and branched-chain amino acids (BCAAs) may influence systemic inflammation and signaling pathways that contribute to pathophysiological processes associated with T2DM. With this background, our review highlights the effects of macronutrients, carbohydrates, proteins, and lipids, as well as micronutrients, vitamins, and minerals, on T2DM, specifically through their alterations in gut microbiota and the metabolites they produce. Additionally, we describe the influences of common food groups, which incorporate varying combinations of these macronutrients and micronutrients, on both microbiota and metabolic parameters in the context of diabetes mellitus. Overall, nutrition is one of the first line modifiable therapies in the management of T2DM and a better understanding of the mechanisms by which gut microbiota influence its pathophysiology provides opportunities for optimizing dietary interventions.

Novel nutritionally-enriched gummy jelly infused with nipa palm vinegar powder and nipa palm syrup as functional food ingredients

The objective of this research was to develop a nutritionally-enriched gummy jelly product incorporating nipa palm vinegar powder (NPVp; a nutrients-rich vinegar) and nipa palm syrup (NPS), a nutrients-rich sweetener with a low glycemic index. A gummy jelly product was developed based on sensory acceptance tests. The water activity and the moisture content of the final product were within the acceptable range for preservation under ambient conditions. The final product had a total phenolic content of 861 μg gallic acid equivalent (GAE) per g and an antioxidant activity (2,2-diphenyl-1-picrylhydrazyl (DPPH) inhibition) of 72.7 %. The final product had the following nutritional attributes (per 100 g dry mass): 319.7 kcal of energy, 8.8 g protein, 0.2 g fats, 70.6 g carbohydrates, 59.9 g total sugars, 0.7 g of total dietary fibers, 34.6 mg calcium, 0.3 mg iron, 168.0 mg sodium, and 774.7 mg vitamin C. The in vitro glycemic index of the product was 27.4. Based on their nutrients-content, NPVp and NPS were suitable for use in other functional food products.

The Impact of Using Carbohydrate Counting on Managing Diabetic Patients: A Review

Carbohydrate counting (CC) is a meal planning practice for diabetic patients, focusing on tracking the amount of carbohydrates in grams consumed at meals to manage blood glucose (BG) levels. The purpose of this narrative review is to evaluate the impact of CC in helping people with diabetes manage their condition. It reveals that CC offers superior glycemic control and flexibility compared to other food planning techniques. Specifically, when applied to children and teenage patients diagnosed with type 1 diabetes mellitus (T1DM), CC demonstrates the potential for substantial improvements in metabolic control without any adverse effects on weight or increased insulin requirements. In the context of T1DM, the combination of CC and the use of automated bolus calculators (ABCs) contributes to lowering glycated hemoglobin (HbA1c) levels. Furthermore, the study highlights that CC also holds promise in the management of type 2 diabetes mellitus (T2DM). In T2DM patients, adhering to a low glycemic index (GI) diet has proven to be more effective in controlling HbA1c and fasting BG levels compared to a higher GI diet or standard dietary control. This research underscores the evolving significance of CC as a pivotal component in diabetes management, attributed to increased awareness and education among patients. CC emerges as a versatile tool that can benefit individuals with various forms of diabetes by enhancing their glycemic control and overall quality of life. The findings affirm the impact of CC in improving patient outcomes, solidifying its status as a vital strategy in the multifaceted landscape of diabetes care.

Adherence to the 2015-2020 Dietary Guidelines for Americans Compared with the Mediterranean Diet in Relation to Risk of Prediabetes: Results from NHANES 2007-2016

Prediabetes presents a high-risk state for the development of various diseases and is reversible by adhering to a healthy lifestyle. We conducted this analysis to explore the associations of the Healthy Eating Index-2015 (HEI-2015) and the Alternate Mediterranean Diet Index (aMed index) with the risk of prediabetes. The data were derived from the National Health and Nutrition Examination Survey, including 20,844 participants. Multivariable-adjusted odds ratios (OR) of prediabetes and 95% confidence intervals (CI) by tertile of diet quality scores were estimated using a weighted logistic regression. Compared to those in the lowest tertile, the multivariable-adjusted OR of prediabetes for the highest tertile was 0.82 (95% CI: 0.72, 0.94; p for trend = 0.005) for HEI-2015 and 0.87 (95% CI: 0.76, 0.98; p for trend = 0.02) for the aMed index. After mutual adjustment, the association for HEI-2015 (p for trend = 0.03) but not for the aMed index (p for trend = 0.59) remained significant. Among the component food groups and nutrients, higher intakes of red and processed meat, sodium, and total saturated fatty acids were associated with a higher risk of prediabetes, while moderate alcohol consumption was associated with a lower risk. In conclusion, adherence to the 2015-2020 Dietary Guidelines for Americans, as compared with the Mediterranean Diet, appeared to be more strongly associated with a lower risk of prediabetes among adults in the United States.

Effect of Artificial Intelligence-based Health Education Accurately Linking System (AI-HEALS) for Type 2 diabetes self-management: protocol for a mixed-methods study

BACKGROUND

Patients with type 2 diabetes (T2DM) have an increasing need for personalized and Precise management as medical technology advances. Artificial intelligence (AI) technologies on mobile devices are being developed gradually in a variety of healthcare fields. As an AI field, knowledge graph (KG) is being developed to extract and store structured knowledge from massive data sets. It has great prospects for T2DM medical information retrieval, clinical decision-making, and individual intelligent question and answering (QA), but has yet to be thoroughly researched in T2DM intervention. Therefore, we designed an artificial intelligence-based health education accurately linking system (AI-HEALS) to evaluate if the AI-HEALS-based intervention could help patients with T2DM improve their self-management abilities and blood glucose control in primary healthcare.

METHODS

This is a nested mixed-method study that includes a community-based cluster-randomized control trial and personal in-depth interviews. Individuals with T2DM between the ages of 18 and 75 will be recruited from 40-45 community health centers in Beijing, China. Participants will either receive standard diabetes primary care (SDPC) (control, 3 months) or SDPC plus AI-HEALS online health education program (intervention, 3 months). The AI-HEALS runs in the WeChat service platform, which includes a KBQA, a system of physiological indicators and lifestyle recording and monitoring, medication and blood glucose monitoring reminders, and automated, personalized message sending. Data on sociodemography, medical examination, blood glucose, and self-management behavior will be collected at baseline, as well as 1,3,6,12, and 18 months later. The primary outcome is to reduce HbA1c levels. Secondary outcomes include changes in self-management behavior, social cognition, psychology, T2DM skills, and health literacy. Furthermore, the cost-effectiveness of the AI-HEALS-based intervention will be evaluated.

DISCUSSION

KBQA system is an innovative and cost-effective technology for health education and promotion for T2DM patients, but it is not yet widely used in the T2DM interventions. This trial will provide evidence on the efficacy of AI and mHealth-based personalized interventions in primary care for improving T2DM outcomes and self-management behaviors.

TRIAL REGISTRATION

Biomedical Ethics Committee of Peking University: IRB00001052-22,058, 2022/06/06; Clinical Trials: ChiCTR2300068952, 02/03/2023.

Longitudinal Associations of Dietary Sugars and Glycaemic Index with Indices of Glucose Metabolism and Body Fatness during 3-Year Weight Loss Maintenance: A PREVIEW Sub-Study

BACKGROUND

Dietary sugars are often linked to the development of overweight and type 2 diabetes (T2D) but inconsistencies remain.

OBJECTIVE

We investigated associations of added, free, and total sugars, and glycaemic index (GI) with indices of glucose metabolism (IGM) and indices of body fatness (IBF) during a 3-year weight loss maintenance intervention.

DESIGN

The PREVIEW (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World) study was a randomised controlled trial designed to test the effects of four diet and physical activity interventions, after an 8-week weight-loss period, on the incidence of T2D. This secondary observational analysis included pooled data assessed at baseline (8), 26, 52, 104 and 156 weeks from 514 participants with overweight/obesity (age 25-70 year; BMI ≥ 25 kg⋅m^-2) and with/without prediabetes in centres that provided data on added sugars (Sydney and Helsinki) or free sugars (Nottingham). Linear mixed models with repeated measures were applied for IBF (total body fat, BMI, waist circumference) and for IGM (fasting insulin, HbA1c, fasting glucose, C-peptide). Model A was adjusted for age and intervention centre and Model B additionally adjusted for energy, protein, fibre, and saturated fat.

RESULTS

Total sugars were inversely associated with fasting insulin and C-peptide in all centres, and free sugars were inversely associated with fasting glucose and HbA1c (Model B: all p < 0.05). Positive associations were observed between GI and IGM (Model B: fasting insulin, HbA1c, and C-peptide: (all p < 0.01), but not for added sugars. Added sugar was positively associated with body fat percentage and BMI, and GI was associated with waist circumference (Model B: all p < 0.01), while free sugars showed no associations (Model B: p > 0.05).

CONCLUSIONS

Our findings suggest that added sugars and GI were independently associated with 3-y weight regain, but only GI was associated with 3-y changes in glucose metabolism in individuals at high risk of T2D.

Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review

STATEMENT OF PROBLEM

The high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking.

PURPOSE

Given the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments.

MATERIAL AND METHODS

An extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English.

RESULTS

A total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved.

CONCLUSIONS

The evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.

Validating Healthy Eating Index, Glycemic Index, and Glycemic Load with Modern Diets for E-Health Era

Predictors of healthy eating parameters, including the Healthy Eating Index (HEI), Glycemic Index (GI), and Glycemic Load (GL), were examined using various modern diets (n = 131) in preparation for personalized nutrition in the e-health era. Using Nutrition Data Systems for Research computerized software and artificial intelligence machine-learning-based predictive validation analyses, we included domains of HEI, caloric source, and various diets as the potentially modifiable factors. HEI predictors included whole fruits and whole grains, and empty calories. Carbohydrates were the common predictor for both GI and GL, with total fruits and Mexican diets being additional predictors for GI. The median amount of carbohydrates to reach an acceptable GL < 20 was predicted as 33.95 g per meal (median: 3.59 meals daily) with a regression coefficient of 37.33 across all daily diets. Diets with greater carbohydrates and more meals needed to reach acceptable GL < 20 included smoothies, convenient diets, and liquids. Mexican diets were the common predictor for GI and carbohydrates per meal to reach acceptable GL < 20; with smoothies (12.04), high-school (5.75), fast-food (4.48), Korean (4.30), Chinese (3.93), and liquid diets (3.71) presenting a higher median number of meals. These findings could be used to manage diets for various populations in the precision-based e-health era.

Determining Dietary Patterns to Recommend for Type 2 Diabetes: An Umbrella Review

Some specific dietary patterns improve glycaemic levels and cardiovascular risk factors better than others. We aimed to identify the most effective dietary patterns using a food-focused approach to improve blood glucose management (primary outcome) and cardiovascular risk factors (secondary outcome) in people with type 2 diabetes. An umbrella review was conducted comparing dietary patterns for the management of these outcomes. Studies published between 2012 and 2022 were identified using PubMed Central, ProQuest, Web of Science, and the Cochrane Database of Systematic Reviews. Thirty systematic reviews met the inclusion criteria. Twenty-two of thirty reviews quantitated (via meta-analyses of over 212 randomised control trials) the effect size of different dietary patterns. Twelve reviews found Low-carbohydrate (LC), Mediterranean (M), Plant-based (PB), and/or Low-glycaemic Index (LGI) diets reduced HbA1c moderately more than control diets (typically a high-carbohydrate, low-fat diet) (i.e., LC: -0.1 to -0.5%; M: -0.3 to -0.5%; PB: -0.2 to -0.4%; LGI -0.2 to -0.5%; all p-value < 0.01). We conclude that Low-carbohydrate, Mediterranean, Plant-based, and Low-glycaemic Index dietary patterns are all clinically effective for people with type 2 diabetes as alternatives to high-carbohydrate, low-fat diets typically used for managing glycaemic levels and CVD risk. However, quality evidence about the sustainability of effects and safety remains limited, warranting future research.

Cross-sectional comparisons of dietary indexes underlying nutrition labels: nutri-score, Canadian 'high in' labels and Diabetes Canada Clinical Practices (DCCP)

PURPOSE

To assess the cross-sectional association between dietary indexes (DI) that underlie, respectively, the Nutri-score (NS), the proposed Canadian 'High In' Symbol (CHIL) and the Diabetes Canada Clinical Practice Guidelines (DCCP) with food consumption, nutrient intakes and metabolic markers.

METHODS

1836 adults (18-74 years) participating in the representative ESTEBAN study, conducted in mainland France in 2014-2016, were included in the analysis. Food consumption was assessed with three repeated 24 h dietary recalls. Anthropometric measurements and biomarkers of metabolic risk (cholesterol-total, LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein)-triglycerides, glucose) were obtained through a clinical examination and fasting blood draw. The DI were assessed for their association with food consumption, dietary intakes and metabolic biomarkers as quintiles and continuous variables using multi-adjusted linear regression. Heathier diets were assigned to lower scores.

RESULTS

Correlations between scores ranged from + 0.62 between CHIL-DI and NS-DI to + 0.75 between NS-DI and DCCP-DI. All DIs discriminated individuals according to the nutritional quality of their diets through food consumption and nutrient intakes (healthier diets were associated with lower intakes of energy, added sugars and saturated fat; and with higher intakes of fiber, vitamins and minerals). NS-DI was associated with blood glucose (adjusted mean in Q1 = 5 vs. Q5 = 5.46 mmol/dl, p_trend = 0.001) and DCCP-DI was associated with BMI (Q1 = 24.8 kg/m² vs. Q5 = 25.8 kg/m², p_trend = 0.025), while CHIL showed no significant association with any anthropometric measures or biomarkers.

CONCLUSIONS

This study provides elements supporting the validity of the nutrient profiling systems underlying front-of-package nutrition labellings (FOPLs) to characterize the healthiness of diets.

The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial

BACKGROUND

Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM).

METHODS

We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model.

RESULTS

The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05).

CONCLUSIONS

Over 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide.

TRIAL REGISTRATION

Registered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569.

Glycemic Responses of Milk and Plant-Based Drinks: Food Matrix Effects

The consumption of food items containing digestible carbohydrates in food products leads to postprandial increases in blood glucose levels and glycemic responses. The extent to which these occur depends on many factors, including concentration and type of carbohydrate, but also other physicochemical properties of the food matrix, which determine the rate of uptake of monosaccharides into the bloodstream, including product structure and factors affecting gastric emptying. For milk, control of postprandial glycemic responses appears to be multifaceted, including a controlled rate of gastric emptying, a rate of glucose and galactose uptake into the bloodstream controlled by enzymatic hydrolysis, as well as stimulated insulin secretion to enhance uptake of blood glucose from the bloodstream. Altogether, this allows milk to deliver comparatively high levels of carbohydrate with limited glycemic responses. For plant-based drinks positioned as milk alternatives, however, compositional differences (including carbohydrate type and concentration) as well as matrix factors limiting control over gastric emptying and insulin secretion can, in some cases, lead to much stronger glycemic responses, which are undesirable in relation to non-communicable diseases, such as type-2 diabetes. This review discusses glycemic responses to milk and plant-based drinks from this perspective, focusing on mechanistic insights and food matrix effects.

Effect of Two-Only-Meal Frequency and Exercise on HbA1C Outcomes, Weight, and Anti-Diabetic Medication in Type 2 Diabetes in a Popular Lifestyle Change Campaign in Maharashtra, Compared to Conventional Clinical Management: A Quasi-Experimental Multicenter Study in Maharashtra

Background

Rising prevalence and poor outcomes make the twin challenges of diabetes epidemiology. This study evaluates effect of 2-only-daily-meals with exercise (2-OMEX) for its effect on HbA1c, oral hypoglycaemic agents (OHA) usage, body-weight among type-2-diabetes (T2DM) subjects, compared with conventional management.

Material and Methods

A quasi-experimental, multicentre study in 2-OMEX arm, and HbA1c by HPLC method. HbA1c and body-weight changes were analyzed by 'Difference in Difference' (DID) method. Meal frequency, exercise, energy intakes were based on recall. The required sample size was 20X2 for 1.1 difference in HbA1c with 95% CL and 80% power.

Results

Socio-demographic and risk profile of analysed and omitted subjects were similar. Studied arms were also similar in baseline features. The results in 2-OMEX and conventional arm are: complete records analyzed 201 and 120. Mean (sd) values as follows: observation days 234 and 236, age 52.03(8.84) and 52.45(9.48) years (P=0.6977), diabetes duration 4.6(3.05) and 4.9(2.97) years, BMI 27.28(5.27), 26.90(3.74) (P = 0.1859), baseline HbA1c gm% 7.46(1.52) and 7.55(1.58), end-line proportion of subjects attaining HbA1c ≤6.5gm% was 35.3% and 19.2% (P=0.002), bodyweight loss 2.57% and 1.26%. OHA count 1.6 (1.23) and 2.7(1.06), (P=0.0003). In 2-OMEX arm log-normal HbA1c declined significantly by 0.94 (95%CI: 1.60 to - 0.56, p=0.0333), weight loss difference 0.96 kg, and statistically not significant (P=0.595). Two subjects in 2-OMEX arm showed partial remission. Mean baseline Kcal intakes in 2-OMEX arm, were 1200.4(F) and 1437.3(M) were significantly higher than conventional arm (F) and 1430 (M).

Conclusion

The 2-OMEX showed a sizeable and significant reduction in HbA1c and OHA use, in 7-months, with moderate intakes, compared to the conventional arm, possibly attributable to fewer insulin surges. More studies are required for its impact and pathways.

Nutritional benefits of sourdoughs: A systematic review

Food fermentation using sourdough-i.e., consortia of lactic bacteria and yeasts-is increasingly considered among the public as a natural transformation yielding nutritional benefits; however, it is unclear whether its alleged properties are validated by science. The aim of this study was to systematically review the clinical evidence related to the effect of sourdough bread on health. Bibliographic searches were performed in 2 different databases (The Lens and PubMed) up to February 2022. Eligible studies were randomized controlled trials involving adults, healthy or not, given any type of sourdough bread compared with those given any type of yeast bread. A total of 573 articles were retrieved and investigated, of which 25 clinical trials met the inclusion criteria. The 25 clinical trials included a total of 542 individuals. The main outcomes investigated in the retrieved studies were glucose response (N = 15), appetite (N = 3), gastrointestinal markers (N = 5), and cardiovascular markers (N = 2). Overall, it is currently difficult to establish a clear consensus with regards to the beneficial effects of sourdough per se on health when compared with other types of bread because a variety of factors, such as the microbial composition of sourdough, fermentation parameters, cereals, and flour types potentially influence the nutritional properties of bread. Nonetheless, in studies using specific strains and fermentation conditions, significant improvements were observed in parameters related to glycemic response, satiety, or gastrointestinal comfort after bread ingestion. The reviewed data suggest that sourdough has great potential to produce a variety of functional foods; however, its complex and dynamic ecosystem requires further standardization to conclude its clinical health benefits.

Within subject cross-tissue analyzes of epigenetic clocks in substance use disorder postmortem brain and blood

There is a possible accelerated biological aging in patients with substance use disorders (SUD). The evaluation of epigenetic clocks, which are accurate estimators of biological aging based on DNA methylation changes, has been limited to blood tissue in patients with SUD. Consequently, the impact of biological aging in the brain of individuals with SUD remains unknown. In this study, we evaluated multiple epigenetic clocks (DNAmAge, DNAmAgeHannum, DNAmAgeSkinBlood, DNAmPhenoAge, DNAmGrimAge, and DNAmTL) in individuals with SUD (n = 42), including alcohol (n = 10), opioid (n = 19), and stimulant use disorder (n = 13), and controls (n = 10) in postmortem brain (prefrontal cortex) and blood tissue obtained from the same individuals. We found a higher DNAmPhenoAge (β = 0.191, p-value = 0.0104) and a nominally lower DNAmTL (β = -0.149, p-value = 0.0603) in blood from individuals with SUD compared to controls. SUD subgroup analysis showed a nominally lower brain DNAmTL in subjects with alcohol use disorder, compared to stimulant use disorder and controls (β = 0.0150, p-value = 0.087). Cross-tissue analyzes indicated a lower blood DNAmTL and a higher blood DNAmAge compared to their respective brain values in the SUD group. This study highlights the relevance of tissue specificity in biological aging studies and suggests that peripheral measures of epigenetic clocks in SUD may depend on the specific type of drug used.

Gluten-Free Diet in Co-Existent Celiac Disease and Type 1 Diabetes Mellitus: Is It Detrimental or Beneficial to Glycemic Control, Vascular Complications, and Quality of Life?

Celiac disease (CeD) is associated with type 1 diabetes mellitus (T1DM), and both have the same genetic background. Most patients with T1DM who develop CeD are either asymptomatic or have mild CeD-related gastrointestinal symptoms. Therefore, children affected by T1DM should undergo screening for asymptomatic CeD. The aim of this review is to highlight the influence of a gluten-free diet (GFD) on glycemic control, growth rate, microvascular complications, and quality of life in patients with T1DM and CeD. PubMed, Google Scholar, Web of Science, and Cochrane Central databases were searched. Reports reviewed were those published from 1969 to 2022 that focused on the interplay of T1DM and CeD and examined the effect of diet on glycemic control, growth rate, and quality of life. The most challenging aspect for a child with T1DM and CeD is that most GFD foods have a high glycemic index, while low glycemic index foods are recommended for T1DM. Interestingly, dietary therapy for CeD could improve the elevated HbA1c levels. Avoiding gluten added to a diabetic dietary regimen in T1DM patients might impose practical limitations and lead to important restrictions in the lifestyle of a young patient. Consequently, non-adherence to GFD in patients with T1DM and CeD is common. GFD in patients with T1DM and CeD seems to lower the incidence of micro- and macrovascular complications, but this requires further investigation. It seems that adherence to GFD in young patients with T1DM and CeD leads to regular growth and a stable body mass index without any negative effect on HbA1c or insulin requirements. Furthermore, the lipid profile and quality of life seem to have improved with the introduction of GFD.

Effect of Lycopene Intake on the Fasting Blood Glucose Level: A Systematic Review with Meta-Analysis

Lycopene is a lipophilic unsaturated carotenoid exhibiting a strong singlet oxygen-quenching ability. Herein, we investigated the effect of lycopene intake on the fasting blood glucose (FBG) level by conducting a systematic review and meta-analyses. We searched 15 databases (from the earliest date to June 2022 for PubMed or to August or September 2018 for the other databases) and included human interventional studies that assessed the effects of oral lycopene intake on FBG levels of participants ≥ 18 years of age. Three authors independently selected applicable studies and then assessed the study quality. Data were pooled as standardized mean difference (SMD) and analyzed by the random-effects model. Heterogeneity was assessed by I² statistics. A meta-analysis including 11 trial arms (n = 750) revealed a tendency towards a significant decrease in FBG level with not-important heterogeneity [SMD = -0.15 (95% CI: -0.31, 0.00), p = 0.05, I² = 9%]. Subgroup meta-analysis including two studies (n = 152) in type 2 diabetes patients revealed significantly decreased FBG levels with not-important heterogeneity [SMD = -0.37 (95% CI: -0.69, -0.05), p = 0.02, I² = 0%]. Most studies meeting the eligibility criteria had a moderate risk of bias. The funnel plot for FBG suggested an absence of publication bias. In conclusion, this systematic review and meta-analyses suggested that lycopene intake exerted an FBG-decreasing effect.

Microbial Communities in Home-Made and Commercial Kefir and Their Hypoglycemic Properties

Kefir is a popular traditional fermented dairy product in many countries. It has a complex and symbiotic culture made up of species of the genera Leuconostoc, Lactococcus, and Acetobacter, as well as Lactobacilluskefiranofaciens and Lentilactobacillus kefiri. Though kefir has been commercialized in some countries, people are still traditionally preparing kefir at the household level. Kefir is known to have many nutritious values, where its consistent microbiota has been identified as the main valuable components of the product. Type 2 diabetes mellitus (T2DM) is a common diet-related disease and has been one of the main concerns in the world’s growing population. Kefir has been shown to have promising activities in T2DM, mostly via hypoglycemic properties. This review aims to explain the microbial composition of commercial and home-made kefir and its possible effects on T2DM. Some studies on animal models and human clinical trials have been reviewed to validate the hypoglycemic properties of kefir. Based on animal and human studies, it has been shown that consumption of kefir reduces blood glucose, improves insulin signaling, controls oxidative stress, and decreases progression of diabetic nephropathy. Moreover, probiotic bacteria such as lactic-acid bacteria and Bifidobacterium spp. and their end-metabolites in turn directly or indirectly help in controlling many gut disorders, which are also the main biomarkers in the T2DM condition and its possible treatment.

Dietary Management Tools Improve the Dietary Skills of Patients with T2DM in Communities

Dietary management is of paramount importance in the prevention and control of type 2 diabetes mellitus (T2DM). This one-year cluster-randomized controlled trial aims to evaluate the effect of dietary management tools on the dietary skills of patients with T2DM. Twenty-two communities were randomly assigned to an intervention group and a control group, and participants in the intervention group received a food guiding booklet (G) and a dinner set (D). The frequency of dietary management tools usage was collected at baseline and every three months, and different use patterns were identified by a group-based trajectory model. A self-compiled diabetic dietary skills scale and blood glucose were collected at baseline, 3, and 12 months, and a using generalized linear mixed model (GLMM) to explore the influence factors of dietary skills and blood glucose. The finding revealed four dietary tool-usage patterns among the participants: Insist using G/D, Give up gradually G/D, Give up after use G, and Never use G/D. GLMM indicated that dietary skills were higher over time (p < 0.05), and in participants using the guiding booklet (p < 0.001) or dinner set (p < 0.001), or with higher education (p < 0.001). Additionally, blood glucose were lower among participants with higher dietary skills (p = 0.003), higher educational level (p = 0.046), and a 3000−5000 monthly income (p = 0.026). These findings support using food management tools like the guiding booklet and dinner set as a useful strategy in primary health care centers for individuals with T2DM to increase their dietary skills and blood glucose control.

Intake of Sugar Substitute Gummy Candies Benefits the Glycemic Response in Healthy Adults: A Prospective Crossover Clinical Trial

Sugar reduction in food has attracted great health concerns worldwide. Gummies have been one of the most popular and highly favored candies due to their chewable properties, simplicity to swallow, and delicious taste. The general perception is that gummies raise blood sugar levels, but the truth is that gummies with the right formula can control glycemic response. The purpose of this study is to investigate the effects of the gummy dosage form and sugar types on the glycemic response control. Maltitol and erythritol as sweetener alternatives were applied in gummy candies (total and partial sugar substitutes gummy, T-SG and P-SG), with sucrose-based gummies used as comparisons (CG). A prospective crossover study was then conducted on 17 healthy adults. The effects of different types of gummies on glycemic response in healthy adults were evaluated on the basis of the participants’ glycemic index (GI) and glycemic load (GL) values. Every three-day interval, participants took CG, P-SG, T-SG, and glucose solution, respectively, and the theoretical glucose conversion content was kept the same in all groups for each trial. Each participant performed four tests with each sample and recorded the changes in blood glucose after food consumption. It was found that all three types of gummies slowed down subjects’ glycemic response when not taken in excess, and the improvement effect was in the trend of T-SG > P-SG > CG. Both P-SG and T-SG were low-GI candies (54.1 and 49.9). CG that was not consumed in excess of 17.2 g had a high GI (81.9) but a low GL (<10). Texture analysis and in vitro digestion were used to explore the effect of gummy matrix on glucose release. T-SG and P-SG retained a higher hardness and were less hydrolyzed to release glucose during digestion compared with CG. Additionally, experiments have revealed that gummies can reverse the poor glucose tolerance in women. In conclusion, gummies are a good carrier for dietary supplements due to their sustained-release characteristic of available carbohydrates and provide healthier options for people in control of glucose homeostasis.

Metabolic effects of truncal vagotomy when combined with bariatric-metabolic surgery

Bariatric-metabolic surgery (BMS) in patients with obesity frequently leads to remission of concurrent type 2 diabetes mellitus (T2DM), even before body weight loss takes place. This is probably based on the correction of a dysmetabolic cycle in the gastrointestinal physiology of T2DM that includes increased vagus-dependent exocrine pancreatic secretion (EPS) and, hence, amplified digestion and nutrient absorption. The resultant chronic exposure of tissues to high plasma levels of glucose, fatty acids and amino acids causes tissue resistance to the actions of insulin and, at a later stage, β-cell dysfunction and reduction of insulin release. We hypothesize that the addition of a surgical truncal vagotomy (TV) may improve and solidify the beneficial results of BMS on T2DM by stably decreasing EPS, - hence reducing the digestion and absorption of nutrients -, and increasing incretin secretion as a result of increased delivery of unabsorbed nutrients to the distal intestine. This hypothesis is supported by surgical data from gastrointestinal malignancies and peptic ulcer operations that include TV, as well as by vagal blockade studies. We suggest that TV may result in a stable reduction of EPS, and that its combination with the appropriate type of BΜS, may enhance and sustain the salutary effects of the latter on T2DM.

Nutritional strategies to attenuate postprandial glycemic response

Maintaining good glycemic control to prevent complications is crucial in people with type 2 diabetes and in people with prediabetes and in the general population. Different strategies to improve glycemic control involve the prescription of blood glucose-lowering drugs and the modulation of physical activity and diet. Interestingly, lifestyle intervention may be more effective in lowering hyperglycemia than pharmaceutical intervention. Regulation of postprandial glycemia is complex, but specific nutritional strategies can be applied to attenuate postprandial hyperglycemia. These strategies include reducing total carbohydrate intake, consuming carbohydrates with a lower glycemic index, the addition of or substitution by sweeteners and fibers, using food compounds which delay or inhibit gastric emptying or carbohydrate digestion, and using food compounds which inhibit intestinal glucose absorption. Nevertheless, it must be noted that every individual may respond differently to certain nutritional interventions. Therefore, a personalized approach is of importance to choose the optimal nutritional strategy to improve postprandial glycemia for each individual, but this requires a better understanding of the mechanisms explaining the differential responses between individuals.

Comparison of Quality of Carbohydrate Metrics Related to Fasting Insulin, Glycosylated Hemoglobin and HOMA-IR in Brazilian Adolescents

Low glycemic index (GI) and glycemic load (GL) diets are effective for glycemic control (GC) associated with a carbohydrate-controlled meal plan. However, whether GI and GL peaks are related to GC is unknown. Objective: To compare the daily GI (DGI)/GL (DGL) and average GI (AvGI)/GL (AvGL) of meals (accounting for peaks) related to GC markers (GCM) in Brazilian adolescents. Methods: A representative national school-based (public/private) sample of students without diabetes, 12−17 years of age, was evaluated. Food intake was based on a 24 h recall. The models for complex cluster sampling were adjusted (sex, sexual maturation, age, and physical activity). Results: Of 35,737 students, 74% were from public schools, 60% girls, 17% overweight, and 8% obese. The minimum DGI and DGL were observed at lunch, with higher values at night. Fasting insulin was 1.5 times higher in overweight/obese (OW) girls, and 1.7 times higher in OW boys than in normal-weight (NW) girls. The same trend was observed for the homeostatic model assessment for insulin resistance (HOMA-IR) (OW = 2.82 vs. NW = 1.84 in girls; OW = 2.66 vs. NW = 1.54 in boys; p < 0.05). The daily and average metrics were greater for NW adolescents. Glycosylated hemoglobin was not associated with these metrics, except for AvGL. Insulin and HOMA-IR were associated with all metrics in NW adolescents, with greater coefficients associated with AvGL. Among overweight/obese adolescents, only GI metrics were associated (β = 0.23; AvGI and insulin) and appeared to have the best association with GCM. Conclusions: Among NW adolescents, GL is a better measure of carbohydrate quality, but for those with overweight/obesity, carbohydrate consumption is more associated with GC, probably because they eat/report small amounts of carbohydrates.

Nutrition Education Regarding the Glycemic Index on the Knowledge of Patients with Diabetes Mellitus

BACKGROUND: Knowledge is one of the keys to diabetes management. Increasing knowledge is an effort to improve their lifestyle to maintain the stability of their blood sugar, one of which is through the media booklet. The booklet is an influential media in nutrition education to improve diabetes mellitus patient knowledge related to the glycemic index. AIM: This study aims to analyze the effect of nutrition education on the knowledge of DM patients about the glycemic index. METHODS: It was quantitative research using a quasi-experimental research design, with a pre-test and post-test design with a control group. The total sample consisted of 46 respondents: A treatment group (23 respondents) and a comparison group (23 respondents). Nutrition education was conducted through poster media in the control group and booklet media in the treatment group, given 3 times for 2 weeks in patients with diabetes. The Mann–Whitney test was used to analyze the respondent’s glycemic index characteristics and intake in the treatment and control, while paired t-test was conducted to determine the difference in the respondents’ level of knowledge before and after the intervention. RESULTS: The dependent t-test showed a significant difference in the average knowledge before and after the nutritional counseling with booklet media in the treatment group, p = 0.024 (α < 0.005). CONCLUSION: Nutrition education program regarding the glycemic index through booklet media was the potential to increase patients’ nutritional knowledge.

Prevalence of hyperglycemia in masters athletes

Background

Ageing is associated with decreased physical activity, obesity and subsequently an increased risk of developing type 2 diabetes mellitus (T2dm). Master athletes (MA) have initiated exercise or sport later in life or pursued a physically active lifestyle for an extended period. Subsequently, MAs have been proposed as a model of successful ageing as this active lifestyle is associated with health benefits including decreased health risk of chronic diseases and a reduction in premature mortality. Given long-term physical activity/exercise has previously been shown to be protective against hyperglycemia, a risk factor for T2dm, it is plausible that MA may have protective benefit against developing hyperglycemia. Therefore, the aim of this study was to investigate the prevalence of hyperglycemia via fasting plasma glucose (FPG) in MAs competing at the World Masters Games (WMG).

Methods

This cross-sectional, observational survey utilized an online survey using open-source web-based software was used to investigate MAs physiological and medical-related parameters. Over 28,000 MAs competed in the WMG, of which 8,072 MAs completed the survey. Of these MAs, a total of 486 (males 277, females 209; range 27 to 91 years, mean age 55.1 ± 10.2 years) attained recent pathology results which included FPG which was subsequently analyzed for this study. FPG and other outcome variables were compared between genders and to the Australian and United States general population.

Results

Mean FPG for MAs was 5.03 mmol (±1.2, 95% CI [4.9-5.1] mmol) with majority (75.5%) of MAs reporting a normal (<5.5 mmol) FPG, followed by pre-diabetes (20.2%, >5.51 to <5.99 mmol) and abnormal (4.3%, >7.0 mmol). There was no significant difference (P = 0.333) in FPG between genders however, males had a slightly higher (+2.1%) FPG as compared to females (5.08 ± 1.2 mmol (95% CI [4.9-5.22] mmol) versus 4.98 ± 1.1 mmol (95% CI 4.8-5.1 mmol)). The majority of males (71.8%) and females (80.3%) were classified with a normal FPG. With regard to an abnormal FPG level, only 4.0% of males and 4.9% of females were classified abnormal which was suggestive of undiagnosed T2dm. With regard to age by decade, there was no significant difference (P = 0.06-1.00) between age groups and no relationship between the MAs' age and FPG (r = .054, P = 0.24). As a group, MAs had a significantly lower FPG as compared to the Australian (-3.2%, P = 0.005) and United States general populations (-13.9%, P < 0.001).

Conclusions

Most, however not all, MAs were found to have normal glycaemia, with only a small percentage indicating a risk of developing T2dm (i.e., impaired fasting glucose) and a smaller percentage identified with an abnormal FPG, suggestive of T2dm. These findings suggest MAs appear to be at low metabolic risk for developing T2dm based upon FPG and the physical activity/exercise they complete as MAs may indeed be protective against hyperglycemia whilst maintaining an active lifestyle.

Effects of high-amylose maize starch on the glycemic index of Chinese steamed buns (CSB)

The incorporation of resistant starch (RS) in food has gained importance to be a good replacement for digestible carbohydrate. This study examined the effect of compositing RS (high-amylose maize starch (HM)) as wheat flour substitute (30%) in Chinese steamed bun (CSB) formulation on postprandial glycemic response in healthy human subject. In this single-blind and cross-over experimental trial, a total of 15 female participants (mean age = 31.5 ± 3.9) were randomly assigned to receive CSB containing 30% HM (HM30) or control CSB (without HM) with their blood glucose were recorded throughout the test. The blood glucose concentrations recorded for HM30 were significantly lower than control CSB at 15 min (6.03 vs. 7.04 mmol/L, p = 0.041), 30 min (6.93 vs. 7.76 mmol/L, p = 0.021), 45 min (6.21 vs. 7.55 mmol/L, p = 0.032), 60 min (5.68 vs. 6.26 mmol/L, p = 0.038), and 90 min (5.08 vs. 5.73 mmol/L, p = 0.022). The 2-h postprandial glucose was significantly lower in HM30 (iAUC = 105.2 mmol x min/L) than the control (186.1 mmol x min/L). The low GI property of HM30 (GI = 39.11 ± 5.6) did not cause sudden rapid increase in blood glucose concentration as observed in medium-GI control CSB (GI = 69.18 ± 9.8). This study suggests that adding 30g of HM decreased the glycemic index of CSB in healthy female adult.

Could Dietary Modification Independent of Energy Balance Influence the Underlying Pathophysiology of Type 2 Diabetes? Implications for Type 2 Diabetes Remission

High-quality clinical trial data demonstrate that remission is possible for people living with type 2 diabetes (T2D) if they lose a large amount of weight (≥ 10 kg). Durable remission appears predicated on the long-term maintenance of weight loss. Unfortunately, long-term follow-up data from lifestyle-based weight loss programmes show that, on average, most people regain at least some of the weight lost. In addition, restoration of a diminished first-phase insulin response also appears necessary for durable remission, and this becomes less likely as T2D progresses. A pragmatic approach to enhance the effects of weight loss on durable remission is to consider whether dietary components could help control blood glucose, independent of caloric balance. This manuscript reviews current evidence on weight-neutral effects of diet on blood glucose, including high-protein, low-carbohydrate, high-fibre and plant-based diets, with a particular focus on the effect of nutrition on the underlying pathophysiology of T2D, including the first-phase insulin response. The importance of mechanistic data in enhancing our understanding of dietary strategies in T2D remission is described, and suggestions are made for future advances in remission research.

Effects of individualized dietary advice compared with conventional dietary advice for adults with type 2 diabetes: A randomized controlled trial

BACKGROUND AND AIMS

To investigate the superiority of individualized dietary advice based on dietary assessment for patients with type 2 diabetes.

METHODS AND RESULTS

A total of 136 Japanese adults with type 2 diabetes were randomized into either individualized or conventional dietary advice groups after dietary assessment using a self-administered brief-type diet history questionnaire. Both participants received three 30-min face-to-face dietary advice sessions by dietitians at 1, 3, and 5 months from study entry. The individualized group received dietary advice based on individual dietary intakes. The conventional group received dietary advice using generalized pamphlets. The primary outcome was the change in HbA1c over 6 months, and secondary outcomes were changes in weight, serum triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and dietary intakes. In total, 126 participants were included in the analysis. After adjustment for age, sex, and baseline measurements, HbA1c significantly decreased larger in the individualized group [-1.1%, (95% CI: -1.3 to -0.8)] than the conventional group [-0.7% (95% CI: -1.0 to -0.4)] (P = 0.0495). The individualized group significantly decreased weight, serum triglyceride, and LDL-C, and significantly increased HDL-C, without a significant difference to the conventional group. In dietary changes, the individualized group decreased intakes of energy, confectioneries, meats, oil and fats, and sugar-sweetened beverages. The conventional group decreased alcohol intake and increased total fat and saturated fatty acid intakes.

CONCLUSIONS

Individualized dietary advice among patients with type 2 diabetes was superior to conventional dietary advice in lowering HbA1c.

TRIAL REGISTRATION

UMIN000037268 (https://www.umin.ac.jp/ctr/index.htm) in July 4, 2019.

Effects of common weight loss plans on diabetes mellitus and cardiovascular risk factors

Diabetes mellitus is globally considered one of the most common chronic diseases, management of which is critically asscociated with an adequate dietary approach. With overweight and obesity being a global epidemic, choosing the appropriate weight loss plan for patients with diabetes seems to be of particular concern for healthcare professionals. Since diabetes and cardiovascular diseases frequently coexist, modern pharmacological therapeutic models aim at addressing both. Therapeutic targets in diabetic population that address glycemic control, adequate lipid and blood pressure control proves to limit the incidence of cardiovascular events, reduce the risk of chronic complications and improve patients quality of life. Similarly, dietary managment in this population should also concentrate on the reduction of reversible cardiovascular risk factors. Nutritional recommendations for diabetic patients should be individualized to meet their expectations and lifestyle in order to ensure compliance and long-term effects. As diabetic population is more vulnerable to further health risks associated with diet induced metabolic changes, inadequate intake of dietary components and increased cardiovascular risk, nutrition plans should be addressed more carefully in this group.

Associations of Glycemic Index and Glycemic Load with Cardiovascular Disease: Updated Evidence from Meta-analysis and Cohort Studies

PURPOSE OF REVIEW

Diet and lifestyle patterns are considered major contributory factors for cardiovascular disease (CVD) and mortality. In particular, consuming a diet higher in carbohydrates (not inclusive of fruits and vegetables, but more processed carbohydrates) has been associated with metabolic abnormalities that subsequently may increase the risk of CVD and related mortality. Glycemic index (GI) and glycemic load (GL) are values given to foods based on how fast the body converts carbohydrates into glucose also referred to as the glycemic burden of carbohydrates from foods. Conflicting associations of how high GI and GL influence CVDs have been observed even in high-quality meta-analysis studies. We synthesize and report the associations of high GI and GL with various CVDs by sex, obesity, and geographical locations using an updated review of meta-analysis and observational studies.

RECENT FINDINGS

We identified high GI or high GL is associated with an increased risk of CVD events including diabetes (DM), metabolic syndrome (MS), coronary heart disease (CHD), stroke, and stroke mortality in the general population, and the risk of CVD outcomes appears to be stratified by sex, obesity status, and preexisting CVD. Both high GI and GL are associated with DM and CHD in the general population. However, high GI is strongly associated with DM/MS, while high GL is strongly associated with an increased risk of CHD in females. In addition, high GL is also associated with incident stroke, and appears to be associated with CVD mortality in subjects with preexisting CVD or high BMI and all-cause mortality in non-obese DM subjects. However, high GI appears to be associated with CVD or all-cause mortality only in females without CVD. High GI/GL is an important risk factor for CVD outcomes in the general population. High GI seems to be markedly associated with DM/MS, and it may enhance the risk of CVD or all-cause mortality in both sexes and predominately females. Although both high GI and high GL are risk factors for CHD in females, high GL is associated with CVD outcomes in at-risk populations for CVD. These data suggest that while high GI increases the propensity of CVD risk factors and mortality in healthy individuals, high GL contributes to the risk of severe heart diseases including CVD or all-cause mortality, particularly in at-risk populations. These data indicate dietary interventions designed for focusing carbohydrate quality by lowering both GI and GL are recommended for preventing CVD outcomes across all populations.

Low-Glycemic Index Diets as an Intervention in Metabolic Diseases: A Systematic Review and Meta-Analysis

We aimed to investigate the effects of a low-glycemic index (GI) diet on the body mass and blood glucose of patients with four common metabolic diseases by conducting a systematic review and meta-analysis of studies comparing a low-GI diet (LGID) and other types of diet. Search terms relating to population, intervention, comparator, outcomes, and study design were used to search three databases: PubMed, Embase, and the Cochrane Library. We identified 24 studies involving 2002 participants. Random-effects models were used for 16 studies in the meta-analysis and stratified analyses were performed according to the duration of the intervention. The systematic review showed that LGIDs slightly reduced body mass and body mass index (BMI) (p < 0.05). BMI improved more substantially after interventions of >24 weeks and there was no inter-study heterogeneity (I² = 0%, p = 0.48; mean difference (MD) = -2.02, 95% confidence interval (CI): -3.05, -0.98). Overall, an LGID had superior effects to a control diet on fasting blood glucose (FBG) and glycosylated hemoglobin. When the intervention exceeded 30 days, an LGID reduced FBG more substantially (MD = -0.34, 95% CI: -0.55, -0.12). Thus, for patients with metabolic diseases, an LGID is more effective at controlling body mass and blood glucose than a high-GI or other diet.

Efficacy of L-Arabinose in Lowering Glycemic and Insulinemic Responses: The Modifying Effect of Starch and Fat

L-arabinose is a bio-active compound derived from the side-streams of plant food processing. L-arabinose lowers glycemic and insulinemic responses when added to simple water-based sugary liquids. However, the effect in more complex foods, including fat and starch, is inconsistent. This study assessed the effect of fat or starch in a sugary drink on the efficacy of L-arabinose. Twenty-three healthy volunteers (12 female/11 male; aged 24 ± 3 years; BMI 23 ± 3 kg/m²) participated in a randomised cross-over trial with six drinks: control: 50 g sucrose in water; fat: control + 22 g oil; starch: control + 50 g starch; and all three with and without the addition of 5 g L-arabinose. The addition of L-arabinose to the control drink lowered glucose and insulin peaks by 15% and 52%; for the fat drink by 8% and 45%; and for the starch drink by 7% and 29%. For all three drinks, adding L-arabinose increased glucagon-like peptide 1 (GLP-1) responses and lowered Glucose-dependent insulinotropic polypeptide (GIP) responses. Despite adding large quantities of starch and fat to sugary drinks, L-arabinose significantly lowered postprandial glycemic and insulinemic responses in healthy subjects. These findings suggest that L-arabinose can be functional in more complex foods; however, the factors affecting its efficacy in solid food matrices need to be studied in more detail.

Effectiveness of Wearable Device-based Intervention on Glycemic Control in Patients with Type 2 Diabetes: A System Review and Meta-Analysis

With the development of flexible electronics and chip technology, the application value of wearable devices in lifelong treatment of chronic diseases is increasing. In view of its rapid development and diversified forms, wearable device-based intervention seems to provide a promising option to solve the problems of long-term glycemic control in type 2 diabetes (T2D). However, to date, it is unclear whether the intervention based on wearable device is effective on glycemic control in patients with T2D. In order to explore whether this choice is effective in glycemic control in patients with T2D, after database search and study screening, 6 studies and 1001 patients were selected from 181studies for this meta-analysis. The results guided that the wearable device-based intervention may be more effective than usual care on glycemic control in patients with T2D. Subgroup analysis showed that when the duration of intervention was equal to or less than 12 weeks, the effect of wearable device-based intervention was significantly different from that of usual care, but when the intervention duration greater than 12 weeks, the effect was not significantly different. The intervention effect of wearable devices with goal-setting or encouragement functions was significantly better than that of usual care, and there was no significant difference between automatic drug delivery wearable devices and usual care. In conclusion, the wearable device-based intervention is effective on glycemic control in patients with T2D. In general, this choice of wearable devices for patients with T2D may be effective to some extent.

Dietary quality, food security and glycemic control among adults with diabetes

BACKGROUND AND AIMS

Nutritionally adequate diets can slow the progression of diabetes, but adherence to recommended dietary choices can be hindered by food insecurity. We examined the relationship between dietary quality, food insecurity, and glycemic control among adults with Type 2 Diabetes.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (2011-2016) for 1682 adults =>20 years old with Type 2 diabetes. Glycemic control was measured by HbA1c. Dietary quality was computed using the Healthy Eating Index 2015 score. Food security was assessed by a questionnaire. We analyzed the data using multinomial regression models.

RESULTS

About 16% of the population had an HbA1c ≥ 9; 31.8% had food insecurity; 68.3% consumed a poor quality diet. About 24% consumed a poor quality diet and had food insecurity. In the multinomial model, an HbA1c of 8-<9% was associated with poor diet quality (adjusted odds ratio (AOR) = 5.2, 95% confidence interval (CI) = 1.4-19.2, p = 0.01) and food insecurity (AOR = 8.5, 95% CI = 1.4-52.0, p = 0.02). Those with both factors had higher odds of both an HbA1c 8-<9% (AOR = 6.1, 95% CI = 1.5-24.8, p = 0.01) and HbA1c ≥ 9% (AOR = 6.7, 95% CI = 2.0-22.2, p < 0.01). Other risk factors for poor glycemic control were being Black or Hispanic, having no regular source of care, and ever having visited a diabetes specialist (p < 0.05).

CONCLUSIONS

Poor glycemic control among adults with diabetes was associated with poor quality of diet and/or food insecurity, being Black, Hispanic, and lacking a regular source of care. There is a need for policies that improve access to healthy food in patients with type 2 diabetes, particularly among minority populations.

The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis

Background

Treatment for polycystic ovary syndrome (PCOS) usually initiates with a series of lifestyle modifications such as diet, weight loss, and exercise.

Aims

We, therefore, conducted this meta-analysis to systematically review and evaluate the possible benefits of LGD on a range of anthropometric, clinical, and biochemical parameters in women with PCOS.

Methods

We performed a systematic search through major indexing databases, including Scopus, Pubmed/Medline, ISI web of science, Embase, Cochrane central, and CINAHL (1966-April 30, 2021) using key concepts of PCOS.

Results

Of 935 initial publications, 542 remain after duplicates removal. Then, 141 records were removed at the title and abstract screening level. After excluding 392 literatures, we finally included 8 articles. The final selected studies included 412 overweight and obese individuals with PCOS (207 cases in LGID group and 205 patients in comparators) with a mean age of 21-32 years. Measured emotional health (3 studies, 132 participants, SMD: -1.97; 95%CI:-3.54, -0.40, P = 0.01, I ² = 89%) and body hair (3 studies, 132 participants, SMD: -0.40; 95%CI:-0.46, -0.35, P < 0.0001, I ² = 0%), were found to be significantly lower in women in LGD vs control diet groups. Moreover, infertility (3 studies, 132 participants, SMD: 1.45; 95%CI: 0.30, 2.61, P = 0.01, I ² = 79%) was significantly higher in women in LGD vs control diet groups.

Conclusion

The present meta-analysis has shown that LGD may play a significant role in reducing the risk and improving the clinical and biochemical features of PCOS. So far the evidences for choosing the best dietary modalities for PCOS are not strong to make a definite recommendation.

Nutrients and Dietary Approaches in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease: A Narrative Review

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality in developed countries. The prevalence of CVD is much higher in patients with type 2 diabetes mellitus (T2DM), who may benefit from lifestyle changes, which include adapted diets. In this review, we provide the role of different groups of nutrients in patients with T2DM and CVD, as well as dietary approaches that have been associated with better and worse outcomes in those patients. Many different diets and supplements have proved to be beneficial in T2DM and CVD, but further studies, guidelines, and dietary recommendations are particularly required for patients with both diseases.

The Effects of Almonds on Gut Microbiota, Glycometabolism, and Inflammatory Markers in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

The use of nutritional interventions for managing diabetes is one of the effective strategies aimed at reducing the global prevalence of the condition, which is on the rise. Almonds are the most consumed tree nut and they are known to be rich sources of protein, monounsaturated fatty acids, essential minerals, and dietary fibre. Therefore, the aim of this review was to evaluate the effects of almonds on gut microbiota, glycometabolism, and inflammatory parameters in patients with type 2 diabetes.

METHODS

This systematic review and meta-analysis was carried out according to the preferred reporting items for systematic review and meta-analysis (PRISMA). EBSCOhost, which encompasses the Health Sciences Research Databases; Google Scholar; EMBASE; and the reference lists of articles were searched based on population, intervention, control, outcome, and study (PICOS) framework. Searches were carried out from database inception until 1 August 2021 based on medical subject headings (MesH) and synonyms. The meta-analysis was carried out with the Review Manager (RevMan) 5.3 software.

RESULTS

Nine randomised studies were included in the systematic review and eight were used for the meta-analysis. The results would suggest that almond-based diets have significant effects in promoting the growth of short-chain fatty acid (SCFA)-producing gut microbiota. Furthermore, the meta-analysis showed that almond-based diets were effective in significantly lowering (p < 0.05) glycated haemoglobin (HbA1c) levels and body mass index (BMI) in patients with type 2 diabetes. However, it was also found that the effects of almonds were not significant (p > 0.05) in relation to fasting blood glucose, 2 h postprandial blood glucose, inflammatory markers (C-reactive protein and Tumour necrosis factor α, TNF-α), glucagon-like peptide-1 (GLP-1), homeostatic model assessment of insulin resistance (HOMA-IR), and fasting insulin. The biological mechanisms responsible for the outcomes observed in this review in relation to reduction in HbA1c and BMI may be based on the nutrient composition of almonds and the biological effects, including the high fibre content and the low glycaemic index profile.

CONCLUSION

The findings of this systematic review and meta-analysis have shown that almond-based diets may be effective in promoting short-chain fatty acid-producing bacteria and lowering glycated haemoglobin and body mass index in patients with type 2 diabetes compared with control. However, the effects of almonds were not significant (p > 0.05) with respect to fasting blood glucose, 2 h postprandial blood glucose, inflammatory markers (C-reactive protein and TNF-α), GLP-1, HOMA-IR, and fasting insulin.

Nutritional management of type 2 diabetes in subjects with obesity: an international guideline for clinical practice

Type 2 diabetes mellitus (T2DM) and obesity represent a global public health problem. Current nutritional recommendations focused on weight loss and overall dietary quality. However, there is no consensus on the optimal macronutrient composition of the diet, particularly for the long-term management of T2DM in subjects with obesity. An international panel of experts reviewed and critically appraised the updated literature published on the topic. This review primarily examines the evidence for areas of consensus and uncertainty about nutritional therapy in patients with T2DM and obesity. The aim of this article is to provide nutritional advice to manage these patients in clinical practice.

Nutrition in Patients with Type 2 Diabetes: Present Knowledge and Remaining Challenges

Unhealthy behaviours, including diet and physical activity, coupled with genetic predisposition, drive type 2 diabetes (T2D) occurrence and severity; the present review aims to summarise the most recent nutritional approaches in T2D, outlining unmet needs. Guidelines consistently suggest reducing energy intake to counteract the obesity epidemic, frequently resulting in sarcopenic obesity, a condition associated with poorer metabolic control and cardiovascular disease. Various dietary approaches have been proposed with largely similar results, with a preference for the Mediterranean diet and the best practice being the diet that patients feel confident of maintaining in the long term based on individual preferences. Patient adherence is indeed the pivotal factor for weight loss and long-term maintenance, requiring intensive lifestyle intervention. The consumption of nutritional supplements continues to increase even if international societies do not support their systematic use. Inositols and vitamin D supplementation, as well as micronutrients (zinc, chromium, magnesium) and pre/probiotics, result in modest improvement in insulin sensitivity, but their use is not systematically suggested. To reach the desired goals, patients should be actively involved in the collaborative development of a personalised meal plan associated with habitual physical activity, aiming at normal body weight and metabolic control.

Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

Medline, Embase, and the Cochrane Library searched up to 13 May 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes.

OUTCOME AND MEASURES

The primary outcome was glycated haemoglobin (HbA1c). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI (body mass index), waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)).

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence.

RESULTS

29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA1c in comparison with higher GI/GL control diets (mean difference −0.31% (95% confidence interval −0.42 to −0.19%), P<0.001; substantial heterogeneity, I2=75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, systolic blood pressure (dose-response), and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or diastolic blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision.

CONCLUSIONS

This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, blood pressure, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population.

STUDY REGISTRATION

ClinicalTrials.gov NCT04045938.

Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed

This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.