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Lee DY, Kim N, Jung I, Park SY, Yu JH, Seo JA, Kim J, Kim KJ, Kim NH, Yoo HJ, Kim SG, Choi KM, Baik SH, Park SM, Kim NH. Clinical and Lifestyle Determinants of Continuous Glucose Monitoring Metrics in Insulin-Treated Patients with Type 2 Diabetes Mellitus. Diabetes Metab J 2023; 47:826-836. [PMID: 37614025 PMCID: PMC10695709 DOI: 10.4093/dmj.2022.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/21/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGRUOUND There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes mellitus (T2DM). METHODS This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide-to-glucose ratio (PCGR), information about glucose lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics. RESULTS Logistic regression analysis revealed that female, participants with high PCGR, low glycosylated hemoglobin (HbA1c) and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95% confidence intervals] which were 0.24 [0.09 to 0.65], 1.34 [1.03 to 1.25], 0.95 [0.9 to 0.99], and 1.15 [1.03 to 1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without. CONCLUSION We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV.
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Affiliation(s)
- Da Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Namho Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jihee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyeong Jin Kim
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, Korea
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
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Rania M, Caroleo M, Carbone EA, Ricchio M, Pelle MC, Zaffina I, Condoleo F, de Filippis R, Aloi M, De Fazio P, Arturi F, Segura-Garcia C. Reactive hypoglycemia in binge eating disorder, food addiction, and the comorbid phenotype: unravelling the metabolic drive to disordered eating behaviours. J Eat Disord 2023; 11:162. [PMID: 37726785 PMCID: PMC10507855 DOI: 10.1186/s40337-023-00891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Impaired metabolic response such as blood glucose fast fluctuations may be hypothesized in binge eating disorder (BED) and food addiction (FA) by virtue of the repetitive consumption of highly processed food. Conversely, rapid changes in plasma glucose (i.e., hypoglycemia) may trigger craving for the same food products. The investigation of early glycemic disturbances in BED and FA could enhance the understanding of the metabolic mechanisms involved in the maintenance of the disorders. Present study investigated hypoglycemia events during a 5-h-long oral glucose tolerance test (OGTT) in people with BED, FA, and the comorbid phenotype. Further, the association between the severity of eating psychopathology and the variability in hypoglycaemia events was explored. METHODS Two-hundred participants with high weight and no diabetes completed the extended OGTT and were screened for BED, FA, BED-FA, or no-BED/FA. The four groups were compared in hypoglycemia events, OGTT-derived measures, and eating psychopathology. The association between predictors (eating psychopathology), confounders (demographics, metabolic features), and the outcomes (hypoglycemia, early/late hypoglycemia, severe hypoglycemia, reactive hypoglycemia) was examined through logistic regression. RESULTS Hypoglycemia in general, and reactive hypoglycemia were highly frequent (79% and 28% of the sample, respectively). Hypoglycemia events (< 70 mg/dL) were equally experienced among groups, whilst severe hypoglycemia (< 54 mg/dL) was more frequent in BED at the late stage of OGTT (5 h; χ2 = 1.120, p = .011). The FA and BED groups exhibited significantly higher number of reactive hypoglycemia (χ2 = 13.898, p = .003), in different times by diagnosis (FA: 210'-240'; BED: at the 270'). FA severity was the only predictor of early and reactive hypoglycemia. CONCLUSIONS People with BED or FA are prone to experiencing reactive hypoglycemia; FA severity may predict early and symptomatic hypoglycemia events. This can further reinforce disordered eating behaviours by promoting addictive responses, both biologically and behaviourally. These results inform professionals dealing with eating disorders about the need to refer patients for metabolic evaluation. On the other hand, clinicians dealing with obesity should screen for and address BED and FA in patients seeking care for weight loss.
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Affiliation(s)
- Marianna Rania
- Psychiatry Unit, Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy.
| | | | - Elvira Anna Carbone
- Psychiatry Unit, Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Marco Ricchio
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Internal Medicine Unit, Outpatient Unit for the Treatment of Obesity, University Hospital "Renato Dulbecco", Catanzaro, Italy
| | - Maria Chiara Pelle
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Internal Medicine Unit, Outpatient Unit for the Treatment of Obesity, University Hospital "Renato Dulbecco", Catanzaro, Italy
| | - Isabella Zaffina
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Internal Medicine Unit, Outpatient Unit for the Treatment of Obesity, University Hospital "Renato Dulbecco", Catanzaro, Italy
| | - Francesca Condoleo
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Internal Medicine Unit, Outpatient Unit for the Treatment of Obesity, University Hospital "Renato Dulbecco", Catanzaro, Italy
| | - Renato de Filippis
- Psychiatry Unit, Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Matteo Aloi
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Internal Medicine Unit, Outpatient Unit for the Treatment of Obesity, University Hospital "Renato Dulbecco", Catanzaro, Italy
| | - Cristina Segura-Garcia
- Psychiatry Unit, Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Kishimoto I. Subclinical Reactive Hypoglycemia with Low Glucose Effectiveness-Why We Cannot Stop Snacking despite Gaining Weight. Metabolites 2023; 13:754. [PMID: 37367911 DOI: 10.3390/metabo13060754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Obesity has grown worldwide owing to modern obesogenic lifestyles, including frequent snacking. Recently, we studied continuous glucose monitoring in obese/overweight men without diabetes and found that half of them exhibit glucose levels less than 70 mg/dL after a 75-g oral glucose load without notable hypoglycemic symptoms. Interestingly, people with "subclinical reactive hypoglycemia (SRH)" snack more frequently than those without it. Since the ingestion of sugary snacks or drinks could further induce SRH, a vicious cycle of "Snacking begets snacking via SRH" can be formed. Glucose effectiveness (Sg) is an insulin-independent mechanism that contributes to most of the whole-body glucose disposal after an oral glucose load in people without diabetes. Our recent data suggest that both higher and lower Sg are associated with SRH, while the latter but not the former is linked to snacking habits, obesity, and dysglycemia. The present review addresses the possible role of SRH in snacking habits in people with obesity/overweight, taking Sg into account. It is concluded that, for those with low Sg, SRH can be regarded as a link between snacking and obesity. Prevention of SRH by raising Sg might be key to controlling snacking habits and body weight.
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Affiliation(s)
- Ichiro Kishimoto
- Department of Endocrinology and Diabetes, Toyooka Public Hospital, 1094, Tobera, Toyooka 668-8501, Hyogo, Japan
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Lower Glucose Effectiveness Is Associated with Subclinical Reactive Hypoglycemia, Snacking Habits, and Obesity. Metabolites 2023; 13:metabo13020238. [PMID: 36837857 PMCID: PMC9962703 DOI: 10.3390/metabo13020238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
The effects of glucose effectiveness, the insulin-independent mechanism of glucose disposal, on hypoglycemia have not yet been fully investigated. Herein, in 50 males without a diagnosis of diabetes mellitus (median age 54 years, body mass index (BMI) ≥ 25), the index of glucose effectiveness (SgIo) was determined by a 75 g oral glucose tolerance test (OGTT), and continuous glucose monitoring (CGM) was performed for 6 days. The minimal glucose levels and the percentages of time below 70 mg/dL (3.9 mmol/L) (TBR70) during CGM were significantly associated with the SgIo tertile category in a biphasic manner. When TBR70 within 24 h after OGTT ≥ 0.6% was defined as subclinical reactive hypoglycemia (SRH), odds ratios of having SRH in SgIo tertile 1 (lowest) and tertile 3 (highest) compared to SgIo tertile 2 (middle) were both 11.7 (p = 0.007), while the odds ratios of the highest post-load insulin quartile were 22.9 (p = 0.001) and 1.07 (p = 0.742), respectively. The chances of having self-reported snacking habits, obesity (BMI ≥ 30), and impaired glucose tolerance were significantly higher in participants in SgIo tertile 1 compared to those in SgIo tertile 2, with odds ratios of 10.7 (p = 0.005), 11.2 (p = 0.02), and 13.8 (p = 0.002), respectively. However, there was no significant difference between SgIo tertile categories 2 and 3. In conclusion, SgIo is associated with SRH in a biphasic manner. In people with lower glucose effectiveness, the SRH-induced increase in appetite may create a vicious cycle that leads to obesity.
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Lower Glucose Effectiveness Is Associated with Postprandial Hyperglycemia in Obese/Overweight Men, Independently of Insulin Secretion. Metabolites 2022; 12:metabo12111022. [PMID: 36355105 PMCID: PMC9695914 DOI: 10.3390/metabo12111022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Abstract
The role of glucose effectiveness on postprandial hyperglycemia in daily life is not fully studied. Here, we examined the association between SgIo, an index of glucose effectiveness calculated from a 75 g oral glucose tolerance test, and the indices of hyperglycemia in obese/overweight men. SgIo was significantly associated with 1,5-anhydroglycitol, a biochemical marker for postprandial hyperglycemia. The receiver operating characteristic analyses of SgIo and oral disposition index for detecting the subjects with 1,5-anhydroglycitol < 14 μg/mL revealed that the areas under the curves were 0.77 and 0.76, while the cutoff points (sensitivity, selectivity) were 2.53 (0.9, 0.7) and 2.06 (0.36, 0.79), respectively. Both the SgIo < 2.53 category and the disposition index < 2.06 category were significantly associated with the percentages of meals with postprandial glucose levels ≥ 200 mg/dL, and the percentages of time when continuous glucose monitoring sensor readings were ≥200 mg/dL. After adjustment with disposition index, 45.5% of the subjects with the SgIo < 2.53 category had their 1,5-anhydroglycitol < 14 μg/mL, while, in the SgIo ≥ 2.53 category, 3.6% of the subjects had the hyperglycemia (p < 0.001). In addition, there were tendencies toward higher and lower SgIo quartile categories in subjects with walking (≥8000 steps) ≥60% of days and with noodle ingestion ≥20% of meals, respectively (p for trend, 0.008 and 0.038). In conclusion, lower glucose effectiveness is associated with postprandial hyperglycemia in the daily life of obese/overweight men, independently of insulin secretion. Lifestyles such as habits of walking and noodle ingestion are significantly associated with higher and lower glucose effectiveness, respectively.
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Subclinical Reactive Hypoglycemia Is Associated with Higher Eating and Snacking Frequencies in Obese or Overweight Men without Diabetes. ENDOCRINES 2022. [DOI: 10.3390/endocrines3030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Impacts of subclinical reactive hypoglycemia on food ingestion are not well studied. In the present study, in obese/overweight males without diabetes (n = 34), continuous glucose monitoring and eating behavior were recorded for 6 days after the 75 g glucose challenge. In 50% of subjects, the minimal sensor glucose levels within 24 h post-challenge (CGMmin) were <70 mg/dL, while symptoms, if any, were subtle. Median eating and snacking frequencies were 3.45 and 0.45 times/day, respectively. In subjects with eating frequency > 3 times/day, CGMmin was significantly lower than CGMmin in those without. The receiver operating characteristic curve of CGMmin for detecting eating frequency > 3 times/day showed the area under the curve of 0.74 with the cutoff point of 65 mg/dL (p = 0.027). Eating frequency of subjects with CGMmin < 65 mg/dL was significantly higher than that of subjects with CGMmin ≥ 65 mg/dL (3.68 vs. 3.3 times/day, p = 0.047). When it was defined as reactive hypoglycemia that either the 2 h post-load blood glucose level, the minimal self-monitored blood glucose level within the 1st day, or CGMmin, was below their respective cutoff for detecting eating frequency > 3 times/day, eating frequency of subjects with the reactive hypoglycemia was significantly higher than that of the subjects without the reactive hypoglycemia (3.75 times/day vs. 3.15 times/day, p = 0.001). In addition, the median snacking frequency was 6 times higher in subjects with reactive hypoglycemia compared to those without it (0.9 times/day vs. 0.15 times/day, p < 0.001). In conclusion, in obese/overweight males without diabetes, subclinical reactive hypoglycemia is significantly associated with higher eating/snacking frequencies.
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