Effect of special types of bread with select herbal components on postprandial glucose levels in diabetic patients

BACKGROUND

Nutrition recommendations in patients with type 2 diabetes mellitus (T2DM) are to consume rye or integral bread instead of white bread. A positive effect on glucoregulation has been achieved by enriching food with various biologically active substances of herbal origin, so we formulated an herbal mixture that can be used as a supplement for a special type of bread (STB) to achieve better effects on postprandial glucose and insulin levels in patients with T2DM.

AIM

To compare organoleptic characteristics and effects of two types of bread on postprandial glucose and insulin levels in T2DM patients.

METHODS

This trial included 97 patients with T2DM. A parallel group of 16 healthy subjects was also investigated. All participants were given 50 g of rye bread and the same amount of a STB with an herbal mixture on 2 consecutive days. Postprandial blood glucose and insulin levels were compared at the 30^th, 60^th, 90^th and 120^th min. A questionnaire was used for subjective estimation of the organoleptic and satiety features of the two types of bread.

RESULTS

Compared to patients who consumed rye bread, significantly lower postprandial blood glucose and insulin concentrations were found in T2DM patients who consumed STB. No relevant differences were found among the healthy subjects. Subjectively estimated organoleptic and satiety characteristics are better for STB than for rye bread.

CONCLUSION

STB have better effects than rye bread on postprandial glucoregulation in T2DM patients. Subjectively estimated organoleptic and satiety characteristics are better for STB than for rye bread. Therefore, STB can be recommended for nutrition in T2DM patients.

Homeostatic microbiome disruption as a cause of insulin secretion disorders. Candida albicans, a new factor in pathogenesis of diabetes: A STROBE compliant cross-sectional study

The study aimed to test the hypothesis that homeostatic microbiome (HM) disorders lead to the increased indirect influence of certain microorganisms (MO) in the gastrointestinal tract, causing a disorder of insulin secretion, insulin resistance, and diabetes. We highlighted Candida and certain types of bacteria since previous in vitro research showed they significantly affect insulin secretion and can cause insulin resistance in obese patients with metabolic syndrome. After determining the type of MO present in the throat swab and the stool, the oral glucose tolerance test (OGTT) test, and analysis of glucose and insulin secretion were performed in patients (n = 38) who were positive for certain types of MO compared to negative patients. Finally, all patients were divided into two groups: overweight patients (body mass index [BMI] < 30) and obese patients (BMI > 30). These two groups were compared for the percentage of certain types of MO to determine which MO can affect an increase in obesity and BMI. The presence of Diphtheroids in the throat (60.5%) reduces insulin secretion in patients compared with the negative group (194.5: 332.4) and the difference was statistically significant (P = .030). The presence of Candida in the throat (10%) increases insulin secretion, but the difference was statistically insignificant. The presence of Candida in the stool (28.9%) also increases insulin secretion and the difference was statistically significant (P = .038). Cumulative results (throat + stool) were similar (180: 332, P = .022). Analysis of BMI showed that the percentage of Diphtheroids in the throat decreases with increased body weight (53.8: 75%) while the percentage of Candida (38.5: 8.3%) and Enterobacter (61.5: 25%) increases, but these differences were statistically insignificant (P > .05). Diphtheroids in the throat can reduce insulin secretion by synthesizing their metabolites. Candida albicans is a conditional pathogen and as a significant indirect factor induces increased insulin secretion and insulin resistance. There are indications that elevated levels of Candida in the intestinal system can cause increased body weight of patients. C albicans should be considered a new factor in the pathogenesis of diabetes.

[Sarcoidosis localized in endocrine glands]

INTRODUCTION

There is a relationship between sarcoidosis and endocrine diseases: hypothalamus, hypophysis, thyroid gland, parathyroid gland, adrenal gland and calcium metabolism disorder.

DISCUSSION

Neurological disorders, obesity, secondary hypogonadism, and thirst as a result of diabetes insipidus, dominate the clinical picture of hypothalanmic sarcoidosis. Diseases of adenohypophysis present with gonadotropic insufficiency and prolactin increase. They may cause disorders in menstruation and ovulation. Disorders of neurohypophysis manifest with moderate polyuria and polydipsia. Disorders of thyroid gland function in systemic sarcoidosis present with hyperthyroidism, hypothyroidism or thyroiditis. Sarcoidosis of the parathyroid gland is rare. Sarcoidosis of adrenal cortex may cause primary insufficiency of the suprarenal gland The secondary insufficiency of the suprarenal gland is caused by hypothalamic and pituitary sarcoidosis. In sarcoidosis, calcium metabolism disorder and hypercalcemia are frequent. Vitamin 1.25(OH)2D has an important role since it is increasingly produced in renal and extra renal regions. Hypercalcemia leads to hypercalciuria and nephrolithiasis, while the level of parathyroid hormone usually decreases. Increased levels of serum angiotensin converting enzyme (ACE) are also important markers in the diagnosis of sarcoidosis.

CONCLUSION

Clinical manifestations of endocrine disorders depend on the localization of sarcoid lesions. The treatment of disorders is directed to the treatment of structure and functional disorders of glands involved, as well as to sarcoidosis. Successful treatment of sarcoidosis may cause regression of granulomatous lesions in the involved glands.

[Sarcoidosis and diabetes: therapeutic aspects]

FIRST CASE

A 45-year-old female patient with diabetes was on corticosteroid therapy for a year due to pulmonary sarcoidosis. During the last six years she was treated with oral antidiabetic drugs, but during the last couple of months, she required insulin therapy due to impaired glycoregulation. After corticosteroid therapy was discontinued, glycoregulation improved and insulin therapy was discontinued as well.

SECOND CASE

a 32-year-old male patient was on prednisolone therapy due to pulmonary and extrapulmonary sarcoidosis. A few weeks later diabetes mellitus (de novo) was established. During the treatment of sarcoidosis with corticosteroids, short-term insulin therapy was due to impaired glycoregulation. Insulin therapy has improved the glycoregulation.

DISCUSSION

There is no certain evidence about the incidence of diabetes mellitus under the influence of corticosteroids, due to increase of hepatic glucose production, insulin resistance and exhaustion of pancreatic beta-cells because of stimulated endogenous secretion. During treatment of sarcoidosis, corticosteroid therapy may cause deterioration of glycoregulation and occurrence of clinically manifested diabetes mellitus in patients with impaired glycose tolerance or predisposition to diabetes.

CONCLUSION

Diabetic patients with sarcoidosis who need corticosteroid therapy, should control glycoregulation Patients with sorcoidosis, treated with corticosteroid therapy need regular control in order to diagnose early diabetes.