Comparing the Effects of Ganoderma lucidum and Kombucha Mushrooms on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial

Review Question/Objective The objective of this systematic review is to synthesise the best available evidence on the effectiveness of physical leisure time activities on glycaemic control in adult patients with diabetes type 2. The specific review question is: What is the effectiveness of physical leisure time activities on glycaemic control in patients with diabetes type 2? Types of participants This review will consider adults over 18 years old diagnosed with type 2 diabetes mellitus according to 2003 American Diabetes Association criteria. Patients receiving oral or insulin medicine treatment will be considered for inclusion, regardless of severity of diabetes or other treatment regimes, but patients who had recently undergone serious operations or who had myocardial infarction, stroke, severe liver or kidney diseases, or any illness limiting participation in the physical activity program, or who were participating in a physical exercise program at the same time will be excluded from the study. Types of Interventions Regular physical leisure time activities for people with type 2 diabetes are defined as at least 150 minutes of moderate-intensity physical activity (50-70% of maximum heart rate) per week, or at least 90 minutes of vigorous-intensity physical activity (>70% of maximum heart rate) per week.26 The minimum duration of the intervention will be at least two months. The review will include the following forms of moderate or vigorous leisure time activities: (1) tai chi exercise (2) walking (3) swimming (4) gardening (5) gigong (an ancient Chinese breathing exercise that combines aerobics, isometric, and isotonic movements and meditation) (6) jogging (7) riding a bicycle (8) dancing. Types of outcomes The outcome measures will include long-term and short-term glycaemic control indicators to reflect the patients’ immediate and two to three months blood sugar changing condition. Therefore, haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) indicators will be included in this study.

Introduction: Exercise and the use of herbal supplements are among the therapeutic interventions in controlling type 2 diabetes. This study aimed to compare the effect of exercise and karela supplement on glycemic control and metabolic complications in patients with type 2 diabetes. Methods: In the present quasi-experimental study, 120 patients with type 2 diabetes were selected by purposive sampling and were randomly divided into 4 groups of exercise, karela supplement, combined, and control. Exercises included 8-week pyramid aerobic training, 3 sessions per week. Karela was consumed in a dose of 50 mg/kg body weight daily in form of karela powder. Results: There was a significant decrease in fasting blood sugar (FBS), 2-hour postprandial glucose (2hPP), insulin resistance, and glycated hemoglobin (HbA1 c) in the intervention groups compared to the control group (P<0.001). Further, there was no significant difference between changes in FBS in the intervention groups (P<0.05), but 2hPP, insulin resistance, and HbA1c were higher in the training and combined groups compared to supplement group (P<0.001); however, there was no difference between the two groups (P>0.05). Conclusion: According to the results, it can be said that both methods of exercise and karela consumption have a positive effect on glycemic control in type 2 diabetes, but interventions and the combination of exercise and the supplement are more effective in glycemic control than karela alone.

While guidelines recommend bedtime snacks for women with gestational diabetes mellitus (GDM), there is insufficient evidence championed those recommendation. To evaluate if bedtime snacking is effective in preventing high fasting blood glucose incidence among women with GDM. An open-label, parallel-group, randomized controlled trial was conducted from December 2023 to July 2024 at Ma'anshan Maternal and Child Health Care Center, Anhui, China. A total of 62 GDM cases at the nutrition clinics were enrolled, and were randomly and equally allocated to groups of bedtime snacks (25g nuts, intervention group) and no bedtime snacks (control group). The intervention was lasted for 8 weeks, during which fasting blood glucose was measured 3 times per week, 1-hour postprandial glucose and 2-hour postprandial glucose 2 times per week with a home glucometer. In the late pregnancy (approximately at 34 weeks), the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides, total cholesterol were measured in the laboratory and birth outcomes information (birth weight, gestational weeks at delivery, delivery mode) were collected. The primary outcomes were the level of fasting blood glucose and the hyper-fasting blood glucose incidence during 8-week duration. The secondary outcomes were the level of the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides and total cholesterol in the late pregnancy. Generalized estimating equations and analysis of covariates were conducted for the analysis of the primary outcomes. The multivariate linear regression was conducted for the analysis of the secondary outcomes. Post-hoc analysis was also conducted for the indicators of 1-hour postprandial glucose, 2-hour postprandial glucose and perinatal outcomes applying generalized estimating equations, analysis of covariates, the multivariate linear regression and logistics regression. After adjusting for maternal age, pre-pregnancy body mass index, mid-pregnancy glucose, mid-pregnancy blood lipids and diet in late pregnancy, neither the average fasting blood glucose (control group: 4.90 mmol l-1, intervention group: 4.96 mmol l-1) (β = 0.05, [95%CI-0.22 to 0.31], P = 0.720) nor hyper-fasting blood glucose incidence (control group: 0.19, intervention group:0.26) (β = 0.07, [95%CI-0.07 to 0.20], P = 0.335) were significant different between the two groups. And we found low-density lipoprotein level were higher in the intervention group (3.21 mmol l-1) compared to the control group (2.52 mmol l-1) (β = 0.70, [95%CI0.07 to 1.34], P = 0.031). Additionally, post-hoc analysis showed that the incidence of elevated 1-hour postprandial glucose was significantly higher in the intervention group (0.42) than in the control group (0.28) (β = 0.14, [95%CI0.01 to 0.27], P = 0.036). No difference was found regarding any perinatal outcomes between the two groups. Bedtime snack did not reduce the risk of morning hyperglycaemia and adverse perinatal outcomes in women with gestational diabetes mellitus, but exacerbated lipid markers and the 1-hour postprandial glucose profile. Our study did not support clinicians and relevant guidelines to recommend bedtime snacking as a form of glycaemic control in women with GDM. Clinical trial identification number: ChiCTR2300078399. URL of the registration site: https://www.chictr.org.cn/bin/project/edit?pid=210400 .

The effect of online health management on type 2 diabetes mellitus: A systematic review and meta-analysis.

BackgroundGestational diabetes mellitus (GDM) is associated with an elevated risk of adverse maternal and neonatal outcomes. Dietary management is a cornerstone of GDM treatment due to its beneficial effects on metabolic control. However, suboptimal adherence to dietary recommendations has diminished its potential benefits in achieving optimal glycemic outcomes. Cognitive behavioral therapy (CBT)–based interventions have emerged as a promising approach to enhance dietary compliance and glycemic control in patients with GDM.ObjectiveThis study aims to investigate the effects of a CBT-based digital dietary intervention on glycemic control and pregnancy outcomes in patients with GDM.MethodsThe intervention group received standard care plus a digital dietary intervention based on CBT principles, delivered via a customized WeChat (Tencent Inc) mini program. This intervention included structured dietary education and behavioral strategies focused on appropriate food selection and meal sequencing. The control group received standard care alone. The primary outcome was the glycemic qualification rate, and secondary outcomes included fasting blood glucose, postprandial blood glucose (PBG), General Self-Efficacy Scale scores, and incidence of macrosomia. Self-monitored blood glucose data were collected and analyzed at biweekly follow-up visits from enrollment until delivery.ResultsOf the 200 participants, 171 completed the study. The average age was 31.2 (SD 4) years, and the average gestational age at enrollment was 26.3 (SD 1.6) weeks. Baseline HbA1c levels were similar between groups (5.2% vs 5.1%; P=.97). The glycemic qualification rate was significantly higher in the intervention group than in the control group at follow-up 3 (mean 87.9%, SD 14.9% vs 81.9%, SD 17.8%; P=.02), follow-up 4 (mean 91.0%, SD 9.9% vs 87.2%, SD 14.4 %; P=.04), follow-up 5 (mean 94.0%, SD 7.4% vs 91.5%, SD 9.5%; P=.04), and follow-up 6 (mean 94.3%, SD 6.7% vs 91.8%, SD 8.9%). PBG levels were significantly lower in the intervention group after lunch (1 h: mean 5.9, SD 0.7 vs 6.0, SD 0.7 mmol/L; P=.0 2 h2h: 5.1, SD 0.7 vs 5.3, SD 0.8 mmol/L; P=.03) and dinner (1 h: mean 6.0, SD 0.5 vs 6.2, SD 0.6; 2 h: 5.5, SD 0.7 vs 5.7, SD 0.8 mmol/L). However, no significant differences were observed in fasting blood glucose or PBG after breakfast between the groups. The intervention group showed significantly higher General Self-Efficacy Scale scores than the control group (mean 195.4, SD 6.9 vs 192.9, SD 5.8). The incidence of macrosomia was significantly lower in the intervention group than in the control group (5% vs 15%; P=.04).ConclusionsThe findings of this randomized controlled trial suggest that a CBT-based digital dietary intervention can significantly enhance glycemic control, particularly PBG levels, and may contribute to improved pregnancy outcomes with a reduced incidence of macrosomia in women with GDM.

Background: The aim of this study was to assess the association of triglyceride-glucose (TyG) index with glycated haemoglobin (HbA1c) and insulin resistance in type 2 diabetes mellitus (T2DM). Methods:A total of 140 patients with T2DM were included in this cross-sectional study and divided into two groups according to their HbA1c levels: participants with HbA1c <7.0% (n=75) and those with HbA1c >7.0% (n=65) were defined as having a good glycemic control (group I) and a poor glycaemic control (group II) in T2DM. Anthropometric and biochemical parameters were measured, while the values of triglyceride (TG) to high density lipoprotein cholesterol (HDL-C) (TG/HDL-C) ratio and TyG index were calculated using formula. Results: Body mass index (BMI), fasting blood glucose (FBS), HbA1c and homeostatic model assessment for insulin resistance (HOMA-IR) were significantly higher in diabetic patients with poor glycemic control. TyG index was significantly correlated with HbA1c, HOMA-IR, TyG-BMI and TyG-WC. The receiver operating characteristic (ROC) analysis showed that TyG had a maximum area under the curve of 0.806, with a cut off value of 15.5 for identifying glycemic control in diabetic patients. Conclusion:TyG index is a useful tool for assessing glycemic control in T2DM patients and positively correlated with HbA1c and HOMA-IR. Hence, TyG can be used as a simple and inexpensive alternative to assess glycemic control in patients with diabetes.

Objective To investigate the effect of blood glucose level on pulmonary diffusion capacity in elderly patients with type 2 diabetes and its clinical significance. Methods Totally 132 older adults with type 2 diabetes were enrolled in this study. According to blood glucose level, the patients were divided into well-controlled group (n=57) and poor-controlled group (n=75). Additionally, 52 age-matched non-diabetic healthy subjects were selected as control group. Levels of fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS) and 2-hour postprandial glucose (2h PG) in the diabetic patients were detected, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The patients with type 2 diabetes underwent urinary albumin excretion rate (UAER) detection, fundus examination and nerve conduction velocity test. pulmonary ventilation, diffusion of the lungs for carbon monoxide (DLCO) and DLCO corrected by alveolar volume (DLCO/VA) were examined in all subjects. Results Levels of FBG, 2h PG, HbA1c and HOMA-IR were higher in poor-controlled group than in good glycemicwell-controlled group (all P 0.05). DLCO and DLCO/VA were lower in diabetic groups than in the control group(all P<0. 05). DLCO and DLCO/VA in poor-controlled group were lower than those in well controlled group (both P<0.05). DLCO and DLCO/VA were lower in patients with microangiopathy score≥2 than those without microangiopathy (both P<0.05). Multiple liner regression analysis showed that DCLO and DLCO/VA were negatively correlated with HbA1c, HOMA-IR, duration of diabetes and microangiopathy (r=-2.51, -2.35, -2.42, -2.37, -2.41, -2.52, -2.47, -2.36, all P<0.05). Conclusions The pulmonary diffusion capacity is significantly impaired in elderly patients with type 2 diabetes. Pulmonary diffusion capacity is negatively correlated with the blood glucose level. The lung may be one of the target organs of type 2 diabetes mellitus. Key words: Respiratory function tests; Diabetes mellitus, type 2; Insulin; Diabetic angiopathies

Introduction: Physical activity plays an important role in glycemic control in patients with type 2 diabetes, but overall adherence rate is low. For patients not able or willing to engage in regular physical exercise, whole body vibration comes as a potential alternative. Objective: To evaluate the effect of 28Hz whole body mechanical vibration on glycemic control and other metabolic parameters in patients with type 2 diabetes. Methods: 24 adults with type 2 diabetes on oral antidiabetic agents, with a baseline HbA1c between 6.5 and 9.0%, were randomized into two groups. The control group (CG) was advised to adopt lifestyle modifications, and the intervention group (IG) received the same orientations and used a 28 Hz whole body vibrating platform daily for 20-30 minutes during 12 weeks. Results: Data from 22 patients were analyzed (one from each group was excluded). Baseline characteristics of both groups were similar except for triglycerides, which were higher in the CG (111.8±39.9 mg/dL vs. 188.9±68.8 mg/dL, p<0.05). After 12 weeks, there was a significant reduction in glycated hemoglobin in the IG (7.69±0.49 vs. 7.17±0.77%, p<0.05), not observed in the CG (8.05±0.98 vs. 7.92±1.07%, p=0.52). A non-significant trend for weight loss in IG was observed (78.14±10.47 vs. 77.14±11.08Kg, p=0.069). There were no significant differences between the groups regarding fasting blood glucose or any other clinical and biochemical variables analyzed. Conclusion: This study suggests an improvement in glycated hemoglobin at 12 weeks with the use of the 28Hz vibration platform in patients with type 2 diabetes. However, further studies with a larger number of patients and longer follow-up are needed to better define the role of whole body vibration as an adjuvant in glycemic control.

Short sleep duration has been reported to increase the risk of diabetes. However, the influence of sleep duration on glycemic control in diabetic patients has not been clarified. In this study we evaluated the association between sleep duration and glycemic control in diabetic patients. We analyzed the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2010. Sleep duration was classified into five groups: <6, 6, 7, 8, and ≥9 h/day. Fasting blood glucose and HbA1c showed a U-shaped trend according to sleep duration. Sleep duration of 7 h/day had the lowest HbA1c (7.26%) among the subjects (P=0.026). In the older age group (≥65 yr), a sleep duration of 6 h/day was associated with the lowest HbA1c (7.26%). The adjusted odds ratio (OR) with a 95% confidence interval (CI) of worse glycemic control (HbA1c ≥7.0%) in group of sleep duration of ≥9 h/day was 1.48 (1.04-2.13) compared with the group of 7 h/day. This relationship disappeared after adjusting duration of diabetes (OR, 1.38; 95% CI, 0.93-2.03). Our results suggest that sleep duration and glycemic control in diabetic patients has U-shaped relationship which was mainly affected by duration of diabetes.

BackgroundMobile-based interventions appear to be promising in ameliorating huge burdens experienced by patients with type 2 diabetes. However, it is unclear how effective mobile-based interventions are in glycemic management of patients with type 2 diabetes based on real-world evidence.ObjectiveThis study aimed to evaluate the effectiveness of a mobile-based intervention on glycemic control in patients with type 2 diabetes based on real-world population data.MethodsThis retrospective, propensity score-matched cohort study analyzed longitudinal data from a clinical electronic health database. The study population included 37,913 patients with type 2 diabetes at cohort entry between October 1, 2016, and July 31, 2018. A total of 2400 patients were matched 1:1, using propensity score matching, into the usual care and mobile health (mHealth) groups. The primary outcomes of glycemic control included control rates of glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and postprandial 2-hour blood glucose (P2BG). Mean values and variation trends of difference with 95% CI were the secondary outcomes. The general linear model was used to calculate repeated-measures analyses of variance to examine the differences between the two groups. Subgroup and sensitivity analyses were performed.ResultsOf the 2400 patients included in the analysis, 1440 (60.00%) were male and the mean age was 52.24 years (SD 11.56). At baseline, the control rates of HbA1c, FBG, and P2BG in the mHealth and usual care groups were 45.75% versus 47.00% (P=.57), 38.03% versus 32.76% (P=.07), and 47.32% versus 47.89% (P=.83), respectively. At the 3-, 6-, 9-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than did the usual care group: 69.97% versus 46.06% (P<.001), 71.89% versus 61.24% (P=.004), 75.38% versus 53.44% (P<.001), and 72.31% versus 46.70% (P<.001), respectively. At the four follow-up sessions, the control rates of FBG in the mHealth and usual care groups were statistically different: 59.24% versus 34.21% (P<.001), 56.61% versus 35.14% (P<.001), 59.54% versus 34.99% (P<.001), and 59.77% versus 32.83% (P<.001), respectively. At the four follow-up sessions, the control rates of P2BG in the mHealth group were statistically higher than in the usual care group: 79.72% versus 48.75% (P<.001), 80.20% versus 57.45% (P<.001), 81.97% versus 54.07% (P<.001), and 76.19% versus 54.21% (P=.001), respectively. At the four follow-up sessions, the percentages of HbA1c reduction in the mHealth group were 8.66% (95% CI 6.69-10.63), 10.60% (95% CI 8.66-12.54), 10.64% (95% CI 8.70-12.58), and 8.11% (95% CI 6.08-10.14), respectively. At the four follow-up sessions, the percentages of P2BG reduction in the mHealth group were 8.44% (95% CI 7.41-10.73), 17.77% (95% CI 14.98-20.23), 16.23% (95% CI 13.05-19.35), and 16.91% (95% CI 13.17-19.84), respectively. Starting from the sixth month, the mean HbA1c and P2BG values in the two groups increased slightly.ConclusionsThis mobile-based intervention delivered by a multidisciplinary team can better improve glycemic control rates of patients with type 2 diabetes than usual care. These effects were best sustained within the first 6 months. Starting from the sixth month, intensive management needs to be conducted to maintain long-term effectiveness of the mobile-based intervention.

Effects of pioglitazone and glimepiride on glycemic control and insulin sensitivity in Mexican patients with type 2 diabetes mellitus: A multicenter, randomized, double-blind, parallel-group trial

How much glycemic control is needed to prevent progression of diabetic nephropathy?

Endovascular Celiac Denervation for Glycemic Control in Patients with Type 2 Diabetes Mellitus

The triglyceride-glucose index is a newly discovered parameter that indicates insulin resistance. This study aims to investigate the relationship between the triglyceride-glucose index and triglyceride/high-density lipoprotein ratio with glycemic control in patients with type 2 diabetes mellitus. This study was performed retrospectively in 296 patients with type 2 diabetes mellitus. Patients were divided into two equal groups according to their HbA1c levels as having good glycemic control (HbA1c 7 and below) and poor glycemic control (HbA1c above 7). Age, gender, body mass index, fasting blood glucose, HbA1c, total cholesterol, serum triglyceride level, serum HDL level, serum LDL level, riglyceride-glucose index, and triglyceride/HDL ratio were compared between the groups. Fasting blood glucose, HbA1c, triglyceride, HDL, triglyceride-glucose index, and triglyceride/HDL ratio wassignificantly different between patient groups with good and poor blood glucose regulation (p&lt;0.05). Patients with poor glycemic control had lower fasting blood glucose, HbA1c, triglycerides, triglyceride-glucose index, and HDL values compared to patients with high triglyceride/HDL ratio and good glycemic control. There was no difference between the groups in terms of other variables (p&gt;0.05). Triglyceride-glucose index and triglyceride/HDL ratio may be indicators of poor glycemic control in diabetic individuals. These indices are cheaper, universal, and easy-to-measure parameters compared to HbA1c and can be used to predict glycemic regulation.

Aims: To study the effect of Vitamin D replacement on glycaemic control and pregnancy outcomes in Gestational Diabetes Mellitus patient with Vitamin D deficiency. Methods: In this prospective, open-label interventional study 60 GDM subjects with Vitamin D deficiency were divided into 2 groups of 30 each, and the intervention group received 60,000 IU of cholecalciferol weekly for 6 weeks and then monthly for the duration of pregnancy. while the control group did not. Vitamin D status was re-assessed at 32 weeks of gestation for both groups. The glycaemic status was assessed using fasting plasma glucose and 1-hour and 2-hour postprandial glucose at 30 weeks of gestation and at time of delivery. Feto-maternal outcomes: Time of delivery (weeks of gestation) , method of delivery, pre-eclampsia, still-birth, neonatal hypoglycaemia, neonatal jaundice, birth weight, head circumference of the baby, APGAR score at 5 minutes in both groups were also assessed. Results: In the intervention group 87% (26 out of 30) of subjects had become vitamin D sufficient. None of the subjects in the control group had become vitamin D sufficient. Fasting Plasma Glucose was significantly lower in the intervention group as compared to the control group) at 30 weeks of gestation (99.57±18.12 vs. 107.90±17.53 mg/dl; p=0.039) and at time of delivery (98.53±15.41 vs. 104.47±18.71mg/dl; p=0.044) . Both 1 hour and 2-hour postprandial plasma glucose (136.81±20.29 vs. 152.58±16.76; p=0.004 and 118±22.10 vs. 132.64±18.48 mg/dl; p=0.017 respectively) values were also significantly lower in the intervention group at the time of delivery. Birth weight was significantly lower in the control group as compared to the intervention group (2348.13±388.965 vs. 2778.67±270.288 gm; p=0.034) . All other neonatal parameters were similar in the two groups. Two subjects in the control group had still-births. Conclusion: Correction of Vitamin D deficiency in GDM subjects may result in better control of their plasma glucose levels. Low Vitamin D levels in GDM subjects may be associated with lower birth weight. Disclosure A. Baidya: None. P. Gaikwad: None. N. Das: None. Y. Pathak: None. N. Sengupta: None. P. Sahana: None. S. Goswami: None. S. Tarenia: None. A. Banerjee: None. M. Chattopadhayay: None. D. Hathi: None.