2-hour Postprandial Plasma Glucose Research Articles

Retagliptin as add-on therapy to metformin in Chinese patients with type 2 diabetes inadequately controlled with metformin: A multicentre, randomized, double-blind, placebo-controlled, phase 3 trial.

To evaluate the efficacy and safety of retagliptin in Chinese patients with type 2 diabetes (T2D) inadequately controlled with metformin. This multicentre, phase 3 trial consisted of a 16-week, randomized, double-blind, placebo-controlled period, where patients with HbA1c levels between 7.5% and 11.0% were randomized to receive either once-daily (QD) retagliptin 100 mg (n = 87) or placebo (n = 87), both as an add-on to metformin. The primary endpoint was the change in HbA1c from baseline to week 16. At week 16, the least squares mean change in HbA1c from baseline, compared with placebo, was -0.82% (95% CI, -1.05% to -0.58%) for the retagliptin 100 mg QD group (P < .0001) per treatment policy estimand. Significantly higher proportions of patients in the retagliptin 100 mg QD group achieved HbA1c levels of less than 6.5% (11.5%) and less than 7.0% (26.4%) compared with those receiving placebo (0% and 4.6%; P = .0016 and P < .0001, respectively) at week 16. Retagliptin 100 mg QD also lowered fasting plasma glucose and 2-hour postprandial plasma glucose levels. The incidence of adverse events (AEs) during the treatment period was similar between the two groups. However, slightly higher proportions of increased lipase and increased amylase in the retagliptin 100 mg QD group were observed. No patients discontinued treatment permanently because of AEs, and no episodes of severe hypoglycaemia were reported. Retagliptin 100 mg QD as an add-on therapy to metformin offers a new therapeutic option for treating Chinese patients with T2D inadequately controlled by metformin alone, and is generally well tolerated.

Utilize multi-metabolic parameters as determinants for prediction of skeletal muscle mass quality in elderly type2 diabetic Chinese patients

BackgroundSarcopenia, an age-related disorder characterized by loss of skeletal muscle mass and function, is recently recognized as a complication in elderly patients with type 2 diabetes mellitus (T2DM). Skeletal muscles play a crucial role in glycemic metabolism, utilizing around 80% of blood glucose. Accordingly, we aimed to explore the relationship between glucose metabolism and muscle mass in T2DM.MethodsWe employed the AWGS 2019 criteria for diagnosing low muscle mass and 1999 World Health Organization (WHO) diabetes diagnostic standards. This study included data of 191 individuals aged 60 and above with T2DM of Shanghai Pudong Hospital from November 2021 to November 2022. Fasting C-peptide (FPCP), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (PPG) and postprandial 2-hour C-peptide (PPCP), glycated hemoglobin A1c (HbA1c), glycated albumin (GA), serum lipids spectrum, renal and hepatic function, hemoglobin, and hormone were measured. Based on the findings of univariate analysis, logistic regression and receiver operating characteristic (ROC) curves were established.ResultsParticipants with low muscle mass had significantly lower alanine and aspartate aminotransferase, and both FPCP and PPCP levels (P < 0.05). Compared with those without low muscle mass, low muscle mass group had significantly higher FPG, HbA1c, GA levels (P < 0.05). Body fat (BF, OR = 1.181) was an independent risk factor for low muscle mass. PPCP (OR = 0.497), BMI (OR = 0.548), and female (OR = 0.050) were identified as protective factors for low skeletal muscle. The AUC of BMI was the highest, followed by the PPCP, gender and BF (0.810, 0.675, 0.647, and 0.639, respectively), and the AUC of the combination of the above four parameters reached 0.895.ConclusionsIn this cross-sectional study, BMI, Female, and PPCP associated with T2DM were protective factors for low muscle mass. BF was associated with T2DM and risk factor for low muscle mass.

Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review.

Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. Various interventions have been developed in response to the multifaceted risk factors for premature birth, including internet-based programs. These programs offer accessibility and enhanced engagement; however, their overall efficacy in preventing premature births requires thorough evaluation. This systematic review aims to identify the study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women. A comprehensive search of the MEDLINE, Embase, CINAHL, and Cochrane Library databases was conducted to identify randomized trials and quasi-experimental studies evaluating internet-based interventions for premature birth prevention in pregnant women. The search was inclusive, with no restrictions based on language or geographical location, allowing for a comprehensive global perspective. The time frame for the inclusion of studies extended until February 2023. The risk of bias (RoB) in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane RoB tool (RoB 2) for randomized trials, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Owing to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted. This review included 26 articles, comprising 12 intention-to-treat and 14 per-protocol studies. The overall RoB was high in most intention-to-treat studies and of some concern in most per-protocol studies. The target populations varied, including nonspecific pregnant women, those with gestational diabetes mellitus (GDM) or those at risk of GDM, individuals with anxiety or depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in nonspecific pregnant women but not in those experiencing preterm labor. Their effectiveness in reducing anxiety and depression varied, with inconsistent results among different groups. In women with GDM or those at risk of GDM, interventions successfully controlled fasting plasma glucose and 2-hour postprandial plasma glucose levels but did not consistently manage glycated hemoglobin levels. These interventions did not reduce the incidence of premature births across the various populations studied. The effectiveness of these internet-based interventions in addressing substance or alcohol abuse and insomnia also varied. Internet-based interventions show promise in improving psychosocial health and managing blood sugar to prevent premature birth, highlighting variability in effectiveness across different risk factors. Further research, including clinical trials, is vital for developing, evaluating, and disseminating effective, safe internet-based interventions. Establishing standardized measurement tools and rigorous evaluation processes is crucial for enhancing these interventions' effectiveness and reliability in clinical practice, significantly contributing to preventing premature births and improving maternal health outcomes. PROSPERO CRD42021278847; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847.

Value of Hcy combined with Framingham score for predicting macrovascular disease in elderly patients with type 2 diabetes.

To analyze the predictive value of homocysteine (Hcy) combined with the Framingham risk score for cardio- and cerebrovascular disease in elderly patients with type 2 diabetes mellitus (T2DM) to provide a reference for clinical treatment. We retrospectively reviewed the clinical data of 1036 elderly patients with T2DM admitted to our hospital between July 2017 and July 2022. The patients were divided into occurrence (n = 438) and control (n = 598) groups based on the incidence of cardio- or cerebrovascular disease. Univariate and multivariate logistic analyses were used to analyze the factors associated with cardio-cerebral small-vessel disease in the elderly patients with T2DM. The predictive value of Hcy combined with the Framingham score for cardio- and cerebrovascular diseases in elderly patients with T2DM was determined using receiver operating characteristic curves. Univariate analysis showed that the occurrence group had significantly higher Framingham score, systolic blood pressure (SBP), total cholesterol (TC), fasting blood glucose (FBG), 2-hour postprandial plasma glucose, Hcy, glycated hemoglobin, smoking history, and disease duration than the control group (all P < .05). Food preferences, sleep duration, physical exercise, high density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol levels were significantly lower in the occurrence group than in the control group (all P < .05). Multivariate logistic analysis showed that smoking history, duration of diabetes, Framingham score, SBP, TC, FBG, HDL-C, 2h postprandial plasma glucose, and Hcy levels were risk factors for cardio- and cerebrovascular disease in elderly patients with T2DM. The area under the curve for Hcy and Framingham scores was 0.741 (95% confidence interval [CI]: 0.635-1.871) and 0.717 (95% CI: 0.601-0.856), respectively. Hcy combined with the Framingham score demonstrated a significantly higher predictive value (0.852, 95% CI: 0.741-0.979). Long smoking history, long diabetes duration, high Framingham score, high SBP, high TC, high FBG, low HDL-C, and high Hcy levels are risk factors for cardio-cerebrovascular disease in elderly patients with T2DM. In addition, Hcy level combined with the Framingham score demonstrated superior predictive power for cardio- and cerebrovascular disease in elderly patients with T2DM.

Prevalence, Metabolic Consequences of Non Alcoholic Fatty Liver Disease (NAFLD) and its Association with Microvascular Complications and Ventricular Dysfunction in Patients with Type 2 Diabetes Mellitus

ABSTRACT Objective: To study the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association of with microvascular complications and ventricular dysfunction in patients with type 2 diabetes mellitus (T2DM). Methods: In this cross-sectional study, 100 T2DM patients were screened randomly for detection of fatty liver in ultrasonography. Patients with fatty liver (NAFLD group, n = 36) were compared with subjects without fatty liver (non-NAFLD group, n = 64). Detailed clinical, biochemical, and imaging parameters like lipid profile, LFT, fasting plasma glucose, 2-hour post-prandial plasma glucose, HbA1C, fasting insulin, spot urinary albumin/creatinine ratio, and 2-D ECHO (M-mode) were performed. Results: The prevalence of NAFLD was found to be 36%. NAFLD group had significantly higher BMI, WHR, blood pressure, glycemic profile, and lipid parameters compared to non-NAFLD group. HOMA IR was elevated significantly in NAFLD group (3.16 ± 1.96) compared to non-NAFLD group (1.73 ± 1.59). There was significantly higher prevalence of all the diabetes-related microvascular complications and LV diastolic dysfunction in NAFLD patients with higher odds for the occurrence of neuropathy (OR = 4.74; P = 0.001), nephropathy (OR = 3.92; P = 0.003), retinopathy (OR = 5.95; P = 0.002), and LV diastolic dysfunction (OR = 1.84; P = 0.043). Conclusions: NAFLD is significantly associated with various diabetes-related microvascular complications as well as LV diastolic dysfunction in T2DM patients.

Glycemic dispersion: a new index for screening high glycemic variability

ObjectiveFor patients with diabetes, high-frequency and -amplitude glycemic variability may be more harmful than continuous hyperglycemia; however, there is still a lack of screening indicators that can quickly and easily assess the level of glycemic variability. The aim of this study was to investigate whether the glycemic dispersion index is effective for screening high glycemic variability.MethodsA total of 170 diabetes patients hospitalized in the Sixth Affiliated Hospital of Kunming Medical University were included in this study. After admission, the fasting plasma glucose, 2-hour postprandial plasma glucose, and glycosylated hemoglobin A1c were measured. The peripheral capillary blood glucose was measured seven times in 24 h, before and after each of three meals and before bedtime. The standard deviation of the seven peripheral blood glucose values was calculated, and a standard deviation of > 2.0 was used as the threshold of high glycemic variability. The glycemic dispersion index was calculated and its diagnostic efficacy for high glycemic variability was determined by the Mann–Whitney U test, receiver operating characteristic (ROC) curve and, Pearson correlation analysis.ResultsThe glycemic dispersion index of patients with high glycemic variability was significantly higher than that of those with low glycemic variability (p < 0.01). The best cutoff value of the glycemic dispersion index for screening high glycemic variability was 4.21. The area under the curve (AUC) was 0.901 (95% CI: 0.856–0.945) and had a sensitivity of 0.781 and specificity of 0.905. It was correlated with the standard deviation of blood glucose values (r = 0.813, p < 0.01).ConclusionsThe glycemic dispersion index had good sensitivity and specificity for screening high glycemic variability. It was significantly associated with the standard deviation of blood glucose concentration and is simple and easy to calculate. It was an effective screening indicator of high glycemic variability.

Detection of Hemostasis Abnormalities in Type 2 Diabetes Mellitus Using Thromboelastography.

Type 2 DM (T2DM) is associated with inflammation and vascular dysfunction which impact hemostasis. Thromboelastography (TEG) as a hemostasis assessment method, is not routinely applied in T2DM. We aimed to detect hemostasis abnormalities by using the TEG method in association with glycemic levels and type of therapy among T2DM patients. A cross-sectional study was conducted among T2DM patients attending the Endocrinology Clinic of Saiful Anwar Hospital, Indonesia. Glycemic profiles were determined using fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPPG), and glycosylated hemoglobin (HbA1c). Therapy for T2DM was classified into insulin and non-insulin regimens. The primary and secondary hemostasis profile were examined using TEG and was classified as hypo- hyper- and normo-coagulable states. A total of 57 T2DM patients were included. Kruskal-Wallis test did not reveal a significant association between glycemic profiles and groups of hemostasis. However, the median HbA1c was higher in the hypercoagulable group of primary hemostasis and fibrinolysis. The median FPG and 2hPPG were higher in the normo-coagulable group of secondary hemostasis. Logistic regression did not indicate a significant association between type of therapy for diabetes and hemostasis profile. This study did not find significant associations between glycemic levels and type of DM therapy with hemostasis profiles using the TEG method in patients with T2DM.

Oat nutritious meal has beneficial effect on lipid metabolism in type 2 diabetes mellitus: A 3-month randomized controlled trial

This study aims to evaluate the effects of oat nutritious meal (ONM) on the blood glucose and lipid metabolism in elderly patients with type 2 diabetes mellitus (T2DM). A randomized controlled trial (RCT) was conducted. Ninety-eight subjects were randomly divided into ONM group and control group. The ONM group was given 20 g ONM twice a day over a course of 3 months and the control group kept the diet as before. Glucose and lipids parameters were measured at baseline and once a month in the study. Repeated-measure analysis of variance was used for data analysis. We found that there were significant changes in the concentrations of fasting plasma glucose, 2-hour postprandial plasma glucose, 2-hour postprandial insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and homeostasis model assessment for beta-cell function(HOMA-β) over time in both groups. For TC and LDL-c, the interaction between time and intervention was also significant, which indicated that the ONM intervention contributed to the reduction of TC and LDL-c levels compared to the control group during the follow-up (P = 0.026 for TC, P = 0.006 for LDL-c). Our research demonstrates that 40 g ONM/d reduces TC and LDL-c levels significantly. But it has no effect on the glucose metabolism in elderly patients with T2DM.

Comparative efficacy and safety of two insulin aspart formulations (Rapilin and NovoRapid) when combined with metformin, for patients with diabetes mellitus: a multicenter, randomized, open-label, controlled clinical trial

Objective This phase 3 confirmatory diabetes mellitus treatment study compared the safety and efficacy of Rapilin and NovoRapid insulin asparts in combination with metformin. Methods This 24-week, open-label, randomized, active-controlled, noninferiority phase 3 confirmatory study conducted across centers in China aimed to enroll patients with type 2 diabetes mellitus and blood sugar glucose inadequately controlled by oral antidiabetic drugs. Randomized patients received subcutaneous mealtime Rapilin or NovoRapid (3:1) injections, with metformin. The primary objectives were to demonstrate noninferiority (margin of 0.4%) in HbA1c change from baseline and compare safety profiles of Rapilin versus NovoRapid after 24 weeks. Secondary outcomes included 2-h postprandial plasma glucose (PPG), fasting plasma glucose (FPG), and patients achieving HbA1c <7.0% and ≤6.5%. Results 590 patients with type 2 diabetes mellitus were randomized to Rapilin (n = 441) and NovoRapid (n = 149) groups. After 24 weeks, the mean HbA1c change from baseline was −2.20% (Rapilin) and −2.32% (NovoRapid); the estimated treatment difference based on least-square means was 0.04% (95% CI: −0.17, 0.26), meeting the noninferiority criteria for Rapilin versus NovoRapid. Comparable improvements were reported for mean 2-hour PPG (6.14 and 6.29 mmol/L), FPG (2.02 and 1.70 mmol/L), and patients with HbA1c <7.0% (52.6% and 51.0%) and ≤6.5% (34.2% and 30.9%), in the Rapilin and NovoRapid groups, respectively, with no significant safety or immunogenicity outcome differences. Conclusions Rapilin demonstrated non-inferior glycemic control, and matching safety and immunogenicity to NovoRapid in patients with type 2 diabetes mellitus also receiving metformin over 24 weeks. Trial registration ChiCTR20003129041

Viscoelastic and Viscoplastic Glucose Theory (VGT #31): Applying VGT with Two Different CGM Sensor Measured 2-Hour Postprandial Plasma Glucose (PPG) values from 240 Liquid Egg Meals and 191 Solid Egg Meals as the Strain, along with the PPG Change Rate Multiplied by a Viscosity Factor of Average Carbs/ Sugar Amounts for Each Egg Meal Type as the Stress, and then

The author has studied strength of materials and theory of elasticity through his undergraduate courses at the University of Iowa. He also conducted research work and earned a master’s degree in Biomechanics under Professor James Andrews. In 1970-1971, he used a combined spring and dashpot model to simulate the behaviors of human joints, bones, muscles, and tendons in order to investigate the human-weapon interactions during the Vietnam war era. Later, he went to MIT to pursue his PhD study under Professor Norman Jones, who taught him theory of plasticity and dynamic plastic behaviors of various structure elements. To further his education, he took additional graduate courses in various fields of fluid dynamics, thermodynamics, bridge design using energy absorption pad, and soil mechanics under earthquake influences which have dealt with “time-dependency” issues. Since then, many advancements have been made in the biomechanics branch, especially with human body live tissues that possess certain viscoelastic characteristics, such as bones, muscles, cartilages, tendons (connect bone to muscle), ligaments (connect bone to bone), fascia, and skin. For example, the author suffered plantar fasciitis for many years. He understood that the night splint dorsiflexes forefoot, at the back of the foot, increases plantar fascia tension to offer stress-relief for the pain. This model where muscles and tendons connect the lower leg and foot is a form of viscoelastic study for medical problem solving. When dealing with human internal organs, it is not easy to conduct live experiments to obtain accurate measurements for the biomedical material properties. Blood itself is a viscous material (time-dependent) and its viscosity factor may fall between water, honey, syrup, or gel. But, the author’s research focus is on “glucose” where the blood sugar amount is produced by the liver and carried by red blood cells, not the blood itself. The postprandial plasma glucose (PPG) is strongly influenced by both energy input via carbs/sugar intake amount (~60%) and energy output via postmeal exercise level (~40%). Fundamentally, the PPG level is also dependent on the individual's health conditions in regard to liver cells and pancreatic beta cells, which produce glucose and release insulin to control the glucose level in blood. Therefore, it is nearly impossible to measure the material geometry or material properties to determine the viscosity of “glucose” like in engineering research work. As a result, the best the author could do is to apply the “concept” of viscoelasticity and/or viscoplasticity” to construct an analogy model of time-dependent glucose behaviors.

158-LB: Effect of Vitamin D Replacement on Glycemic Status and Pregnancy Outcomes in Vitamin D–Deficient Subjects with Gestational Diabetes Mellitus

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.

Qibin Tongbian Decoction in the Treatment of Diabetic Constipation and Its Influence on the Intestinal Environment and the Incidence of Adverse Reactions: A Randomized Trial.

Objective This study aimed to study the clinical efficacy of Qibin Tongbian decoction in the treatment of diabetic constipation and its influence on the intestinal environment and the incidence of adverse reactions. Methods In this prospective study, a total of 62 patients with diabetic constipation admitted to our hospital from June 2020 to March 2021 were recruited and assigned at a ratio of 1 : 1 to receive either traditional treatment (control group) or Qibin Tongbian decoction (experimental group). Outcome measures included clinical efficacy, intestinal environment, and incidence of adverse reactions. Results Qibin Tongbian decoction was associated with significantly higher efficacy and a lower TCM symptom score versus conventional treatment (P < 0.05). Qibin Tongbian decoction resulted in significantly lower fasting plasma glucose (FPG) levels and 2-hour postprandial plasma glucose (2hPG) levels versus conventional treatment (P < 0.05). Patients receiving Qibin Tongbian decoction showed significantly lower constipation symptom scores and PAC-QOL scores versus conventional treatment (P < 0.05). Qibin Tongbian decoction resulted in a significantly larger number of bifidobacteria and enterococci and a smaller number of yeasts versus conventional treatment (P < 0.05). Qibin Tongbian decoction was associated with a significantly lower incidence of adverse reactions and recurrence rate versus conventional treatment (P < 0.05). Conclusion Qibin Tongbian decoction combined with conventional TCM therapy yields a promising effect in the treatment of diabetic constipation. It can improve the intestinal environment of patients, mitigate the symptoms of constipation, enhance the quality of life of patients, and reduce the incidence of adverse reactions, so it is worthy of promotion and application.

Study of the Association between Plasminogen ActivatorInhibitor-1, other Inflammatory Markers, Metabolic Control Parameters, and Diabetic Foot Disease

Background: The incidence of type 2 diabetes mellitus (T2DM) has been increasing in recent years. As such, early identification and management of its complications—especially diabetic foot disease (DFD)—is of great importance. Multiple factors are involved in the pathogenesis of DFD; in this study, we aimed to study the association between plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), 1st hour erythrocyte sedimentation rate (ESR), and DFD. Methods: The present work was conducted on 200 T2DM patients with DFD (group I), 200 T2DM patients without DFD (group II), and 100 healthy subjects (group III, as a control group). Serum PAI-1 levels (using ELISA) and other inflammatory markers (hs-CRP and 1st hour ESR) were measured in the three groups. Results: T2DM patients with DFD had significantly higher mean serum levels of inflammatory markers (including PAI-1, hs-CRP, and 1st hour ESR) compared to T2DM patients without DFD and the control group (p &lt; 0.001). There was a significant positive correlation between inflammatory markers (including PAI-1, hs-CRP, and 1st hour ESR), metabolic control parameters (including fasting plasma glucose, 2-hour postprandial plasma glucose, and glycated hemoglobin), and severity of DFD in group I and group II (p &lt; 0.001). Conclusion: DFD is associated with elevated indicators of systemic and vascular inflammation. PAI-1, hs-CRP, and 1st hour ESR can be considered as early predictors for vascular tissue damage and can be used for early detection of complications in diabetic patients. Among these indicators, hs-CRP has greater diagnostic value in the detection of DFD.

Viscoelastic and Viscoplastic Glucose Theory (VGT #31): Applying VGT with Two Different CGM Sensor Measured 2-Hour Postprandial Plasma Glucose (PPG) Values from 240 Liquid Egg Meals and 191 Solid Egg Meals as the Strain, Along with the PPG Change Rate Multiplied by a Viscosity Factor of Average Carbs/Sugar Amounts for Each Egg Meal Type as the Stress, and then Applying

The author has studied strength of materials and theory of elasticity through his undergraduate courses at the University of Iowa. He also conducted research work and earned a master’s degree in Biomechanics under Professor James Andrews. In 1970-1971, he used a combined spring and dashpot model to simulate the behaviors of human joints, bones, muscles, and tendons in order to investigate the human-weapon interactions during the Vietnam war era. Later, he went to MIT to pursue his PhD study under Professor Norman Jones, who taught him theory of plasticity and dynamic plastic behaviors of various structure elements. To further his education, he took additional graduate courses in various fields of fluid dynamics, thermodynamics, bridge design using energy absorption pad, and soil mechanics under earthquake influences which have dealt with “time-dependency” issues. Since then, many advancements have been made in the biomechanics branch, especially with human body live tissues that possess certain viscoelastic characteristics, such as bones, muscles, cartilages, tendons (connect bone to muscle), ligaments (connect bone to bone), fascia, and skin. For example, the author suffered plantar fasciitis for many years. He understood that the night splint dorsiflexes forefoot, at the back of the foot, increases plantar fascia tension to offer stress-relief for the pain. This model where muscles and tendons connect the lower leg and foot is a form of viscoelastic study for medical problem solving. When dealing with human internal organs, it is not easy to conduct live experiments to obtain accurate measurements for the biomedical material properties. Blood itself is a viscous material (time-dependent) and its viscosity factor may fall between water, honey, syrup, or gel. But, the author’s research focus is on “glucose” where the blood sugar amount is produced by the liver and carried by red blood cells, not the blood itself. The postprandial plasma glucose (PPG) is strongly influenced by both energy input via carbs/sugar intake amount (~60%) and energy output via post-meal exercise level (~40%). Fundamentally, the PPG level is also dependent on the individual’s health conditions in regard to liver cells and pancreatic beta cells, which produce glucose and release insulin to control the glucose level in blood. Therefore, it is nearly impossible to measure the material geometry or material properties to determine the viscosity of “glucose” like in engineering research work. As a result, the best the author could do is to apply the “concept” of viscoelasticity and/or viscoplasticity” to construct an analogy model of time-dependent glucose behaviors.

The Effects of C. lacerata on Insulin Resistance in Type 2 Diabetes Patients.

Background Several experimental studies have suggested beneficial effects of Ceriporia lacerata on glucose metabolism. However, there has been no human study assessing the effects of C. lacerata on glucose metabolism. Therefore, we investigated whether C. lacerata improves glucose control and insulin resistance in type 2 diabetes patients. Methods Ninety patients diagnosed with type 2 diabetes (T2DM) for more than 6 months were enrolled. Subjects were randomly divided into placebo (n = 45) or C. lacerata (n = 45) groups and then assigned to take placebo or C. lacerata capsules (500 mg/capsule) for a 12-week intervention period. Biochemical markers, including fasting glucose, 2-hour postprandial plasma glucose, and lipid profile levels, as well as insulin, c-peptide, and Hba1c, were measured. Furthermore, insulin sensitivity indices, such as HOMA-IR, HOMA-beta, and QUICKI, were assessed before and after the 12-week administration. Results Eighty-four patients completed the study. There were no significant differences in fasting, postprandial glucose, HbA1c, or lipid parameters. HOMA-IR and QUICKI indices were improved at week 12 in the C. lacerata group, especially in subjects with HOMA-IR of 1.8 or more (p < 0.05). Fasting, postprandial c-peptide, and insulin levels decreased at week 12 in the C. lacerata group (p < 0.05). These significant differences were not observed in the placebo group. Conclusion Twelve-week administration of C. lacerata in T2DM patients resulted in significant improvement in insulin resistance, especially in those with lower insulin sensitivity. A larger population study with a longer follow-up period and an effort to elucidate the mechanism is warranted to further assess the effects of C. lacerata on T2DM patients.

Teneligliptin versus vildagliptin in Indian patients with type 2 diabetes inadequately controlled with metformin

India is heading towards being the diabetes capital of the world indicating that every fifth diabetic in the world is an Indian. The aim to prevent and control diabetic complications can be achieved with a target of glycated haemoglobin (HbA1c) less than 7.0%. There is an urgent need for a cost-effective and safer therapeutic approach for the management of type 2 diabetes. The primary objective was to compare the reduction in fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2-h PPG), and HbA1c, in Group-1and Group-2 at 6, 12, 18 and, 24 weeks with baseline values of two groups. This was a 24-week, randomized, open-label study. Patients with type 2 diabetes who were inadequately controlled on Metformin (850mg, twice a day) were randomized into two groups, Group-1(Metformin 850mg, twice daily added with Vildagliptin 50mg, twice daily) and Group 2(Metformin 850mg, twice daily added with Teneligliptin 20mg, once a day). Reductions in fasting plasma glucose, 2 hours postprandial plasma and HbA1c in the vildagliptin group (Group1) were comparable with the teneligliptin group (Group2). Patients in both groups showed similar tolerability with lesser episodes of hypoglycemia and, are weight neutral. Teneligliptin is noninferior to vildagliptin in controlling glycaemic parameters and shows similar tolerability.

Association Between Dietary Salt and Plasma Glucose, Insulin and Hemoglobin A1c Levels Among Type 2 Diabetes Patients in Eastern China.

PurposeType 2 diabetes (T2D) is one of the major public health concerns in China. Studies on the association between dietary salt intake and the glycemic response of T2D are lacking in China. The aim was to investigate the association between the levels of dietary salt intake and the plasma glucose, insulin and hemoglobin A1c (HbA1c) levels in T2D patients.MethodsPatients with T2D, who accepted management and treatment by the National Standardized Metabolic Disease Management Center at Ningbo First Hospital from March 2018 to January 2020, were included in this study. Dietary salt intake was assessed through a standardized food frequency questionnaire. Anthropometry, blood pressure and biomarkers were measured by well-trained endocrinology nurses. Generalized linear models (GLMs) were used to examine the associations.ResultsA total of 1145 eligible T2D patients with a mean age of 51.4 years were included in the study. Fasting plasma glucose (FPG), 2-hour postprandial plasma glucose and 2-hour postprandial insulin were significantly increased across dietary salt categories. The GLMs further showed that dietary salt intake >8 g/day was positively associated with FPG and HbA1c.ConclusionHigher daily salt intake was found to be associated with FPG and HbA1c in T2D patients. Lifestyle education and promotion of salt reduction should be provided to T2D patients.

Increased Circulating Levels of Ectodysplasin A in Newly Diagnosed Type 2 Diabetic Patients.

ObjectiveEctodysplasin A (EDA), a newly discovered hepatokine, has recently been considered to be closely related to glycolipid metabolism disorders, but the pathophysiological effects of EDA are still poorly understood. This study was the first time to determine the level of serum EDA in newly diagnosed type 2 diabetes mellitus (T2DM) patients, and to explore the relationships between serum EDA levels and various metabolic indexes.MethodsA total of 184 subjects were enrolled in the study, including 92 subjects with newly diagnosed T2DM and 92 subjects with age- and sex-matched normal glucose tolerance (NGT). Serum EDA levels were determined using enzyme-linked immunosorbent assay (ELISA). Oral glucose tolerance test, glycosylated hemoglobin c (HbA1c), and insulin were also measured.ResultsSerum EDA levels were significantly increased in the T2DM group than in the NGT group (359.91 ± 117.99 vs. 265.82 ± 86.51 pg/ml, p < 0.001). Serum EDA levels were positively correlated with body mass index (BMI), waist-to-hip ratio (WHR), fasting plasma glucose (FPG), HbA1c, 2-hour postprandial plasma glucose (2hPG), fasting plasma insulin (FIns), fasting C peptide (FCP), triglyceride (TG), HOMA-IR, and negatively correlated with high-density lipoprotein cholesterol (HDL-c) and HOMA-β (p < 0.05). Multiple stepwise regression analysis demonstrated that 2hPG and FIns were independent influencing factors of serum EDA level (p < 0.05). Logistic regression analysis showed that serum EDA level was significantly independently correlated with T2DM (p < 0.05).ConclusionsSerum EDA levels are significantly higher in T2DM patients, suggesting that EDA may play a role in the occurrence and development of T2DM.

Postprandial plasma glucose excursion is associated with an atherogenic lipid profile in individuals with type 2 diabetes mellitus: A cross-sectional study.

Coronary heart disease (CHD) is a prevalent complication of type 2 diabetes mellitus (T2DM). The atherogenic low-density lipoprotein (LDL) cholesterol is an established risk factor of cardiovascular disease, and evidence also suggests that postprandial plasma glucose (PPG) levels closely delineate CHD mortality in diabetes. The investigators hypothesized that postprandial plasma glucose excursion (PPGE), defined as the difference between 2-hour PPG and fasting plasma glucose (FPG), may be associated with plasma LDL cholesterol levels in patients with T2DM. This study enrolled diabetic participants for whom FPG and lipid profile were sampled after a 12-hour fast, followed by PPG sampling two hours after consuming a standard meal with 75 grams of carbohydrates. The study enrolled 379 participants who were divided into PPGE tertiles according to the difference between their 2-hour PPG and FPG. Participants in the highest PPGE tertile had considerably greater plasma LDL cholesterol levels than patients in the lowest tertile (126.7 mg/dL vs. 99.5 mg/dL, P <0.001). Linear regression analysis also demonstrated that the PPGE was positively correlated with plasma LDL cholesterol levels (β coefficient: 0.165, P < 0.001). Postprandial glucose excursion positively correlated with plasma LDL cholesterol levels in individuals with T2DM. Participants with raised PPGE harbored greater LDL cholesterol levels than those with lower postprandial glucose fluctuations. Therefore, postprandial glucose excursion is associated with an atherogenic lipid profile and may be a modifiable risk factor of diabetic CHD.

The efficacy and safety of glucokinase activators for the treatment of type-2 diabetes mellitus: A meta-analysis.

Background:Glucokinase activators (GKAs) are a novel family of glucose-lowering agents used for the treatment of type-2 diabetes mellitus. Treatment with different GKAs has been shown to reduce blood glucose levels in these patients. We compared the efficacy/safety of GKAs in patients with type-2 diabetes mellitus through a meta-analysis.Methods:We searched the PubMed, Excerpt Medica Database, and Cochrane Central Register of Controlled Trials databases for articles published before December 30, 2020. We computed the weighted mean difference (WMD) and 95% confidence interval (CI) for the change from baseline to the study endpoint for GKA versus placebo treatments.Results:A total of 4 articles (5 studies) were included in the meta-analysis. GKAs were associated with reductions in glycated hemoglobin levels from baseline (WMD, −0.3%; 95% CI, −0.466% to −0.134%). No significant difference between GKA and placebo treatment was observed in the results of fasting plasma glucose levels from baseline (WMD 0.013 mmol/L; 95% CI, −0.304–0.33 mmol/L). A significantly higher change in 2-hour postprandial plasma glucose (2-h PPG) levels (WMD −2.434 mmol/L; 95% CI, −3.304 to −1.564 mmol/L) was observed following GKA than placebo treatment. GKAs were associated with a higher prevalence of causing hypoglycemic events than placebo treatment (risk difference [RD], 0.06; 95% CI 0.013–0.106). GKAs had no association with the risk of developing adverse effects (RD, 0.038; 95% CI, −0.03–0.106) and serious adverse events (RD, 0.01; 95% CI, −0.004–0.023).Conclusions:GKAs were more effective for postprandial blood glucose control. However, these agents showed a significantly high risk of causing hypoglycemia.PROSPERO registration number:CRD42021220364.