Blood Glucose Control In Diabetes Research Articles

Development and implementation of ambulatory care pharmacy services at an internal medicine clinic.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This report describes the step-by-step process that led to expansion of ambulatory care pharmacy services at a newly established internal medicine clinic within a patient-centered medical home in North Carolina. Implementation of clinical pharmacist services at the clinic was led by a postgraduate year 2 (PGY2) pharmacy resident and guided by the 9 steps described in the book Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. After a needs assessment and review of the demographics and insurance status of the clinic's target population, it was determined that pharmacist services would focus on quality measures including diabetes nephropathy screening, diabetes eye examination, blood glucose control in diabetes, discharge medication reconciliation, annual wellness visits, and medication adherence in diabetes, hypercholesterolemia, and hypertension. Clinic appointments were conducted under 3 models: a pharmacist-physician covisit model, a "floor model" of pharmacist consultation on drug information or medication management issues during medical resident sign-out sessions with supervising physicians (medical residents could also see patients along with the pharmacist at a covisit appointment), and a covisit model of stacked physician and pharmacist appointments. The pharmacist's services were expanded from 2 half-day clinic sessions per week initially to 5 or 6 half-day clinic sessions by the end of the residency year. By the fourth quarter of the first PGY2 residency year in which ambulatory care pharmacy services were provided in the clinic, the clinical and financial impact of those services justified the addition of a second full-time pharmacist to the clinic team.

Orally-delivered insulin-peptide nanocomplexes enhance transcytosis from cellular depots and improve diabetic blood glucose control.

Insulin regulates blood glucose levels, and is the mainstay for the treatment of type-1 diabetes and type-2 when other drugs provide inadequate control. Therefore, effective oral Insulin delivery would be a significant advance in drug delivery. Herein, we report the use of the modified cell penetrating peptide (CPP) platform, Glycosaminoglycan-(GAG)-binding-enhanced-transduction (GET), as an efficacious transepithelial delivery vector in vitro and to mediate oral Insulin activity in diabetic animals. Insulin can be conjugated with GET via electrostatic interaction to form nanocomplexes (Insulin GET-NCs). These NCs (size and charge; 140nm, +27.10mV) greatly enhanced Insulin transport in differentiated in vitro intestinal epithelium models (Caco2 assays; >22-fold increased translocation) with progressive and significant apical and basal release of up-taken Insulin. Delivery resulted in intracellular accumulation of NCs, enabling cells to act as depots for subsequent sustained release without affecting viability and barrier integrity. Importantly Insulin GET-NCs have enhanced proteolytic stability, and retained significant Insulin biological activity (exploiting Insulin-responsive reporter assays). Our study culminates in demonstrating oral delivery of Insulin GET-NCs which can control elevated blood-glucose levels in streptozotocin (STZ)-induced diabetic mice over several days with serial dosing. As GET promotes Insulin absorption, transcytosis and intracellular release, along with in vivo function, our simplistic complexation platform could allow effective bioavailability of other oral peptide therapeutics and help transform the treatment of diabetes.

Hepatic AMPK signaling dynamic activation in response to REDOX balance are sentinel biomarkers of exercise and antioxidant intervention to improve blood glucose control.

Antioxidant intervention is considered to inhibit reactive oxygen species (ROS) and alleviate hyperglycemia. Paradoxically, moderate exercise can produce ROS to improve diabetes. The exact redox mechanism of these two different approaches remains largely unclear. Here, by comparing exercise and antioxidant intervention on type 2 diabetic rats, we found moderate exercise upregulated compensatory antioxidant capability and reached a higher level of redox balance in the liver. In contrast, antioxidant intervention achieved a low-level redox balance by inhibiting oxidative stress. Both of these two interventions could promote glucose catabolism and inhibit gluconeogenesis through activation of hepatic AMP-activated protein kinase (AMPK) signaling; therefore, ameliorating diabetes. During exercise, different levels of ROS generated by exercise have differential regulations on the activity and expression of hepatic AMPK. Moderate exercise-derived ROS promoted hepatic AMPK glutathionylation activation. However, excessive exercise increased oxidative damage and inhibited the activity and expression of AMPK. Overall, our results illustrate that both exercise and antioxidant intervention improve blood glucose control in diabetes by promoting redox balance, despite different levels of redox state(s). These results indicate that the AMPK signaling activation, combined with oxidative damage markers, could act as sentinel biomarkers, reflecting the threshold of redox balance that is linked to effective glucose control in diabetes. These findings provide theoretical evidence for the precise management of diabetes by antioxidants and exercise.

A Multitask Learning Approach to Personalized Blood Glucose Prediction.

Blood glucose prediction algorithms are key tools in the development of decision support systems and closed-loop insulin delivery systems for blood glucose control in diabetes. Deep learning models have provided leading results among machine learning algorithms to date in glucose prediction. However these models typically require large amounts of data to obtain best personalised glucose prediction results. Multitask learning facilitates an approach for leveraging data from multiple subjects while still learning accurate personalised models. In this work we present results comparing the effectiveness of multitask learning over sequential transfer learning, and learning only on subject-specific data with neural network and support vector regression. The multitask learning approach shows consistent leading performance in predictive metrics at both short-term and long-term prediction horizons. We obtain a predictive accuracy (RMSE) of 18.8 ±2.3, 25.3 ±2.9, 31.8 ±3.9, 41.2 ±4.5, 47.2 ±4.6mg/dL at 30, 45, 60, 90, and 120min prediction horizons respectively, with at least 93% clinically acceptable predictions using the Clarke Error Grid (EGA) at each prediction horizon. We also identify relevant prior information such as glycaemic variability that can be incorporated to improve predictive performance at long-term prediction horizons. Furthermore, we show consistent performance - ≤ 5% change in both RMSE and EGA (Zone A) - in rare cases of adverse glycaemic events with 1-6 weeks of training data. In conclusion, a multitask approach can allow for deploying personalised models even with significantly less subject-specific data without compromising performance.

Observation on the Effect of Community Nursing on Diabetic Blood Glucose Control

Observation on the Effect of Community Nursing on Diabetic Blood Glucose Control

The effects and acceptability of different exercise modes on glycemic control in type 2 diabetes mellitus: A protocol for systematic review and network meta-analysis.

Introduction:Exercise has been believed to have positive effects on blood glucose control in patients with type 2 diabetes mellitus. However, few medical evidences have been found to ascertain which type of exercise has the best effect on blood glucose control in diabetes and which type of exercise is more acceptable. The purpose of this study is to compare the effects and acceptability of different exercise modes on glycemic control in type 2 diabetes patients by using systematic review and network meta-analysis.Methods and analysis:Relevant randomized controlled trial studies will be searched from PubMed, EMbase, CochraneCENTRAL, CNKI, VIP, and Chinese medical paper libraries. Primary outcome indicators: glycosylated hemoglobin and dropout rate of the research (number of dropouts/numbers of initially enrolled subjects). Secondary outcome measures: fasting blood glucose, body weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, triglycerides (TG), diastolic pressure, systolic pressure (SBP). Two reviewers are arranged to screen Title, , and then review full text to further extract data. Standard meta-analysis and network meta-analysis of the data are performed afterward. Methodological quality assessment is planned to be conducted using Cochrane risk of bias tool. The outcome will be analyzed statistically according to Bayesian analysis methods. After that, subgroup analysis is conducted on the duration of intervention, whether there is supervision of intervention, frequency of intervention per week, age, gender, and medication use.Trial registration number:PROSPERO CRD42020175181Discussion:The systematic review and network meta-analysis include evidence of the impact of different exercise modes on blood glucose control in type 2 diabetes mellitus. There are 2 innovative points in this study. One is to conduct a classified study on exercise in as much detail as possible, and the other is to study the acceptability of different exercise modes. The network meta-analysis will reduce the uncertainty of intervention and enable clinicians, sports practitioners, and patients to choose more effective and suitable exercise methods.Ethics and dissemination:The findings of the study will be disseminated through publications in peer-reviewed journals and scientific conferences and symposia. Further, no ethical approval is required in this study.

Sub-clinical thickening of the fovea in diabetes and its relationship to glycaemic control: a study using swept-source optical coherence tomography

BackgroundAccumulation of multiple pockets of fluid at the fovea, as a complication of poor blood glucose control in diabetes, causes impairment of central vision. A new ability to demonstrate a pre-clinical phase of this maculopathy could be valuable, enabling diabetic individuals to be alerted to the need to improve their glycaemic control. This study aimed to use swept-source optical coherence tomography (SS-OCT) to measure foveal thickness and macular volume in diabetic individuals without cystoid macular oedema, and in non-diabetic individuals, and relate these measures to participants’ glycaemic control.MethodsCentre point thickness (CPT) and total macular volume (TMV) were measured using SS-OCT (DRI OCT Triton™, Topcon, Tokyo, Japan). Participants’ glycosylated haemoglobin (HbA1c) level was also assessed (A1cNow®+ System, PTS Diagnostics, Indianapolis, IN, USA). The diabetic (n = 27) and non-diabetic (n = 27) groups were matched for age (p = 0.100) and sex (p = 0.414), and HbA1c level differed between diabetic and non-diabetic groups (p < 0.0005). The diabetic group comprised type 1 (n = 7) and type 2 (n = 20) diabetic individuals who were matched for duration of diabetes (p = 0.617) and whose glycaemic control was similar (p = 0.814).ResultsDiabetic individuals had significantly higher CPT (t(37) = 3.859, p < 0.0005) than non-diabetic individuals. In the diabetic group, multiple linear regression analysis revealed a conspicuous relationship between CPT and HbA1c level (β = 0.501, t(21) = 3.139, p = 0.005): there was a 19-μm increase in CPT for each 1% increase in HbA1c level. This relationship was not present in the non-diabetic group (β = − 0.068, t(23) = − 0.373, p = 0.712).ConclusionsSS-OCT is the only way to measure macular thickness in vivo. Diabetic individuals en bloc had higher CPT compared with non-diabetic individuals. Moreover, in the diabetic group, HbA1c level significantly predicted CPT. Our results suggest that, in diabetes, sub-clinical thickening may occur at the fovea before cystoid macular oedema becomes clinically evident. This could provide diabetic individuals with an early warning of disease progression and motivate them to improve control of their diabetes, with a view to avoiding the need of intra-vitreal injections with their attendant risks.

Relationship between loneliness and blood glucose control in diabetes

BackgroundThe data of the International Diabetes Federation show that about 463 million people have diabetes. Better understanding of psychosocial aspects of life with this disease has become one of healthcare priorities in this group of patients. The aim of this study was to assess the relationships between loneliness and blood glucose control in diabetic patients.MethodsThe study included 250 hospitalized patients with type 1 and 2 diabetes. The patients included in the study were those who had had diabetes for at least 1 year and received pharmacotherapy. Standardized Revised UCLA Loneliness Scale (R-UCLA) and an analysis of patient test results including 10 indicators of blood glucose control were used for data collection. Correlation analysis, i.e. Pearson’s linear correlation coefficient (r, parametric method), was used for hypothesis verification.ResultsLess than one-fifth (16%) of the patients included in the study had higher loneliness index (based on the R-UCLA scale), and this loneliness index (total result) was significantly correlated with higher blood pressure. No significant correlations were demonstrated between loneliness and the other 9 indicators of blood glucose control.ConclusionsSystolic blood pressure was significantly correlated with loneliness in patients with diabetes. Further studies are needed to confirm these findings.

Effect of Shenqi compound on inflammatory markers and glycemic measures among diabetes mellitus: A protocol for systematic review and meta-analysis.

Background:Diabetes is a chronic disease characterized by chronic hyperglycemia, absolute or relative deficiency of insulin secretion, and chronic inflammation. Shenqi compound (SC) is a traditional Chinese medicine formula widely used in the treatment of diabetes and diabetic complications. Although many randomized clinical trials have proved that SC can benefit a lot from diabetes and its complications, the systematic evaluation of the effect of SC on diabetic blood glucose control and inflammatory markers has not yet appeared. The purpose of this study is to provide evidence that the therapeutic effect of SC on diabetes and its multiple system complications is related to its control of blood glucose and inflammatory mediators.Methods:Three English database and 4 Chinese medical databases will be searched from its inception to May 2020. Then 2 methodological trained researchers will screen the qualified articles by reading the title, abstract, and full texts according to an established inclusion and exclusion criteria. The assessment of risk of bias will be conducted by using the Cochrane collaboration's tool. We will conduct meta-analyses for fasting blood glucose, postprandial blood glucose, glycated hemoglobin, tumor necrosis factor, C-reactive protein or high-sensitivity C-reactive protein, and other outcomes. The heterogeneity of data will be evaluated by Cochrane X2 and I2 tests. Subgroup analysis will also be carried out. We will conduct sensitivity analysis to evaluate the stability of the results, funnel plot analysis, and Egger test to evaluate the publication bias, and assessment for the quality of evidence by the grading of recommendations assessment, development, and evaluate system.Results:The results of our research will be published in a peer-reviewed journal.Conclusion:In this study, we will systematically evaluate the influences of SC on glycemic measures and inflammatory markers of diabetes mellitus. Our research is supposed to provide evidence-based support for clinical practice.Registration number:INPLASY202040179.

Effects of endurance exercise and Urtica dioica on the functional, histological and molecular aspects of the hippocampus in STZ-Induced diabetic rats

Ethnopharmacological relevanceMany body systems and organs, including the hippocampus, are affected by diabetes, and undergo changes that may increase the risk of cognitive decline. Urtica dioica (UD) has long been recognized as a medicinal plant with beneficial effects on blood glucose control in diabetes. Aim of the studyThe present study aimed to investigate the effect of endurance exercise (Ex), along with Urtica dioica (UD) hydro-alcoholic extract on some functional, histological, and molecular aspects of the hippocampus in streptozotocin (STZ)-induced diabetic rats. Materials and methods60 male Wistar rats were divided into five groups (N = 12): healthy control (H-C), diabetes control (D-C), diabetes exercise (D-Ex), diabetes Urtica dioica (D-UD), and diabetes exercise Urtica dioica (D-Ex-UD). Diabetes was induced intraperitoneally by STZ (45 mg/kg) injection. Two weeks after the injection by STZ, Ex (moderate intensity/5day/week) and gavage of UD extract (50mg/kg/day) was performed for six weeks. Cognitive functions were evaluated by the Morris Water Maze test, routine histological examination, and molecular studies were done via Hematoxylin & Eosin stain, and Western blot. ResultsDiabetic rats showed spatial learning and memory deficits, as well as negatively affects to the tissue and structure of the hippocampus in the dentate gyrus (DG) and cornu ammonis (CA) areas. Ex + UD treatment caused a decrease of neural disorganization, an increase of neural-microglial density, and thickness of the pyramidal-molecular layer in the hippocampus. In addition, Ex + UD caused a rise of GAP-43 protein levels, a reduction of CAP-1 protein levels, improved hippocampal structure, and improved learning and memory function. ConclusionsThese results show that Ex, along with the UD extract, may decrease levels of the central neural complications of diabetes. Given the importance of recognizing non-pharmacological complementary therapies in this field, future studies are warranted.

Reinforcement learning application in diabetes blood glucose control: A systematic review.

Reinforcement learning (RL) is a computational approach to understanding and automating goal-directed learning and decision-making. It is designed for problems which include a learning agent interacting with its environment to achieve a goal. For example, blood glucose (BG) control in diabetes mellitus (DM), where the learning agent and its environment are the controller and the body of the patient respectively. RL algorithms could be used to design a fully closed-loop controller, providing a truly personalized insulin dosage regimen based exclusively on the patient's own data. In this review we aim to evaluate state-of-the-art RL approaches to designing BG control algorithms in DM patients, reporting successfully implemented RL algorithms in closed-loop, insulin infusion, decision support and personalized feedback in the context of DM. An exhaustive literature search was performed using different online databases, analyzing the literature from 1990 to 2019. In a first stage, a set of selection criteria were established in order to select the most relevant papers according to the title, keywords and abstract. Research questions were established and answered in a second stage, using the information extracted from the articles selected during the preliminary selection. The initial search using title, keywords, and abstracts resulted in a total of 404 articles. After removal of duplicates from the record, 347 articles remained. An independent analysis and screening of the records against our inclusion and exclusion criteria defined in Methods section resulted in removal of 296 articles, leaving 51 relevant articles. A full-text assessment was conducted on the remaining relevant articles, which resulted in 29 relevant articles that were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion. The advances in health technologies and mobile devices have facilitated the implementation of RL algorithms for optimal glycemic regulation in diabetes. However, there exists few articles in the literature focused on the application of these algorithms to the BG regulation problem. Moreover, such algorithms are designed for control tasks as BG adjustment and their use have increased recently in the diabetes research area, therefore we foresee RL algorithms will be used more frequently for BG control in the coming years. Furthermore, in the literature there is a lack of focus on aspects that influence BG level such as meal intakes and physical activity (PA), which should be included in the control problem. Finally, there exists a need to perform clinical validation of the algorithms.

Nitrilotriacetic Acid-Functionalized Glucose-Responsive Complex Micelles for the Efficient Encapsulation and Self-Regulated Release of Insulin.

Insulin plays a significant role in diabetes treatment. Although a huge number of insulin-loaded, glucose-responsive nanocarriers have been developed in past decades, most of them showed a lower loading capacity and efficiency due to the weak interaction between insulin and nanocarriers. In this work, a novel insulin-encapsulated glucose-responsive polymeric complex micelle (CM) is devised, showing (i) enhanced insulin-loading efficiency owing to the zinc ions' chelation by nitrilotriacetic acid (NTA) groups of NTA-functioned glycopolymer and the histidine imidazole of insulin, (ii) the glucose-triggered pulse release of insulin, and (iii) long stability under physiological conditions. This CM was fabricated by the self-assembly of block copolymer PEG- b-P(Asp- co-AspPBA) and glycopolymer P(Asp- co-AspGA- co-AspNTA), resulting in complex micelles with a PEG shell and a cross-linked core composed of phenylboronic acid (PBA)/glucose complexations. Notably, the modified nitrilotriacetic acid (NTA) groups of CM could specifically bind insulin via chelated zinc ions, thus enhancing the loading efficacy of insulin compared to that of nonmodified CM. The dynamic PBA/glucose complexation core of CM dissociates under the trigger of high glucose concentration (>2 g/L) while being quite stable in low glucose concentrations (<2 g/L), as demonstrated by the pulse release of insulin in vitro. Finally, in a murine model of type 1 diabetes, NTA-modified complex micelles loading an insulin (NTA-CM-INS) group exhibited a long hypoglycemic effect which is superior to that of free insulin in the PBS (PBS-INS) group and insulin-loaded complex micelles without an NTA modification (CM-INS) group. This long-term effect benefited from Zn(II) chelation by NTA-modified complex micelles and could avoid hypoglycemia caused by the burst release of insulin. Taken together, this constitutes a highly effective way to encapsulate insulin and release insulin via an on-demand manner for blood glucose control in diabetes.

Atypical presentation of central pontine myelinolysis in hyperglycemia.

Central pontine myelinolysis (CPM) usually occurs with rapid correction of severe chronic hyponatremia. Despite the pronounced fluctuations in serum osmolality, CPM is rarely seen in diabetics. This is a case report of CPM associated with hyperglycemia. A 45-year-old non-smoking and non-alcoholic African American male with past medical history of type 2 diabetes, hypertension, stage V chronic kidney disease and hypothyroidism presented with a two-week history of intermittent episodes of gait imbalance, slurred speech and inappropriate laughter. Physical examination including complete neurological assessment and fundoscopic examination were unremarkable. Laboratory evaluation was significant for serum sodium: 140 mmol/L, potassium: 3.9 mmol/L, serum glucose: 178 mg/dL and serum osmolality: 317 mosmol/kg. His ambulatory blood sugars fluctuated between 100 and 600 mg/dL in the six weeks prior to presentation, without any significant or rapid changes in his corrected serum sodium or other electrolyte levels. MRI brain demonstrated a symmetric lesion in the central pons with increased signal intensity on T2- and diffusion-weighted images. After neurological consultation and MRI confirmation, the patient was diagnosed with CPM secondary to hyperosmolar hyperglycemia. Eight-week follow-up with neurology was notable for near-complete resolution of symptoms. This case report highlights the importance of adequate blood glucose control in diabetics. Physicians should be aware of complications like CPM, which can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion.Learning points:Despite the pronounced fluctuations in serum osmolality, central pontine myelinolysis (CPM) is rarely seen in diabetics. This case report of CPM associated with hyperglycemia highlights the importance of adequate blood glucose control in diabetics.Physicians should be aware of complications like CPM in diabetics.CPM can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion.

Current methods of assessing blood glucose control in diabetes

The HbA1c measurement effectively averages blood glucose over the previous few months, but can conceal wide variations during that period and patients with apparently well-controlled HbA1c may have very different risks of potentially debilitating hypoglycaemia. Self-monitoring of blood glucose provides only snapshots of glycaemic control that are unlikely to reveal the true extent of glucose variability. Continuous glucose (CGM) systems offer a far more comprehensive 24-hour picture of glycaemia, but need regular calibration, are expensive, and limited by short sensor life. Also, the sheer volume of data from CGM downloads can render it difficult to identify patterns. The ambulatory glucose profile (AGP) presents glucose data in a standardised manner, with glucose values presented as a median with 10th, 25th, 75th and 90th centiles. Examination of the AGP can reveal patterns highlighting areas of hypoglycaemia risk or excessive glucose variability, in a way that helps patients to understand and accept the needed changes to their treatment. Software for analysis is available for current systems to indicate possible areas for attention, for example a simple traffic light system where the colour red shows a possible area of risk. AGP could make the difference between identifying or missing a glycaemic pattern and an associated effective therapeutic change, within the time-pressured and resource-limited healthcare environment. Finally, the newer technique of flash glucose monitoring involves a small factory calibrated sensor which can store glucose data for up to 8 hours; users use a handheld receiver to interrogate the sensor rather than having information pushed through continuously as in CGM.

Evaluation of possible mechanisms of three plants for blood glucose control in diabetes

&lt;p class="Abstract"&gt;This study was conducted to provide the evidence for the mechanism of anti-diabetic activity of &lt;em&gt;Cocculus orbiculatus, Leea indica&lt;/em&gt; and &lt;em&gt;Ventilago maderaspatana&lt;/em&gt;. This was accomplished by employing methods like uptake of glucose, glycogen synthesis and inhibition of α-glucosidase. For uptake of glucose, diaphragms were dissected out in Tyrode solution with 2% glucose and assayed for glucose content. In glycogen synthesis methodology liver, skeletal muscle and cardiac muscles were isolated, homogenized and glycogen content was analyzed. In α-glucosidase enzyme inhibition procedure involved estimation of α-glucosidase enzyme inhibition. All the three plant extracts exhibited significant (p&amp;lt;0.05 - p&amp;lt;0.01) anti-diabetic activity by increasing glucose uptake, glycogen synthesis and inhibiting α-glucosidase enzyme. Among the three plants, &lt;em&gt;V. maderaspatana&lt;/em&gt; (500 mg/kg) exhibited higher glucose uptake, glycogen content and α-glucosidase inhibition activity (IC&lt;sub&gt;50&lt;/sub&gt; 145 µg/mL). The present experimental results evidenced the anti-diabetic activity of three plants by all the three mechanisms.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Rapid Model Identification for Online Glucose Prediction of New Subjects With Type 1 Diabetes Using Model Migration Method

Online prediction of glucose concentration is of importance for blood glucose control in diabetes. For conventional modeling methods, model identification has to be repeated with sufficient data collected for each subject. This may cause repetitive cost and burden for patients and clinician and requires a lot of modeling efforts. Here, a rapid model development strategy is proposed using the idea of model migration for new subjects. First, a base model is obtained which can be empirically identified from any subject or constructed by priori knowledge. Then parameters of inputs in the base model are properly revised based on a small amount of data from new subjects. These issues are investigated by developing auto-regressive models with exogenous inputs (ARX) based on thirty in silico subjects. Some important issues relating to model adjustment performance are also checked, referring to the data used for model parameter adjustment and the interaction of two inputs, etc. The rapid modeling method is compared with subject-dependent models developed based on a large number of data with respect to on-line short-term (30min) glucose prediction accuracy.

Is snacking good or bad for health: An overview

SummarySnacking, or the habit of eating little and often, has been postulated to have a range of health benefits in relation to appetite control, bodyweight management and improved blood glucose control in diabetics and pre‐diabetics. However, there is widespread agreement that our current obesogenic environment is encouraging overeating in response to increased food portion sizes, palatability and/or energy‐density of foods, alongside the many social and psychological cues to eat. In this context, and as findings on the health effects of snacking are conflicting, the question remains as to whether more frequent eating and snacking can be of benefit to health. Snacks, if added to habitual meal intake, with no compensation for snack energy contribution, are likely over time to lead to positive energy balance. Hence, snacking might be a contributing factor to the obesity epidemic, in addition to more established factors, such as food choice and physical activity. This paper explores the existing evidence concerning the impact of snacking on bodyweight and the behavioural and metabolic response to snacking. The impact of snacking on cognitive function is also discussed. The review highlights the need for further research as, despite many years of scientific interest in snacking, the lack of consistency in study design and snacking definitions and the array of potential confounding factors (e.g. physical activity levels) makes interpretation of findings difficult and has led to little consensus about the optimum number and composition of meals and/or snacks for bodyweight control, health and wellbeing on a population‐wide basis.

Functionality and Application of Dietary Fiber in Meat Products

Dietary fiber naturally present in various sources of cereals, legumes, fruits and vegetables plays a physiological role in human health, such as lowering cholesterol and blood pressure, improving blood glucose control in diabetes, helping with weight loss and management, and reducing cancer risk. In addition, dietary fibers have has been added as a functional food ingredient to food products to provide water-holding capacity, viscosity, gel-forming ability, and fat-binding capacity to food products. These beneficial characteristics of dietary fiber components can improve the image of meat products to be healthy and functional food products. This article reviews the concept and current definition of dietary fibers in food products along with their health benefits and functional characteristics. Dietary fibers from different sources like cereals, legumes, fruits, and vegetables and soluble dietary fibers have been applied as functional ingredients to various types of meat products, such as beef patties, ground beef and pork, pork and chicken sausages, meatballs, and jerky etc. Based on the application of dietary fibers to different types of meat products, possible future characteristics in selecting appropriate dietary fiber ingredients and their proper incorporation are explored to develop and produce healthy and functional meat products with high dietary fiber contents.

Diabetic Blood Glucose Control via Optimization over Insulin and Glucose Doses

The proposed algorithm aims at helping diabetic patients which use multi-dose injection (MDI) therapy to determine the dose and time of insulin and glucose intakes to stabilize their blood glucose (BG) concentration. The objective is to spend most of the time in normal BG range (70-180 mg/dl). The control was done by minimizing the risk of hypo- and hyperglycemia over the doses and times of insulin and glucose intakes.

Society for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery

Optimal evidence-based perioperative blood glucose control in patients undergoing ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing ambulatory surgery. A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. The consensus panel used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for providing suggestions. It was revealed that there is insufficient evidence to provide strong recommendations for the posed clinical questions. In the absence of high-quality evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. In addition, areas of further research were also identified.