Glucose Curve Research Articles

Relationship between Intrapartum Continuous Glucose Monitoring Values and Neonatal Hypoglycemia in Individuals with Diabetes.

We aimed to evaluate the relationship between intrapartum continuous glucose monitoring (CGM) and neonatal hypoglycemia (NH) in individuals with diabetes. a multicenter prospective study (November 2021-December 2022) of laboring individuals with pregestational or gestational diabetes at ≥34 weeks. Cohorts had a blinded CGM placed from admission through delivery and were monitored with fingerstick (FS) according to usual care. The primary outcome was NH. Secondary neonatal outcomes included neonatal intensive care unit (NICU) length of stay, need for intravenous (IV) glucose therapy, hyperbilirubinemia, respiratory distress, or respiratory distress syndrome. Time in the target range (TIR; range 70-110 mg/dL) and time above the target range (TAR; >110 mg/dL) were expressed as a percentage of all CGM readings, and mean glucose was obtained. Youden index was used to choose the cut point for TAR and prediction of NH. Of 9,479 deliveries during the study period, 202 (2.1%) met the inclusion criteria, and 112 (56%) participants were enrolled (n = 7 did not have available CGM data). Of the study participants, 45 (40%) had pregestational diabetes, and 67 (60%) had gestational diabetes. The mean glucose in labor using a CGM was 102.6 mg/dL (interquartile range [IQR]:89.9, 113.5 mg/dL), and the average percentage of TIR was 62.1% (IQR, 36.9, 85.6). CGM and FS were poor predictors of NH, with no differences in area under the curve (AUC) of mean glucose as a predictor (0.64, 95% CI: 0.48-0.23 vs. 0.53, 95% CI: 0.4-0.6, respectively). The best cut-off for the prediction of NH was a TAR of 61%, with 23% (n = 24) being above the threshold. The rate of NH for TAR >61% versus ≤61% was 45.8 versus 25.9% (p = 0.06). Neonates born to individuals with TAR >61% were more likely to require continuous positive airway pressure after delivery and had a higher cord c-peptide level. In this prospective study of laboring individuals with diabetes, intrapartum CGM TAR was associated with a higher rate of NH. · CGM use in labor is feasible with a complete glucose profile in the various stages of labor.. · Best cut-off for predicting NH was a time above range (≥110 mg/dl) of >61%.. · CGM and FS were poor predictors of NH..

Prediction of metabolic subphenotypes of type 2 diabetes via continuous glucose monitoring and machine learning

AbstractThe classification of type 2 diabetes and prediabetes does not consider heterogeneity in the pathophysiology of glucose dysregulation. Here we show that prediabetes is characterized by metabolic heterogeneity, and that metabolic subphenotypes can be predicted by the shape of the glucose curve measured via a continuous glucose monitor (CGM) during standardized oral glucose-tolerance tests (OGTTs) performed in at-home settings. Gold-standard metabolic tests in 32 individuals with early glucose dysregulation revealed dominant or co-dominant subphenotypes (muscle or hepatic insulin-resistance phenotypes in 34% of the individuals, and β-cell-dysfunction or impaired-incretin-action phenotypes in 40% of them). Machine-learning models trained with glucose time series from OGTTs from the 32 individuals predicted the subphenotypes with areas under the curve (AUCs) of 95% for muscle insulin resistance, 89% for β-cell deficiency and 88% for impaired incretin action. With CGM-generated glucose curves obtained during at-home OGTTs, the models predicted the muscle-insulin-resistance and β-cell-deficiency subphenotypes of 29 individuals with AUCs of 88% and 84%, respectively. At-home identification of metabolic subphenotypes via a CGM may aid the risk stratification of individuals with early glucose dysregulation.

Effect of sorghum flour-containing pasta on postprandial glycemia, appetite and energy intake in healthy individuals.

In vitro studies suggest that incorporating sorghum flour into staple foods including pasta reduces their starch digestibility and hence may suppress postprandial blood glucose levels, appetite and energy intake; however, these effects in humans have yet to be reported. Therefore, this study investigated the effect of red and white sorghum-containing pasta on blood glucose response, appetite and energy intake in humans. In a randomised crossover design, healthy individuals (n = 20) consumed the following three iso-caloric test meals (each providing 50 g available carbohydrates) as breakfast: control pasta (CP) made from100% durum wheat; 30% red sorghum pasta (RSP) and; 30% white sorghum pasta (WSP). Blood glucose and subjective appetite were measured postprandially for 2 and 3 h, respectively. Energy intakes from ad libitum lunch consumed 3 h after breakfast and for the remainder of the day were also measured. Incremental areas under or over the curves (iAUCs/iAOCs) for blood glucose and appetite parameters were calculated. The RSP meal resulted in significantly lower blood glucose response (-0.35 ± 0.09 mmol/l; 95% CI: -0.61 ~ -0.09; P = 0.005) and glucose iAUC over 120 min (-36.11 ± 10.53 mmol/l × min; 95% CI: -67.11 ~ -5.11; P = 0.017) compared to CP meal. Compared to CP meal, the RSP meal resulted in significantly higher satiety iAUC (1219.46 ± 383.26 mm × min; 95% 91.18 ~ 2347.75; P = 0.029), lower hunger iAOC (-1410.47 ± 349.14 mm x min; 95% CI: -2438.30 ~ -382.63; P = 0.004) and lower prospective food intake iAOC (-1645.73 ± 324.14 mm x min; 95% CI: -2599.97 ~ -691.49; P < 0.001). Energy intake at ad libitum lunch was significantly lower after the RSP meal than after the CP meal (-794.17 ± 163.25 kJ; 95% CI: -1274.77 ~ -313.57; P = 0.001). The results indicate that red sorghum addition into pasta provides a product inducing reduced glycemia, favourably changed appetite parameters and decreased subsequent energy intake.

Fresh-Cooked but Not Cold-Stored Millet Exhibited Remarkable Second Meal Effect Independent of Resistant Starch: A Randomized Crossover Trial.

It is well established that cold storage results in increased resistant starch and a reduced glycemic index in carbohydrate food. However, the effects of cold storage on the glycemic response of the second meal of cereals remain unclear. The aim of this study was to compare the postprandial glycemic responses between the paired glutinous and non-glutinous grains, either fresh-cooked or refrigerated, after both the first and second meals. In this randomized crossover trial, eighteen healthy female participants consumed eight test meals, each containing 50 g of carbohydrate, including fresh-cooked non-glutinous and glutinous rice, non-glutinous and glutinous millet, and their refrigerated counterparts (4 °C for 24 h). Postprandial blood glucose and insulin were measured at 240 min and 120 min after breakfast. After a standard lunch, the participants' blood glucose concentrations were measured within 180 min. The rapidly digestible starch (RDS), slowly digestible starch (SDS), and resistant starch (RS) contents of the samples were determined by in vitro enzymatic analysis. Cold-stored non-glutinous rice (CR) and cold-stored non-glutinous millet (CM) had a 24.4% and 29.5% lower incremental area under the curve (iAUCglu) of glucose within 240 min compared to the control (fresh-cooked rice non-glutinous, FR), respectively (p < 0.05). There were no significant differences between either the cold or hot glutinous grains and FR with respect to postprandial glycemic and insulinemic parameters. After a standard lunch, the fresh-cooked non-glutinous millet (FM) achieved a 39.1% lower iAUCglu0-180 compared to the FR (p < 0.05). FM had the highest percentage of SDS (64.8%, p < 0.05) among all grain samples. Refrigeration treatment reduced the glycemic excursion only in non-glutinous grains at the first meal, but the FM instead of CM demonstrated a significant second meal effect.

The Influence of X Chromosome Parent-of-Origin on Glycemia in Individuals with Turner Syndrome

Introduction: The cause of increased diabetes mellitus (DM) risk in individuals with Turner syndrome (TS) is poorly understood. Parent-of-origin effects related to whether the maternal or paternal X chromosome (Xchr) remains intact have been found for several TS phenotypes, including hypercholesterolemia. Therefore, Xchr parent-of-origin may impact DM risk in TS. The aim of this study was to determine whether Xchr parent-of-origin affects glycaemia, as measured by oral glucose tolerance test (OGTT), in TS. Methods: A total of 81 individuals with 45,X karyotype from the TS: Genotype Phenotype study had Xchr parent-of-origin assessment and completed a 3-h OGTT. Parallel-slopes multiple linear regression modeling was used to test whether Xchr parent-of-origin, age, and/or body mass index (BMI) significantly predicted incremental area under the glucose curve (iAUC). A second analysis included 62 additional individuals with 45,X mosaicism. Results: All three factors predicted iAUC glucose in the 81 individuals with 45,X karyotype (age: β = 0.36, p = 0.0004; BMI: β = 0.33, p = 0.001; Xchr parent-of-origin: β = 0.21; p = 0.01). The overall model remained statistically significant when including individuals with 45,X mosaicism, but Xchr parent-of-origin was no longer significant. Conclusions: Maternal Xchr monosomy predicts higher glucose concentration than paternal Xchr monosomy in response to oral glucose in 45,X individuals. This effect is obscured when including individuals who are mosaic, potentially due to the presence of both parent Xchrs in the non-45,X cell line.

Differently Processed Low Doses of β-Glucan from Oat Bran Similarly Attenuate Postprandial Glycemic Response.

Incorporating β-glucan-rich oat bran (OB) can attenuate postprandial glycemic response (PPGR) in solid foods, but its effect in liquid matrices is unclear. This study investigated the ability of differently processed low-dose-β-glucan-containing beverages to lower PPGR, and the mechanisms of action. Twenty participants consumed five malt beverages made from cocoa powder: intact OB (Intact), OB treated with enzymatic hydrolysis (EnzymA, EnzymB) or extrusion (Extr), or no OB (Ctrl). Four-hour postprandial incremental areas under the curve (iAUC) and peak incremental concentrations (iCmax) of glucose, insulin, glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP), and paracetamol were evaluated. The molecular weight (MW) and extractability of the β-glucan in all the test products were also assessed. The three-hour glucose iAUC significantly decreased by -26%, -28%, -32%, and -38% in Intact, EnzymA, EnzymB, and Extr, respectively, and the insulin levels of the oat-containing products were also significantly lower compared to Ctrl. Intact and Extr elicited a lower insulin iCmax and GLP-1 3 h iAUC compared to Ctrl. However, the GIP and paracetamol levels were not changed. All the processed OBs improved β-glucan extractability and lowered the MW of β-glucan compared to Intact. In conclusion, low-dose oat β-glucan in a beverage significantly reduced PPGR, with effects maintained across different oat processing methods.

Bioactivity-Based Analysis and Chemical Characterization of Hypoglycemic Components from Helicteres angustifolia L.

Helicteres angustifolia L. (H. angustifolia), a well-known traditional Chinese medicine, has been demonstrated to have hypoglycemic activity. We found that the EtOAc extract of H. angustifolia (HAEF) showed stronger α-glucosidase inhibitory activity than that of positive control. Furthermore, the hypoglycemic activity of HAEF was evaluated in streptozotocin (STZ)-induced type 2 diabetes mellitus (T2DM) rats. The results demonstrated that HAEF reduced the drinking quantity, feeding quantity, and controlled weight loss in diabetic rats. Besides, the fasting blood glucose (FBG), viscera index, and the area under time-blood glucose curve (AUC) were significantly decreased, and the oral glucose tolerance was also improved after 5 weeks. Then, the high-performance liquid chromatography with quadrupole time of flight tandem mass spectrometry (HPLC-Q-TOF-MS/MS) method was performed for qualitative analysis of the chemical constituents in HAEF. Twenty-one compounds were identified from in HAEF. Four compounds were further isolated from HAEF and subjected to α-glucosidase inhibition experiments. At the end, molecular docking was empolyed simulate the interaction of three compounds with α-glucosidase. This is the first report on major hypoglycaemic components has been identified in the roots of H. angustifolia. These findings provide a material basis for the use of H. angustifolia in the treatment of diabetes.

8488 Sex-Specific Differences in an Alstrom Syndrome Mouse Model

Abstract Disclosure: Y. Carcamo-Bahena: None. J. Youn: None. E. Lartigue: None. S. Sisley: None. Background: Alström syndrome is a monogenic autosomal recessive disorder caused by loss of the ALMS1 gene that affects 1 in 1 million. Loss of a functional ALMS1 protein leads to global disorganization of microtubules. Patients are affected by progressive vision and hearing loss and are at risk of developing obesity and type 2 diabetes. Aside from reproductive system anomalies, no clinical reports have identified sex-specific difference in patients with Alström syndrome. Methods: Male and female Alms1tvrm[1]02/tvrm[1]02 (null), Alms1tvrm[1]02/+ (heterozygous) and wildtype littermate mice were weaned onto standard chow diet. At 16 weeks of age, they were changed to a 45% high fat diet (HFD). Weekly body weights were collected and intraperitoneal glucose tolerance tests (GTTs, 1.5 g/kg D20W) were performed at three different time points (11, 16, 25 weeks of age). Results:Alms1 null mice were heavier than wildtype and heterozygous mice on standard chow diet. In males, significant changes in weight gain in null mice occurred by 10 weeks compared to wildtype and heterozygous mice (p&amp;lt;0.05). In females, compared to null, this change was observed by 13 weeks (p&amp;lt;0.05). Although female mice are typically protected from diet-induced obesity, the null females weighed the same as the null males (65.0 ± 2.0 vs 67.7 ± 2.8 g) after 9 weeks on HFD. We observed sex and diet specific differences in GTT outcomes. On chow diet, Alms1 deficiency did not affect glucose levels during a GTT in female mice. However, after 9 weeks of HFD (25 weeks of age), baseline fasting glucose levels were higher in the null females compared to wildtype (p&amp;lt;0.05) and heterozygotes (p&amp;lt;0.01). Additionally, the GTT curve was monophasic, indicating onset of diabetes whereas wildtype and heterozygotes (p&amp;lt;0.0001) had normal curves. Null male mice showed an impaired glucose response at 11 weeks of age on chow diet compared to wildtype and heterozygous males (p&amp;lt;0.001) and by 16 weeks, the GTT glucose curve for Alms1 null mice was monophasic. After 9 weeks of HFD, no differences were observed in glucose levels during a GTT. Conclusions: We observed sex-specific differences in this Alms1 null mouse model related to body weight and glucose tolerance with male null mice exhibiting earlier obesity and impaired glucose tolerance and female mice showing more pronounced effects on a HFD. Future research should investigate if these sex-specific effects alter responses to dietary or pharmaceutical interventions. Presentation: 6/1/2024

Metabolic profile and glycemic response in fully-grown sows born using assisted reproductive technologies

The aim of the present work was to gain insight into the metabolism of pigs derived from assisted reproductive technologies during their adulthood. Approximately 4h after feeding, a blood sample was taken from 3.5 year old sows born by artificial insemination (AI group, n = 7) and transfer of in vitro produced embryos (IVP group, n = 11) to determine the physiological concentrations of the main biomarkers of carbohydrates (glucose and lactate), proteins (albumin, creatinine and urea) and lipids (cholesterol and triglycerides). Four weeks later, an oral glucose tolerance test (OGTT; 1.75g glucose/kg body weight) was performed after an overnight fast and 1h of water withdrawal. Blood samples were obtained prior (T = 0 min; fasting conditions) and 15, 30, 45, 60, 90, 120, 150, 180, 210 and 240 min after glucose intake. At each time point, glycemia was measured immediately using glucometer test strips, and serum was collected to determine the above metabolites along with insulin and glucagon. After OGTT, the area under the curve (AUC) between sampling times and homeostasis model assessment of insulin resistance (HOMA) indices were calculated. Under physiological conditions, the concentration of metabolites studied was similar between AI and IVP sows. In both groups, fasting decreased cholesterol and increased triglycerides and urea (P < 0.001). However, creatinine and lactate were similar in both groups under physiological and fasting conditions. The expected increase in albuminemia and decrease in glycaemia after fasting was only observed in IVP sows. OGTT revealed a different glucose curve pattern (monophasic in AI and biphasic in IVP group), a lower mean concentration of cholesterol, glucose, lactate, triglycerides in IVP compared to AI pigs (P < 0.01), and a higher mean concentration of albumin, creatinine and insulin in IVP compared to AI group (P < 0.05). On the contrary, no differences were found between groups for mean serum glucagon and urea levels, nor for glucose homeostasis indices HOMA-IR and HOMA-%B. The AUC differed between groups at several time points with larger AUC for creatinine, and smaller AUC for glucose, glucagon, and triglycerides, in IVP pigs than in AI pigs at 180–210 min (P < 0.05). In conclusion, under physiological conditions the metabolic profile of fully-grown AI and IVP sows is similar and within normal ranges. Glucose challenge revealed differences in metabolic and insulin responses between groups but with normal glucose tolerance in both cases.

Optical Interaction of CdTe/ZnS Quantum Dots with Sodium Alginate Biopolymer PAA-Modified for Glucose Detection

In this paper, a novel and efficient method for glucose detection is designed and synthesized using a biopolymer-based nanocomposite covering zinc sulfide-coated cadmium telluride quantum dots. The obtained quantum dot is modified with polyacrylic acid (PAA) polymer attached to sodium alginate so that it can be used as a biosensor based on nanotechnology to detect glucose with a new method while taking advantage of the characteristics of fluorescent cadmium telluride-sulfide. The used method has advantages such as a safe preparation method and the use of cheap materials. The Fluorescence quenching method is used to systematically investigate the effect of quantum dots of cadmium telluride-zinc sulfide modified with biopolymer on glucose. One of the important advantages is the possibility of evaluating several parameters at the same time according to the multiple wavelengths of radiation of quantum dots of the sensor. The resulted experiments shows that quantum dots prepared from acrylic acid monomer with a concentration of 50 microliters and measured at temperatures lower than 25 °C at which the sensitivity is measured as 6.36 μg ml−1 at the lowest detection range whose characteristics can be evident from the glucose and absorption curve studies.

Breakfast skipping suppresses the vascular endothelial function of the brachial artery after lunch.

Breakfast skipping has been suggested to be associated with cardiovascular diseases. However, whether breakfast skipping affects vascular endothelial function (VEF), a marker of cardiovascular diseases, remains unclear. This study aimed to investigate the impact of breakfast consumption (Eating trial) and skipping (Skipping trial) on brachial artery (BA) VEF in healthy breakfast eaters. A total of nine healthy individuals (4 females and 5 males) either had breakfast between 830 and 900 or skipped it and had lunch between 1200 and 1230, followed by a 3-h rest period until 1530. For BA VEF evaluation, flow-mediated dilation (FMD) was measured by ultrasound before and after breakfast and lunch. FMD was calculated as the percent change in BA diameter normalized to the shear rate area under the curve (FMD/SRAUC). Blood glucose, plasma insulin, and plasma free fatty acid levels in capillaries were measured before and after breakfast and lunch. At 1530, the Eating trial, but not the Skipping trial, significantly increased FMD/SRAUC from baseline (P = 0.006). The Skipping trial showed significantly lower changes in FMD/SRAUC from 830 than the Eating trial at 1530 (P < 0.001). We found a significant inverse correlation between changes in FMD/SRAUC between 830 and 1530 and peak glucose levels after lunch (r = -0.882, P < 0.001) and with an incremental area under the curve for glucose between 830 and 1530 (r = -0.668, P < 0.001). These results suggest that a single bout of breakfast skipping can suppress BA VEF in the afternoon because of postlunch hyperglycemia.NEW & NOTEWORTHY Skipping breakfast does not affect vascular endothelial function (VEF) before lunch. However, after lunch on normal meals (i.e., not oral glucose tolerance test), VEF was found to be lower in those who skipped breakfast than those who ate breakfast. Such reduced postlunch VEF after skipping breakfast was associated with postprandial hyperglycemia. These results provide important insight into the impact of eating breakfast on VEF and glycemic control in healthy adults.

The effect of post-oral bitter compound interventions on the postprandial glycemia response: A systematic review and meta-analysis of randomised controlled trials

Background & AimsThe post-oral sensing of bitter compounds by a family of bitter taste receptors (TAS2Rs) is suggested to regulate postprandial glycemia in humans. However, reports are inconsistent. This systematic review used meta-analysis to synthesise the impact of bitter compound interventions on the postprandial glycaemic response in humans. MethodsElectronic databases (Medline, PubMed, and Web of Science) were systematically searched from inception to April 2024 to identify randomised controlled trials reporting the effect of interventions utilising post-oral bitter compounds vs. placebo on postprandial plasma glucose levels at t=2h (2h-PPG), and area under the curve (AUC) of glucose, insulin, and c-peptide. The random-effect and subgroup analysis were performed to calculate pooled weighted mean differences (WMD), overall and by predefined criteria. ResultsForty-six studies (within 34 articles) were identified; 29 and 17 studies described chronic and acute interventions, respectively. The chronic interventions reduced 2h-PPG (n= 21, WMD= -0.35 mmol/L, 95%CIs= -0.58, -0.11) but not AUC for glucose or insulin. Subgroup analysis showed the former was particularly evident in individuals with impaired glycemia, interventions longer than three months, or quinine family administration. The acute interventions did not improve the postprandial glycemia response, but subgroup analysis revealed a decrease in AUC-glucose after quinine family administration (n=4 WMD= -90.40 (nmol × time/L), 95%CIs= -132.70, -48.10). ConclusionChronic bitter compound interventions, particularly those from the quinine family, may have therapeutic potential in those with glycemia dysregulation. Acute intervention of the quinine family may also improve postprandial glucose. Given the very low quality of the evidence, further investigations with more rigorous methods are still required.

The influence of lactation on insulin and glucose metabolism, lipid profile, and cytokines in pregnant mares

Glucose metabolism adapts to gestation, resulting in progressive physiological insulin resistance and increased insulin secretion to maintain maternal euglycemia and glucose availability for the developing fetus. These changes can impact mare fertility and maternal and neonatal health. This is the first comparison of body condition, regional adiposity, insulin and glucose dynamics, lipid metabolism, and cytokine production between lactating and non-lactating mares before, during pregnancy, and early postpartum. Twelve pregnancies from 9 broodmares, five nonlactating (NL) and seven lactating (L), were used. Evaluations were performed on the day of ovulation, at 55, 110, 165, 220, 275, and 330 days of gestation (D55, D110, D165, D220, D275, D330) and 21 days postpartum (21pp). Mares in the L group had lower basal insulin and glucose at the beginning of pregnancy, smaller area under the curve of insulin and glucose, and greater insulin sensitivity and glucose tolerance. Resistin was higher in D110 and D165 than in D0, D275, 330 and 21pp, while leptin was higher in D55, and in D110, at D110 it was equal to D0, D220, and D275, but higher than at D330 and D21pp. As for the groups, L presented lower body condition score (BCS), crest neck score (CNS), rump fat thickness (RUM), basal insulin, glucose area under the curve (AUCg), MIRG and higher RISQI, adiponectin and tumor necrosis factor (TNFα). There was no effect over time in non-esterified fatty acids (NEFA) concentrations between the L mares; in the NL, D275 presented higher concentrations than those of D0, D55, and D110, which in turn were equal to the other time points; there were higher concentrations in NL mares than L in samples D165 and D275. In conclusion, a different metabolic profile during pregnancy was detected, and NL mares were closer to the metabolic threshold for the occurrence of metabolic syndrome during pregnancy. Understanding the impacts of these differences on mare's health and their offspring's future is fundamental as most of our recipient mares for embryo transfer are non-lactating. Therefore, we suggest that further studies be performed to evaluate lactation's influence on mares' metabolic parameters.

Predicting Type 2 Diabetes Metabolic Phenotypes Using Continuous Glucose Monitoring and a Machine Learning Framework.

The study challenges the conventional classification of type 2 diabetes (T2D) and prediabetes based solely on glycemic levels. Instead, the results highlight the heterogeneity of underlying physiological processes that represent separate pathways to hyperglycemia. Individuals with normoglycemia and prediabetes can be classified according to the relative contribution of four distinct metabolic subphenotypes: insulin resistance, muscle and hepatic, β-cell dysfunction, and incretin defect, which comprise a single dominant or codominant physiologic process in all but 9% of individuals.Use of multiple time points during OGTT generates time-series data to better define the shape of the glucose curve: the application of a novel machine learning framework utilizing features derived from dynamic patterns in glucose time-series data demonstrates high predictive accuracy for identifying metabolic subphenotypes as measured by gold-standard tests in the clinical research unit. This method predicts insulin resistance, β-cell deficiency, and incretin defect better than currently-used estimates, with auROCs of 95%, 89%, and 88%, respectively.The muscle insulin resistance and β-cell deficiency prediction models above were validated with an independent cohort and then tested using glucose data series derived from OGTT performed at home with a continuous glucose monitor (auROC of at-home prediction of insulin resistance and β-cell deficiency is 88% and 84%, respectively). This approach offers a practical and scalable method for metabolic subphenotyping and risk stratification in individuals with normoglycemia or prediabetes, with potential to inform targeted treatments to prevent progression to T2D.

Effects of postprandial exercise timing on blood glucose and fluctuations in patients with type 2 diabetes mellitus.

The aim of this study was to assess how moderate-intensity aerobic exercise performed 45 minutes and 90 minutes after a meal affects blood glucose levels and fluctuations in individuals diagnosed with type 2 diabetes mellitus (T2DM). Twenty-two patients with T2DM, who were solely receiving oral hypoglycemic medication, were enrolled and divided randomly into two categories: those exercising 45 minutes after a meal (45-minute postprandial exercise group) and those exercising 90 minutes post-meal (90-minute postprandial exercise group). Both groups engaged in a 30-minute session of moderate-intensity aerobic stationary bike exercise following breakfast. This aerobic exercise regimen consisted of two stages, with the groups switching exercise timings after the initial phase. Continuous glucose monitoring (CGM) was utilized to evaluate the blood glucose levels and fluctuations in the participants. After breakfast, both overall daily blood glucose levels and the area under the curve for blood glucose following breakfast were reduced in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. The 45-minute postprandial exercise group demonstrated greater time spent within the target glucose range and less time above the target range than the 90-minute postprandial exercise group. Additionally, measures such as standard deviation, mean amplitude of glycemic excursions, largest amplitude of glycemic excursions, and postprandial glucose excursion for breakfast, peak postprandial glucose levels, and duration of elevated glucose levels were all lower in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. Moderate-intensity aerobic exercise lasting 45 minutes after meals was found to be more efficient in decreasing blood glucose levels and minimizing fluctuations compared to exercising 90 minutes after meals in patients with T2DM. Additionally, it notably reduced the peak in blood glucose levels after meals.

Liver fat accumulation is associated with increased insulin secretion independent of total, visceral, and pancreatic fat.

Studies in heterogenous groups of people with respect to sex, body mass index (BMI), and glycemic status (normoglycemia, impaired glucose tolerance, diabetes), indicate no relationship between liver fat accumulation and pancreatic insulin secretion. To better understand the association of liver fat with insulin secretion. Cross-sectional analysis of 61 men with abdominal obesity who had high liver fat (HLF, ≥5.6% by magnetic resonance spectroscopy, n=28) or low liver fat (LLF, n=33), but were balanced on BMI, total body fat, visceral adipose tissue (VAT), and pancreatic fat. A frequently sampled 5-hour oral glucose tolerance test with 11 samples, in conjunction with mathematical modeling, was used to compute indices of insulin sensitivity and insulin secretion (oral minimal model). Compared to subjects with LLF, those with HLF had significantly greater fasting glucose, insulin, C-peptide, and triglyceride; lower high-density lipoprotein-cholesterol; but similar glycated hemoglobin. Areas under the 5-hour curve for glucose, insulin, and C-peptide were greater in the HLF group than the LLF group (by ∼10%, ∼38%, and ∼28%, respectively); fasting and total postprandial insulin secretion rates were ∼37% and ∼50% greater, respectively (all P<0.05); whereas the insulinogenic index was not different. HLF subjects had lower whole-body and hepatic insulin sensitivity, disposition index, and total insulin clearance than LLF subjects (all P<0.05). Accumulation of liver fat is associated with increased insulin secretion independently of total adiposity, abdominal fat distribution, and pancreatic fat. Thereby, hyperinsulinemia in fatty liver disease is partly because of insulin hypersecretion and partly because of impaired insulin clearance.

Postprandial Blood Glucose and Insulin Response in Healthy Adults When Lentils Replace High-Glycemic Index Food Ingredients in Muffins, Chilies and Soups.

This study aimed to assess postprandial blood glucose response (PBGR), relative glycemic response (RGR) and insulin response when 25 g available carbohydrates (AC) is replaced with cooked lentils in the formulation of muffins, chilies and soups. In randomized, crossover studies, healthy adults consumed foods containing 25 g AC from green lentils, red lentils or a control (wheat muffin, n = 24; rice chili, n = 24; potato soup, n = 20). Blood collected at fasting and at 15, 30, 45, 60, 90 and 120 min was analyzed to derive the incremental area under the response curve (iAUC) for glucose, insulin, RGR and maximum concentration (CMAX). Treatment effects were assessed with repeated measures ANOVA. A replacement of 25 g AC with green lentils significantly decreased glucose iAUC compared to chili and soup (p < 0.0001), but not muffin (p = 0.07) controls, while also eliciting a significantly lower insulin iAUC for all three foods (muffin p = 0.03; chili p = 0.0002; soup p < 0.0001). Red lentil foods significantly decreased glucose iAUC (muffin p = 0.02; chili p < 0.0001; soup p < 0.0001) compared to controls, with a significantly lower insulin iAUC for chili and soup (p < 0.0001) but not muffins (p = 0.09). The RGR for muffins, chilies and soups was 88, 58 and 61%, respectively, for green lentils, and 84, 48 and 49%, respectively, for red lentils. PBGR, insulin and RGR are decreased when lentils are incorporated into food products, providing credible evidence to promote carbohydrate replacement with lentil-based foods.

Personalized insulin dosing using reinforcement learning for high-fat meals and aerobic exercises in type 1 diabetes: a proof-of-concept trial

In type 1 diabetes, high-fat meals require more insulin to prevent hyperglycemia while meals followed by aerobic exercises require less insulin to prevent hypoglycemia, but the adjustments needed vary between individuals. We propose a decision support system with reinforcement learning to personalize insulin doses for high-fat meals and postprandial aerobic exercises. We test this system in a single-arm 16-week study in 15 adults on multiple daily injections therapy (NCT05041621). The primary objective of this study is to assess the feasibility of the novel learning algorithm. This study looks at glucose outcomes and patient reported outcomes. The postprandial incremental area under the glucose curve is improved from the baseline to the evaluation period for high-fat meals (378 ± 222 vs 38 ± 223 mmol/L/min, p = 0.03) and meals followed by exercises (−395 ± 192 vs 132 ± 181 mmol/L/min, p = 0.007). The postprandial time spent below 3.9 mmol/L is reduced after high-fat meals (5.3 ± 1.6 vs 1.8 ± 1.5%, p = 0.003) and meals followed by exercises (5.3 ± 1.2 vs 1.4 ± 1.1%, p = 0.003). Our study shows the feasibility of automatically personalizing insulin doses for high-fat meals and postprandial exercises. Randomized controlled trials are warranted.

Oligomalt, a New Slowly Digestible Carbohydrate, Reduces Post-Prandial Glucose and Insulin Trajectories Compared to Maltodextrin across Different Population Characteristics: Double-Blind Randomized Controlled Trials in Healthy Individuals, People with Obesity, and People with Type 2 Diabetes.

We assessed the glucometabolic effects of oligomalt, a novel fully slowly digestible carbohydrate, compared with maltodextrin, in cross-over randomized controlled trials (NCT05058144; NCT05963594) involving healthy volunteers (HV), people with overweight or obesity (PwO), and people with type 2 diabetes (T2D). We tested 33 g and/or 50 g of oligomalt/maltodextrin, which were dissolved in 300 mL of water and consumed after fasting in the morning. The primary exploratory endpoint was the incremental area under the curve (iAUC) for postprandial glucose, assessed by frequent blood sampling over 3 h. Insulin levels were also assessed. In the HV cohort, a 4 h hydrogen breath test was performed with 15 g of inulin as a positive control. Analysis was performed by a mixed model. Oligomalt elicited a lower post-prandial glucose response compared to maltodextrin in HV (50 g, n = 15 [7 women], mean age/BMI 31 years/22.6 kg/m2), in PwO (33 g and 50 g, n = 26 [10 women], age/BMI 44 years/29.9 kg/m2, mean HbA1c 5.3%), and in people with T2D (50 g, n = 22 [13 women], age/BMI 61 years/31.8 kg/m2, HbA1c 7.4%), with significant reductions observed in PwO and T2D for the 0-1 h window (HV: -19% [p = 0.149]/PwO33g-38% [p = 0.0002]/PwO50g-28% [p = 0.0027]/T2D-38% [p < 0.0001]; the 0-2 h window (HV: -17% [p = 0.311]/PwO33g-34% [p = 0.0057]/PwO50g-21% [p = 0.0415]/T2D-37% [p < 0.0001]), and the 0-3 h window (HV: -15% [p = 0.386]/PwO33g-30% [p = 0.0213]/PwO50g0-19% [p = 0.0686]/T2D-37% [p = 0.0001]). The post-prandial insulin response was significantly lower, by 38-60%, across all populations, dose, and time points, with oligomalt. In HV, the breath-hydrogen pattern was comparable between oligomalt and maltodextrin, but increased significantly with inulin. These data support the glucometabolic advantages of oligomalt over maltodextrin, hence confirming it as a healthier carbohydrate, and underscoring its full digestibility. This therefore opens up the possibility for the incorporation of oligomalt in relevant food products/matrices.

Effects of Methanolic Leaf-extract of Costus pictus D. Don on Swiss Albino Mice with Hyperglycemia Associated Renal Complications

Effects of Costus pictus leaf extract (CPLE) in ameliorating the adverse outcomes of hyperglycemia-associated renal injury is investigated in Swiss Albino Mice. To induce renal injury associated with hyperglycemia, adult mice were given intraperitoneal injections of Streptozotocin (STZ) dissolved in 0.5mol citrate buffer for five days. Animals were divided into five groups, namely CMC (vehicle control group, receiving only carboxy methyl cellulose), DC (Disease control group, receiving only STZ and without any treatment), GLD (positive control group, receiving standard drug glibenclamide), LD (experimental group treated with CPLE at 250 mg/kg bw) and HD (experimental group treated with CPLE at 500 mg/kg bw). After a rearing/treatment regimen of 4 weeks, animals were sacrificed to analyze various parameters. Oral glucose tolerance test (OGTT) based area under the curve of plasma glucose (AUCglucose), kidney index, lipid profiling, serum, urine parameters (creatinine, albumin, urea), antioxidant studies and kidney histopathology were carried out. It was found that harmful lipids like cholesterol, triglycerides (TG) and low-density lipoprotein-C (LDL-C) levels were significantly elevated in the DC group, whereas LD, HD and GLD showed a tendency towards normalcy. Urine and serum parameters also showed the same trend in treatments and the GLD group, whereas the DC group showed steep abnormalities. Antioxidant study also reveals that treatment with CPLE, balances antioxidant activity by mitigating the effects of reactive oxygen species (ROS). Histopathological investigations displayed significant disruptions in the microstructure of glomeruli of the DC group compared to both the treatments and GLD groups. These preliminary findings indicate that CPLE shows a trend to ameliorate hyperglycemia-associated renal complications and demands further detailed study.