Index Of Glucose Control Research Articles

The relationship between neonatal hypoglycaemia and cord blood C-peptide levels in neonates of birthing individuals with type 1 diabetes.

Neonates of individuals with type 1 diabetes (T1D) are at increased risk of neonatal hypoglycaemia. It is hypothesised that this is a result of birthing-individual hyperglycaemia and subsequent foetal hyperinsulinemia. To test for association between clinically significant neonatal hypoglycaemia (requiring intravenous glucose treatment) and cord-blood c-peptide (CBCP) concentrations in birthing-individuals with T1D. This is a prospective cohort study of individuals with T1D followed at a single tertiary centre. Clinical variables and glucose control during pregnancy were recorded. Cord-blood was collected and CBCP concentrations determined. The correlation between clinically significant neonatal hypoglycaemia and CBCP concentrations was determined. Fifty-four pregnant individuals and their newborns were included in the study. Individuals to neonates who experienced hypoglycaemia had longer diabetes duration (19 vs. 13years, respectively, p=0.023), higher HbA1c at conception (7.3 [6.3-8.8] vs. 6.5 [6.0-7.0], respectively, p=0.042) and higher rates of caesarian section (73.3% vs. 28.2%, respectively, p=0.005) than individuals to those who did not. CBCP levels were significantly higher in neonates with clinically significant neonatal hypoglycaemia as compared to those who did not experience hypoglycaemia (3.3 mcg/L vs. 1.9 mcg/L, respectively, p=0.002). After adjustment for possible confounders, every 1 unit higher in CBCP level was associated with a 1.46 (1.02-2.09, p=0.035)-fold greater risk for neonatal hypoglycaemia. No significant differences were observed in either birthing individual complications or glucose control indices during pregnancy between the two groups. In neonates of individuals with T1D, higher CBCP levels are an independent risk factor for clinically significant neonatal hypoglycaemia.

Glycemic control is not associated with neurocognitive decline after cardiac surgery.

Whether perioperative glycemic control is associated with neurocognitive decline (NCD) after cardiac surgery was examined. Thirty patients undergoing cardiac surgery utilizing cardiopulmonary bypass (CPB) were screened for NCD preoperatively and on postoperative day 4 (POD4). Indices of glucose control were examined. Serum cytokine levels were measured and human transcriptome analysis was performed on blood samples. Neurocognitive data are presented as a change from baseline to POD4 in a score standardized with respect to age and gender. A decline in neurocognitive function was identified in 73% (22/30) of patients on POD4. There was no difference in neurocognitive function between patients with elevated HbA1c levels preoperatively (p = .973) or elevated fasting blood glucose levels the morning of surgery (>126 mg/dl, p = .910), or a higher maximum blood glucose levels during CPB (>180 mg/dl, p = .252), or higher average glucose levels during CPB (>160 mg/dl, p = .639). Patients with postoperative leukocytosis (WBC ≥ 10.5) had more NCD when compared to their baseline function (p = .03). Patients with elevated IL-8 levels at 6 h postoperatively had a significant decline in NCD at POD4 (p = .04). Human transcriptome analysis demonstrated unique and differential patterns of gene expression in patients depending on the presence of DM and NCD. Perioperative glycemic control does not have an effect on NCD soon after cardiac surgery. The profile of gene expression was altered in patients with NCD with or without diabetes.

EXAMINATION OF THE EFFECT OF LIRAGLUTIDE ON BLOOD PRESSURE AND URINARY SODIUM EXCRETION

Objective: GLP-1 analog is suitable for use in obese diabetic patients as a drug having an effect of improving postprandial blood glucose and suppressing weight loss. Recently, it has been reported that the use of this drug causes hypotension, and its mechanism is to act on the GLP-1 receptor of the proximal tubule to promote sodium excretion and increase NO production of vascular endothelium. However, few clinical reports have examined the antihypertensive effects of GLP-1 analogs. We investigated the effects of liraglutide on blood pressure and urinary sodium excretion. Design and method: The subjects were ten patients with type 2 diabetes who admitted to our department for the adjustment of the antidiabetic treatment regimen (age 66.9 ± 11.7 years, male 40%). Before introduction of liraglutide and before discharge, various tests including blood pressure and blood glucose control index and measurement of urinary sodium excretion. The dose of liraglutide was 0.3 mg/day for the first week, then increased to 0.6 mg/day, up to a maximum of 0.9 mg/day. Results: Both BMI and HbA1c (NGSP) decreased with the administration of liraglutide (BMI from 28.1 ± 3.8 to 27.0 ± 3.7, p < 0.001, HbA1c from 8.7 ± 1.5% to 7.5 ± 1.1%, p < 0.001). Urinary Na excretion increased with administration of liraglutide (frome 135.7 ± 13.71 mEq/day to 155.2 ± 30.7 mEq/day, p < 0.05). Systolic blood pressure tended to decrease in patients with hypertension (from 130.9 ± 15.0 mmHg to 124.0 ± 11.5 mmHg, p = 0.06). Conclusions: Liraglutide, a GLP-1 analog, showed an improvement in glycemic control and a weight loss effect, as well as a decrease in urinary Na excretion. The drug was considered to exhibit antihypertensive effects, particularly in cases of hypertensive complications.

The impact of glucose control index on erectile hardness score among type 2 diabetes mellitus patients

The prevalence of erectile dysfunction (ED) was reported to vary from 37.5 to 52% in men above 40. Type 2 diabetes mellitus (T2DM) maycause the nerves and blood vessels damages that worsened the ED. This study aimed to evaluate the correlation between the glucose control index and the erection hardness score (EHS) among T2DM patients. The cross-sectional observational study was conducted in two district hospitals i.e. Manambai Abdulkadir District Hospital, Sumbawa, and Dompu District Hospital, Dompu, West Nusa Tenggara, Indonesia. Forty-five patients with T2DM were involved in this study. Data were collected using structural questioners during the period from June 1st to August 1st, 2017 and were analyzed using SPSS 24.0. Pearson correlation and logistic regression analysis were used to determine the odds ratio (OR). Among 45 patients having age 57.38± 7.22 years involved in this study, 38 (84.4%) patients had ED, 26 (57.8%) uncontrolled DM, 5 (11.1%) congestive heart failure (CHF), 4 (8.9%) chronic kidney diseases (CKD), and 7 (15.6%) neuropathy diabetic. A strong correlation between random glucose level and IIEF-5 score (r=0.91; p=0.01) was observed. The overall odds ratio of ED in this study was 4.3 (95% CI: 0.73 to 25.1) for uncontrolled DM, 2.5 (95% CI: 0.1 to 51.1) for CHF, 2 (95% CI: 0.01 to 41.6) for CKD, and 1.2 (95% CI: 0.1 to 11.5) for neuropathy diabetics. In conclusion, there is a strong correlation between random glucose level, duration of diagnosed DM and EHS. Active screening is recommended for this population.

The Effect of Palm Oil on Health Outcomes: A Protocol for Systematic Reviews and Meta-analyses of Controlled Clinical Trials

Background: It is suggested that palm oil consumption might increase chronic diseases including cardiovascular disease. Previous studies that investigated the effect of palm oil intake on anthropometric measures, blood glucose control, inflammation, and oxidative stress markers have led to inconsistent results. This is while no systematic review and meta-analysis has been performed to summarize the data in this regard.
 Objectives: The present study describes a protocol for a range of systematic reviews and meta-analyses to examine the effect of palm oil intake on body weight and fat, inflammatory markers, oxidative stress, liver enzymes, blood pressure, and blood glucose control indices.
 Methods: ISI web of science, EMBASE, MEDLINE, Scopus, and Google Scholar will be searched using medical subject heading (MeSH) and non-MeSH keywords. Controlled clinical trials will be selected based on predefined eligibility criteria. The intra-study risk of bias will be checked by using the Cochrane collaboration tool. Mean difference (MD) (the difference between mean change values in the intervention group/period and control group/period) and its corresponding standard deviation will be calculated to be used as effect size. A random-effects meta-analysis will be performed to pool the results. Subgroup analysis and meta-regression will be conducted to explore the possible sources of heterogeneity. Sensitivity analysis will be conducted by removing the studies one-by-one from the overall analyses. Publication bias will be assessed by inspecting funnel plots and asymmetry tests.
 Conclusion: The results of systematic reviews and meta-analyses might provide helpful data about the effects of palm oil consumption on different aspects of health among adults. The evidence provided by the results of systematic reviews can be useful for dietitians, clinicians, public health policy-makers, and the public.

The Effect of Palm Oil on Health Outcomes: A Protocol for Systematic Reviews and Meta-analyses of Controlled Clinical Trials

Background: It is suggested that palm oil consumption might increase chronic diseases including cardiovascular disease. Previous studies that investigated the effect of palm oil intake on anthropometric measures, blood glucose control, inflammation, and oxidative stress markers have led to inconsistent results. This is while no systematic review and meta-analysis has been conducted to summarize the data in this regard.
 Objectives: The present study describes a protocol for a range of systematic reviews and meta-analyses to examine the effect of palm oil intake on body weight and fat, inflammatory markers, oxidative stress, liver enzymes, blood pressure, and blood glucose control indices.
 Methods: ISI web of science, EMBASE, MEDLINE, Scopus, and Google Scholar will be searched using medical subject heading (MeSH) and non-MeSH keywords. Controlled clinical trials will be selected based on predefined eligibility criteria. The intra-study risk of bias will be checked by using the Cochrane collaboration tool. Mean difference (MD) (the difference between mean change values in the intervention group/period and control group/period) and its corresponding standard deviation will be calculated to be used as effect size. A random-effects meta-analysis will be performed to pool the results. Subgroup analysis and meta-regression will be conducted to explore the possible sources of heterogeneity. Sensitivity analysis will be conducted by removing the studies one-by-one from the overall analyses. Publication bias will be assessed by inspecting funnel plots and asymmetry tests.
 Conclusion: The results of systematic reviews and meta-analyses might provide helpful information about the effects of palm oil consumption on different aspects of health among adults. The evidence provided by the results of systematic reviews can be useful for dietitians, clinicians, public health policy-makers, and the public.

The association between novel glucose indices in parturients with type 1 diabetes mellitus and clinically significant neonatal hypoglycemia

The aim of this study was to determine the association between glucose control indices of parturient with type 1 diabetes (T1DM), treated with an insulin pump and utilizing continuous glucose monitoring (CGM), and clinically significant neonatal hypoglycemia. This was a retrospective cohort study which included 37 pregnant women with T1DM. All women were followed at a single tertiary center and had available CGM data. The association between maternal glucose indices before delivery and the risk for neonatal hypoglycemia requiring IV glucose (clinically significant hypoglycemia) was assessed using logistic regression. Mothers to neonates that experienced clinically significant hypoglycemia had a higher glucose standard deviation (SD) before delivery than did mothers to neonates who did not (25.5 ± 13 mg/dL vs. 14.7 ± 6.7 mg/dl respectively; p = .008). This association persisted after adjustment for maternal age, maternal pregestational body mass index (BMI), gestational age at delivery, neonatal birth weight, large for gestational age (LGA) and gender. This study demonstrates an association between high maternal glucose standard deviation before delivery and the risk for clinically significant neonatal hypoglycemia. Larger studies are needed to confirm these results and further explore the role of intrapartum glucose variability in the prediction and prevention of significant neonatal hypoglycemia.

Analysis of risk factors for male type 2 diabetes mellitus patients with erectile dysfunction complicated with depression

Objective To explore the risk factors associated with depression in type 2 diabetes mellitus (T2DM) patients with erectile dysfunction (DMED). Methods A total of 60 male DMED patients in Kangning Hospital Affiliated to Wenzhou Medical University were enrolled.They were divided into group A (DMED with depression, 40 cases) and group B (DMED without depression, 20 cases) according to the results of self-rating depression scale (SDS). The comorbidity rate of DMED and depression was calculated.Baseline index, blood glucose control index, sex hormone index and blood lipid biochemical index were compared between the two groups.Pearson correlation analysis was used to judge the correlation between SDS scale scores and the indicators.Finally, these indicators were substituted into logistic regression analysis to find out the factors that may cause the comorbidity of DMED and depression. Results The age of the patients in group A was older than that in group B[(55.95±6.33)years vs.(44.15±5.08)years, t=7.242, P=0.000], the course of T2DM in group A was longer than that in group B [(10.28±0.94)years vs.(4.38±0.60)years, t=29.467, P=0.000]. The fast plasma glucose (FPG)[(10.24±1.55)mmol/L vs.(8.22±1.15)mmol/L, t=5.153, P=0.000], fasting insulin (FIns) [(21.34±2.58)mU/L vs.(17.35±2.13)mU/L, t=5.967, P=0.000] and glycosylated hemoglobin (HbAlc) [(8.75±1.05)% vs.(6.55±0.84)%, t=8.146, P=0.000] in group A were higher than those in group B. Testosterone (TT) level in group A was lower than that in group B [(1.89±0.24)ng/mL vs.(2.46±0.31)ng/mL, t=-7.855, P=0.000]. The luteinizing hormone (LH) [(12.95±1.14)U/L vs.(8.53±0.70)U/L, t=18.515, P=0.000] and follicle-stimulating hormone (FSH) [(19.55±1.83)U/L vs.(15.40±1.47)U/L, t=8.808, P=0.000] in group A were higher than those in group B. Pearson analysis showed that the SDS scale score was positively correlated with age, T2DM duration, FPG, Fins, HbAlc, LH, FSH (r=0.310, 0.503, 0.465, 0.583, 0.676, 0.355, 0.540, P=0.002, 0.008, 0.017, 0.022, 0.030, 0.026, 0.011), and negatively correlated with TT level (r=-0.713, P=0.028). Logistic regression analysis showed that the age, the course of T2DM and TT were the independent risk factors which caused the comorbidity of DMED and depression. Conclusion In male T2DM patients, the independent risk factors for DMED with depression are age, long duration, and low TT level. Key words: Diabetes mellitus, type 2; Erectile dysfunction; Depression; Depression self-rating scale; Blood glucose; Testosterone; Male

Role of apolipoprotein C-III overproduction in diabetic dyslipidaemia.

To investigate how apolipoprotein C-III (apoC-III) metabolism is altered in subjects with type 2 diabetes, whether the perturbed plasma triglyceride concentrations in this condition are determined primarily by the secretion rate or the removal rate of apoC-III, and whether improvement of glycaemic control using the glucagon-like peptide-1 analogue liraglutide for 16 weeks modifies apoC-III dynamics. Postprandial apoC-III kinetics were assessed after a bolus injection of [5,5,5-2 H3 ]leucine using ultrasensitive mass spectrometry techniques. We compared apoC-III kinetics in two situations: in subjects with type 2 diabetes before and after liraglutide therapy, and in type 2 diabetic subjects with matched body mass index (BMI) non-diabetic subjects. Liver fat content, subcutaneous abdominal and intra-abdominal fat were determined using proton magnetic resonance spectroscopy. Improved glycaemic control by liraglutide therapy for 16 weeks significantly reduced apoC-III secretion rate (561 ± 198 vs. 652 ± 196 mg/d, P = 0.03) and apoC-III levels (10.0 ± 3.8 vs. 11.7 ± 4.3 mg/dL, P = 0.035) in subjects with type 2 diabetes. Change in apoC-III secretion rate was significantly associated with the improvement in indices of glucose control (r = 0.67; P = 0.009) and change in triglyceride area under the curve (r = 0.59; P = 0.025). In line with this, the apoC-III secretion rate was higher in subjects with type 2 diabetes compared with BMI-matched non-diabetic subjects (676 ± 208 vs. 505 ± 174 mg/d, P = 0.042). The results reveal that the secretion rate of apoC-III is associated with elevation of triglyceride-rich lipoproteins in subjects with type 2 diabetes, potentially through the influence of glucose homeostasis on the production of apoC-III.

Effect of BASNEF-based nutrition education on nutritional behaviors among elderly people and Mini Nutritional Assessment on nutritional status in elderly with diabetes with type 2 diabetes (A clinical trial intervention).

INTRODUCTION:The number of elderly people is growing in different communities like Iran, increasingly. Malnutrition prevalence is unknown among elderly patients with diabetes. Malnutrition is a common risk factor in elderly people with diabetes that may affect their health.SUBJECTS AND METHODS:This study is a random clinical trial. There are 200 samples in this study chosen randomly and divided into two intervention and control groups (100 each). Data of both groups were collected in the same way, before and 3 months after the intervention. Educational intervention was based on pretest, baseline BASNEF model, and Mini Nutritional Assessment questionnaire in four sessions.STATISTICAL ANALYSIS USED:Descriptive indices were used to analyze the data while Chi-square, t-test, one-way ANOVA, and correlation tests were used to examine the relationship between variables.RESULTS:The results were significantly different after intervention (P < 0.05), but they were not significantly different in control group after 3 months (P > 0.05). It was clear that 22% of samples had normal nutrition (score >24), 29% of participants were exposed to malnutrition, and 51% of samples were suffering from malnutrition. These numbers were 20% for normal nutrition, 30% for exposing to malnutrition, and 50% for suffering from malnutrition in the control group, respectively. Fifty percent of elderly people with diabetes suffered from malnutrition and almost half of them had normal nutrition that was 20%.CONCLUSIONS:BASNEF-based nutrition education intervention improves nutritional behaviors in addition to knowledge and attitude of elderly people with type 2 diabetes. It led to improve indices of glucose control during 3-month intervention.AIMS:The aim of this study was to investigate the nutritional status of elderly people with diabetes and the effect of educational intervention based on the BASNEF model on promoting nutritional behaviors in the elderly with type 2 diabetes in Babol city, Iran.

409: Novel maternal glycemic indices during labor and the risk of significant neonatal hypoglycemia in T1DM

While it is well accepted that glycemic control during pregnancy is important in order to reduce the risk for maternal and neonatal complications, the optimal management of blood glucose levels during labor and delivery is still a matter of controversy. This is especially true among women with type I diabetes mellitus (T1DM). Thus, the aim of our study was to determine if there is an association between maternal glucose control indices during labor and neonatal hypoglycemia. A historical prospective study pertaining 37 women with T1DM managed during pregnancy and delivery with an insulin pump and continuous glucose monitoring. Data regarding maternal glucose levels during active labor, pregnancy and neonatal outcome were collected. The relationship between maternal glucose control indices during active labor and neonatal hypoglycemia requiring IV glucose treatment was determined. The prevalence of neonatal hypoglycemia requiring IV dextrose was 40.5% (15/37). Maternal glucose variability indices during active labor were higher in mothers of neonates requiring IV dextrose than in mothers of neonates not requiring IV intervention (glucose standard deviation 25.5±13 vs. 14.7±6.7 mg/dL, respectively, p=0.007; maternal glucose IQR 37.3±24.3 vs. 21.6±10.7 mg/dl, respectively, p=0.03). For every 1 unit (1 mg/dl) increase in maternal glucose SD there was a 1.12 (CI 1.03-1.23, p= 0.01) greater odds for neonatal hypoglycemia requiring IV glucose treatment. This relationship persisted after adjustment for maternal age, pregestational BMI, gestational age at delivery, birth weight, and neonatal gender. In addition, maternal maximal glucose values were higher among infants requiring IV glucose (162.8±48.9 vs. 131.3±29.5 mg/dl respectively, p=0.03). Finally, there was a negative correlation between maternal maximum glucose value and neonatal lowest glucose value (p= 0.03, r= -0.34). Nonetheless, the mean and minimum maternal glucose values were not significantly different. To the best of our knowledge this is the first study to determent the association between intrapartum glucose variability indices and neonatal hypoglycemia in parturient with T1DM. There is a relationship between maternal glucose variability and excursions during active labor and risk for neonatal hypoglycemia requiring IV glucose treatment. These results highlight the clinical importance of tight glycemic control during labor in patients with T1DM.

Evolution of Glycemic Control and Variability After Kidney Transplant.

The evolution of glycemic changes after kidney transplantation has not been described. We prospectively examined glycemic control and variability over time from transplantation using continuous glucose monitoring (CGM). Continuous glucose monitoring devices were fitted for 3 to 5 days at time of transplant, month 3, and month 6 posttransplant. Indices of glucose control (mean glucose, percent time in hyperglycemic range, and Glycemic Risk Assessment Diabetes Equation score) and variability were calculated. An oral glucose tolerance test was performed at month 3. Twenty-eight patients (mean age, 45 ± 15 years) were enrolled, 64% male, 75% white, receiving tacrolimus, mycophenolate, and prednisolone (93%). Of 24 patients with complete CGM data at month 0, 3 had prior diabetes and 6 (25%) developed new-onset diabetes after transplant (NODAT). Hyperglycemia (>11.1 mM) was evident in 79% during days 0 to 3 posttransplant, particularly between 1 and 9 PM. Compared with recipients without diabetes, recipients with prior diabetes had higher mean glucose (7.8 mM; 95% confidence interval [CI], 7.4-8.2 vs 9.9 mM; 95% CI, 8.9-10.8; P < 0.001), Glycemic Risk Assessment Diabetes Equation (GRADE) score (4.5; 95% CI, 3.7-5.4 vs 7.8; 95% CI, 5.6-10.4; P = 0.003) and percent time with hyperglycemia. Glycemic control was also inferior in those that subsequently developed NODAT (mean glucose, 8.8 mM; 95% CI, 8.2-9.4; P = 0.004, GRADE: 6.2, 95% CI, 5.2-7.7; P = 0.04 vs no diabetes). Glucose variability was increased in patients with prior diabetes (glucose standard deviation, 1.99; 95% CI, 1.72-2.27 vs 2.97; 95% CI, 2.27-3.67; P = 0.006) but not in NODAT. All measures of glucose control and variability significantly improved over time after transplantation (P < 0.001). Dysglycemia is very common after renal transplantation, exhibiting a distinct diurnal pattern of afternoon and evening hyperglycemia. The magnitude of hyperglycemia and variability are maximal in recipients with preexisting diabetes and significant in those who go on to develop NODAT. Dysglycemia improves with time.

Effect of diabetes base education combined with peer education on type 2 diabetes

Objective To observe the effect of diabetes base education combined with peer education on blood glucose control, metabolic index and self management level in type 2 diabetes patients. Methods 150 patients with type 2 diabetes were randomly divided into 3 groups. Group A received diabetes base education, Group B received peer education group, and group C received peer education joint base education group. Before treatment and 6 months after treatment, fasting blood glucose (FPG), postprandial blood glucose (2 h PG), glycosylated hemoglobin (HbA1c), triglyceride(TG), cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), systolic blood pressure, diastolic blood pressure change, body mass index (BMI) were observed, so as to evalute the diabetes self-management behavior at the same time before and after treatment. Results After 6 months of intervention, FPG, 2 h PG, HbA1c, TG, TC, LDL-C, HDL-C, blood pressure, body weight and other metabolic indicators in the three groups were significantly improved (P 0.05). In group C, the blood glucose control index (FPG, 2 h PG, HbA1c) and the improvement of blood lipid were obviously superior to those in the group A and B (P<0.05). Conclusions The combination of base education and peer education can improve blood glucose control and blood lipid level in patients with type 2 diabetes, and can also promote self-management behavior in patients with type 2 diabetes. Key words: Diabetes mellitus, type 2; Health education

Effects of Pomegranate Juice on Cardiovascular Risk Factors in Patients with Metabolic Syndrome: a Double-Blinded, Randomized Crossover Controlled Trial.

The aim of this study is to investigate the simultaneous effect of pomegranate juice on components of the metabolic syndrome, including high sensitive C-reactive protein (hs-CRP) as an inflammatory index and glycemic and lipid profile indices in patients with metabolic syndrome. In a double- blind 2*2 crossover study, 30 individuals suffering from metabolic syndrome received a daily dose of 500 mL pomegranate juice for a period of one week. After one week of wash out period, they received a placebo for one week. Lipid profile, blood glucose control indices including fasting blood glucose, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), systolic and diastolic blood pressure, and hs-CRP were measured at the beginning and end of the study. To analyze the data, a repeated measure analysis of variance and a t-test were performed. The results indicated that in comparison to the placebo, pomegranate juice was more effective in reducing the systolic and diastolic blood pressure (p=0.00) and hs-CRP (p=0.018). The level of triglyceride (p=0.030) and very low-density lipoproteins cholesterol (VLDL-C) (p=0.014) were increased after the consumption of pomegranate juice, as opposed to the baseline condition. The rest of lipid profile, fasting blood glucose (FBS), insulin, and HOMA-IR of the participants did not show any significant difference. Natural pomegranate juice supplementation lowered the level of systolic and diastolic blood pressure in patients with metabolic syndrome as well as their blood hs-CRP. However, it also increased their triglyceride and VLDL-C.

Glycemic Control Indices and Their Aggregation in the Prediction of Nocturnal Hypoglycemia From Intermittent Blood Glucose Measurements.

Despite the risk associated with nocturnal hypoglycemia (NH) there are only a few methods aiming at the prediction of such events based on intermittent blood glucose monitoring data. One of the first methods that potentially can be used for NH prediction is based on the low blood glucose index (LBGI) and suggested, for example, in Accu-Chek® Connect as a hypoglycemia risk indicator. On the other hand, nowadays there are other glucose control indices (GCI), which could be used for NH prediction in the same spirit as LBGI. In the present study we propose a general approach of combining NH predictors constructed from different GCI. The approach is based on a recently developed strategy for aggregating ranking algorithms in machine learning. NH predictors have been calibrated and tested on data extracted from clinical trials, performed in EU FP7-funded project DIAdvisor. Then, to show a portability of the method we have tested it on another dataset that was received from EU Horizon 2020-funded project AMMODIT. We exemplify the proposed approach by aggregating NH predictors that have been constructed based on 4 GCI associated with hypoglycemia. Even though these predictors have been preliminary optimized to exhibit better performance on the considered dataset, our aggregation approach allows a further performance improvement. On the dataset, where a portability of the proposed approach has been demonstrated, the aggregating predictor has exhibited the following performance: sensitivity 77%, specificity 83.4%, positive predictive value 80.2%, negative predictive value 80.6%, which is higher than conventionally considered as acceptable. The proposed approach shows potential to be used in telemedicine systems for NH prediction.

Controlling type 2 diabetes mellitus with herbal medicines: A triple-blind randomized clinical trial of efficacy and safety.

The use of alternative medicines is common in patients with diabetes mellitus. The primary aim of the present study was to determine the effects of cinnamon and Caucasian whortleberry (Vaccinium arctostaphylos L.) on blood glucose control, lipid profile and body mass index (BMI) in patients with type 2 diabetes (T2DM). In all, 105 T2DM patients were recruited to the present randomized triple-blinded clinical trial. Patients were randomly divided into three groups and administered either placebo, cinnamon or whortleberry supplements (1 g/day) for 90 days. Fasting blood glucose (FBG), serum insulin, lipid profiles, and HbA1c were measured before and after the study. There were no significant differences in baseline characteristics among the three groups. After treatment, FBG, 2-h blood postprandial glucose and homeostasis model assessment of insulin resistance (HOMA-IR) scores were significantly reduced in patients in the whortleberry group, but not in the placebo group. After treatment, there was a significant difference in BMI between the cinnamon and control groups (P = 0.02). There were no significant differences in any variables between the cinnamon and whortleberry groups (P>0.05 for all). In addition, there was a significant decrease in all indices of glucose control in all the cinnamon and whortleberry groups (P < 0.05). There were no significant differences in blood glucose levels, insulin sensitivity or lipid profile among the three groups. However, the use of cinnamon and whortleberry in addition to conventional medical treatment is recommended to adjust weight and blood glucose levels in patients with T2DM, respectively.

A mixed diet supplemented with L-arabinose does not alter glycaemic or insulinaemic responses in healthy human subjects.

In addition to a yet-to-be published study showing arabinose to have an inhibiting effect on maltase, in vitro studies have shown L-arabinose to exert an inhibiting effect on small-intestinal sucrase and maltase and the consumption of a sucrose-rich drink containing L-arabinose to exert positive effects on postprandial blood glucose, insulin and C-peptide responses in humans. However, the effects of adding L-arabinose to mixed meals on the indices of glucose control are unknown. The purpose of the present study was to investigate whether the positive effects of L-arabinose added to a sugar drink could be reproduced in subjects consuming a mixed meal containing sucrose and/or starch from wheat flour. A total of seventeen healthy men participated in study 1, a randomised, double-blind, cross-over trial. In this study, the subjects consumed two different breakfast meals containing sucrose and starch from wheat flour (meal A) or starch from wheat flour (meal B) supplemented with 0, 5 and 10 % L-arabinose by weight after a 12 h fast. A total of six healthy men participated in study 2, a randomised, double-blind, cross-over trial. In this study, the subjects also consumed meal B served in two different textures and a liquid meal with maltose supplemented with 0 and 20% L-arabinose. In addition, 1·5 g of paracetamol was chosen as an indirect marker to assess gastric emptying. Postprandial plasma glucose, insulin and C-peptide concentrations were measured regularly for 3 h. The results of the present study showed that the peak plasma concentration, time to reach peak plasma concentration or AUC values of glucose, insulin and C-peptide were not altered after consumption of the test meals. Overall, it was not possible to reproduce the beneficial effects of L-arabinose added to sucrose drinks when L-arabinose was mixed in a solid or semi-solid mixed meal.

Resveratrol ameliorates hepatic metaflammation and inhibits NLRP3 inflammasome activation

ObjectiveResveratrol (RSV) regulates NAD bioavailability and sirtuin-related metabolism, which relates to aging, metabolic syndrome and non-alcoholic fatty liver disease. The purpose of this study was to investigate the effects of resveratrol on hepatic metaflammation in a rodent model of high-fat (HF) diet-induced obesity (DIO). Materials/MethodsDIO was induced in a subset of mice given an HF diet (45% kcal fat). After 6weeks of HF diet feeding, RSV was delivered via an osmotic pump for 4weeks. The experimental groups were as follows: 1) lean control fed with a standard diet, 2) HF diet-induced obese control, and 3) HF_RSV (8mg/kg/day). After 4weeks of each treatment, blood and liver tissues were collected and the indices of glucose control, serum and liver triglyceride (TG), sirtuin pathway, inflammation, and NOD-like receptor family, pryin domain containing 3 (NLRP3) inflammasome were analyzed. ResultsBody weight and food intake were not altered by administering resveratrol. Glucose control was impaired, and serum and liver TG levels were increased by the HF diet. Hepatic inflammation was aggravated in mice fed with the HF diet, as shown by the increased levels of the pro-inflammatory markers interleukin-1 (IL-1), IL-6 and tumor necrosis factor-alpha in the liver. However, resveratrol administration significantly improved glucose control, and serum and liver TG contents. Also, resveratrol treatment reduced the levels of the pro-inflammatory markers. These improvements were accompanied by alterations in sirtuin pathway and NLRP3 inflammasome activation. ConclusionThese results demonstrate that resveratrol ameliorates hepatic metaflammation, accompanied by alterations in NLRP3 inflammasome.

Modification in redox status of diabetes mellitus type 1 patients after insulin transition

Aims To determine and compare an extensive array of biochemical redox indices before and after insulin type change in diabetes mellitus (DM) patients’ type 1. Methods Glutathione, malondialdehyde, peroxidation potential, superoxide dismutase, catalase, total hydroperoxide and advanced oxidation protein products in relation to blood glucose and glucose indicators control such as glycosylated haemoglobin and fructosamine were measured in 40 patients before and after 2 months since pork insulin was changed to human insulin in type 1 diabetic patients. These data was compared to sex and age-matched healthy control. Results After 2 months of changing, all indicator measured were favorably evolved and were significantly modified ( P < 0.05) except activity of erythrocyte enzymes superoxide dismutase and catalase. Adverse reactions (hypoglycaemic events) were observed in seven patients with 0.7% of incidence. It was related to concomitant use of captopril, clortalidone and nitropental for hypertension treatment. Simultaneous beneficial change in glucose, glucose control indices and redox markers were noted in 27 (68%) of total patients of study. Conclusion These results contribute to both evidences that transition process from animal to human insulin could be beneficial to DM type 1 patients and an integral overview about metabolic events involved could be valid for evaluate treatment effects. The results contribute to evidences that transition to human insulin can improve the antioxidant status of diabetic patients.

Modification in redox status of diabetes mellitus type 1 patients after insulin transition

Aims To determine and compare an extensive array of biochemical redox indices before and after insulin type change in diabetes mellitus (DM) patients’ type 1. Methods Glutathione, malondialdehyde, peroxidation potential, superoxide dismutase, catalase, total hydroperoxide and advanced oxidation protein products in relation to blood glucose and glucose indicators control such as glycosylated haemoglobin and fructosamine were measured in 40 patients before and after 2 months since pork insulin was changed to human insulin in type 1 diabetic patients. These data was compared to sex and age-matched healthy control. Results After 2 months of changing, all indicator measured were favorably evolved and were significantly modified ( P < 0.05) except activity of erythrocyte enzymes superoxide dismutase and catalase. Adverse reactions (hypoglycaemic events) were observed in seven patients with 0.7% of incidence. It was related to concomitant use of captopril, clortalidone and nitropental for hypertension treatment. Simultaneous beneficial change in glucose, glucose control indices and redox markers were noted in 27 (68%) of total patients of study. Conclusion These results contribute to both evidences that transition process from animal to human insulin could be beneficial to DM type 1 patients and an integral overview about metabolic events involved could be valid for evaluate treatment effects. The results contribute to evidences that transition to human insulin can improve the antioxidant status of diabetic patients.