Glucose Metabolism In Adults Research Articles

Late eating is associated with poor glucose tolerance, independent of body weight, fat mass, energy intake and diet composition in prediabetes or early onset type 2 diabetes

This study investigates the impact of habitual late calorie intake on glucose metabolism in adults with overweight or obesity and diet or metformin-controlled prediabetes or type 2 diabetes independently of body weight, fat mass, energy intake or diet composition. Participants (n = 26) were classified as Later Eaters (LE) if ≥45% daily calories were consumed after 5 pm and Early Eaters (EE) if not, based on daily caloric intake assessed over 2-wk. EE and LE did not differ in anthropometrics or daily energy intake, but LE consumed more carbohydrates (p = 0.038) and fats (p = 0.039) after 5 pm. Fasting glucose, insulin, and C-peptide did not differ between groups but LE exhibited higher glucose concentrations after an oral glucose tolerance test (p = 0.001), even after adjusting for body weight, fat mass, energy intake and diet composition (p < 0.05). Glucose results remained when participants with T2D were excluded (p = 0.031). After diabetes status adjustment, differences in glucose concentrations were higher in LE for time 30 (p = 0.028) and 60 min (p = 0.036). LE, compared to EE, had poorer glucose tolerance, independent of body weight, fat mass, daily energy intake and diet composition. ClinicalTrials.gov: NCT04465721.

Congenital disorders of glucose metabolism in adults with nondiabetic hypoglycemia

Congenital disorders of glucose metabolism in adults with nondiabetic hypoglycemia

The effect of acute and 14-day exogenous ketone supplementation on glycemic control in adults with type 2 diabetes: two randomized controlled trials.

Acute ingestion of the exogenous ketone monoester supplement [(R)-3-hydroxybutyl-(R)-3-hydroxybutyrate] lowers blood glucose, suggesting therapeutic potential in individuals with impaired glucose metabolism. However, it is unknown how acute or repeated ingestion of exogenous ketones affects blood glucose control in individuals with type 2 diabetes (T2D). We conducted two randomized, counterbalanced, double-blind, placebo-controlled crossover trials to determine if 1) acute exogenous ketone monoester (0.3 g/kg body mass; N = 18) or 2) 14-day thrice daily premeal exogenous ketone monoester (15 g; N = 15) supplementation could lower blood glucose in individuals living with T2D. A single dose of the ketone monoester supplement elevated blood β-OHB to ∼2 mM. There were no differences in the primary outcomes of plasma glucose concentration (acutely) or serum fructosamine (glycemic control across 14 days) between conditions. Ketone monoester ingestion acutely increased insulin and lowered nonesterified fatty acid concentrations; plasma metabolomics confirmed a reduction in multiple free fatty acids species and select gluconeogenic amino acids. In contrast, no changes were observed in fasting metabolic outcomes following 14 days of supplementation. In the context of these randomized controlled trials, acute or repeated ketone monoester ingestion in adults with T2D did not lower blood glucose when consumed acutely in a fasted state and did not improve glycemic control following thrice daily premeal ingestion across 14 days. Future studies exploring the mechanistic basis for the (lack of) glucose-lowering effect of exogenous ketone supplementation in T2D and other populations are warranted.NEW & NOTEWORTHY Exogenous ketone supplements can acutely lower blood glucose, suggesting therapeutic potential in individuals with impaired glucose metabolism. However, the effect of exogenous ketones on glucose metabolism in adults with type 2 diabetes has not been investigated in a controlled setting. In adults with type 2 diabetes, ketone monoester ingestion did not lower blood glucose acutely in a fasted state and did not improve glycemic control across thrice daily premeal ingestion across 14 days.

The Association between Unhealthy Food Consumption and Impaired Glucose Metabolism among Adults with Overweight or Obesity: A Cross-Sectional Analysis of the Indonesian Population.

It has been shown that dietary patterns are associated with glucose control. However, the association between the types of food consumed and blood glucose in overweight or obese individuals is still unclear. The present study aimed to determine the association between unhealthy food consumption and impaired glucose metabolism in adults with overweight or obesity. The analysis presented in this study was based on the data from a population-based, cross-sectional, nationally representative survey (Indonesian Basic Health Research 2018/RISKESDAS 2018). The body mass index (BMI) was calculated as weight (kg)/height squared (m2) and was determined based on the World Health Organization (WHO) criteria for the Asian population. A validated questionnaire and food card were used to assess the diet. Fasting plasma glucose and 2-hpost-prandial glucose were employed to determine blood glucose markers. In total, 8752 adults with overweight or obesity were included in this analysis. We found that consumption of sweet, grilled, and processed foods was associated with impaired fasting plasma glucose (IFG) before and after adjustment (p < 0.05). Consumption of high-fat foods was also associated with impaired glucose tolerance (IGT) for all models tested (p < 0.05). Furthermore, all models showed a link between processed food consumption and combined glucose intolerance (CGI) (p ≤ 0.001). Differential food group consumption was associated with IFG, IGT, and CGI in Indonesian adults who were overweight or obese.

The association between plasma zinc concentrations and markers of glucose metabolism in adults in Cameroon.

An abnormal Zn status has been suggested to play a role in the pathogenesis of type 2 diabetes. However, epidemiological studies of the relationship between plasma Zn concentrations and diabetes are sparse and inconclusive. We aimed to investigate the association between plasma Zn concentrations and glycaemic markers (fasting glucose, 2-h glucose and homeostatic model assessment of insulin resistance) in rural and urban Cameroon. We studied 596 healthy adults (63·3 % women) aged 25-55 years in a population-based cross-sectional study. The mean plasma Zn concentration was 13·7 ± 2·7 µmol/L overall, with higher levels in men (14·4 ± 2·9 µmol/l) than in women (13·2 ± 2·6 µmol/l), P-value < 0·0001. There was an inverse relationship between tertiles of plasma Zn and 2-h glucose concentrations (P-value for linear trend = 0·002). The difference in 2-h glucose between those in the highest tertile of plasma Zn compared to the lowest was -0·63 (95 % CI - 1·02, -0·23) mmol/l. This remained significant after adjusting for age, sex, smoking status, alcohol intake, education level, area of residence, adiposity and objectively measured physical activity -0·43(-0·82, -0·04). Similar inverse associations were observed between plasma Zn concentrations and fasting glucose and homeostatic model assessment of insulin resistance when adjusted for socio-demographic and health-related behavioural characteristics. The current findings of an inverse association between plasma Zn concentrations and several markers of glucose homeostasis, together with growing evidence from intervention studies, suggest a role for Zn in glucose metabolism. If supported by further evidence, strategies to improve Zn status in populations may provide a cheap public health prevention approach for diabetes.

Relationships between metabolic activity in the brain and circulating metabolites vary by sex

AbstractBackgroundGlucose hypometabolism in the brain measured by [F‐18] fluorodeoxyglucose (FDG) positron emission tomography has been observed in a number of neurological disorders. In both Down syndrome (DS) and non‐DS populations, it is associated with higher amyloid load and lower cognitive performance.MethodWe obtained plasma samples, FDG PET and [C‐11] Pittsburgh compound B (PiB) from a sample of 89 adults with DS (mean age [standard deviation] = 38.9[8.3] years). We measured levels of metabolites using targeted mass spectrometry. We calculated correlation constants between glucose uptake in discrete brain regions, global amyloid load, and plasma metabolite levels. We examined the effect of sex and age on these correlations.ResultWe found significant correlations between plasma metabolites, primarily lipids, and FDG PET signal in the brain with regional specificity. Additionally, metabolites which were positively associated with FDG PET signal in a specific brain region were negatively associated with amyloid load and vice versa. While FDG PET signal in each region were not significantly different between males and females, their correlation with metabolites did. When examining females only, we find primarily lipid correlates again. The lipid metabolites negatively associated with FDG PET signal were distinguished from those lipids positively correlated with FDG PET signal by lipid class and not fatty acid length. In males, a completely distinct set of associations between brain regions and metabolites were observed. The number of FDR significant correlations decrease dramatically, however the magnitudes of these correlation constants are higher than those observed in females and there is very little overlap between any of the brain regions correlated with each metabolite.ConclusionThe levels of brain amyloid and regional brain glucose metabolism in adults with DS are both reflected in the concentration of certain metabolites measured in blood plasma. Surprisingly, each brain region has its own orthogonal metabolic correlate. Moreover, these relationships are distinct in males and females. It will be important to explore the basis for these differences and determine if they are present in the general population. Future metabolic analysis of neurological diseases could also benefit from separate analysis in males and females so as not to obscure these differences.

Weekly somapacitan had no adverse effects on glucose metabolism in adults with growth hormone deficiency

PurposeThe long-term effects of long-acting growth hormone (LAGH) analogues on glucose metabolism in adult growth hormone deficiency (AGHD) are not known. We investigated the impact of LAGH somapacitan, administered once-weekly, on glucose metabolism in patients with AGHD.MethodsIn post hoc-defined analyses, we compared the effects of somapacitan with daily growth hormone (GH) and placebo on fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β) in patients with AGHD across a unique data set from three phase 3 randomized controlled trials (REAL 1, REAL 2 and REAL Japan).ResultsNo new cases of diabetes mellitus were reported with somapacitan. Among GH-naïve patients (n = 120 somapacitan, n = 119 daily GH), higher changes from baseline in FPG, HOMA-IR and fasting insulin levels were observed with daily GH versus somapacitan at 34 weeks, but not at 86 weeks. HbA1c and HOMA-β did not differ between groups at either timepoint. Among treatment-naïve patients, sex, age, fasting insulin, glucose tolerance status and body mass index did not influence changes in glucose metabolism. In previously treated patients (REAL 1 extension: n = 51 somapacitan, n = 52 daily GH; REAL 2: n = 61 and n = 31, respectively; REAL Japan: n = 46 and n = 16, respectively), the difference in changes from baseline were not statistically significant between somapacitan and daily GH for any glucose metabolism parameters.ConclusionsSomapacitan, compared with daily GH, did not adversely affect glucose metabolism up to 86 weeks in a large cohort of treatment-naïve or previously treated patients with AGHD.Trial registrations (date of registration): NCT02229851 (2 September 2014), NCT02382939 (3 March 2015), NCT03075644 (7 March 2017).

Effects of somapacitan on glucose metabolism in adults with GH deficiency

Effects of somapacitan on glucose metabolism in adults with GH deficiency

Mediation effects of thyroid function in the associations between phthalate exposure and glucose metabolism in adults.

The mediating influence of thyroid function on the association of phthalate exposure with glucose metabolism, including insulin resistance, remains unclear. We explored the mediating influence of thyroid hormone levels on the phthalate exposure-insulin resistance association. This cross-sectional study of 217 Taiwanese adults assessed insulin resistance (Homeostatic Model Assessment for Insulin Resistance, HOMA-IR scores) and the levels of 11 urinary phthalate metabolites and 5 thyroid hormones. Multiple regression models were used to analyze the associations among serum thyroid hormone levels, urinary phthalate metabolite levels, and HOMA-IR scores. The mediation analysis assessed the influence of thyroid function on the phthalate exposure-HOMA-IR association. Our data indicated urinary mono-ethylhexyl phthalate (MEHP) levels was negatively associated with free thyroxine (T4) (β=-0.018; 95% confidence interval [CI]:-0.031,-0.005) and positively associated with HOMA-IR scores (β=0.051, 95% CI: 0.012, 0.090). The study also revealed urinary mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) levels was negatively associated with free T4 (β=-0.036, 95% CI:-0.056,-0.017) and HOMA-IR (β=0.070, 95% CI: 0.013, 0.126). Free T4 and HOMA-IR had a negative association (β=-0.757, 95% CI:-1.122,-0.392). In the mediation analysis, free T4 mediated 24% and 35% of the associations of urinary MEHP and MEOHP with HOMA-IR, respectively. Our findings revealed the mediating role of thyroid function in the phthalate exposure-glucose metabolism association in adults.

Dietary Pattern Trajectories from Youth to Adulthood and Adult Risk of Impaired Fasting Glucose: A 31-year Cohort Study.

The influence of dietary pattern trajectories from youth to adulthood on adult glucose metabolism is unknown. To identify dietary pattern trajectories from youth to adulthood and examine their associations with adult impaired fasting glucose (IFG). Thirty-one-year population-based cohort study among 1007 youths aged 3-18 years at baseline in Finland. Diet intake was assessed in 1980, 1986, 2001, 2007, and 2011. Group-based trajectory modelling was used to identify dietary pattern (identified by factor analysis) trajectories. Adult IFG was measured by the latest available data from 2001, 2007, and 2011. Among 1007 participants, 202 (20.1%) developed IFG and 27 (2.7%) developed type 2 diabetes in adulthood (mean follow-up of 30.7 years; mean [SD] age 40.5 [5.0] years). Three dietary patterns were identified at baseline and were retained in 1986 and 2001: "Traditional Finnish," "High carbohydrate," and "Vegetables and dairy products." Three different patterns were identified in 2007, which remained similar in 2011: "Traditional Finnish and high carbohydrate," "Red meat," and "Healthy." Trajectories of increased or stably medium "red meat" pattern scores from youth to adulthood were detrimentally associated with IFG (relative risk 1.46, 95% CI 1.12-1.90 for Medium (M)-stable/M-large increase vs low-stable trajectory) after adjusting for confounders. This association was slightly reduced after further adjusting for long-term dietary fiber intake. Trajectories of an increased or stably moderate adherence to a "red meat" dietary pattern from youth to adulthood are associated with higher risk of adult IFG. This association is partly explained by low dietary fiber intake.

Rationale and design of the Hyperglycemic Profiles in Obstructive Sleep Apnea (HYPNOS) trial

The Hyperglycemic Profiles in Obstructive Sleep Apnea (HYPNOS) randomized clinical trial was conducted in adults with type 2 diabetes and moderate-to-severe obstructive sleep apnea (OSA) to determine whether treatment with positive airway pressure (PAP) therapy is associated with improvements in glycemic measures. Participants were randomly assigned to PAP therapy with lifestyle counseling or lifestyle counseling alone. While observational and experimental evidence indicate that intermittent hypoxemia and recurrent arousals in OSA may alter glucose metabolism and worsen glycemic measures, the effect of treating OSA with PAP therapy on these measures in type 2 diabetes is uncertain. Adequately powered randomized clinical trials have yet to be performed to demonstrate whether PAP therapy for OSA in patients with type 2 diabetes can improve glycemic measures. The HYPNOS trial was designed to determine whether PAP therapy for OSA in patients with type 2 diabetes over 3 months leads to improvements in glycemic measures including glycemic variability (standard deviation) based on Dexcom G4 Platinum continuous glucose monitoring. Secondary objectives were to assess the effects of PAP therapy for OSA on measures of: (1) glycemic variability based on Abbott Freestyle Pro Libre continuous glucose monitoring; (2) point-of-care hemoglobin A1c (HbA1c); (3) degree of post-prandial hyperglycemia as determined by 7-point self-monitoring of blood glucose; (4) clinic and ambulatory blood pressure; and (5) endothelial function. The HYPNOS trial was designed to address gaps in our understanding of the effects of PAP therapy on glucose metabolism in adults with type 2 diabetes and moderate-to-severe OSA.Trial Registration: ClinicalTrials.gov Identifier NCT02454153

Phthalates exposure, thyroid function and glucose metabolism: exploring associations and mediation effects in Taiwanese adults

Background: Information regarding the mediation effects of thyroid function in associations between phthalates exposure and glucose metabolism including insulin resistance is unclear. Objective: Our aim was to examine whether thyroid hormone levels could mediate the associations between phthalates exposure and insulin resistance. Method: Eleven urinary phthalate metabolites levels, five thyroid hormone levels and insulin resistance (by using the Homeostatic Model Assessment of estimated Insulin Resistance [HOMA-IR]) were determined in a cross-sectional study comprised of 217 Taiwanese adults. Associations between urinary phthalate metabolite levels, serum thyroid hormone levels and HOMA-IR were explored using multiple regression models. Mediation analysis was conducted to assess the role of thyroid function in the associations between phthalates exposure and HOMA-IR. Results: Urinary mono-ethylhexyl phthalate (MEHP) levels were negatively associated with free thyroxine (free T4) (β= -0.018 ; 95% confidence interval [CI]: -0.031, -0.005 ) and positively associated with HOMA-IR (β=0.051, 95% CI: 0.012, 0.090), respectively. Urinary mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) levels were associated with free T4 (β= -0.036, 95% CI:-0.056, -0.017) and HOMA-IR (β=0.070 , 95% CI: 0.013, 0.126), respectively. Free T4 was negatively associated with HOMA-IR (β= -0.757, 95% CI:-1.122, -0.392). The results of mediation analysis indicated that 24% of the association between urinary MEHP and HOMA-IR was mediated by free T4, as well as 35% of the association between urinary MEOHP and HOMA-IR was mediated by free T4. Conclusions: Our findings support the hypothesis that thyroid function could mediate the association between phthalates exposure and glucose metabolism in adults.

Effect of long-term growth hormone replacement on glucose metabolism in adults with growth hormone deficiency: a systematic review and meta-analysis.

This systematic review and meta-analysis was performed to summarize the long-term (more than 6months) effect of growth hormone (GH) replacement therapy (GHRT) on glucose metabolism among adults growth hormone deficiency (AGHD) patients. We searched MEDLINE, EMBASE and the Cochrane Library databases from inception till March 2020 for relevant studies evaluating the effect of GHRT on glucose metabolism in AGHD patients. Results were stratified into two periods (6-12months and more than12 months) according to the length of follow-up. Thirty-three studies including 11 randomized controlled trials (RCTs) and 22 prospective open-label studies (POLs) were included in the meta-analysis. The findings of this meta-analysis showed that GH supplementation with a duration of 6-12months among adults with growth hormone deficiency (GHD) significantly increased fasting plasma glucose (FPG) (SMD 0.37; 95% CI 0.25 to 0.49; I2 = 0%; P < 0.00001), fasting insulin (FI) (SMD 0.2; 95% CI 0.08 to 0.33; I2 = 9%; P = 0.001), glycated hemoglobin (HbA1c) (SMD 0.31; 95% CI 0.17 to 0.46; I2 = 10%; P < 0.0001) and homeostasis model of assessment-insulin resistance (HOMA-IR) (SMD 0.28; 95% CI 0.08 to 0.47; I2 = 13%; P = 0.006). Notably, GH intervention with a duration of more than 12months showed no significant effect on FI (SMD 0.14; 95% CI - 0.09 to 0.37; I2 = 0%; P = 0.24), HbA1c (SMD - 0.02; 95% CI - 0.3 to 0.26; I2 = 72%; P = 0.89) and HOMA-IR levels (SMD 0.04; 95% CI - 0.24 to 0.31; I2 = 0%; P = 0.80) in adults with GHD. However, FPG levels in AGHD were still significantly increased with more than one year intervention period (SMD 0.41; 95% CI 0.29 to 0.53; I2 = 0%; P < 0.00001). Overall, the current meta-analysis demonstrated that GHRT with a shorter duration (6-12months) led to a deterioration in glucose metabolism including FPG, FI, HbA1c and HOMA-IR in AGHD patients. However, the negative effects of GH therapy on these glucose homeostasis parameters were not seen in longer duration of GHRT, except for FPG.

Effect of Berry Polyphenols on Glucose Metabolism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

ABSTRACTThe effect of berry polyphenols on glucose metabolism has been evaluated in several studies; however, the results are conflicting. A systematic review and meta-analysis was therefore conducted to evaluate the effect of berry polyphenol consumption on glucose metabolism in adults with impaired glucose tolerance or insulin resistance. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), and Scopus were searched for randomized controlled trials published by June 2019. Of the 3240 articles found, 21 met inclusion criteria. Study-specific effects were calculated as mean differences, which were pooled using fixed-effect, inverse-variance weighting. Overall, berry polyphenol consumption did not have a clear effect on biomarkers of glucose metabolism compared with placebo or no treatment. Although some analyses showed statistically significant effects, these effects were too small to be of clinical relevance. The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews as CRD42019130811.

Effects of nut and seed consumption on markers of glucose metabolism in adults with prediabetes: a systematic review of randomised controlled trials.

The primary aim was to investigate the effects of nut and seed consumption on markers of glucose metabolism in adults with prediabetes. Studies with a randomised controlled trial (RCT) design, comparing the effects of a diet containing nuts or seeds against a diet without nuts or seeds in adults with prediabetes, were considered eligible. Primary outcome measures included fasting plasma glucose (FPG), 2-h plasma glucose during oral glucose tolerance test and glycated Hb (HbA1c) concentrations. Studies were identified by searching PubMed and Scopus electronic databases and by checking full texts and reference lists of relevant records. Risk of bias was assessed using the Cochrane Collaboration's tool. We included five RCT involving 371 adults with prediabetes or at risk of diabetes; three RCT investigated the effects of whole nut consumption and two the effects of ground flaxseed consumption. Consumption of 57g/d pistachios or mean intake of 60g/d almonds for 4months improved FPG and fasting plasma insulin (FPI) concentrations, insulin resistance, cellular glucose uptake in lymphocytes and β-cell function. Consumption of 56g/d walnuts for 6months was not found to affect FPG or HbA1c concentrations. Consumption of 13g/d flaxseed for 3months improved FPG and FPI concentrations and insulin resistance. In a second study, however, flaxseed consumption was not found to affect markers of glucose metabolism. The risk of bias was generally low, thus the reported results could be reliable. Further investigation of nut and seed consumption effects in the field of prediabetes is warranted.

Patterns of changes in overtime working hours over 3 years and the risk for progression to type 2 diabetes in adults with pre-diabetes

No information exists regarding the effects of working hours on glucose metabolism in adults with pre-diabetes, a high-risk group for developing diabetes. Further, longitudinal patterns in working hours and their effects on glucose metabolism have not been described previously. We investigated the association between changes in overtime working hours over 3 years and the risk for progression to type 2 diabetes among adults with pre-diabetes. We analyzed patterns of overtime working hours from 2008 to 2011 among 18,172 workers in Japan (16,474 men, aged 30 to 64 years) with pre-diabetes in 2011 (baseline) using the sub-cohort data from the Japan Epidemiology Collaboration on Occupational Health Study. Participants were followed up to March 2016. Overtime working hours per month were self-reported annually in 2008–2011 and trajectory patterns were identified using group-based trajectory modeling. Type 2 diabetes was diagnosed by fasting or random plasma glucose test, hemoglobin A1c, and history of diabetes. Multivariable-adjusted hazard ratios of incident diabetes were calculated using Cox regression. We identified 3 distinct trajectories of overtime work: persistently short, long-to-short, and persistently long. During a mean follow-up of 3.5 years, 1613 participants (8.9%) developed diabetes. Compared with persistently short overtime working hours, no material increase in diabetes risk was observed for either long-to-short working hours or persistently long working hours. After adjustment for potential confounders, this association was materially unchanged. The results suggest that among individuals with pre-diabetes, persistently long working hours over 3 years were not associated with an increased risk of developing type 2 diabetes.

Offspring from maternal nutrient restriction in mice show variations in adult glucose metabolism similar to human fetal growth restriction.

Fetal growth restriction (FGR) is a pregnancy condition in which fetal growth is suboptimal for gestation, and this population is at increased risk for type 2 diabetes as adults. In humans, maternal malnutrition and placental insufficiency are the most common causes of FGR, and both result in fetal undernutrition. We hypothesized that maternal nutrient restriction (MNR) in mice will cause FGR and alter glucose metabolism in adult offspring. Pregnant CD-1 mice were subjected to MNR (70% of average ad libitum) or control (ad libitum) from E6.5 to birth. Following birth, mice were fostered by mothers on ad libitum feeds. Weight, blood glucose, glucose tolerance and tissue-specific insulin sensitivity were assessed in male offspring. MNR resulted in reduced fetal sizes but caught up to controls by 3 days postnatal age. As adults, glucose intolerance was detected in 19% of male MNR offspring. At 6 months, liver size was reduced (P = 0.01), but pAkt-to-Akt ratios in response to insulin were increased 2.5-fold relative to controls (P = 0.004). These data suggest that MNR causes FGR and long-term glucose intolerance in a population of male offspring similar to human populations. This mouse model can be used to investigate the impacts of FGR on tissues of importance in glucose metabolism.

P.365 - Glycemic control during fasting in patients with low skeletal muscle mass

Patients with low skeletal muscle mass have shown to react differently to fasting than expected. An earlier study of the glucose metabolism in adults with Spinal muscular atrophy (SMA) and congenital myopathies among others found that especially the patients with low skeletal muscle mass became hypoglycemic after a period of fasting and the same has been described in cases with children with low muscle mass admitted after febrile episodes and fasting. This indicates that further research into the glycemic control of persons with low muscle mass is warranted. The aim of the study is to investigate the carbohydrate and fatty acid oxidation in patients with low muscle mass. Furthermore, the study will investigate the metabolic differences in children and adults with the same diagnosis. These systemic metabolic pathways have never been described in these patient groups before. Fat and carbohydrate metabolism will be measured using metabolic tracers (stable isotopes) combined with indirect calorimetry from measures of oxygen consumption (VO2) and carbon dioxide production (VCO2). The study will focus on adult patients diagnosed with SMA types II and III and paediatric patients diagnosed with SMA type II and congenital muscular dystrophies with mutations in the LAMA2 gene. The primary outcome measure will be registering development of hypoglycaemia during fasting. Secondary outcome measures are changes in fat and carbohydrates metabolisms from fed to fasted state and changes in hormones and metabolites during fasting. Data from the children will be compared to data from WHO and literature on healthy children and their overall energy utilization using the Schofield equation. Data from the adult patients will be compared to a group of matched untrained healthy control subjects for comparison of the primary and secondary outcome measures. The research trials will be conducted in late spring and summer and preliminary data will be available for presentation at the WMS meeting.

Effect of continuous positive airway pressure on glucose metabolism in adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

Obstructive sleep apnea (OSA) has many serious consequences, and one of these may be the exacerbation of type 2 diabetes mellitus (T2DM). Reports on the effect of continuous positive airway pressure (CPAP) on glucose metabolism in people with T2DM and OSA are conflicting. Therefore, the purpose of this review was to examine the effect of CPAP treatment on glucose metabolism by synthesizing findings from randomized controlled trials. The PRISMA review protocol was developed and registered in PROSPERO. A systematic search of PubMed, CINAHL, Embase, Web of Science, PsycInfo, and Cochrane was conducted from inception to March 2017. The Cochrane risk of bias tool was used to assess the study quality. Review Manager (v5.2) was used for the meta-analyses, and the standardized mean difference was calculated. Six studies consisting of 496 participants were included in this review. The meta-analyses indicated that CPAP treatment did not have significant impact on glucose metabolism measured by A1C (mean difference=0.05, 95% CI -0.14 to 0.24, P=0.61), fasting insulin level (mean difference=-2.34, 95% CI -8.19 to 3.51, P=0.43), and fasting glucose (mean difference=-0.05, 95% CI -0.52 to 0.42, P=0.84). As expected, CPAP treatment can improve daytime sleepiness (mean difference=-2.68, 95% CI -3.91 to -1.54, P<0.001). Findings of this meta-analysis do not substantiate a positive effect of CPAP on glucose metabolism in people with T2DM and coexisting OSA. Future large-scale clinical trials with a longer treatment duration and better CPAP compliance are warranted.

Moderate Physical Activity is Associated with Cerebral Glucose Metabolism in Adults at Risk for Alzheimer's Disease.

The objective of this study was to investigate the relationship between accelerometer-measured physical activity (PA) and glucose metabolism in asymptomatic late-middle-aged adults. Ninety-three cognitively healthy late-middle-aged adults from the Wisconsin Registry for Alzheimer's Prevention participated in this cross-sectional study. They underwent 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging and wore an accelerometer (ActiGraph GT3X+) to measure free-living PA. Accelerometer data yielded measures of light (LPA), moderate (MPA), and vigorous (VPA) intensity PA. FDG-PET images were scaled to the cerebellum and pons, and cerebral glucose metabolic rate was extracted from specific regions of interest (ROIs) known to be hypometabolic in AD, i.e., hippocampus, posterior cingulate, inferior temporal cortex, and angular gyrus. Regression analyses were utilized to examine the association between PA and glucose metabolism, while adjusting for potential confounds. There were associations between MPA and glucose metabolism in all ROIs examined. In contrast, LPA was not associated with glucose uptake in any ROI and VPA was only associated with hippocampal FDG uptake. Secondary analyses did not reveal associations between sedentary time and glucose metabolism in any of the ROIs. Exploratory voxel-wise analysis identified additional regions where MPA was significantly associated with glucose metabolism including the precuneus, supramarginal gyrus, amygdala, and middle frontal gyrus. These findings suggest that the intensity of PA is an important contributor to neuronal function in a late-middle-aged cohort, with MPA being the most salient. Prospective studies are necessary for fully elucidating the link between midlife engagement in PA and later life development of AD.