Glycemia In Type Research Articles

The Role of Whole Food Plant-Based Food Intake on Postprandial Glycemia in Type 1 Diabetes.

Whole food plant-based diet (WFPBD), minimally processed foods with limited consumption of animal products, is associated with improved health outcomes. The benefits of WFPBD are underexplored in individuals with type 1 diabetes (T1D). The primary objective of this analysis is to evaluate the association between WFPBD on glycemia in individuals with T1D. Utilizing prospectively collected meal events from the Type 1 Diabetes Exercise Initiative, we examined the effect of WFPBD intake on glycemia, determined by the Plant-Based Diet Index (PDI). The PDI calculates overall, healthful (hPDI), and unhealthy PDI (uPDI) to evaluate for degree of processed foods and animal products (i.e. WFPBD). Mixed effects linear regression model assessed time-in-range (TIR), time-above-range, and time-below-range. We analyzed 7,938 meals from 367 participants. TIR improved with increasing hPDI scores, conferring a 4% improvement in TIR between highest and lowest hPDI scores (high hPDI:75%, low hPDI:71%; p<0.001). Compared to meals with low hPDI, meals with high hPDI had lower glucose excursion (high hPDI:53mg/dL, low hPDI:62mg/dL; p<0.001) and less time >250mg/dL (high hPDI:8%, low hPDI:14%; p<0.001). These effects were present but less pronounced by PDI (high PDI:74%, low PDI:71%; p=0.01). No differences in time below 70mg/dL and 54mg/dL were observed by PDI or hPDI. Meal events with higher hPDI were associated with 4% postprandial TIR improvement. These benefits were seen primarily in WFPBD meals (captured by hPDI) and less pronounced plant-based meals (captured by PDI), emphasizing the benefit of increasing unprocessed food intake over limiting animal products alone.

Acute endothelial, blood pressure, and glycemic responses after aerobic sessions in type-2 diabetic with hypertension: A double-blinded randomized study

ObjectivesTo compare the acute response of moderate intensity continuous exercise (MICE) vs moderate intensity interval exercise (MIIE) on endothelial function, post-exercise hypotension (PEH), and glycemia in type 2 diabetes (T2DM) with hypertension. MethodsTwelve T2DM (aged 52.8±3.8 years old) patients with hypertension underwent a randomized cross-over study following isocaloric (200 kcal) protocols: (i) MICE: walk-jogging at 50% of VO2peak, (ii) MIIE session: walking – jogging (stimulus/recovery – 3:3 minutes each) at 60% of VO2peak followed by recovery at 40% of VO2peak, and (iii) control (CON): lying quietly in a supine position for 30 minutes. A generalized estimating equation was utilized to verify possible differences over time × session. ResultsThe %FMD (Baseline: 3.59±1.58 vs. 30 min: 6.73±4.34) and the absolute FMD changed after MIIE (Baseline: 0.16±0.10 vs. 30 min: 0.17±0.14). Only absolute FMD changed after MIIE (Baseline: 0.14±0.07 vs. 30 min: 0.16±0.07). Besides, MIIE at 30 minutes provides higher absolute FMD values when compared to baseline from MICE and baseline, 30 minutes, and 60 minutes from control. Regarding blood pressure, no PEH statistical main effect was found. Finally, the glycemia changed at baseline vs. 30 minutes and 60 minutes after MIIE (210.5±9.4 vs. 127.6±10.0 and 120±8.9), MICE (219.5±12.7 vs. 125.2±12.0 and 118.2±11.6), and control sessions (215.9±11.8 vs. 187.4±11.2 and 172.6±11.3 mg/dL, p<0.05). However, MIIE and MICE showed higher decreases compared to the control. ConclusionsMIIE and MICE sessions are similar and effective exercise strategies to induce changes in endothelial function and glycemic responses in type-2 diabetics with hypertension.

Reducing cardiometabolic risk with semaglutide in type 1 diabetes (RESET1): Study protocol of a phase 2double-blinded randomised placebo-controlled trial.

Premature cardiovascular disease is the leading cause of death in people living with type 1 diabetes. Therapies are urgently needed to address cardiovascular risk in this group. Semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, has been shown to reduce cardiovascular events and improve weight and glycaemia in type 2 diabetes. Semaglutide may offer cardioprotective and metabolic benefits in type 1 diabetes. We will study 60 adults aged 25-70 years with type 1 diabetes of duration at least 2 years, body mass index ≥25 kg/m2, HbA1c ≥7% and at least one cardiovascular risk factor (microalbuminuria, hypertension or anti-hypertensive treatment, hyperlipidemia or lipid lowering therapy, current smoking). Participants will receive semaglutide up to 1.0 mg weekly or matched placebo for 26 weeks. The primary outcome is carotid femoral pulse wave velocity, a measure of arterial stiffness, as a surrogate marker of cardiovascular risk. Potential mechanisms for metabolic changes will be explored including change in insulin sensitivity determined by hyperinsulinaemic-euglycaemic clamp; and incretin and pancreatic hormone action measured during mixed meal tolerance test. The REducing cardiometabolic risk with SEmaglutide in Type 1 diabetes study will investigate whether semaglutide, a long acting glucagon-like peptide receptor agonist, can improve markers of cardiometabolic health in T1D. Underlying mechanisms predicting response, including insulin resistance and incretin hormone status, will also be explored.

Manipulation of Post-Prandial Hyperglycaemia in Type 2 Diabetes: An Update for Practitioners.

This review paper explores post-prandial glycemia in type 2 diabetes. Post-prandial glycemia is defined as the period of blood glucose excursion from immediately after the ingestion of food or drink to 4 to 6 hours after the end of the meal. Post-prandial hyperglycemia is an independent risk factor for cardiovascular disease with glucose "excursions" being more strongly associated with markers of oxidative stress than the fasting or pre-prandial glucose level. High blood glucose is a major promoter of enhanced free radical production and is associated with the onset and progression of type 2 diabetes. Oxidative stress impairs insulin action creating a vicious cycle where repeated post-prandial glucose spikes are key drivers in the pathogenesis of the vascular complications of type 2 diabetes, both microvascular and macrovascular. Some authors suggest post-prandial hyperglycemia is the major cause of death in type 2 diabetes. Proper management of post-prandial hyperglycemia could yield up to a 35% cut in overall cardiovascular events, and a 64% cut in myocardial infarction. The benefits of managing post-prandial hyperglycemia are similar in magnitude to those seen in type 2 diabetes patients receiving secondary prevention with statins - prevention which today is regarded as fundamental by all practitioners. Given all the evidence surrounding the impact of post-prandial glycemia on overall outcome, it is imperative that any considered strategy for the management of type 2 diabetes should include optimum dietary, pharma, and lifestyle interventions that address glucose excursion. Achieving a low post-prandial glucose response is key to prevention and progression of type 2 diabetes and cardiometabolic diseases. Further, such therapeutic interventions should be sustainable and must benefit patients in the short and long term with the minimum of intrusion and side effects. This paper reviews the current literature around dietary manipulation of post-prandial hyperglycemia, including novel approaches. A great deal of further work is required to optimize and standardize the dietary management of post-prandial glycemia in type 2 diabetes, including consideration of novel approaches that show great promise.

STUDY ON CORRELATION OF SERUM FERRITIN WITH GLYCOSYLATED HEMOGLOBIN IN TYPE 2 DIABETES MELLITUS PATIENTS

Introduction: Diabetes mellitus is one of the leading cause of mortality and morbidity worldwide. Type 2 DM is a complex group of disorders characterized by different levels of insulin resistance, impaired secretion of insulin , and increased production of glucose. The complications of diabetes mellitus are inuenced by the average level of blood glucose along with glycosylated hemoglobin. Serum ferritin is an indicator of iron store. Iron stores are associated with decrease in insulin sensitivity, insulin secretion and hence type 2 diabetes. Methods: This study was done in Department of Biochemistry in collaboration with Medicine Department of Gandhi medical college Bhopal. 160 previously diagnosed type 2 diabetes subjects (mean age 55.59±7.74 years) with mean BMI 30.14±3.48kg/m2 were taken and their Serum ferritin, Fasting Blood Sugar and Glycosylated Hemoglobin were measured. Results: It was found that serum ferritin was signicantly high in diabetic patients and serum ferritin had a positive correlation with increasing glycosylated hemoglobin and Fasting blood sugar. Conclusion:It was concluded that serum ferritin level can be used as an indicator of control of glycaemia in type 2 diabetes mellitus patients. HbA1C and Serum ferritin level can also be used as a marker to prevent complications of the disease.

Treating to Target Glycaemia in Type 2 Diabetes Pregnancy.

There is an increasing awareness that in those who develop early-onset (18-39 years) adult type 2 diabetes, an increase in insulin resistance, deterioration in beta-cell, and clustering of cardiovascular risk factors are particularly pronounced. Pregnant women with type 2 diabetes have additional risk factors for serious adverse pregnancy outcomes as well as added barriers regarding healthcare access before, during, and after pregnancy. Compared to pregnant women with type 1 diabetes, those with type 2 diabetes are older, have higher body mass index (BMI), with more metabolic comorbidities and concomitant medications, are more likely to belong to minority ethnic groups, and live in the highest areas of socio-economic deprivation. Approximately, one in seven pregnant women with type 2 diabetes (median age 34 years) are taking ACE-inhibitors, statins (13%), and/or other potentially harmful diabetes therapies (7%). Fewer than one in four are taking a high dose of folic acid before pregnancy, which may suggest that planning for pregnancy is not a priority for women themselves, their healthcare professionals, or the healthcare system. Knowledge of the epidemiology, pathophysiology, and unique management considerations of early-onset type 2 diabetes is essential to providing evidence-based care to pregnant women with type 2 diabetes. This narrative review will discuss contemporary data regarding type 2 diabetes pregnancy outcomes and the increasing recognition that different types of diabetes may require different treatment strategies before, during, and after pregnancy.

Relationship of Glycemic Control with Level of Blood Pressure amongst Type 2 Diabetic Patients

Introduction: Inadequate control of glycemia in type-II diabetic patients is an important community health issue and a risk factor for the progression of problems among diabetic patients. Hypertension is a common disease accompanying diabetes. Among patients with diabetes mellitus; high blood pressure is an important factor involved in poor glycemic control which has not been adequately assessed in Pakistan. Aim: The main goal was to evaluate the glycemic control status in type II diabetic patient depending on the basis of blood pressure levels. Place and Duration: In Medicine Department of Islamic International Hospital and Medical College, Islamabad for the duration of six months from January 2021 to June 2021. Methods: 220 adult patients &gt;18 years of age with type-II diabetes mellitus were included. Patients with conditions such as liver cirrhosis, systemic infection, pregnant females, end-stage renal disease and those who were not observing diabetes treatment, counting exercise, dietary restrictions and medication, they were omitted from the anlaysis. By evaluating medical records; the patient’s demographic information was obtained which includes medical history, patient age, clinical history, gender, hypertension and type of DM in addition to the assessment of blood sugar level control. Statistical analysis was performed by using the SPSS 20.0. Results: The patients mean age was 58.10 ± 10.94 years with 35-80 years of age range. Of 220 patients, 145 (65.9%) had hypertension and 75 (34.1%) had normal blood pressure, and 7.72 ± 1.28 years was the patient’s mean duration of hypertension. The males have the HbA1c levels of 7.11 ±1.34 and 7.81 ±1.58 in females. In the hypertensive group of patients; mean HbA1c was higher significantly in comparison to the normal blood pressure group (p = 0.003). The HbA1c mean levels were also higher significantly among hypertensive patients with duration for over ten years (p = 0.04) and in subjects using diuretics (p = 0.03) and beta-blockers (p = 0.006) as an antihypertensive drug. Among patients with normal body mass index and nutritional recommendations, the mean (± SD) HbA1c in patients with hypertension was 5.13 ± 0.03 compared with patients with normal blood pressure (p = 0.00007). Conclusions: The control of Glycemia in type II diabetic patients is poor with hypertension. There is a complex relation of various factors, including gender, age, hypertension duration, and drugs that strongly effect control of glycemia among hypertensive patients and type-II diabetes mellitus. Keywords: Hypertension, Type 2 diabetes, HbA1c

Sodium-Glucose Cotransporter-2 Inhibitor and Glucagon-Like Peptide-1 Receptor Agonist Combination Therapy in Type 2 Diabetes: Protocol for a Kidney End Points Real-world Study (COMBi-KID Study).

BackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are both considered to be part of standard care in the management of glycemia in type 2 diabetes. Recent trial evidence has indicated benefits on primary kidney end points for individual drugs within each medication class. Despite the potential benefits of combining SGLT2is and GLP-1RAs for glycemia management, according to national and international guideline recommendations, there is currently limited data on kidney end points for this drug combination.ObjectiveThe aims of the study are to assess the real-world effects of combination SGLT2i and GLP-1RA therapies for diabetes management on kidney end points, glycemic control, and weight in people with type 2 diabetes who are being treated with renin-angiotensin system blockade medication.MethodsThis retrospective cohort study will use the electronic health records of people with type 2 diabetes that are registered with general practices covering over 15 million people in England and Wales and are included in the Oxford-Royal College of General Practitioners Research and Surveillance Centre network. A propensity score–matched cohort of prevalent new users of SGLT2is and GLP-1RAs and those who have been prescribed SGLT2is and GLP-1RAs in combination will be identified. They will be matched based on drug histories, comorbidities, and demographics. A repeated-measures, multilevel, linear regression analysis will be performed to compare the mean change (from baseline) in estimated glomerular filtration rate at 12 and 24 months between those who switched to combined therapy and those continuing monotherapy with an SGLT2i or GLP-1RA. The secondary end points will be albuminuria, serum creatinine level, glycated hemoglobin level, and BMI. These will also be assessed for change at the 12- and 24-month follow-ups.ResultsThe study is due to commence in March 2022 and is expected to be complete by September 2022.ConclusionsOur study will be the first to assess the impact of combination SGLT2i and GLP-1RA therapy in type 2 diabetes on primary kidney end points from a real-world perspective.International Registered Report Identifier (IRRID)PRR1-10.2196/34206

Influence of resistant starch resulting from the cooling of rice on postprandial glycemia in type 1 diabetes

IntroductionCarbohydrates are one of the macronutrients which have the most substantial influence on glycemic response. The cooling of rice after cooking causes retrogradation of starch, which becomes a non-absorbable product in the human digestive tract.Aim of the studyThis study aimed to assess whether cooling of rice affects postprandial glycemia in subjects with type 1 diabetes.Materials and methodsThe study included 32 patients with type 1 diabetes. Each participant of the study consumed two standardized test meals consisting of long-grain white rice. One of the test meals was served immediately after preparation, and another was cooled for 24 h at 4 °C after preparation and reheated before being served. Postprandial glycemia was measured for 3 h using the FreeStyle Libre flash glucose monitoring system for each patient.ResultsAfter consumption of the test meal containing rice subjected to the cooling process when compared to fresh rice, a significantly lower value of maximum glycemia (11 vs. 9.9 mmol/L, p = 0.0056), maximum glycemic increase (2.7 vs. 3.9 mmol/L, p < 0.0001), areas under the glycemic curve (135 vs. 336 mmol/L * 180 min, p < 0.0001) and significantly shorter time to peak (35 vs. 45 min, p = 0.031) was observed. There was a significantly higher number of hypoglycemic episodes among the patients after consuming test meals with cooled rice compared to fresh ones during 180 min of observation (12(38) vs. 3(9), p = 0.0039).ConclusionsConsumption of rice subjected to the cooling process results in a lower increase of postprandial blood glucose in subjects with type 1 diabetes. At the same time it increases the risk of postprandial hypoglycemia using a standard insulin dose.

Evaluating the Interrelationship Between Salivary Cortisol and Glycemia in Type 2 Diabetics

Introduction: Diabetes mellitus is a multifactorial metabolic condition marked by high blood sugar levels as well as problems with carbohydrate, lipid, and protein metabolism. Impaired insulin secretion and hepatic gluconeogenesis cause high blood sugar levels. Cortisol in the saliva is the unbound, free hormone, with absolute quantities between 30% and 50% fewer than in blood. The aim of the study was to evaluate the levels of salivary cortisol in normal healthy controls and type 2 diabetics. The objective was to evaluate the morning and evening levels of salivary cortisol in normal and type 2 diabetics by enzyme-linked immunosorbent assay (ELISA). Materials and Methods: 20 patients in the age group of 30 to 60 years with type 2 diabetes with HbA1c <6.5% were included in Group I. Twenty participants in the age group of 30 to 60 years were included in Group II. Salivary samples were collected and centrifuged at –4°C at 3500 rpm and ELISA was performed. Data were analyzed using Statistical Package for the Social Sciences version software version 16. Paired sample t test was used. Results: The mean morning salivary cortisol level of diabetic patients (Group I) was 1.62 mmol/dL and the evening was 1.34 mmol/dL. The difference was statistically significant (P = 0.00001). The mean salivary cortisol level of healthy subjects in the morning was 0.47 mmol/dL and evening was 0.29 mmol/dL, which is statistically significant (P = 0.00001). Conclusion: From this study, we can conclude that the salivary cortisol level is increased in patients with type 2 diabetes when compared to healthy individuals. There are no obvious changes in morning and evening salivary cortisol levels of diabetes patients.

Investigating the Role of EPA and DHA on Cellular Oxidative Stress; Profiling Antidiabetic and Antihypertensive Potential.

Polyunsaturated fatty acids (PUFAs) remain part of the diet and are essential for growth and development. Furthermore, omega - 3 fatty acids boost various cardiovascular disease risk factors as well as lower blood pressure and cholesterol levels. The effects of PUFAs on glycemia in type 2 diabetes patients are unclear. In the present study, the anti-diabetic and anti-hypertensive potential of eicosapentenoic acid (EPA) and docosahexaenoic acid (DHA)-two polyunsaturated fatty acids-were examined. Using 3T3-L1 pre-adipocyte cells fed with PUFAs, the antioxidant capacity of EPA and DHA was assessed using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay/test. The DPPH activity of EPA and DHA was 49.72 and 50.51%, respectively, indicating a reduction in oxidative stress. The number, size, and total lipid content of adipocytes in adipose tissue were used to study the anti-diabetic effect of EPA and DHA. Both PUFAs were revealed to have a much lower capacity for cell lysis of 3T3-L1 pre-adipocytes when compared to propylene glycol monomethyl ether acetate (PMA). In 3T3-L1 pre-adipocyte cells that had been treated with EPA and DHA, the gene expression profiles for ATP synthase 6 were examined. The results demonstrated a similar trend of reducing total lipid content in 3T3-L1 pre-adipocyte cells treated with EPA and DHA. The amount of cell lysis was then examined for 3T3-L1 pre-adipocyte cells exposed to DHA and EPA, and the results showed 38.45% and 41.26%, respectively. In the 3T3-L1 pre-adipocyte cells, treatment with PUFAs, EPA, and DHA dramatically lowered total lipid content after 48 hours. The study also revealed that exposing 3T3-L1 pre-adipocyte cells to EPA at 90 g/ml for 48 hours reduced the total lipid content by a significant amount. According to the findings, EPA and DHA therapy reversed oxidative stress in mitochondria and upregulated the ATP synthase 6 gene. This discovery shows how EPA and DHA have anti-diabetic and hypertension properties.

Photoacoustic spectroscopy allows to make correlations between blood p450 cytochrome and glycemia in type 1 experimental diabetes

Diabetes is the eight-cause death worldwide. The cause of death of patients with diabetes is mostly the long-term complications, that are not easy to detect opportunely. In previous studies, we applied photoacoustic spectroscopy (PAS), a non-destructive technique, to detect several components of blood. The goal of the study was to apply the phase-resolved method (PRM), on blood optical absorption spectra obtained by PAS, to analyse blood components in experimental type 1 diabetes. Diabetes was produced in male Wistar rats through the administrations of streptozotocin (STZ). Venous blood samples were obtained one, two, four and eight weeks after STZ. PRM applied to spectra allowed to detect p450 cytochrome. There was a significant and positive correlation between glycaemia and p450 cytochrome (p=0.001). Since p450 cytochrome participates in detoxification function, results indicate that glycaemia could affect detoxification. It will be important in future studies to study the implications of those results on the development of diabetes complications. The novelty of the study was to use PAS to find out if there was any correlation between spectroscopy variables and glycaemia. It is concluded that PRM applied to PAS is a suitable technology to study p450 cytochrome in diabetes.

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus—beyond dietary patterns: a narrative review

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

Phenotypes of high-density lipoprotein cholesterol and their relationship with glycemic status in type 2 diabetic patients

Background: There are varying reports on the association of high-density lipoprotein cholesterol (HDL-C) phenotypes and glycemia in type 2 diabetes mellitus (T2D) patients. Such information is lacking in Nigerian data. Aim: The aim of this study was to determine the relationship between HDL-C phenotypes and glycemic control in T2D patients. Materials and Methods: Clinical and laboratory data were collected from consenting T2D patients. Information was managed and analyzed with appropriate software. Results: Four hundred T2D patients consisting of 235 and 165 persons with and without poor glycemic control, respectively, were recruited for this study. There was a significant negative correlation between glycosylated hemoglobin (HbA1c) and the HDL2-C phenotype (rs = −0.12, P = 0.01). The correlation between HbA1c and the HDL3-C phenotype was not statistically significant (rs = −0.06, P = 0.21). Conclusion: The HDL2 phenotype has a stronger correlation with glycemic status than the HDL3 phenotype in T2D patients.

A Comparison of Feature Selection and Forecasting Machine Learning Algorithms for Predicting Glycaemia in Type 1 Diabetes Mellitus

Type 1 diabetes mellitus (DM1) is a metabolic disease derived from falls in pancreatic insulin production resulting in chronic hyperglycemia. DM1 subjects usually have to undertake a number of assessments of blood glucose levels every day, employing capillary glucometers for the monitoring of blood glucose dynamics. In recent years, advances in technology have allowed for the creation of revolutionary biosensors and continuous glucose monitoring (CGM) techniques. This has enabled the monitoring of a subject’s blood glucose level in real time. On the other hand, few attempts have been made to apply machine learning techniques to predicting glycaemia levels, but dealing with a database containing such a high level of variables is problematic. In this sense, to the best of the authors’ knowledge, the issues of proper feature selection (FS)—the stage before applying predictive algorithms—have not been subject to in-depth discussion and comparison in past research when it comes to forecasting glycaemia. Therefore, in order to assess how a proper FS stage could improve the accuracy of the glycaemia forecasted, this work has developed six FS techniques alongside four predictive algorithms, applying them to a full dataset of biomedical features related to glycaemia. These were harvested through a wide-ranging passive monitoring process involving 25 patients with DM1 in practical real-life scenarios. From the obtained results, we affirm that Random Forest (RF) as both predictive algorithm and FS strategy offers the best average performance (Root Median Square Error, RMSE = 18.54 mg/dL) throughout the 12 considered predictive horizons (up to 60 min in steps of 5 min), showing Support Vector Machines (SVM) to have the best accuracy as a forecasting algorithm when considering, in turn, the average of the six FS techniques applied (RMSE = 20.58 mg/dL).

Direct Versus Iterated Multi-Step Forecasting of Glycaemia in Type 1 Diabetics Using Autoregressive Models.

The paper compares two approaches to multi-step ahead glycaemia forecasting. While the direct approach uses a different model for each number of steps ahead, the iterative approach applies one one-step ahead model iteratively. Although it is well known that the iterative approach suffers from the error accumulation problem, there are no clear outcomes supporting a proper choice between those two methods. This paper provides such comparison for different ARX models and shows that the iterative approach outperformed the direct method for one-hour ahead (12-steps ahead) forecasting. Moreover, the classical linear ARX model outperformed more complex non-linear versions for training data covering one-month period.

894-P: Intermittent Use of Flash Glucose Monitoring (FGM) and Education Improves Glycemia in Type 2 Diabetes (T2D) in Singapore: Pilot Data from Glimpse Project

Limited evidence exists on the use of FGM in people with type 2 diabetes (T2D) on non-prandial insulin therapies. Aim: To study the feasibility of intermittent FGM and education among sub-optimally controlled T2D. Adult T2Ds on any treatment but prandial insulin, HbA1c 7.5-10%, received Freestyle Libre sensor and structured education. Sensor use was continuous for 6 weeks (w), then 2 weekly up to 24w. A blinded sensor was worn at -2w and 24w. n=28, 11 men, mean age 55± 12 y, BMI 27.2 ± 4 kg/m2, 6/28 on basal insulin. Mean HbA1c fell from baseline of 8.5 ± 0.5% to 7.9 ± 0.9% (69 to 63 mmol/mol, p=0.001) and was sustained to 24w (fig 1). SD and TAR (&amp;gt;13.9 mmol/L) showed a trend to improvement (Table 1). Intermittent FGM use with education in T2D showed a sustained improvement in glycemia up to 24 weeks. Disclosure S. Rama Chandran: None. M. Gandhi: None. K. Adaikan: None. N. Tan: None. I.K.Y. Phoon: None. D. Gardner: None. Funding Singapore Ministry of Health (MH34:31/2)

7-LB: Insulin and Glucagon Coadministration in Type 1 Diabetes Prevents Hypoglycemia without Worsening Hyperglycemia

Despite pharmacological and technical advances, risk of hypoglycemia remains the greatest impediment to optimal glycemia in type 1 diabetes (T1D) and there is increasing interest in how the opposing actions of insulin and glucagon (Gn) may be harnessed to optimize glycemic control. We studied T1D subjects (n=11; age 36±4y, gender M:F 5:6, BMI 25.0±0.7 kg/m2, disease duration 23±3y, A1C 7.0±0.3%, daily insulin dose 43±3u) on two occasions, under meal challenge conditions (liquid mixed meal, 100g carbohydrate) during a phased 6h IV regular insulin infusion with (+Gn) and without (-Gn) IV glucagon. On both occasions, subjects were treated overnight with low dose IV insulin prior to the morning meal to prevent antecedent nocturnal hypoglycemia and to attain near-normal fasting glycemia. Insulin dosing was designed to control the early rise in plasma glucose (PG) but also to elicit hypoglycemia in the later phase. During +Gn, glucagon was co-administered with insulin at a fixed molar ratio. At the two visits, fasting PG was similar (-Gn 121±5, +Gn 119±6 mg/dl) and the initial meal-induced PG elevation (0-3h) was indistinguishable whether glucagon was present or not (peak PG -Gn 224±18, +Gn 228±15 mg/dl; ΔPG 0-180AUC -Gn 10501±3014, +Gn 11537±1778 mg.min/dl). During the latter phase (3-6h), 7/11 -Gn subjects experienced an excessive fall in PG to &amp;lt;80mg/dl with 5/11 dropping to 50mg/dl requiring IV glucose rescue (by protocol). During +Gn, the fall in PG was attenuated in all cases with a significant difference observed in PG nadir (-Gn 51.1±4.0, +Gn100.5±11.0 mg/dl; p=0.007). Appropriate elevations in plasma insulin and glucagon were observed in keeping with study design. To conclude, it is feasible that insulin and glucagon can be co-administered under specific conditions allowing protection against insulin-induced hypoglycemia without impeding hyperglycemic control. This unique observation offers insight into novel approaches to glucose control in diabetes. Disclosure B.W. Bode: Advisory Panel; Self; Medtronic, Novo Nordisk A/S. Consultant; Self; Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Abbott, Advance, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., MannKind Corporation, Medtronic, National Institutes of Health, Nova Biomedical, Novo Nordisk A/S, Provention Bio, Inc., Sanofi, Senseonics. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., MannKind Corporation, Medtronic, Novo Nordisk A/S, Sanofi, Senseonics. Stock/Shareholder; Self; Aseko. J. Boyd: None. A. Shah: Consultant; Self; Abvance Therapeutics. Stock/Shareholder; Spouse/Partner; Fractyl Laboratories, Inc. D. Parkes: Consultant; Self; Abvance Therapeutics, Fractyl Laboratories, Inc., Prolynx, ProSciento. S. Ghosh: Consultant; Self; Abvance Therapeutics, Fractyl Laboratories, Inc., Takeda Pharmaceutical Company Limited. A.D. Cherrington: Advisory Panel; Self; Biocon, Fractyl Laboratories, Inc., Metavention, Sekkei Bio, Sensulin, LLC., vTv Therapeutics, Zafgen, Inc. Consultant; Self; Thetis Pharmaceuticals LLC. Research Support; Self; Diasome Pharmaceuticals, Inc. Other Relationship; Self; Abvance Therapeutics, Novo Nordisk Inc.

Optimization of Metformin in the GRADE Cohort: Effect on Glycemia and Body Weight.

We evaluated the effect of optimizing metformin dosing on glycemia and body weight in type 2 diabetes. This was a prespecified analysis of 6,823 participants in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) taking metformin as the sole glucose-lowering drug who completed a 4- to 14-week (mean ± SD 7.9 ± 2.4) run-in in which metformin was adjusted to 2,000 mg/day or a maximally tolerated lower dose. Participants had type 2 diabetes for <10 years and an HbA1c ≥6.8% (51 mmol/mol) while taking ≥500 mg of metformin/day. Participants also received diet and exercise counseling. The primary outcome was the change in HbA1c during run-in. Adjusted for duration of run-in, the mean ± SD change in HbA1c was -0.65 ± 0.02% (-7.1 ± 0.2 mmol/mol) when the dose was increased by ≥1,000 mg/day, -0.48 ± 0.02% (-5.2 ± 0.2 mmol/mol) when the dose was unchanged, and -0.23 ± 0.07% (-2.5 ± 0.8 mmol/mol) when the dose was decreased (n = 2,169, 3,548, and 192, respectively). Higher HbA1c at entry predicted greater reduction in HbA1c (P < 0.001) in univariate and multivariate analyses. Weight loss adjusted for duration of run-in averaged 0.91 ± 0.05 kg in participants who increased metformin by ≥1,000 mg/day (n = 1,894). Optimizing metformin to 2,000 mg/day or a maximally tolerated lower dose combined with emphasis on medication adherence and lifestyle can improve glycemia in type 2 diabetes and HbA1c values ≥6.8% (51 mmol/mol). These findings may help guide efforts to optimize metformin therapy among persons with type 2 diabetes and suboptimal glycemic control.

A Novel Dual-Hormone Insulin-and-Pramlintide Artificial Pancreas for Type 1 Diabetes: A Randomized Controlled Crossover Trial.

The rapid insulin-alone artificial pancreas improves glycemia in type 1 diabetes but daytime control remains suboptimal. We propose two novel dual-hormone artificial pancreas systems. We conducted a randomized crossover trial comparing a rapid insulin-alone artificial pancreas with rapid insulin-and-pramlintide and with regular insulin-and-pramlintide artificial pancreas systems in adults with type 1 diabetes. Participants were assigned to the interventions in random order during three 24-h inpatient visits. Each visit was preceded by an outpatient hormonal open-loop run-in period of 10-14 days. The dual-hormone artificial pancreas delivered pramlintide in a basal-bolus manner, using a novel dosing algorithm, with a fixed ratio relative to insulin. The primary outcome was time in the range 3.9-10.0 mmol/L. Compared with the rapid insulin-alone artificial pancreas system, the rapid insulin-and-pramlintide system increased the time in range from 74% (SD 18%) to 84% (13%) (P = 0.0014), whereas the regular insulin-and-pramlintide system did not change the time in range (69% [19%]; P = 0.22). The increased time in range with the rapid insulin-and-pramlintide system was due to improved daytime control (daytime time in range increased from 63% [23%] to 78% [16%], P = 0.0004). There were 11 (1 per 2.5 days) hypoglycemic events (<3.3 mmol/L with symptoms or <3.0 mmol/L irrespective of symptoms) with the rapid insulin-alone system, compared with 12 (1 per 2.3 days) and 18 (1 per 1.4 days) with the rapid and regular insulin-and-pramlintide systems, respectively. Gastrointestinal symptoms were reported after 0% (0 of 112) of meals with the rapid insulin-alone system, compared with 6% (6 of 108) and 11% (11 of 104) with the rapid and regular insulin-and-pramlintide systems, respectively; none of the symptoms were severe. A novel rapid insulin-and-pramlintide artificial pancreas improves glucose control compared with a rapid insulin-alone artificial pancreas (ClinicalTrials.gov number NCT02814123).