Glycemic Parameters Research Articles

Effectiveness of Probiotic Therapy in the Management of PeriodontalDisease in Diabetic Patients: A Scoping Review.

Probiotics can compete with periodontal pathogens in the formation of dental biofilm, and they are able to modulate local and systemic immune responses. Thus, its use in diabetic patients with periodontal disease (PD) can overcome the limitations of conventional periodontal treatment. This scoping review aimed to understand the extent and type of evidence in relation to the effects of probiotic therapy on periodontal and glycaemic parameters of diabetic patients with PD. An electronic search was performed in the following databases: Cochrane Library, EMBASE, Virtual Health Library (including LILACS and BBO), PubMed (including Medline), Scopus, Web of Science, and Google Scholar. The review included clinical trials on patients with type 2 diabetes, diagnosed with gingivitis or periodontitis, who received probiotic therapy as a single therapy or adjuvant to scaling and root planning, and on whom the analyses of clinical periodontal, immunological, microbiological, or glycaemic parameters were performed. The electronic search yielded a total of 1165 articles. After removing duplicate titles and performing systematic screening, 6 studies were included in the qualitative summary. Probiotic administration improved clinical periodontal parameters (bleeding on probing and probing depth), oxidative stress markers, and inflammatory cytokines (IL-8, IL-10, and TNF-α) in relation to control groups. Experimental groups were also more advantageous in reducing the frequency of periodontopathogenic bacteria. However, the evidence of probiotics in decreasing glycated hemoglobin is still uncertain. Probiotics may provide safe additional benefits to periodontal parameters of patients with type 2 diabetes and periodontal disease.

Роль самоконтроля гликемии у подростков с сахарным диабетом 1-го типа: клинический разбор

Type 1 diabetes mellitus (dm) is a disease characterized by chronic hyperglycemia and the development and progression of severe microvascular complications. The results of the AdVAnce, Accord and VAdT large-scale research studies have definitely proved that glycemic control plays a role in prevention of the dm microvascular complications. A number of studies have shown that glycemic variability parameters play a separate role in prediction of diabetic retinopathy, nephropathy and cardiovascular complications. Adolescents with type 1 dm are characterized by the labile disease course and the tendency to develop hypoglycemia and ketoacidosis. modern approach to type 1 dm management, especially in adolescents, includes the need for mandatory self-monitoring of blood glucose (BG). Adolescents with type 1 dm are unable to achieve target glucose levels themselves at home without BG monitoring. Glycemic control in type 1 dm should be accurate, simple and convenient, allowing patients to adjust insulin therapy for dm on their own. Selection of BG monitor is one of the main aspects of self-monitoring of BG. From the doctor's point of view, compliance with accuracy standards is the most important criterion for choosing the glucose meter, while from the patient’s perspective it is convenience and ease of use. With improvements in technology, the accuracy of BG measurement increases, the self-monitoring of BG procedure gets simpler, which results in higher adherence to treatment and treatment efficacy. It is impossible to achieve and maintain target BG levels without active full-fledged participation of patient with type 1 dm, self-monitoring of BG using the advanced, accurate and convenient for patient glucose meter, such as contour Plus one.

A systematic review, meta-analysis, dose-response, and meta-regression of the effects of acarbose intake on glycemic markers in adults.

Prior research has yielded mixed results regarding the impact of acarbose intake on glycemic markers. To provide a more comprehensive analysis, a systematic review and meta-analysis was performed to compile data from various randomized controlled trials (RCTs) examining the effects of acarbose intake on fasting blood sugar (FBS), insulin, hemoglobin A1C (HbA1c), and homeostasis model assessment of insulin resistance (HOMA-IR) in adults. To identify relevant literature up to April 2023, a comprehensive search was conducted on various scholarly databases, including PubMed, Web of Science, and Scopus databases. The effect size of the studies was evaluated using a random-effects model to calculate the weighted mean differences (WMD) and 95% confidence intervals (CI). Heterogeneity between studies was assessed using Cochran's Q test and I2. This systematic review and meta-analysis included a total of 101 RCTs with a total of 107 effect sizes. The effect sizes for FBS in milligrams per deciliter (mg/dl), insulin in picomoles per liter (pmol/l), hemoglobin A1C (HbA1c) in percentage (%), and homeostasis model assessment of insulin resistance (HOMA-IR) were 92, 46, 80, and 22, respectively. The pooled analysis indicated that acarbose intake resulted in significant decreases in FBS (p = 0.018), insulin (p < 0.001), HbA1c (p < 0.001), and HOMA-IR (p < 0.001). The findings of this systematic review and meta-analysis suggest that acarbose intake can potentially lead to significant improvements in glycemic parameters by decreasing the levels of FBS, HbA1c, and insulin. However, larger and more rigorously designed studies are still needed to further evaluate and strengthen this association.

Serum neuregulin 1 in relation to ventricular function and subclinical atherosclerosis in type 2 diabetes patients

Background and aimsNeuregulin 1 (NRG-1) is one of the members of the epidermal growth factors proteins. The present study provides novel insights into the relationship between serum levels of NRG-1 and insulin resistance, subclinical atherosclerosis and cardiac dysfunction that occur in type 2 diabetes (T2D). MethodsThe study included 50 patients with T2D and 40 healthy age- and gender-matched controls. Serum NRG-1 was measured using ELISA. Glycemic parameters, lipid profile and insulin resistance were assessed. Trans-thoracic echocardiography and carotid intima media thickness (CIMT) were studied for all study subjects. ResultsT2D patients had significantly lower serum NRG-1 levels than controls. Serum NRG-1 was negatively correlated with age, fasting blood glucose, HbA1c, insulin resistance, blood urea, serum creatinine and LDL-C, and positively correlated with HDL-C, eGFR and CIMT. Regarding echocardiographic variables, serum NRG-1 was found to correlate positively with left ventricular global longitudinal strain and negatively with E/Ea ratio. NRG-1 was found to predict subclinical atherosclerosis in type 2 diabetes patients at a cut-off value<108.5pg/ml with 78% sensitivity and 80% specificity. ConclusionsA robust relationship was found between serum NRG-1 levels and hyperglycemia, insulin resistance, subclinical atherosclerosis, and cardiac dysfunction in patients with type 2 diabetes. These results shed light on a possible role of NRG-1 as a potential noninvasive biomarker for detection of cardiometabolic risk in T2D.

The Effect of COVID-19 on Type 1 Diabetes Occurrence among Children and Adolescents: A Multicenter Prospective Observational Cohort Study in Israel

Aim. The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pediatric occurrence of type 1 diabetes (T1D) is inconclusive. We aimed to assess associations between seroprevalences of the distinct anti-SARS-CoV-2 antibodies and T1D occurrence in children and adolescents. Methods. This multicenter prospective observational cohort comprised children diagnosed with T1D between October 2020 and July 2022 and unrelated children who performed endocrine tests (control group) in a 1 : 3 ratio. Anti-SARS-CoV-2 antibodies, including anti-S, anti-N, and neutralizing antibodies, were assessed in each group. Results. The cohort included 51 children with T1D and 182 children in the control group. The median (interquartile range) age was 11.4 (8.2, 13.3) years, with 45% being female. Increases were not observed in the seroprevalence of any of the anti-SARS-CoV-2 antibodies among the children with new-onset T1D compared to the control group. Among the T1D group, anti-S seroprevalence was higher among those without diabetic ketoacidosis (DKA) than in those with DKA upon T1D diagnosis (72% vs. 42%, p = 0.035 ). After adjustment to vaccination status, this difference was not statistically significant. Additionally, anti-N antibodies and neutralizing antibodies did not differ between the DKA and the non-DKA groups. None of the anti-SARS-CoV-2 antibodies were associated with any of the glycemic parameters. Conclusions. This study is the first to assess several distinct anti-SARS-CoV-2 antibodies in new-onset T1D, and our findings do not support an association between SARS-CoV-2 infection and the occurrence of T1D in children and adolescents. Since autoimmunity may emerge years after a viral infection, we recommend conducting follow-up epidemiological studies to assess whether there is a change in the incidence of T1D following the SARS-CoV-2 pandemic.

The effect of oral probiotics on glycemic control of women with gestational diabetes mellitus—a multicenter, randomized, double-blind, placebo-controlled trial

Gestational diabetes mellitus should be treated adequately to avoid maternal hyperglycemia-related complications. Previously, probiotic supplements were suggested to improve fasting blood glucose in women with gestational diabetes mellitus. However, a major limitation of previous studies was that preprandial and especially postprandial glucose values, which are important predictors of pregnancy outcomes, were not studied. This study aimed to examine the effect of a mixture of probiotic strains on maternal glycemic parameters, particularly preprandial and postprandial glucose values and pregnancy outcomes among women with gestational diabetes mellitus. A multicenter prospective randomized, double-blind, placebo-controlled trial was conducted. Women newly diagnosed with gestational diabetes mellitus were randomly allocated into a research group, receiving 2 capsules of oral probiotic formula containing Bifidobacterium bifidum, B lactis, Lactobacillus acidophilus, L paracasei, L rhamnosus, and Streptococcus thermophilus (>6 × 109/capsule), and a control group, receiving a placebo (2 capsules/day) until delivery. Glycemic control was evaluated by daily glucose charts. After 2 weeks, pharmacotherapy was started in case of poor glycemic control. The primary outcomes were the rate of women requiring medications for glycemic control and mean daily glucose charts after 2 weeks of treatment with the study products. Forty-one and 44 women were analyzed in the treatment and placebo cohorts, respectively. Mean daily glucose during the first 2 weeks in the probiotics and placebo groups was 99.7±7.9 and 98.0±9.3 mg/dL, respectively (P=.35). The rate of women needing pharmacotherapy because of poor glycemic control after 2 weeks of treatment in the probiotics and placebo groups was 24 (59%) and 18 (41%), respectively (P=.10). Mean preprandial and postprandial glucose levels throughout the study period were similar between the groups (P>.05). There were no differences in maternal and neonatal outcomes, including birthweight and adverse effect profile between the groups. The oral probiotic product tested in this study did not affect glycemic control of women with gestational diabetes mellitus.

Efficacy, safety, and patient satisfaction with oral semaglutide: first single-centre clinical experience.

To explore the effects of oral semaglutide on glycaemic parameters, body weight, and satisfaction in the first recipient patients with type 2 diabetes mellitus in Slovenia, in a real-world clinical practice setting. The first consecutive adult patients with type 2 diabetes who were eligible for oral semaglutide treatment were included in this prospective, open-label interventional study. Patients received increasing doses of oral semaglutide and were evaluated at inclusion, at 1 month, then 3-5 months after starting treatment. Fasting blood glucose, glycosylated haemoglobin (HbA1c), body weight, patient satisfaction with oral semaglutide treatment (using the validated Treatment Satisfaction Questionnaire for Medication), and adverse effects, were analysed. Statistical analyses were performed using one-way analysis of variance, and, when significant interactions were found, Bonferroni post-hoc test. A P-value <0.05 was considered statistically significant. Twenty patients (11 male: 9 female; mean age, 59.9 ± 1.5 years; mean diabetes duration, 8.5 ± 1.4 years) were included. Oral semaglutide (7 and 14 mg) significantly decreased HbA1c (from 9.4 ± 0.3% to 8.2 ± 0.2% and 7.8 ± 0.2%, respectively) and fasting plasma glucose (from 11.2 ± 0.5 mmol/L to 9.2 ± 0.7 mmol/L and 8.9 ± 0.4 mmol/L, respectively). Oral semaglutide (14 mg) significantly decreased body weight (from 100.9 ± 2.7 kg to 92.7 ± 2.4 kg). Patients reported that treatment was easy to use and expressed high global satisfaction. Mild and transient, mostly gastrointestinal, adverse effects were reported in 10 patients. Oral semaglutide, the first oral glucagon-like peptide 1 receptor agonist, was effective and safe, and associated with high patient satisfaction, in its first recipients in Slovenia. The results are important for daily clinical practice involving patients with type 2 diabetes, however, due to the small study population, lack of placebo control, and short exposure to oral semaglutide, the effectiveness of oral semaglutide in clinical practice requires further investigation.

Study of neuregulin-4 levels in newly diagnosed type 2 diabetes mellitus.

Neuregulin-4 is a recently recognized adipokine acting as ligands to tyrosine kinases receptor of the Erb B family. This adipose tissue augmented endocrine factor participates in the modulation of lipid and glucose metabolism and energy homeostasis. This novel adipokine is associated with insulin resistance, dyslipidemia, obesity, oxidative stress, and inflammation. The study aimed to compare plasma levels of neuregulin-4 in newly diagnosed type 2 diabetes mellitus as compared to matched controls and to correlate with glycemic and lipid parameters. 100 newly diagnosed T2DM patients and 100 age, sex, and BMI-matched controls after fulfilling all exclusion and inclusion criteria were included in the study. Fasting and postprandial blood glucose levels, glycated hemoglobin (HbA1c), and fasting plasma insulin levels were measured in both cases and controls. HOMA-IR values in both groups were calculated using fasting glucose and insulin levels. Mean levels of plasma neuregulin-4(pg/mL) in newly diagnosed T2DM were 7949.76 ± 949.76) pg/ml, which was significantly lower as compared to 9143 ±949.76) pg/ml in the control group (P-value <.0001). In the present study, a significant negative correlation was seen between plasma neuregulin-4 (pg/mL) with fasting blood sugar, postprandial blood sugar, HbA1C, and HOMA-IR with a correlation coefficient of -0.303, -0.416, -0.433, and -0.514, respectively. Moreover, a significant positive correlation was seen between plasma neuregulin-4 (pg/mL) with HDL with a correlation coefficient of 0.216. A significant negative correlation was seen between plasma neuregulin-4 (pg/mL) and LDL, with a correlation coefficient -0.208. Neuregulin levels are significantly lower in diabetics as compared to controls. There levels correlated inversely with HbA1C and HOMA IR.

Glycemic control parameters in children with type 1 diabetes treated with fast-acting insulin aspart domestic biosimilar by continuous subcutaneous infusion

Introduction. Type 1 diabetes (T1D) is a chronic autoimmune disease requiring constant insulin therapy under regular continuous monitoring of glycemic parameters. The use of domestic insulin bioanalogues in CSII therapy is currently not sufficiently covered in the literature.Aim. To evaluate glycemic control parameters in children with T1D treated with the domestic fast-acting insulin aspart biosimilar by CSII.Materials and methods. Retrospective study was carried out on the basis of K.A. Raukhfus center St. Petersburg State Medical and Biomedical Center VMT. Fifty-five children with T1D aged 6 to 17 years (mean age 12 ± 4) were examined, including 29 boys (52.7%, mean age 11 ± 3 years) and 26 girls (47.3%, mean age 13 ± 4 years). Insulin therapy was carried out by systems of CSII Glycemic parameters were monitored by continuous and flash glycemic monitoring systems. The center visits frequency was once a month.Results. During dynamic follow-up after 3 and 6 months, children showed statistically significant (p &lt; 0.05) improvement in glycemic control parameters–decrease in HbA1c level from 8.0 ± 1.8% to 7, 1 ± 1.2% and 6.8 ± 0.6%, increase in TIR from 60.4 ± 20.6% to 71.5 ± 13.0% and 75.9 ± 9.4%, decrease in TAR from 31.1 ± 22.1% to 23.0 ± 12.8% and 20.3 ± 9.3%, decrease in TBR from 9.1 ± 8.2% to 5.8 ± 4.3% and 4.1 ± 1.8%, and decrease in CV from 40.0 ± 9.1% to 33.7 ± 6.7% and 32.5 ± 5.6%.Discussion. The use of domestic biosimilar insulin aspart in insulin pumps iis associated with significant improvement in glycemic control in children and adolescents with T1D. Dynamic observation together with therapeutic education contribute to the maintenance of the achieved parameters at a high level.Conclusions. Therapy with the domestic fast-acting insulin aspart biosimilar by CSII allows achieving target glycemic control in children with T1D.

Динамическая оценка параметров гликемии у госпитализированных пациентов с COVID-19

В статье представлены результаты собственных исследований клинико-анамнестических и лабораторных параметров у пациентов с тяжелым течением COVID-19, а также динамическое определение гликемического статуса через 6 месяцев после выписки из стационара с целью выявления возможных предикторов неблагоприятного исхода и оценки прогноза развития нарушения толерантности к углеводам и сахарного диабета. Выполнен ретроспективный анализ клинико-анамнестических и лабораторных параметров 320 пациентов, которые получали медицинскую помощь в условиях отделения интенсивной терапии и реанимации инфекционного стационара г. Минска в период с июня 2020 г. по март 2022 г., а также проведено уточнение гликемического статуса пациентов через 6 месяцев после выписки. У пациентов с госпитальной гипергликемией и сахарным диабетом отмечались более высокие уровни СОЭ, прокальцитонина, СРБ, ЛДГ, нейтрофилов, более выраженная лимфопения, что свидетельствовало о более выраженном воспалительном процессе; также параметры Д-димеров как маркеров коагуляции были выше в указанных группах. Согласно полученным результатам, 70% пациентов с тяжелым течением COVID-19 имели впервые выявленную гипергликемию. Спустя 6 месяцев у 10,3% пациентов отмечены повышенные уровни глюкозы сыворотки крови, что было реклассифицировано в нарушение толерантности к углеводам в 7,5% случаев (3,4% женщин vs. 4,1% мужчин) и у 2,8% пациентов установлен диагноз «сахарный диабет» (0,7% женщин vs. 2,1% мужчин). The own studies result of clinical, anamnestic and laboratory parameters in patients with severe COVID-19 is presented in the article, as well as a dynamic determination of glycemic status in 6 months outpatient state in order to identify possible predictors of an unfavorable outcome and assess the prognosis for the development of impaired tolerance to glucose and diabetes mellitus. A retrospective analysis of clinical, anamnestic and laboratory parameters of 320 patients who received medical care in the intensive care unit of an infectious hospital in Minsk from June 2020 to March 2022 was performed, and the glycemic status of patients was clarified 6 months after discharge. Patients with hospital hyperglycemia and diabetes mellitus had higher levels of ESR, procalcitonin, CRP, LDH, neutrophils, and more pronounced lymphopenia, which indicated a more pronounced inflammatory process; also, the parameters of D-dimers as markers of coagulation were higher in these groups. According to the results obtained, 70% of patients with severe COVID-19 glucose intolerance in 7.5% of cases (3.4% women vs. 4.1% men) and 2.8% of patients were diagnosed with diabetes mellitus (0.7% of women vs. 2.1% of men).

Effectiveness of Dapagliflozin as Add-On to Metformin with or without Other Oral Antidiabetic Drugs in Type 2 Diabetes Mellitus: A Multicentre, Retrospective, Real-World Database Study.

Real-world Indian studies evaluating effectiveness of dapagliflozin as an add-on to other oral antidiabetic drugs (OAD) in patients with type 2 diabetes mellitus (DM) are scarce. An electronic medical record (EMR)-based, retrospective, multicentre study was conducted to evaluate the effectiveness of dapagliflozin as add-on therapy in adult patients with inadequately controlled DM on metformin with or without other OAD. Baseline characteristics (visit 1: metformin or metformin plus OAD treatment for at least 30 days) and treatment-related outcomes (visit 2: follow-up) considered between 60 and 140 days after adding/switching dapagliflozin [glycated haemoglobin (HbA1c), body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP)] were analysed. A total of 3616 patients were screened from 478 centres. Most patients had received dapagliflozin(D)+metformin(M)+at least one other OAD [D+M+OAD, n=2907 (80.4%), 408 followed-up with HbA1c reported], while 709 patients (19.6%, 138 followed-up with HbA1c reported) received dapagliflozin+metformin (D + M). Treatment with dapagliflozin as an add-on therapy resulted in significant change in HbA1c (-1.1 ± 1.44%; p < 0.05 for HbA1c subgroup ≥7.5%; -1.6±1.41%; p < 0.05 for HbA1c subgroup ≥8%) at visit 2 compared with visit 1. Significant change in body weight (-1.4±3.31 kg; p < 0.05 for HbA1c subgroup ≥7.5%; -1.5±3.22kg; p < 0.05 for HbA1c subgroup ≥8%) was observed at visit 2. Similarly, a significant change in BMI was noted for the HbA1c subgroup ≥7.5% (-1.0±8.38 kg/m2). However, the change in BMI in the HbA1c subgroup ≥8% was noted to be -1.4±10.4 kg/m2, which was not statistically significant (p=0.08). In the overall study population, significant change in the SBP (-4.5±14.9mmHg; p < 0.05 for HbA1c subgroup ≥7.5%; -4.5±15.1 mmHg; p < 0.0001 for HbA1c subgroup ≥8%) was observed at visit 2 compared with visit 1. On identical lines, significant change in DBP (-1.5±8.94 mmHg; p < 0.05 for HbA1c subgroup ≥7.5%; -1.4±8.91mmHg; p < 0.05 for HbA1c subgroup ≥8%) was noted. Dapagliflozin showed significant improvement in glycemic parameter, BMI and BP when added to metformin, with or without other OADs in a real-world scenario.

Intermediate Monocytes and Circulating Endothelial Cells: Interplay with Severity of Atherosclerosis in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus.

The aim was to investigate the association of monocyte heterogeneity and presence of circulating endothelial cells with the severity of coronary atherosclerosis in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). We recruited 62 patients with CAD, including 22 patients with DM2. The severity of atherosclerosis was evaluated using Gensini Score. Numbers of classical (CD14++CD16-), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) monocyte subsets; circulating endothelial progenitor cells; and the presence of circulating endothelial cells were evaluated. Counts and frequencies of intermediate monocytes, but not glycaemia parameters, were associated with the severity of atherosclerosis in diabetic CAD patients (rs = 0.689; p = 0.001 and rs = 0.632; p = 0.002, respectively). Frequency of Tie2+ cells was lower in classical than in non-classical monocytes in CAD patients (p = 0.007), while in patients with association of CAD and T2DM, differences between Tie2+ monocytes subsets disappeared (p = 0.080). Circulating endothelial cells were determined in 100% of CAD+T2DM patients, and counts of CD14++CD16+ monocytes and concentration of TGF-β predicted the presence of circulating endothelial cells (sensitivity 92.3%; specificity 90.9%; AUC = 0.930). Thus, intermediate monocytes represent one of the key determinants of the appearance of circulating endothelial cells in all the patients with CAD, but are associated with the severity of atherosclerosis only in patients with association of CAD and T2DM.

Serum Oxidative Status in People with Obesity: Relation to Tissue Losses, Glucose Levels, and Weight Reduction.

This work aims to study the effect of reductions in various body mass components on the oxidative, glycemic, and lipid parameters of people with obesity (PWO). A total of 53 PWO underwent a six-month individualized low-calorie diet combined with moderate exercise, during which anthropometric, biochemical, and oxidative parameters were measured. Probands were divided into groups based on weight, visceral fat area (VFA), total body water (TBW), and skeletal muscle mass (SMM) losses. Weight reduction normalizes glycemia, but VFA reduction is less pronounced, while SMM and TBW reductions are more pronounced in patients with higher initial concentrations of glucose and fructosamine. Moreover, changes in oxidative parameters correlate with changes in glucose. Weight loss, regardless of the reduced tissue, decreases cardiovascular risk. We observed a significant change in almost all parameters related to the redox state. In general, parameters responsible for antioxidant action improved, and markers of oxidative damage decreased. Malondialdehyde, lipid peroxides, and total oxidative status levels can be considered biomarkers reflecting only the current severity of reactive oxygen species genesis processes. When considering the glycemic state, the results are not as clear due to the substantial differences between normoglycemic and hyperglycemic patients. Glycemic status is a factor playing a crucial role in weight reduction.

Effect of Postmeal Fast-Acting Insulin Aspart Injection on the Frequency of Hypoglycemia among Pre-School Children with Type 1 Diabetes: An Open-Label, Cross-Over, Randomized Control Trial.

To study the effect of postmeal Fast-acting insulin Aspart (Fiasp®) on the frequency of hypoglycemia compared to premeal injection among preschool children with type 1 diabetes. A single-center trial was conducted among 65 pre-school children (6 mo to 6 y) with Type 1 diabetes for at least 6 mo, on multiple daily insulin injections. Children were randomized to receive their meal bolus postmeal or premeal for the first 3 mo, followed by cross-over at 3 mo. The two groups were compared at the end of 6 mo for the change in frequency of hypoglycemia and hyperglycemia, HbA1c, glycemic variability, and parental satisfaction. Ten children (5 in each group) underwent pharmacokinetic studies. The trial was approved by Institutional Ethics Committee and registered with the Controlled Trial Registry of India vide no CTRI/2020/10/028750. Fifty-four children completed the study, with 27 children in each group. There were no significant differences in the frequency of clinical (p = 0.921), severe (p = 0.167) or serious (p = 0.753) hypoglycemia in the two groups. There were no differences in secondary outcome parameters and pharmacokinetics. The premeal or postmeal injection ofFiasp® does not affect the frequency of hypoglycemia or other glycemic control parameters among pre-school children with Type 1 diabetes. The trial is registered with the Controlled Trial Registry of India vide no CTRI/2020/10/028750.

The role of herbal teas in reducing the starch digestibility of cooked rice (Oryza sativa L.): An in vitro co-digestion study

Herbal teas are well known for their antidiabetic effects due to the abundance of phenolic acids, flavonoids, and tannins. An in vitro co-digestion test was conducted to observe influence of herbal teas (HTs) i.e., beal fruit (BA), mulberry leaf (MB), gymnema leaf (GM), and chrysanthemum flower (CS) on starch digestibility of cooked rice and to elucidate correlation analysis of phytochemicals and their antioxidant activities during in vitro starch hydrolysis (SH). HTs prepared from GM and MB showed highest reduction of SH, kinetic constant and estimated glycemic index (eGI) of cooked rice, followed by BA and CS. Besides, MB and GM teas decreased the eGI of cooked rice up to 15%, followed by BA and CS teas, respectively. Phytochemicals and their antioxidant activities were positively correlated to SH, with both parameters displaying a higher decrease in intestinal phase when compared to gastric phase during in vitro co-digestion. These results indicate a strong interaction among phytochemicals and α-amylase in influencing glycaemic parameters. Thus, HTs has the potential to provide functional health benefits in lowering postprandrial hyperglycemia.

Intermittent fasting in the management of diabetes: a review of glycemic control and safety.

Intermittent fasting (IF) regimens have emerged as a dietary tool to improve the glycemic profile, but a critical appraisal of clinical studies assessing the effects of IF regimens in patients with diabetes is needed. Thus, this review encompasses clinical studies examining the impact of different IF regimens on markers of glycemic control in patients with diabetes. Furthermore, clinical nuances relative to pharmacological treatment are also addressed, mainly insulin therapy, to discuss the risk of hypoglycemic events. Only a handful of clinical studies have investigated the effects of IF on patients with diabetes. Overall, IF regimens may elicit modest benefits on glycemic parameters in patients with diabetes, but their effects are not necessarily greater than those of control diets. Last, although IF regimens may be considered safe for patients receiving insulin therapy within interventional and observational research, markers of glycemic control must be constantly monitored in clinical practice to reduce the risk of hypoglycemia and its related complications.

Health-related quality of life and its determinants among South Indian type 2 diabetes patients with and without non-alcoholic fatty liver disease

Background and aimsNon-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease in type-2 diabetics. The quality of life among those patients was not explored well. Hence, the present study aimed to correlate the determinants with the quality of life (QoL) among the study subjects.MethodsA hospital-based case–control study was conducted at Bhargavi Gastro and Surgical Hospital, Warangal, Telangana, with 358 subjects, from 1 November 2019 to 31 October 2021 (24 months). A 358 of cohort type-2 diabetes mellitus (T2DM) subjects were recruited with 1:1 of NAFLD and without NAFLD. QoL was determined with the SF-36 questionnaire, which comprises eight domains. Statistical analysis included t test, chi-square, and Spearman correlation performed with SPSSV.25 software.ResultsOut of 358 subjects, 200 (55.8%) were males and 158 (44.1%) were females. Glycemic parameters (FBS and HbA1c), lipid profile, liver transaminases (SGPT and SGOT), and serum uric acid levels were significantly high in NAFLD subjects (p < 0.05). The SF-36 score, four domains (physical, energy, mental health, and pain) are significantly reduced in NAFLD subjects p < 0.05). A significant correlation between blood urea and impaired physical, emotional mental, and general health was observed in NAFLD subjects. In the NAFLD subjects, elevated FBS levels lead to impairment of physical and emotional status. Social functioning, general health, and pain were impaired with BMI and TG levels in NAFLD subjects. The mean, SD of SF-36 scores showed no significant difference in contrast to HbA1c among both groups (p > 0.05).ConclusionThe decreased QoL was observed in subjects of T2DM with NAFLD. The QoL is significantly influenced by elevated FBS, SGPT, SGOT, and TG levels. Hence, clinicians need to be vigilant and implement strategies to improve the quality of life in type 2 diabetics with NAFLD.

Gut microbiome and prediabetes - a review

While there is extensive information available on how the gut microbiota alters in composition between normal individuals and individuals with diabetes, there is little evidence available on whether the alterations become apparent at the prediabetes stage (a preliminary state to T2DM which is characterized by altered glycemic parameters relative to a normal euglycemic state), and if these variations are potentially linked with the progression from prediabetes into diabetes. In this review, we aim to summarize all the findings on compositional shifts in the gut microbiome that are shown to occur in individuals with prediabetes and diabetes in contrast to euglycemic states. Our review also highlights the potential pathophysiological mechanisms that could explain these alterations in metabolism due to the presence of varying microbial environments in the gut. Moreover, we also gather the available evidence on the role played by various factors, such as dietary changes and exercise, and their potential role in inducing a change in the gut microbiome. Last but not least, our review also assess the changes to the microbiota population brought about by a subsequent probiotic and symbiotic supplementation, Metformin and Acarbose. Additionally, we also evaluate the use of above mentioned interventions in mitigating the progression of prediabetes into subsequent diabetes mellitus. We believe this review can help understand the dynamic role played by the gut microbiome in the onset of prediabetes and if there is a possibility of reverting back to euglycemia with correct measures.

The effects of apple cider vinegar on cardiometabolic risk factors: A systematic review and meta-analysis of clinical trials.

Cardiometabolic syndrome (CMS) is a set of metabolic abnormalities that are risk factors for cardiovascular disease (CVD). Apple cider vinegar (ACV) has been used in several studies as a natural agent to improve CMS risk factors. The present study aimed to perform a systematic review and meta-analysis of the effects of ACV consumption on lipid and glycemic parameters. PubMed, Scopus, and ISI Web of Science databases were systematically searched to find clinical trials evaluating the effects of ACV consumption on CMS risk factors. Overall, 25 clinical trials (33 arms) comprising 1320 adults were entered in this study. ACV consumption could significantly improve the levels of FBG (-21.20 mg/dl; 95% CI: -32.31 to -2.21; I2: 95.8%), HbA1c (-0.91mg/dl; 95% CI: -1.62 to -0.21; I2: 98.9%), and TC (-6.72 mg/dl; 95% CI: -12.91 to -0.53; I2:50.8%). No significant results were observed for BMI, HOMA-IR, serum insulin, TG, LDL-C, and HDL-C. Subgroup analysis showed a significant decrease in FBG, HbA1c, TC, and TG in diabetic patients. In this type of analysis, ACV consumption significantly reduced FBG levels when administered for both duration subgroups (≥12 and <12 weeks). Moreover, in the subgroup analysis based on duration, TG concentration was significantly decreased following ACV consumption for ≥ 12 weeks. This meta-analysis showed that consumption of ACV has a favorable effect in decreasing some CMS risk factors including FBG, HbA1c, and TC.

Urtica dioica (Nettle) in Type 1 Diabetes Mellitus: A Randomized Controlled Trial

Background: As the role of nettle supplementation for type 1 diabetic patients is still unclear, we aimed to evaluate the impact of nettle supplementation on children with type 1 diabetes mellitus. Methods: In this single-blind randomized controlled trial, 50 patients with type one diabetes aged 12 - 18 with improper glycemic parameters (HbA1c greater than 6.5 mg/dL) received either insulin with 5 cc of nettle syrup (i.e., quercetin-based on at least 0.04 mg/mL of chlorogenic acid) twice daily for 12 weeks, or insulin monotherapy. Demographic characteristics, fasting blood sugar, HbA1c, blood urea nitrogen (BUN), serum creatinine, and insulin dosage were investigated at the beginning of the study and at multiple intervals in both groups. Results: Changes in fasting blood sugar (FBS), HbA1c, mean dose of rapid-acting and long-acting insulin, and mean total insulin dose were significant in both groups, and the increase in total insulin dose was significantly lower in the intervention group (P &lt; 0.05). The trend of BUN and serum creatinine changes was not significant over time (P = 0.532 and P = 0.785, respectively). Conclusions: We found lower total insulin dose in the intervention group that may emphasize the positive effect of nettle concomitant use through insulin secretion or sensitizing effect.