Glycemic Research Articles

Study on Glycemic and Lipidemic Status in Different Trimesters of Pregnancy

Impaired glycemic and lipidemic status during pregnancy may cause severe morbidity both in fetus and mother. Therefore timely evaluation of these parameters throughout the pregnancy is of paramount importance in order to detect impaired glucose tolerance, gestational diabetes and dyslipidemia. This will surely help to take appropriate control measures in order to avoid unwanted health danger to fetus and mother. Focus of this study is to understand and evaluate the variations of glycemic and lipidemic status in different trimesters of pregnancy.

Sulfonylureas for Patients with Type 2 Diabetes: Still an Option

Prescribing of sulfonylureas, generally as add-on therapy when metformin alone does not achieve adequate glycemic control in patients with type 2

Near and long-term effects of acceptance and commitment therapy on patients with type 2 diabetes

Objective To observe the near-and long-term effects of acceptance and commitment therapy (ACT) on psychological flexibility, self-efficacy, and glycemic control in patients with type 2 diabetes. Methods A total of 96 patients with type 2 diabetes admitted to Zhuzhou Central Hospital during the period from January to December 2017 were selected as subjects. According to the random number table method, they were divided into the control group and the ACT group, 48 cases in each group. The control group was given regular health education, and the ACT group was given ACT-oriented health education. The psychological flexibility, self-efficacy and glycemic control of the two groups were compared before intervention, 7 weeks after intervention and 1 year after intervention. Results After 7 weeks of intervention, the psychological flexibility and self-efficacy scores of the ACT group was (21.47±4.89) and (8.96±1.70) respectively, the control group was (25.28±6.33) and (7.80±1.42) respectively. After 1 year of intervention, the psychological flexibility and self-efficacy scores of the ACT group was (23.87±5.03) and (8.09±1.38) respectively, and the control group was (27.19±5.48) and (6.97±1.24) respectively. The ACT group was significantly better than the control group, and the difference was statistically significant (t=-3.300-4.044, P<0.01). After 7 weeks of intervention, the effective rate of blood glucose control in the ACT group was 93.75% (45/48), and the control group was 75.00% (36/48). After 1 year of intervention, the effective rate of blood glucose control in the ACT group was 86.96% (40/46), and the control group was 65.91% (29/44). The ACT group was significantly higher than the control group, and the difference was statistically significant (χ2=6.400, 5.569, P<0.05). Conclusions The application of health education activities based on ACT is significant in patients with type 2 diabetes, can significantly improve the patient's near-term psychological flexibility and self-efficacy, conducive to better long-term blood sugar management. Key words: Acceptance and commitment therapy; Diabetes mellitus, type 2; Health education

Development of Low Glycemic Index Rice and Its Effectiveness in the Regulation of Postprandial Glucose Response in Type 2 Diabetes

Background/Objective: To determine the glycemic index (GI) of RNR15048 rice variety and study its effectiveness in reducing postprandial blood glucose levels and the regulation of lipid profile in patients with type 2 diabetes. Subjects/Methods: The GI of RNR15048 rice was measured in 54 healthy subjects in the age group of 30-50 years. The dietary intervention study was conducted in 80 subjects with diabetes in the age group of 40-60 years where 40 test subjects replaced their regular rice with RNR 15048 rice variety for 3 months. Anthropometric and biochemical parameters, HbA1c, fasting blood glucose, lipid profile, insulin were determined before and after the study. Results: The glycemic index (GI) of RNR 15048 rice variety was observed to be low with GI of 51.72 ± 3.39. The dietary intervention study in type 2 diabetic subjects revealed significant decrease in fasting blood glucose (158.4 ± 9.30 vs 140.2 ± 8.87 mg/dL) and HbA1c levels (7.1 ± 0.34 vs 6.1 ± 0.33 %) with an increase in HDL levels (33.7 ± 1.29 vs 37.1 ± 1.83 mg/dL) while parameters such as body weight, blood pressure and insulin levels did not show any significant changes. Conclusion: Low GI rice is effective in the reduction of postprandial glucose response in type 2 diabetes and increase in plasma HDL levels and therefore useful in the management of type 2 diabetes and in the long term management of cardiovascular diseases.

Glycemic control of newly-diagnosed type 2 diabetes with different baseline body mass index under the standardized metabolic disease management model

Objective To explore the glycemic control of newly-diagnosed type 2 diabetes with different levels of baseline body mass index (BMI) after 6 months treatment under the standardized metabolic disease management model. Methods (1) 163 patients of newly-diagnosed type 2 diabetes were divided into normal weight (BMI 18.5-23.9 kg/m2), overweight (BMI 24.0-27.9 kg/m2), and obese (BMI≥28 kg/m2) groups according to baseline BMI, the blood glucose and lipids levels were compared among 3 groups. (2) The blood glucose levels were compared among 3 groups after 6 months of standardized management. (3) The overweight and obese patients were divided into group weight loss≥5% and group weight loss<5% or weight gain in 6 months. The blood glucose levels were compared. Results (1) At baseline, overweight and obese groups had higher homeostasis model assessment for insulin resistance and lower high density lipoprotein-cholesterol compared with normal weight group. (2) After 6 months of treatment, HbA1C and HbA1C reduction showed no difference among 3 groups (normal, overweight and obese) after adjusted by baseline HbA1C. The rate of HbA1C 0.05). (3) After 6 months of treatment, 32.28% overweight and obese patients lost weight by ≥ 5%, while HbA1Cand HbA1Creduction showed no difference between 2 groups (weight loss≥5% and weight gain or weight loss 0.05). Group weight loss≥5% had better glucose control (92.68% vs 77.91%, P<0.05). Conclusions As BMI increased, insulin resistance and lipid disorders were more serious in newly-diagnosed type 2 diabetes. After 6 months of standardized metabolic management, newly-diagnosed type 2 diabetes with different baseline BMI and weight changes both achieved good glycemic control. In addition, patients losing weight equal to or more than 5% achieved higher attainment of HbA1C targets. Key words: Newly-diagnosed type 2 diabetes; Body mass index; HbA1C; Weight changes

Risk factor control and medical therapy of coronary artery disease in Taiwan - Review and Recommendations - Part III: Blood sugar management for patients with coronary artery disease

Cardiovascular disease (CVD) is the leading cause of death in the world and the second important cause of death in Taiwan. Atherosclerosis CVD (ASCVD) especially coronary artery disease (CAD) is the major cause of CVD [1]. Clinically, the presentation of CAD can be divided into acute unstable disease, so-called acute coronary syndrome (ACS) and chronic stable disease. Up to now, the main risk factors for CAD are known as hyperlipidemia, hypertension, hyperglycemia, smoking and family history. The control of the above risk factors and lifestyle modifications can improve the prognosis of CAD patients [1,2]. Here, we described the blood lipid control, blood pressure control, blood glucose control, and lifestyle modifications for CAD in Taiwan. The followings are the part III for blood glucose control. Type 2 Diabetes mellitus (T2DM) has been suggested a CAD equivalent. The risk of CAD may be correlated with the baseline HbA1c. Numerous studies have demonstrated the benefits of controlling modifiable CV risk factors in people with diabetes. Therefore, in patients with documented CAD, DM control is recommended.Because the benefits of intensive glucose control emerge slowly, while the harms can be immediate, people with longer life expectancy have more to gain from intensive glucose control. The 4 randomized clinical trials (RCTs), including UKPDS, ACCORD, ADVANCE, VADT trials, or large meta-analyses, testing intensive glucose control vs. conventional glucose control did not show positive results in reducing major adverse cardiovascular events (MACE) in individual trials. There are also lack of HbA1c target CV outcome trials in patients with CAD. The impact of glucose control on macrovascular complications is less certain. In the consensus, glycemic treatment targets should be individualized based on patient characteristic, including frailty and comorbid conditions, and risk of adverse effects of therapy (e.g., hypoglycemia and weight gain), to balance the benefit and risks of glycemic control, rather than the strengthen the HbA1c target in patients with documented CAD.

O uso da cirurgia bariátrica no controle do diabetes tipo 2 em pacientes com índice de massa corpórea ≤35 kg/m2

Objetivo: Explicar a possibilidade da cirurgia bariátrica como alternativa terapêutica no controle do Diabetes Mellitus tipo 2 em pacientes com índice de massa corpórea abaixo de 35 kg/m2. Métodos: Trata-se de uma Revisão Sistemática com base em estudos randomizados e não randomizados, sobre a efetividade da cirurgia bariátrica no controle do diabetes tipo 2 em obesos leves. Foi realizada uma busca de artigos publicados em periódicos internacionais nas bases de dados: SCOPUS, Web Of Science e PubMed indexados de 2013 a 2017. Resultados: O DM 2 é um grave problema mundial de saúde pública e suas complicações microvasculares e cardiovasculares aumentam substancialmente a morbidade e a mortalidade. Hoje, a cirurgia bariátrica é a terapia de emagrecimento mais eficaz disponível e possibilita atingir níveis glicêmicos adequados em pacientes com DM2 ainda com reserva de células beta pancreáticas. Considerações finais: Concluiu-se que as pesquisas sobre o tema são recentes, sendo a mais longa efetuada num período de sete anos, seus resultados no geral mostram excelentes taxas de controle no primeiro ano de seguimento, porém conforme o passar do tempo há ainda menos estudos que acompanharam esses pacientes, e os seus resultados decaem, não sendo possível efetivamente corroborar com seus achados iniciais.

Inappropriate Insulin Use for Older Adults in Poor Health

Tight glycemic control is inappropriate for older patients in poor health who are unlikely to benefit from long-term prevention of complications and

Dietary intake and eating patterns of young children with type 1 diabetes achieving glycemic targets

背景 相比常规糖尿病饮食指南推荐量，患1型糖尿病（T1D）的幼儿摄入饱和脂肪更多、水果和蔬菜更少。该年龄段儿童的常见特点之一是饮食时间和摄入量不确定，这影响着父母对其餐时血糖的管理方案。本小型研究旨在评估门诊T1D幼儿中血糖达标者的膳食摄入量和饮食习惯，探讨饮食模式与糖化血红蛋白（HbA1c）的关系。 方法 采用回顾性横断面研究方法，对澳大利亚一家儿童糖尿病服务中心7.0岁以下的T1D患儿（n=24）进行研究。收集患儿的基线资料、HbA1c、3天食物称重记录和进餐时间管理调查表。 结果 纳入符合条件的儿童22例（男性55%），平均年龄（4.9±1.3）岁（均数±标准差），HbA1c（47±10）mmol/mol（6.4%±0.9%），体质指数Z评分（0.8±0.9），糖尿病患病时间（1.7±1.1）年。结果显示，95%患儿在餐前注射胰岛素。主要营养摄入分布（能量摄入比例）：碳水化合物（48%±4%）、蛋白质（16%±2%）和脂肪（33%±5%），其中包括饱和脂肪（15%±3%）。大部分患儿没有达到蔬菜和瘦肉/蛋白质的摄入量建议（分别为0%和28%)。HbA1c与每日总碳水化合物、蛋白质或脂肪摄入量无相关性（P>0.05)。放牧模式（grazing pattern）（编者注：放牧模式指饮食的摄入量和膳食模式不受限制）下的儿童HbA1c水平明显高于正常膳食的儿童（平均61 mmol/mol比43 mmol/mol) (7.7%比6.1%)，P=0.01。 结论 T1D患儿饱和脂肪摄入量过多、蔬菜摄入量不足的饮食质量问题值得关注。我们的研究结果表明，血糖达标的患儿多在餐前给予胰岛素，并遵循规律的饮食模式。

Comparison of Associated Factors for Diabetic Retinopathy between Elderly and Younger Adult Patients with Type 2 Diabetes Mellitus in Northern Taiwan: Experience from One Medical Center

Background: The prevalence of diabetic retinopathy (DR) is higher in elderly patients with type 2 diabetes mellitus (T2DM) than the younger adult population, and the associated factors involved may be different between these two groups. This study aimed to investigate the prevalence and associated factors of DR in the elderly and younger adult population with T2DM. Methods: The study recruited 428 patients with T2DM, including 220 elderly subjects and 208 younger adult subjects. All subjects were examined for DR using fundus photography by an experienced ophthalmologist. Data including age, anthropometric measurements, blood pressure, glycemic profiles, lipid profiles, liver enzymes, renal function and microalbuminuria were collected. Simple logistic regression analysis and multiple logistic regression analysis were then performed to analyze the associated factors of DR in the elderly and younger adult groups. Results: The prevalence of DR was 26% and 16% in elderly and younger adult patients, respectively. In multiple logistic regression analysis, independent factors associated with DR in elderly patients were the presence of albuminuria (OR: 3.47, 95% CI: 1.79-6.71, p ＜ 0.001) and longer DM duration (OR: 2.56, 95% CI: 1.20-5.46, p = 0.015). For younger adult patients, higher HbA1c level (OR: 3.26, 95% CI: 1.33-7.99, p = 0.010) was found to be associated with DR. Conclusion: Microalbuminuria showed a stronger association with DR in elderly patients with T2DM, while high glucose level showed stronger association with DR in the younger adult population. In order to prevent development of retinopathy, these independent factors should be recognized early in T2DM patients according to different age groups.

Can Endoscopic Remodeling of the Duodenum Treat Type 2 Diabetes Mellitus

Exclusion of the duodenum through bariatric surgery has shown immediate benefit of improved glycemic control, independent of weight loss, in obese

The effects of L-carnitine supplementation on glycemic control: a systematic review and meta-analysis of randomized controlled trials.

The findings of trials investigating the effect of L-carnitine administration on glycemic control are controversial. This meta-analysis of randomized controlled trials (RCTs) was performed to explore the effects of L-carnitine intake on glycemic control. Two authors independently searched electronic databases including MEDLINE, EMBASE, Cochrane Library, Web of Science, PubMed and Google scholar from 1990 until February 2019, in order to find relevant RCTs. 37 studies with 44 effect sizes met the inclusion criteria and were eligible for the meta-analysis. L-carnitine supplementation resulted in a significant reduction in fasting plasma glucose (FPG) (WMD: -4.57; 95 % CI: -6.88, -2.25), insulin (WMD: -1.21; 95 % CI: -1.85, -0.57), homeostatic model assessment for insulin resistance (HOMA-IR) (WMD: -0.67; 95 % CI: -0.90, -0.44) and HbA1C concentrations (WMD: -0.30; 95 % CI: -0.47, -0.13). L-Carnitine supplementation significantly reduced FPG, insulin, HOMA-IR, and HbA1c levels.

Does a Specialized Diabetes Management Team Improve Hospital Outcomes

Hypoglycemia and hyperglycemia in hospitalized patients are associated with worse patient outcomes. To improve glycemic control, many hospitals have

An Oral Glucagon-Like Peptide-1 Agonist for Glycemic Control and Weight Loss

Among once-weekly injectable glucagon-like peptide-1 (GLP-1) receptor agonists, semaglutide (Ozempic) is more effective than exenatide (Byetta) and

The review of the effects of glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists on hypothalamus-pituitary-gonad axis

Mammalian reproduction is closely related to their metabolic status. The hypothalamus-pituitary-gonad axis (HPG axis) is regulated by various metabolic factors. Glucagon-like peptide-1 (GLP-1) is one of various metabolic factors that not only affect glycemic and metabolic control, but also with many other effects, including affecting HPA axis.The function of GLP-1 is related to the location of glucagon-like peptide-1 receptor (GLP-1R) distribution. It has been confirmed that GLP-1R is widely distributed in HPG axis. The effects of GLP-1 and GLP-1R agonists on the HPG axis have also attracted much attention. The positive effects of GLP-1 and GLP-1R agonists on the HPG axis indicated it could be the new target for the new treatment for gonadal diseases. The role of GLP-1 and GLP-1R agonists in the central nervous system is reviewed. Key words: Glucagon-like peptide-1; Glucagon-like peptide-1 receptor; Glucagon-like peptide-1 receptor agonists; Hypothalamus-pituitary-gonad; Gonadal diseases

Clinical observation on intravitreal anti-VEGF injection combined with trabeculectomy for neovascular glaucoma

Objective To evaluate the efficacy of intravitreal anti-VEGF injection combined with trabeculectomy in the treatment of neovascular glaucoma. Methods The data of 31 eyes of 30 patients with neovascular glaucoma from Oct. 2015 to May 2017 were analyzed retrospectively. All cases underwent intravitreal anti-VEGF(Conbercept or Lucentis) injection combined with trabeculectomy. Trabeculectomy was performed at 1 week after injection and the follow-up time was 6 months after surgery. Results The post-operative visual acuity(VA) were all significantly increased at 1 week, 1 and 6 months compared with those before surgery (P<0.05). The average intraocular pressure at 1 week, 1 and 6 months were(16.3±1.7)mmHg, (18.2±1.9)mmHg and (18.4±1.6)mmHg (1 mmHg=0.133 kPa) respectively. The difference were statistically significant between before and after surgery (P<0.01). At 1 week after surgery all cases had functional filter bleb. At 6 months after surgery, the functional and non-functional filtering blebs occurred in 25 eyes(80.65%) and 6 eyes(19.35%) respectively. Iris neovascularization and intraocular pressure elevation were found in 1 eye (3.23%)because of poor glycemic control. The IOP returned to normal after intravitreal anti-VEGF injection combined with filter bleb separation. The mainly postoperative complications were hyphema, shallow anterior chamber, anterior uveitis and vitreous hemorrhage. Conclusion Intravitreal anti-VEGF injection combined with trabeculectomy in treatment of neovascular glaucoma is effective. Key words: Glaucoma, neovascular; Injection, intravitreal; Anti-VEGF; Trabeculectomy

Effect of standardized eating scheme based on blood glucose value on blood glucose of patients with diabetic nephropathy on hemodialysis

Objective To investigate the effect of standardized eating plan based on blood glucose on blood glucose level during dialysis. Methods A total of 30 diabetic nephropathy patients who underwent maintenance hemodialysis in the outpatient department of hemodialysis center of the hospital from October 2017 to December 2017 were selected.30 patients received two kinds of intervention before and after, namely the intervention of routine nursing measures and the intervention of standardized eating plan based on blood glucose value, and blood glucose data during the two interventions were collected. Results The incidence of hypoglycemia before intervention(6.67%) was lower than after intervention(1.33%), and the difference was statistically significant(P 0.05). Conclusions Standardized feeding scheme based on blood glucose values can significantly reduce the incidence of hypoglycemia during dialysis and stabilize blood glucose levels at various time points during dialysis. Key words: Diabetic nephropathy; Hemodialysis; Standardized food intaking based on glycemic values; Blood glucose

Symposium proceedings: sugars and sweeteners: science, innovations, and consumer guidance for Asia

Background and Objectives: Rising obesity in Southeast Asia, one consequence of economic growth, has been linked to a rising consumption of energy from added sugars. This symposium, organized by ILSI Southeast Asia, explored regional issues related to dietary sugars and health and identified ways in which these issues could be addressed by regional regulatory agencies, food producers, and the consumer. Methods and Study Design: Papers on the following topics were presented: 1) current scientific evidence on the effects of sugars and non-caloric sweeteners on body weight, health, and eating behaviors; 2) innovations by food producers to reduce sugar consumption in the region; 3) regional dietary surveillance of sugar consumption and suggestions for consumer guidance. A panel discussion explored effective approaches to promote healthy eating in the region. Results: Excessive consumption of energy in the form of added sugars can have adverse consequences on diet quality, lipid profiles, and health. There is a need for better surveillance of total and added sugars intakes in selected Southeast Asian countries. Among feasible alternatives to corn sweeteners (high fructose corn syrup) and cane sugar are indigenous sweeteners with low glycemic index (e.g., coconut sap sugar). Their health benefits should be examined and regional sugar consumption tracked in detail. Product reformulation to develop palatable lower calorie alternatives that are accepted by consumers continues to be a challenge for industry and regulatory agencies. Conclusions: Public-private collaborations to develop healthy products and effective communication strategies can facilitate consumer acceptance and adoption of healthier foods.

The VA Diabetes Trial: 15-Year Follow-Up

The VA Diabetes Trial was one of three randomized trials published in 2008 and 2009 in which intensive glycemic control did not significantly lower the

Impact of flash glucose monitoring on glycemic control in type 1 diabetic patients

Objective The application of flash glucose monitoring (FGM) in type 1 diabetes could diminish the frequency of hypoglycaemia, however, how FGM improving the glycaemic control target (e.g. HbA1C) is waited to be investigated. Methods Seventy type 1 diabetic patients were recruited from December 2017 to July 2018 in the First Affiliated Hospital of Nanjing Medical University. Their demographic data, use of FGM and HbA1C level were collected. Results We observed that type 1 diabetic patients wearing the FGM showed lower insulin dose [(0.562±0.059)U/kg vs (0.772±0.049)U/kg, P=0.008)], shorter diabetic duration[2.0(0.8-6.0) vs 6.0(2.5-10), P=0.013], lower HbA1C value [6.8%(6.2%-7.7%) vs 8.0%(6.9%-9.4%), P=0.001]. Nevertheless, after adjusting the potential confounders, the level of HbA1C in patients wearing FGM was significantly lower than those without FGM. Moreover, it was independent of other factors, such as the dose of insulin and the insulin delivery method. Conclusion Type 1 diabetic patients wearing FGM had lower HbA1C value but it needs further follow-up to confirm the improvement of glycaemic control in type 1 diabetes with the use of FGM. Key words: Diabetes mellitus, type 1; Flash glucose monitoring; Glycemic control