Lower Average Glucose Research Articles

DIFFERENT DIETARY INTAKE OF CARBOHYDRATES IN GLYCEMIC CONTROL IN PREGNANT WOMEN WITH DIABETES MELLITUS TYPE 2: CASE REPORT

Introduction. The glycemic impact of moderately high or low carbohydrate intake in an isocaloric diet remains undetermined. Report. An intervention was carried out with pregnant women with type 2 diabetes, who were fitted with a continuous glucose monitor for two weeks. They followed two 7-day nutritional plans, the first with 60% of the total caloric value coming from carbohydrates (VCT60), and the second with 40% of the total caloric value from carbohydrates (VCT40). On the first day of each week, a supervised breakfast corresponding to the intervention was provided. During the VCT60 week, there was a tendency for: lower average glucose, higher number of hypoglycemia events, and higher frequency of sensor scans compared to the VCT40 week. Conclusion. The continuous glucose monitor was well-received and assisted in making decisions regarding their diet and medical treatment

Medical Certification of Pilots Through the Insulin-Treated Diabetes Mellitus Protocol at the FAA.

INTRODUCTION: In 2019, the Federal Aviation Administration (FAA) announced a protocol to evaluate pilots with insulin treated diabetes mellitus (ITDM) for special issuance (SI) medical certification for first-/second-class pilots. The protocol's aim is improved assessment of ITDM control/hypoglycemia risk and relies on continuous glucose monitoring (CGM) data. This study compares the characteristics of first-/second-class pilots with ITDM and certification outcome.METHODS: Data was collected retrospectively from the FAA Document Imaging Workflow System (DIWS) for pilots considered for a first-/second-class SI under the ITDM program between November 2019 and October 2021. Inclusion criteria required submission of information required for certification decision (SI vs. denial). We extracted data on demographics and CGM parameters including mean glucose, standard deviation, coefficient of variance, time in range (%), time > 250 mg · dl-1 (%), and time < 70-80 mg · dl-1 (%). We compared these parameters between pilots issued an SI vs. denial with Mann-Whitney U-tests and Fisher exact tests using R.RESULTS: Of 200 pilots with ITDM identified, 77 met inclusion criteria. Of those, 55 received SIs and 22 were denied. Pilots issued SI were statistically significantly older (46 vs. 27 yr), had a lower hemoglobin A1c (6.50% vs. 7.10%), lower average glucose (139 mg · dl-1 vs. 156 mg · dl-1), and spent less time with low glucose levels (0.95% vs. 2.0%).DISCUSSION: The FAA program has successfully medically certificated pilots with ITDM for first-/second-class. Pilots granted an ITDM SI reflect significantly better diabetes control, including less potential for hypoglycemia. As this program continues, it will potentially allow previously disqualified pilots to fly safely.Stanwyck LK, DeVoll JR, Pastore J, Gamble Z, Poe A, Gui GV. Medical certification of pilots through the insulin-treated diabetes mellitus protocol at the FAA. Aerosp Med Hum Perform. 2022; 93(8):627-632.

990-P: Prebiotics and Metformin: A Pilot Randomized Controlled Trial in Youth-Onset Type 2 Diabetes

Metformin is the only first-line oral agent for youth with type 2 diabetes mellitus (Y-T2D) , but efficacy and adherence is complicated by gastrointestinal (GI) side effects. Prebiotic microbiome modulators (MM) may reduce side effects by shifting the microbial flora and promoting metabolism of short-chain fatty acid producing bacteria. The feasibility and tolerability of prebiotic use in Y-T2D is unknown. We hypothesized that a prebiotic MM would be safe, tolerable, and decrease GI symptoms in youth. We compared lower GI symptoms and glycemia in Y-T2D at initiation of daily metformin therapy in a 1-week, randomized, double-blind, crossover trial of a daily prebiotic MM versus placebo shake (Phase 1) followed by a 1 month open-labeled extension (Phase 2) . We assessed stool frequency, stool consistency (King’s Stool Chart) , and used principal component analysis to create a composite GI symptom score (urgency, bloating, flatulence, consistency) . Mixed effects models were used to compare continuous glucose monitor profiles and quality of life metrics (Pediatric Quality of Life Inventory™) . In six Y-T2D (17.2±1.7y (mean±SD) , 66% female, BMI 42±9 kg/m2, HbA1c 6.4±0.6%) stool frequency was assessed every 1-2 days. Stool frequency, stool composition, GI symptom score, and quality of life scores were not different by group or study phase. There were no severe adverse effects during the trial. One youth had increased bloating and discontinued the prebiotic in Phase 2. During phase 1, prebiotic MM tended to have lower average glucose (122±26 vs. 135±23 mg/dL, P=0.07) but this was not sustained in phase 2 (136±31 vs.135±23, P=0.8) . Time in range, standard deviation, and coefficient of variation of glucose were similar during the study. In summary, the prebiotic MM was well tolerated during short-term metformin therapy in Y-T2D, but was not associated with GI symptom, quality of life, or metabolic changes. Future studies should explore localized gut and systemic metabolic effects of prebiotics in youth. Disclosure K. Tuttle: None. L. Mabundo: None. M.S. Stagliano: None. K.B. Dietsche: None. A.B. Courville: None. D.E. Estrada: None. S.T. Chung: None. Funding NIDDK/NIH Intramural Research Program

979-P: Lower Glucose Thresholds for Hyperglycemia Alarm and Narrower Threshold Range for Hyper/Hypoglycemia Alarm on Continuous Glucose Monitoring Systems Correlate with Lower Average Glucose Levels and Longer Time-in-Range

Average glucose levels (AG) and glucose time-in-range (TIR; 70-180 mg/dL) are important glucose control measurements for patients with type 1 diabetes (T1D). Continuous glucose monitoring (CGM) systems provide audible alarms for actual/impending hyper/hypoglycemic events; however, there are little data regarding optimal CGM alarm settings to improve these measures. A cross-sectional observational study was conducted enrolling 91 T1D active CGM users (real-time CGM use &amp;gt;3 months and CGM usage time ≥70%). CGM alarm settings and two-week glucose data (total 28,133 hours) were analyzed. Glucose thresholds for hyperglycemia alarm and intra-threshold range (hyperglycemia minus hypoglycemia alarm thresholds) correlated positively with AG (P&amp;lt;0.001, P=0.003) and negatively with TIR (P=0.004, P=0.039, respectively). Compared to quartiles with higher hyperglycemia alarm thresholds and higher intra-threshold ranges; quartiles with, 1) lower glucose threshold settings for hyperglycemia alarm, and 2) lower intra-threshold ranges, were associated with up to 45 mg/dL lower AG and 20% longer TIR. These data indicate the benefits of lower glucose thresholds for hyperglycemia alarm and lower intra-threshold ranges in promoting lower glucose levels and longer glucose time-in-range. Disclosure Y. Lin: None. M. Hung: None. A. Sharma: None. O. Chan: Research Support; Self; Zucara Therapeutics Inc. M. Varner: None. D. Groat: None. D. Dopita: None. S. Fisher: None.

Hypoglycemia after initiating insulin therapy based on the results of structured self-control and monitoring of blood glucose

Hypoglycemia detection in T2DM patients is an important issue which is usually accomplished with self-monitoring of blood glucose (SMBG). Optimal schedule of testing and diagnostic threshold are important for effective SMBG. Aims of study: To evaluate hypoglycemia frequency by SMBG using structured AccuChek 360 View protocol and glucose monitoring and increase SMBG efficacy in the detection of hypoglycemia. Study design: 16 T2DM patients after initiation of insulin treatment were included. Each patient had 3 days of glucose monitoring together with SMBG 7 times a day after hospital discharge and 3 months later. Results: Hypoglycemia was detected in 38% of monitoring periods; this patients had higher glucose variability and lower average glucose. SMBG detected hypoglycemia in 16% of periods. 6 out of 7 unrecognized hypoglycemias were during night. This 6 cases were characterized by minimal daytime glucose levels by SMBG below 5 mmol/l. ROC-analysis demonstrated minimal glucose level during daytime of 4.8 mmol/l to have 92% sensitivity and 74% specificity for detection of any hypoglycemia by glucose monitoring. Conclusion: Structured Accu-Chek 360 View SMBG can reliably detect daytime hypoglycemia but regular nighttime testing is recommended in all T2DM patients using insulin for detection of nighttime hypoglycemia. Minimal glucose levels below 4.8-5 mmol/l during daytime corresponds with high hypoglycemia risk.

Effect of a low dose whey/guar preload on glycemic control in people with type 2 diabetes--a randomised controlled trial.

ObjectiveLarge preloads of protein and fat have been shown to lower glucose after a carbohydrate-rich meal in people with type 2 diabetes but add a considerable energy burden. Low calorie preloads [<5% of daily energy intake] have been tested in this study in people with prediabetes and with type 2 diabetes.Research design and methodsThis was an unblinded randomised crossover study with two placebo days and two active treatment days. Glucose was measured for 3 hours with fingerprick samples as well as continuous glucose monitoring [CGMS]. Twenty-four subjects with pre-diabetes or moderately controlled type 2 diabetes [fasting glucose < 10 and HbA1c < 8.5%] were recruited. The preload contained 17 g whey protein plus 3 g lactose and 5 g guar, and 1 g flavour material [including sucralose] dissolved in 150 ml cold water or 150 ml cold water with no additives. The breakfast test meal consisted of 2 slices of bread, margarine and jam [3 slices for men] with the test drink 15 minutes beforehand.ResultsPeak fingerprick glucose was reduced by 2.1 mmol/L at 45 min [p < 0.0001]. Average fingerprick glucose over 3 hours was reduced by 0.8 mmol/L [p = 0.0003]. There was no difference between those with diabetes or prediabetes or those on medication or not on medication.ConclusionsAn 80 kcal whey protein/fibre preload can lower average glucose over 3 hours by 0.8 mmol/L. If used long term before at least two carbohydrate-rich meals/day this preload could lower HbA1c by up to 1%.Trial registrationThe trial was registered with the Australian New Zealand Clinical Trials Registry number ACTRN12612001251819.

Clinical Management of the Physically Active Patient with Type 1 Diabetes

The prevalence and incidence of type 1 diabetes continues to increase worldwide. Most patients with type 1 diabetes are young at the time of diagnosis and wish to continue leading a physically active life. Although regular exercise, insulin therapy, and proper nutrition are the cornerstone of treatment, there are considerable challenges in managing the active individual with type 1 diabetes. The current recommendation for diabetes management is intensive glycemic control for all patients when possible to help prevent secondary complications. Both insulin pump therapy and multiple daily injections are beneficial treatment options to lower average glucose levels; however, without continuous glucose monitoring, these treatment options typically increase the risk of hypoglycemia. In active patients with type 1 diabetes, the challenges of maintaining good glycemia are complicated by the inability to regulate insulin concentrations during and after exercise. Physiological and psychosocial factors during growth and maturation also provide additional challenges. This article highlights challenges and key strategies for diabetes management in the active individual with type 1 diabetes, including the application of the most recent diabetes technologies.