Lower Postprandial Glucose Research Articles

Effects of Multi-Ingredient Nutritional Drink Including Mulberry Leaf Extract (MLE) on Postprandial Glycemic and Appetite Responses in Healthy Chinese Adults

ObjectivesOur study aimed to evaluate the impact of adding MLE to a nutritional drink containing protein, fat, carbohydrate (maltodextrin) on maltodextrin digestion in-vitro and postprandial glucose and appetite responses in healthy Chinese adults. MethodsTwo randomized cross-over trials were conducted in healthy Chinese adults (20–40 y; 19–24 kg/m2) measuring glucose, hunger and satiety responses. Visual Analog Scale (VAS) was used to evaluate hunger and satiety. In trial 1, participants (n = 12) received either 25 g anhydrous glucose powder mixed in water or the tested nutritional drink (25 g carbohydrate and MLE). Blood glucose was tested 5 min before and at 0, 15, 30, 45, 60, 90, and 120 min after sample intake. In trial 2, participants (n = 10) received either the MLE nutritional drink (∼200 kcal) or a reference food with similar energy and macronutrient composition but no MLE. VAS results were collected at 0, 30, 60, 90 and 120 min after sample intake. An in-vitro digestion study was conducted using 3 different ratios of MLE and maltodextrin to explore the effects of MLE on maltodextrin digestion. ResultsBaseline glucose levels were similar between the two groups. Postprandial glucose was significantly lower in the test group at 15 min (5.9 ± 0.3 mmol/L vs 7.4 ± 0.4 mmol/L), 30 min (5.9 ± 0.7 mmol/L vs 8.3 ± 0.7 mmol/L) and 45 min (5.7 ± 0.6 mmol/L vs 7.0 ± 0.9 mmol/L) compared to reference group. Glucose iAUC0-120 min was also significantly lower (64.6 ± 11.1 mmol/L x min vs 135.0 ± 14.5 mmol/L x min) in the test group. In trial 2, VAS desire to eat iAUC0-120 min, was significantly lower (–494.9 ± 80.97 cm x min vs –307.4 ± 52.05 cm x min) in MLE test group, but other satiety parameters were similar between the two groups. Maltodextrin hydrolysis rate (in-vitro digestion study) iAUC0-180 min was significantly inhibited by MLE (P < 0.05) at ratio of 20:1 and 10:1 (Maltodextrin: MLE). ConclusionsConsumption of tested nutritional drink with optimized MLE dose produced a significant lower postprandial glucose response and meets the ISO requirements to be claimed low GI. Moreover, the satiety (as measured by desire to eat using VAS) is higher than the reference food with similar energy and macronutrient composition without MLE. Therefore, adding MLE into nutritional drink lowers GI, reduces postprandial glucose response and may promote satiety. Funding SourcesMary Kay, Inc.

38-OR: Glycemic Control with Ultrarapid Lispro (URLi) vs. Lispro in Children and Adolescents with T1D: PRONTO-Peds

This phase 3, treat-to-target study evaluated efficacy and safety of URLi vs. lispro in 716 pediatric patients (pts) with type 1 diabetes (T1D) . After 4-week lead-in to optimize basal insulin, pts were randomized to double-blind URLi (n=280) or lispro (n=298) injected 0-2 min prior to meals, or open-label URLi (n=138) injected up to 20 min after meals (URLi+20) . Pts remained on prestudy basal insulin (degludec, detemir, or glargine) . Primary endpoint was HbA1c change from baseline after 26 weeks. Noninferiority was shown in HbA1c change with URLi vs. lispro: estimated treatment difference (ETD) -0.02% (95% CI -0.17, 0.13) and with URLi+20 vs. lispro: ETD -0.02% (95% CI -0.20, 0.17) . Postprandial glucose (PPG) measured by self-monitored blood glucose (SMBG) was lower with URLi vs. lispro 1 h after breakfast (p&amp;lt;0.001) and dinner (p=0.006) . URLi significantly reduced 1 h postmeal glucose daily mean vs. lispro (p=0.001) . Total daily insulin dose was similar between treatments. There were no significant differences among treatments in rate or incidence of severe, nocturnal or documented hypoglycemia (&amp;lt;54 mg/dL) . With URLi vs. lispro, rate of postdose hypoglycemia (&amp;lt;54 mg/dL) was higher at ≤2 h (p=0.034) . Incidence of treatment-emergent adverse events was similar between groups. More pts reported an injection site reaction related event with URLi (7.9%) and URLi+20 (2.9%) vs. lispro (2.7%) . All injection site reactions were mild or moderate in severity. Two URLi patients discontinued the study due to injection site reactions. In children and adolescents with T1D, URLi demonstrated similar overall glycemic control and greater PPG lowering with an acceptable safety and tolerability profile compared with lispro. URLi dosed at the start of meals or up to 20 min after the start of meals showed noninferiority for HbA1c change from baseline vs. lispro. URLi dosed at the beginning of meals showed lower PPG at 1 h after breakfast and dinner and lower 1 h postmeal glucose daily mean vs. lispro. Disclosure R. Wadwa: Advisory Panel; Dompé. Consultant; Beta Bionics, Inc. Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. Other Relationship; Tandem Diabetes Care, Inc. L.M. Laffel: Advisory Panel; Medtronic, Roche Diabetes Care. Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. D.R. Franco: Advisory Panel; Abbott Diabetes, Medtronic, Novo Nordisk, Sanofi. Research Support; Eli Lilly and Company. Speaker's Bureau; Abbott Diabetes, AstraZeneca, Medtronic, Roche Diabetes Care, Sanofi. M.A. Dellva: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. R.K. Pollom: Employee; Eli Lilly and Company. Funding Eli Lilly and Company

538-P: Effects of Exercise Timing on Glucometabolic Response in Patients with Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Controlled Trials

Background and purpose: Exercise is widely perceived to benefit glycemic control through remodeling metabolic pathways in patients with type 2 diabetes mellitus (T2DM) . Circadian clock-regulated metabolic pathways could be reprogrammed by dietary challenges, timing of exercise relevant to feeding may also create a divergent effect. Nowadays, the optimal time of day to amplify training-mediated benefits remains unknown. Here, we aimed to evaluate the effects of different exercise timing on glucometabolic response in patients with T2DM. Data sources and study selection: PubMed/MEDLINE, EMBASE, and Cochrane Library were systematically reached on June 30, 2021 for randomized controlled trials investing the effects of exercise timing on glucometabolic response in patients with T2DM. Data extraction and data synthesis: Reporting postprandial glucose (PPG) , or fasting blood glucose (FBG) , or incremental area under the blood glucose curve (iAUC) , or glycosylated hemoglobin (HbA1c) , or 24-hours average glucose concentrations, or insulin sensitivity index (HOMA-IS) , or insulin resistance index (HOMA-IR) were extracted. Random effects models were used to calculate the standardized mean differences (SMD) and 95% confidence intervals (CI) . A total of 29 studies were included, involving 516 individuals for analysis. Post-meal exercise improved PPG, iAUC, HbA1c, 24-h average glucose (SMD: -4.03, -1.15, -0.43, -0.83 respectively) , but not in HOMA-IS (SMD: 0.76) and HOMA-IR (SMD: 0.01) . Within 30-120 min after meal consumption lowered PPG, iAUC, HbA1c, and 24-h average glucose by a greater amount (SMD: -4.31, -1.25, -0.46, -0.75, respectively) . Conclusion: Post-meal exercise exerted the most significant and consistent effects on glucometabolic respons. Within 30-120 min after meal is the optimal exercise timing for glycemic control. Promoting timely post-meal exercise would be of tremendous benefits to patients with T2DM. Disclosure Y.Fu: None. X.Tang: None. B.Qin: None. X.Guo: None. Y.Huang: None. Y.Chen: None. Y.Zhu: None.

Soy flour snack bars lower glycaemic response in type 2 diabetes mellitus subjects: A randomised cross-over design

Introduction: Low glycaemic snacks may help to improve blood glucose control. However, data on the effect of soybean snack bars on postprandial glucose levels of the diabetic population is scarce. Therefore, the current study aimed to examine the effect of consuming soy flour snack bars on glycaemic response (GR) over a 180-minute period in individuals with diabetes by estimating postprandial glucose levels variation and total area under the curve (AUC). Methods: Nine subjects (age: 54.6±4.0 years; BMI: 25.0±2.5 kg/m2) with type 2 diabetes mellitus (T2DM) diagnoses without complication enrolled in this randomised, open-label, cross-over trial. On three separate sessions, they consumed glucose standard solution, soy flour snack bar (SF), and wheat flour snack bar (WF) containing 25 g of available carbohydrate, respectively. Finger prick capillary method was executed to measure blood glucose levels at 30, 60, 90, 120, 150, 180 minutes after test product ingestion. Results: Overall, significantly lower postprandial glucose levels were observed at 30, 60, 90, and 120 minutes (122.3±17.6, 136.3±24.9, 125.7±25.3, and 107.2±24.1 mg/dL; p&lt;0.001) in those who consumed SF snack bars than WF snack bars (147.9±41.3, 168.0±43.6, 152.6±30.0, and 140.6±33.4 mg/dL). The AUC level after the ingestion of SF snack bar was 2044.8±503.1 mg.min/dL, &gt;20% lower compared to ingestion of WF snack bar (4735.0±666.8 mg.min/dL), p&lt;0.001. These glycaemic control benefits can be explained due to the high fibre and protein content linked to the physicochemical properties of SF. Conclusion: With high nutritional properties, SF snack bar has a low GR and might help control blood glucose in T2DM subjects.

Qibin Tongbian Decoction in the Treatment of Diabetic Constipation and Its Influence on the Intestinal Environment and the Incidence of Adverse Reactions: A Randomized Trial.

Objective This study aimed to study the clinical efficacy of Qibin Tongbian decoction in the treatment of diabetic constipation and its influence on the intestinal environment and the incidence of adverse reactions. Methods In this prospective study, a total of 62 patients with diabetic constipation admitted to our hospital from June 2020 to March 2021 were recruited and assigned at a ratio of 1 : 1 to receive either traditional treatment (control group) or Qibin Tongbian decoction (experimental group). Outcome measures included clinical efficacy, intestinal environment, and incidence of adverse reactions. Results Qibin Tongbian decoction was associated with significantly higher efficacy and a lower TCM symptom score versus conventional treatment (P < 0.05). Qibin Tongbian decoction resulted in significantly lower fasting plasma glucose (FPG) levels and 2-hour postprandial plasma glucose (2hPG) levels versus conventional treatment (P < 0.05). Patients receiving Qibin Tongbian decoction showed significantly lower constipation symptom scores and PAC-QOL scores versus conventional treatment (P < 0.05). Qibin Tongbian decoction resulted in a significantly larger number of bifidobacteria and enterococci and a smaller number of yeasts versus conventional treatment (P < 0.05). Qibin Tongbian decoction was associated with a significantly lower incidence of adverse reactions and recurrence rate versus conventional treatment (P < 0.05). Conclusion Qibin Tongbian decoction combined with conventional TCM therapy yields a promising effect in the treatment of diabetic constipation. It can improve the intestinal environment of patients, mitigate the symptoms of constipation, enhance the quality of life of patients, and reduce the incidence of adverse reactions, so it is worthy of promotion and application.

Efficacy of IDegLira Versus IDegAsp Therapy in Patients with Type2 Diabetes: A Randomized Crossover Study by isCGM.

IntroductionWe aimed to compare the efficacy of insulin degludec/insulin aspart (IDegAsp) and insulin degludec/liraglutide (IDegLira) in controlling glucose fluctuation and suppressing postprandial glucose levels using intermittently scanned continuous glucose monitoring.MethodsTwenty-four patients with type 2 diabetes mellitus were randomly allocated to receive either IDegLira or IDegAsp followed by IDegAsp or IDegLira, respectively. A crossover study was conducted with intermittently scanned continuous glucose monitoring. We compared the postprandial blood glucose level, time in range, and time below range from a 3-day intermittently scanned continuous glucose monitoring period for each treatment group.ResultsThe time in range was significantly higher in IDegLira than in IDegAsp. Postprandial glucose levels 90 and 120 min after breakfast and 60, 90, and 120 min after lunch were significantly lower for IDegLira than for IDegAsp. However, postprandial glucose levels 90 and 120 min after supper were significantly lower for IDegAsp than for IDegLira. There was no significant difference in the time below range between IDegLira and IDegAsp.ConclusionIDegLira was more effective in treating type 2 diabetes mellitus than IDegAsp, as indicated by a higher time in range and lower postprandial glucose level at breakfast and lunch. This study was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN 000039221).Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02138-w.

Bread with a high level of resistant starch influenced the digestibility of the available starch fraction

Eating foods in which available starch was replaced by resistant starch (RS) causes lower glucose and insulin responses. There is insufficient evidence for the effects of RS when the total available carbohydrates content remains constant. The present study aimed to evaluate the effects of bread with a high amount of RS3, compared to control bread. The effects of RS on glycaemia, insulin response, appetite visual analogue scale (VAS) scores were examined. It was also determined the glycaemic index (GI) of both loaves of bread. In a single-blind, crossover study, 37 nondiabetic adults consumed equivalent samples of a test bread with a high amount of RS (HRS - 2.4%) or a conventional bread (REF - 0.8%), with a washout period of at least one week. Postprandial glucose and VAS scores were measured at fasting, 15, 30, 45, 60, 90 and 120 min after the meal. Insulin response was measured at fasting and 30 min. HRS bread presented a significantly lower postprandial glucose response at 60, 90 and 120 min (P ≤ 0.05). Incremental AUC glycaemia response showed significantly lower values for HRS bread (127.15 ± 71.54 mmol*min/l) as well as higher satiety scores, compared to REF bread (153.77 ± 80.38 mmol*min/l); t(36) = 2.234; P = 0.016. HRS bread showed a GI = 60 much lower than the REF bread. The higher amount of RS causes a significantly lower postprandial glucose response. These results shows that RS3 influenced the digestibility of the available starch fraction. No differences were observed at insulin response. RS is related to higher satiety scores.

Lack of Evidence for a Causal Role of Hyperinsulinemia in the Progression of Obesity in Children and Adolescents: A Longitudinal Study.

The carbohydrate-insulin model (CIM) claims that chronic exposure to hyperinsulinemia induced by dietary carbohydrates explains development of obesity via direct effects of insulin and/or low postprandial metabolic fuel levels. We aimed at testing whether indices of hyperinsulinemia and postprandial glucose levels can predict increases in the degree of obesity over time. Children and adolescents with obesity attending a pediatric obesity clinic performed oral glucose tolerance tests (OGTTs) and received standard obesity management. Indices of hyperinsulinemia and insulin secretion were derived from the OGTT and evaluated in the face of changes in the degree of obesity over time. A total of 591 children (217 males and 374 females) participated, and the mean follow-up was 1.86 ± 1.29 years. OGTT-derived area under the curve of insulin, peak insulin, fasting insulin, the insulinogenic index, or insulin at 30 min were not associated with greater changes in the degree of obesity in univariate or multivariate analyses (adjusted for baseline age, BMI z score, sex, and ethnicity). Low postprandial glucose <75 mg/dL was not associated with greater changes in the degree of obesity in univariate or multivariate analyses. In a subsample of 104 participants with a follow-up >4 years, none of these parameters was associated with greater increases in the degree of obesity. In children and adolescents with obesity, exposure to hyperinsulinemia, greater insulin secretion, or low postprandial glucose is not associated with greater increases in the degree of obesity over 2-4 years. The CIM should be evaluated in children with lower BMI and for longer follow-up periods.

Processing, digestion property and structure characterization of slowly digestible gorgon nut starch.

The online version contains supplementary material available at 10.1007/s10068-021-01007-6.

Post-exercise Warm or Cold Water Immersion to Augment the Cardiometabolic Benefits of Exercise Training: A Proof of Concept Trial

We investigated whether substituting the final half within 60-min bouts of exercise with passive warm or cold water immersion would provide similar or greater benefits for cardiometabolic health. Thirty healthy participants were randomized to two of three short-term training interventions in a partial crossover (12 sessions over 14–16 days, 4 week washout): (i) EXS: 60 min cycling 70% maximum heart rate (HRmax), (ii) WWI: 30 min cycling then 30 min warm water (38–40°C) immersion, and/or (iii) CWI: 30 min cycling then 30 min cold water (10–12°C) immersion. Before and after, participants completed a 20 min cycle work trial, O2max test, and an Oral Glucose Tolerance Test during which indirect calorimetry was used to measure substrate oxidation and metabolic flexibility (slope of fasting to post-prandial carbohydrate oxidation). Data from twenty two participants (25 ± 5 year, BMI 23 ± 3 kg/m2, Female = 11) were analyzed using a fixed-effects linear mixed model. O2max increased more in EXS (interaction p = 0.004) than CWI (95% CI: 1.1, 5.3 mL/kg/min, Cohen’s d = 1.35), but not WWI (CI: −0.4, 3.9 mL/kg/min, d = 0.72). Work trial distance and power increased 383 ± 223 m and 20 ± 6 W, respectively, without differences between interventions (interaction both p > 0.68). WWI lowered post-prandial glucose ∼9% (CI −1.9, −0.5 mmol/L; d = 0.63), with no difference between interventions (interaction p = 0.469). Substituting the second half of exercise with WWI provides similar cardiometabolic health benefits to time matched exercise, however, substituting with CWI does not.

Postprandial plasma glucose excursion is associated with an atherogenic lipid profile in individuals with type 2 diabetes mellitus: A cross-sectional study.

Coronary heart disease (CHD) is a prevalent complication of type 2 diabetes mellitus (T2DM). The atherogenic low-density lipoprotein (LDL) cholesterol is an established risk factor of cardiovascular disease, and evidence also suggests that postprandial plasma glucose (PPG) levels closely delineate CHD mortality in diabetes. The investigators hypothesized that postprandial plasma glucose excursion (PPGE), defined as the difference between 2-hour PPG and fasting plasma glucose (FPG), may be associated with plasma LDL cholesterol levels in patients with T2DM. This study enrolled diabetic participants for whom FPG and lipid profile were sampled after a 12-hour fast, followed by PPG sampling two hours after consuming a standard meal with 75 grams of carbohydrates. The study enrolled 379 participants who were divided into PPGE tertiles according to the difference between their 2-hour PPG and FPG. Participants in the highest PPGE tertile had considerably greater plasma LDL cholesterol levels than patients in the lowest tertile (126.7 mg/dL vs. 99.5 mg/dL, P <0.001). Linear regression analysis also demonstrated that the PPGE was positively correlated with plasma LDL cholesterol levels (β coefficient: 0.165, P < 0.001). Postprandial glucose excursion positively correlated with plasma LDL cholesterol levels in individuals with T2DM. Participants with raised PPGE harbored greater LDL cholesterol levels than those with lower postprandial glucose fluctuations. Therefore, postprandial glucose excursion is associated with an atherogenic lipid profile and may be a modifiable risk factor of diabetic CHD.

Time Restricted Eating: A Dietary Strategy to Prevent and Treat Metabolic Disturbances.

Time-restricted eating (TRE), a dietary approach limiting the daily eating window, has attracted increasing attention in media and research. The eating behavior in our modern society is often characterized by prolonged and erratic daily eating patterns, which might be associated with increased risk of obesity, diabetes, and cardiovascular diseases. In contrast, recent evidence suggests that TRE might support weight loss, improve cardiometabolic health, and overall wellbeing, but the data are controversial. The present work reviews how TRE affects glucose and lipid metabolism based on clinical trials published until June 2021. A range of trials demonstrated that TRE intervention lowered fasting and postprandial glucose levels in response to a standard meal or oral glucose tolerance test, as well as mean 24-h glucose and glycemic excursions assessed using continuous glucose monitoring. In addition, fasting insulin decreases and improvement of insulin sensitivity were demonstrated. These changes were often accompanied by the decrease of blood triglyceride and cholesterol levels. However, a number of studies found that TRE had either adverse or no effects on glycemic and lipid traits, which might be explained by the different study designs (i.e., fasting/eating duration, daytime of eating, changes of calorie intake, duration of intervention) and study subject cohorts (metabolic status, age, gender, chronotype, etc.). To summarize, TRE represents an attractive and easy-to-adapt dietary strategy for the prevention and therapy of glucose and lipid metabolic disturbances. However, carefully controlled future TRE studies are needed to confirm these effects to understand the underlying mechanisms and assess the applicability of personalized interventions.

Inhibitory effects of acorn (Quercus variabilis Blume) kernel-derived polyphenols on the activities of α-amylase, α-glucosidase, and dipeptidyl peptidase IV

The chemical constituents of the free and bound polyphenols extracted from acorn kernels were analyzed, and the predominant chemical components in the free polyphenol extract were quercetin, azelaic acid, and gallic acid, while the bound polyphenol extract mainly contained ellagic acid, gallic acid, and ferulic acid. The inhibitory activities of the four main components on α-glucosidase showed the following trend: ellagic acid > quercetin > azelaic acid > gallic acid. The IC50 values of the free and bound polyphenol extracts on α-amylase were 5.25 and 1.37 mg/mL, respectively. The free polyphenol extract exhibited a greater ability to inhibit α-glucosidase and dipeptidyl peptidase IV (DPP-IV) than the bound polyphenol extract. The polyphenols were found to change the secondary structures of α-amylase, α-glucosidase and DPP-IV. The inhibitory effects of the polyphenols on the three enzymes may give rise to low postprandial blood glucose after eating acorn-containing foods and can be beneficial to diabetics.

Dumping Syndrome and Postbariatric Hypoglycemia: Supporting Evidence for a Common Etiology.

Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as "early and late dumping," these complications have been separated due to differences in their onset and behaviors. To investigate a potentially common etiology of DS and PBH using an analysis of a mixed meal test (MMT) study. A large teaching hospital in the Netherlands. From all patients who underwent bariatric surgery in 2008-2011, a random selection completed an MMT (n = 47). Patients scored complaints related to DS and PBH with a standardized questionnaire at several time intervals. The groups were divided into patients with (DS+; n = 22) and without (DS-; n = 25) an increase in DS symptoms after the start of the MMT. Glucose and gut hormone levels were compared. Hypoglycemia was defined as a blood glucose level below 3.3 mmol/L. The DS+ group had lower blood glucose values compared to the DS- group, which reached significance at 90 and 120 minutes (P < .05). For the DS+ group, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and satiety were higher at various time intervals (P < .05) compared to the DS- group. No differences were found for insulin and hunger score. GLP-1 and PYY were correlated with symptoms of DS. Patients with DS complaints had lower postprandial glucose values. GLP-1 and PYY values were elevated in the DS+ group early and late during the test. These hormones also correlated with DS. These findings support the hypothesis of a common etiology of DS and PBH and a role of GLP-1 and PYY in both complications.

Walking Initiated 20 Minutes before the Time of Individual Postprandial Glucose Peak Reduces the Glucose Response in Young Men with Overweight or Obesity: A Randomized Crossover Study

Although a single bout of postmeal exercise can lower postprandial glucose (PPG), its optimal timing remains unclear. This study aimed to investigate the effect of exercise timing using an individualized approach on PPG in overweight or obese young men. Twenty men [age: 23.0±4.3y; BMI (kg/m2): 27.4±2.8] each completed three 240-min trials in a randomized order separated by 6-14 d: 1) sitting (SIT), 2) walking initiated at each participant's PPG-peak time (PPGP) (iP), and 3) walking initiated 20min before the PPGP (20iP). For each participant, PPGP was predetermined using continuous glucose monitoring. Walking was performed at 50% maximal oxygen consumption for 30min. Venous blood was collected at 15- and 30-min intervals for 0-120min and 120-240min, respectively. The primary outcome was plasma PPG. Generalized estimating equations were used for comparison between trials. Compared with SIT, the 4-h incremental AUCs (iAUCs) for plasma PPG (-0.6 mmol · L-1 · h; P=0.047) and insulin (-28.7%, P < 0.001) were reduced in 20iP only, and C-peptide concentrations were lower after iP (-14.9%, P=0.001) and 20iP (-28.7%, P < 0.001). Plasma insulin (-11.1%, P=0.006) and C-peptide (-8.3%, P=0.012) were lower due to the 20iP compared with iP treatment. Finally, PPG reductions due to iP and 20iP occurred only in men with a BMI > 27.5 kg/m2 (iP, -11.2%; 20iP, -14.7%; P=0.047) and higher glucose iAUC values during SIT (iP, -25.5%; 20iP, -25.7%; P < 0.001). Walking initiated 20min before PPGP lowered PPG and plasma insulin and C-peptide concentrations in young men with overweight or obesity, in particular in those with high BMI or glucose iAUC values during SIT; it also lowered plasma insulin and C-peptide concentrations more effectively than did exercise initiated at PPGP. This trial was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) as ChiCTR1900023175.

Comparative Effects of Intragastric and Intraduodenal Administration of Quinine on the Plasma Glucose Response to a Mixed-Nutrient Drink in Healthy Men: Relations with Glucoregulatory Hormones and Gastric Emptying.

In preclinical studies, bitter compounds, including quinine, stimulate secretion of glucoregulatory hormones [e.g., glucagon-like peptide-1 (GLP-1)] and slow gastric emptying, both key determinants of postprandial glycemia. A greater density of bitter-taste receptors has been reported in the duodenum than the stomach. Thus, intraduodenal (ID) delivery may be more effective in stimulating GI functions to lower postprandial glucose. We compared effects of intragastric (IG) and ID quinine [as quinine hydrochloride (QHCl)] administration on the plasma glucose response to a mixed-nutrient drink and relations with gastric emptying, plasma C-peptide (reflecting insulin secretion), and GLP-1. Fourteen healthy men [mean±SD age: 25±3y; BMI (in kg/m2): 22.5±0.5]received, on 4 separate occasions, in double-blind, randomly assigned order, 600 mgQHCl or control, IG or ID, 60min (IG conditions) or 30min (IG conditions) before a mixed-nutrient drink. Plasma glucose (primary outcome) and hormones were measured before, and for 2 h following, the drink. Gastric emptying of the drink was measured using a 13C-acetate breath test. Data were analyzed using repeated-measures 2-way ANOVAs (factors: treatment and route of administration) to evaluate effects of QHCl alone and 3-way ANOVAs (factors: treatment, route-of-administration, and time) for responses to the drink. After QHCl alone, there were effects of treatment, but not route of administration, on C-peptide, GLP-1, and glucose (P<0.05); QHCl stimulated C-peptide and GLP-1 and lowered glucose concentrations (IG control: 4.5±0.1; IG-QHCl: 3.9±0.1; ID-control: 4.6±0.1; ID-QHCl: 4.2±0.1 mmol/L)compared with control. Postdrink, there were treatment×time interactions for glucose, C-peptide, and gastric emptying, and a treatment effect for GLP-1 (all P<0.05), but no route-of-administration effects. QHCl stimulated C-peptide and GLP-1, slowed gastric emptying, and reduced glucose (IG control: 7.2±0.3; IG-QHCl: 6.2±0.3; ID-control: 7.2±0.3; ID-QHCl: 6.4±0.4 mmol/L) compared with control. In healthy men, IG and ID quinine administration similarly lowered plasma glucose, increased plasma insulin and GLP-1, and slowed gastric emptying. These findings have potential implications for lowering blood glucose in type 2 diabetes. This study was registered as a clinical trial with the Australian New Zealand Clinical Trials at www.anzctr.org.au as ACTRN12619001269123.

EFFECTS OF ACUTE EXERCISE WITH DIFFERENT INTENSITIES ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

Exercise intensity is one of the most important factors that determines the effects of exercise; however, there is little known about the acute glycemic control of different exercise intensities on patients with Type 2 Diabetes Mellitus (T2DM). Here we aimed at exploring the influence of a single bout of exercise with different intensities on blood glucose levels in T2DM patients. Fifteen subjects (54.7 ± 5.8 years old) participated in a session of walking (WG), jogging (JG), or sedentary control (CG) in a randomized order on three different days. Distances in both WG and JG were set as 2 Km with a speed set as 4~4.5 Km/h for walking and 5~6 Km/h for jogging based on pretrial test. Blood glucose levels at fasting (~6:30am), pre-exercise (~8:30am), post-exercise (~9am), 11am and 4pm were detected. Walking and jogging reached approximately moderate and high intensity based on the immediate post-exercise heart rate and RPE scores. Blood glucose levels at fasting, pre-exercise and 4pm were not substantially different among all groups (p > 0.05). JG had a significantly lower post-exercise blood glucose level (p < 0.05) when compared with CG and WG. The blood glucose level at 11am was notably lower in WG and JG than in CG (p < 0.05). Both a single bout of jogging and walking can lower postprandial blood glucose levels in T2DM patients. When matched for exercise distance, jogging represents a more effective strategy to immediately lower postprandial glucose levels than walking.

A natural mutation in Pisum sativum L. (pea) alters starch assembly and improves glucose homeostasis in humans.

Elevated postprandial glucose (PPG) is a significant risk factor for non-communicable diseases globally. Currently, there is a limited understanding of how starch structures within a carbohydrate-rich food matrix interact with the gut luminal environment to control PPG. Here, we use pea seeds (Pisum sativum) and pea flour, derived from two near-identical pea genotypes (BC1/19RR and BC1/19rr) differing primarily in the type of starch accumulated, to explore the contribution of starch structure, food matrix and intestinal environment to PPG. Using stable isotope 13C-labelled pea seeds, coupled with synchronous gastric, duodenal and plasma sampling in vivo, we demonstrate that maintenance of cell structure and changes in starch morphology are closely related to lower glucose availability in the small intestine, resulting in acutely lower PPG and promotion of changes in the gut bacterial composition associated with long-term metabolic health improvements.

Hp1-1 as a Genetic Marker Regulating Inflammation and the Possibility of Developing Diabetic Complications in Patients with Type 2 Diabetes-Cohort Studies.

Background: This study assessed the influence of the haptoglobin phenotype on markers regulating inflammation in patients with type 2 diabetes. Methods: The haptoglobin phenotypes, soluble form of CD163 receptor (sCD163), p53 concentrations and high mobility group box protein 1 (HMGB1), interleukin 10 (IL-10) secretion in serum were assayed via ELISA tests. In the first part of the project, patients were divided into three groups which differed by the haptoglobin phenotype, and afterwards into two groups according to the criterion of the presence or absence of cardiovascular disease. Results: Diabetic patients with haptoglobin phenotype 1-1 (Hp1-1) had a significantly higher concentration of IL-10 and sCD163 compared to haptoglobin phenotype 2-1 (Hp2-1) and haptoglobin phenotype 2-2 (Hp2-2). Moreover, diabetic patients with Hp1-1 had a significantly lower concentration of p53 and HMGB1 compared to diabetic patients with Hp2-1 and Hp2-2. The results have shown that diabetics with Hp2-1 had a significantly lower postprandial glucose level compared to diabetics with Hp2-2. Apart from that, there were no differences in the occurrence of haptoglobin variants between patients with or without cardiovascular disease. Conclusions: Our study provides new data for a relationship between the type of haptoglobin in patients with type 2 diabetes and the concentration of factors that regulate the body’s inflammation. We have shown that the Hp1-1 can serve as a genetic marker of inflammatory processes.

Effects of Polyphenols on Insulin Resistance.

Insulin resistance (IR) is apparent when tissues responsible for clearing glucose from the blood, such as adipose and muscle, do not respond properly to appropriate signals. IR is estimated based on fasting blood glucose and insulin, but some measures also incorporate an oral glucose challenge. Certain (poly)phenols, as supplements or in foods, can improve insulin resistance by several mechanisms including lowering postprandial glucose, modulating glucose transport, affecting insulin signalling pathways, and by protecting against damage to insulin-secreting pancreatic β-cells. As shown by intervention studies on volunteers, the most promising candidates for improving insulin resistance are (−)-epicatechin, (−)-epicatechin-containing foods and anthocyanins. It is possible that quercetin and phenolic acids may also be active, but data from intervention studies are mixed. Longer term and especially dose-response studies on mildly insulin resistant participants are required to establish the extent to which (poly)phenols and (poly)phenol-rich foods may improve insulin resistance in compromised groups.