Mean Change In Glucose Research Articles

Short-term multifactorial intervention (STEMI): An approach using structured blood glucose monitoring (BGM) and conventional therapies in persons with diabetes

ABSTRACT Background: Achieving glucose and glycosylated hemoglobin (HbA1c) targets have been shown to reduce long-term microvascular complications of diabetes; however, suboptimal glucose control is common. We tested whether glucose control could be improved within 8 weeks by employing structured blood glucose monitoring (BGM) qid in addition to seven times per day prior to visits for diabetes education and medication management that occurred every 2–4 weeks. Methods: This single-center, prospective study was conducted on 78 adults with either type 1 diabetes (T1D) or type 2 diabetes (T2D), HbA1c >8%, and serum creatinine (sCr) <2.0 mg/dl. HbA1c was checked at baseline, Week 2, Week 4, and at Week 8. Patients were evaluated by a physician and a certified diabetes educator (CDE) at baseline, Week 2, and Week 4 for treatment adjustments and lifestyle advice based on a review of BGM done qid plus 7-point profiles conducted before Weeks 2, 4, and 8. Study outcomes were change in HbA1c from baseline to Week 8 and change in mean glucose on the 7-point profile from Week 2 to Week 8. These were compared using one-way repeated measures ANOVA. Results: Of the 78 patients, 64.1% had T2D, 50% were women, and 72% were Caucasian. Mean age (±SD) was 51.3.5 ± 11.1 years, and median diabetes duration was 9 (5–17) years. The percentage of patients using insulin increased from 58.9% at baseline to 67.9% at Week 8. The mean (±SD) HbA1c was 9.53% (±1.71) at baseline, declined -1.38% from baseline to week 8 (CI -1.62 to -0.14, P < 0.001). The mean (±SD) glucose on the 7-point profile was 187 (±52) mg/dl at Week 2, and 157 (±5) mg/dl at Week 8. (P < 0.01). Conclusions: An intensive glucose optimization program using structured BGM qid plus 7-point profiles, diabetes education, and conventional anti-diabetic therapies was successful in reducing HbA1c by 1.38% over 8 weeks in patients with poor glucose control.

336-OR: Insulin Delivery Modality Does Not Impact Glycemic Change during Physical Activity in Youth with Type 1 Diabetes (T1D)—Results from the Real-World T1DEXI Pediatric Study

Despite its well-established benefits, exercise can cause blood glucose levels to drop precipitously. Factors such as pre-exercise glucose, exercise type and insulin on board (IOB) all appear to influence the magnitude of drop in glucose during exercise, but it is currently unclear if insulin delivery modality (i.e., MDI vs. standard pump vs. closed loop pump) has a clinically significant effect. Data from the Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) study allowed us to examine if insulin delivery modality influences the change in glucose during exercise in youth with T1D. Youth (N=248) with T1D ([mean ± SD] age= 14±2 years; T1D duration= 5.4±3.9 years; HbA1c= 7.1±1.3%; BMI percentile= 62±27%; 58% male) wore a continuous glucose monitor (Dexcom G6) and a Garmin, Vivosmart 4 activity monitor while logging meals and activity with the bant smartphone app over a 10-day period. Drop in glucose level during exercise was associated with pre-exercise glucose and IOB (mean change in glucose of 5.7 mg/dL, -15.7 mg/dL, and -26.5 mg/dL for IOB of 0 U/kg, >0 to <0.1 U/kg, and ≥0.1 U/kg, respectively; p<0.001), but did not differ significantly by insulin delivery modality (Figure). Pre-exercise glucose and IOB, but not insulin delivery method, are associated with changes in glucose during exercise in youth with T1D. Disclosure M.Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Indigo Diabetes, Consultant; Lilly Diabetes, Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Novo Nordisk, Sanofi, Stock/Shareholder; Supersapiens, Zucara Therapeutics. S.Bergford: None. R.L.Gal: None. S.R.Patton: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. P.Calhoun: None. J.Sherr: Advisory Panel; Bigfoot Biomedical, Inc., Insulet Corporation, Medtronic, Vertex Pharmaceuticals Incorporated, Cecelia Health, StartUp Health T1D Moonshot, Consultant; Bigfoot Biomedical, Inc., Insulet Corporation, Medtronic, Lilly, Research Support; Insulet Corporation, Medtronic, NIH - National Institutes of Health, Juvenile Diabetes Research Foundation (JDRF), Speaker's Bureau; Insulet Corporation, Zealand Pharma A/S, Lilly, Medtronic. T1dexip study group: n/a. Funding The Leona M. and Harry B. Helmsley Charitable Trust; Dexcom, Inc.

Abstract 105: High-dose Intranasal Insulin In A Dose-escalation Study For Healthy Human Subjects

Introduction: Intranasal insulin is a putative neuroprotective therapy that could be easily delivered very early after cardiac arrest, but safety at doses extrapolated from animal models have not been studied in humans. We hypothesized that high-dose intranasal insulin can be safely delivered to healthy human subjects. Methods: This was a phase 1, open label dose-finding study of intranasal insulin in healthy participants.The primary objective was to determine the maximum tolerated dose of intranasal insulin in healthy subjects. Placebo and insulin were given intranasally to supine healthy volunteers intranasally at escalating doses from 0 to 1000 units on repeated weekly visits. Serum glucose, insulin, and C-peptide levels were measured serially at 0, 15, 30, 60, 120, 180 and 240 minutes after administration. Results: Twenty four participants (12 female, median age 53.5, IQR 35.75-61) were enrolled. There was no change in average serum glucose after administration of intranasal insulin. Average serum insulin increased slightly in a dose-dependent manner, peaking at 15 minutes. C-peptide went down over time from administration in all groups. One participant had severe hypoglycemia (minimum 24 mg/dL 45 min after receiving 600U intranasal insulin) that was corrected with oral intake and intravenous dextrose. Another participant had transient hypoglycemia (minimum 51 mg/dL at 30 min) also after 600U intranasal insulin with mild symptoms that was corrected with oral intake. Hypoglycemic episodes were associated with increases in serum insulin. Both participants continued in the study without hypoglycemia after additional doses. One participant dropped out for reasons unrelated to the intervention. Discussion: High-dose intranasal insulin up to 1000U was well tolerated, without changes in mean glucose, but with small measurable systemic absorption. Idiosyncratic hypoglycemia requires further study. Delivery of intranasal insulin to the brain at these doses, and efficacy of high-dose intranasal insulin as a neuroprotective therapy after cardiac arrest require further study.

Impact Of Traditional Blood Flow Restriction Versus Band Tissue Flossing On Metabolism And Performance

Blood flow restriction during resistance exercise (BFR + RE) increases metabolic stress and muscle fiber recruitment, elevating fatigue even at low resistance loads. Band tissue flossing (BTF) is a method for BFR in which an elastic band wraps around the limb. PURPOSE: The purpose of this study was to compare the effects of BTF to BFR during RE on changes in glucose, lactate, and total work performed. METHODS: Fifteen apparently healthy subjects (25 ± 1.2 yrs) visited the lab for three sessions separated by at least 72 hours. Each session involved 3 sets of 20 max-effort seated leg extensions and flexions on an isokinetic dynamometer with one of three randomized conditions: control (CON), BFR, or BTF. During BFR and BTF sessions, occlusion was applied immediately before exercise and removed immediately after collecting post- blood. Glucose and lactate measurements were collected pre- and immediately post-exercise. Total work performed was recorded during each extension and analyzed for between-condition differences. RESULTS: Only CON and BTF conditions resulted in significantly lower glucose immediately post-exercise compared to pre- (mean change: CON = -11.0 ± 13.5 and BTF = -10.31 ± 10.9 mg/dL). However, no significant differences in mean change in glucose were found between any conditions. In all conditions, blood lactate post-exercise was significantly greater than pre- (mean change: CON = 3.5 ± 0.6, BFR = 3.4 ± 0.5, BTF = 3.4 ± 0.6 mmol/L), again with no between-condition differences in mean change. Total work performed during set 1 was not significantly different between conditions. During set 2, significantly less work was performed in BFR (p = 0.046; 1024.9 ± 96.9 ft-lbs) and BTF (p = 0.004; 865.1 ± 118.2 ft-lbs) when compared to CON (1182.0 ± 115.6 ft-lbs). During set 3, significantly less work was again performed in the BTF condition (p < 0.001; 663.1 ± 333.7 ft-lbs) when compared to CON (1050.7 ± 325.8 ft-lbs). CONCLUSIONS: Application of an occluding device, whether BFR or BTF, results in significantly less work done than without occlusion. Despite the decrease in work, BFR and BTF + RE result in similar increases in lactate and uptake of glucose than CON. This suggests both BTF and BFR are effective for achieving significant metabolite production during RE via lesser amounts of work.

Effect of different doses of Moringa oleifera in postprandial glucose. Influence of participants’ glucose control status

AbstractThe multipurpose plant Moringa oleifera (MO) has shown a variety of in vitro activities potentially beneficial for health and evidences are also numerous in animal models. However, the exact composition of the plant is highly variable depending on the area, culture and post harvesting conditions and the effects in humans are scarcely studied. This is a pilot study of the effect of different doses of MO from an Iberian Peninsula cultivar on postprandial glucose level in non-diabetic subjects. Five adult subjects (40 to 70 years, 3 males) with normal renal and hepatic function were included. Two had normal fasting glucose and 3 had pre-diabetic fasting glucose. A standard breakfast plus, respectively, one placebo capsule (PLC), or 1, 3 and 6 capsules containing 400 mg of MO dry leaf powder (MO-1cap, -3cap and -6cap) were consumed by each subject on 4 consecutive visits, one week apart. The basal and postprandial (30, 60, 90, 120, 150 and 180 min) glucose was measured. The mean glucose change from baseline (ΔGlc) at each measure time was calculated and compared between treatments with the Wilcoxon tests and considered significant at P &lt; 0.05 level. The postprandial curves were also studied separately in pre-diabetic subjects. A difference was found 90 min after breakfast in ΔGlc for the MO-6cap compared to the MO-1cap, being lower in MO-6cap. No more significant differences were observed due to the small number of subjects and high variability in glucose values among subjects. However, the graphical representation of separated curves for the three pre-diabetic participants showed that all three MO doses led to values always below those with PLC. In addition, during the first experimental hour all MO doses showed lower ΔGlc than PLC while this was not the case when all subjects were studied. No adverse events occurred during the experiment. The study, thus, showed a trend to lower glycemic postprandial response with MO leaf powder which seems to be more evident in pre-diabetic subjects than in normoglycemic subjects and especially during the first postprandial hour. The MO-6cap seems to be the election daily dose for a long term intervention study on the glycemic control with MO in pre-diabetic subjects.

Effect of Exercise Training Intensity on Glycemic Control in Older Adults with Prediabetes

INTRODUCTION: Older adults have the highest rates of prediabetes and diabetes in the US. Exercise is a well-established method to improve glycemic control, however, the optimal dose (duration and intensity) of exercise required to improve glycemic control among older adults is unclear. PURPOSE:To compare the effect of 12 weeks of moderate vs. high intensity exercise training on daily glycemic control in older adults with prediabetes. METHODS: 15 older adults (66.4 ±5.1 yrs) with prediabetes (HbA1c 5.7-6.4% or fasting glucose 100-125 mg/dl) participated in a 12-week supervised aerobic exercise training intervention. Participants were screened prior to being randomized to the moderate (MOD: 60-65% HRmax) or vigorous (VIG: 80-85% HRmax) intensity training group. During the intervention, participants exercised 4 days per week (45 minutes/session) in their target heart rate range. Continuous glucose monitors (CGM) were worn for 1 week at baseline and during the 12thweek of supervised exercise training. Daily glycemic control was quantified over 24 hour periods (00:00 to 23:29) for each day the CGMs were worn during the week at baseline and after exercise training. We calculated mean, total area under the curve (trapezoidal method), and duration of hyperglycemia (percent time glucose ≥140mg/dL). Using linear mixed models with repeated measures, we determined the effect of exercise training and whether the effect of training varied by exercise intensity group. Significance was set at p < 0.05. Data are reported as mean±SD. SUMMARY OF RESULTS: There were no significant differences in any baseline participant characteristics (e.g. sex, age, BMI) between exercise training groups. At baseline, VIG had significantly lowermean (MOD: 136.0 ±18.4; VIG: 122.6 ±7.4 mg/dL), total area under the curve (AUC) (MOD: 3243.0 ±505.1; VIG: 2873.4 ±226.2 mg*hr/dL), and duration of hyperglycemia (MOD: 38.5 ±28.6%; VIG: 19.9 ±9.6%). After the intervention, there were no significant changes in mean glucose, AUC, or duration of hyperglycemia in either group. CONCLUSION: Regardless of exercise intensity,12 weeks of aerobic exercise training did not significantly change daily glycemic control in older adults with prediabetes, suggesting that changing other lifestyle factors may be needed to improve glycemic control in this population.

Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: The higher they start, the harder they fall.

To evaluate the pattern of change in blood glucose concentrations and hypoglycemia risk in response to prolonged aerobic exercise in adolescents with type 1 diabetes (T1D) that had a wide range in pre-exercise blood glucose concentrations. Individual blood glucose responses to prolonged (~60 minutes) moderate-intensity exercise were profiled in 120 youth with T1D. The mean pre-exercise blood glucose concentration was 178 ± 66 mg/dL, ranging from 69 to 396 mg/dL, while the mean change in glucose during exercise was -76 ± 55 mg/dL (mean ± SD), ranging from +83 to -257 mg/dL. Only 4 of 120 youth (3%) had stable glucose levels during exercise (ie, ± ≤10 mg/dL), while 4 (3%) had a rise in glucose >10 mg/dL, and the remaining (93%) had a clinically significant drop (ie, >10 mg/dL). A total of 53 youth (44%) developed hypoglycemia (≤70 mg/dL) during exercise. The change in glucose was negatively correlated with the pre-exercise glucose concentration (R2 = 0.44, P < 0.001), and tended to be greater in those on multiple daily insulin injections (MDI) vs continuous subcutaneous insulin infusion (CSII) (-98 ± 15 vs -65 ± 7 mg/dL, P = 0.05). No other collected variables appeared to predict the change in glucose including age, weight, height, body mass index, disease duration, daily insulin dose, HbA1c , or sex. Youth with T1D have variable glycemic responses to prolonged aerobic exercise, but this variability is partially explained by their pre-exercise blood glucose levels. When no implementation strategies are in place to limit the drop in glycemia, the incidence of exercise-associated hypoglycemia is ~44% and having a high pre-exercise blood glucose concentration is only marginally protective.

Glucose variability during delirium in diabetic and non-diabetic intensive care unit patients: A prospective cohort study.

PurposeTo determine whether glucose variability is altered during delirium days compared to non-delirious days in critically ill patients with and without diabetes in the intensive care unit (ICU).Materials and methodsCritically ill patients with delirious and non-delirious days during ICU stay were included from a prospective cohort study which was conducted from January 2011- June 2013. Glucose variability was measured each observation day using various definitions (change in mean glucose, standard deviation, mean absolute glucose, daily delta and occurrence of hypo- and hyperglycemia). Mixed-effects models and generalized mixed-effects models with logit link function were performed to study the association between delirium and glucose variability, adjusting for potential confounders.ResultsWith the exception of the risk of hypoglycemia, delirium was not linked to higher glucose variability using the various definitions of this estimate. For hypoglycemia, we did find an association with delirium in diabetic patients (OR adj.: 2.78; 95% CI: 1.71–6.32, p = 0.005), but not in non-diabetic patients (OR adj.: 1.16; 95% CI: 0.58–2.28, p = 0.689).ConclusionsDespite the positive association between delirium and hypoglycemia in critically ill patients with diabetes, delirium was not associated with more pronounced glucose variability. Our findings suggest that glucose levels should be monitored more closely in diabetic patients during delirium at the ICU to prevent hypoglycemia.

Habituation to the Cold Pressor Test

During acute cold exposure, a stress response is induced. PURPOSE: The purpose of this study was to see if daily, cold water exposure to the dominant hand causes habituation to the stress responses that occur due to cold exposure. METHODS: Fourteen seemingly healthy men (age=22± 2 years, height=70± 3cm, body fat %= 17.5± 12.9%) participated in the study. Subjects performed the cold pressor test (CPT) a total of 20 times for 4 weeks (5 times per week). Data was collected during the first and final day of the 20-day habituation period. Blood glucose levels were measured before and immediately after the CPT. Subjects were asked to respond to both pain and thermal sensation scale every 30 seconds during the CPT testing. RESULTS: A repeated measures ANOVA showed a significant main effect for time for glucose, day 1 versus the final day (F=5.16; p=.04). A paired T-test also revealed a significant difference between the changes in glucose levels (pre-CPT-post-CPT), day 1 versus the final day (mean difference=11.79; t-ratio=2.27; p=.02). The mean change pre to post CPT in glucose on day one was 12±13 mmol/L, and the mean change in glucose on the final day was .5±18 mmol/L. Repeated measures ANOVA showed a significant main effect for time for pain scale, but there was no significant main effect for time for thermal sensations (pain scale: F=27.39; p=.01) (thermal sensation: F=.68; p=.72). Pain scale responses decreased significantly while thermal sensations remained unaltered. The average pain scale response on day one was 5±5, and on the final day 1±1. CONCLUSION: This study found a significantly decreased glucose response after 20 days of cold water exposure to the hand. This demonstrates habituation to the stress response. The perception of pain decreased significantly, but not thermal discomfort. More studies are needed to further the investigation on the physiological processes that habituated due to repeated cold exposure.

A single dose of dapagliflozin, an SGLT-2 inhibitor, induces higher glycosuria in GCK- and HNF1A-MODY than in type 2 diabetes mellitus

AimsSGLT2 inhibitors are a new class of oral hypoglycemic agents used in type 2 diabetes (T2DM). Their effectiveness in maturity onset diabetes of the young (MODY) is unknown. We aimed to assess the response to a single dose of 10 mg dapagliflozin in patients with Hepatocyte Nuclear Factor 1 Alpha (HNF1A)-MODY, Glucokinase (GCK)-MODY, and type 2 diabetes.MethodsWe examined 14 HNF1A-MODY, 19 GCK-MODY, and 12 type 2 diabetes patients. All studied individuals received a single morning dose of 10 mg of dapagliflozin added to their current therapy of diabetes. To assess the response to dapagliflozin we analyzed change in urinary glucose to creatinine ratio and serum 1,5-Anhydroglucitol (1,5-AG) level.ResultsThere were only four patients with positive urine glucose before dapagliflozin administration (one with HNF1A-MODY, two with GCK-MODY, and one with T2DM), whereas after SGLT-2 inhibitor use, glycosuria occurred in all studied participants. Considerable changes in mean glucose to creatinine ratio after dapagliflozin administration were observed in all three groups (20.51 ± 12.08, 23.19 ± 8.10, and 9.84 ± 6.68 mmol/mmol for HNF1A-MODY, GCK-MODY, and T2DM, respectively, p < 0.001 for all comparisons). Post-hoc analysis revealed significant differences in mean glucose to creatinine ratio change between type 2 diabetes and each monogenic diabetes in response to dapagliflozin (p = 0.02, p = 0.003 for HNF1-A and GCK MODY, respectively), but not between the two MODY forms (p = 0.7231). Significant change in serum 1,5-AG was noticed only in T2DM and it was −6.57 ± 7.34 mg/ml (p = 0.04).ConclusionsA single dose of dapagliflozin, an SGLT-2 inhibitor, induces higher glycosuria in GCK- and HNF1A-MODY than in T2DM. Whether flozins are a valid therapeutic option in these forms of MODY requires long-term clinical studies.

Glucose- and glycaemic factor-lowering effects of probiotics on diabetes: a meta-analysis of randomised placebo-controlled trials.

This meta-analysis examined the effect of probiotics on glucose and glycaemic factors in diabetes and its associated risk factors. All randomised-controlled trials published in English in multiple databases from January 2000 to June 2015 were systematically searched. Only studies that addressed glucose- and glycaemic-related factors as outcome variables were included. The main outcomes of interest in trials were mean changes in glucose, HbA1c, insulin and homoeostasis model assessment-estimated insulin resistance (HOMA-IR). Using the Physiotherapy Evidence Database (PEDro) scale to assess the quality of studies, a total of eleven studies with 614 subjects were included. The pooled mean difference and effect size with a 95% CI were extracted using a random-effect model. It was found that there are statistically significant pooled mean differences between the probiotics and the placebo-controlled groups on the reduction of glucose (-0·52 mmol/l, 95% CI -0·92, -0·11 mmol/l; P=0·01) and HbA1c (-0·32%, 95% CI -0·57, -0·07%; P=0·01). There was no statistically significant pooled mean difference between the probiotics and the placebo-controlled groups on the reduction of insulin (-0·48 µIU/ml, 95% CI -1·34, 0·38 µIU/ml; P=0·27) and HOMA-IR (pooled effect of -0·44, 95% CI -1·57, 0·70; P=0·45). Meta-regression analysis identified that probiotics had significant effects on reduction of glucose, HbA1c, insulin and HOMA-IR in participants with diabetes, but not in participants with other risk factors. The present meta-analysis suggested that probiotics may be used as an important dietary supplement in reducing the glucose metabolic factors associated with diabetes.

A comparative study of oral olanzapine and oral haloperidol on glucose tolerance levels in patients with schizophrenia

Background: Schizophrenia is a mental disorder characterized by persistent defects in the perception, thinking or the expression of reality. The term translates roughly as shattered mind, and comes from the Greek (schizo, split or divide) and (phrAÂA‚“n, mind). Material and Methods: The study was designed to be a prospective control study. Schizophrenic patients taking Olanzapine and Haloperidol were selected and follow up at three weeks and six weeks was done. Results: In this prospective control study, Olanzapine and Haloperidol were associated with an increase in Blood Glucose Levels. The mean changes in Glucose remained within clinically normal range in this six week study. Conclusion: Antipsychotic treatmemt leads to the development of Diabetes mellitus in a significant 10.1% of patients within 6 weeks. Given the serious implications for morbidity and mortality attributable to diabetes mellitus, clinicians need to be aware of these risk factors when treating patients with chronic schizophrenia

Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus.

Many hormonal contraceptives have been associated with changes in carbohydrate metabolism. Alterations may include decreased glucose tolerance and increased insulin resistance, which are risk factors for Type 2 diabetes mellitus and cardiovascular disease. These issues have been raised primarily with contraceptives containing estrogen. To evaluate the effect of hormonal contraceptives on carbohydrate metabolism in healthy women and those at risk for diabetes due to overweight. In April 2014, we searched the computerized databases MEDLINE, POPLINE, CENTRAL, and LILACS for studies of hormonal contraceptives and carbohydrate metabolism. We also searched for clinical trials in ClinicalTrials.gov and ICTRP. The initial search also included EMBASE. All randomized controlled trials were considered if they examined carbohydrate metabolism in women without diabetes who used hormonal contraceptives for contraception. Comparisons could be a placebo, a non-hormonal contraceptive, or another hormonal contraceptive that differed in drug, dosage, or regimen. Interventions included at least three cycles. Outcomes included glucose and insulin measures. We assessed all titles and abstracts identified during the literature searches. The data were extracted and entered into RevMan. We wrote to researchers for missing data. For continuous variables, the mean difference (MD) was computed with 95% confidence interval (CI) using a fixed-effect model. For dichotomous outcomes, the Peto odds ratio with 95% CI was calculated. We found 31 trials that met the inclusion criteria. No new trials were eligible in 2014. Twenty-one trials compared combined oral contraceptives (COCs); others examined different COC regimens, progestin-only pills, injectables, a vaginal ring, and implants. None included a placebo. Of 34 comparisons, eight had any notable difference between the study groups in an outcome.Twelve trials studied desogestrel-containing COCs, and the few differences from levonorgestrel COCs were inconsistent. A meta-analysis of two studies showed the desogestrel group had a higher mean fasting glucose (MD 0.20; 95% CI 0.00 to 0.41). Where data could not be combined, single studies showed lower mean fasting glucose (MD -0.40; 95% CI -0.72 to -0.08) and higher means for two-hour glucose response (MD 1.08; 95% CI 0.45 to 1.71) and insulin area under the curve (AUC) (MD 20.30; 95% CI 4.24 to 36.36).Three trials examined the etonogestrel vaginal ring and one examined an etonogestrel implant. One trial showed the ring group had lower mean AUC insulin than the levonorgestrel-COC group (MD -204.51; 95% CI -389.64 to -19.38).Of eight trials of norethisterone preparations, five compared COCs and three compared injectables. In a COC trial, a norethisterone group had smaller mean change in glucose two-hour response than a levonorgestrel-COC group (MD -0.30; 95% CI -0.54 to -0.06). In an injectable study, a group using depot medroxyprogesterone acetate had higher means than the group using norethisterone enanthate for fasting glucose (MD 10.05; 95% CI 3.16 to 16.94), glucose two-hour response (MD 17.00; 95% CI 5.67 to 28.33), and fasting insulin (MD 3.40; 95% CI 2.07 to 4.73).Among five recent trials, two examined newer COCs with different estrogen types. One showed the group with nomegestrel acetate plus 17β-estradiol had lower means than the levonorgestrel group for incremental AUC glucose (MD -1.43; 95% CI -2.55 to -0.31) and glycosylated hemoglobin (HbA1c) (MD -0.10; 95% CI -0.18 to -0.02). Two trials compared extended versus conventional (cyclic) regimens. With a dienogest COC, an extended-use group had greater mean change in AUC glucose (MD 82.00; 95% CI 10.72 to 153.28). In a small trial using two levonorgestrel COCs, the lower-dose group showed smaller mean change in fasting glucose (MD -3.00; 95% CI -5.89 to -0.11), but the obese and normal weight women did not differ significantly. Current evidence suggests no major differences in carbohydrate metabolism between different hormonal contraceptives in women without diabetes. We cannot make strong statements due to having few studies that compared the same types of contraceptives. Many trials had small numbers of participants and some had large losses. Many of the earlier studies had limited reporting of methods.We still know very little about women at risk for metabolic problems due to being overweight. More than half of the trials had weight restrictions as inclusion criteria. Only one small trial stratified the groups by body mass index (obese versus normal).

The effect of obesity and low-dose oral contraceptives on carbohydrate and lipid metabolism

BackgroundCombination oral contraceptives (OCs) have little effect on carbohydrate and lipid metabolism in normal-weight women. Based on lack of change in intermediate markers, as well as results of epidemiologic studies, low-dose OCs do not increase the risk of diabetes or cardiovascular disease. Obesity is a risk factor for impaired glucose tolerance, diabetes and coronary artery disease, and most previous OC studies excluded these women; thus, we have limited information about carbohydrate and lipid metabolism in obese OC users. Study DesignThis study compared changes in carbohydrate and lipid parameters in 71 normal-weight and 38 obese women initiating the OC. Women were randomized to two pills: 30 mcg ethinyl estradiol (EE)/150 mcg levonorgestrel (LNG) or 20 mcg EE/100 mcg LNG. Participants underwent baseline and cycle-3 measurements of fasting serum glucose; insulin; triglycerides and total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. ResultsNormal-weight and obese participants experienced similar changes in mean glucose, insulin and log homeostatic model assessment, as well as similar changes in total cholesterol, HDL and triglycerides; however, change in mean LDL (−4.9±20.6 mg/dL vs. +3.8±17.3 mg/dL) was different between the obese and normal-weight groups, respectively. Among the obese participants, change in glucose was marginally greater with the higher dose pill (p=.06); otherwise, changes between the body mass index groups were not modified by pill dose. ConclusionsObesity had little effect on any OC-induced changes in carbohydrate or lipid metabolism except for a borderline adverse interaction between obesity and OC dose with respect to fasting glucose and a positive interaction between obesity and OC use with respect to LDL cholesterol.

Use of Continuous Glucose Monitoring in Subjects With Type 1 Diabetes on Multiple Daily Injections Versus Continuous Subcutaneous Insulin Infusion Therapy

OBJECTIVETo compare use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injection (MDI) therapy versus continuous subcutaneous insulin infusion (CSII) therapy for 6 months.RESEARCH DESIGN AND METHODSSixty type 1 diabetic adults with similar baseline characteristics, using either MDI (n = 30) or CSII (n = 30) therapy, were enrolled in this 6-month prospective study. Subjects were instructed to wear the DexCom SevenPLUS continuous glucose monitor at all times throughout the study. All subjects were initially blinded from the continuous glucose monitoring (CGM) glucose data. After 4 weeks of blinded CGM use, the CGM was unblinded, making glucose data available to the patient. The CGM remained in the unblinded state for the remainder of the study (20 weeks). Clinic visits occurred every 4 weeks, at which time A1C values were collected and CGM data were downloaded.RESULTSMean baseline (± SD) A1C was 7.61 (± 0.76) and 7.63 (± 0.68) for CSII and MDI, respectively (P > 0.05). Without any significant therapy change, A1C decrease at 12 weeks was similar in both groups (P = 0.03). When compared with the blinded phase, unblinded use of CGM was associated with similar but significant reductions in glycemic control and variability parameters. In addition, both therapy groups had similar changes in mean glucose and glucose variability indexes at 3 and 6 months (ITT analysis, P > 0.05). Predefined per protocol analysis (sensor use at least 6 days/week) showed greater improvement in time spent in target range glycemia, 3.9–10.0 mmol/L (70–180 mg/dL), in the CSII group.CONCLUSIONSWe conclude that CGM provides similar benefits in glucose control for patients using MDI or CSII therapy.

Tesamorelin for the treatment of excess abdominal fat in HIV-1-infected patients with lipodystrophy

Morphologic and metabolic abnormalities remain a common problem in patients with HIV-1 infection, which contributes to poor self image and may negatively impact on patient’s adherence to medication and success of therapy. In addition, these physiological and metabolic changes can lead to increased cardiovascular risk. In such patients, excess central fat could be associated with loss of subcutaneous fat. Several strategies to decrease the excess of visceral fat have been assessed. Tesamorelin, an injectable growth hormone-releasing factor analogue, has been shown to improve visceral fat adiposity with relatively little effect on subcutaneous fat with improvement in triglycerides and belly appearance distress. It is well tolerated overall without clinically significant changes in mean glucose or insulin levels. However, these benefits cease if treatment is discontinued.

B-cell response to exercise in diabetic and non-diabetic children.

20 non-diabetic and 11 insulin dependent diabetic (IDD) children underwent short time (20 min) bicycle ergometer exercise followed by a 10 min rest period. Glucose, IRI, C-peptide and proinsulin were determined prior to and at the end of the exercise, and again after 10 min rest. While no significant change in mean glucose was observed during exercise in the non-diabetics, significant decreases were observed in IRI, C-peptide and proinsulin. After 10 min rest glucose as well as the three B-cell secretory products increased significantly. The change in glucose was significantly (p less than 0.001) correlated to the change in IRI. In the resting period IRI rose more than C-peptide in some subjects. IRI even rose without simultaneous rise in C-peptide indicating a release of tissue bound IRI. The group of IDD children did not show any significant changes in glucose and total IRI, while the endogenous insulin, as measured by C-peptide, did show a fall during exercise. The same was found for proinsulin. The lack of increased endogenous secretion during the rest period was most likely due to suppression of B-cell due to hyperinsulinism and lack of increased glucose concentrations during the rest period.