Mean Postprandial Blood Glucose Research Articles

Association between short-term glucose fluctuations and cognition in patients with acute ischemic stroke complicated by type 2 diabetes mellitus

ObjectivesGlucose fluctuations are more harmful than persistent hyperglycemia for chronic complications of diabetes. However, the relationship between cognition and glucose fluctuations in patients with acute ischemic stroke (AIS) complicated by type 2 diabetes mellitus (T2DM) remains unclear. We aimed to evaluate the association between short-term glucose fluctuations and cognition in patients with AIS complicated by T2DM. DesignA cohort study with a 2-year follow-up. Setting and participantsWe included 554 patients with mild AIS (mean age: 62 years; 170 females and 384 males). MeasurementsGlucose variability (GV) was evaluated using glycated hemoglobin (HbA1c), stress hyperglycemia (SHR), standard deviation of blood glucose (SDBG), mean postprandial blood glucose (MPBG), mean amplitude of glycemic excursion (MAGE), and time in range (TIR). We evaluated the relationship between GV, fasting blood glucose (FBG) and cognition during the acute phase using linear regression analysis. We evaluated the relationship between GV, FBG and the occurrence of post-stroke cognitive impairment (PSCI) using a logistic regression model. Mediation analyses were fitted to explore whether the relationships of HbA1c with cognition were mediated by cerebral small vessel disease (CSVD). ResultsA clear pattern of age-related GV was observed. Higher SHR in middle-aged participants; higher HbA1c, and lower TIR in older participants; and higher MAGE, MPBG, and SDBG across a broad age range (50–80 years) were associated with cognitive impairment in the acute phase of AIS. Higher SHR and SDBG together with lower TIR in middle-aged participants, higher HbA1c in older participants, and higher FBG, MPBG, and MAGE across a broad age range (50–80 years) were associated with the occurrence of PSCI. The association between HbA1c and cognition was partially mediated (proportion: 7–16%) by CSVD. ConclusionsShort-term glucose fluctuations are associated with cognition and a higher risk of PSCI in patients with AIS complicated by T2DM. CSVD might play an important role in the relationship between short-term glucose fluctuations and cognition.

The Significance of Repeated Education in Correcting Insulin Injection Techniques and Improving Glycemic Control

Background: The success of insulin therapy in achieving glycemic control highly relies on proper insulin injection practices. Proper insulin injection technique is crucial for optimizing the efficacy of insulin therapy. Therefore, it becomes imperative to train people with diabetes on standard insulin injection techniques. In some clinic settings, the education about the technique of injection may be delivered only once, and there is possibility that the patients can still commit mistakes while administering insulin. Ensuring proper insulin injection practices can help improve hemoglobin A1c (HbA1c) and achieve good glycemic control. Aim and Objective: This study aimed to assess the significance of wrong insulin injection techniques on poor glycemic control, and the impact of brief education sessions in inculcating proper insulin injection practices among patients with Type 2 diabetes mellitus (T2DM) was assessed in a real-world diabetes care setting. Methods: A retrospective analysis was conducted for the past 2 years among T2DM patients who exhibited improper injection techniques despite attending a 15-min training session. They were asked to fill in a questionnaire as well as their injection sites were examined. They were again made to attend the session and followed up for the succeeding 6 months to understand the underlying benefits of such training episodes. Results: Among people with T2DM, 126 individuals were identified with wrong injection practices. The mean HbA1c was 10.42% ± 2.33%, mean fasting blood glucose 199.60 ± 82.46 mg/dL, and mean postprandial blood glucose 236.70 ± 96.11 mg/dL. The participants' average number of insulin shots a day was 2.85 ± 1.11. The site of injection was incorrect in 20.17% of the patients; in 35.65%, the procedure of injecting was incorrect; and 11.97% did not follow injection site rotation. 18.80% of the patients presented with lipodystrophy or lipoatrophy. Conclusion: Improvement of insulin injection technique requires the involvement of all the key stakeholders in insulin therapy, these being diabetes educators and/or nurses, physicians, patients, and needle/device manufacturers. However, there is a need for clear guidance for diabetes educators and other health-care professionals so that they can, in turn, educate their patients to successfully self-manage their insulin therapy.

Sea Fish Consumption is Associated with Lower Risk of Diabetes Mellitus: A Cross-Sectional Study

The present study aimed to highlight the fasting and postprandial blood glucose levels among Sea Fish-Eaters (SFE) and Freshwater Fish-Eaters (FWFE) to establish the percentage of the existence of T2DM. The study was carried out among the sea fish-eaters both male and female (n=124) belonging to the community of Ramnagar block, Purba Medinipur district, and fresh water fish eaters (n=124) belonging to the community of Kotulpur block, Bankura district West Bengal, India. We collected data by directly interacting with the locals regarding the type of fish consumption for one week and correlated this with their fasting and postprandial blood glucose level measured using a glucometer. Among the SFE and FWFE participants the mean age of male and female is respectively 48.27±1.26 (n=30, 24.4%), 47.68±1.09 (n=40, 32.5%) and 56.09±1.23 (n=94, 94%), 52.33±1.06 (n=84, 67.5%).The mean fasting blood glucose level among female FWFE (121.41mg/dl) was significantly higher (P <0.05) than female SFE (91.36mg/dl). The mean postprandial blood glucose level among female FWFE (196.13mg/dl) were also significantly higher (P <0.05) than female SFE (140.05mg/dl). This study found that people who consume freshwater fish have a higher risk of T2DM than sea fish eaters. However, it remains unclear whether consumption of sea fish itself has a protective effect on T2DM or not we were not able to take a protective lifestyle into account in this study. To gather these findings we have to examine many other aspects.

Effect of Dietary Intervention Using Low-Carbohydrate Diet to Manage Newly Diagnosed Type 2 Diabetes Mellitus in TUTH Hospital, Nepal

Introduction: Low-carbohydrate diet is effective in improving blood glucose parameters, glycated hemoglobin A1c, weight, and waist circumference. The effectiveness of this diet is well accepted in America and the United Kingdom but in Nepal due to many preexisted misbeliefs regarding carbohydrates, we still have a carbohydrate-based diet for type 2 diabetes mellitus.Material and Methods: Fifty-four newly diagnosed type 2 diabetes mellitus without any treatment were selected for solely low-carbohydrate diet intervention (<130g carbohydrate) in the endocrinology unit of Tribhuvan University Teaching Hospital, Kathmandu from March to August 2019. Antidiabetic medications were not used. Individualized diet plans and repeated counseling were given and followed for 3 months. Blood glucose (fasting and postprandial),glycated hemoglobin A1c, weight, and waist circumference were compared at entry and 3 months. Statistical analysis was done using SPSS version 21.Results: The mean ± SD age was 44.77 ± 10.32. The mean body weight decreased by 4.52 ± 1.79 kg (p<0.001), mean waist circumference decreased by 7.85±0.72 cm (p<0.001), mean fasting blood glucose decreased from 10.44±3.52 mmol/L to 6.18±1.02 mmol/L (p<0.001), mean postprandial blood glucose decreased from 16.76±8.26 mmol/L to 8.26±1.66 mmol/L (p<0.001) and mean glycated hemoglobin A1c decreased by 2.38 ± 1.49 % (p<0.001) after 3months of low-carbohydrate diet intervention.Conclusions: The use of a low-carbohydrate diet may effectively produce glycemic control and decrease glycated hemoglobin A1c without medication in newly diagnosed type 2 diabetes mellitus. Additionally, this diet may also help to lower weight and waist circumference in newly diagnosed type 2 diabetes mellitus.

Effectiveness of the Family Portal Function on the Lilly Connected Care Program (LCCP) for Patients With Type 2 Diabetes: Retrospective Cohort Study With Propensity Score Matching.

BackgroundDiabetes is a major health concern worldwide. Family member engagement in diabetes self-management education programs can improve patients’ diabetes management. However, there is limited evidence that the family portal on diabetes management apps is effective in the glycemic control of patients with diabetes.ObjectiveWe aimed to evaluate the effectiveness of family support through the family portal function on Lilly Connected Care Program (LCCP) platform.MethodsThis retrospective cohort study included patients with type 2 diabetes recruited to the LCCP platform from September 1, 2018, to August 31, 2019. Propensity score matching was used to match family (group A) and non–family (group B) portal use groups with similar baseline characteristics. The patients were followed up with for 12 weeks. The main objectives were differences in mean fasting blood glucose, proportion of patients achieving fasting blood glucose target <7mmol/L, mean postprandial blood glucose, proportion of patients achieving postprandial blood glucose target <10mmol/L, proportion of patients achieving both fasting blood glucose <7mmol/L and postprandial blood glucose <10mmol/L, self-monitoring of blood glucose frequency at week 12 and the number of diabetes education courses patients completed during the 12 weeks. Moreover, logistic regression analysis was used to explore the baseline factors which may be associated with the use of family portal, and odds ratios with 95% confidence intervals were calculated.ResultsA total of 6582 adult patients (aged ≥18 years) with type 2 diabetes who were receiving insulin therapy were enrolled in the study. Overall, 6.1% (402/6582) of the patients chose to engage their family members to use the family portal. Two groups of 394 patients were well-matched regarding baseline characteristics. After matching, mean fasting blood glucose and postprandial blood glucose at week 12 were significantly lower in group A than in group B (fasting blood glucose: 7.12 mmol/L, SD 1.70 vs 7.42 mmol/L, SD 1.88, respectively, P=.02; postprandial blood glucose: 8.56 mmol/L, SD 2.51 vs 9.10 mmol/L, SD 2.69, respectively, P=.002). When comparing group A to group B, the proportion of patients achieving both fasting blood glucose <7mmol and postprandial blood glucose <10mmol/L at week 12 (46.8% vs 39.4%, respectively, P=.04), self-monitoring of blood glucose frequency at week 12 (8.92 times per week, SD 6.77 vs 8.02 times per week, SD 5.97, respectively, P=.05) and number of diabetes education courses completed in 12 weeks (23.00, IQR9.00-38.00 vs 15.00, IQR 4.00-36.00, respectively, P<.001) was higher. Additionally, multivariate logistic regression analysis showed that higher age (OR=0.987, 95% CI 0.978-0.996, P=.006) and higher baseline fasting blood glucose (OR=0.914, 95% CI 0.859-0.972, P=.004) were correlated with less use of the family portal function, while increased baseline self-monitoring of blood glucose frequency (OR=1.022, 95% CI 1.012-1.032], P<.001) as well as increased education courses (OR=1.026, 95% CI 1.015-1.036, P<.001) were associated with more use of the family portal function.ConclusionsFamily support through the LCCP family portal is effective for glycemic control and self-management behavior improvement in type 2 diabetes patients.

A randomized controlled trial protocol of the cardiovascular safety and efficacy of liraglutide in the treatment of type 2 diabetes.

Background:Recently, many clinical experiments have evaluated the influences of liraglutide in the treatment of type 2 diabetes. However, the outcomes of these studies are inconsistent, and the number of high-quality prospective trials that conducted to assess the cardiovascular safety is limited. Hence, for this research, it was implemented for the assessment of the cardiovascular effectiveness and safety of liraglutide in type 2 diabetes patients.Methods:This research was a 26-week active controlled and randomized trial. Our research protocol follows the guidelines of Good Clinical Practice issued via the Helsinki Declaration and International Conference on Coordination. All the patients will receive the written informed consent in order to involve in our clinical experiment. The participants with type 2 diabetes aged from 18 years to 80 years, patients with 45.0 kg/m2 body-mass index or less, and with glycosylated hemoglobin of 7.5 to 10.0 percent, and received metformin (daily 1500 mg or more) for 3 months or longer were eligible. All the patients were randomized to 1 of 2 interventions (in the ratio of 1:1): liraglutide placebo once daily (blinded) and liraglutide once daily (blinded), respectively, both combined with the glimepiride and metformin (open-labeled). For the efficacy variable, the major endpoint was the baseline glycated hemoglobin change after treating for 26 weeks. The secondary end points involved: the percentage of participants who achieved the goals of postprandial blood glucose, fasting blood glucose, and glycosylated hemoglobin; the changes of mean postprandial blood glucose, fasting blood glucose, and the body weight, pancreatic B-cell function index, and changes in blood pressure and insulin resistance assessed by homeostasis model.Conclusions:For this research, the limitations involve the short trial period and the limitation of glimepiride in some countries, thus excluding the maximum doses of glimepiride.Trial registration:This study protocol was registered in Research Registry (researchregistry6306).

Physical Exercise and Glucose Tolerance in Nigerian University Students

Background: Studying post-prandial fluctuations in blood glucose has high physiological and clinical relevance. Physical exercise is known to influence this fluctuation. Objectives: To determine the gender difference in glucose tolerance following physical exercise in a population of university students. Methods: A total of 146 students were randomly selected from the Olabisi Onabanjo University, Sagamu, Ogun State, southwest Nigeria. Following overnight fast, Oral Glucose Tolerance Test (OGTT) was carried out. Pre-exercise, fasting blood glucose (FBG) was measured at 0 mins, and after oral glucose load of 75 grams at 30 minutes intervals for 2 hours. The physical exercise involved cycling using a bicycle ergometer for an hour. Thereafter, OGTT was conducted again 1 hour post-exercise. Results: The ages of the subjects ranged from 20 years to 49 years. There were 73 (50.0%) females. The mean Body Mass Index (BMI) of 23.5±1.1 kg/m2 for females was comparable to 22.8±0.3 kg/m2 for the males (p = 0.571). Seven (9.6%) females were obese compared to 2 (2.7%) males. The mean post-prandial blood glucose increased from 71.6±1.6 mg/dl to 90.8±1.8 mg/dl after oral glucose load and thereafter to 88.0±4.2 mg/dl at 120 minutes among males. The post-exercise blood glucose patterns included a significant reduction in the mean FBS for males compared to females (64.5±1.9 mg/dl vs. 71.7±1.9 mg/dl; p = 0.001). Conclusions: Glucose tolerance with exercise is better in females than males. The clinical importance of physical exercise lies in its effect on glucose tolerance.

584-P: Optimal Utilisation of Statins in Real-World Settings

Aim: The purpose of this retrospective data analysis is to assess prescription practices including appropriate use and dose of statins in patients with T2DM. Methods: This is an observational retrospective data analysis of T2DM patients with dyslipidemia and who were on statin treatment for at least 6 months. Data for this study was obtained from EMRs of diabetes and endocrinology specialty outpatient clinics (n=35), pan India between Jan 2018 and May 2019. Patients aged &amp;lt;40 and &amp;gt;75 years were excluded from the analysis. Patient’s record with demographics, medical history, prescriptions (antidiabetes and statin drugs) and lab investigations data were collected. Results: Of the total 45,205 diabetes patients, 15023(33%) were on statins. The mean age was 53.2 years, 64% were males and 36% were females. Final analysis included 4099 patients between ages 40 and 75 years on statin drugs along with antidiabetes drugs. Mean HbA1c, fasting and post-prandial blood glucose was 8.5%, 173mg/dL and 257 mg/dL, respectively. The lipid profile TC, TG, HDL, and LDL was 174mg/dL, 188 mg/dL, 41 mg/dL, and 107 mg/dL, respectively. Low-intensity statins (2539[62%]) were the most common prescriptions followed by moderate (1402[34%]) and high (158[4%]) intensity statins. Rosuvastatin (2615[64%]) was most commonly prescribed followed by atorvastatin (1302[32%]), and non-statin fenofibrate (182[4%]). 4% of the patients on low-intensity statins at the first visit moved to moderate or high dose intensity statins. In contrast, 2% of patients on moderate dose moved to low dose intensity. Conclusion: In endocrine clinic population with 45205 patients only 33% of patients were on statins. In the population between 40 and 75, a majority were on low-intensity statins with relatively very few progressing to moderate and high-intensity statin. The low uptake of statins and low dose use indicates the need to increase awareness of appropriate patient selection and correct dose of statin use in the clinic population including referral and tertiary care clinics. Disclosure S.G. Krishna: None. S. Das: None. N. Nk: None. S.P. Manohar: None. N. Bs: None. D. Mc: None. S. Shah: None. A. Ahmed: None. M. Chavan: None. S. Sathyakumar: None. V.K. Kolukula: None.

Predictors of periodontal disease among rural Indian type 2 diabetic population

BackgroundPeriodontal Disease (PD) is associated with complications of diabetes. Control of the PD reduces glycated hemoglobin (HbA1c) level. This study aimed to evaluate the relationship of PD with duration, severity of diabetes and eGFR. Material and methodA Prospective observational study conducted at Sidhi Vinayaka Hospitals (SVH) Sangareddy during the period of January 2014 to December 2019. Total 1436 patients with a definite diagnosis of type 2 diabetes (T2DM), between the ages of 45–60 years were included. They were classified according to CPITN score for PD and compared against the variables. ResultsA total of 1436 consecutive outpatients attending to SVH were included. Among them 662 (46.1%) were males and 774(53.9%) were females. The mean age of the patients was 48.3(SD ± 10.62) and mean duration of diabetes was 2.9(SD ± 4.18). The mean fasting blood glucose was 198.5(SD ± 85), mean post prandial blood glucose was 277.2 (SD ± 107.7) and mean HBA1c was 9.98% (SD ± 2.6). Among the study group 1198 (83.4%) had none/mild (Grade I) PD, 192(13.4%) had moderate/severe (Grade II) PD and 46(3.2%) were completely edentulous (Grade III). ConclusionThere is a linear correlation between PD and age of patient, duration of diabetes, eGFR and level of glycemic status among rural population with T2DM.

Pengaruh lama mengunyah terhadap kadar glukosa postprandial dewasa obesitas

Background: Obesity cause various physiological changes in the body, one of which is insulin resistance causes high blood glucose levels. Chewing is a stimulus of cephalic phase responses and sensory stimulation that can increase hormones releasing such as insulin, ghrelin, cholecystokinin (CCK) and glucagon like peptide-1 (GLP-1). Chewing plays important role in determining postprandial plasma glucose concentration.Objective: Investigate the effect of chewing on postprandial blood glucose in obese adults.Method: This was true experimental research. Research subjects were treated in the form of chewing 22 times and 40 times each mouthful. Blood glucose levels were measured using glucometer on fasting blood glucose and postprandial blood glucose 15 minutes, 30 minutes, 60 minutes, and 120 minutes. Statistical test using Independent t-test.Results: The mean postprandial glucose levels in the 22 chews group at 15 minutes, 30 minutes, 60 minutes, and 120 minutes were 112.11 ± 14.3328, 126.11 ± 15.667, 116.94 ± 15.539, and 89.67 ± 11.668 . While the mean postprandial blood glucose levels in the 40 chews group at 15 minutes, 30 minutes, 60 minutes, and 120 minutes were 122.22 ± 14.381, 129.61 ± 15.112, 109.50 ± 14.995, and 85.83 ± 13.963. There were statistically significant differences between chewing groups 22 times and chewing 40 times on fasting blood glucose and 15 minutes postprandial blood glucose (p = 0.041 and p = 0.042), while on 30 minutes postprandial glucose testing, 60 minutes , and 120 minutes there was no significant difference (p&gt; 0.05).Conclusion: There was significant differences in 15 minutes postprandial blood glucose level between group 22 times chewing and 40 times chewing each mouthful.

Subgroup Analysis Stratified by Baseline Pancreatic β-cell Function in a Japanese Study of Dulaglutide in Patients with Type 2 Diabetes.

IntroductionThis analysis investigated the relationship between baseline fasting pancreatic β-cell function and efficacy in Japanese patients with type 2 diabetes (T2D) treated with once-weekly dulaglutide 0.75 mg (dulaglutide) or once-daily liraglutide 0.9 mg (liraglutide) for up to 52 weeks.MethodsIn a 52-week study of monotherapy in Japanese patients with T2D, patients were categorized into three subgroups defined by tertiles (low, medium, and high) of baseline values of three pancreatic β-cell function parameters [fasting C-peptide, C-peptide index, and secretory units of islets in transplantation (SUIT) index]. Associations between these parameters and efficacy [defined by changes from baseline in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG), mean of all meals blood glucose excursion, and body weight] in the dulaglutide group (280 patients) or the liraglutide group (137 patients) were evaluated.ResultsPatients in the subgroups with high insulin-secreting ability (based on pancreatic β-cell function) were younger and had shorter disease duration and higher body mass index compared to those with low insulin-secreting ability. No specific trend was observed between baseline pancreatic β-cell function and changes in HbA1c or FBG. Reductions from baseline in mean PBG and excursion were greatest for patients in the low β-cell function tertiles. Inconsistent trends in body weight were observed across the treatment groups and β-cell function parameters.ConclusionIn Japanese patients with T2D, changes in HbA1c and body weight after 52 weeks of treatment with dulaglutide or liraglutide could not be predicted by patients’ fasting pancreatic β-cell function before treatment.Clinical Trial RegistrationClinicalTrials.gov (NCT01558271).FundingEli Lilly K.K. (Kobe, Japan).

Adding Prandial Insulin to Basal Insulin Plus Oral Antidiabetic Drugs in Chinese Patients with Poorly Controlled Type 2 Diabetes Mellitus: An Open-Label, Single-Arm Study.

IntroductionThere is relatively little data from China on the efficacy and safety of adding prandial insulin to basal insulin plus oral antidiabetic drugs (OADs) in people with poorly controlled type 2 diabetes mellitus (T2DM). This study assessed the efficacy and safety of basal insulin dose optimization followed by the addition of prandial insulin in Chinese people with T2DM achieving suboptimal glycemic control with basal insulin and OADs.MethodsIn this open-label, single-arm study, adults with T2DM receiving basal insulin plus OADs underwent insulin dose optimization for 12 weeks. At week 12, subjects who achieved fasting blood glucose (FBG) ≤6.5 mmol/L but not HbA1c ≤7% added one injection of prandial insulin at the main meal for an additional 24 weeks. Endpoints included mean HbA1c, the achievement rate of HbA1c ≤7%, hypoglycemia, and other adverse events (AEs).ResultsA total of 120 subjects underwent basal insulin optimization; At week 12, 110 study subjects achieved FBG ≤6.5 mmol/L, of whom 66 did not achieve HbA1c ≤7% and therefore initiated prandial insulin. Three patients discontinued prandial insulin due to dissatisfaction with treatment outcome (n = 1), accidental injury (n = 1), or personal reasons (n = 1). After 24 weeks of basal-plus treatment, mean HbA1c significantly decreased (8.06% to 7.17%; p < 0.001), 65.1% of subjects achieved HbA1c ≤7%, there was no change in FBG (6.23–6.20 mmol/L; p = 0.118), and mean post-prandial blood glucose decreased (13.17–10.14 mmol/L; p < 0.001). During basal-plus treatment, three individuals experienced hypoglycemia, and no significant change in the mean subject weight was observed (73.2 vs. 73.3 kg; p = 0.379).ConclusionsIn people with T2DM who are achieving suboptimal glycemic control with basal insulin plus OADs, basal insulin dose optimization followed by the addition of prandial insulin improves glycemic control, is well tolerated, and is associated with a low incidence of hypoglycemia.

POSTPRANDIAL EXERCISE IS SUPERIOR TO REGULAR CONTINUOUS EXERCISE IN HBA1C REDUCTION FOR TYPE 2 DIABETICS IN SAUDI ARABIA

ABSTRACT BACKGROUND AND OBJECTIVES: Exercise helps people on diet to lose weight, also helps having better Blood Pressure. The aim of the study is to compare the response of glycosylated hemoglobin (HbA1c), body mass index (BMI) and incidence of hypoglycemia to continue running exercise (group A) and intermittent postprandial exercise (group B) for individuals with type 2 diabetes in Jeddah – Saudi Arabia DESIGN AND SETTINGS: Out of 44 enrolled patients from Jeddah region, 24 patients were group A, who were asked to run daily for 45 minutes at any time of the day, continuous running without stopping -as much as they can, and 20 other patients were group B, who were asked to run 60-90 minutes after main meals for 15 minutes three times daily. The study involves mandatory baseline visit then follow up, once after 12 weeks. Results: The mean age was 42.1 (2.8) [Mean (SD)] years for group A, whereas it was 43.8 (1.7) years for group B. 17% were males and 83% were females for group A whereas all patients were females for group B. The main BMI was 26.2 (1.2) kg/m 2 (group A), while it was 26.9 (1.0) kg/m 2 (group B). The mean Postprandial Blood Glucose (PPG) was 150.4 (7.5) mg/dl (group A), while it was 144.5 (11.2) mg/dl (group B). There was no statistically significant difference in the mean PPG between group A and group B ( P > 0.05) . 50 % were house wives (group A), whereas 100% were house wives (group B). There was statistically significant difference in patients’ jobs for group A compared to group B ( P 0.01) All patients on metformin and statin for both groups, and There was no statistically significant difference in Current Medication between group A and group B ( P > 0.05), but There was statistically significant difference in the mean dose between group A and group B ( P 0.01).The mean time of exercise was 33.6 (14.1) min/day (group A), while it was 33.5 (8.3) min/day (group B). There was no statistically significant difference in time of exercise groups between group A and group B ( P > 0.05) . Both groups resulted in a decline in HbA1c. However, the mean of HbA1c was dropped from 8 % (at baseline visit) to 7% (at the end of the study. There was a very high statistically significant decrease of 1% ( P 0.001). Group A resulted in a decline in mean of BMI which was the percentage decrease in BMI was 1.7% with group A. There was statistically significant decrease in mean BMI from baseline visit to the end of the study for group A of 0.4 kg/m² ( p 0.01), while there was no statistically significant difference for group B ( P > 0.05). There was high statistically significant difference in BMI reduction from baseline visit to the end of the study between group A and group B ( P 0.001) . The mean number of episodes of hypoglycemia was 1.8 (3.7) times (group A), while it was 3.9 (3.8) times (group B). There was no statistically significant difference in number of episodes of hypoglycemia in group A compared to group B ( P > 0.05) . Conclusion: The reduction of HbA1c levels with continuous running exercise is less than its levels with intermittent postprandial exercise during both exercises in individuals with type 2diabetes, while the reduction of BMI levels with intermittent postprandial exercise is less than its levels with continuous running exercise However, No significant change in incidences of hypoglycemia was found in both groups. Key Words: Exercise, Type 2 Diabetes, HbA1c, BMI and Hypoglycemia.

Macronutrient Composition or Social Determinants? Impact on Infant Outcomes With Gestational Diabetes Mellitus.

The purpose of this study was to examine, through a randomized, controlled trial, the effects of a maternal carbohydrate-restricted diet on maternal and infant outcomes in gestational diabetes mellitus (GDM). Women diagnosed with GDM were randomly allocated into one of two groups: an intervention group that was placed on a lower-carbohydrate diet (35–40% of total calories) or a control group that was placed on the usual pregnancy diet (50–55% carbohydrate). A convenience sample of participants diagnosed with GDM (ages 18–45 years) was recruited from two different sites: one urban and low-income and the other suburban and more affluent. Individual face-to-face diet instruction occurred with certified diabetes educators at both sites. Participants tested their blood glucose four times daily. Specific socioeconomic status indicators included enrollment in the Supplemental Nutrition Program for Women, Infants and Children or Medicaid-funded health insurance, as well as cross-sectional census data. All analyses were based on an intention to treat. Although there were no differences found between the lower-carbohydrate and usual-care diets in terms of blood glucose or maternal-infant outcomes, there were significant differences noted between the two sites. There was a lower mean postprandial blood glucose (100.59 ± 7.3 mg/dL) at the suburban site compared to the urban site (116.3 ± 15 mg/dL) (P <0.01), even though there was no difference in carbohydrate intake. There were increased amounts of protein and fat consumed at the suburban site (P <0.01), as well as lower infant complications (P <0.01). Further research is needed to determine whether these disparities in outcomes were the result of macronutrient proportions or environmental conditions.

Aferição da glicemia capilar na clínica odontológica - rastreamento de casos de Diabete tipo II

Estimates show that in 2025, the Brazilian population is expected to reach 228 million. The type 2 Diabetes was the third leading cause of death in Brazil (Censo 2010). By 2025, should be about 11 million diabetics in the country, representing an increase of over 100 % compared to 5 million in 2000. This study aims to track possible cases through benchmarking test postprandial blood glucose. The evaluation of 69 women and 34 men showed a percentage of 8% possible cases which had mean postprandial blood glucose of more than two hours of 232.75 mg/dl and a maximum of 412mg/dl in agreement with Ministry of Health studies.

A randomized non‐inferiority study comparing the addition of exenatide twice daily to sitagliptin or switching from sitagliptin to exenatide twice daily in patients with Type 2 diabetes experiencing inadequate glycaemic control on metformin and sitagliptin

To test the hypothesis that glycaemic control achieved when switching sitagliptin to exenatide twice daily plus metformin is non-inferior to adding exenatide twice daily to sitagliptin and metformin. Patients with Type 2 diabetes inadequately controlled with sitagliptin plus metformin were randomly assigned to 20 weeks of treatment with twice-daily exenatide plus placebo and metformin (SWITCH, n = 127) or twice-daily exenatide plus sitagliptin and metformin (ADD, n = 128). Non-inferiority (0.4% margin) of SWITCH to ADD treatment, measured by change in HbA(1c) from baseline to week 20, was not shown {between-treatment difference in least-squares mean [95% CI 3 mmol/mol (0.30%)] [0.8-5.8 (0.07-0.53)]}. A greater reduction (P = 0.012) in HbA(1c) [least-squares mean (se)] was experienced by patients in the ADD group {-7 mmol/mol [-0.68%] [0.9 (0.08)]}, compared with those in the SWITCH group {-4 mmol/mol [-0.38%] [1.0 (0.09)]} and a greater proportion (P = 0.027) of patients in the ADD group (41.7%) reached < 7.0% (< 53 mmol/mol) HbA(1c) target, compared with those in the SWITCH group (26.6%) by week 20. Patients in the ADD group experienced greater fasting serum glucose (P = 0.038) and daily mean postprandial self-monitored blood glucose (P = 0.048) reductions, compared with patients in the SWITCH group, by week 20. Patients in both groups experienced a lower incidence of nausea and vomiting compared with previous exenatide studies. Non-inferiority of SWITCH to ADD treatment was not supported by the results of this study. In patients with Type 2 diabetes inadequately controlled with sitagliptin plus metformin, adding exenatide provided better glycaemic control than switching to exenatide. These results are consistent with the clinical approach that adding is better than switching to another oral anti-hyperglycaemic medication.

Psyllium Lowers Blood Glucose and Insulin Concentrations in Horses

A total of 16 mature healthy horses (body weight: 515.3 ± 37 kg [mean ± SD]) were used in two experiments to determine (1) how psyllium affects postprandial blood glucose and insulin concentrations, and (2) how psyllium affects blood glucose and insulin concentrations after an intravenous glucose infusion. Psyllium was fed along with a grain and hay ration (given twice daily) for 60 days. Treatments were as follows: (1) 90 g psyllium/d, (2) 180 g psyllium/d, (3) 270 g psyllium/d, (4) an isocaloric, no supplemental psyllium control. Pre- and postprandial blood samples were collected on day 60 for experiment 1, and blood samples collected before and after intravenous glucose infusion were analyzed for experiment 2. In experiment 1, horses fed with psyllium for 60 days had lower (P < .01) mean postprandial blood glucose concentrations and there was a treatment × time effect for glucose (P < .001) and insulin (P = .03). Plasma glucose was lower at 90 minutes (P = .05) and 120 minutes (P < .001) after a meal in horses fed with psyllium as compared with an isocaloric control. Postprandial serum insulin concentrations were lower at 90 minutes (P = .002) and 300 minutes (P < .001) after a meal in horses fed with psyllium as compared with an isocaloric control. In experiment 2, peak glucose concentrations were lower (P = .01) in horses fed with psyllium for the previous 60 days compared with untreated horses and there was a treatment by time effect for glucose (P = .05). Peak blood glucose response was lower (P = .01) in horses fed with psyllium as compared with an isocaloric control after intravenous glucose infusion, whereas peak insulin concentrations and average insulin concentrations remained similar. Psyllium fed daily for 60 days alters postprandial glycemia and insulinemia in normal, nonobese, and unexercised horses.

Effects of a Structured Self-Monitoring of Blood Glucose Method on Patient Self-Management Behavior and Metabolic Outcomes in Type 2 Diabetes Mellitus

The purpose of this study was to evaluate the effect of structured self-monitoring of blood glucose (SMBG) on patient self-management behavior and metabolic outcomes in patients with type 2 diabetes mellitus (T2DM). From January to June 2009, 30 patients with basic diabetes education were followed for a period of 90 days. To provide assessment of glycemic control and frequency of dysglycemia, patients, underwent 3 consecutive days of seven-point SMBG during each month for 3 consecutive months, using the ACCU-CHEK 360° View tool. Glucose profiles of the first and third month were used for comparison. Hemoglobin A1c (HbA1c) improved significantly during the 90-day period in all patients [confidence interval (CI) 95%, 0.32-1.64%, p < .05] and those with poor metabolic control (group B; CI 95%, 0.86-2.64%, p < .05). Mean blood glucose (MBG) values decreased significantly in group B (CI 95%, 0.56-24.78 mg/dl, p < .05) and all cases (CI 95%, 1.61-19.73 mg/dl, p < .05). Meanwhile, there was an average decrease of 15.7 mg/dl in fasting blood sugar (FBS) levels in the whole subjects. Mean postprandial blood glucose levels (MPP) decreased by 19.3 and 11.3 mg/dl in group B and in all cases, respectively. However, there were no significant changes in HbA1c, MBG, FBS, and MPP in people with good metabolic control. A structured SMBG program improves HbA1c, FBS, MPP, and MBG in people with poorly controlled diabetes. This improvement shows the importance of patient self-management behavior on metabolic outcomes in T2DM.

The effect of nitric oxide inhibitors and Snitroso-Nacetylpenicillamine on glucose concentration in an animal model.

Background:Nitric oxide (NO) is becoming an increasingly important signaling molecule implicated in a growing number of physiological and pathophysiological processes. Research on the effect of NO donors on glucose metabolism in peripheral tissues have grown rapidly in the last decade. This study examined the effects of NGmethyl-L-arginine acetate (L-NMMA) and NGmethyl-L-arginine ester (L-NAME) on fasting and postprandial blood glucose concentrations. The study also investigated if L-NMMA and L-NAME decrease the hyperglycemic effect caused by the NO donor S-nitrosoN-acetylpenicillamine (SNAP) in normoglycemic rats.Results:L-NAME and L-NMMA significantly lowered the postprandial blood glucose concentrations. Mean postprandial blood glucose concentrations in rats treated with L-NAME were 5.04 ± 0.07 mmol/L at 120 min, 4.62 ± 0.19 mmol/L at 150 min and 4.36 ± 0.17 mmol/L at 180 min time points compared with 5.46 ± 0.14 (P = 0.029), 5.20 ± 0.17 mmol/L (P = 0.036), and 4.89 ± 0.14 mmol/L (P = 0.015) at the same time points respectively for saline control. Mean blood glucose concentrations in rats treated with L-NMMA were 4.35 ± 0.23 mmol/L (P = 0.0018) at 120 min, 4.60 ± 0.14 mmol/L (P = 0.090) at 150 min and 3.88 ± 0.16 mmol/L (P 0.001) at 180 min. There were significant differences in mean postprandial blood glucose concentrations in rats treated with SNAP, compared with those treated with L-NAME and SNAP at 90 min (P = 0.012), 180 min (P = 0.013) and 210 min (P < 0.0001). In addition, there were significant differences in mean postprandial blood glucose concentrations in rats treated with SNAP compared with those treated with L-NMMA and SNAP at 90 min (P = 0.0011), 180 min (P = 0.015) and 210 min (P = 0.0077).Conclusion:The nitric oxide synthase [NOS] inhibitors were effective in reducing postprandial blood glucose concentration in rats treated with SNAP. This suggests that although SNAP is an effective antihypertensive agent it decreases glucose tolerance which can be improved by the use of NOS inhibitors such as L-NMMA or L-NAME. These drugs could be beneficial in controlling blood glucose tolerance in rats administered with SNAP, and possibly in humans.

Postprandial Glycemic Excursions with the Use of a Closed-Loop Platform in Subjects with Type 1 Diabetes: A Pilot Study

The aim of this study was to evaluate the efficacy of a proportional derivative algorithm closed-loop system to control postprandial glucose concentrations in subjects with type 1 diabetes. Six subjects treated with continuous subcutaneous insulin infusion received a standardized meal on three days. The first day served as control, the second day as learning experiment for the algorithm, and the third day to compare the closed loop to the control day. Venous blood glucose was measured as reference until 300 min postprandially. The artificial pancreas platform consisted of a subcutaneous continuous glucose monitor (CGM), the GlucoDay S (Menarini Diagnostics), two D-Tron+ pumps (Disetronic Medical Systems) for subcutaneous insulin, and glucagon administration connected to a personal computer. One subject was excluded due to technical failure of the CGM. Two of five subjects were male, mean age was 50.8 years (range 38-60), and mean hemoglobin A1c was 8.7% (range 7.0-12.2). The mean postprandial venous blood glucose concentration of day 1 was 205 mg/dl (range 94-265 mg/dl) compared with 128 mg/dl (range 128-158 mg/dl) on day 3 (p = .14). Percentage of time spent in euglycemia postprandially on day 1 was 31% versus 60% on day 3 (p = .08). Time spent below 3.9 mmol/liter (70 mg/dl) was 19% on day 1 compared with 11% on day 3 (p = 1.0). Time above 10 mmol/liter (180 mg/dl) on day 1 was 60% versus 29% on day 3 (p = .22). The artificial pancreas provided comparable postprandial glycemic control to usual care.