Postprandial Blood Glucose Values Research Articles

Implementing a standardized workflow for early detection of steroid-induced hyperglycemia in allogeneic stem cell transplant recipients: A quality improvement project

BackgroundSteroid-induced hyperglycemia (SIH) worsens overall outcomes in the allo-SCT population. Currently, there is no standardized workflow for monitoring SIH. To address this need, a quality improvement (QI) initiative was implemented, as part of a Doctor of Nursing Practice project for the University of Kansas School of Nursing, to standardize glucose monitoring after the initiation of glucocorticoids (CGs) for the treatment of acute or chronic graft-versus-host-disease (GVHD). ObjectiveThis QI initiative aimed to decrease the median time to identification of SIH and the initiation of treatment in allo-SCT recipients on GCs for GVHD. Study DesignThe study took place at a large Midwestern blood and marrow transplant program. Patients diagnosed with acute or chronic GVHD and prescribed ≥0.5 mg kg-1/day prednisone equivalent (PE) steroids were requested to monitor postprandial blood glucose values for 14 days. A control group (retrospective chart review) was used for comparison. Time to the identification of SIH was compared between the two groups, as well as the time to treatment of hyperglycemia. ResultsOver 9 weeks, 19 patients enrolled in the QI initiative. The control group consisted of 21 patients. The median PE steroid dose was 1 mg kg-1/day in both groups (p = 0.8100). Eighteen of the 19 patients (95 %) had at least 1 blood glucose (BG) > 180 mg/dL and only 6 of 21 patients (29 %) had at least 1 BG > 180 mg/dL (p < 0.0001). The median time to a BG > 180 mg/dL was 1.5 days in the QI group and 7 days in the control group (p = 0.0232). The median time to insulin was 2 days in the QI group and 10 days in the control group (p = 0.0355). ConclusionThis project demonstrated that daily postprandial blood glucose monitoring is superior for the earlier identification and treatment of SIH when compared to monitoring at routine clinic visits alone.

Analysis of the Clinical Efficacy of Glimepiride Combined with Insulin in the Treatment of Elderly Diabetes

Objective: To explore the clinical efficacy and incidence of hypoglycemia in the treatment of elderly diabetes with glimepiride combined with insulin. Methods: A total of 100 patients diagnosed with diabetes in Qinghai Red Cross Hospital from January 2018 to January 2019 were selected and divided into an observation group and a control group according to the order of their visits, with 50 patients in each group. The observation group was treated with glimepiride combined with insulin, while the control group was treated with insulin alone. The blood sugar indicators, including glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and 2-hour postprandial blood glucose (2h PBG), were compared between the two groups. Additionally, the incidence of hypoglycemia was compared, and the causes of hypoglycemia were analyzed and summarized, proposing corresponding countermeasures. Results: The glycated hemoglobin value of the observation group was lower than that of the control group, and the statistical analysis showed a significant difference (t = 3.54, P &lt; 0.05). The fasting blood glucose value in the observation group was lower than that in the control group, with statistically significant differences (t = 4.08, P &lt; 0.05). The 2-hour postprandial blood glucose value in the observation group was also lower than that in the control group, with a significant difference (t = 3.82, P &lt; 0.05). The incidence of hypoglycemia in the observation group was 10%, while it was 56% in the control group, with a statistically significant difference between the two groups (χ2 = 5.813, P &lt; 0.05). Conclusion: The efficacy of glimepiride combined with insulin in the treatment of elderly diabetes is significantly higher than that of insulin alone, with a lower incidence of hypoglycemia.

A Minimized Measurement Scheme for Predicting HbA1c Using Discrete Self-Monitoring Blood Glucose Data Within 4 Weeks for People with Type 2 Diabetes.

Objective: To establish an accurate and robust calculation model for predicting hemoglobin A1c (HbA1c) for people with type 2 diabetes (T2D) by using the fewest discrete blood glucose values according to an irregular data set and propose an appropriate cost-effective and scientific scheme for routine blood glucose monitoring. Methods: By using two data sets obtained from 2017 to 2022, which involved 2432 people with T2D, ∼420,000 irregular blood glucose values, and 10,000 HbA1c values, multiple blood glucose monitoring schemes were designed and compared to find the optimal one. The data were structured and then fitted using a regularized extreme learning machine, and the results were evaluated on the basis of indicators such as mean absolute error (MAE), root mean square error, and the relevance analysis (R) value; the optimal scheme for routine blood glucose monitoring was determined by combining the accuracy and the cost and was compared with previous studies in terms of accuracy and stability. Results: Data fitting results for the chosen scheme: R = 0.8029 (P < 0.001), MAE = 0.3181% (95% confidence interval, 0.2666-0.3695%). Within the last 4 weeks before the prediction of HbA1c, a minimum of only seven fasting and seven postprandial blood glucose values are needed, of which are one fasting and one postprandial blood glucose values per 4 days. Compared with previous studies, the prediction model shows better accuracy and stability (P < 0.05), especially under the great glucose fluctuation group. Conclusion: A minimized calculation model for accurately and robustly predicting HbA1c using discrete self-monitoring of blood glucose data within 4 weeks for people with T2D has been established and provides a new reference for the design of a scheme for blood glucose monitoring. The diabetes care clinic of Peking University First Hospital (Registration Number: ChiCTR2300068139).

Correlation Between Abdominal Fat Distribution and Serum Uric Acid in Patients Recently Diagnosed with Type 2 Diabetes.

To investigated the link between the distribution of abdominal fat and the concentration of serum uric acid (SUA) in individuals recently diagnosed with type 2 diabetes. Studied 364 individuals had been diagnosed with type 2 diabetes within one month, and evaluated factors such as the distribution of fat in the abdomen, indicators related to glucose and lipid metabolism. The participants' SUA concentrations were divided into a normal control group (CG) and a hyperuricemia group (HG). The HG group had elevated abdominal subcutaneous fat area (SFA), visceral fat content (VFA), body mass index (BMI), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG), glycosylated albumin (GA), serum creatinine (SCr), triacylglycerol (TG), and lower values in glomerular filtration rate (eGFR), high-density lipoprotein cholesterol (HDL-C) when compared to the CG group (P < 0.05). Among the obese individuals, the hyperuricemia subgroup exhibited higher measurements in waistline, hipline, VFA, SFA, BMI, PBG, SCr, TG, and lower HDL-C (P < 0.05) compared to the subgroup with normal uric acid levels. In the non-obese group, the hyperuricemia subgroup showed higher VFA, SCr, and FBG levels, and lower HDL-C (P < 0.05). There was a positive correlation between VFA and serum uric acid (SUA) levels (r = 0.329, P < 0.0001). Logistic regression analysis indicated a 24% increased risk of hyperuricemia with every 10cm2 increase in abdominal VFA. Generate the Receiver Operating Characteristic (ROC) curve analysis revealed that VFA was the most effective predictor of hyperuricemia and insulin resistance (P < 0.05). Newly diagnosed type 2 diabetes patients exhibit a strong correlation between abdominal visceral fat and SUA concentration, the former is identified as an autonomous risk factor for hyperuricemia and an effective indicator for assessing the presence of hyperuricemia and predicting insulin resistance.

Mediterranean Diet Quality Index (MDQI) of the pregnant women

Introduction: This study aimed to determine pregnant women's nutritional status and habits in the middle and low-income groups and the level of compliance with the Mediterranean diet. The Mediterranean diet supports healthy fetal growth and development by providing sufficient nutrients for pregnant women and protecting against the development of obstetrical pathologies. Materials and Methods: One hundred and thirty-two pregnant women aged 17-45 were included. The demographic characteristics and anthropometric measurements, systolic blood pressure, fasting, and postprandial blood glucose values were noted.24-hour recall was determined and The Mediterranean Diet Quality Index (MDQI) developed by Gerber et al. was used to assess nutritional status. Nutritional habits and food attitude changes during gestation were recorded. Results: Overall, 15.2% of the pregnant women had good, 54.5% had medium-good, and %29.5 had medium-poor adherence to MDQI. The dietary macronutrient intakes were close to the daily dietary recommended intakes (DRI); however, micronutrient intakes were below the recommendations. Pre-pregnancy mean BMI was found to be 26.4 kg/m2. Conclusions: According to the mean pre-pregnant BMI, the pregnant women were overweight, and their adherence to the Mediterranean diet needed to be improved. General measures should be taken to improve pregnant women's diets and micronutrient intakes, even in the Mediterranean countries where this diet is the daily nutrition habit of local inhabitant pregnant women.

Can orbital artery resistive indexes detect complications of diabetes in the prediabetic phase?

Prediabetic patients have generalized microvascular dysfunction, which leads to end-organ damage, just like diabetes. Therefore, prediabetes is not just a mild elevation in blood sugar, and early detection and prevention of possible complications should be the main goal. Color Doppler imaging (CDI) provides morphologic and vascular information on various diseases. The Resistive Index (RI) is a widely used measure of resistance to arterial flow and is calculated from the CDI. CDI evaluation of vessels in the retrobulbar region may be the first sign of micro- and macrovascular complications. Consecutively, 55 prediabetic patients and 33 healthy subjects were recruited for the study. Prediabetic patients were divided into three groups according to their fasting and postprandial blood glucose values. The groups included an impaired fasting glucose (IFG) group (n = 15), an impaired glucose tolerance (IGT) group (n = 13), and an IFG+IGT group (n = 27). The RI of the ophthalmic artery, posterior ciliary artery, and central retinal artery were measured in all patients. The orbital artery, central retinal artery, and posterior cerebral artery mean RI of prediabetic patients (0.76 ± 0.06, 0.69 ± 0.03, and 0.69 ± 0.04, respectively) were significantly higher than those of the healthy group (0.66 ± 0.04, 0.63 ± 0.04, and 0.66 ± 0.04, respectively; p < 0.001; Student's t-test). The mean ophthalmic artery RI of the healthy, IFG, IGT, and IFG+IGT groups were 0.66 ± 0.39, 0.7 ± 0.27, 0.72 ± 0.29, and 0.82 ± 0.16, respectively, with a significant difference between the groups (p < 0.001, ANOVA). The mean central retinal artery RI of the healthy, IFG, IGT, and IFG+IGT groups were 0.63 ± 0.04, 0.66 ± 0.02, 0.7 ± 0.02, and 0.71 ± 0.02, respectively (p < 0.001, post-hoc Tukey). The mean posterior cerebral artery RI of the healthy, IFG, IGT, and IFG+IGT groups were 0.66 ± 0.04, 0.66 ± 0.04, 0.69 ± 0.03, and 0.71 ± 0.03, respectively, with a significant difference between the groups (p < 0.001 Fisher ANOVA). Increased RI may be the first sign of developing retinopathy, as well as the first sign of microangiopathies occurring simultaneously in the coronary, cerebral, and renal vessels. Precautions to be taken during the prediabetic stage can prevent many possible complications.

Evaluation of microvascular complications in patients with new diagnosis type 2 diabetes.

The incidence of microvascular complications such as diabetic retinopathy, diabetic nephropathy and diabetic neuropathy has increased in newly diagnosed diabetes patients. The aim of this study was to determine the factors affecting the incidence of microvascular complications in newly diagnosed patients with type 2 diabetes. This study was conducted on 97 newly diagnosed type 2 DM patients who applied to Malatya Training and Research Hospital Endocrinology outpatient clinic between September 2021 and July 2022. The patient files were reviewed retrospectively and their age, height, weight, body mass index (BMI), fasting/postprandial blood glucose measurements, serum HDL cholesterol, LDL cholesterol, total cholesterol, triglyceride, HbA1c levels, glomerular filtration rate (GFR) and complications of retinopathy, nephropathy, and neuropathy were recorded. Mann-Whitney U, t-test, Kruskal-Wallis, Binary logistic regression analysis, and Chi-square analysis were used to analyze the data. The mean age of the patients included in the study was 47.40±7.78 (min: 23 - max: 62). Non-proliferative retinopathy was observed in 74.2% of patients, proliferative retinopathy in 25.8%, diffuse neuropathy in 49.5% and mononeuropathy was detected in 9.3% of them. Fasting blood glucose, postprandial blood glucose and HbA1c values were found to be higher in patients with proliferative retinopathy than in patients without retinopathy. Fasting blood glucose, postprandial blood glucose and HbA1c values were found to be higher in patients with neuropathy than in patients without neuropathy. In addition, patients with mononeuropathy had statistically significantly higher HbA1c values than patients with diffuse-type neuropathy. It was found that the urine protein values of patients with mononeuropathy were significantly higher than those without neuropathy and those with diffuse neuropathy. Each 0.677-unit increase in HbA1c increases the risk of proliferative retinopathy 1.98-fold, and every 1.018-unit increase increases the risk of neuropathy 2.76-fold. Proliferative retinopathy and mononeuropathy rates were discovered to be higher in patients with a family history. Microvascular complications are common in newly diagnosed T2DM patients and an increase in HbA1c is a significant risk factor. Every newly diagnosed T2DM patient should be screened for microvascular complications.

Correlation of 25-Hydroxycholecalciferol and Glycaemic Status in Recent Onset Type 2 Diabetes Mellitus

Introduction: Type 2 Diabetes Mellitus (T2DM) is a non communicable disease caused by increased insulin resistance and beta cells dysfunction. Recently vitamin D has sparked wide spread interest in pathogenesis of diabetes by playing a role in insulin resistance. As a major regulator of homeostasis of calcium, vitamin D directly and/or indirectly improves insulin exocytosis and glucose tolerance. Aim: To estimate the serum 25 hydroxy cholecalciferol level and also to correlate with fasting, two hour postprandial blood glucose and Glycated Haemoglobin (HbA1c) values in recent onset T2DM patients. Materials and Methods: This cross-sectional study was conducted at Government Kilpauk Medical College, Tamil Nadu, India from November 2017-April 2018. One hundred and thirty nine recently diagnosed T2DM patients aged between 30-60 years of both sex, who were on oral hypoglycemic drugs for less than three months duration were included in the study. The patients were grouped into three groups according to their vitamin D levels, Group 1 Vitamin D deficient- 52 patients (≤20 ng/mL), Group 2- Insufficient Vitamin D -33 patients (&gt;20-30 ng/mL), Group 3- Vitamin D sufficient-54 patients (&gt;30 ng/mL). Fasting and 2 hour postprandial glucose, 25 hydroxy cholecalciferol and HbA1c were estimated. Statistical analysis was performed using analysis of variance (ANOVA) and Pearson’s correlation. Results: Out of 139 participants, 64 were males and 75 were females. The mean age of the study population was 50.64±5.343 years. The mean fasting blood glucose values among the three groups were 168.13, 129.61, and 125.33 mg/dL respectively. The mean two hour postprandial blood glucose values among the three groups were 269.44, 212.45, and 194.11 mg/dL respectively. The mean HbA1c among the three groups were 7.481±1.16, 6.027±0.31, and 5.86±0.19, respectively. Decreased 25 hydroxy cholecalciferol level in patients of T2DM showed a statistically significant inverse correlation with fasting and two hour postprandial blood glucose and HbA1c with p-value &lt;0.001. Conclusion: The study suggested that hypovitaminosis D was prevalent in T2DM. The study showed that decreased vitamin D level in T2DM patients was associated with increased fasting, postprandial blood sugar, and HbA1c. So, vitamin D screening in diabetics and supplementation can improve the glycemic status.

Adherence and Barriers to Medical Nutrition Therapy and the Effect on Glycemic Control Among Individuals With Type 2 Diabetes in India

Medical Nutrition Therapy (MNT) has a remarkable effect on glycemic control among individuals with Type 2 Diabetes. However, the extent of adherence to MNT isn't hundred percent. Therefore, we aim to determine the adherence level towards the MNT advised by a Registered Dietitian (RD); to identify the barriers and associated contributing factors and strategies to improve the compliance towards the MNT among people with Type 2 Diabetes. A cross-sectional study was conducted among people with Type 2 Diabetes visiting the out-patient diabetes clinic from Kolhapur city, India. A structured questionnaire was used to capture the adherence and non-adherence, reasons and barriers to adhering the MNT. Out of 293 participants, 41.6% were adhering to the MNT. There was a significant association between the non working group (p = 0.01), presence of co-morbidities (p = 0.03) and diabetes duration &lt; 10 years (p = 0.05) with the increased adherence level. Similarly, there was a significant reduction of 26.7%, 38.1%, and 30.9% in the fasting, postprandial blood glucose and HbA1c values respectively in adhering group post MNT advice. More than 50% of the participants in the adhering group gave ‘To Improve overall health’ and ‘To control sugar’ as reasons to adhere. ‘Habitual to what they eat’ (64.3%), ‘Does not satisfy hunger’ (42.1%) and ‘Lack of willpower’ (42.1%), were the common barriers identified in our study. Our study shows that the MNT advised by an RD is effective in reducing the socio-cultural barriers to adherence and improves glycemic control. Strategies like making the workplace more diabetes-friendly and adopting behavior changing techniques should be implemented to increase adherence.

Prediction and Prevention of Gestational Diabetes Mellitus and Its Sequelae by Administering Metformin in the Early Weeks of Pregnancy.

Diabetes mellitus in recent years has become a relentlessly evolving pandemic. Measures for the screening and early detection of diabetes are practiced all around the world. However, considering the ever-increasing magnitude of the problem, the present efforts should especially focus on the primordial prevention of diabetes. A ray of hope for preventing the development of diabetes in an individual arises from the concept that many adult-onset diseases have already been programmed while the individual was still in-utero. In women with hyperglycemia-in-pregnancy, maternal hyperglycemia results in fetal hyperinsulinemia, which leads to increased adiposity in the fetus, and insulin resistance and diabetes in adulthood. We have ventured to point out that the fetal beta-cells start secreting insulin at 10-11 weeks of pregnancy and fetal hyperinsulinemia persists with maternal hyperglycemia, in a pregnant woman who would develop gestational diabetes. Considering the fetal glucose-steal phenomenon and the fetal renal threshold for glucose, we have suggested a two-hour post-prandial blood-glucose (PPBG) value of >110 mg/dL as the cut-off for the prediction of gestational diabetes in the early weeks of pregnancy. Furthermore, we have emphasized the use of metformin in addition to medical nutrition therapy in the early weeks to maintain PPBG around 110 mg/dL to prevent gestational diabetes. In this paper, we recommend early, universal screening of all pregnant women during the early weeks of the first trimester and put forward that a two-hour PPBG of >110 mg/dl during the 8th-10th week of pregnancy would predict the risk of gestational diabetes in the pregnant woman. We suggest early testing and intervention to prevent the development of fetal hyperinsulinemia as a primordial prevention approach for diabetes.

Postprandial Glycemic and Insulinemic Response by a Brewer's Spent Grain Extract-Based Food Supplement in Subjects with Slightly Impaired Glucose Tolerance: A Monocentric, Randomized, Cross-Over, Double-Blind, Placebo-Controlled Clinical Trial.

Dietary fiber exerts beneficial effects on human health reducing the risk factors of metabolic related diseases such as hyperglycemia, insulin resistance, and hypercholesterolemia. The aim of this study is to demonstrate the efficacy of a food supplement based on brewer’s spent grain (BSG) extract in the reduction of postprandial glycemia and insulinemia in normoglycemic subjects. BSG was chemically characterized, revealing the presence of resistant starch (14.64 g/100 g), arabinoxylans (7.50 g/100 g), β-glucans (1.92 g/100 g) and other soluble fibers (6.43 g/100 g), and bioaccessible ferulic acid (91.3 mg/100 g). For the clinical study, 40 normoglycemic subjects were randomized into two groups, 1 and 2 (n = 20), for a cross-over clinical design and received either BSG extract-based food supplement or placebo. Postprandial blood glucose values were significantly lower than corresponding values in the placebo group after 90 and 120 min, while at the baseline and in the first 60 min, the two glycemic curves overlapped substantially. This improved clinical outcome was corroborated by significant reductions in postprandial insulinemia. None of the subjects reported adverse effects. This study showed that the tested BSG extract-based food supplement improves glucose metabolism and insulinemic response in normoglycemic subjects with at most a mild insulin resistance.

Increased Protein with Decreased Carbohydrate Intake Reduces Postprandial Blood Glucose Levels in Women with Gestational Diabetes: The iPRO Study.

Introduction:There is an urgent need to establish an evidence base for recommendations regarding proportions of macronutrients for optimized nutritional management of gestational diabetes mellitus (GDM). Our study compared isocaloric diets in women with GDM that differed in protein and carbohydrate content with fats held constant. We hypothesized that the glucose area under the curve (AUC) would be lower with the higher protein/lower carbohydrate diet.Research Design and Methods:This study used a random order crossover design within a controlled research unit environment. Nineteen women were randomized to treatment, with 12 participants completing both arms of the study. Blood sampling occurred preprandially and at t = 30, 60, 120, and 180" relative to meals. Inclusion criteria were confirmed diet-controlled GDMA1, singleton gestation, and with no pre-existing medical comorbidities. Mean gestational age at entrance to study = 32 (±1.76) weeks. Mean prepregnant body mass index of participants = 28.7 (±5.3) kg/m2 Participants were randomly assigned initially to either an increased protein/low carbohydrate (iPRO30%/CHO35%) diet or a lower protein/higher carbohydrate (LPRO15%/CHO50%) diet for a 36 hour inpatient stay on the research unit. All meals and snacks were prepared in a metabolic kitchen. After a 3–7 day washout period, participants were randomized to the opposite treatment.Results:On day 2 (with confirmed overnight fasting), the average 3-hour pre- through postprandial glucose AUC was lower in iPRO30%/CHO35% treatment arm (17395.20 ± 2493.47 vs. 19172.47 ± 3484.31, p = 0.01).Conclusion:This study is the first to demonstrate that a higher protein, lower carbohydrate meal, especially at breakfast, can result in lower postprandial blood glucose values in women with gestational diabetes. A lack of statistically significant differences at other collection time points could have been due to several factors, but most likely due to small sample size. Longer term outcomes of a higher protein diet, including maternal glycemic control, nitrogen balance, and impact on fetal growth outcomes, are needed.

1353-P: Activation of Brown Adipose Tissue by Low-Protein Diet Ameliorates Hyperglycemia in Lipodystrophic Diabetic Mice Model

Long-term ad libitum dietary restriction such as low-protein diet (LPD) improves metabolic health and extends the life span of mice and possibly humans. However, most studies conducted thus far have focused on the preventive, but not therapeutic, potential of LPDs. Previously we shown that LPD (5.1% kcal from protein) was able to improve postprandial blood glucose values of the lipodystrophic IRFKO (adipose-specific insulin receptor knockout) mice after 14 days with strong activation of interscapular brown adipose tissue (iBAT) and increase energy expenditure. To determine whether iBAT activation was responsible for the hyperglycemia normalization after the LPD treatment, we surgically denervated iBAT of IRFKO mice before LPD treatment. Blood glucose were measured twice a week for up to 4 weeks, at the end of the monitoring mice were subjected to indirect calorimetry assessment (Promethion, Sable Systems) . Our data showed that surgical denervation of iBAT abolished the hyperglycemia normalization effect of LPD in the IRFKO mice. Morphologically, surgical denervation also prevented the ‘browning’ effect of LPD on the whitening iBAT observed in IRFKO mice. In line with the morphological data, LPD failed to induce thermogenic markers including UCP1 and BMP8b in denervated iBAT. In contrast, iBAT denervation has lesser effects on the LPD-induced energy expenditure and circulating FGF21 level, possibly due to compensation by beige fat formation in the inguinal WAT. Together, our data confirms that hyperglycemia normalization caused by LPD on IRFKO is iBAT activation dependent. Our observation suggests that blood glucose could be utilized to fuel LPD-induced iBAT activation as a mechanism for amino acid homeostasis. Further experimentation needs to be done in order to narrow down the mechanism driving this phenomenon. Taken together, our data suggest that short-term LPD could be a potential strategy for the treatment of metabolic syndrome. Disclosure M.D.Munoz: None. A.Zamudio: None. M.A.Mccann: None. C.Liew: None. Funding NIH RDK109015A1

Evaluation of insulin resistance and beta-cell dysfunctions in newly diagnosed polycystic ovarian syndrome patients

Introduction: Women with polycystic ovary syndrome (PCOS) are at increased risk of developing glucose intolerance and diabetes attributed to increased insulin resistance (IR). However, it is not clear whether β-cell dysfunction has a central role in pathogenesis. The distinction has important implications for the prevention of type 2 diabetes in PCOS with interventions that ameliorate IR. This study aimed to find if IR differs among the various phenotypes of PCOS and perform a quantitative estimation of β-cell dysfunction versus IR in patients of PCOS participants. Materials and Methods: This case–control study was conducted for 1 year in the Endocrinology and Gynaecology outpatient departments at Gauhati Medical College. Fifty women newly diagnosed with PCOS, as per the Rotterdam criteria, were considered cases. Fifty, age- and body mass index-matched healthy females were taken as controls. Fasting and postprandial blood glucose, serum insulin, testosterone, and oral glucose tolerance test values were taken. Impaired fasting glucose, impaired glucose tolerance (IGT), and type 2 diabetes mellitus T2DM were diagnosed according to ADA 2011 criteria. IR and β-cell function were determined by “homeostasis model assessment (HOMA)”. Results: We observed an altered relationship between IR and insulin secretion, consistent with an intrinsic β-cell defect, wherein IR led to a decreased amount of compensatory insulin secretion in PCOS compared with normal women. The correlation coefficients relating HOMA%B to HOMA-IR were lower in PCOS, indicating less compensatory insulin secretion for a given increment in IR. Conclusion: PCOS patients are at increased risk of developing glucose intolerance and diabetes.

1180-P: Short-Term Low-Protein Diet Ameliorates Metabolic Dysfunction in Diabetic Lipodystrophic Mice

Long-term ad libitum dietary restriction such as low-protein diet (LPD) improves metabolic health and extend the life spans of mice and possibly human. However, most studies conducted thus far have mainly focused on preventive rather than the treatment potential of LP diets. To determine whether dietary protein or caloric restriction could be used to treat preexisting metabolic symptoms, particularly in a more severely affected mouse model, we subjected hyperglycemic lipodystrophic IRFKO (adipose-specific insulin receptor knockout) mice to LPD (5.1% kcal from protein). Interestingly, postprandial blood glucose (BG) values of the IRFKO mice began to improve 10 days after the introduction of LPD. The IRFKO mice became normoglycemic 2 weeks after the onset of the LPD treatment. Activation of adaptive thermogenesis in brown (BAT) and beige adipose tissues promotes energy expenditure (EE) and utilization of BG and triglyceride (TG). A LPD has been previously shown to promote EE via the sympathetic nervous system (SNS). Consistent with previous study, we observed that a LPD acutely and sustainably upregulates EE in both the WT and IRFKO mice. This is likely due to LPD dramatically improves BAT functions by transforming the whitened unilocular lipid droplet BAT in the IRFKO mice into normal looking brown multi-locular lipid droplet BAT within 1 week of LPD treatment. This is further supported by significant increase in thermogenic markers expression in the BAT after LPD. Besides thermogenic markers, we also observed a time-dependent regulation of gene markers for fatty acid transport, oxidation and glucose metabolism in BAT after LPD. Together with changes in blood chemistry in the IRFKO mice, we think that glucose and lipid-lowering effects of LPD is the consequence of continuous activation of EE leading to utilization and depletion of systemic thermogenic fuels. Taken together, our data suggest that short-term LPD could be a potential strategy for the treatment of metabolic syndrome. Disclosure M. D. Munoz: None. M. A. Mccann: None. P. Kim: None. C. Liew: None.

The role of vitamin D deficiency and thyroid dysfunction on blood glucose regulation in patients with type 2 diabetes mellitus: A retrospective cohort study

Background/Aim: In patients with diabetes mellitus (DM), complications due to hyperglycemia decrease the quality of life and increase mortality. Vitamin D deficiency and thyroid dysfunction negatively affect blood glucose regulation. We aimed to demonstrate effects of treatment of vitamin D deficiency and thyroid dysfunction on blood glucose regulation. This study aimed to reduce the complications that may develop due to hyperglycemia. Methods: In this retrospective cohort study, Type 2 DM patients admitted to our clinic between 2015-2018 were reviewed from hospital registry. Patients who did not attend to their control visits for DM at the 0th, 3rd and 6th months and those with the exclusion criteria were not included. Patients who regularly attended diabetes controls at the 0th, 3rd and 6th months were determined. Among them, those with 25-hydroxy (OH) vitamin D, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PPG), free T4, free T3, thyroid stimulating hormone (TSH) values in the hospital registry were sought. Patients with vitamin D deficiencies and thyroid disorders who began treatment at the 0th month were finally included in the study, and the effects of vitamin D replacement treatment and thyroid dysfunction treatment on blood glucose regulation parameters at the 3rd and 6th months were examined. Results: HbA1c levels significantly decreased in Type 2 DM patients whose vitamin D levels were within normal limits at the 3rd month after receiving vitamin D replacement therapy (P=0.023). Vitamin D and HbA1c levels at the 3rd month controls were negatively correlated (r=-0.23, P=0.016, respectively). There were no significant differences in FBG and PPG levels at the 3rd month (P=0.063, P=0.361, respectively). In type 2 DM patients with hypothyroidism at the 0th month who were euthyroid at the 3rd month, there were no statistically significant differences in HbA1c, FBG and PPG (P=0.202, P=0.14, P=0.40, respectively). Six type 2 DM patients became euthyroid at the 3rd and 6th months after beginning levothyroxine treatment at the 0th month, and six patients became euthyroid at the 3rd and 6th months after hyperthyroidism treatment. Two patients had their FBG, and PPG values measured. Due to the insufficient sample size, statistical significance of differences in HbA1c, FBG and PPG levels could not be determined. Conclusion: Vitamin D replacement treatment had positive effects on blood glucose regulation in DM patients with vitamin D deficiency. The effects of vitamin D on blood glucose regulation should be evaluated by HbA1c. Thyroid dysfunctions were not sufficiently questioned during the three-month follow-up of DM patients, so its effects on blood glucose regulation could not be evaluated. Thyroid dysfunction should be questioned in the 3-month follow-up of DM patients and thyroid function tests should be requested.

No Effect of Lifestyle Intervention during Third Trimester on Brain Programming in Fetuses of Mothers with Gestational Diabetes.

Maternal metabolism and intrauterine conditions influence development of health and disease in offspring, leading to metabolic, physiologic, and/or epigenetic adaptation of the fetus. Maternal gestational diabetes (GDM) leads to higher incidence of obesity and type 2 diabetes in offspring. We have previously shown that fetuses of insulin-resistant mothers with GDM have a delayed reaction to auditory stimuli in the postprandial state, indicating a fetal central insulin resistance. We tested whether this effect could be influenced by a lifestyle intervention in mothers with GDM, including diet counselling and regular blood glucose measurements. We measured fetal brain activity over the course of a maternal glucose challenge, at two measurement time points (baseline at an average of 29 weeks of gestation and follow-up after 4 weeks) in mothers with GDM and mothers with normal glucose tolerance (NGT). Data from eight mothers were able to be included. Fetuses of GDM mothers showed longer latencies than those of NGT mothers postprandially at both measurement time points during the third trimester and did not show a difference in response patterns between baseline and after 4 weeks. Maternal postprandial blood glucose and insulin values did not change from baseline to follow-up either. While the overall intervention seems to have been effective, it does not appear to have influenced the fetal postprandial brain responses. This might have been because interventions for GDM take place relatively late in pregnancy. Future research should focus on maternal lifestyle interventions as early as possible during gestation, or even prenatally.

Diabetes mellitusta uyku ile metabolik faktörler arasındaki ilişki

Introduction: This study was conducted to determine the relationship between sleep status and sociodemographic features, body mass index (BMI), blood pressure (BP), additional diseases, duration of diabetes mellitus diagnosis, received therapies, and laboratory values in patients with diabetes mellitus.Methods: The study was carried out with 200 adult diabetic patients applying to the Internal Medicine Department of Tepecik Training and Research Hospital with normal cognitive function and without any known psychiatric disorder. The research was conducted between July 10 and August 31, 2019. Sociodemographic data of patients were recorded, and the Pittsburgh Sleep Quality Index (PSQI) was applied. Those with a total score of 5 or above were considered poor, while those less than 5 were deemed good.Results: Of the 200 patients, 64% (n = 128) were female, and 36% (n = 72) were male. The mean total PDQI score was 10.44. Sleep quality was good in 7.5%, while poor in 92.5%. In both genders, the mean total score was greater than five. However, there was a statistically significant difference according to gender. Namely, 3.9% of women had good sleep quality, which was 13.9% among men (p=0.010). Higher educational status was related to higher sleep quality (p=0.007). Sleep quality was further impaired in patients with additional hypertension, hyperlipidemia, or coronary artery disease (p=0.010). The sleep quality of those living with their spouses was lower than that of other participants (p=0.033). There was no statistically significant difference between mean PUKI total scores and diabetes type, BMI, BP, lipid values, fasting &amp;amp; postprandial blood glucose, creatinine, or ALT values (p&amp;gt;0.05).Conclusion: Sleep quality is poor in diabetics. Clinicians should handle patients' sleep status during diabetes mellitus follow-up. Interventions to increase sleep quality in diabetics will no doubt improve the quality of life.

Immediate Effect of Stretching Versus Strengthening Excercises on Blood Glucose Level in Chronic Diabetes Mellitus

Background : Diabetes mellitus affects the muscles as muscle play notable role in the regulation of blood sugar level. The lack of glucose can lead to muscle cells atrophying and therefore loss of muscle mass. Stretching can increase cellular glucose uptake. Strengthening may improve strength , enlarged muscle mass and to improve insulin sensitivity and glycaemic control. Their paucity of literature on immediate effect of stretching versus strengthening exercises on blood glucose level in diabetes mellitus . Objective: To find out immediate effect of stretching on blood glucose level in diabetes mellitus individuals. To find out immediate effect of strengthening exercises on blood glucose level in diabetes mellitus individuals. To compare the immediate effectiveness of stretching and strengthening exercises on blood glucose level in diabetes mellitus individuals. Methodology: the study was conducted in Krishna hospital, in physiotherapy department. 44 subjects were selected with simple random sampling method. Chronic type 2 diabetes mellitus individuals were divided in to two groups. Group A (stretching) and group B (strengthening exercises)was given. The pre- and post –treatment postprandial Blood glucose values was measured by glucometer. Result: In conducted study, postprandial BGL showed statistically significant difference between pre and post treatment values in both group A and B. Conclusion: from the above conducted study it concludes that both stretching and strengthening exercises are effective in decreasing postprandial blood glucose level in type 2 diabetes mellitus, as there is no significant difference between both the groups . Strengthening exercises increased more flexibility in females than passive stretching and males were benefited with both stretching and strengthening exercises.

Lixisenatide in type 1 diabetes: A randomised control trial of the effect of lixisenatide on post-meal glucose excursions and glucagon in type 1 diabetes patients.

AimsThe GLP1 agonist lixisenatide is glucagonostatic and reduces post‐prandial blood glucose (PPBG) in type 2 diabetes. This study investigates its impact in type 1 diabetes (T1D).MethodsIn a blinded, crossover trial, 25 patients with T1D were randomised to 4 weeks adjunctive treatment with lixisenatide (L) or placebo (P), with a 4‐week washout period. The primary outcome was percentage of 3 hours PPBG in target (4‐10 mmol/L) assessed by CGM before and after treatment. Participants also underwent post‐treatment standardised mixed meal test (MMT, n = 25) and hyperinsulinaemic hypoglycaemic clamp (n = 15).ResultsPPBG CGM readings in target were similar between L vs P (Mean % ± SE, breakfast 45.4 ± 6.0 vs 44.3 ± 6.0, P = .48, lunch 45.5 ± 5.8 vs 50.6 ± 5.3, P = .27 and dinner 43.0 ± 6.7 vs 47.7 ± 5.6, P = .30). HbA1C was similar between L vs P (64.7 ± 1.6 vs 64.1 ± 1.6 mmol/mol, P = .30). Prandial insulin fell after lixisenatide (dose change −0.7 ± 0.6 vs +2.4 ± 0.7 units/d, P = .004), but basal insulin dose was similar between groups. The post‐MMT glucose area under the curve (AUC) was lower with L than P (392.0 ± 167.7 vs 628.1 ± 132.5 mmol/L × min, P < .001), as was the corresponding glucagon AUC (140.0 ± 110.0 vs 304.2 ± 148.2 nmol/L × min, P < .001). Glucagon and counter‐regulatory hormone values at a blood glucose of 2.4 mmol/L during the hypoglycaemic clamp were similar between L and P.ConclusionIn T1D, PPBG values were not altered by adjunctive lixisenatide although prandial insulin dose fell. Glucose and glucagon level during an MMT were significantly lower after lixisenatide, without affecting counter‐regulatory response during hypoglycaemia.