Postprandial Blood Sugar Levels Research Articles

Research on the Influences of Five Food-Borne Polyphenols on In Vitro Slow Starch Digestion and the Mechanism of Action.

Inhibiting starch digestion can effectively control postprandial blood sugar level. In this study, the in vitro digestion differences among the mixtures of five polyphenols (i.e., procyanidins [PAs], catechin [CA], tannic acid [TA], rutin [RU], and quercetin [QU]) and starch were analyzed through an in vitro simulation test of starch digestion. The interaction characteristics of these five polyphenols with α-amylase and α-glucosidase were investigated in terms of the inhibition effect, dynamics, fluorescence quenching, and circular dichroism (CD). The results revealed that the rapidly digestible starch (RDS) contents decreased, while the resistant starch (RS) contents increased. All five polyphenols inhibited the α-amylase activity through the noncompetitive approach but inhibited the α-glucosidase activity through the competitive approach. Five polyphenols combined with α-amylase spontaneously by using the hydrophobic effect. The interaction of PAs and QU with α-glucosidase were recognized as van der Waals forces and H bonding, whereas CA and TA interacted with α-glucosidase through the hydrophobic effect. All five polyphenols can cause conformational changes in enzymes.

Estimation of Aldose Reductase Activity and Malondialdehyde Levels in Patients with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia due to insufficient secretion or action of insulin.Elevated oxidative stress and diminished antioxidants may play an important role to develop T2DM and its complications. Aldose reductase (AR) enzyme plays a key role in the reduction of glucose to sorbitol by Polyol pathway. To estimate the AR activity and malondialdehyde (MDA) levels and in patients with T2DM. In this case-control study, a total number of 60 subjects (30 T2DM and 30 age-matched controls) wererecruited.Fasting blood sugar (FBS), Post-Prandial blood sugar (PPBS), AR activity and MDA levels were estimated in all the subjects. The AR activity was estimated by nicotinamide adenine dinucleotide phosphate hydrogen (NADPH) oxidation method. The plasma MDA levels were estimated by the thiobarbituric acid reactive substance (TBARS) method. For Statistical analysis, all the data were compared between the two groups by using unpaired t-test. Pearson correlation coefficient was calculated among T2DM. A P value <0.05 was considered as statistically significant for all data analyzed. The mean of FBS, PPBS, AR activity, and MDA levels were found significantly high in T2DM as compared to controls (P<0.001, P<0.001, P<0.001, P<0.001, respectively). A significant positive correlation was found between FBS and PPBS among T2DM (r=0.71, P<0.01). However, There was no significant correlation found between AR activity and MDA level among T2DM (r=0.002, P>0.05). Results showed thatthe mean of FBS, PPBS, AR activity, and MDA levels were found significantly higher in T2DM than controls. There was no significant correlation found between AR activity and MDA level among T2DM.

Oral hypoglycemic drugs: An overview

The aim of this study was to evaluate safety and efficacy of oral hypoglycemic agents in obese Type-2 diabetic patients. The objectives are to compare fasting and postprandial blood sugar (PPBS) levels, to compare body mass index in all the groups and to identify glycosylated hemoglobin levels and adverse drug reaction in all the groups. Diabetes mellitus is one of the world’s major diseases. It currently affects an estimated143 million people worldwide and the number is growing rapidly. In the India, about 1-5% population suffer from diabetes or related complication. So there is need to cure this disease. Anti-diabetic drugs treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions of insulin, exenatide, and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral anti hyperglycemic agents. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors. Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in Type 1, which must be injected or inhaled. Diabetes mellitus type 2 is a disease of insulin resistance by cells. Treatments include agents which increase the amount of insulin secreted by the pancreas, agents which increase the sensitivity of target organs to insulin , and agents which decrease the rate at which glucose is absorbed from the gastrointestinal tract. Keywords: hypoglycemic, blood suger, insulin, diabetes mellitus, pancreas

Hospital-based Analytical Study of Anti-thyroid Peroxidase Titre Among Type-2 Diabetic Patients Suffering from Thyroid Disorders

Introduction: Thyroid hormones control growth, development and metabolic processes. Either excessive or deficient secretion of these hormones interfere with metabolism. Thyroid hormones, therefore, can alter a person's blood sugar. Relatively, thyroid peroxidise enzyme plays a key role in thyroid hormone production. The individuals who suffer from autoimmune thyroid diseases produce auto antibodies against thyroid peroxidise (called anti-TPO).
 Objectives: We aimed to investigate an association of anti-TPO titer among type-2 diabetic patients suffering from thyroid disorders attending the local hospital.
 Methodology: Based on findings of thyroid variables [such as total triiodothyronine (TT3 ), thyroxine (T4 ) and thyroid stimulated hormone (TSH)], type-2 diabetic patients were categorized into Euthyroidism, Subclinical hypothyroidism and Hypothyroidism. In this hospital-based prospective study, venipuncture was performed to collect anti-cubital venous blood samples (n=100) from January to December, 2018. After separation of sera, estimation of certain parameters such as TT3, T4 , TSH and anti-TPO were carried out for correlative analyses. In this aspect, based on WHO guidelines, the patients who had fasting as well as postprandial blood sugar levels > 126 and 200 mg/dl were confirmed for diabetes mellitus. In addition, if these patients exhibited HbA1C levels > 10.8 %, they were enrolled into the 1 study. The patients who were hyperglycemic (with fasting as well as post-prandial blood sugar levels < 126 and 200 mg/dl) were excluded.
 Results: In the three groups as stated above, we observed that more a rise in level of glucose, greater were the values of TSH and anti-TPO.
 Conclusion Such findings emphasize and put an impact in situations of thyroid abnormality among type-2 local diabetic population.

A study of clinical profile and complications in patients with type 2 diabetes mellitus in a tertiary care centre

Background: Diabetes is the most common non-communicable disease known today. This study was conducted to assess the clinical profile and complications in patients with type 2 diabetes mellitus.Methods: A prospective study was carried out between April 2017 to April 2018 in patients attending a tertiary care hospital in Chennai. Patients with type 2 diabetes of age 25-80 years, minimum of 5 years duration were enrolled.Results: Out of 66 patients, 23(34.8%) were males whereas 43 (65.2%) were females. Mean age in this study population was 55.36 years with a standard deviation of 11.362. In present study, the mean fasting blood sugar level was 196.12±77.180, mean postprandial blood sugar level was 303.26±115.385 and the mean HbA1C levels was 10.95±2.369. 77.3% were on oral hypoglycaemic agents, 13.6% on insulin and 9.1% on combined therapy with oral hypoglycemic agents and insulin. The complications associated with diabetes found in present study were microvascular complications which include peripheral neuropathy 41(62.1%), retinopathy 31(46.96%), nephropathy 28 (42.42%). Peripheral neuropathy was found to be most commonly associated. Macrovascular complications include cardiovascular disease in 12.12% (n=8) and cerebrovascular disease in 4.54% (n=3). Autonomic neuropathy was found in 69.69% (n=46).Conclusions: The complications of DM are commonly seen in patients with poor glycaemic control. Among microvascular complications, peripheral neuropathy was most commonly seen. Autonomic neuropathy usually goes unnoticed and asymptomatic in most of the individuals. Increasing levels of HbA1c was found to be significantly correlated with neuropathy.

Effect of Ayurveda intervention, lifestyle modification and Yoga in prediabetic and type 2 diabetes under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)-AYUSH integration project.

Background:Type 2 diabetes is a lifestyle-related disorder that affects around 422 million individuals in India. Integration of AYUSH (Ayurveda) with the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was conceived on pilot basis at Gaya, Bihar, to provide integrative treatment for non-communicable disease patients and to manage the burden of non-communicable diseases in India.Objectives:The objective of this study was to analyze the effect of Ayurveda intervention, lifestyle modification and Yoga in the management of type 2 diabetes under NPCDCS-AYUSH integration project.Materials and Methods:A multi-centric, open-labeled, prospective, comparative clinical study was conducted at 17 community health centers and 1 district hospital. Population over 30 years of age was screened and prediabetic or type 2 diabetic individuals were enrolled in two cohorts, i.e., pre-diabetic (Cohort A) and type 2 diabetic (Cohort B). Each cohort was further divided into two groups: Group A1 was advised for lifestyle modification and Yoga and group A2 was given Ayurveda medication in addition to lifestyle modification and Yoga. Similarly, group B1 was advised for lifestyle modification and Yoga along with allopathic medication and group B2 was given Ayurveda medication, i.e., Mamajjaka, Amalaki and Guduchi powder in addition to lifestyle modification and Yoga along with allopathic medication. Treatment was given for 6 months. Data were analyzed through paired t-test.Results:A significant reduction was observed in fasting blood sugar level in groups A2 and B2 (P = 0.001) and also in the postprandial blood sugar level in Groups A2 and B2 (P = 0.001). Further, improvement in subjective symptoms such as polyuria, polydipsia, polyphagia, blurred vision and weakness was found in all the groups, while non-healing ulcer does not show any improvement.Conclusion:The study reveals that Ayurveda intervention, i.e., Mamajjaka Churna (1 g), Amalaki Churna (3 g) and Guduchi Churna (3 g) two times a day effectively controls blood sugar level in pre-diabetic and type 2 diabetic patients and improves the disease management with lifestyle modification and Yogasana as well as with allopathic treatment.

Efficacy and safety of Mamajjaka Ghanavati in the treatment of type-2 diabetes mellitus: a prospective open label multi-center clinical study

Background and objectives: The purpose of this study is to investigate the efficacy and safety of Mamajjaka Ghanavati on blood glucose level, symptoms, and quality of life in patients with type 2 diabetes mellitus. Subjects and methods: This prospective, multi-center, open-label, single-arm clinical study was performed at three peripheral institutes of the Central Council for Research in Ayurvedic Sciences, New Delhi during April 2016 to May 2017. A total of 177 eligible patients with type 2 diabetes mellitus were included and administered Mamajjaka Ghanavati two tablets (500 mg each) twice daily after food for 84 days. At the end of the treatment period (84th day), the changes in Diabetes Symptom Questionnaire (i.e., glycosylated hemoglobin and fasting and postprandial blood sugar levels) were analyzed. Quality of life was evaluated using 36-Item Short Form Health Survey (SF-36). Clinical safety of Mamajjaka Ghanavati was assessed by liver and renal function tests. This study was approved by the Medical Ethics Committee of Central Council for Research in Ayurvedic Sciences, New Delhi (approval number: CTRI Reg No Ref/2016/06/011468) on March 14, 2016. Results: Compared to baseline data, after 84 days of treatment with Mamajjaka Ghanavati, Diabetes Symptom Questionnaire score was significantly decreased, and SF-36 score was significantly increased (both P Conclusion: Mamajjaka Ghanavati can greatly improve the quality of life and is safe in the treatment of type 2 diabetes mellitus. Actually, Mamajjaka Ghanavati does not change blood sugar level greatly. Trial registration: This study was registered in the Clinical Trial Registry of India (CTRI/2017/09/009887) on September 22, 2017.

CLINICAL EVALUATION OF MANAGEMENT AND PREVALENCE OF TYPE TWO DIABETES MELLITUS COMPLICATIONS IN SOUTH INDIAN POPULATION

Objective: The present study was aimed to assess the prevalence of complications and to assess the targets achieved during the management of diabetes mellitus type 2.Methods: The study was prospective and conducted out in a diabetes center, Chennai, ethical approval was obtained from the Institutional Ethics Committee, case records of the 300 patients diagnosed with type 2 diabetes mellitus and its complications were monitored during March 2017–April 2018. Major result actions are body weight, height, body mass index (BMI), blood pressure, fasting blood sugar (FBS), post-prandial blood sugar (PPBS) levels, glycosylated hemoglobin, serum lipids, and presence of complications of diabetes. Comparison of the average of various biochemical parameters was made in patients with and no diabetic complications.Results: The average age of 300 patients was found to be 55.006±13.04. The average BMI was 27.10±12.81 kg/m2. The average duration of diabetes was 10.48±7.53. The average of systolic (SBP) and diastolic blood pressure was 137±20.88 and 79.95±11.81. The mean glycated hemoglobin, FBS, PPBS, low-density lipoprotein, high-density lipoprotein, and triglyceride, and total cholesterol were found to be 8.5±3.99, 148.85±55.64 mg/dl, 200.98±72.63 mg/dl, 88.06±19.46 mg/dl, 36.20±8.27 mg/dl, 141.22±60.15 mg/dl, and 144.45±29.03 mg/dl, respectively. Among the microvascular complications; neuropathy, nephropathy, and retinopathy were documented in 8.33%, 23.66%, and 17.33% of patients, respectively. The prevalence of peripheral artery disease was 20.66%.Conclusion: The prevalence of diabetic complications is significantly increased with patients age, duration, SBP, low-density lipoprotein,total cholesterol, and post-prandial blood sugar levels. Knowledge concerning the supervision of target blood pressure and lipidparameters is need further than the glycemic manage among diabetes patients type two.

Suppressive effect of ascophyllan HS on postprandial blood sugar level through the inhibition of α-glucosidase and stimulation of glucagon-like peptide-1 (GLP-1) secretion

A sulfated polysaccharide ascophyllan inhibited α-glucosidase in a concentration dependent manner, and >90% activity was inhibited at 1.0 mg/mL. The inhibitory activity was much higher than that of acarbose. No significant inhibitory effect of ascophyllan on α-amylase was observed up to 10.0 mg/mL. Ascophyllan HS, a commercially available ascophyllan preparation showed even higher inhibitory effect on α-glucosidase than ascophyllan. Interestingly, ascophyllan and ascophyllan HS induced the secretion of glucagon-like peptide-1 (GLP-1) from human intestinal NCI-H716 cell line in a concentration dependent manner (10–100 ng/mL). The oral glucose tolerance tests revealed that after continuous 8-week ingestion of ascophyllan HS at 100 mg/day, the glucose area under the curve values of the ascophyllan HS ingested group were significantly lower than placebo ingested group. Serum glycosylated hemoglobin (HbA1c) level in ascophyllan HS ingested group tended to decrease after 8-week ingestion, whereas no significant change was observed in placebo ingested group. This is the first report indicating that ascophyllan can induce the secretion of GLP-1 from human intestinal cell line (NCI-H716), besides the potent inhibitory effect on α-glucosidase. Furthermore, clinical trial suggested that ascophyllan HS may be a practically applicable blood glucose controlling agent in humans.

Clinical presentations of diabetes in children attending the paediatric ward in the medical institute: a cross sectional study

Background: By 2025, India due to its immense population size and high diabetes prevalence will contribute about 57 million diabetics. Hence the aim of the present study was clinical presentations of diabetes in children attending the paediatric ward in the medical institute.Methods: Total of 50 cases were included in the study. All the children who were less than age of 18years and also diagnosed with diabetes that is fasting blood sugar >126mg/dl or random blood sugar level > 200 mg/dl were included in the study. A detailed clinical examination of the child was carried out with detailed anthropometric measurements. Metabolic profile was done by investigating for the following. Fasting blood sugar, post prandial blood sugar, glycoslated haemoglobin.Results: The various ranges of fasting blood sugar were as follows: 25% were in the range of 130-200mg/dl, 35% in 200-300 mg/dl, 25% in 300-400mg/dl and 15% had more than 400 mg/dl fasting blood sugar levels. The various ranges of post prandial blood sugar were as follows: 16% were in the range of 200 - 300mg/dl, 40% in 300-400mg/dl, 44% had more than 400 mg/dl post prandial blood sugar levels. In the present study lipid profile of all the children was analysed by their serum cholesterol and triglycerides.Conclusions: A total of 50 diabetic children of age less than 18 years attending medical Hospital were studied using a predesigned and pretested proforma. Information was collected on socio-demographic, dietary intake, treatment and compliance history. Detailed clinical examination done and anthropometric measurements were taken. Metabolic profile was done by investigating for blood sugar levels, glycoslated haemoglobin and lipid profile. In the present study 46% had onset of diabetes mellitus at 15 to 18 years age group with male to female ratio of 1.26:1.

Effect of Supplementation of Cinnamon (Cinnamomum zeylanicum) Powder on Diabetics

The present study was designed to determine the effect of supplementation of cinnamon powder on blood glucose level of selected diabetic patients. The cinnamaldehyde an active component in cinnamon have health protecting effect. Cinnamon has insulin like activity and it contains an active ingredient water soluble polyphenol compound MHCP (methyl hydroxi chalcon polymer). It initiates insulin, triggers its receptors and works synergistically with insulin cells. The investigation was conducted in two phases. In the first phase of experiment, thirty Type II diabetic subjects were selected by purposive sampling technique in Parbhani city. They were personally interviewed with the help of pre-tested questionnaire to elicit the information regarding socio-economic background, health status and food and nutrient intake. In the second phase of experiment, they were divided into two equal groups experimental and control group. The experimental group was supplemented by three capsules (containing 500 mg of cinnamon powder each) daily for 60 days. No supplementation was given to control group. The fasting and post prandial blood sugar level of all the selected thirty subjects, both experimental and control group was recorded initially, after 30 and 60 days. Anthropometric measurements were taken before and after the experiment. Nutrient content of cinnamon powder was analyzed. The collected data was analyzed statistically and it was concluded that the consumption of 1.5 g of cinnamon powder continuously for 60 days has positive effect in diabetic subjects.

Preliminary analysis of the effect of Stevia (Stevia rebaudiana) in patients with chronic kidney disease (stage I to stage III).

BackgroundStevia, Stevia rebaudiana (Bertoni), has become an important economic plant for its commercial use as a sweetener. Stevia plays a significant role in the healthcare practice of different cultures and in population. Previous animal and clinical studies demonstrated the efficacy of Stevia against chronic diseases like diabetes and hypertension. This study aimed to investigate the beneficial effect of Stevia in chronic kidney disease (CKD) patients after three (3) months of treatment along with the conventional antihypertensive and anti diabetic medications.MethodsA prospective, interventional, randomized, single-blind, placebo-controlled trial has been done with 97 participants. Stevia capsule (250 mg) or matching placebo was given to the participants twice daily along with Angiotensin-II Receptor Blocker (ARB) and/or Ca2+ Channel Blocker (CCB). First follow up visits were done after 3 months of the interval. Blood and urine samples were collected for the biochemical tests. A structured questionnaire was used for the baseline assessment. Informed consent was taken from each participant.ResultsBoth hypertension and diabetes were found to be associated with CKD. Most of the participants (52.3%) of Stevia group were in CKD Stage II. Significant changes were found in Serum creatinine (p < 0.027), Serum Uric acid (p < 0.009), Fasting blood sugar (p < 0.041) and Postprandial blood sugar (p < 0.013) and Microalbumin (p < 0.041) level in the treatment group.ConclusionThe initial result demonstrated that Stevia has the potential for a significant improvement of some biochemical parameters in CKD patients. After completion of the nine (9) months clinical trial, the constructive effect of Stevia can be confirmed in this group of patients.

Prevalence and clinical predictors of silent myocardial ischemia in asymptomatic type 2 Diabetes Mellitus patients at Puducherry, India

Background: Silent MI is common among diabetics due to autonomic dysfunction and loss of pain alert mechanism. There are various risk factors associated with silent MI in diabetes which needs screening earlier to prevent unanticipated cardiovascular mortality. The objective of the present investigation was to study the prevalence and clinical factors associated with silent myocardial ischemia as diagnosed by TMT among type 2 diabetics who had no previous history or symptoms of cardio-vascular disease.Methods: A total of 200 type 2 diabetes affected subjects with duration of diabetes for at least 6 months, above 18 years of age, attending to the diabetology OPD, during the time period June 2017 to May 2018 were included in the study. Blood investigations and TMT were done for all the participants and documented in a proforma.Results: Silent MI was documented by using TMT in 36.5% (n=73) of patients with type 2 diabetes mellitus. The factors like age (59.1±16.3 years), duration of diabetes (8.2±2.6 years), obesity (BMI=29.6±4.7 kg/m2), Glycated haemoglobin (9.7±2.8 %), lipid levels and post-prandial blood sugar levels (236±11.8 mg/dl) associated well with silent MI as predicted by TMT. Fasting blood sugar did not show significant association with Silent MI.Conclusions: The prevalence of silent MI was higher among the type 2 diabetic individuals compared to non-diabetics. Age, duration of diabetes, HbA1c levels, BMI, dyslipidemia and post prandial blood glucose levels were associated significantly with incidence of silent MI in patients with type 2 diabetes.

Prevalence and clinical predictors of silent myocardial ischemia in asymptomatic type 2 Diabetes Mellitus patients at Puducherry, India

Background: Silent MI is common among diabetics due to autonomic dysfunction and loss of pain alert mechanism. There are various risk factors associated with silent MI in diabetes which needs screening earlier to prevent unanticipated cardiovascular mortality. The objective of the present investigation was to study the prevalence and clinical factors associated with silent myocardial ischemia as diagnosed by TMT among type 2 diabetics who had no previous history or symptoms of cardio-vascular disease.Methods: A total of 200 type 2 diabetes affected subjects with duration of diabetes for at least 6 months, above 18 years of age, attending to the diabetology OPD, during the time period June 2017 to May 2018 were included in the study. Blood investigations and TMT were done for all the participants and documented in a proforma.Results: Silent MI was documented by using TMT in 36.5% (n=73) of patients with type 2 diabetes mellitus. The factors like age (59.1±16.3 years), duration of diabetes (8.2±2.6 years), obesity (BMI=29.6±4.7 kg/m2), Glycated haemoglobin (9.7±2.8 %), lipid levels and post-prandial blood sugar levels (236±11.8 mg/dl) associated well with silent MI as predicted by TMT. Fasting blood sugar did not show significant association with Silent MI.Conclusions: The prevalence of silent MI was higher among the type 2 diabetic individuals compared to non-diabetics. Age, duration of diabetes, HbA1c levels, BMI, dyslipidemia and post prandial blood glucose levels were associated significantly with incidence of silent MI in patients with type 2 diabetes.

A Two-Level Food Classification System For People With Diabetes Mellitus Using Convolutional Neural Networks.

Accurate estimation of food's macronutrient content for people with Diabetes Mellitus (DM) is of great importance, as it determines postprandial insulin dosage. This paper introduces a classification system for food images that is adjusted to the nutritional needs of people with DM. A two-level image classification scheme, exploiting Convolutional Neural Networks (CNNs), is proposed, in order to classify an image in one of eight broad food categories with similar macronutrient content and then assign it to a specific food within that category. To this end, a visual dataset, namely NTUA-Food 2017, has been designed, consisting of 3248 images organized in eight broad food categories of totally 82 different foods. Moreover, a novel evaluation metric is proposed, which penalizes classification errors proportionally to the discrepancy in postprandial blood sugar levels between the actual and predicted class. The proposed system achieves 84.18% and 85.94% classification accuracy at the first and second level of classification, respectively, on the NTUA-Food 2017 dataset. The algorithm developed for the first level of classification on the NTUA-Food 2017 dataset improves classification accuracy on the benchmark Food Image Dataset (FID) to 97.08% outperforming previous approaches. The algorithm's mean error in terms of carbohydrate content estimation on the NTUA-Food 2017 dataset is less than 2 g per food serving.

COMPARATIVE STUDY OF ORAL HYPOGLYCEMIC AGENTS IN TYPE-2 DIABETES OBESE PATIENTS

Objectives: The aim of this study was to evaluate safety and efficacy of oral hypoglycemic agents in obese Type-2 diabetic patients. The objectives are to compare fasting and postprandial blood sugar (PPBS) levels, to compare body mass index (BMI) in all the groups, and to identify glycosylated hemoglobin levels and adverse drug reactions (if present) in all the groups.Method: This is a prospective observational study conducted in care diabetic center over a period of 1 year. All the patients those are receiving only oral hypoglycemic agents continuously over a period of 3 months and BMI ≥30 were enrolled. The patients receiving insulin were excluded. Patients were followed over a period of 3 months and were reviewed on visit basis (every 30 days). All the necessary information was collected into the data collection form that includes demographic details (age, gender, etc.), past medication history, current treatment charts, and their relevant laboratory reports (fasting blood sugar levels [mg/dl], PPBS levels [mg/dl], glycosylated hemoglobin A1c [HbA1c] (%), and BMI [kg/m2]). Results: A total of 395 patients were recruited into the study and the drugs received by the population were found to be metformin+sulfonylureas (33%), metformin+pioglitazone (26%), and metformin+dipeptidyl peptidase inhibitors (DPI) (23%). A significant reduction in HbA1c was seen in all groups of patients. Adverse drug reactions observed were hypoglycemia, pedal edema, and itching distributed to drugs metformin+DPI, respectively. A significant reduction in BMI was seen in patients receiving DPI and BMI was found to be increased in other groups of patients.Conclusion: Overall, three classes of drugs were found to have similar efficacy. Sulfonylureas were commonly associated with hypoglycemia when compared to other drugs and weight reduction observed in dipeptidyl peptidase inhibitors.

The Therapeutic Effects of Sevelamer on Blood Sugar, HbA1c, Lipid Profile, and hs-CRP in Patients with Diabetic Nephropathy

Background: Diabetic nephropathy (DN) is one of the major complications of diabetes. Hyperglycemia, inflammation and oxidative stress as well as advanced glycation end products (AGEs) are reported as the risk factors for DN. Sevelamer has shown promising results in reducing inflammation and even HbA1c levels in DN. Objectives: We aim to evaluate the therapeutic effects of sevelamer on blood sugar, HbA1c level, lipid profile, and high sensitivity CRP (hs-CRP) in patients with diabetic nephropathy. Patients and Methods: In this clinical trial, 18 patients (13 female with mean age of 61.22±9.32 years) with stages 2-4 of diabetic nephropathy were recruited. Patients were administered with 800 mg of sevelamer twice a day for three months. Blood sugar, HbA1C, hs-CRP, lipid profile and other laboratory findings were measured before and 1, 2 and three months after initiation of the treatment. Results: There was significant decline in HbA1c (p=0.001), postprandial blood sugar (p=0.02) and phosphorus (p&lt;0.001) at the end of the study period. Sevelamer had no effect on fasting blood sugar, lipid profile, blood urea nitrogen, creatinine, Na, K and hs-CRP. Conclusion: Our results indicated that along with its phosphorus reducing effects, sevelamer plays an important role in decreasing postprandial blood sugar and HbA1c level. Sevelamer had no effects on lipid profile and hs-CRP.

Effect of a Residential Integrated Yoga Program on Blood Glucose Levels, Physiological Variables, and Anti-Diabetic Medication Score of Patients with Type 2 Diabetes Mellitus: A Retrospective Study

Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent disease characterized by chronic hyperglycemia. Yoga is a form of mind-body intervention shown to have a positive impact on several health conditions in both healthy and diseased patients. The present study is intended to assess the effects of the Residential Integrated Yoga Program (RIYP) on blood glucose levels in patients with T2DM. Material and Methods: Data of 598 (186 females) T2DM patients from a holistic health center in Bengaluru, India, who attended a 15-day RIYP between January 2013 and December 2015 was obtained retrospectively. Average age of the participants was 56.45 ± 11.02 years. All subjects underwent a 15-day RIYP which involved yoga-based lifestyle changes with components of regulated sleep, balanced diet, asanas, pranayama, relaxation techniques, meditations, yogic cleaning procedures, and tuning to the nature. Fasting and post-prandial blood sugar, medication score, symptom score, systolic and diastolic blood pressure, pulse rate, and respiratory rate were assessed before and after intervention. Result: There was a significant decrease in fasting (p < 0.001) and post-prandial blood sugar levels (p < 0.001) along with a significant reduction in medication and symptom scores after 15 days of RIYP compared to baseline. Conclusion: The present study indicates that 2 weeks of a yoga-based residential program improves blood glucose levels, blood pressure, and medication score in patients with T2DM. However, further randomized controlled studies need to be performed in order to confirm the present findings.

Substantial effects of empowerment case management on physical health of type 2 diabetic patients.

To evaluate the effects of empowerment case management on the physical health of patients with type 2 diabetes. Diabetes is a global health issue. Case management is often used on diabetes management at various levels. Empowerment has been used for chronic situation management, but its effects have not been widely studied in diabetic populations. Purposive sampling was used to recruit 125 participants with type 2 diabetes aged 18years or older from a regional teaching hospital in Taiwan. Empowerment case management was applied for 42 participants, while the other 83 received normal case management. Survey items included demographics, preprandial (AC) and postprandial (PC) blood sugar levels, glycated haemoglobin (HbA1C), systolic and diastolic blood pressure, total cholesterol, and the presence or absence of acute and chronic complications. Descriptive statistics and a generalised estimating equationwere used to analyse the model's effects on the two groups. The PC blood sugar levels of patients receiving empowerment case management declined at 3months (B=-34.26, p<.01), and this decrease was maintained at 6months (B=-83.66, p<.001). As of 6months after starting the intervention, patients receiving empowerment case management enjoyed better physical health. These patients' AC blood sugar levels (B=-50.16, p<.001), HbA1C (B=-0.98, p<.001), systolic blood pressure (B=-8.24, p<.001), diastolic blood pressure (B=-5.73, p<.01) and total cholesterol (B=-13.74, p<.05) all experienced a continuous drop and were controlled well, and no diabetes-related acute or chronic complications were observed either. Patients with type 2 diabetes who received empowerment case management managed their physical health better. Moreover, its greatest effect was that patients were able to form exercise groups and continue to maintain their health. Empowerment case management was shown to have a substantial effect on the physical health and self-care of patients with diabetes, thus making it a suitable intervention tool for managing diabetes cases. The study results showed that empowerment case management is suitable for managing diabetes cases. It has a substantial effect on the maintenance of physical health, occurrence of complications and effectiveness of self-care among patients with diabetes. For better care outcomes, empowerment case management should be integrated into the guidelines of diabetes management.

Investigation the interaction between procyanidin dimer and α-glucosidase: Spectroscopic analyses and molecular docking simulation.

Procyanidins are reported to inhibit α-glucosidase, which may be a useful attribute for developing functional foods that control post-prandial blood sugar levels. At present, the nature of the molecular interaction between procyanidins and α-glucosidase is poorly understood. In this study, spectroscopic analyses and computer simulations were used to investigate the interactions between α-glucosidase and B-type procyanidin dimer (BPD). Our results suggest that BPD binds to α-glucosidase through a combination of hydrophobic and hydrophilic interactions. This hypothesis was based on measurements of the intrinsic fluorescence quenching, conformational changes, and surface hydrophobicity of the α-glucosidase after binding. Thermodynamic analysis suggested that α-glucosidase had one binding site for BPD and that the interaction was spontaneous. Homologous modeling of α-glucosidase was used to provide information about the precise nature of the molecular interactions. Molecular docking analysis suggested that BPD formed hydrogen bonds and hydrophobic interactions with α-glucosidase when it bound to its active site. This research offers new insights into the mechanism of interaction between procyanidins and α-glucosidase, which may be useful for the development of functional foods to tackle type 2 diabetes.