Postprandial Capillary Blood Glucose Research Articles

Type 2 Diabetes Mellitus Patients' Knowledge About Disease Complications and Management Targets for Glucose, Lipids, Blood Pressure, and Body Weight.

Background As a result of the chronic nature of type 2 diabetes mellitus (T2DM), its complications, and treatment complexity, patients should have a comprehensive knowledge of various aspects of T2DM management and follow-up. The study aimed to assess T2DM patients' knowledge of disease complications and their screening strategies and the management targets for glucose, lipids, blood pressure, and body weight. Methods This was a cross-sectional and questionnaire-based study including 205 adult patients with T2DM from November 2023 to March 2024. The patients were randomly selected at one tertiary endocrine center and the outpatient clinics of three teaching hospitals in Basrah, southern Iraq. Social and disease-related data were collected. Another 18 T2DM-related questions were designed to assess the patients' knowledge about the aim of treatment; T2DM complications and their screening; the recommended targets for glycemic, lipid, and blood pressure control; and the recommended exercise and weight loss. We gave one point for each correct answer and considered a final score of 10/18 as adequate. Results Of a total of 205 patients, 109 (53.2) were women. The mean age for patients was 48.7 ± 13.1 years. Based on the patients' responses, 107 (52.2%) had adequate knowledge about T2DM. Questions about the target fasting and post-prandial capillary blood glucose, HbA1c target and frequency, and naming the current treatment were the most correctly answered questions (80.9%, 73.1%, 68.7%, and 72.6%, respectively). Questions about the lipid target, definition of hypoglycemia, and ideal lifestyle for T2DM (exercise and bodyweight loss) were least correctly answered. Patients younger than 40 years old, being a man, with a higher educational level, and T2DM duration of more than five years had significantly higher T2DM knowledge. Conclusions Only half of the patients had adequate T2DM knowledge. Better degree of knowledge was particularly observed in patients with younger age, male gender, higher educational level, and longer T2DM duration.There is a need to promote diabetes education strategies for people with T2DM.

Predictability of the Development of Insulin Resistance Based on the Risk Factors Among Female Medical Students at a Private College in Saudi Arabia.

Insulin resistance (IR) is currently an underlying phenomenon in the etiology of mostnon-communicable diseases. IR has been proposed as the key linking factor for the metabolic syndrome disease cluster of glucose intolerance. This study's target was to assess the predictability of risk factors for IR among female medical students Methods: A cross-sectional study involving female medical students was carried out. The sample size was 272, and a suitable non-probability sampling method was employed. A correlation test was done, and a P value less than 0.05 is considered statistically significant.Each participant underwent assessment of anthropometric measurements and biochemical testing. For assessing lifestyle, validated questionnaires on physical activity, sleep pattern, dietary pattern, and stress were adopted. The anthropometric data such as height, weight, and waist circumference were collected. Biochemical testing involved estimation of the postprandial capillary blood glucose level on campus. Additionally, systolicblood pressure and diastolic blood pressurewere measured. The association of lifestyle risk factors with waist circumference as an indicator of IR was done wherethe majority of those with high waist circumference were physically inactive and more prone to stress which was statistically significant when compared to those with normal waist circumference. However, poor sleep and unhealthy diet were high among those with high waist circumference, but they were not statistically significant. The correlation of waist circumference as an indicator of IR was highly significant with body mass index, postprandial blood sugar, systolic blood pressure, and diastolic blood pressure. A series of unhealthy lifestyle habits was contributable to developing obesity and therefore IR among medical students in Saudi Arabia.

Dual-basal-insulin regimen for the management of dawn phenomenon in children with type 1 diabetes: a retrospective cohort study.

Handling of the dawn phenomenon (DP) with multiple daily insulin injection (MDII) regimen is a real challenge. We aimed to demonstrate the effectiveness of a dual-basal-insulin (a long-acting glargine and an intermediate-acting neutral protamine Hagedorn (NPH)) regimen for the management of DP in children with type 1 diabetes mellitus (T1DM). The primary efficacy outcome was to overcome morning hyperglycemia without causing hypoglycemia during the non-DP period of the night. Retrospective cohort study. Charts of 28 children with T1DM (12 female; 42.8%, mean age 13.7 ± 2.1 years) treated with MDII were retrospectively reviewed. The median duration of diabetes was 4.5 years (range 2-13.5 years). DP was diagnosed using a threshold difference of 20 mg/dL (0.1 mmol/L) between fasting capillary blood glucose at 3 a.m. and prebreakfast. NPH was administered at midnight in addition to daily bedtime (08.00-09.00 p.m.) glargine (dual-basal-insulin regimen). Midnight, 03:00 a.m., prebreakfast and postprandial capillary blood glucose readings, insulin-carbohydrate ratios, and basal-bolus insulin doses were recorded the day before the dual-basal-insulin regimen was started and the day after the titration of the insulin doses was complete. Body mass index standard deviation scores (BMI SDS) at the onset-3rd-12th month of treatment were noted. Before using dual basal insulin, prebreakfast capillary blood glucose levels were greater than those at midnight and at 03:00 a.m. (F = 64.985, p < 0.01). After titration of the dual-basal-insulin doses, there were significant improvements such that there were no statistically significant differences in the capillary blood glucose measurements at the three crucial time points (midnight, 03.00 a.m., and prebreakfast; F = 1.827, p = 0.172). No instances of hypoglycemia were reported, and the total daily insulin per kilogram of body weight did not change. The BMI SDS remained steady over the course of the 1-year follow-up. In this retrospective cohort study, the dual-basal-insulin regimen, using a long-acting glargine and an intermediate-acting NPH, was effective in overcoming early morning hyperglycemia due to insulin resistance in the DP. However, the effectiveness of the dual-basal-insulin regimen needs to be verified by prospective controlled studies using continuous glucose monitoring metrics or frequent blood glucose monitoring.

Estimated Treatment Effects of Tight Glycaemic Targets in Mild Gestational Diabetes Mellitus: A Multiple Cut-Off Regression Discontinuity Study Design.

Background: We investigated the treatment effects of tight glycaemic targets in a population universally screened according to the International Association of Diabetes and Pregnant Study Groups (IADPSG)/World Health Organisation (WHO) gestational diabetes mellitus (GDM) guidelines. As yet there, have been no randomized control trials evaluating the effectiveness of treatment of mild GDM diagnosed under the IADPSG/WHO diagnostic thresholds. We hypothesize that tight glycaemic control in pregnant women diagnosed with GDM will result in similar clinical outcomes to women just below the diagnostic thresholds. Methods: A multiple cut-off regression discontinuity study design in a retrospective observational cohort undergoing oral glucose tolerance tests (OGTT) (n = 1178). Treatment targets for women with GDM were: fasting capillary blood glucose (CBG) of ≤5.0 mmol/L and the 2-h post-prandial CBG of ≤6.7 mmol/L. Regression discontinuity study designs estimate treatment effects by comparing outcomes between a treated group to a counterfactual group just below the diagnostic thresholds with the assumption that covariates are similar. The counterfactual group was selected based on a composite score based on OGTT plasma glucose categories. Results: Women treated for GDM had lower rates of newborns large for gestational age (LGA), 4.6% versus those just below diagnostic thresholds 12.6%, relative risk 0.37 (95% CI, 0.16–0.85); and reduced caesarean section rates, 32.2% versus 43.0%, relative risk 0.75 (95% CI, 0.56–1.01). This was at the expense of increases in induced deliveries, 61.8% versus 39.3%, relative risk 1.57 (95% CI, 1.18–1.9); notations of neonatal hypoglycaemia, 15.8% versus 5.9%, relative risk 2.66 (95% CI, 1.23–5.73); and high insulin usage 61.1%. The subgroup analysis suggested that treatment of women with GDM with BMI ≥30 kg/m2 drove the reduction in caesarean section rates: 32.9% versus 55.9%, relative risk 0.59 (95%CI, 0.4–0.87). Linear regression interaction term effects between non-GDM and treated GDM were significant for LGA newborns (p = 0.001) and caesarean sections (p = 0.015). Conclusions: Tight glycaemic targets reduced rates of LGA newborns and caesarean sections compared to a counterfactual group just below the diagnostic thresholds albeit at the expense of increased rates of neonatal hypoglycaemia, induced deliveries, and high insulin usage.

Food Insecurity and Cardiometabolic Disease Risk Factors in Mexican Women from Sinaloa

Abstract Objectives To investigate the association between food security levels and nutritional indicators of cardiometabolic disease risk (anthropometric, clinical, and biochemical) in vulnerable women from Culiacan, Sinaloa. Methods This was a cross-sectional study. Participants were adult females from Sinaloa, Mexico. Questionnaires applied included socio-demographic characteristics, the Mexican Food Security Scale, a 24-h dietary recall, and personal and family medical history. Anthropometric indicators included BMI, waist circumference and body fat percentage. Clinical and biochemical indicators were blood pressure and postprandial capillary blood glucose, respectively. Associations between food security levels and risk factors were assessed using Mann-Whitney U test and t student test for continuous variables and chi-square test for categorical variables. Data is presented as mean ± SD or median (IQR). Results One hundred and seventy five women aged: 46.2 ± 15.9 y; and BMI: 29.8 ± 6.8 k/m2, participated in this study. Energy intake was 1586 kcal (1149, 2147 kcal). The prevalence of food security (FS) was 51%, whereas 49% of the population reported some level of food insecurity (FI); 26% mild insecurity, 12% moderate insecurity and 11% severe insecurity. There were no differences between groups (FS vs. FI) for age, BMI and energy intake. The prevalence of overweight and obesity was 76% and median body fat-mass was 37%; differences between groups on waist circumference showed a trend towards an increased risk in the FI group; FS: 91.3 ± 15.3 cm, FI: 95.6 ± 13.9 cm (P = 0.055). Postprandial capillary blood glucose was not significantly different between groups; FS: 120 (105, 139) mg/dL and FI: 125 (107, 145) mg/dL, however 56% of women in the FI group categorized under risk of postprandial hyperglycemia compared to 44% in the FS group (P = 0.168). Systolic and diastolic blood pressure were no different between groups, nevertheless when comparing classification of hypertension, there was a higher prevalence in the FI group than in the FS; 61 and 39%, respectively. Conclusions Women with FI tended to have higher risk of cardiometabolic disease. Funding Sources UAS.

Metformin's effectiveness in preventing prednisone-induced hyperglycemia in hematological cancers

Research has established the development of steroid-induced hyperglycemia as a glucometabolic side effect of high-dose prednisone therapy. Few studies, however, have demonstrated preventative measures that could effectively curtail this side effect in susceptible patients undergoing high-dose prednisone treatment. To assess metformin's prophylactic effectiveness of prednisone-induced hyperglycemia among hematological cancer patients. Prospective randomized controlled trial conducted at the Kenyatta National Hospital Oncology Clinic and Wards, Nairobi, Kenya. Non-hyperglycemic hematological cancer patients on current or newly initiated high-dose prednisone-based chemotherapy were randomized to receive metformin 850 mg once then 850 mg twice daily for two successive weeks each or to the control group receiving the standard care. Patients were subjected to once weekly fasting and 2-h postprandial glucose measurements for four weeks. The primary outcome of measure was the development of hyperglycemia defined by fasting capillary blood glucose values >5.6 mmol/L or 2-h postprandial capillary blood glucose values >7.8 mmol/L. Eighteen of 24 randomized patients completed the study (11 control and 7 treatment). The proportion of the control subjects that developed prediabetes was 72.7% (95% confidence interval 45.5-90.9%) using fasting glucose and 54.5% (95% confidence interval 27.3-81.8%) using 2-h postprandial glucose. One treatment group participant developed prediabetes using fasting glucose, representing 14.3% (95% confidence interval 0-42.9%). No prediabetes was detected using the 2-h postprandial glucose. Analysis of mean fasting glucose between the two arms found no significant difference. However, significant differences in mean 2-h postprandial glucose were noted in week 2 (p = 0.0144), week 3 (p = 0.0095), and week 4 (p = 0.0074) of the study. Double dose (1700 mg) metformin was more effective in lowering blood glucose than single dose (850 mg) (p = 1.0000 (fasting), p = 0.4531(2-h postprandial). Metformin's prophylactic effectiveness was demonstrated in this randomized study on new and previously exposed non-diabetic cancer patients on high-dose prednisone-based chemotherapy.

Insulin requirement profiles and related factors of insulin pump therapy in patients with type 2 diabetes.

Continuous subcutaneous insulin infusion (CSII) is an effective therapy to control hyperglycemia in both patients with type 1 diabetes and type 2 diabetes. However, there is little data investigating the insulin dose setting during CSII therapy in type 2 diabetes to achieve optimal glycemic control and avoid the risk of hypoglycemia. Thus, this study is aimed to assess the dose characteristics of insulin requirement and explore the related clinical factors in patients with type 2 diabetes who were treated with CSII. A total of 327 patients (195 males) aged 52.9±12.5 years old were included in this study. Patients were treated with CSII to achieve the target fasting capillary blood glucose (4.4-7.0 mmol L-1) and 2-h postprandial capillary blood glucose (4.4-10.0 mmol L-1) by adjusting insulin infusion according to the seven-point capillary blood glucose profiles. Total daily insulin dose (TDD), total daily insulin dose per kilogram (TDD kg-1) and the ratio of total basal insulin dose (TBD) to TDD (%TBa) were calculated after patients achieved the glucose targets for at least 3 days via 1-2 weeks of CSII treatment. And insulin dose, insulin dosing patterns and the relevant clinical factors were analyzed. The mean ratio of basal/bolus insulin distribution of all patients was 40%:60%. Patients with central obesity needed more TDD (51.3±17.1 U versus 43.5±14.0 U, P<0.05) and TDD kg-1 (0.8±0.3 U kg-1 versus 0.7±0.2 U kg-1, P<0.05) than those without central obesity. Pearson's correlation analysis demonstrated that TDD was positively correlated with body mass index (BMI), waist circumference (WC), baseline fasting plasma glucose (FPG), fasting C-peptide level, 2 h-postprandial C-peptide level and time to achieve glycemic target (all P<0.05); TDD kg-1 was positively correlated with waist-to-hip ratio (WHR), baseline FPG, glycosylated hemoglobin A1c (HbA1c), fasting C-peptide level and time to achieve glycemic target, and negatively correlated with BMI (all P<0.05). Multiple linear regression analyses revealed that BMI (β=1.796, P<0.01), WC (β=0.709, P<0.01), baseline FPG (β=1.459, P<0.01) and HbA1c (β=0.930, P=0.021) were independently related to TDD. Gender (β=-0.107, P=0.003), WC (β=0.005, P=0.029), baseline FPG (β=0.025, P<0.01) and HbA1c (β=0.016, P=0.007) were independently associated with TDD kg-1. Gender (β=-0.015, P=0.048) and disease duration (β=0.134, P=0.029) were independently associated with %TBa. %TBa is around 40% in Chinese patients with type 2 diabetes treated with CSII when glycemic control is achieved. In addition to body weight or BMI, WC and glucose levels before CSII should be considered to set TDD. Patients with central obesity or poor glycemic control might need more TDD. Higher %TBa should be considered in female patients or patients with longer disease duration.

Impact of an educational DVD on anxiety and glycaemic control in women diagnosed with gestational diabetes mellitus (GDM): A randomised controlled trial.

The diagnosis of gestational diabetes mellitus (GDM) during pregnancy can lead to anxiety. This study evaluated the impact of an innovative patient-centred educational DVD on anxiety and glycaemic control in women newly diagnosed with GDM. 150 multi-ethnic women, aged 19-44years, from three UK hospitals were randomised to either usual care plus DVD (DVD group, n=77) or usual care alone (control group, n=73) at GDM diagnosis. Primary outcomes were anxiety (State-Trait Anxiety Inventory) and mean 1-h postprandial capillary self-monitored blood glucose for all meals, on day prior to follow-up. No significant difference between the DVD and control group were reported, for anxiety (37.7±11.7 vs 36.2±10.9; mean difference after adjustment for covariates (95% CI) 2.5 (-0.8, 5.9) or for mean 1-h postprandial glucose for all meals (6.9±0.9 vs 7.0±1.2mmol/L; -0.2 (-0.5, 0.2). However, the DVD group had significantly lower postprandial breakfast glucose compared to the control group (6.8±1.2 vs 7.4±1.9mmol/L; -0.5 (-1.1, -<0.1; p=0.04). The results in this trial did not highlight any differences between those who received the intervention and those who received usual care. It is possible that women already felt supported by their frequent attendance at specialist clinics for monitoring and advice. Healthcare professional and family support are key elements to empowering women with GDM and require further consideration in future interventions. Nonetheless, educational resources such as this will be beneficial to help support women given the current resource and time implications of the year on year rises in the incidence of gestational diabetes.

Glycaemic index values and physicochemical properties of five brown rice varieties cooked by different domestic cooking methods

Background: The prevalence of diabetes has increased dramatically in recent decades in the regions where people excessively consume white rice. In spite of the higher nutritional values and bioactive components, only the low to medium glycaemic index (GI) brown rice could be of interests as an alternative to white rice in these regions. Methods: Five varieties, Chiang (CH), Sungyod (SY), Lepnok (LP) from Thailand and Long grain specialty 1 (LS1) and Long grain specialty 2 (LS2) from Malaysia were tested for GI. Ten test foods were prepared from 5 varieties by 2 cooking techniques (pressure cooker, PC and rice cooker, RC). Overnight fasted healthy subjects were fed with 25 g glucose as a reference food (RF) on 3 occasions and amount equivalent to 25 g available carbohydrate portion of test food (TF) on 1 occasion in separate days. Fasting and post-prandial capillary blood glucose was measured via finger-prick methods at 0, 15, 30, 45, 60, 90 and 120 min, and the incremental area under curve (iAUC) was determined. The GI of each TF was calculated as percentage of incremental area under curve (iAUC) of TF over RF.Results: The mean GI values of SY (72 – 81, high), CH and LP (59 – 65, medium) and LS1 and LS2 (64 – 73, medium to high) were found due to cooking by PC and RC methods. The GI did not vary significantly (p&gt;0.05) among varieties as well as between cooking methods. GI showed a significant negative correlation with the amylose content (r = –0.70, p&lt;0.05) and significant positive correlation with cold peak viscosity (r = 0.80, p&lt;0.01).Conclusions: All five varieties by either cooking methods are classified as medium to high GI. Medium GI varieties could have potential of being used in diabetic diet. Cooking methods did not significantly alter the glycaemic characteristics of the studied varieties. Amylose content and pasting properties can be used for predicting GI of brown rice. It is urgent to explore low GI brown rice varieties in these regions.

High Amylose White Rice Reduces Post-Prandial Glycemic Response but Not Appetite in Humans.

The present study compared the effects of three rice cultivars on postprandial glycemic control and appetite. A single-blind, randomized, crossover clinical trial was performed with 18 healthy subjects, nine males and nine females. Three treatments were administered at three separate study visits: commercially available conventional white rice (short grain), specialty high amylose white rice 1 (Dixiebelle), and specialty high amylose white rice 2 (Rondo). Postprandial capillary blood glucose, venous blood glucose and insulin measurements, and appetite visual analog scale (VAS) surveys were done over the course of two hours. The capillary blood glucose concentrations were significantly lower for Rondo compared to short grain rice at 30 min, and for Dixiebelle and Rondo compared to short grain rice at 45, 60, and 120 min. Capillary blood glucose area under the curve (AUC) was significantly lower for Dixiebelle and Rondo compared to short grain rice. Subjects were significantly more hungry at 30 min after Dixiebelle intake than Rondo intake, but there were no other significant effects in appetite ratings. The present study determined that intake of high amylose rice with resistant starch (RS) can attenuate postprandial blood glucose and insulin response in comparison to short grain rice.

Effect of Cinnamon Tea on Postprandial Glucose Concentration.

Glycaemic control, in particular at postprandial period, has a key role in prevention of different diseases, including diabetes and cardiovascular events. Previous studies suggest that postprandial high blood glucose levels (BGL) can lead to an oxidative stress status, which is associated with metabolic alterations. Cinnamon powder has demonstrated a beneficial effect on postprandial glucose homeostasis in animals and human models. The purpose of this study is to investigate the effect of cinnamon tea (C. burmannii) on postprandial capillary blood glucose level on nondiabetic adults. Participants were given oral glucose tolerance test either with or without cinnamon tea in a randomized clinical trial. The data revealed that cinnamon tea administration slightly decreased postprandial BGL. Cinnamon tea ingestion also results in a significantly lower postprandial maximum glucose concentration and variation of maximum glucose concentration (p < 0.05). Chemical analysis showed that cinnamon tea has a high antioxidant capacity, which may be due to its polyphenol content. The present study provides evidence that cinnamon tea, obtained from C. burmannii, could be beneficial for controlling glucose metabolism in nondiabetic adults during postprandial period.

Glycemic response to high‐amylose rice in humans (1039.7)

Rice is a staple carbohydrate in many countries. Previous studies have indicated that solid foods with resistant starch (RS) can attenuate glycemic response. The present study investigated the best rice for glycemic control. A single‐blind, randomized, crossover clinical trial was performed with 18 healthy subjects. Three treatments were administered at three separate study visits: short grain rice, high amylose (HA) rice 1, and HA rice 2. Postprandial capillary blood glucose, venous blood glucose and insulin measurements, and appetite visual analogue scale (VAS) surveys were done over the course of two hours. The capillary blood glucose concentrations were significantly lower for HA rice 2 compared to short grain rice at 30 min, and for HA rice 1 and HA rice 2 compared to short grain rice at 45, 60, and 120 min. Capillary blood glucose AUC was significantly lower for HA rice 1 and HA rice 2 compared to short grain rice. Venous insulin concentrations were significantly lower for HA rice 1 and HA rice 2 than short grain rice at 60 min. Subjects were significantly more hungry at 30 minutes after HA rice 1 intake than HA rice 2 intake, but there were no other significant effects in appetite ratings. The present study determined that intake of HA rice can attenuate postprandial blood glucose and insulin response in comparison to short grain rice.Grant Funding Source: Supported by USDA Hatch project number HA‐262

Effects of Food Processing Methods on Diets Proximate Nutrient Composition and Glycemic Profile in Male Type 2 Diabetic Subjects

This experimentally-controlled designed study investigated the effects of selected food processing methods: boiling, flouring, frying, pounding and roasting on proximate nutrient compositions of white yam ( Diascorea rotundata)-based diets and postprandial glycemic profiles in male type 2 diabetic Nigerians .Proximate composition of yam meals (raw and processed) and 50g digestible carbohydrates of served portions were determined and analyzed using standard methods of food analysis. The glycemic index (GI) was determined using 20 volunteers (10 type 2 diabetic patients and ten healthy (control) subjects; age range 30-70 years) who consumed served portions of each processed meals containing 50g digestible carboh ydrates. Postprandial capillary blood glucose concentrations taken half hourly for two hours using glucometer were used to construct the mean incremental glycemic response (GR) curve from which the GI was calculated. Product of each processing method was c lassified into low or high GI diet based on the international GI classification of foods while the glycemic profile to each processed meal was based on the pattern of the mean postprandial glycemic responses. Fibre, protein and calorie contents of the proc essed yam meals increased significantly ( Pd0.05) compared with the raw meal while their ash and moisture contents decreased according to the degree and extent of exposure to heat. Roasting of yam gave the highest GI (93.3±4.0%) while frying gave the lowest GI (36.2±2.7%). Postprandial glycemic response patterns (glycemic profile) varied with the different processing methods: High -GI meal

Impacto del ambiente glucémico sobre el peso fetal en la diabetes gestacional

ObjectiveTo assess the relationship between maternal glycaemic control and final newborn (NB) birth weight in patients with gestational diabetes (GD). MethodsA retrospective study was conducted on 214singleton pregnancies with GD. Maternal characteristics, newborn outcomes and glycaemic control during pregnancy were analysed. GD was assessed by measurements of glycated haemoglobin (HbA1c) at different times during the third trimester (3T), fasting, pre-prandial, and 1 and 2hour post-prandial capillary blood glucose (1hPP-2hPP). ResultsThe percentage of NB large for gestational age (LGA) was 9.9% (macrosomia 5.4%), with no differences between genders. Mothers with LGA NB had a higher weight and percentage of body fat before pregnancy (P<.05), more weight gain during pregnancy (P<.01), and required more insulin. In pregnancies with LGA NB, the mean third trimester HbA1c and mean HbA1c (P<.01), were higher, as well as 1hPP (P<.05), 2hPP (P<.01) blood glucose and mean capillary blood glucose (P<.05). The mean third trimester HbA1c and 2hPP blood glucoses were correlated with the fetal weight index (r=0.22, P<.01, and r=0.17, P<.05, respectively). ConclusionsMothers with LGA NB have worse glycaemic control, despite having received a more intensive treatment. Treatment strategies should be implemented early during pregnancy, not forgetting maternal overweight treatment. HbA1c and 2hPP blood glucose are the only control parameters that correlated with NB weight in our group.

Glycaemic index of three Indian rice varieties

Three commonly consumed Indian rice varieties (Sona Masuri, Ponni and Surti Kolam) were tested for their glycaemic index (GI). Healthy volunteers were recruited and after an overnight fast were given a 50 g available carbohydrate portion of glucose (reference food) or different varieties of cooked rice (test foods) on separate occasions. The fasting as well as postprandial capillary blood glucose response was determined over 2 h, and the incremental area under the curve (IAUC) was calculated. The GI was calculated as the IAUC of the test food/IAUC of the reference food (glucose) × 100. The differences between the GI values for Sona Masuri (72.0 ± 4.5), Ponni (70.2 ± 3.6) and Surti Kolam (77.0 ± 4.0) rice varieties were non-significant (p = 0.606) and are all classified as high GI varieties of rice. There is an urgent need to study the GI of other commonly consumed rice varieties and to develop rice of a lower GI value.

Measurement of fasting ketonuria and capillary blood glucose after main meals in women with gestational diabetes mellitus: How well is the metabolic picture captured?

Metabolic monitoring of women with gestational diabetes mellitus (GDM) usually consists of measuring fasting ketonuria and postprandial capillary blood glucose (CBG) after main meals. We aimed to evaluate how this monitoring system captures the metabolic picture as compared to a scheme with a greater number of time points. Thirty-five women with GDM were recommended to follow a fractionated diet and trained in CBG and ketonuria monitoring. They were asked to monitor ketonuria before a main meal, and to monitor CBG at fasting and 1 h postprandial after any two of the six daily meals. Participants were requested to monitor different meals each day. The goal for 1 h postprandial CBG was <135 mg/dL (7.5 mmol/L). Ketonuria was defined as significant before a certain meal when ≥30% of measurements at that point were positive. Similarly, postprandial CBG was defined as abnormal after a meal when ≥30% measurements exceeded the goal. Ketonuria was significant in 22.5% of the time points and 41.2% of women had significant ketonuria at one or more time points; 61% of the time points and 35.7% of the women with significant ketonuria would have been undetected with monitoring restricted to breakfast. Postprandial CBG was abnormal in 17.6% of meals and 57% of women had abnormal postprandial CBG at one or more meals; 37.8% of points and 15% of women with abnormal postprandial CBG would have been undetected with monitoring restricted to main meals. A substantial proportion of metabolic abnormalities in GDM women are not detected with a monitoring program that measures only fasting ketonuria and postprandial CBG after main meals.

Combination Insulin Therapy with Pre-Mixed Intermediate/Rapid-Acting Insulin (70/30) and Insulin Lispro Mimicking Physiologic Insulin Secretion: Optimal Glycemic Treatment with Systainability of Control in Type 2 Diabetic Patients

Methods: In this descriptive retrospective study, we measured glycemic control and sustainability in terms of reduction in HbA1c and postprandial capillary blood glucose (pCBG) between patients on insulin 70/30 with lispro and insulin 70/30 alone. We reviewed records of 218 patients (153 females; 65 males) in an outpatient endocrinology clinic. Initial and follow-up pCBG (2 to 4 hours after lunch) and HbA1c were measured and compared among study groups. Metformin 1000 to 1500 mg daily was given in combination with insulin.

Comparison of postprandial glycaemia in Asians and Caucasians

To compare postprandial glycaemic responses between Asian and Caucasian subjects. Postprandial capillary blood glucose concentrations were measured as 2-h incremental areas-under-the-curve (iAUCs) following consumption of a glucose beverage and a breakfast cereal in 27 Asians and 73 Caucasians. The mean difference in iAUC was 29%(95%CI 10, 51) and 63%(95%CI 32, 102) higher in the Asian compared with the Caucasian group following the glucose beverage and cereal, respectively.The glycaemic index (GI) of the cereal was 77(95%CI 66, 90) in the Asian group and 61 (95% CI 55, 67) in the Caucasian group; the values were different (P = 0.01). The findings suggest that dietary recommendations for people with diabetes and those at risk of Type 2 diabetes may be more appropriate if based on research in the ethnic group for which they are intended.

The Use of Exenatide in Islet Transplant Recipients with Chronic Allograft Dysfunction: Safety, Efficacy, and Metabolic Effects

A current limitation of islet transplantation is reduced long-term graft function. The glucagon-like peptide-1 receptor agonist, exenatide (Byetta, Amylin Pharmaceuticals, CA) has properties that could improve existing islet function, prevent further loss of islet mass and possibly even stimulate islet regeneration. This prospective study evaluated the safety, efficacy, and metabolic effects of exenatide in subjects with type 1 diabetes mellitus and islet allograft dysfunction requiring exogenous insulin. Sixteen subjects commenced exenatide, 12 continue (follow-up 214+/-57 days; range 108-287), four (25%) discontinued medication because of side effects. At 6 months, exogenous insulin was significantly reduced with stable glycemic control (0.15+/-0.02 vs. 0.11+/-0.025 U/kg per day; P<0.0001); three subjects discontinued insulin from 4, 5, and 9 U/day, respectively, two sustained insulin independence with A1c reduction below graft dysfunction criteria. Postprandial capillary blood glucose was significantly decreased (129.4+/-3.8 vs. 118.7+/-4.6 mg/dL; P<0.001), C-peptide and C-peptide-to-glucose ratio increased significantly by 5th and 6th months of treatment (ratio, 1.09+/-0.15 vs. 1.52+/-0.18; P<0.05). Weight loss more than 3 kg occurred in 8 of 12 (67%) subjects. Stimulation testing demonstrated improved glucose disposal and C-peptide secretion (glucose area under the curve 52,332+/-3,219 vs. 42,072+/-1,965; P=0.002 mg x min x dL, mixed meal stimulation index 0.50+/-0.06 vs. 0.66+/-0.09; P=0.03 pmol x mL), with marked suppression of glucagon secretion and progressive increase in amylin secretion. Side effects were more frequent and severe compared with published reports in type 2 diabetes, tolerated doses were lower. Exenatide was tolerated in this patient population after appropriate dose titration and there appeared to be gradual but sustained positive effects on glycemic control and islet graft function.

Intrapartum Maternal Glycemic Control in Women With Insulin Requiring Diabetes: A Randomized Clinical Trial of Rotating Fluids Versus Insulin Drip

Because maternal hyperglycemia during labor foretells neonatal hypoglycemia and subsequent neurodevelopmental impairment, aggressive control of intrapartum maternal plasma glucose levels has been proposed. Current guidelines recommend continuous low-dose insulin infusion for women with insulin-dependent diabetes. The present investigators have alternated glucose-containing IV fluids with fluids lacking glucose, based on measurements of capillary blood glucose (CBG). This randomized trial compared glycemic control using these two techniques in 36 women in labor who had pregestational or gestational insulin-requiring diabetes. Fifteen women received “rotating” fluids, whereas 21 had an insulin drip. The participants, all of whom were past 20 weeks’ gestational age, presented during spontaneous labor or for induction. The women monitored their fasting and 1-hour postprandial CBG levels using a home glucometer. In the insulin drip group, women received 5% dextrose in normal saline and insulin was added when the maternal CBG exceeded 80 mg/dL. Women in the rotating fluids group received 5% dextrose in normal saline when the CBG was 100 mg/dL or lower, and lactated Ringers solution if the CBG was in the range 101–140 mg/dL; an insulin drip was started if the CBG exceeded 140 mg/dL. Patients randomized to the two management groups were similar in maternal age, median gestational age, nulliparity, gestational versus pregestational diabetes, and daily insulin requirements. There were no differences in the rates of induced versus spontaneous labor, vaginal versus cesarean delivery, or the median duration of labor. Mean intrapartum maternal CBG levels were comparable in patients managed by the rotating fluids and insulin drip protocols (103.9 and 103.2 mg/dL, respectively). None of the mothers became hypoglycemic. Neonatal outcomes were similar in the two groups. Two newborn infants in the insulin drip group required IV dextrose for persistent neonatal hypoglycemia which was defined as a blood sugar less than 35 mg/dL in the first 24 hours of life. By this definition, neonatal hypoglycemia was recorded in 7% of the rotating fluids group and 19% of the insulin drip group—not a significant difference. The investigators suggest that an insulin drip need not be routinely used in well-controlled women with either pregestational or gestational insulin-dependent diabetes. Rotating between IV fluids with and without glucose may achieve comparable control.