Postprandial Capillary Blood Glucose Research Articles

Pinitol from Soybeans Reduces Postprandial Blood Glucose in Patients with Type 2 Diabetes Mellitus

The effect of 3-O-methyl-D-chiro-inositol (D-pinitol), purified from soybean, on the postprandial blood glucose response in patients with type 2 diabetes mellitus was examined. Fifteen Korean subjects with type 2 diabetes mellitus (seven men, eight women; 60.3 +/- 3.1 years old) ingested cooked white rice containing 50 g of available carbohydrate with or without prior ingestion of soy pinitol. Pinitol was given either as a 1.2 g dose at 0, 60, 120, or 180 minutes prior to rice ingestion, or as a 0.6 g dose at 60 minutes prior to rice ingestion. Capillary blood glucose levels were monitored for 4 hours after rice consumption. The ingestion of 1.2 g of pinitol 60 minutes prior to rice consumption controlled postprandial capillary blood glucose most effectively, significantly diminishing the postprandial increase in plasma glucose levels measured at 90 and 120 minutes after rice consumption (P < .05). The incremental area under the plasma glucose response curve for subjects who consumed both pinitol and rice was significantly lower than that for subjects who consumed only rice (P < .05), but pinitol had no apparent effect on postprandial insulin levels. Therefore, soybean-derived pinitol may be useful in controlling postprandial increases in blood glucose in patients with type 2 diabetes.

Pre- and post-prandial capillary glucose self-monitoring achieves better glycaemic control than pre-prandial only monitoring

No consensus exists amongst professionals as to the timing of capillary blood glucose self-monitoring (CBGSM). No studies have addressed the timing of CBGSM in the general population with diabetes. This study was designed to compare the efficacy of pre- and post-prandial CBGSM with pre-prandial CBGSM only, in a cohort of insulin treated diabetic patients receiving a basal-bolus insulin regimen. A total of 24 patients, recruited from a diabetes review clinic, took part in a within-patient cross-over study. They were allocated, in random order, to one of two methods of CBGSM: 12 weeks pre- and post-prandial testing, followed by another 12 weeks of pre-prandial only testing (or vice versa) with a four-week washout period between. HbA1c, pre- and post-prandial blood glucose levels, weight and insulin dosage were used as indicators for comparing the two methods of testing. HbA1c improved with both methods of monitoring but the improvement was significantly better during pre- and post-prandial monitoring (0.1% versus 0.6%; p=0.001). The mean pre-prandial blood glucose levels were significantly lower during pre- and post-prandial testing than during pre-prandial only testing (8.5 mmol/L versus 9.0 mmol/L, p=0.002). The patients' weight increased significantly during the combination testing method (2 kg, p<0.005), which was correlated with the improvement in HbA1c (r=73, p<0.005), whilst there was no significant increase in weight during the pre-prandial only testing period. In patients receiving a basal-bolus insulin regimen a combination of pre- and post-prandial capillary blood glucose self-monitoring provides a better tool for achieving improved glycaemia than pre-prandial monitoring only. Copyright © 2005 John Wiley & Sons, Ltd.

Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: A randomized controlled clinical trial

OBJECTIVE: This study was undertaken to compare preprandial and postprandial capillary glucose monitoring in pregnant women with type 1 diabetes. STUDY DESIGN: Sixty-one women with type 1 diabetes were randomly assigned at 16 weeks' gestation to preprandial or postprandial blood glucose monitoring using memory-based glucose reflectance meters throughout pregnancy. Serial measurements of hemoglobin A1c and fructosamine were obtained throughout pregnancy. Insulin, glucose, and insulin-like growth factor-I (IGF-I) were measured in cord blood at delivery. Neonatal anthropometric measures were performed within 72 hours of delivery RESULTS: Maternal age, parity, age of onset of diabetes, number of prior miscarriages, smoking status, social class, weight gain in pregnancy, and compliance with therapy were similar in the two groups. The postprandial monitoring group had a significantly reduced incidence of preeclampsia (3% vs 21%, P<.048), a greater success in achieving glycemic control targets (55% vs 30%, P<.001) and a smaller neonatal triceps skinfold thickness (4.5±0.9 vs 5.1±1.3, P = .05). CONCLUSION: Postprandial capillary blood glucose monitoring in type 1 diabetic pregnancy may significantly reduce the incidence of preeclampsia and neonatal triceps skinfold thickness compared with preprandial monitoring.

Insulin antibodies do not preclude optimization of metabolic control in women with IDDM during pregnancy.

To evaluate whether the presence of insulin antibodies (IAs) may preclude the optimization of metabolic control during pregnancy and affect outcome in women with IDDM. IAs were measured by radiobinding assay in 44 women with IDDM referred to the Diabetes and Pregnancy Outpatients' Clinic during 46 pregnancies. Age, duration of IDDM, metabolic control (HbA1c, mean pre- and postprandial capillary blood glucose, frequency of hypo- or hyperglycemia), insulin requirement at 1st and 3rd trimester of pregnancy, BM1, and weight gain were recorded. Neonatal variables such as gestational age, weight, length, and the presence at birth of either hypoglycemia, hypocalcemia, or jaundice requiring phototherapy were also considered. IAs correlated positively with insulin requirement (P < 0.05) and negatively with HbA1c at term (P < 0.01). Patients with IA levels > or = 40% insulin binding (8 of 46) had a higher insulin requirement and lower preprandial capillary blood glucose at the beginning of pregnancy but not at term (P < 0.005), whereas they had lower HbA1c at term than did patients with low IA levels (P < 0.01). IA levels decreased slightly at term (P = 0.007). IA levels > or = 40% were not associated with a higher rate of hypo- or hyperglycemic episodes or with diabetic complications or thyreopathy. No correlation was found between 1A levels and any of the neonatal variables considered. The presence of IAs does not preclude optimization of metabolic control during pregnancy and is compatible with a favourable outcome.

A GENERALIZED LINEAR MODEL FOR ANALYSING RECEIVER OPERATING CHARACTERISTIC CURVES

We present a continuation ratio model for analysing ordinal categorical data and we apply the model to the problem of estimating receiver operating characteristic (ROC) curves. We apply the methods to post-prandial capillary blood glucose measurements as a criterion for a potential screening test for diabetes mellitus. One can obtain point estimates of sensitivity and specificity and their associated standard errors at any value along the observed range of post-prandial capillary blood glucose measurements. Also, in comparison to the models for ROCs described by Tosteson and Begg, ROC curves based on the continuation ratio model have the desired features that allow ROCs to be concave but not necessarily symmetric.

Preconception Care of Diabetes

To test the value of intensive management of diabetes before and during early pregnancy, 84 women recruited prior to conception were compared with 110 women who were already pregnant referred at 6 to 30 weeks' gestation. All underwent daily measurement of fasting and postprandial capillary blood glucose levels. Mean blood glucose levels during embryogenesis and organogenesis were within 3.3 to 7.8 mmol/L in 50% of preconception subjects and exceeded 10 mmol/L in 6.5%. One major congenital anomaly occurred in 84 infants (1.2%) of women treated before conception compared with 12 anomalies in 110 infants (10.9%) of mothers in the postconception group. Transient symptomatic hypoglycemia occurred during embryogenesis in 60% of women in the preconception group, with a median frequency of 2.7 episodes per week, but was not associated with excess malformations. We conclude that education and intensive management for glycemic control of diabetic women before and during early pregnancy will prevent excess rates of congenital anomalies in their infants.

Gestational diabetes: Impact of home glucose monitoring on neonatal birth weight

Two groups of 58 gestational diabetic women matched for age, prepregnancy weight, height, and parity were studied. The home glucose monitoring study group performed fasting and 1-hour postprandial capillary blood glucose testing after every meal. The control group was followed by conventional treatment. The incidence of macrosomia (birth weight of ≥4000 gm) and large (≥90%) for gestational age infants was significantly reduced in the home glucose monitoring group. The mean birth weight of the study group was 3231 ± 561 gm, while that of the control group was 3597 ± 721 gm (p < 0.002). Significantly more patients in the home glucose monitoring group were receiving insulin therapy (50% versus 21%). We believe that intensive home glucose monitoring will allow for the early identification of those gestational diabetic patients needing insulin and thus reduce the incidence of macrosomia and large for gestational age infants.