Postprandial Blood Glucose Control Research Articles

Rhodiosin from Rhodiola crenulata effectively alleviate postprandial hyperglycemia by inhibiting both the activity and production of α‑glucosidase

BackgroundEffective control of postprandial blood glucose (PBG) level is essential for the prevention and treatment of diabetes and its complications. Several flavonoids have attracted much attention due to their significant PBG-lowering effects. However, there is still a certain gap in the in vivo hypoglycemic activity of most flavonoids compared to first-line drugs available on the market, and are still lack of the PBG-lowering effects of 8-hydroxyflavones and their structure–activity relationship. PurposeEvaluate hypoglycemic effects of 8-hydroxyflavones from Rhodiola crenulata in vitro and in vivo, especially comparatively analyze the relationship between hypoglycemic effects and flavonoid configuration and reveal the possible mechanism of 8-hydroxyflavones in lowering hyperglycemia. MethodsStarch, maltose, sucrose, and glucose tolerance tests in both diabetic and normal mice were used to evaluate and compare the hypoglycemic effects of 8-hydroxyflavones rhodiosin (RHS), rhodionin (RHN), and herbacetin (HBT). Molecular docking, enzyme kinetics, and immunofluorescence analysis were used to research the possible hypoglycemic mechanisms of 8-hydroxyflavones. ResultsRHS (5 and 10 mg/kg) could efficiently decrease PBG levels in both normal and diabetes mice. Moreover, RHS, RHN, and HBT all had significant PBG-lowering effects in transgenic diabetes mice, and the effects were equivalent to or stronger than acarbose. Further mechanism research indicated that 8-hydroxyflavones achieved PBG-lowering effects by inhibiting both the activity and production of glycosidase. Notably, we have innovatively discovered that inhibiting the expression of glycosidases rather than just their activities may be a new target for hypoglycemic drugs. ConclusionWe have firstly comprehensively and systematically clarified PBG-lowering effects of 8-hydroxyflavones from Rhodiola crenulata, and revealed their structure-activity relationships and hypoglycemic mechanisms. The study demonstrated that the substitution of 8-hydroxy groups in flavonoids could significantly enhance their hypoglycemic effects, which were equivalent to or stronger than commercially available drug acarbose. 8-Hydroxyflavones could be used as therapeutic or health drugs with significant potential to reduce postprandial hyperglycemia.

Study on the effectiveness of postprandial blood glucose control and glycemic index of acetylated wheat flour in healthy volunteers

Background: The study was conducted to determine the ability to control postprandial blood glucose response and glycemic index of acetylated wheat starch cakes containing 31,2% of resistant starch on 12 healthy volunteers. Material and methods: Research designed using experimental and double-blind methods. During the two days of the clinical trial, after more than 12 hours of overnight fasting, each volunteer consumed a diet consisting of 1 cake containing 50 g of acetylated wheat starch or 50 g of natural wheat starch and 330 ml of filtered water in 15 minutes. Volunteers had determined their capillary blood glucose concentrations at times before meals, 60 and 120 minutes after meals. Results: Blood glucose concentration at 60 minutes after eating acetylated wheat starch cake (G1= 8.6 ± 0.8 mmol/L) was lower than natural wheat starch cake (G1= 11.7 + 1.1 mmol/L) (p < 0.05). Similarly, blood glucose concentration at 120 minutes after eating acetylated wheat starch cake (G2= 7.1 ± 0.7 mmol/L) was lower than natural wheat starch cake (G2= 9.2 ± 1.7 mmol/L) (p < 0.05). The area under the curve of blood glucose concentration after 120 minutes of eating natural wheat starch cake (AUC0-120min= 337.0 min*mmol/L) is doulble times larger than the acetylated wheat starch cake (AUC0-120min= 175.5 min*mmol/L) (p < 0.05). Glycemic index of acetylated wheat starch cake is 52.0. Conclusion: Acetylated wheat starch cake has a low glycemic index, possessing the ability to control postprandial blood glucose effectively, limiting the increase of postprandial blood glucose concentration within the safe range, and it did not cause any digestive disorders in volunteers. This is very meaningful in the application of acetylated wheat starch to process foods not only for diabetic patients but also for pre-diabetic or overweight and obese people to support treatment and improve quality of life. Key words: resistant starch, blood glucose, glycemic index, volunteers.

Optimizing Blood Glucose Control through the Timing of Exercise in Pregnant Individuals Diagnosed with Gestational Diabetes Mellitus.

This study aimed to evaluate the effectiveness of moderate intensity walking on postprandial blood glucose control for pregnant individuals with (GDM) and without gestational diabetes mellitus (NON-GDM). Using a randomized cross-over design, individuals completed 5 days of exercise (three 10-min walks immediately after eating (SHORT), or one 30-min walk (LONG) outside of 1 h after eating). These protocols were preceded and separated by 2-days of habitual exercise (NORMAL). Individuals were instrumented with a continuous glucose monitor, a physical activity monitor for 14-days, and a heart rate monitor during exercise. Participants completed a physical activity enjoyment scale (PACES) to indicate their protocol preference. The GDM group had higher fasting, 24-h mean, and daily peak glucose values compared to NON-GDMs across all conditions (effect of group, p = 0.02; p = 0.02; p = 0.03, respectively). Fasting, 24-h mean, and daily peak glucose were not influenced by the SHORT or LONG exercise (effect of intervention, p > 0.05). Blood glucose values were higher among the GDM group for at least 1 h after eating, yet the exercise intervention had no effect on 1 or 2 h postprandial glucose values (effect of intervention, p > 0.05). Physical activity outcomes (wear time, total activity time, and time spent on each intensity) were not different between the groups nor interventions (effect of group, p > 0.05; effect of intervention, p > 0.05,). There were no differences between the groups or interventions for the PACES score (effect of group, p > 0.05; effect of intervention, p > 0.05). To conclude, there were no differences between the groups or exercise protocols on blood glucose control. More research is warranted to elucidate higher exercise volumes in this outcome for individuals with GDM.

Insights into the rheological properties, multi-scale structure and in vitro digestibility changes of starch-β-glucan complex prepared by ball milling

High amylose corn starch (HACS)-oat β-glucan (OBG) complex was prepared by ball milling treatment. The morphology and structure of the samples were characterized, and the digestibility of the samples was studied. SEM analysis showed that the grain structure of oat β-glucan-starch after ball milling showed an irregular aggregate shape. The rheological results indicated that the apparent viscosity of the solution of HACS-OBG complex prepared by ball milling, with the values of both G′ and G″ decreasing on the increase of OBG addition. Multi-scale structure analysis showed that the disorder of the crystal structure and short-range structure of the HACS-OBG complex would lead to the decrease of the double helix structure content. In terms of digestibility, the RDS of the complex decreased from 75.88 % to 66.26 %, which suppressed the digestibility of starch. Molecular docking and quantum chemistry techniques further demonstrated the strong hydrogen bond interaction between HACS and OBG and the inhibition rate of OBG on the enzyme, which was conducive to the slow digestion of HACS-OBG complex. Therefore, ball milling treatment can promote the binding of OBG to starch, which may be an effective method for postprandial blood glucose control.

COMPARATIVE EFFICACY OF METFORMIN AND INSULIN IN THE TREATMENT OF GESTATIONAL DIABETES - A RANDOMISED CONTROL STUDY.

AIMS AND OBJECTIVES: To compare the efcacy of insulin over metformin in the management of gestational diabetes mellitus and to compare maternal and foetal outcome in patients treated with Metformin and Insulin. : This was a hospital based randomised control study conductedMATERIALS AND METHODOLOGY over a period of 12 months from April 2020 to March 2021 amongst 104 pregnant women attending antenatal OPD of Department of Obstetrics and Gynaecology ,Guwahati medical college and hospital, Assam. Open label RCT Randomization process was used to randomize participants into Insulin and Metformin group. Maternal and foetal variables were followed up among both the groups and the results were compared. Metformin when compared with Insulin was showing similarRESULTS: efcacy and safety in terms of variables like Fasting and Post Prandial blood glucose control.Metformin signicantly reduces the incidence of polyhydramnios, fasting hypoglycaemia, post prandial hyperglycaemia and excessive weight gain during pregnancy. In the foetus, Metformin use was found to have reduced incidence of large for gestational age babies and indirectly preventing its related complications like need for LSCS, occurrence of shoulder dystocia at labour and neonatal hypoglycaemia. Insulin use in Gestational diabetes showed better neonatal outcome in terms of APGAR score and neonatal hypoglycaemia. But comparative efcacy of Insulin to Metformin in terms of post prandial blood glucose control was better, thus reducing the incidence of complications of poor glycaemic control in Gestational diabetes. ComparedCONCLUSION: with Insulin, Metformin also can be used as an effective treatment of Gestational Diabetes but efcacy of Insulin is more than Metformin in terms of maternal and foetal outcomes. Further larger trials are needed to conrm.

Dietary determinants of postprandial blood glucose control in adults with type 1 diabetes on a hybrid closed-loop system

Aims/hypothesisThe aim of this work was to assess the relationship between meal nutrients and postprandial blood glucose response (PGR) in individuals with type 1 diabetes on a hybrid closed-loop system (HCLS).MethodsThe dietary composition of 1264 meals (398 breakfasts, 441 lunches and 425 dinners) was assessed by 7-day food records completed by 25 individuals with type 1 diabetes on HCLSs (12 men/13 women, mean ± SD age 40 ± 12 years, mean ± SD HbA1c 51 ± 10 mmol/mol [6.9 ± 0.2%]). For each meal, PGR (continuous glucose monitoring metrics, glucose incremental AUCs) and insulin doses (pre-meal boluses, post-meal microboluses automatically delivered by the pump and adjustment boluses) over 6 h were evaluated.ResultsBreakfast, lunch and dinner significantly differed with respect to energy and nutrient intake and insulin doses. The blood glucose postprandial profile showed an earlier peak after breakfast and a slow increase until 4 h after lunch and dinner (p < 0.001). Mean ± SD postprandial time in range (TIR) was better at breakfast (79.3 ± 22.2%) than at lunch (71.3 ± 23.9%) or dinner (70.0 ± 25.9%) (p < 0.001). Significant negative predictors of TIR at breakfast were total energy intake, per cent intake of total protein and monounsaturated fatty acids, glycaemic load and absolute amounts of cholesterol, carbohydrates and simple sugars consumed (p < 0.05 for all). No significant predictors were detected for TIR at lunch. For TIR at dinner, a significant positive predictor was the per cent intake of plant proteins, while negative predictors were glycaemic load and intake amounts of simple sugars and carbohydrate (p < 0.05 for all).Conclusions/interpretationThis study shows that nutritional factors other than the amount of carbohydrate significantly influence postprandial blood glucose control. These nutritional determinants vary between breakfast, lunch and dinner, with differing effects on postprandial blood glucose profile and insulin requirements, thus remaining a challenge to HCLSs.Graphical abstract

The efficacy and safety of glucokinase activators for the treatment of type-2 diabetes mellitus: A meta-analysis.

Background:Glucokinase activators (GKAs) are a novel family of glucose-lowering agents used for the treatment of type-2 diabetes mellitus. Treatment with different GKAs has been shown to reduce blood glucose levels in these patients. We compared the efficacy/safety of GKAs in patients with type-2 diabetes mellitus through a meta-analysis.Methods:We searched the PubMed, Excerpt Medica Database, and Cochrane Central Register of Controlled Trials databases for articles published before December 30, 2020. We computed the weighted mean difference (WMD) and 95% confidence interval (CI) for the change from baseline to the study endpoint for GKA versus placebo treatments.Results:A total of 4 articles (5 studies) were included in the meta-analysis. GKAs were associated with reductions in glycated hemoglobin levels from baseline (WMD, −0.3%; 95% CI, −0.466% to −0.134%). No significant difference between GKA and placebo treatment was observed in the results of fasting plasma glucose levels from baseline (WMD 0.013 mmol/L; 95% CI, −0.304–0.33 mmol/L). A significantly higher change in 2-hour postprandial plasma glucose (2-h PPG) levels (WMD −2.434 mmol/L; 95% CI, −3.304 to −1.564 mmol/L) was observed following GKA than placebo treatment. GKAs were associated with a higher prevalence of causing hypoglycemic events than placebo treatment (risk difference [RD], 0.06; 95% CI 0.013–0.106). GKAs had no association with the risk of developing adverse effects (RD, 0.038; 95% CI, −0.03–0.106) and serious adverse events (RD, 0.01; 95% CI, −0.004–0.023).Conclusions:GKAs were more effective for postprandial blood glucose control. However, these agents showed a significantly high risk of causing hypoglycemia.PROSPERO registration number:CRD42021220364.

Comparative studies on the physicochemical profile and potential hypoglycemic activity of different tea extracts: Effect on sucrase-isomaltase activity and glucose transport in Caco-2 cells

Tea is one of the most popular beverages in the world and is believed to be beneficial for health. The main components in tea change greatly depending on different processes, and thus, the effects of different teas on human health may differ. In this study, we compared the effect of green, oolong, black, and dark tea extracts on sucrase-isomaltase (SI) activity and glucose transport, which are two intervention options for postprandial blood glucose control, using Caco-2 cells as a model. Theaflavin-rich black tea extracts showed the highest inhibition of SI activity and retardation of the hydrolysis of sucrose, maltose, and isomaltose, with IC50 values of 8.34 μg/mL, 16.10 μg/mL, and 21.63 μg/mL, respectively. All four kinds of tea extracts caused a dose-dependent inhibition of glucose transport, which were closely related to the catechin content. Green tea extracts showed the highest inhibition of glucose transport and was more effective against sodium-dependent glucose cotransporter 1 (SGLT1) than glucose transporter 2 (GLUT2) in the management of glucose transport. Black tea extracts also inhibited glucose transport despite low level of catechins. The reason could partly lie in the suppression of Na+/K+-ATPase, which reduced the energy needed for SGLT1 to actively transport glucose. Furthermore, the mRNA level of SI, SGLT1, GLUT2, and Na+/K+-ATPase in Caco-2 cells were significantly reduced after treatment with tea extracts for 2 h. These in vitro studies suggested that tea could be used as a functional food in the diet to modulate postprandial hyperglycaemia for diabetic patients.

Impact of Structured Diabetes Pharmaceutical Care Training on Practices of Community Pharmacist

Objectives: The diabetes epidemic in India has placed it in the second position in having the largest number (77 million) of adults with diabetes, worldwide. Diabetes is a chronic progressive disease that can be effectively controlled by medication adherence, monitoring and managing well on regular basis. A well-trained pharmacist can help the patients to achieve good glycaemic control by providing them pharmaceutical care. This study aims to evaluate the effect of tailored diabetes pharmaceutical-care training on the practices of pharmacists and the subsequent impact on patients’ clinical outcomes. Methods: A prospective interventional quantitative study was conducted to assess the impact on Knowledge, Attitude and Practice (KAP) levels of community pharmacists after providing diabetes pharmaceutical care training. The selected trained pharmacists enrolled type-2 diabetes patients to assess the practice component further, by observing patients’ outcomes in terms of knowledge, attitude, practices along with clinical outcomes in terms of glycemic control, post pharmaceutical care provision. A descriptive analysis and statistical evaluation, using SPSS Version 21. Key Findings: Significantly improved outcomes were observed across all the pharmacist participants in terms of KAP levels, from baseline to post-interventional training (p<0.0001). Also, a considerable impact on patients' knowledge, awareness, practices and clinical outcomes was noted in the intervention group. Clinically there was a significant reduction in fasting blood glucose levels, postprandial blood glucose levels, HbA1c and control in systolic and diastolic blood pressure (p<0.05) was also observed. Conclusion: Community pharmacists who had completed structured training in diabetes care could practice pharmaceutical- care well and help patients with type-2 diabetes in achieving good glycemic control.

Nutrient-sensing components of the mouse stomach and the gastric ghrelin cell.

The ability of the gut to detect nutrients is critical to the regulation of gut hormone secretion, food intake, and postprandial blood glucose control. Ingested nutrients are detected by specific gut chemosensors. However, knowledge of these chemosensors has primarily been derived from the intestine, while available information on gastric chemosensors is limited. This study aimed to investigate the nutrient-sensing repertoire of the mouse stomach with particular emphasis on ghrelin cells. Quantitative RT-PCR was used to determine mRNA levels of nutrient chemosensors (protein: G protein-coupled receptor 93 [GPR93], calcium-sensing receptor [CaSR], metabotropic glutamate receptor type 4 [mGluR4]; fatty acids: CD36, FFAR2&4; sweet/umami taste: T1R3), taste transduction components (TRPM5, GNAT2&3), and ghrelin and ghrelin-processing enzymes (PC1/3, ghrelin O-acyltransferase [GOAT]) in the gastric corpus and antrum of adult male C57BL/6 mice. Immunohistochemistry was performed to assess protein expression of chemosensors (GPR93, T1R3, CD36, and FFAR4) and their co-localization with ghrelin. Most nutrient chemosensors had higher mRNA levels in the antrum compared to the corpus, except for CD36, GNAT2, ghrelin, and GOAT. Similar regional distribution was observed at the protein level. At least 60% of ghrelin-positive cells expressed T1R3 and FFAR4, and over 80% expressed GPR93 and CD36. The cellular mechanisms for the detection of nutrients are expressed in a region-specific manner in the mouse stomach and gastric ghrelin cells. These gastric nutrient chemosensors may play a role modulating gastrointestinal responses, such as the inhibition of ghrelin secretion following food intake.

Effect of Afrezza on Glucose Dynamics During HCL Treatment.

A major obstacle in optimizing the performance of closed-loop automated insulin delivery systems has been the delay in insulin absorption and action that results from the subcutaneous (SC) route of insulin delivery leading to exaggerated postmeal hyperglycemic excursions. We aimed to investigate the effect of Afrezza inhaled insulin with ultrafast-in and -out action profile on improving postprandial blood glucose control during hybrid closed-loop (HCL) treatment in young adults with type 1 diabetes. We conducted an inpatient, three-way, randomized crossover standardized meal study to assess the efficacy and safety of Afrezza at a low (AL) and a high (AH) dose as compared with a standard SC rapid-acting insulin (aspart) premeal bolus during Diabetes Assistant (DiAs) HCL treatment. Participants received two sequential meals on three study days, and premeal insulin bolus was determined based on home insulin-to-carbohydrate ratio for each meal (rounded up to the closest available Afrezza cartridge dose for AH and down for AL). The primary efficacy outcome was the peak postprandial plasma glucose (PPG) level calculated by pooling data for up to 4 h after the start of each meal. Secondary outcomes included hyperglycemic, hypoglycemic, and euglycemic venous glucose metrics. The mean ± SD PPG for the rapid-acting insulin control arm and AH was similar (185 ± 50 mg/dL vs. 195 ± 46 mg/dL, respectively; P = 0.45), while it was higher for meals using AL (208 ± 54 mg/dL, P = 0.04). The AH achieved significantly lower early PPG level than the control arm (30 min; P < 0.001), and improvement in PPG waned at later time points (120 and 180 min; P = 0.02) coinciding with the end of Afrezza glucodynamic action. Afrezza (AH) premeal bolus reduced the early glycemic excursion and improved PPG during HCL compared with aspart premeal bolus. The improvement in PPG was not sustained after the end of Afrezza glucodynamic action at 120 min.

The Effect Of Arm Versus Leg Dominant Physical Activity On Postprandial Blood Glucose Levels

PURPOSE: The aim of this investigation was to assess the effects of two different exercise trials that used different amounts of muscle mass on postprandial blood glucose levels. METHODS: Subjects (n = 8) participated in a series of three tests after ingesting a 75g 100% glucose solution: a control, a bout of arm- only exercise, and a bout of leg-only exercise following the standard OGTT protocol. Each exercise bout was thirty minutes in length, the intensity of which was matched at 0.5 watts/ kg of body weight between trials. RESULTS: The average postprandial blood glucose was significantly different between conditions (Two Way Repeated Measures ANOVA, p <0.05). At 20 minutes blood glucose was significantly lower in legs conditions versus the arm condition (p = 0.003). There was no difference in mean HR or RPE between trials. CONCLUSION: The data suggests that when factors such as workload are matched, the amount of muscle mass recruited for light physical activity can impact postprandial blood glucose control. The results of this pilot study help to further define the role exercise could play in the prevention of increasingly prevalent metabolic disorders, helping people to live longer, healthier lives utilizing exercise as medicine.

Impact of Daily Physical Activity as Measured by Commonly Available Wearables on Mealtime Glucose Control in Type 1 Diabetes.

Objective: In contrast with exercise, or structured physical activity (PA), glycemic disturbances due to daily unstructured PA in patients with type 1 diabetes (T1D) is largely underresearched, with limited information on treatment recommendations. We present results from retrospective analysis of data collected under patients' free-living conditions that illuminate the association between PA, as measured by an off-the-shelf activity tracker, and postprandial blood glucose control. Research Design and Methods: Data from 37 patients with T1D during two clinical studies with identical data collection protocols were analyzed retrospectively: 4 weeks of continuous glucose monitoring, carbohydrate intake, insulin injections, and PA (assessed through wearable activity tracker) were collected in free-living conditions. Five-hour glucose area under curves (GAUCs) following the last-bolused meal of every day were computed to assess postprandial glucose excursions, and their relation with corresponding antecedent PA was analyzed using linear mixed-effects regression models, accounting for meal, insulin, and current glycemic state. Results: Datasets yielded 845 days of data from 37 subjects (22.8 ± 11.6 days/subject); postmeal GAUC was negatively associated with total daily PA measured by step count (P = 0.025), and total time spent performing higher than light-intensity PA (P = 0.042). Patients with higher median total daily PA exhibited lower average postprandial GAUC (P < 0.01). Additional analyses indicated that daily PA likely presents an immediate and delayed impact on glucose control. Conclusion: Daily PA assessed by commonly available sensors is significantly associated with glycemic exposure after an evening meal, indicating that quantitative assessment of PA may be useful in mealtime treatment decisions.

Anticipating Meals with Behavioral Profiles in an Artificial Pancreas System - An Informed Multistage Model Predictive Control Approach

This contribution presents an individualized multistage model predictive control (MS-MPC) algorithm for blood glucose (BG) stabilization and improved postprandial BG control for people with type 1 diabetes (T1D) with consistent meal patterns. The multistage formulation utilizes different meal patterns as disturbance realizations entering the glucose-insulin system, then assesses the best possible control input among all of the probable scenarios. The disturbance realizations, in the form of glucose rate of appearance traces, are estimated by using meal records (time and carbohydrate amount) as the input into an individualized oral model. Meal signatures are then clustered with the k-medoids algorithm to obtain meal patterns. Two approaches, a hybrid closed-loop (HCL) and fully closed-loop (FCL) MS-MPC were tested and compared with their respective control treatments (hybrid and fully automated MPC, respectively) using the complete in silico adult cohort of the FDA-accepted UVA/Padova metabolic simulator. Results confirm an improvement in both postprandial and overall percent time in 70-180 mg/dL 85.2 ± 15.5 v. 89.6 ± 12.2 and 94.1 ± 6.3 v. 95.7 ±5.0, respectively, using the HCL approach, and 37.8 ± 15.7 v. 63.4± 16.6 and 65.8 ± 12.7 v. 82.2± 9.2, using the FCL approach.P

One potato, two potato,… assessing carbohydrate counting accuracy in adolescents with type 1 diabetes

Diabetes education includes nutritional education and the provision of practical guidelines as to the interrelation between insulin requirements and carbohydrate intake. Carbohydrate (CHO) counting has therefore been a recommended daily practice to help patients to manage blood glucose levels in type 1 diabetes (T1D). Evidence suggests that CHO estimates should be within 10–15 g of the actual meal for optimal postprandial blood glucose control.

One potato, two potato,… assessing carbohydrate counting accuracy in adolescents with type 1 diabetes.

Carbohydrate (CHO) counting is a recommended daily practice to help manage blood glucose levels in type 1 diabetes. Evidence suggests that CHO estimates should be within 10 to 15 g of the actual meal for optimal postprandial blood glucose control. The objective of this study was to assess accuracy of CHO counting in adolescents with type 1 diabetes. Adolescents (aged 12-18 years) with type 1 diabetes who self-identified as regular CHO counters were recruited from the SickKids Diabetes Clinic, Toronto, Canada. Adolescents completed the PedsCarbQuiz (PCQ) and estimated CHO content of test trays (three meals and three snack trays) that were randomly assigned. Analyses were conducted to identify factors associated with accuracy of counting and CHO counting knowledge (PCQ score). A total of 140 adolescents (78 females, mean age 14.7, SD = 1.8) participated. The average PCQ score was 81 ± 10%. Forty-two percent of adolescents were accurate in estimating meal trays (ie, within 10 g of the actual CHO content), 44% estimated inaccurately (within 10-20 g), while 14% were significantly inaccurate counters (>20 g variation). PCQ scores were higher in teens who CHO counted accurately than in those with significant inaccuracy (>20 g) (P < 0.05), and a longer duration of diabetes corresponded significantly with a lower PCQ score. No demographics correlated significantly with CHO counting accuracy. Less than half of the teens in our study were accurate CHO counters. These results indicate the need for regular clinical accuracy check and reeducation.

Postprandial fuzzy adaptive strategy for a hybrid proportional derivative controller for the artificial pancreas.

This paper presents a support fuzzy adaptive system for a hybrid proportional derivative controller that will refine its parameters during postprandial periods to enhance performance. Even though glucose controllers have improved over the last decade, tuning them and keeping them tuned are still major challenges. Changes in a patient's lifestyle, stress, exercise, or other activities may modify their blood glucose system, making it necessary to retune or change the insulin dosing algorithm. This paper presents a strategy to adjust the parameters of a proportional derivative controller using the so-called safety auxiliary feedback element loop for type 1 diabetic patients. The main parameters, such as the insulin on board limit and proportional gain are tuned using postprandial performance indexes and the information given by the controller itself. The adaptive and robust performance of the control algorithm was assessed "in silico" on a cohort of virtual patients under challenging realistic scenarios considering mixed meals, circadian variations, time-varying uncertainties, sensor errors, and other disturbances. The results showed that an adaptive strategy can significantly improve the performance of postprandial glucose control, individualizing the tuning by directly taking into account the intra-patient variability of type 1 patients. Graphical Abstract title: Postprandial glycaemia improvement via fuzzy adaptive control A fuzzy inference engine was implemented within a clinically tested artificial pancreas control system. The aim of the fuzzy system was to adapt controller parameters to improve postprandial blood glucose control while ensuring safety. Results show a significant improvement over time of the postprandial glucose response due to the adaptation, thus demonstrating the usefulness of the fuzzy adaptive system.

Hydroxytyrosol nicotinate, a new multifunctional hypolipidemic and hypoglycemic agent

Hydroxytyrosol (HT) is a natural polyphenol antioxidant that exists in olive oil. In the study of multifunctional hypolipidemic of nicotinic derivatives, we found that hydroxytyrosol nicotinate (HT-N) incorporation of niacin with HT displayed α-glucosidase inhibitory activities in vitro, such as yeast α-glucosidase (IC50 = 117.72 μM) and rat intestinal α-glucosidases maltase (IC50 = 31.86 μM) and sucrase (IC50 = 22.99 μM), and had a good control of postprandial blood glucose (PBG). HT-N shown significantly hypoglycemic action by 16.9% and protection of pancreatic tissue in type 2 diabetic mellitus (T2DM) mouse model. HT-N also shown a potent antioxidant activity and property of anti-glycation in vitro, which were benefit for ameliorating diabetic complications. Moreover, HT-N exhibited much significant hypolipidemia, lowering plasma triglyceride (TG), total cholesterol (TC), and malonaldehyde (MDA) by 34.6%, 45.8% and 32.1% respectively, in hyperlipidemic mice induced by Triton WR 1339. The results indicated that HT-N has hypolipidemic, hypoglycemic and antioxidant actions. All these properties could be conducive to amelioration of oxidative stress, hyperlipidemia, and diabetes that HT-N may serve as a multifunctional potential therapeutic strategy in diabetic patients with hyperlipidemia.

Time of Day When Type 1 Diabetes Patients With Eating Disorder Symptoms Most Commonly Restrict Insulin.

Restricting insulin to lose weight is a significant problem in the clinical management of type 1 diabetes (T1D). Little is known about this behavior or how to effectively intervene. Identifying when insulin restriction occurs could allow clinicians to target typical high-risk times or formulate hypotheses regarding factors that influence this behavior. The current study investigated the frequency of insulin restriction by time of day. Fifty-nine adults with T1D and eating disorder symptoms completed 72 hours of real-time reporting of eating and insulin dosing with continuous glucose monitoring. We used a generalized estimating equation model to test the global hypothesis that frequency of insulin restriction (defined as not taking enough insulin to cover food consumed) varied by time of day, and examined frequency of insulin restriction by hour. We also examined whether patterns of insulin restriction for 72 hours corresponded with patients' interview reports of insulin restriction for the past 28 days. Frequency of insulin restriction varied as a function of time (p = .016). Insulin restriction was the least likely in the morning hours (6:00-8:59 AM), averaging 6% of the meals/snacks consumed. Insulin restriction was more common in the late afternoon (3:00-5:59 PM), peaking at 29%. Insulin was restricted for 32% of the meals/snacks eaten overnight (excluding for hypoglycemia); however, overnight eating was rare. Insulin restriction was associated with higher 120-minute postprandial blood glucose (difference = 44.4 mg/dL, 95% confidence interval = 22.7-68.5, p < .001) and overall poorer metabolic control (r = 0.43-0.62, p's < .01). Patients reported restricting insulin for a greater percentage of meals and snacks for the past 28 days than during the 72 hour real-time assessment; however, the reports were correlated (Spearman's ρ = 0.46, p < .001) and accounted for similar variance in HbA1c (34% versus 35%, respectively). Findings suggest that insulin restriction may be less likely in the morning, and that late afternoon is a potentially important time for additional therapeutic support. Results also suggest that systematic clinical assessment and treatment of overnight eating might improve T1D management.

Exploring application of WeChat for gestational diabetes mellitus management

Objective To researching the effect of gestational diabetes mellitus (GDM) prevention and control management by WeChat consultation on the Internet platform. Methods There were 586 pregnant women who performed prenatal care regularly and accepted glucose tolerance test for GDM at 24 to 28 weeks in our hospital during 2015 and 2016 as research objects. Determination of the observation group: in 2016, the 308 people who match the condition of the study during annual prenatal examination in line, in addition to routine guidance outside the clinic and joined the division to establish a dedicated WeChat group for a comprehensive health management consulting. Determination of the control group: in 2015, the 278 people who match the condition of the study during annual prenatal examination in line were treated as control groups. The two groups of observation indexes included the fasting blood glucose and two-hour postprandial blood glucose control in GDM pregnant women, the weight growth rate of the whole pregnancy, cesarean section rate, birth rate of newborns, neonatal referral rate and so on. Results The rate of fasting blood glucose and two-hour postprandial blood glucose control in the observation group was significantly better than that in the control group (t= 2.01- 3.11, all P<0.05). According to the pre-pregnancy physical index, the weight growth of the observation group was significantly better than the control group (t= 2.12- 3.76, all P< 0.05).The cesarean section rate, birth rate and neonatal referral rate were 21.10% (65/308) , 4.87% (15/308) , 7.14% (22/308) in the observation group, and 28.78% (80/278) , 10.07% (28/278) , 12.23% (34/278) in the control group, there were significant differences (U= 2.10- 2.42, all P<0.05). Conclusions Gestational diabetes prevention and control management in the Internet platform for WeChat consultation application effect is remarkable, which can effectively improve the maternal and child outcomes. In the protection of maternal and child health is of great significance. Key words: Wechat consulting; Gestational diabetes mellitus; Management