Peak Postprandial Glucose Research Articles

At-home bodyweight interval exercise in the fed versus fasted state lowers postprandial glycemia and appetite perceptions in females.

Limited research has characterized the metabolic health benefits of bodyweight interval exercise (BWE) performed outside of a laboratory setting. Metabolic responses to exercise can also be influenced by meal timing around exercise, but the interactive effects of BWE and nutrition are unknown. This study investigated the effects of BWE performed in the fasted or fed state on postprandial glycemia, post-exercise fat oxidation and appetite perceptions. Twelve females (23±2years; 22±2kg/m2) underwent two virtually-monitored trials that involved completing BWE (10 × 1 min, 1 min recovery) 5min before (FastEX) or beginning BWE 10min after (FedEX) a standardized breakfast. Heart rate and rating of perceived exertion (RPE) were measured during exercise and capillary glucose concentrations were measured for 2 h postprandial. Following exercise, appetite perceptions were assessed and Lumen expired carbon dioxide percentage (L%CO2) was measured as an index of fat oxidation. Heart rate (85±5%) and RPE (14±2) did not differ between conditions (p>0.05). Postprandial glucose mean (6.1±0.6vs. 6.8±0.8mmol/L, p=0.03), peak (7.4±1.2vs. 8.5±1.5mmol/L, p=0.01), and area under the curve (AUC) (758 ± 72vs. 973 ± 82mmol/L × 2 h, p=0.004) were lower in FedEX versus FastEX. Appetite perceptions were lower in FedEX versus FastEX (-87.63±58.51vs. -42.06±34.96mm, p=0.029). Post-exercise L%CO2 was transiently decreased 30min post-exercise in both conditions (4.03±0.38vs. 4.29±0.34%, p=0.0023), reflective of increased fat oxidation following BWE. These findings demonstrate that BWE performed in the fed compared to the fasted state lowered postprandial glycemia and appetite perceptions in females.

Effects of postprandial exercise timing on blood glucose and fluctuations in patients with type 2 diabetes mellitus.

The aim of this study was to assess how moderate-intensity aerobic exercise performed 45 minutes and 90 minutes after a meal affects blood glucose levels and fluctuations in individuals diagnosed with type 2 diabetes mellitus (T2DM). Twenty-two patients with T2DM, who were solely receiving oral hypoglycemic medication, were enrolled and divided randomly into two categories: those exercising 45 minutes after a meal (45-minute postprandial exercise group) and those exercising 90 minutes post-meal (90-minute postprandial exercise group). Both groups engaged in a 30-minute session of moderate-intensity aerobic stationary bike exercise following breakfast. This aerobic exercise regimen consisted of two stages, with the groups switching exercise timings after the initial phase. Continuous glucose monitoring (CGM) was utilized to evaluate the blood glucose levels and fluctuations in the participants. After breakfast, both overall daily blood glucose levels and the area under the curve for blood glucose following breakfast were reduced in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. The 45-minute postprandial exercise group demonstrated greater time spent within the target glucose range and less time above the target range than the 90-minute postprandial exercise group. Additionally, measures such as standard deviation, mean amplitude of glycemic excursions, largest amplitude of glycemic excursions, and postprandial glucose excursion for breakfast, peak postprandial glucose levels, and duration of elevated glucose levels were all lower in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. Moderate-intensity aerobic exercise lasting 45 minutes after meals was found to be more efficient in decreasing blood glucose levels and minimizing fluctuations compared to exercising 90 minutes after meals in patients with T2DM. Additionally, it notably reduced the peak in blood glucose levels after meals.

Structural changes of wheat starch and activity inhibition of α-glucosidase by persimmon (Diospyros kaki Thunb.) leaves extract retarding starch digestibility

Elevated blood sugar levels caused by starch digestion was a target for controlling diabetes mellitus. The in vitro and in vivo digestibility of wheat starch was evaluated to find that adding 15 % persimmon leaf extract (PLE) to starch reduced its digestibility by 69.50 % and the peak postprandial blood glucose by 23.63 %. Subsequently, we observed under scanning electron microscopy and atomic force microscopy that the presence of PLE led to the destruction of starch structure and the aggregation of α-glucosidase so as to decrease starch digestion and hinder the binding of starch to α-glucosidase. Through multi-spectral analysis, PLE hindered the clathrate of iodine and starch, and also increased the crystallinity of starch by 48.58 %. For α-glucosidase inhibitory activity (IC50 = 72.49 μg/mL), PLE preferentially occupied the active center of α-glucosidase, changed its fluorescence characteristics and secondary structure through hydrogen bonding and hydrophobic interaction. Moreover, among the 23 potential α-glucosidase inhibitors screened from PLE, combined with molecular simulation, Procyanidin B2 had the strongest inhibitory effect (IC50 = 33.22 μg/mL) and binding energy (−7.09 kcal/mol), which was most effectively inhibitory on digestion. These results indicated the potential of PLE in hypoglycemia targeting both starch and α-glucosidase.

Glucose levels measured with continuous glucose monitoring in uncomplicated pregnancies

IntroductionTo characterize glucose levels during uncomplicated pregnancies, defined as pregnancy with a hemoglobin A1c <5.7% (<39 mmol/mol) in early pregnancy, and without a large-for-gestational-age birth, hypertensive disorders of pregnancy, or...

Formulation of category-2 hypoglycemic Improved Traditional Medicines from selected Cameroonian medicinal plants: &lt;i&gt;Mangifera indica, Persea americana&lt;/i&gt; and &lt;i&gt;Ageratum conyzoides&lt;/i&gt;

Diabetes mellitus is the fourth leading cause of death worldwide, and constitutes a major public health crisis. Management of the adverse condition relies mostly on synthetic drugs such as metformin, glibenclamide and insulin. However, treatment with synthetic drugs is challenged by side effects and high cost especially to patients in low-income countries like Cameroon. This study set out to formulate Improved Traditional Medicines (ITMs) in the form of capsules from lyophilized aqueous leaf extracts of Ageratum conyzoides, Mangifera indica and Persea americana, in combination, coded as ITM-1, and leaf extract of Mangifera indica alone, referred to as ITM-2. Phytochemical profiling of individual extracts was carried out using standard methods, while their antioxidant activity was evaluated in vitro by the 2,2-diphenyl-1-picryhadrazyl reducing (DPPH) assay and the Ferric (Iron) reducing antioxidant power assay (FRAP). Capsule formulation was guided by findings from prior Physicochemical and pharmacotechnical analysis of individual extracts and their combination. Safety studies were carried out both in vitro (cytotoxicity testing in Vero cells); and in vivo (acute toxicity tests using the mouse model). Preliminary evaluation of the antidiabetic potential of the formulated ITMs was achieved through determination of their acute hypoglycemic and antihyperglycemic properties in Wistar rats (Oral Glucose Tolerance Test). Major classes of phytochemicals detected were alkaloids, phenols, tannins, flavonoids, anthocyanins, tri-terpenes and anthraquinones. The DPPH and FRAP assays showed dose-dependent antioxidant activity for ITM-1 and ITM-2. Both ITMs showed no toxic effects, be it in vitro, (Cytotoxic Concentration 50% - CC50&gt;1000 µg/mL in cells) or in vivo. At the dose of 25 mg/Kg, both ITMs exhibited significant hypoglycemic effects in Wistar rats. The ITM-2 capsules completely suppressed post-prandial glucose peak in rats as compared to the negative control (distilled water), ITM-1 capsule was able to cause restoration of the glucose levels to normal levels after 120 minutes

Effect of high-amylose rice "Hoshinishiki" on postprandial glucose levels measured by continuous glucose monitoring in patients with diabetes.

We examined the effect of consuming Hoshinishiki, a type of high-amylose rice, on postprandial glucose as measured by continuous glucose monitoring in diabetes patients. A single-blinded clinical trial involving 11 hospitalized patients diagnosed with type 1 or type 2 diabetes was performed. The patients consumed high-amylose rice for 2 days (days 2 and 4 of the study) and control rice for 2 days (days 1 and 3 of the study). Linear mixed models were used to test the effects on the 24-h mean glucose levels, time in range (TIR), incremental area under the curve of glucose levels at 2 h after meals, the average glucose levels at 1, 2, and 3 h after meals, and the maximum glucose levels within 3 h. The results showed that the consumption of high-amylose rice led to significantly lower 24-h mean glucose levels, levels at 2 and 3 h after a meal, and postprandial glucose peak levels within 3 h, as well as significantly higher TIR. A similar trend was observed when the analysis was restricted to patients with type 2 diabetes. These results suggest that high-amylose rice may be a more beneficial staple food for glycemic control than regular rice.

Characterization of Postprandial Bile Acid Profiles and Glucose Metabolism in Cerebrotendinous Xanthomatosis.

Cerebrotendinous xanthomatosis (CTX) is a rare inherited disease characterized by sterol 27-hydroxylase (CYP27A1) deficiency and, thus, a lack of bile acid synthesis with a marked accumulation of 7α-hydroxylated bile acid precursors. In addition to their renowned lipid-emulgating role, bile acids have been shown to stimulate secretion of the glucose-lowering and satiety-promoting gut hormone glucagon-like peptide 1 (GLP-1). In this paper, we examined postprandial bile acid, glucose, insulin, GLP-1 and fibroblast growth factor 19 (FGF19) plasma profiles in patients with CTX and matched healthy controls. Seven patients and seven age, gender and body mass index matched controls were included and subjected to a 4 h mixed meal test with regular blood sampling. CTX patients withdrew from chenodeoxycholic acid (CDCA) and statin therapy three weeks prior to the test. Postprandial levels of total bile acids were significantly lower in CTX patients and consisted of residual CDCA with low amounts of ursodeoxycholic acid (UDCA). The postprandial plasma glucose peak concentration occurred later in CTX patients compared to controls, and patients' insulin levels remained elevated for a longer time. Postprandial GLP-1 levels were slightly higher in CTX subjects whereas postprandial FGF19 levels were lower in CTX subjects. This novel characterization of CTX patients reveals very low circulating bile acid levels and FGF19 levels, aberrant postprandial glucose and insulin profiles, and elevated postprandial GLP-1 responses.

225-OR: The Effect of Tirzepatide vs. Insulin Degludec on Post-meal Glucose Control in Patients with Type 2 Diabetes (SURPASS-3 CGM)

Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist approved for treatment of patients with type 2 diabetes (T2D). This post-hoc analysis evaluated the impact of TZP vs insulin degludec (IDeg) on post-meal glucose control. In this sub-study of the 52-week open label, parallel arm, Phase 3, SURPASS-3 trial, 243 insulin naive adults with T2D (mean age 57 years; T2D duration 8.8 years, HbA1c 8.15%), were randomised (1:1:1:1 to receive weekly TZP 5, 10, 15 mg or titrated IDeg daily). Interstitial glucose values were collected by continuous glucose monitor (CGM) for approx. 7-10 days at baseline and 52 weeks. The 5-hour post-prandial period (PPP) was defined after meals detected via a validated algorithm. The impact of TZP 5, 10, and 15mg vs IDeg on interstitial glucose post meal from area under the curve (AUC) and peak post prandial glucose (PPG) at 52 weeks were assessed. PPG excursions were decreased with all doses of TZP as seen by less AUC &amp;gt;140 mg/dL and &amp;gt;180 mg/dL vs IDeg (Fig). All TZP doses spent significantly less time &amp;gt; 140mg/dL during the PPP 0-5 hrs (135, 96, and 99 mins for TZP 5, 10, and 15mg) vs IDeg (171 mins; p=0.051, p&amp;lt;0.001, p&amp;lt;0.001 respectively). All TZP doses had significantly lower peak PPG at 52 weeks vs IDeg (180.4 ± 4.45 mg/dL, 163.2 ± 4.97 mg/dL, 168.5 ±4.38 mg/dL vs 198.6± 4.98mg/dL respectively, p&amp;lt;0.001). All 3 doses of TZP led to improved AUC and reduced peak PPG vs IDeg as assessed by CGM. Disclosure T.Battelino: Advisory Panel; Eli Lilly and Company, Novo Nordisk, Sanofi, Medtronic, Abbott Diabetes, Consultant; Indigo Diabetes, Research Support; Novo Nordisk, Sanofi, Medtronic, Novartis, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk, Sanofi, Medtronic, Abbott Diabetes, Dexcom, Inc. J.Johnson: Employee; Eli Lilly and Company. M.Katz: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. R.Bray: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J.Xue: Employee; Eli Lilly and Company. K.Brown: Employee; Eli Lilly and Company. Funding Eli Lilly and Company

235-LB: Incretin-Linked Adipose Tissue Microvascular Blood Flow in Healthy People With and Without a Family History of Type 2 Diabetes

Adipose tissue microvascular blood flow (ATMBF) increases in response to a mixed meal challenge (MMC) to promote nutrient storage. This vascular action is impaired in apparently healthy people with a parent with type 2 diabetes (FH+). The mechanisms for this vascular impairment in FH+ are unknow. We aimed to investigate whether incretins [glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)] are associated with ATMBF responses to a MMC. Thirteen healthy (FH-, no parents or grandparents with type 2 diabetes) and fourteen FH+ underwent a 2-hr MMC after an overnight fast. Age, BMI, fasting and peak postprandial blood glucose and plasma insulin concentrations were similar between FH- and FH+ (Table 1). Baseline ATMBF, assessed by contrast ultrasound, was similar between groups, but was impaired in FH+ in response to the MMC (Table 1). Peak plasma GLP-1 and GIP concentrations, but not their ratio (GLP-1:GIP), were higher in FH+ in response to the MMC (Table 1). GLP-1 and GIP concentrations were not associated with ATMBF, however, GLP-1:GIP was significantly associated with postprandial ATMBF at 1-hr (p=0.025, r=0.46). We conclude that impaired postprandial ATMBF in FH+ is not exclusively linked to incretin levels. However, lower GLP-1:GIP ratios may be linked to impaired ATMBF responses in the postprandial state. Disclosure K. Roberts-thomson: None. L. Parker: None. M. Keske: None.

1181-P: Substituting Protein for Fat Lowers Postprandial Glycemic Response in Gestational Diabetes

Background: Dietary guidelines in gestational diabetes mellitus (GDM) focus on carbohydrate without regard to other macronutrients. We tested the impact of fat and protein on postprandial glycemia in GDM and analyzed whether the physiology underlying GDM influenced this response. Methods: In a pilot crossover trial, participants ate two isocaloric breakfast meals with the same carbohydrate content and different protein and fat content (High protein meal: 390 kCal, 35 g protein, 9 g fat, 45 g carb, High fat meal: 411 kCal, 15 g protein, 19 g fat, 46 g carb) on subsequent days in a random order. We measured peak postprandial glucose (primary outcome) using continuous glucose monitors. We used homeostatic model assessment to determine if participants had insulin resistant (IR) or insulin deficient (ID) GDM. We used paired t-tests to test if glycemic response to the meals differed and linear regression to test if differential response to meals was influenced by having IR vs ID GDM. Results: We studied 16 women with diet-controlled GDM (median [IQR] 31 [30-33] weeks’ gestation). Mean [SD] peak glucose after the high fat meal (146 [20] mg/dl) was higher than after the high protein meal (137 [21] mg/dl) (P=0.03), but individuals varied in their differential response to the meals (range: 25 mg/dl higher after high protein meal to 35 mg/dl higher after high fat meal). Median time to peak glucose (IQR) was 72 (63-74) minutes after the high protein meal and 65 (60-73) minutes after the high fat meal (P=0.11). There was no difference in differential glycemic response to the meals in IR (n=8) vs ID (n=4) GDM (P=0.98); age (median [IQR] 36 [33-38] yrs) and BMI (median [IQR] 27 [24-30]) adjustment did not change results (P=0.82). Conclusion: On average, women with GDM have lower post prandial glucose levels after a high protein meal compared to a high fat meal with equivalent carbohydrate content. This may inform GDM dietary recommendations and motivate research on determinants of individual-level response to macronutrients. Disclosure E.A.Rosenberg: None. T.Thaweethai: None. K.James: None. E.Kelty: None. R.L.Azevedo: None. S.Nelson: None. J.L.Garry: None. E.W.Seely: None. C.E.Powe: Consultant; Mediflix, Inc., Other Relationship; Wolters Kluwer Health. Funding Robert Wood Johnson Foundation; National Institutes of Health (5F32DK12634302); Endocrine Fellows Foundation

In vivo assessment of antidiabetic activity and safety of polyherbal teas from selected Cameroonian medicinal plants: Persea americana, Ageratum conyzoides and Mangifera indica

Background: Diabetes mellitus (DM) is a metabolic disorder of the endocrine system which results in persistently high blood glucose levels. Available control measures do not completely cure the disease and most patients in the tropics cannot afford diabetes drugs regularly. Amongst other plants, Mangifera indica (MI), Persea americana (PA), and Ageratum conyzoides (AC) are used individually as traditional medicine by most people for the management of diabetes. This work was set to produce polyherbal teas (water infusion) from these plants and evaluate in vivo antidiabetic activity and safety of the teas. Methods: Three (3) monoherbal teas (MI, PA, AC) and 4 polyherbal of which 3 composed of two plants each (MI+PA, MI+AC, PA+AC) and one including all the plants (MI+PA+AC) were formulated. The antidiabetic activity was assessed by evaluating the hypoglycaemic activity of the teas by carrying out the oral glucose tolerance test (OGTT) in male Wistar albino rats and the subacute antidiabetic assay in streptozotocin-induced diabetic rats. Safety was evaluated using the in vivo acute toxicity test in mouse model. Results: The OGTT revealed a significant drop in post-prandial glucose peak in rats treated with 20mg/kg monoherbal tea from Mangifera indica leaf (MI), as compared to the negative control (distilled water). The polyherbal tea of all three plants (AC+MI+PA) at a dose of 20mg/kg was able to return the glucose levels to normal 30mins after the glucose peak. The tea AC+MI+PA also exhibited a higher antidiabetic activity as it produced a 60% glycemia recovery rate compared to the reference drug glibenclamide and monoherbal tea MI with 40% and 20% recovery rate respectively. Polyherbal tea and MI exhibited hepato-protective and nephron-protective activities. The in vivo acute toxicity test showed that the teas were not toxic as there was no record of mortality and adverse effects in physical appearance, behavior, change in body weight, water, and food intake. Conclusion: Out of the seven teas produced, two showed promising antidiabetic potential, with both acute hypoglycemic effects and significant subacute efficacy. Further investigations are envisaged to pursue the development of improved alternative therapies from these, to address the enduring challenge of diabetes, particularly in resource-limited settings. Keywords: Diabetes mellitus; antidiabetic; activity; polyherbal tea.

A novel purgative mechanism of multiflorin A involves changing intestinal glucose absorption and permeability

BackgroundMultiflorin A (MA) is a potential active ingredient of traditional herbal laxative, Pruni semen, with unusual purgative activity and an unclear mechanism, and inhibiting intestinal glucose absorption is a promising mechanism of novel laxatives. However, this mechanism still lacks support and a description of basic research. PurposeThis study aimed to determine the main contribution of MA to the purgative activity of Pruni semen and elucidate the effect intensity, characteristics, site, and mechanism of MA in mice, and determine the novel mechanism of traditional herbal laxatives from the perspective of intestinal glucose absorption. MethodsWe induced diarrhoea in mice by administering Pruni semen and MA, and the defecation behaviour, glucose tolerance, and intestinal metabolism were analysed. The effects of MA and its metabolite on peristalsis of the intestinal smooth muscle were evaluated using an intestinal motility assay in vitro. Intestinal tight junction proteins, aquaporins, and glucose transporters expression were analysed using immunofluorescence; gut microbiota and faecal metabolites were analysed using 16S rRNA and liquid chromatography-mass spectrometry. ResultsMA administration (20 mg/kg) induced watery diarrhoea in over half of the experimental mice. The activity of MA in lowering peak postprandial glucose levels was synchronous with purgative action, with the acetyl group being the active moiety. MA was metabolised primarily in the small intestine, where it decreased sodium-glucose cotransporter-1, occludin, and claudin1 expression, then inhibited glucose absorption, resulting in a hyperosmotic environment. MA also increased the aquaporin3 expression to promote water secretion. Unabsorbed glucose reshapes the gut microbiota and their metabolism in the large intestine and the increasing gas and organic acid promoted defecation. After recovery, the intestinal permeability and glucose absorption function returned, and the abundance of probiotics such as Bifidobacterium increased. ConclusionThe purgative mechanism of MA involves inhibiting glucose absorption, altering permeability and water channels to promote water secretion in the small intestine, and regulating gut microbiota metabolism in the large intestine. This study is the first systematic experimental study on the purgative effect of MA. Our findings provide new insight into the study of novel purgative mechanisms.

Glycaemia in low-premixed insulin analogue type 2 diabetes patients in a real-world setting: are the CGM targets met?

BackgroundThere are insufficient data on continuous glucose monitoring (CGM) in nonintensive insulin therapy patients. Using CGM and the recommended CGM targets, we wanted to evaluate low-premix insulin analogue therapy (biphasic aspart/NovoMix 30 and biphasic lispro 25/Humalog Mix 25) in real-world type 2 diabetes patients for glycaemic efficacy and especially hypoglycaemia.MethodsThe prospective observational study was performed on 35 patients who were treated with a low-premixed insulin. We used the Dexcom G6 system for CGM (9.6 ± 1 days) to measure the clinically relevant CGM parameters: glycaemic variability (%CV), TBR (time below range) < 3.0 mmol/l = 54 mg/dl (level 2 hypoglycaemia), TBR 3.0–3.8 (= 54–69 mg/dl), TIR (time in range) 3.9–10–0 mmol/l (70–180 mg/dl), TAR (time above range) 10–13.9 mmol/l (180–250 mg/dl) and TAR > 13.9 mmol/l (250 mg/dl). We also assessed clinical and demographic characteristics, laboratory HbA1c, fasting blood glucose, peak postprandial glucose values, and the percentage of hypoglycaemia between 00:00 and 06:00.ResultsIn our patients, the average ± SD age was 70.4 ± 9.2 years, diabetes duration 17.4 ± 7.1 years, 51% were females, average daily insulin dose was 46.4 units (80% received biphasic aspart). The average ± SD TIR was 62.1 ± 12.2%, TBR < 3.0 mmol/l 0.8 ± 2.0%, TBR 3.0–3.8 mmol/l 1.5 ± 1.5%, TAR 10–13.9 mmol/l 29.2 ± 12.4%, TAR > 13.9 mmol/l 6.4 ± 7.2% and %CV 29.9 ± 7.1%. The average time in hypoglycemia was 33.1 min daily in our patients (11.5 min in the level 2 range). In the older/high-risk population, the TBR/TIR/TAR/level 2 TAR targets were met in 40/80/77/80%, respectively. For the general T2D people, level 2 TBR/TBR/TIR/TAR/level 2 TAR would be met in 74/83/34/77/49%. Average fasting blood glucose was 8.0 ± 2.5 mmol/l (144 ± 45 mg/dl), BMI 31.3 ± 5.1 kg/m2, daily insulin dose 46.4 ± 12.1 units, HbA1c 57.4 ± 5.4 mmol/mol (7.4 ± 0.7%). The glycaemic variability goal was met in 80% (with 66% meeting the lower 33% CV goal). 17 ± 12% of hypoglycaemia was nocturnal. People with TBR > 4% were significantly older.ConclusionsMost of our type 2 diabetes patients, treated with low-premixed insulin, did not meet the recommended TBR target for older/high-risk patients while meeting the TIR and TAR targets. Nevertheless, the time spent in (total and nocturnal) hypoglycemia was short. The study indicates that the general type 2 diabetes population targets would mostly be met for TBR and %CV in our patients but not the TIR and TAR targets. CGM appears to be a useful clinical tool in these patients.

Effects of accumulated versus continuous individualized exercise on postprandial glycemia in young adults with obesity

ABSTRACT Background: Elevated postprandial glucose (PPG) is an independent risk factor for cardiovascular disease. Post-meal exercise effectively reduces PPG concentrations. However, the effect of accumulated versus continuous post-meal exercise on PPG control remains unclear. This study aimed to investigate the effects of individualized accumulated or continuous exercise on PPG in young adults with obesity. Twenty young adults with obesity (11 males) completed three 4-h randomized crossover trials with 6–14-day washout periods: (1) sitting (SIT), (2) one 30-min walking bout (CONT), and (3) three 10-min walking bouts separated by 20-min resting (ACCU). Walking was initiated 20 min before individual PPG peak after breakfast, which was predetermined by continuous glucose monitoring. Blood samples were collected at 15–30 min intervals, and the 24-h glucose was monitored via continuous glucose monitoring. Results: The 4-h PPG incremental area under the curve (iAUC) was 12.1%±30.9% and 21.5%±21.5% smaller after CONT (P = 0.022) and ACCU (P < 0.001), respectively, than after SIT. PPG concentrations were lower during CONT at 30–60 min and during ACCU at 30–105 min after breakfast than during SIT (all P < 0.05). The 4-h plasma insulin and C-peptide iAUC, and mean amplitude of glycemic excursions were lower after CONT and ACCU than after SIT (all P < 0.05). Conclusions: Both continuous and accumulated exercises reduced PPG, insulin, and C-peptide concentrations and improved glucose fluctuations. Accumulated exercise maintained lower PPG concentrations for a longer time than continuous exercise in young adults with obesity. Clinical Trial Information: Clinical trial registration No. ChiCTR 2000035064, URL: http://www.chictr.org.cn/showproj.aspx?proj=56584; (registered July 29, 2020).

Incorporation of okra (Abelmoschus esculentus (L.) Moench) seed powder into fresh rice noodles with tapioca starch improves postprandial glycemia, insulinemia and satiety in healthy human volunteers

This study investigates freeze-dried okra seed flour (OSF) as a functional ingredient to attenuate postprandial blood glucose rise by creating lower glycemic index (GI) rice noodles. Secondary objectives are postprandial gut hormone responses, noodle satiety, and sensory evaluation. Twenty healthy individuals consumed control rice noodle (CON), 10 % okra seed fortified noodle (OKN), 20 % OKN and glucose reference drinks on separate visits. 20 % OKN significantly lowered the postprandial glucose and insulin peaks compared to CON. Compared to CON, there was a 20-point reduction of GI value for 20 % OKN to 64. All noodles produced similar responses in postprandial ghrelin and glucagon-like peptide-1 (GLP-1). OKN were found to be more satiating than control noodles given the same amount of available carbohydrates. Sensory evaluation revealed that OSF can be added to noodle to create sensorially acceptable products, though ratings for sensory characteristics decreased with increased fortification.

Continuous Glucose Monitoring System Profile of Women Stratified Using Different Levels of Glycated Hemoglobin (HbA1c) in Early Pregnancy: A Cross-sectional Study.

To evaluate the differences in the continuous glucose monitoring system (CGMS) profiles of women in early pregnancy stratified based on different HbA1c levels known to be predictive of gestational diabetes mellitus (GDM) at 24-28weeks of gestation (≥ 5.2%) and adverse pregnancy outcomes (≥ 5.5%) in Indian women. We enrolled women at 8+ 0 to 19+ 6weeks of gestation (early pregnancy), evaluated the glycaemic parameters of clinical interest using CGMS, and reported them per standard methodologyproposed by Hernandez et al. WHO 2013 criteria were used for diagnosis of early GDM. Ninety-six women were enrolled at 14.0 ± 3.2weeks of gestation. Of these, 38 were found to have early GDM (diagnosed before 20weeks of gestation) on evaluation. Of 96 women, 33 (34.4%) had HbA1c value ≥ 5.5% [11 (19.0%) with normoglycaemia and 22 (57.9%) with GDM]. The women with elevated HbA1c differed significantly from those with HbA1c < 5.5% for all evaluated parameters. The differences for overall women were > 10mg/dl (0.56mmol/l) for 1-h postprandial glucose (difference of 0.78mmol/l), 2-h postprandial glucose (difference of 0.59mmol/l), peak postprandial glucose (difference of 0.75mmol/l), and 1-h postprandial glucose excursion (difference of 0.59mmol/l). Of 58 women with normoglycaemia, 29 (50.0%) had an HbA1c value ≥ 5.2%. In comparison, in the normoglycaemic group of women with and without HbA1c ≥ 5.2% (known to be predictive of future GDM), the results were significant for 1-h (difference of 0.44mmol/l), 2-h (difference of 0.278mmol/l), and peak postprandial glucose (difference of 0.35mmol/l). The results suggest that women with elevated HbA1c (≥ 5.5%) in early pregnancy significantly differ from those with HbA1c < 5.5% in all glycaemic parameters evaluated in this study, suggesting that HbA1c at this cut-off has a role to play in early pregnancy.

Reduction in Postprandial Peak Glucose With Increased Technosphere Insulin Dosage.

Technosphere Insulin (TI) is an ultra-rapid-acting inhaled insulin. This study assessed the mean peak two-hour postprandial glucose concentration with the initial TI dose (dose 1) calculated per the current label (United State Prescribing Information) compared with a ~2× higher dose (dose 2). Secondary objectives were to evaluate hypoglycemia within the two-hour postprandial period, evaluate change in forced expiratory volume in one second (FEV1) before and after the two-hour postprandial period, and monitor for other adverse events. Twenty patients with diabetes, on basal-bolus insulin therapy, received an initial dose 1 of TI followed by the higher dose 2, one to three days later. Subjects received an identical meal for both visits, and TI doses were administered immediately prior to the meal. The higher dose 2 provided significant reductions in mean postprandial glucose excursion (PPGE) in the two-hour postprandial period starting from 45 minutes (P = .008) to 120 minutes (P < .0001). Mean peak glucose was reduced from 228.6 to 179.3 mg/dL (P < .001) at two hours. Two hypoglycemic events (one level 1, one level 2) were observed in a single subject during the two-hour postprandial period with dose 2. There were no significant changes in FEV1 after either dose of TI. The higher dose 2 reduced PPGE versus the current label recommended dose 1 within the two-hour postprandial timeframe without any new safety concerns. When confirmed with a larger study, this higher TI dosing recommendation may help patients and clinicians minimize immediate postprandial hyperglycemia when titrating TI for prandial glucose control.

Continuous glucose monitoring system profile of women diagnosed as gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups criteria and labeled as normoglycemic by alternate criteria in early pregnancy.

Aims/IntroductionWe aimed to evaluate and compare continuous glucose monitoring system (CGMS)‐based glycemic parameters in women in early pregnancy (<20 weeks of gestation) who were classified as: (i) gestational diabetes mellitus (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), but normoglycemia by alternate (UK National Institute for Health and Care Excellence, Canadian Diabetes Association and Diabetes in Pregnancy Study group of India) criteria; and (ii) normoglycemia by both (IADPSG and alternate) criteria.Material and MethodsIn this cross‐sectional study, eligible women underwent standard 75‐g oral glucose tolerance test, followed by the placement of a CGMS. Glycemia‐related parameters were calculated using the standard approach for CGMS data in pregnancy.ResultsWe enrolled 96 women at 14.0 ± 3.2 weeks of gestation. Of the women diagnosed as GDM by IADPSG criteria, 34.2%, 26.3% and 44.7% were classified as normoglycemic by UK National Institute for Health and Care Excellence, Canadian Diabetes Association and Diabetes in Pregnancy Study group of India criteria, respectively. Mean 1‐h postprandial glucose and time above range were significantly higher in women who were GDM by IADPSG, but normoglycemia by Canadian Diabetes Association criteria, compared with women with normoglycemia using both criteria. Similarly, mean 1‐h postprandial glucose, 2‐h postprandial glucose, peak postprandial glucose, 1‐h postprandial glucose excursion and time above range were significantly higher in women who were not identified as GDM by the UK National Institute for Health and Care Excellence criteria. Finally, women missed by the Diabetes in Pregnancy Study group of India criteria had significantly higher mean 1‐h postprandial glucose, 2‐h postprandial glucose, peak postprandial glucose, postprandial glucose excursion, 24‐h glucose and time above range parameters.ConclusionsMore than one‐quarter of women diagnosed as GDM by IADPSG criteria are not identified by alternate criteria. Such women are significantly different from normoglycemic women in terms of several CGMS‐based glycemic parameters of clinical significance.

A pilot study on the effect of d-allulose on postprandial glucose levels in patients with type 2 diabetes mellitus during Ramadan fasting

BackgroundDuring Ramadan fasting, postprandial hyperglycemia is commonly observed after iftar (break of fast at sunset) meal. d-allulose is a rare sugar and is reported to have several health benefits, including the suppression of increase in postprandial glucose levels. This study investigates whether d-allulose (a C-3 epimer of d-fructose) improves the postprandial glucose in patients with type 2 diabetes mellitus (T2DM) during Ramadan.MethodsThis was a pilot, prospective single-arm study design that was conducted for 10 consecutive days; 5 days of control and 5 days of consumption. The primary outcome was postprandial peak glucose levels. During the consumption period, 8.5 g of d-allulose was consumed by the participants before iftar meal. Postprandial glucose was measured using a continuous glucose monitoring system.ResultsA total of 12 participants completed the study. Significant lower (p < 0.01) postprandial glucose values and the glucose incremental area under the curve (iAUC) were observed from 0 to 180 min during the consumption period compared to the control period. The consumption period demonstrated significantly higher percentages of time in which glucose values were found in the target range (p = 0.0032), and when the glucose levels above the target range were reduced (p = 0.0015).ConclusionsThe supplementation with d-allulose has the potential to improve postprandial hyperglycemia in patients with T2DM after iftar during Ramadan. Further studies are needed to confirm these findings.Trial registration ClinicalTrials.gov NCT05071950. Retrospectively registered, 8 October 2021.

273-OR: Postprandial Dysfunction in Metabolic Associated Fatty Liver Disease (MAFLD)

Metabolic dysfunction in patients with metabolic fatty liver disease (MAFLD) may increase the risk for diabetes development. The liver is essential for the postprandial control of our metabolism and hormonal response, yet most studies focus on fasting conditions. We therefore studied the fasting and postprandial phase in individuals with biopsy-proven nonalcoholic fatty liver disease (NAFLD, (n = 9, mean age 50 y, mean BMI 35 kg/m2, no/mild fibrosis) , cirrhosis (n = 10, age 62 y, BMI 32 kg/m2, CHILD A/B) and healthy controls (n = 10, age 23, BMI 25 kg/m2) , randomized 1:1 to fasting or Nutridrink (Nutricia, 300 kcal) . None of the postprandial patients had type 2 diabetes (T2D) . In the NAFLD/cirrhosis groups, 17/classified as MAFLD. Peripheral blood samples were collected at 0, 15, 45, 60, 90 and 120 minutes. At time point 60, a transjugular liver biopsy and liver vein blood were taken. Levels of glucose, insulin, C-peptide, glucagon, and fibroblast growth factor 21 (FGF21) were measured in peripheral blood, glucagon and FGF21 also in liver vein blood. Postprandial peak glucose and C-peptide was increased in NAFLD and cirrhosis compared with healthy (mean peak glucose (mM) 7, 10, 6; mean peak C-peptide (pM) 2675, 3340, 1689, respectively) . The postprandial incremental AUC for insulin was significantly increased in patients with NAFLD compared to healthy. Patients with NAFLD and cirrhosis had hyperglucagonemia, a phenotype related to prediabetes. FGF21 was increased in NAFLD and cirrhosis and correlated to age (r= .61, P = .001) and fasting glucose (r = .54, P = .006) . Glucagon levels were higher in liver vein compared to peripheral blood, while FGF21 levels were similar in both compartments. In summary, patients with NAFLD and cirrhosis without T2D showed significant metabolic dysfunction after a standardized meal compared to healthy controls. We found impaired glucose tolerance, hyperinsulinemia and hyperglucagonemia in both NAFLD and cirrhosis, suggesting a condition of prediabetes in patients with MAFLD. Disclosure J. Grandt: None. A.H. Jensen: None. M.P. Werge: None. E.B. Rashu: None. A. Junker: None. L. Hobolth: None. C. Mortensen: None. M. Vyberg: None. R. Serizawa: Consultant; Merck Sharp &amp; Dohme Corp. L. Gluud: Advisory Panel; Novo Nordisk. Consultant; Pfizer Inc. Research Support; Alexion Pharmaceuticals, Inc., Gilead Sciences, Inc., Novo Nordisk, Sobi. N.J. Wewer Albrechtsen: Research Support; Mercodia AB, Novo Nordisk, Regeneron Pharmaceuticals Inc. Speaker's Bureau; Merck &amp; Co., Inc., Mercodia AB. Funding Nicolai J. Wewer Albrechtsen was financed by NNF Excellence Emerging Investigator Grant – Endocrinology and Metabolism (Application No. NNF19OC0055001) , EFSD Future Leader Award (NNF21SA0072746) and DFF Sapere Aude.