Postprandial Glucose Increase Research Articles

Protein-starch interaction plays a key role in controlling starch digestion and postprandial glucose increases for moderately milled quinoa grains

Whole grains were reported to exhibit positive effects on management of T2DM. However, the components of whole grains are complex. To clarify which factor played a key role in reducing starch digestion and postprandial glucose increase, quinoa grains with different milling time (MT-0s, 20s, 40s, 80s) were used. As the MT increased, starch digested ratio in vitro and postprandial glucose in vivo increased. Different factors that contributed to this result were further investigated. For starch itself, damaged starch increased from 6.20% in MT-0s to 9.13% in MT-80s. During in vitro gastrointestinal digestion, a maximum of 13.05 mg/g polyphenols were released from quinoa, which was not able to inhibit the activity of α-amylase and α-glucosidase to decrease starch digestion. Besides, the starch digested ratio increased in MT-0s, 20s and 40s as the amount of added trypsin increased, indicating that protein-starch interaction was important for starch digestion. This was also observed in CLSM images. Spearman correlation analysis confirmed that protein content strongly correlated with starch digested ratio compared with other factors. Our results would provide guidance for food processing industry to produce low GI food products.

Understanding the mechanism of high viscosity food delaying gastric emptying.

Controlling the structure and viscosity of food can influence the development of diet-related diseases. Food viscosity has been linked with health through its impact on human digestion and gastrointestinal transit, however, there is limited understanding of how the viscosity of food regulates gastric emptying. Here, we used model food preparations with different viscosities using guar gum, to explore the mechanism underlying the influence of viscosity on gastric motility, gastric emptying and postprandial blood glucose. Based on experiments in human volunteers and animals, we demonstrated that high viscosity meals increased gastric antrum area and gastric retention rate. Viscosity also affected gut hormone secretion, reduced the gene expression level of interstitial cells of Cajal, resulting in a delay of gastric emptying and limiting the increase in postprandial glucose. This improved mechanistic understanding of food viscosity during gastric digestion is important for designing new foods to benefit human health.

Saturated Fatty Acids Consumed in Smoothies Increase Glucose and Metabolic Load Index in Young Adults Compared to Polyunsaturated Omega-3-Fatty Acids.

Introduction: Chronic diets high in saturated fat (SF) and omega-6-fatty acids (O6FAs) elevate fasting triglycerides (TRGs) and glucose (GLU). Postprandial TRGs, GLU, and Metabolic Load Index (MLI) are better predictors of disease risk compared to fasting levels alone. Conversely, diets high in omega-3 fatty acids (O3FAs) may be cardioprotective. Unfortunately, many existing postprandial studies are not standardized to body weight and given in an amount individuals would typically consume in their daily lives; the MLI is not calculated, and varying types of fat content are not examined. Therefore, we sought to determine whether SF, O3FAs, or O6FAs altered postprandial TRGs, GLU, and MLI from a standardized mixed meal. Methods: Fifteen individuals (6 M and 9 F) visited the laboratory three times, separated by at least 48 h, to consume HFM smoothies with varying FA composition (SF, high O6FAs, and high O3FAs). The smoothies were standardized to 12 kcal/kg body weight, 63% total fat, and 0.72 g/kg sugar. TRGs and GLU were collected at baseline and at 2 h and 4 h postprandially; the MLI was calculated by summing the TRG and GLU responses at each time point. Results: There was a significant increase in TRGs across time points (p < 0.001). For TRGs, there was a trend toward a significant interaction between smoothie type and time (p = 0.06) due to the increase in TRGs in the SF compared to the O3FA smoothie. There was an increase in postprandial GLU that varied across smoothie types (p = 0.036). Taken together, the MLI was elevated in the SF smoothie compared to the O3FAs at 2 h (p = 0.041). Conclusion: A SF smoothie in the morning elevated the metabolic load compared to an O3FA smoothie. Mechanisms of action in the competing clearance of TRGs and GLU warrant further investigation.

PSUN111 Rationale and Design of the Dinner Time 2 Trial: A Randomized, Crossover Trial to Compare the Effects of Delayed Eating vs Delayed Sleeping on Overnight Metabolism in Healthy Volunteers

Abstract Background Obesity and its associated metabolic complications are leading causes of morbidity and mortality worldwide. Recent studies suggest that the timing of meals may be critically important for weight control and metabolic health. Consuming calories later in the day is associated with greater risks of obesity and metabolic syndrome. Interventional diet studies show more weight loss with early, rather than later, eating. Our team conducted a randomized, crossover study ("Dinner Time Study") that compared the metabolic effects of routine dinner (6pm) vs late dinner (10pm) with a fixed sleep period (11pm-7am) in young, healthy adults. We found that late dinner caused an 18% increase in post-prandial glucose and a 10% decrease in dietary fat oxidation. These metabolic consequences in the long term may lead to the development of obesity and type 2 diabetes. However, it remains unclear whether the adverse metabolic effects of late dinner are mediated by circadian misalignment (eating at the "wrong" time relative to the body's central circadian clock) or mediated by sleep (eating too close to bedtime, coinciding with the fall in metabolic rate induced by sleep). To address this question, we aim to examine the metabolic effects of early dinner, late dinner, and late dinner followed by delayed sleep, in healthy adults. Methods Dinner Time 2 Study is a randomized crossover trial with 3 treatment arms with a 3-4-week washout period: (1) early dinner + routine sleep; (2) late dinner + routine sleep; (3) late dinner + late sleep. Dinner times and bedtimes will be customized to each participant's central circadian rhythm (assessed by dim light melatonin onset, DLMO). The primary objectives of this study are to (1) examine the metabolic effects of early dinner (DLMO-3h) vs late dinner (DLMO+1h) with a fixed routine bedtime (DLMO+2h); (2) examine the metabolic effects of routine bedtime (DLMO+2h) vs delayed bedtime (DLMO+6h) with a fixed late dinner time (DLMO+1h). We will examine 24-h profiles of glucose, insulin, free fatty acids, triglycerides, and dietary fat oxidation using serial blood sampling and an ingested stable isotope ([2H31] palmitate) tracer. We aim to recruit 20 healthy adults, age 18-30 years old, with a BMI 18-29.9 kg/m2. Participants who perform night shift work or have any sleep disorders or metabolic diseases including diabetes are ineligible. Each participant will have 4 overnight admissions to our Clinical Research Unit (1 DLMO visit and 3 metabolic visits). A total of 3 participants have successfully completed the protocol since recruitment started in 2021. Conclusion Dinner Time 2 will greatly advance our understanding of the interactions between meal timing, sleep timing, and metabolism, which could inform the design and implementation of future studies that leverage chronobiology to combat diabetes and obesity. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Pathological newborn body weight as predictor of metabolic disorders and reduced exercise tolerance in young female

Background and Aims : Background: Metabolic syndrome (MS) is a claster of metabolic disorders associated with insulin resistance and abdominal obesity, associated with an increased risk of type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). Due to the high prevalence of MS (20-40%), and especially in young people of working age, its early detection has undoubtedly great importance for the timely initiation of prevention of complications (heart attack, stroke, diabetes, etc.). Purpose: assessment of newborn body influence on subsequent metabolic disorders and exercise intolerance in young females during adolescence.Methods: The total number of patients was 92 aged18-21 years. Metabolic syndrome (MS) was diagnosed according to the following "summary" criteria: WHO criteria, 1999 (impaired glucose tolerance), modified WHO criteria (fasting plasma insulin level more than its upper quartile in this population) and IDF criteria (2005, 2009, 2014). Exclusion criteria: active physical activity and/or sports.Results: 48 patients (52.7%) had abnormal body weight at birth: low (<2800 g) - in 23 people (25.3% - group 1); high (>4000 g) - in 25 people (27.5% - group 2). Group 1 showed the highest values of total and LDL cholesterol (p=0.006), group 2 - hypercholesterolemia, hypertriglyceridemia (p=0,05) and hypoalphacholesterolemia (p=0.05). The last had increased basal glycemia (p=0.004), insulin (p=0.05) and C-peptide (p=0.006), while patients of group 1 had an increase in postprandial glucose (p=0.009) and insulin (p=0.05). In patients of group 2 were mentioned cardiac remodeling, reduced exercise tolerance.Conclusions: Abnormal fetal body weight may be a predictor of MS and low exercise tolerance in adolescent females. Background and Aims : Background: Metabolic syndrome (MS) is a claster of metabolic disorders associated with insulin resistance and abdominal obesity, associated with an increased risk of type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). Due to the high prevalence of MS (20-40%), and especially in young people of working age, its early detection has undoubtedly great importance for the timely initiation of prevention of complications (heart attack, stroke, diabetes, etc.). Purpose: assessment of newborn body influence on subsequent metabolic disorders and exercise intolerance in young females during adolescence. Methods: The total number of patients was 92 aged18-21 years. Metabolic syndrome (MS) was diagnosed according to the following "summary" criteria: WHO criteria, 1999 (impaired glucose tolerance), modified WHO criteria (fasting plasma insulin level more than its upper quartile in this population) and IDF criteria (2005, 2009, 2014). Exclusion criteria: active physical activity and/or sports. Results: 48 patients (52.7%) had abnormal body weight at birth: low (<2800 g) - in 23 people (25.3% - group 1); high (>4000 g) - in 25 people (27.5% - group 2). Group 1 showed the highest values of total and LDL cholesterol (p=0.006), group 2 - hypercholesterolemia, hypertriglyceridemia (p=0,05) and hypoalphacholesterolemia (p=0.05). The last had increased basal glycemia (p=0.004), insulin (p=0.05) and C-peptide (p=0.006), while patients of group 1 had an increase in postprandial glucose (p=0.009) and insulin (p=0.05). In patients of group 2 were mentioned cardiac remodeling, reduced exercise tolerance. Conclusions: Abnormal fetal body weight may be a predictor of MS and low exercise tolerance in adolescent females.

A Novel Approach to Maintain Physiological Ketosis During Intermittent Fasting With the Consumption of a Fast BarTM and Coffee or Tea: a Randomized, Controlled Study

ObjectivesIntermittent fasting has gained popularity in promoting health and been proposed to combat metabolic diseases. The study aimed to evaluate the effects of consuming a Fast BarTM (FB) with coffee or tea in extending physiological ketosis associated with time-restricted eating (Clinicaltrial.gov: NCT04790552). MethodsWe conducted the study remotely during the COVID-19 pandemic with healthy adults. Participants were randomized into 4 groups: water-only fast (overnight for 15 hours), FB as a nighttime snack, FB + coffee or FB + tea in the morning. Blood ketone (BHB) and glucose levels were measured hourly for 4 hours (Precision Xtra Blood Ketone & Glucose Monitoring System, Abbott) after consuming study foods. Subjects also completed a satiety and mood survey. Results84 of the 89 enrolled participants completed the study. There was no postprandial glucose increase after consuming the Fast Bar with either black coffee or tea. The mean (SD) BHB AUC0–4 for nighttime FB, FB + coffee, FB + tea, or water-only fast were 1.40 (0.81), 1.22 (0.73), 1.11 (0.45), 1.36 (0.78) mM∙h, respectively. Despite a delay in BHB increase 1 hour after consuming the Fast Bar, the 4-h ketone and glucose AUCs of the Fast Bar groups were similar to those of subjects water-fasted for 19 hours (one-way ANOVA with Dunn’s multiple comparison test). ConclusionsFast BarTM can be used as a nighttime snack, or with coffee or tea in the morning, to extend physiologic fasting state comparable to a 19-h water fasting. Fast BarTM may be used to support intermittent fasting or time-restricted eating pattern while providing satiety. Funding SourcesFully funded by L-Nutra, Inc.

Feruloyl Sucrose Esters: Potent and Selective Inhibitors of α-glucosidase and α-amylase.

Feruloyl Sucrose Esters (FSEs) are a class of Phenylpropanoid Sucrose Esters (PSEs) widely distributed in plants. They were investigated as potential selective Alpha Glucosidase Inhibitors (AGIs) to eliminate the side effects associated with the current commercial AGIs. The latter effectively lowers blood glucose levels in diabetic patients but causes severe gastrointestinal side effects. Systematic structure-activity relationship (SAR) studies using in silico, in vitro and in vivo experiments were used to accomplish this aim. FSEs were evaluated for their in vitro inhibition of starch and oligosaccharide digesting enzymes α-glucosidase and α- amylase followed by in silico docking studies to identify the binding modes. A lead candidate, FSE 12 was investigated in an STZ mouse model. All active FSEs showed desired higher % inhibition of α-glucosidase and desired lower inhibition of α -amylase in comparison to AGI gold standard acarbose. This suggests a greater selectivity of the FSEs towards α -glucosidase than α -amylase, which is proposed to eliminate the gastrointestinal side effects. From the in vitro studies, the position and number of the feruloyl substituents on the sucrose core, the aromatic 'OH' group, and the diisopropylidene bridges were key determinants of the % inhibition of α - glucosidase and α -amylase. In particular, the diisopropylidene bridges are critical for achieving inhibition selectivity. Molecular docking studies of the FSEs corroborates the in vitro results. The molecular docking studies further reveal that the presence of free aromatic 'OH' groups and the substitution at position 3 on the sucrose core are critical for the inhibition of both the enzymes. From the in vitro and molecular docking studies, FSE 12 was selected as a lead candidate for validation in vivo. The oral co-administration of FSE 12 with starch abrogated the increase in post-prandial glucose and significantly reduced blood glucose excursion in STZ-treated mice compared to control (starch only) mice. Our studies reveal the potential of FSEs as selective AGIs for the treatment of diabetes, with a hypothetical reduction of side effects associated with commercial AGIs.

Bound Polyphenols from Red Quinoa Prevailed over Free Polyphenols in Reducing Postprandial Blood Glucose Rises by Inhibiting α-Glucosidase Activity and Starch Digestion.

Inhibiting α-glucosidase activity is important in controlling postprandial hyperglycemia and, thus, helping to manage type-2 diabetes mellitus (T2DM). In the present study, free polyphenols (FPE) and bound polyphenols (BPE) were extracted from red quinoa and their inhibitory effects on α-glucosidase and postprandial glucose, as well as related mechanisms, were investigated. HPLC-MS analysis showed that the components of FPE and BPE were different. FPE was mainly composed of hydroxybenzoic acid and its derivatives, while BPE was mainly composed of ferulic acid and its derivatives. BPE exhibited stronger DPPH and ABTS antioxidant activities, and had a lower IC50 (10.295 mg/mL) value in inhibiting α-glucosidase activity. The inhibition kinetic mode analysis revealed that FPE and BPE inhibited α-glucosidase in a non-competitive mode and an uncompetitive mode, respectively. Furthermore, compared to FPE, BPE delayed starch digestion more effectively. BPE at 50 mg/kg reduced postprandial glucose increases comparably to acarbose at 20 mg/kg in ICR mice. These results could provide perspectives on the potential of BPE from red quinoa, as a functional food, to inhibit α-glucosidase activity, delay postprandial glucose increases and manage T2DM.

The influence of bright and dim light on substrate metabolism, energy expenditure and thermoregulation in insulin-resistant individuals depends on time of day

Aims/hypothesisIn our modern society, artificial light is available around the clock and most people expose themselves to electrical light and light-emissive screens during the dark period of the natural light/dark cycle. Such suboptimal lighting conditions have been associated with adverse metabolic effects, and redesigning indoor lighting conditions to mimic the natural light/dark cycle more closely holds promise to improve metabolic health. Our objective was to compare metabolic responses to lighting conditions that resemble the natural light/dark cycle in contrast to suboptimal lighting in individuals at risk of developing metabolic diseases.MethodsTherefore, we here performed a non-blinded, randomised, controlled, crossover trial in which overweight insulin-resistant volunteers (n = 14) were exposed to two 40 h laboratory sessions with different 24 h lighting protocols while staying in a metabolic chamber under real-life conditions. In the Bright day–Dim evening condition, volunteers were exposed to electric bright light (~1250 lx) during the daytime (08:00–18:00 h) and to dim light (~5 lx) during the evening (18:00–23:00 h). Vice versa, in the Dim day–Bright evening condition, volunteers were exposed to dim light during the daytime and bright light during the evening. Randomisation and allocation to light conditions were carried out by sequential numbering. During both lighting protocols, we performed 24 h indirect calorimetry, and continuous core body and skin temperature measurements, and took frequent blood samples. The primary outcome was plasma glucose focusing on the pre- and postprandial periods of the intervention.ResultsSpending the day in bright light resulted in a greater increase in postprandial triacylglycerol levels following breakfast, but lower glucose levels preceding the dinner meal at 18:00 h, compared with dim light (5.0 ± 0.2 vs 5.2 ± 0.2 mmol/l, n = 13, p=0.02). Dim day–Bright evening reduced the increase in postprandial glucose after dinner compared with Bright day–Dim evening (incremental AUC: 307 ± 55 vs 394 ± 66 mmol/l × min, n = 13, p=0.009). After the Bright day–Dim evening condition the sleeping metabolic rate was identical compared with the baseline night, whereas it dropped after Dim day–Bright evening. Melatonin secretion in the evening was strongly suppressed for Dim day–Bright evening but not for Bright day–Dim evening. Distal skin temperature for Bright day–Dim evening was lower at 18:00 h (28.8 ± 0.3°C vs 29.9 ± 0.4°C, n = 13, p=0.039) and higher at 23:00 h compared with Dim day–Bright evening (30.1 ± 0.3°C vs 28.8 ± 0.3°C, n = 13, p=0.006). Fasting and postprandial plasma insulin levels and the respiratory exchange ratio were not different between the two lighting protocols at any time.Conclusions/interpretationTogether, these findings suggest that the indoor light environment modulates postprandial substrate handling, energy expenditure and thermoregulation of insulin-resistant volunteers in a time-of-day-dependent manner.Trial registrationClinicalTrials.gov NCT03829982.FundingWe acknowledge the financial support from the Netherlands Cardiovascular Research Initiative: an initiative with support from the Dutch Heart Foundation (CVON2014–02 ENERGISE).Graphical abstract

Changes in glycemic variability, gastric emptying and vascular endothelial function after switching from twice-daily to once-weekly exenatide in patients with type 2 diabetes: a subpopulation analysis of the twin-exenatide study

BackgroundWe investigated the changes in blood glucose fluctuation, gastric emptying, and vascular endothelial function by switching from an exenatide twice-daily formulation (BID) to a once-weekly formulation (QW) since the evaluation of postprandial glucose excursion and glycemic variability (GV) by continuous glucose monitoring (CGM) after switching was lacking.MethodsTwenty-nine patients with type 2 diabetes treated with exenatide BID were included in this study and switched to exenatide QW for 24 weeks. GV assessed by CGM, gastric emptying (by 13 C-acetate breath test) and vascular endothelial function (by reactive hyperemia - peripheral arterial tonometry) were evaluated at baseline and 24 weeks after switching.ResultsHbA1c decreased significantly from the baseline to week 24, while postprandial glucose levels after breakfast and dinner significantly increased (both P <0.05). However, the increases in GV indices were modest and not statistically significant at week 24. Vascular endothelial function was also not significantly changed after switching (P >0.05). Gastric emptying was significantly accelerated at week 24 (Tmax 83.4 ± 12.1 min vs. 58.2 ± 16.4 min) (P <0.001) and correlated with increased postprandial glucose levels after breakfast and dinner (both P <0.05).ConclusionsDespite the increase in postprandial glucose associated with accelerated gastric emptying after switching from exenatide BID to QW, change in GV was modest and no significant deterioration in vascular endothelial function was observed after switching. These results support the superiority of treatment with exenatide QW over exenatide BID in clinical practice; however, attention should be paid to the monitoring and management of postprandial glucose levels when selecting exenatide QW.Trial registrationClinical trial registry number; UMIN000016390 and jRCTs031180320.Approval date of Registry and the Registration: December 12, 2014.

Fast Acting Insulin Aspart Compared with Insulin Aspart in the Medtronic 670G Hybrid Closed Loop System in Type 1 Diabetes: An Open Label Crossover Study.

This is a single-center randomized open label active-controlled crossover trial comparing efficacy and safety of fast acting insulin aspart (FA) (FIASP®) versus insulin aspart (IAsp) (NovoLog®) when used in the Medtronic 670G system in auto mode in patients with type 1 diabetes. Forty patients were randomized to either IAsp or FA. Each treatment period was 7 weeks and a standardized meal test was administered 6 weeks after the start of each treatment period. The primary endpoint was postprandial glucose (PPG) increment after the meal test at 1 h. Treatment with FA using the MiniMed 670G hybrid closed loop (HCL) led to a greater reduction in 1-h postprandial glucose increase compared with treatment with IAsp during the standardized mixed meal test. Change in glucose: [estimated treatment difference (ETD ± standard deviation [SD]); 95% confidence interval]: 70.27 (±17.36) mg/dL (3.9 ± 1.0 mmol/L) with FA versus 98.42 (±17.36) mg/dL (5.5 ± 1.0 mmol/L) with IAsp (P = 0.008). Patients spent 1.81% (P = 0.016) more time (equivalent to 26 min per day) in the 70–180 mg/dL (3.89–9.99 mmol/L) range with FA than with IAsp. The entire sample spent only 0.5% of time <54 mg/dL (<3.0 mmol/L) range. The increment in the 1 h postmeal test glucose was significantly lower with FA versus IAsp. FA in a HCL setting is safe and effective with patients spending more time in the 70–180 mg/dL (3.89–9.99 mmol/L) target range than with IAsp.Trial registration: Clinicaltrials.gov identifier: NCT03977727.

Study on the state of knowledge of medical students about the glycemic index of popular food products in Poland. A survey study

Introduction: The glycemic index (GI) is a helpful indicator in composing a healthy diet, especially for people at risk of carbohydrate metabolism disorders. High GI products are quickly digested and absorbed in the human body. There is a sharp increase in postprandial glucose and insulin secretion, followed by a rapid decrease in blood glucose level, which results in increased glucagon secretion and increased appetite. A high GI diet may be one of the causes of insulin resistance and obesity.Aim: The aim of the study is to examine the state of knowledge of medical students studying in Poland about the glycemic index of popular food products.Material and Methods: An anonymous online survey was conducted. The answers of 140 medical students of polish medical universities were analyzed.Results: Despite the fact that 52.1% of respondents declared that they are interested in the subject of healthy eating, milk chocolate and honey were most often recognized as high GI by the respondents (respectively 90.6% and 84,1% of answers). However, these products are classified as low/medium GI products. A baguette with a very high GI obtained 70.3% of responses. Another product with a medium Gi, boiled potatoes, got 56.5% response.Conclusion: The knowledge of medical students about the glycemic index is not large, despite expressed interest in the subject of healthy eating.

Palatable Noodles as a Functional Staple Food Made Exclusively from Yellow Peas Suppressed Rapid Postprandial Glucose Increase.

Legumes are low-carbohydrate food and are abundant in dietary fiber. In order to provide a functional staple food that does not cause a rapid increase in postprandial blood glucose levels, four kinds of legumes were focused on as ingredients. Noodles made from dehulled yellow pea, unshelled yellow pea, chickpea, and lentil were prepared and evaluated as functional staple foods for controlling blood glucose via an in vitro digestion method. We also measured breaking stress and breaking strain using a creep meter, as well as sensory tests on a 9-point hedonic scale. The noodles made from yellow pea had high values for both breaking stress and breaking strain, and was highly regarded in the sensory tests. Therefore, the noodles made from yellow pea on postprandial glucose and insulin response were measured in a randomized double-blind study (n = 12). The results show that noodles made from yellow pea have a low glycemic index (50.4), and have potential as a functional staple food.

Comparison of the Acute Glycemic and Insulinemic Response of Fossence™, a Short Chain Fructo-Oligosaccharide, Taken Alone, Added or Substituted into a Carbohydrate Load

Abstract Objectives To explore the physiological response to ingestion of FossenceTM, a short chain fructo-oligosaccharide, when taken alone or when added or substituted into a carbohydrate load. Methods In a randomized, controlled, cross-over design, 25 healthy subjects completed three phases (phase 1: 13M:12F; 41 ± 14y; 24.4 ± 2.2 kg/m²; phase 2: 13M:12F; 40 ± 14y; 24.5 ± 2.4 kg/m²; phase 3: 13M:12F; 41 ± 14y; 24.3 ± 2.6 kg/m²; Mean ± SD). On separate days, each subject received in Phase 1: 10 g FossenceTM(10FOS), 10 g Dextrose (10Dex) or a water control (Control); Phase 2: 50 g Dextrose alone (50Dex), Dextrose with 15 g FossenceTM(50Dex + 15FOS), 35 g Dextrose alone (35Dex) or Dextrose with 15 g FossenceTM(35Dex + 15FOS); and Phase 3 received: 50 g available carbohydrate (avCHO) from white bread alone (50WB) or with 15 g FossenceTM(50WB + 15FOS), 35 g avCHO from white bread alone (35WB) or with 15 g FossenceTM(35WB + 15FOS). Blood samples were collected at fasting and over 2 hours after the start of the test meal and analyzed for glucose and insulin levels. The primary endpoint was differences in glucose IAUC. (ClinicalTrials.gov: NCT03755232). Results Phase 1: The glucose IAUC was significantly lower after 10FOS and Control compared to 10Dex (P &amp;lt; 0.0001). Similarly, the insulin IAUC was significantly lower after Control and 10FOS compared to 10Dex (P &amp;lt; 0.0001). Phase 2: The glucose IAUC was significantly lower after 35Dex and 35Dex + 15FOS compared to 50Dex (P &amp;lt; 0.0001). Insulin IAUC was significantly lower after 35Dex compared to 50Dex and 50Dex + 15FOS, the IAUC of 35Dex + 15FOS was significantly lower than 50Dex (P &amp;lt; 0.0003). Phase 3: The glucose IAUC was significantly lower after 35WB and 35WB + 15FOS compared to 50WB and 50WB + 15FOS (P &amp;lt; 0.00001). Insulin IAUC was significantly lower after 35WB and 35WB + 15FOS compared to 50WB and 50WB + 15FOS (P &amp;lt; 0.00001). Conclusions These studies demonstrate that FossenceTM, when consumed alone, does not increase postprandial glucose and insulin levels, indicating it is resistant to breakdown. When added to a carbohydrate load, no increase in postprandial glucose or insulin levels is observed while substitution of 30% of glycemic carbohydrate by FossenceTMsignificantly decreased postprandial glucose and insulin levels. FossenceTM, being sweet to taste, may be advised to individuals on restricted sugar intake. Funding Sources Tata Chemicals Ltd, India.

Antidiabetic Activity of Aloe vera Leaves.

This research evaluated the potential of using the methanol extract of Aloe vera (L.) Burm.f (AVM) to prevent the formation of AGEs by means of the BSA/glucose assay, BSA-methylglyoxal assay, arginine-methylglyoxal assay, fructosamine, Nɛ-(carboxymethyl) lysine (CML), thiol groups, and carbonyl protein in vitro. The effect of AVM was also evaluated with regard to inhibiting the enzymes α-amylase, α-glucosidase, and pancreatic lipase. For this, the plant was dried, ground, and subsequently macerated with methanol. Aloe vera methanol extract (AVM) significantly decreased the formation of AGEs, as well as the formation of fructosamine, CML, and carbonyl protein. The concentration of 5 mg/ml of AVM presented the best results. AVM significantly inhibited the α-amylase and α-glucosidase enzymes. As regards the content of thiol groups, a significant increase was observed during the four weeks of the experiment. So, we can conclude that Aloe vera methanol extract decreases the formation of AGEs and may inhibit the increase in postprandial glucose, suggesting that AVM can prevent diabetes complications associated with AGE.

Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study.

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD. Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring over 12 months. Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, N = 1,298] vs. 4.7% [95% CI 3.4-5.9%, N = 1,089], P = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N = 27) or GCD (N = 24). No HbA1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI -0.79 to 1.08; P = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4-2.7; P = 0.014) emerged with a GFD. CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.

Toxicity of agents used for opioid withdrawal: a case-based approach.

Toxicity of agents used for opioid withdrawal: a case-based approach.

Effects of a whole diet approach on metabolic flexibility, insulin sensitivity and postprandial glucose responses in overweight and obese adults - A randomized controlled trial.

Metabolic flexibility is the ability to adapt fuel oxidation to fuel availability. Metabolic inflexibility has been associated with obesity, the metabolic syndrome and insulin resistance, and can be improved by exercise or weight loss. Dietary changes can modulate metabolic flexibility; however, the effect of a whole diet approach on metabolic flexibility has never been studied. Therefore, our objective was to assess the effect of a healthy diet (HD), as compared to a typical Western diet (WD), on several fasting and postprandial markers of metabolic flexibility and insulin sensitivity. In this parallel randomized trial, overweight or obese men and women (50-70 years; BMI 25-35kg/m2) consumed a healthy diet (HD; high in fruits and vegetables, pulses, fibers, nuts, fatty fish, and low in high-glycemic carbohydrates; n=19) or a typical Western diet (WD; n=21) for six weeks, following a two-week run-in period. The change in respiratory quotient upon insulin stimulation (ΔRQ), and insulin sensitivity, expressed as the M-value, were both determined with a hyperinsulinemic euglycemic clamp. Additionally, other fasting and postprandial markers of metabolic flexibility were assessed during a 5-h high-fat high-glycemic mixed meal challenge. ΔRQ (p=0.730) and insulin sensitivity (p=0.802) were not significantly affected by diet. Postprandial RQ did also not show significant differences (p=0.610), whereas postprandial glucose excursions were significantly higher in the HD group at T30 (p=0.014) and T45 (p=0.026) after mixed meal ingestion (p=0.037). Fasting glucose (p=0.530) and HbA1c (p=0.124) remained unchanged, whereas decreases in fasting insulin (p=0.038) and the HOMA-IR (p=0.050) were significantly more pronounced with the HD. A healthy diet for six weeks, without further life-style changes, did not improve metabolic flexibility and whole-body insulin sensitivity, when compared to a Western-style diet. It remains to be determined whether the short time increase in postprandial glucose is physiologically relevant or detrimental to metabolic health. This trial was registered at clinicaltrials.gov as NCT02519127.

Insulin therapy-new insulin analogues

A multitude of short-acting and long-acting insulin analogues are currently available for the treatment of diabetes mellitus, which mimic physiological insulin secretion better than normal insulins. By the use of ultrarapid insulin analogues postprandial glucose increases can be significantly reduced. Newer long-acting insulin analogues have avery stable action profile and reduce the rate of hypoglycemia, especially nocturnal hypoglycemia, even more than first generation long-acting insulin analogues. Future developments focus on a further acceleration of prandial insulin effects with a simultaneous shorter effect time and an even more prolonged action of long-acting insulin analogues.

Rice bran triterpenoids improve postprandial hyperglycemia in healthy male adults: a randomized, double-blind, placebo-controlled study.

BackgroundCompared to white rice, brown rice induces a lower glycemic response in healthy and diabetic humans. This effect is partly attributed to the higher amounts of water- or oil-soluble bran components and dietary fiber in brown rice. We hypothesized that dietary supplementation with oil-soluble rice bran triterpenoids (RBTs; triterpene alcohol and sterol prepared from rice bran) might reduce the incidence of postprandial hyperglycemia in healthy humans.ObjectiveWe examined the acute effects of a single RBT-supplemented meal on the postprandial blood glucose responses of healthy male adults in a double-blind, randomized, placebo-controlled, crossover trial.DesignNineteen subjects consumed a test meal containing either placebo- or RBT-supplemented olive oil. Blood biomarkers were evaluated in a fasting state and up to 240 min postprandially.ResultsCompared to the placebo-supplemented meal, the RBT-supplemented meal significantly suppressed the increase in postprandial blood glucose level. A subclass analysis revealed that RBT-supplemented oil significantly reduced blood glucose increases in subjects with higher postprandial blood glucose elevations. Postprandial increases in blood insulin, glucose-dependent insulinotropic peptide (GIP), and glucagon-like peptide-1 (GLP-1) levels did not differ between the groups.ConclusionThese results suggest that RBT consumption improves postprandial hyperglycemia in healthy humans, especially those with higher postprandial glucose increases.