Postprandial Interstitial Glucose Research Articles

Interventions to reduce sedentary behaviour in adults with type 2 diabetes: A systematic review and meta-analysis.

Treatment and management of Type 2 Diabetes (T2D) includes physical activity, nutrition, and pharmacological management. Recently, the importance of reducing and breaking up sedentary behaviour has become recognized. This review aimed to summarize and synthesize the effectiveness of interventions in reducing and/or breaking up sedentary behaviour and cardiometabolic biomarkers in adults with T2D. A study protocol was preregistered on PROSPERO (CRD42022357281) and a database search (PubMed, EMBASE, Scopus, Web of Science, PsycINFO, SPORTDiscus, CINAHL, and Cochrane Library) was conducted on 16/09/2022 and updated on 03/01/2024. This review followed PRISMA guidelines and study quality was assessed with the Cochrane risk of Bias Tools. Twenty-eight articles were included in the review. The meta-analysis of short-term (Range: 3 hours- 4 days) sedentary behaviour interventions found significant improvement in continuous interstitial glucose measured for 24 hours after the sedentary behaviour intervention compared to control (SMD:-0.819,95%CI:-1.255,-0.383,p<0.001). Similarly, there was a significant improvement in postprandial interstitial glucose after the sedentary behaviour intervention compared to control (SMD:-0.347,95%CI:-0.584,-0.110,p = 0.004). Ten out of eleven longer-term (Range: 5 weeks- 3 years) sedentary behaviour interventions improved at least one measure of sedentary behaviour compared to control. Eight out of eight longer-term sedentary behaviour interventions improved at least one cardiometabolic biomarker compared to control. Reducing sedentary behaviour, independent of physical activity, can improve glycemic control in adults with T2D. Further, sedentary behaviour may be a feasible/ sustainable behaviour change.

Effects of a therapeutic weight loss diet on weight loss and metabolic health in overweight and obese dogs.

Obesity has become a major health issue in dogs. Obesity in dogs increases the risk of many chronic diseases and chronic low-grade inflammation. The objective of this study was to determine the effect of a therapeutic weight loss (TWL) diet on weight loss and metabolic health in overweight and obese dogs. Thirty overweight and obese dogs were randomized into two groups with 15 dogs per group based on key baseline (BSL) parameters and allotted to either a control or TWL diet for 6 mo. At the start of the study, the control group had six females and nine males with mean age of 9.12 ± 0.48 (mean ± SEM) yr; there were seven females and eight males with mean age of 9.73 ± 0.63 yr in the TWL group. The control group and the TWL group had comparable body weight (34.78 ± 0.76 and 34.63 ± 0.86 kg, respectively), % body fat (BF; 39.77 ± 1.18 and 39.89 ± 0.93, respectively), and body condition score (BCS; 7.80 ± 0.14 and 7.67 ± 0.16 on a 9-point BCS scale, respectively). The control (CTRL) diet was formulated based on the macronutrient ratio of a commercial metabolic diet, and the TWL diet was enriched with dietary protein, fish oil, and soy germ meal. Both diets were fortified with essential nutrients to account for caloric restriction during weight loss. Dogs were fed with 25% less than BSL maintenance energy requirement (MER) for the first 4 mo and if they did not reach a BCS of 5, they were fed 40% less than BSL MER for the last 2 mo. Body composition was determined by dual-energy x-ray absorptiometry. Postprandial glucose profiles were determined by continuous glucose monitoring devices. Serum samples were collected for analyses of blood parameters, hormones, and cytokines. All data were analyzed using SAS 9.3, with significance being P < 0.05. At the end of the study, the control group and the TWL group had comparable weight loss (-5.77 ± 0.31 and -6.14 ± 0.32 kg, respectively; P = 0.4080). But the TWL group lost significantly (P = 0.034) more BF (-13.27 ± 1.28%) than the control group (-9.90 ± 1.23%). In addition, the TWL diet completely prevented loss of lean body mass (LBM) in dogs compared with BSL. Dogs fed with the TWL diet had significantly lower fasting serum cholesterol, triglycerides, insulin, leptin, mean postprandial interstitial glucose, and pro-inflammatory cytokines compared with dogs fed with the CTRL diet. In summary, the TWL diet prevented loss of LBM, promoted weight loss and metabolic health, and reduced pro-inflammatory cytokines and chemokines in overweight and obese dogs during weight loss.

Short-term removal of exercise impairs glycemic control in older adults: A randomized trial.

Postprandial glycemia (PPG) predicts cardiovascular disease, and short-term physical inactivity increases PPG in young, active adults. Whether this occurs in older, active adults who may be more prone to bouts of inactivity is unknown. This study determined if postprandial interstitial glucose (PPIG) was impaired in active older adults following the removal of exercise for 3 days (NOEX) compared to active young adults. In this randomized, crossover study, 11 older (69.1 ± 1.9 years) and 9 young (32.8 ± 1.8 years) habitually active (≥90 min/week of exercise) adults completed 3-days of NOEX and 3-days of normal habitual exercise (EX), separated by ≥1week. Diet was standardized across phases. Glycemic control (3-day average) was assessed via continuous glucose monitoring during both phases. Significant main effects of age and phase were detected (p < 0.05), but no interaction was found for steps/day (p > 0.05) (old EX: 6283 ± 607, old NOEX: 2380 ± 382 and young EX: 8798 ± 623, young NOEX: 4075 ± 516 steps/day). Significant main effects of age (p=0.002) and time (p < 0.001) existed for 1-h PPIG, but no effect of phase or interactions was found (p > 0.05). Significant main effects (p < 0.05) of age (old: 114 ± 1mg/dl, young: 106 ± 1mg/dl), phase (NOEX: 112 ± 1mg/dl, EX: 108 ± 1mg/dl), and time (0min: 100 ± 2, 30 min: 118 ± 2, 60 min: 116 ± 2, 90 min: 111 ± 2, 120 min: 108 ± 2mg/dl) in 2-h PPIG were detected, but no interaction was found (p > 0.05). However, only significant main effects of phase (NOEX: 14 ± 1 and EX:12 ± 1, p > 0.05) were found for 24-h blood glucose standard deviation. Older adults appear to have impaired glycemic control compared to young adults and exercise removal impairs glycemic control in both populations. Yet, the impairment in glycemic control with exercise removal is not different between old and young adults.

733-P: Postprandial Glucose Variability in People with Type 1 Diabetes Is Individual and Impacted by Physiological and Clinical Parameters

Aim: To assess whether postprandial glucose responses (PPGRs) are individual in people with type 1 diabetes (T1DM) and influenced by personal physiological and clinical parameters. Methods: We assessed physiological and clinical parameters of one-hundred and twenty individuals with type 1 diabetes (mean±SD: Age 31±7years, BMI 26.9±2.3kg.m2, HbA1c 7.6±0.8% [55.8±8.2mmol/moL]) and captured postprandial interstitial glucose responses via continuous glucose monitoring (CGM) in response to two carbohydrate-based standardised meals (shredded wheat [SW] or millet oat-porridge [OP]), twice, on four separate occasions. Each meal was matched for energy, fibre, and macronutrient composition, glycaemic index (GI), and insulin administration. Results: Despite identical energy, fibre, and macronutrient content, GI, and prandial insulin administration, the average PPGR differed significantly between OP and SW, respectively (IG AUC: 1807±588 vs. 1678±533 mmol.L.min-1; p=0.05). PPGRs to each meal type showed a high degree of reproducibility within individuals (OP r=0.994, p&amp;lt;0.001 vs. SW r=0.987 p&amp;lt;0.001), but large interpersonal variation within each meal type (CV%: OP 32.5% vs. SW 31.7%). Higher PPGR was positively associated with PPGR variability (r=0.698, p&amp;lt;0.001), HbA1c (r=0.223, p=0.014), BMI (r=0.316, p&amp;lt;0.001), and age (r=0.277, p&amp;lt;0.001). Conclusions: Using a total of 19,200 glucose measurements, we show that PPGR in individuals with type 1 diabetes is interpersonal and influenced by BMI, age, and HbA1c. We show that identification of personal characteristics is a promising means for designing effective nutritional interventions to predict and control glycaemic responses to food in this population. Disclosure C.F.B. Dingena: None. A. Marsh: None. R. Ajjan: Advisory Panel; Self; Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk Inc., Takeda Pharmaceutical Company Limited. Other Relationship; Self; Abbott. M. Campbell: None.

Effect of Lupin-Enriched Biscuits as Substitute Mid-Meal Snacks on Post-Prandial Interstitial Glucose Excursions in Post-Surgical Hospital Patients with Type 2 Diabetes.

Hospital biscuit snacks offered to Type 2 Diabetes Mellitus (T2DM) patients may adversely affect glycaemic control. This study investigated the effect of lupin mid-meal biscuit snacks, compared to spelt or standard hospital biscuits, on interstitial glucose levels in post-operative T2DM inpatients. In a pilot cross-over pragmatic study, 20 patients (74 ± 12 years) consumed, in order, lupin biscuits (20% lupin), wholemeal spelt and standard plain sweet biscuits as mid-meal snacks (2 biscuits each for morning and afternoon tea) on three consecutive days. Continuous glucose monitoring, appetite perceptions and bowel motions were recorded. Glucose levels were not significantly different in the first 90 min after mid-meal biscuit consumption at morning and afternoon tea, irrespective of type. However, after consuming the lupin biscuits only, glucose levels were significantly (p < 0.001) reduced 90 min postprandially after dinner, indicating a potential second-meal effect. Patients also reported improved satiety after lupin biscuit consumption on day 1, compared to days 2 and 3 (p = 0.018). These findings suggest that lupin-enriched biscuits may improve both glycaemic control and satiety in hospitalised T2DM patients, potentially contributing to reduced length of stay. Larger controlled studies are warranted to confirm these findings and inform potential revision of hospital menu standards for T2DM patients.

Differences in the effects of Kenyan, Tanzanian, and Ethiopian coffee intake on interstitial glucose levels measured by FreeStyle Libre: A pilot case study

BackgroundAlthough generally considered part of a healthy diet, coffee consumption has been suspected to be associated with elevated epinephrine levels and increasing insulin resistance.ObjectivesWe studied the effects of the intake of 3 different types of coffee (Tanzanian, Ethiopian, and Kenyan) on postprandial interstitial glucose levels.MethodInterstitial glucose levels were measured every 15 minutes using the FreeStyle Libre glucose monitoring system (Abbott Diabetes Care Ltd, Witney, United Kingdom) in each individual after drinking coffee compared with when not consuming coffee.ResultsUnlike Tanzanian and Ethiopian coffees, Kenyan coffee suppressed the increase of postprandial interstitial glucose levels. Kenyan coffee beans contain less anhydrous caffeine and more chlorogenic acid than Tanzanian and Ethiopian coffee beans. These findings may explain the different effects of these coffee types on postprandial interstitial glucose levels. Furthermore, Kenyan coffee beans inhibited α-glucosidase activity, which may partially explain why Kenyan coffee reduces postprandial interstitial glucose levels.ConclusionsCoffee is widely consumed as a beverage worldwide, and our findings suggest that patients with diabetes mellitus may benefit from drinking Kenyan coffee because of its ability to reduce postprandial interstitial glucose levels. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)

Chickpea processing does not impact postprandial glycaemic response

Chickpeas are low glycaemic index foods with delayed digestion and reduced postprandial glycaemic responses (PPGR)(1). However, in vitro studies suggest that mechanical processing of chickpeas, that result in cell wall disruption, significantly increase both the rate and extent of starch digestion(2). There is little evidence on the impact of processing on the acute glycaemic response elicited after chickpea intake in vivo(3). Therefore, the aim of this study was to determine the effect of mechanical processing on PPGR in humans. Thirteen healthy adults (4 males and 9 females) with mean (±SD) age 28.7 ± 6.6 years and, BMI 23.2 ± 2.5 kg/m2, attended 4 separate laboratory visits following an overnight fast. Participants were randomly allocated to consume a meal made of three different physical forms of chickpeas: whole chickpeas (CW), pureed chickpeas (CP), and pasta made of chickpea flour (CF); and control instant mashed potatoes (CT). All meals were matched for carbohydrate (50g) and fat (8g) content. Baseline and postprandial interstitial glucose responses were captured by continuous glucose monitoring (FreeStyle Libre pro) for a total of 24 hours. Here we report the acute postprandial responses during a 180 min observation window. Incremental area under the curve (iAUC) was calculated by the trapezoidal method, and data analysed using repeated measures ANOVA with post hoc tests using Bonferroni correction. Data are presented as mean (±SD) and statistical significance was set at p < 0.05. All participants had significantly lower PPGR in response to each chickpea meal as demonstrated by iAUC values (180 min period) which were significantly higher for CT visit (146.7 ± 63.5 mmol.min/L) compared to CW (62.2 ± 67.9 mmol.min/L), CF (59.6 ± 45.2 mmol.min/L), and CP (45.7 ± 45.4 mmol.min/L) with (p < 0.001) identified by ANOVA. Similarly, incremental peak postprandial glucose (after 45 min) was highest in CT (2.0 ± 1.3 mmol/L) in comparison to CF (0.8 ± 1.0 mmol/L), CW (0.6 ± 1.1 mmol/L), and CP (0.5 ± 0.4 mmol/L) with (p = 0.008). Due to high individual variations following chickpea product consumption, no differences between different processing methods could be established. These results suggest that the postprandial glycaemic response to chickpeas is not impacted by mechanical processing. This may relate to higher protein content and presence of dietary fibre.

Immediate post-breakfast physical activity improves interstitial postprandial glycemia: a comparison of different activity-meal timings

The optimal timing between meal ingestion and simple physical activity for improving blood glucose control is unknown. This study compared the effects of physical activity on postprandial interstitial glucose responses when the activity was conducted either immediately before, immediately after, or 30 min after breakfast. Forty-eight adults were randomized to three separate physical activity interventions: standing still (for 30 min), walking (for 30 min), and bodyweight exercises (3 sets of 10 squats, 10 push-ups, 10 lunges, 10 sit-ups). In each intervention, 16 participants completed four trials (A to D) during which a 500 kcal mixed nutrient liquid breakfast meal was consumed. Interstitial glucose responses were recorded using continuous glucose monitoring for 2 h after the meal. The activity was completed either after the glucose monitoring period (trial A; control) or immediately before (trial B), immediately after (trial C), or 30 min after (trial D) the breakfast. Mean, coefficient of variance (CV), and area under the curve (AUC) for glucose were calculated and compared between the four trials. Walking and bodyweight exercises immediately after the meal improved mean, CV, and AUC glucose (P ≤ 0.05 vs. control), while standing immediately after the meal only improved AUC glucose (P ≤ 0.05 vs. control) and nearly improved mean glucose (P = 0.06). Mean, CV, and AUC glucose were not affected by standing, walking, or bodyweight exercise conducted immediately before, or 30 min after the meal (all P > 0.05 vs. control). Energy intake (diet records) and energy expenditure (Actigraph) were consistent throughout the studies and did not influence the findings. Low- to moderate-intensity activity should be implemented soon after eating to improve glucose control following breakfast. The type of activity appears less important than the timing. These findings will help optimize exercise-meal timing in general health guidelines. ClinicalTrials.gov Identifier: NCT03730727

Comparison of Meal Pattern and Postprandial Glucose Response in Duodenal Switch and Gastric Bypass Patients

BackgroundBariatric surgery improves glucose homeostasis; however, side effects such as hypoglycemia can occur. We investigated the effects of meals on interstitial glucose (IG) response in biliopancreatic diversion with duodenal switch (BPD-DS) and Roux-en-Y gastric bypass (RYGBP)-operated patients at least 1 year after surgery.MethodsThirty patients treated with BPD-DS or RYGBP were recruited at the outpatient Obesity Unit, Uppsala University Hospital. IG was measured by continuous glucose monitoring (CGM) for 3 consecutive days, and postprandial IG levels from 5 to 120 min were analyzed for 2 of these days. All intake of food and beverages was simultaneously registered in a food diary, which was processed using The Meal Pattern Questionnaire.ResultsPostprandial IG levels were significantly lower in BPD-DS (n = 14) compared to RYGBP (n = 15)-treated patients, with mean concentrations of 5.0 (± 1.0) and 6.3 (± 1.8) mmol/L respectively (p < 0.001). The mean postprandial IG increment was lower in BPD-DS than in RYGBP patients, 0.2 (± 0.6) vs. 0.4 (± 1.4) mmol/L (p < 0.001). Furthermore, the postprandial IG variability was less pronounced in BPD-DS than in RYGBP patients. The mean number of daily meals did not differ between the two groups, 7.8 (± 2.6) in BPD-DS and 7.2 (± 1.7) in the RYGBP (p = 0.56).ConclusionBPD-DS patients demonstrated lower postprandial IG concentrations, with smaller postprandial IG increments and less pronounced postprandial IG variability compared to RYGBP patients. The two groups had similar meal pattern and the postprandial IG responses is probably associated with differences in postoperative physiology.

Continuous Glucose Monitoring in Patients With or Without Symptoms of Hypoglycemia after Bariatric Surgery

Objective: Hypoglycemia after bariatric surgery is an increasingly recognized metabolic complication. We sought to determine the sensitivity and specificity of a prior hypo-sx survey in detecting post-bariatric surgery hypoglycemia (PBSH) using a continuous glucose monitor (CGM). Methods: Among the patients who underwent bariatric surgery at our institution and completed the hypo-sx survey, we enrolled 13 Roux-en-Y gastric bypass (RYGB, 7 with and 6 without hypo-sx) and 19 sleeve gastrectomy (SG, 9 with and 10 without hypo-sx) patients. Patients wore the CGM (Dexcom, San Diego, CA) for 72-120 hours at home. Hypoglycemia was defined as postprandial interstitial glucose (IG)&amp;lt;54 mg/dl. We used Kruskal Wallis test to compare the difference in hypoglycemia across groups. Results: A total of 19 patients (59%) had hypoglycemia (Table 1), with a mean low glucose of 46.8 mg/dl. Two patients reported hypo-sx. The prevalence of hypoglycemia did not differ by the type of surgery (69% vs. 53%) or the presence of hypo-sx by survey (63% vs. 56%). The survey had a specificity of 53.8% and sensitivity of 52.6% for measured PBSH. Conclusions: Asymptomatic postprandial hypoglycemia was common in post-bariatric patients regardless of surgery type. Assessments that focus on hypoglycemic symptoms may not adequately capture PBSH. Future studies should consider CGM to assess the true prevalence and impact of PBSH. Table 1. Baseline Characteristics and Results from continuous glucose monitoring on post-bariatric surgery patients who were categorized as with or without symptoms of hypoglycemia based on their survey responsesRYGB with Hypo-sx (N=7)RYGB without Hypo-sx (N=6)SG with Hypo-sx (N=9)SG without Hypo-sx (N=10)P ALLP RYGB vs SGP With vs Without Hypo-sxMean Age, years52.9 (5.1)52.0 (10.0)41.9 (11.3)44.8 (11.9)% Female67%56%89%82%% Caucasian71%67%33%60%Time since surgery (years)7.3 (3.2)4.8 (1.3)4.7 (0.7)4.2 (0.8)Percent Patients with Postprandial Hypoglycemia (N)71% (5)67% (4)56% (5)50% (5)Total Average IG (mg/dl, SD)97.0 (6.7)103.5 (12.5)93.0 (8.1)96.9 (6.4)0.3730.2270.228Average Minimum IG (mg/dl, SD)47.7 (10.9)45.8 (9.7)46.4 (5.6)47.0 (9.9)0.8570.7440.429Postprandial Minutes/day IG &amp;lt;54 mg/dl (SD)9.5 (12.7)4.7 (4.9)3.0 (3.9)11.3 (25.1)0.8020.3370.955Abbreviations: SD: standard deviation , RYGB: Roux-en-Y gastric bypass, Hypo-sx: hypoglycemic symptoms, SG: sleeve gastrectomy, IG: interstitial glucose, Postprandial: within 3 hours of eating Disclosure C. Lee: None. T. Brown: Advisory Panel; Self; Merck &amp; Co., Inc. M. Schweitzer: Consultant; Self; Ethicon US, LLC.. T. Magnuson: None. J. Clark: None.

The Acute Effects of Breaking Up Seated Office Work With Standing or Light-Intensity Walking on Interstitial Glucose Concentration: A Randomized Crossover Trial.

The aim of this randomized, 3-period, 3-treatment crossover trial was to examine the acute effects of regularly breaking up seated office work with short bouts of standing or light-intensity walking on postprandial interstitial glucose concentration. Seventeen middle-aged office workers performed 3 5-hour trial conditions at their workplace in a random order: 1) uninterrupted sitting, 2) sitting interrupted by 2 minutes of standing every 20 minutes, and 3) sitting interrupted by 2 minutes of light-intensity walking every 20 minutes. Participants consumed 2 standardized test drinks at the start of each trial condition and an iPro2 continuous glucose monitoring system (CGMS) recorded average interstitial glucose concentration every 5 minutes for the duration of the study. The 5-hour interstitial glucose incremental area under the curve (iAUC) was 55.5% lower after sitting interrupted by light-intensity walking compared with after uninterrupted sitting (95% CI, -104.2% to -6.8%). There was also a suggestion of a beneficial effect of regular standing breaks, particularly in overweight men, although they were not as effective as the walking breaks (mean difference [95% CI], -29.6% [-73.9% to 14.7%]). Regularly breaking up prolonged sitting lowers postprandial glycemia in middle-aged adults without metabolic impairment.

A Fixed Ratio Combination of Insulin Degludec and Liraglutide (IDegLira) Reduces Glycemic Fluctuation and Brings More Patients with Type 2 Diabetes Within Blood Glucose Target Ranges.

Background: Reducing glycemic fluctuation is important for optimal diabetes management. This post hoc analysis examined glycemic fluctuations and the proportion of subjects achieving recommended blood glucose targets with the fixed ratio combination of insulin degludec and liraglutide (IDegLira) compared to insulin degludec (IDeg) and liraglutide alone.Methods: We analyzed nine-point self-monitored blood glucose (SMBG) profiles from two randomized trials involving IDegLira in patients with type 2 diabetes (T2D), and continuous glucose monitoring (CGM) data from a subset of patients in one of these trials to assess glycemic fluctuation and day-to-day variability.Results: Compared with IDeg, IDegLira resulted in a greater proportion of subjects with SMBG values within target ranges (3.9–9.0 mmol/L) than IDeg for all pre- and postprandial values, and for the full nine-point profile (P < 0.05 for all). IDegLira also resulted in a greater reduction in the range of SMBG values over 24 h than IDeg (P ≤ 0.0001). CGM data showed that IDegLira provided greater reductions in interstitial glucose (IG) fluctuation (P = 0.0018) and postprandial IG increment (P = 0.0288) compared with IDeg. Compared with liraglutide, IDegLira brought a higher proportion of subjects within SMBG target ranges (all pre- and all postprandial values, and the full nine-point profile, P < 0.01 for all) and resulted in a greater reduction of time outside the IG target range (P = 0.0072). IDegLira also reduced mean IG more than liraglutide (P < 0.0001).Conclusions: Treatment with IDegLira allows more patients with T2D to maintain blood glucose within target ranges throughout the day than either IDeg or liraglutide alone.

Glucose Profiles in Pregnant Women After a Gastric Bypass : Findings from Continuous Glucose Monitoring.

The diagnosis of gestational diabetes mellitus (GDM) usually requires an oral glucose tolerance test, but this procedure seems inappropriate after gastric bypass surgery (Roux-en-Y gastric bypass (RYGB)) due to specific altered glycemic responses. We aimed here at describing continuous glucose monitoring (CGM) profile of pregnant women after RYGB. CGM was performed in 35 consecutive pregnant women after RYGB at 26.2 ± 5weeks of gestation. After RYGB, pregnant women display high postprandial interstitial glucose (IG) peaks and low IG before and 2h after meals. The postprandial IG peak is reached early, within 54 ± 9min. The maximum IG values reach 205mg/dl, and the percentage of time above 140mg/dl (6.6 ± 7%) is similar to what is described in GDM women. This study is the first to describe CGM profile in pregnant women after RYGB. CGM features are similar to those of non-pregnant post-RYGB patients, characterized by wide and rapid changes in postprandial IG, and high exposure to hyperglycemia. The exposure to hyperglycemia is similar to what is reported in GDM although the time to postprandial peak is shorter. CGM could be an additional useful approach to screen for glucose intolerance during pregnancy after RYGB.

Impact of Carbohydrate Content and Glycemic Load on Postprandial Glucose After Roux-en-Y Gastric Bypass.

Abnormal glucose profiles have been described after Roux-en-Y gastric bypass (RYGB) with intense postprandial hyperglycemic peaks in some but not all the patients. The underlying mechanisms of these anomalies are not totally understood. The aim of this study is to determine whether or not the composition of the meal impacts the existence and maximum interstitial glucose (IG) concentration, measured under real-life conditions. Retrospective cohort. Referral bariatric surgery left. Continuous glucose monitoring (CGM) and meal composition were recorded for at least 3days on an outpatient basis in 56 patients after RYGB. The presence of postprandial peaks defined by IG above 140mg/dl, the maximum postprandial IG, the carbohydrate content, and the glycemic load of the meals were analyzed. Thirty-two patients had a hyperglycemic peak (PEAK), and 24 did not (NO PEAK). The average max IG was 159.6 ± 33.0mg/dl in PEAK individuals and 111.8 ± 13.0mg/dl in NO PEAK. Age was significantly higher in PEAK, but no other parameter was different between the two groups, including meal composition. In the PEAK patients, in multivariate analyses, carbohydrate content in model one and glucose load in model two explained respectively 50 and 26% of maximum IG variance. For each gram of ingested carbohydrates, interstitial glucose increased by 1.68mg/dl. Following a gastric bypass, under real-life conditions, irrespective of the carbohydrate content of the meal, some patients develop postprandial hyperglycemic peaks, whereas others do not. In patients with postprandial hyperglycemic peaks, the maximum IG depends on the carbohydrate content of the meal.

A novel insulin combination of insulin degludec and insulin aspart achieves a more stable overnight glucose profile than insulin glargine: results from continuous glucose monitoring in a proof-of-concept trial.

Insulin degludec coformulated with insulin aspart (as IDegAsp) can cover 24 h basal insulin and postprandial insulin requirements after a main meal with one injection. We compared glycemic stability following IDegAsp or insulin glargine (IGlar) given before the evening meal in patients with type 2 diabetes. A subset of 112 insulin-naïve type 2 diabetes patients from a randomized, parallel-group trial (IDegAsp versus IGlar, each added to metformin) underwent 72 h continuous interstitial glucose (IG) monitoring after 16 weeks of treatment. End points included mean IG concentrations, 2 h postprandial IG increments and postprandial peak, IG fluctuation (summed area above and below mean IG), within-subject coefficient of variation (day-to-day variation) in mean nocturnal IG, and episodes of low (<3.5 mmol/liter) and high (>10 mmol/liter) IG. Values were derived for the entire 72 h, with the nocturnal interval (0001-0559 h) also assessed. The postdinner IG increment observed with IGlar did not occur with IDegAsp [IDegAsp - IGlar, -1.42 (-2.15, -0.70) mmol/liter]. Nocturnal IG fluctuation was 21% lower with IDegAsp [IDegAsp/IGlar, 0.79 (0.66, 0.96) mmol/liter], with 48% fewer nocturnal high IG episodes [ratio IDegAsp/IGlar, 0.52 (0.32, 0.87)]. IDegAsp given with the evening meal reduces postdinner glucose excursion and provides more stable nocturnal glycemia as compared with IGlar.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content (50 grams), but with different types of carbohydrates and variable protein and fat content. Twenty-four healthy volunteers (12 female, 12 male, age 27.1 +/- 3.6 years) participated in the study. Each subject wore two microdialysis devices (SCGM1, Roche Diagnostics) simultaneously. The mean 24-hour interstitial glucose concentration under everyday life conditions was 89.3 +/- 6.2 mg/dl (mean +/- SD, n = 21), and mean interstitial glucose concentrations at daytime and during the night were 93.0 +/- 7.0 and 81.8 +/- 6.3 mg/dl, respectively. The highest postprandial glucose concentrations were observed after breakfast: 132.3 +/- 16.7 mg/dl (range 101-168 mg/dl); peak concentrations after lunch and dinner were 118.2 +/- 13.4 and 123.0 +/- 16.9 mg/dl, respectively. Mean time to peak glucose concentration was between 46 and 50 minutes. After ingestion of standardized meals with fast absorption characteristics, peak interstitial glucose concentrations were 133.2 +/- 14.4 and 137.2 +/- 21.1 mg/dl, respectively. Meals with a higher fiber, protein, and fat content induced a smaller increase and a slower decrease of postprandial glucose concentrations with peak values of 99.2 +/- 10.5 and 122.1 +/- 20.4 mg/dl, respectively. This study provided continuous glucose profiles in nondiabetic subjects and demonstrated that differences in meal composition are reflected in postprandial interstitial glucose concentrations. Regarding the increasing application of continuous glucose monitoring in diabetic patients, these data suggest that detailed information about the ingested meals is important for adequate interpretation of postprandial glucose profiles.