Postprandial Research Articles

Study on glycemic profiles and emotional scales in diabetic patients after the outbreak of COVID-19

Objective: To observe the glycemic profiles and emotion management in diabetic patients after the outbreak of novel coronavirus disease 2019(COVID-19) Methods: A questionnaire survey was used to observe the blood glucose levels and metabolic indexes before and after the outbreak of COVID-19, and to detect emotion ratings after the outbreak of COVID-19 The aim of the study is to present the effects of the COVID-19 on glycemic and emotional management in diabetic patients Results: A total of 136 patients were included in this survey The average age of the patients was 62 5 years old, and the average duration of diabetes was 10 1 years Glycemic profiles(fasting blood glucose, 2 h postprandial blood glucose, HbA1C), lipid profiles(triglycerides, low-density lipoprotein cholesterol), and body weight were not significantly different before and after the outbreak of COVID-19(P>0 05) According to emotional scales(scores of anxiety, depression, and sleep-related scales), 76 5% diabetic patients did not develop anxiety symptoms, 61 0%~69 9% diabetic patients did not have depressive symptoms and 52 0% diabetic patients did not have sleep disorder 19 9% diabetic patients had mild anxiety symptoms, 25 7%~30 9% diabetic patients presented mild depression symptoms and 28 3% diabetic patients had mild sleep disorders 2 9% diabetic patients had moderate anxiety, 2 2%~8 1% diabetic patients had moderate depression and 14 2% diabetic patients had moderate sleep disorder Only a very small part of patients presented severe emotional symptoms including 0 7% patients with anxiety symptoms(GAD-7 15 points and above), 2 2% patients with depressive symptoms(PHQ9 and PHQ15 15 points and above)and 5 6% patients with sleep symptoms(PSQI 15 points and above) Compared with asymptomatic patients, neither patients with mild and moderate/severe depression and sleep disorder showed significant difference in HbA1C, nor did patients with moderate/ severe anxiety symptoms However, patients with mild anxiety symptoms showed significant lower HbA1C than asymptomatic patients Conclusion: After the outbreak of COVID-19, there was an increasing trend in blood glucose, but there was no statistical difference Body weight, lipids profiles were not different in diabetic patients, either Most of diabetic patients had mild symptoms of anxiety, depression and sleep disorders Very few patients presented moderate to severe symptoms of anxiety, depression and sleep disorders Copyright © 2020 by the Chinese Medical Association

The role of intraoperative endoscopic guidance during laparoscopic repair of esophageal achalasia

Purpose The aim was to assess the advantage of using intraoperative endoscopic guidance during laparoscopic repair of esophageal achalasia. Materials and methods This was a retrospective study conducted at Ain Shams Specialized Hospitals that included 84 patients. A total of 42 patients had Heller cardiomyotomy procedure with dor fundoplication and another 42 patients had the same procedure with intraoperative endoscopic guidance. Results Preoperative symptoms included dysphagia in 80 (95%) patients, regurgitation and vomiting in 60 (71.5%) patients, heartburn in 56 (66%) patients, and postprandial chest pain in 40 (49%) patients. Weight loss occurred in 42 (50%) patients. Overall, 72 (85%) patients had tried 2–3 pneumatic dilation. Mean lower esophageal sphincter pressure preoperatively was 33 and was 13.3 mmHg postoperatively (4.1–28.4). The operative time was 45±20 min in the endoscopic group and was 40±10 in the nonendoscopic guidance. Overall, 5 patients of the nonendoscopic group had perforation and one case of bleeding. Postoperatively, dysphagia was seen in one (2.25%) patient of the endoscopic group and four (9.5%) patients of the nonendoscopic group. Postprandial heart pain was seen in two (4.6%) patients of the endoscopic group and four (9.2%) patients of the nonendoscopic group. Moreover, 2 (4.6%) patients of the endoscopic group and four (9.5%) patients of the nonendoscopic group had postoperative regurgitation. Weight regain was seen in 19 (90%) patients of the endoscopic group and 17 (80%) patients of the patients of nonendoscopic group after 12-month follow-up. Conclusion Heller cardiomyotomy with endoscopic guidance is very important not only as a guide to ensure adequate myotomy but also to limit the extent of the myotomy, thereby minimizing the postoperative reflux symptoms.

COMPARISON OF URINE GLUCOSE LEVELS IN DIABETES MELITUS TYPE 2 USING REDUCTION AND OPTICAL DENSITY METHODS IN HOSPITAL. PROF. DR. ALOEI SABOE

Diabetes Mellitus (DM) is a chronic disease that is characterized by blood glucose levels that exceed normal caused by the malfunctioning of the pancreas in producing sufficient insulin (DM type 1) or the body's inability to use insulin that has been produced (DM type 2). When glucose in the blood increases, the sugar will be excreted in urine, this is called glucosuria. Urine glucose testing is a chemical examination and as a screening test for diabetics. Urine glucose testing can be done by several methods including the reduction method and optical density method.
 The purpose of this study was to determine the comparison of urine glucose levels in patients with type 2 diabetes mellitus using the re-duction method and optical density method in hospitals. Prof. Dr. Aloei Saboe. This research is a quantitative study with a pre-experimental design. The sampling technique was purposive sampling that is by setting specific criteria in inclusion and exclusion. 2-hour PP (Postprandial) urine samples from inpatients with type 2 of diabetes mellitus. Each urine sample was tested by two methods, namely the reduction method using Reagent benedict and the optical density method using a urine analyzer. Glucosuria levels of both types of examinations are interpreted semiquantitatively. Then compare the results of the two methods.
 Data were analyzed by paired sample t-test using SPSS (Statistical Packege for Social Science). Paired sample t-Test statistical test showed a significant value of 0,000 with a significance level of 0.05, 0.000 <0.05. So it can be concluded that there are differences in the urine glucose levels of patients with type 2 diabetes using the reduction method and optical density method

Salud familiar y nivel glucémico en mujeres durante el segundo y tercer trimestre de embarazo

<p>Objetivo: analizar la salud familiar y el nivel glucémico en mujeres que cursan el segundo y tercer trimestre de embarazo. <strong>Métodos:</strong> estudio transversal analítico. Participaron 230 gestantes del segundo y tercer trimestre de la Unidad de Medicina Familiar (umf) No. 75 del Instituto Mexicano del Seguro Social (imss), Estado de México. Se evaluó salud familiar en gestación mediante el cuestionario isf:ges-17 y el nivel glucémico mediante la glucosa capilar preprandial. <strong>Resultados:</strong> 45% (n=103) de las participantes mostraron buen nivel glucémico en el tercer trimestre y 22% (n=50) en el segundo trimestre, mientras que el mal nivel glucémico se reportó para el tercer trimestre con 19% (n=44) y en el segundo trimestre con 14% (n=33). Existió una asociación entre la salud familiar saludable y el buen nivel glucémico en 33% de las gestantes. <strong>Conclusiones:</strong> existió asociación entre salud familiar saludable y el buen nivel glucémico. Es importante implementar medidas para un apropiado entorno familiar, empoderando a la gestante en estilos de vida saludable y promoviendo evaluaciones oportunas del nivel glucémico.</p>

The effects of auricular acupressure on postprandial glucose, HbA1c, blood lipids in aged patients with type 2 diabetes mellitus

The effects of auricular acupressure on postprandial glucose, HbA1c, blood lipids in aged patients with type 2 diabetes mellitus

Postprandial Triglyceride-Rich Lipoproteins from Type 2 Diabetic Women Stimulate Platelet Activation Regardless ofthe Fat Source in the Meal.

The aim of this study is to examine whether postprandial (PP) triglyceride-rich lipoproteins (TGRL) secreted after a moderate fat intake would activate platelets differently according to their fatty acid (FA) composition. In a parallel single-blind randomized trial, 30 women with type 2 diabetes are assigned a breakfast containing 20g lipids from butter versus hazelnut-cocoa spread (HCS) rich in palm oil. Blood samples are collected at fasting and 4 h PP. FA composition of fasting and PP TGRL and their effects on the activation of platelets from healthy blood donors are assessed. Both breakfasts similarly increase plasma ApoB-48, plasma, and TGRL triglycerides (p<0.05). TGRL mean diameter increases after both breakfasts and is greater after the butter breakfast. Both breakfasts are rich in palmitic acid, and the HCS breakfast contains 45% oleic acid. TGRL FA composition reflects the dietary FA composition. Pre-incubation of platelets with fasting and PP TGRL increases collagen-stimulated aggregation (p<0.01 vs control). Fasting and PP TGRL similarly increase agonist-induced thromboxane B2 concentrations, and this effect is concentration-dependent for PP TGRL. PP TGRL from type 2 diabetic women after a palm-oil spread versus butter-based mixed meal induce similar acute in vitro platelet activation.

Evaluation of Calorie Content of an All-natural Cane Sugar and Botanical Extract Sweetener: Studies in Wistar Rats

The purpose of the study was to evaluate the caloric content and biochemical effects of an all-natural cane sugar/botanical extract sweetener in comparison to reference glucose in Wistar rats. A total of 24 male Wistar rats aged 6-7 weeks, weighing 148-188 grams, free from disease, and possessing a functional health status were chosen for the study. The animals were divided into four sets and allocated to different treatment groups using a randomized block design. For the study, the test and reference substances were administered orally at approximately one-hour intervals from Day 8 until the end of the treatment period. A greater than 50% reduction (58.7%) of liver adenosine triphosphate (ATP) levels (a proxy for caloric content) was observed for the test item (TI) treatment group compared to the reference glucose group. In the preliminary oral glucose tolerance test (OGTT), treatment with TI at a dose of 5.8 g/kg bodyweight considerably decreased the normal post-prandial rise in serum glucose levels. Other biochemical parameters such as cholesterol, triglycerides, LDL, and VLDL also decreased in the test item high dose group as compared to the normal control (NC). The current study confirms a significant reduction in calories (>50%) and blood glucose levels in Wistar rats when cane sugar is combined with a formulation of botanical extracts. Based on these results, we feel that all-natural TI has potential as a reduced-calorie, low glycemic index (GI) alternative to standard sucrose and can be a valuable dietary aid in the fight against the global obesity epidemic and its associated metabolic disorders.

Uso da Salvia officinalis como agente fitoterápico no controle da Diabetes Mellitus

O presente estudo objetivou realizar uma revisão de literatura a respeito do uso da Salvia officinalis no tratamento da Diabetes Mellitus, tendo em vista a importância do controle glicêmico para a saúde sistêmica e bucal dos portadores dessa doença. A revisão de literatura foi elaborada utilizando as plataformas Google Scholar, PubMed e Scielo como fonte de pesquisa. A partir dos descritores: “Fitoterapia”, “Salvia officinalis” e “Diabetes”, foram selecionados 31 artigos publicados entre 2010 e 2020. A diabetes mellitus, destaca-se como um importante causa de morbidade e mortalidade em todo o mundo. Vários pesquisadores têm investigado os efeitos de Salvia officinalis contra a diabetes, e o seu uso tradicional como antidiabético pode ser justificado pelos metabólicos secundários que estão presentes nas preparações feitas dessa planta. Estudos indicam que S. officinalis pode melhorar o controle glicêmico e perfil lipídico, sendo útil no tratamento de pacientes diabéticos e hiperlipidêmicos. Além disso, não foi relatado nenhum efeito adverso. A Salvia officinalis vem se destacando por sua capacidade de ação hipoglicemiante, através da atividade dos seus diversos constituintes, mostrando-se capaz de reduzir a glicemia em jejum e pós-prandial em vários estudos, além da diminuição da hemoglobina glicosilada, colesterol total, triglicerídeos e LDL, seja isolada ou associada a outros compostos naturais.

A Gluten-Free Meal Produces a Lower Postprandial Thermogenic Response Compared to an Iso-Energetic/Macronutrient Whole Food or Processed Food Meal in Young Women: A Single-Blind Randomized Cross-Over Trial.

Consumption of ultra-processed food (PF) is associated with obesity risk compared with whole food (WF) intake. Less is known regarding the intake of gluten-free (GF) food products. The purpose of this study was to directly compare the thermic effect (TEM), substrate utilization, hunger/taste ratings, and glucose response of three different meals containing PF, WF, and GF food products in young healthy women. Eleven volunteers completed all three iso-caloric/macronutrient test meals in a single-blind, randomized crossover design: (1) whole food meal (WF); (2) processed food meal (PF); or (3) gluten-free meal (GF). TEM was significantly lower following GF compared with WF (−20.94 kcal/meal, [95% CI, −35.92 to −5.96], p = 0.008) and PF (mean difference: −14.94 kcal/meal, [95% CI, −29.92 to 0.04], p = 0.04), respectively. WF consumption resulted in significantly higher feelings of fullness compared to GF (mean difference: +14.36%, [95% CI, 3.41 to 25.32%], p = 0.011) and PF (mean difference: +16.81%, [95% CI, 5.62 to 28.01%], p = 0.004), respectively, and enhanced palatability (taste of meal) compared to PF meal (mean Δ: +27.41%, [95% CI, 5.53 to 49.30%], p = 0.048). No differences existed for substrate utilization and blood glucose response among trials. Consumption of a GF meal lowers postprandial thermogenesis compared to WF and PF meals and fullness ratings compared to a WF meal which may impact weight control and obesity risk over the long-term.

Yagya Therapy Treatment Reduced Blood Glucose Level in Diabetic Patients in 2 weeks - a Single Arm Study

Diabetes is a disease that occurs when blood glucose level is too high. To control blood glucose levels in diabetic patients, modern therapies with a healthy diet and regular physical activity has been a good approach for the management of the diabetes. However, the disease eventually becomes deepen in most of the patients with age, and current approaches are not sufficient, demanding supportive and alternative approaches. The present paper portrays a contextual analysis of the impact of Yagya Therapy on diabetic level (HbA1C) in 2 weeks, using an appropriate herbal formulation on 10 patients, who had been experiencing diabetes since recent years. 10 diabetic patients (5 males and 5 females) on allopathic medicine for past more than 1 year without any change in medication and dose in past 3 months participated in the study. They were given 13 days of Yagya Therapy twice a day and their pre and post blood level of fasting glucose, Post Prandial (PP) glucose, and HbA1C were measured. Among 10 patients only 6 had attended nearly all of the sessions. Among 6 Patient, all of them showed reduction in the HbA1c value. The four of the patients, it was remarkable HbA1c difference i.e. 0.4, 0.4, 0.3, 0.2 respectively indicating impressive results i.e. affecting 3 months glucose sugar average and producing reduction in them with just 26 sessions in 13 days. The present study indicated Yagya therapy as a potential supportive and alternative solution in the management of diabetes. The increase in the time duration of the Yagya Therapy for more than 3-6 months may give the desired results for managing the diabetes.

1363-P: Continuous Glucose Monitoring (CGM) of Postprandial (PP) Glycemic Responses in Pregnancies Complicated by Diabetes

Background: Diabetes in pregnancy portends increased maternal and fetal morbidity and mortality. Glucose testing is advised at 1 or 2 hours Pp. CGM during pregnancy may improve meal-time glycemic monitoring. Limited Pp CGM data exist for gestational diabetes (GDM), type 1 diabetes (T1D), or type 2 diabetes (T2D). Methods: We report prospective Pp glycemic data for 32 pregnant women collected during a 6-hour YSI clinic session for a 10-day Dexcom G6 CGM accuracy trial. Each subject wore 2 sensors. During the session, food consumption was recorded and analyzed if &amp;gt;5g. Meals were not standardized. CGM and YSI Pp responses within 2 hours of meals and carbohydrate content were evaluated. Results: Most women had T1D (n=20) (See table). Subjects consumed 1 (n=6), 2 (n=13) or 3 (n=13) meals for a total 71 meals. Mean carbohydrate intake per meal was 29 ± 19 g (range 6-101). Peak CGM values were recorded for 32 morning and 31 afternoon meals in 2 sensors/subject (n=139 values). Pp CGM values peaked at 136 ± 32 mg/dL (range 78-233) at median 60 minutes (interquartile range: 44, 99). Conclusions: Eating patterns are heterogeneous among pregnant women. These data support 1 hour Pp testing, and CGM use allows more detailed glycemic evaluations around meals. Our YSI results support CGM reliability. Timing of Pp peak glucose levels related to nutrient content in pregnancy needs further evaluation. Disclosure E.V. Nosova: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. T. Johnson: Employee; Self; Dexcom, Inc. S. Shah: Employee; Self; Dexcom, Inc. G. Haroush: None. K. Nelson: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. S.J. Ogyaadu: None. C. Levister: None. S.J. Brackett: None. S. Polsky: None.

Recent clinical advances of glucokinase activators in the treatment of diabetes mellitus type 2.

Glucokinase (GK) is an isozyme of hexokinase that catalyzes the phosphorylation of glucose. GK is present in many organs of the human body, including the liver and pancreas. GK plays an important role in promoting the synthesis of hepatic glycogen and balancing postprandial blood glucose. Mutations in the GK gene can result in the inclusion of maturity-onset diabetes of the young (MODY2) and permanent neonatal Diabetes mellitus (PNDM). Glucokinase activators (GKAs) are a class of type 2 diabetes drugs designed for this target. In various animal models of type 2 diabetes, GKAs have been shown to have the ability to decrease blood glucose, and some GKAs also have the ability to stimulate β cell proliferation. However, due to the induction of hypoglycemia and increased liver burden, many candidates stopped in phase II clinical trials. Recently, dorzagliatin has reached the primary endpoint of phase III clinical trial, which can repair the core function of GK as a blood glucose sensor, and can delay or even reverse islet β -cell damage and functional decline. This provides a promising prospect for the study of GKAs as candidates for the treatment of type 2 diabetes. This review summarizes the clinical advances in GKAs.

2309-PUB: Postprandial Thermogenesis Is Reduced in Obesity

Background and Aims: Postprandial thermogenesis is thought to be important for the control of metabolism. This process could be reflected by minute changes in body temperature after glucose load. In this study, we measured body temperature before and its change during a glucose challenge and investigated the relationships with anthropometric and glycemic traits. Methods: We prospectively studied 383 volunteers (251 females, 132 males) with a mean age of 46.6 (SD ± 16) years and a BMI of 27.9 kg/m2 (SD ± 5.9). All participants underwent a 75 g oral glucose tolerance test (OGTT) and repeated bilateral measurements of intra-auricular temperature at time points 0, 30 and 120 minutes during the OGTT using a tympanic thermometer (Covidien Genius 2). Results: Baseline temperature was 0.17°C lower in males compared to females (p = 0.001) and inversely associated with age (p &amp;lt; 0.0001). During the OGTT, there was a significant increase in body temperature (0.18 ± 0.34°C). This response was present in females and males. BMI was negatively associated with the increase of temperature during the OGTT (p = 0.0147). Participants with higher BMI displayed higher fasting temperatures, but less increase of temperature during the OGTT. Body temperature was not associated with glycemia, insulin sensitivity or insulin secretion, neither in females nor males. Conclusions: There is a robust increase in body temperature during a glucose load that can be captured by intra-auricular temperature measurements. We did not detect any associations of the body temperature with glucose metabolism, arguing against a major contribution of the variability of body temperature in the pathogenesis of diabetes. However, the rise in temperature in response to oral glucose is reduced in obesity and might therefore be involved in body weight regulation. Disclosure A. Vosseler: None. L. Fritsche: None. J. Hummel: None. C. Dannecker: None. N. Stefan: None. A.L. Birkenfeld: None. H. Haering: None. A. Fritsche: None. R. Wagner: Advisory Panel; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Novo Nordisk A/S. Other Relationship; Self; Eli Lilly and Company. M. Heni: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. Speaker’s Bureau; Self; Novo Nordisk A/S. Funding German Federal Ministry of Education and Research (01GI0925)

Randomized Controlled Crossover Dose-Response Trial Shows Low Dose (2 g) Barley β-Glucan Provided in Waffles Lowers Post-Prandial Glycaemic Response In Healthy Adults

Abstract Objectives Barley β-glucan (BG) has reported post-prandial (PP) glycemic response lowering effects. The objective of this study was to ascertain the minimum and most effective dose of BG on PP glucose and insulin response using waffles as the test food. Methods Healthy adults (7 men/17 women) completed a randomized controlled crossover trial at the Asper Research Institute in Winnipeg, MB. Each participant attended five 2.5-hour study visits separated by 3–14 days (average = 7 days). At each visit participants ate waffles containing 30 g available carbohydrates (AC) with varied doses of BG (0, 2, 4, or 6 g). Wheat waffles with low fibre and protein (0g-1) and wheat waffles matched to BG waffles for insoluble dietary fibre and protein (0g-2) were used as controls. The order of treatments was random. Fasting, 15, 30, 45, 60, 90 and 120 minute PP capillary blood samples were collected for analysis of blood glucose and plasma insulin levels. Data were analyzed using analysis of covariance with treatment, participant, visit number and interaction between treatment and visit number included in the model. Differences (P ≤ 0.05) among treatments were determined using least square means adjusted using the Tukey option. Results There was a significant effect of treatment on both glucose and insulin iAUC (P &amp;lt; 0.0001). Glucose iAUC was 31–40% lower after eating 2, 4 and 6 g BG waffles compared to both 0 g waffles. Glucose iAUC was not significantly different between 0 g waffles or among BG waffles. Insulin iAUC was not significantly different between 0 g waffles. Insulin iAUC was 32% lower after eating 2 g BG compared to 0g-1, but not significantly different from 0g-2 waffles. Insulin iAUC was 36–58% lower after eating 4 and 6 g BG compared to both 0 g waffles, and 38% lower after eating 6 g BG compared to 2 g BG waffles. Conclusions The low dose (2 g BG per 30 g AC) provided a physiological benefit (reduction in PP glucose response &amp;gt;20%). Increasing dose to 4 or 6 g BG did not provide additional glucose lowering benefits, but insulin response decreased as BG dose increased. Lack of difference in glucose and insulin iAUC between the two 0 g control waffles (insoluble fibre 1 g vs 8 g; soluble fibre 0 g), but higher PP glycemic responses than BG waffles emphasizes that the type of fibre is key to PP glycemic responses. Funding Sources Agriculture and Agri-Food Canada.

Insights into Manipulating Postprandial Energy Expenditure to Manage Weight Gain in Polycystic Ovary Syndrome.

SummaryWomen with polycystic ovary syndrome (PCOS) are more likely to be obese and have difficulty in losing weight. They demonstrate an obesity-independent deficit in adaptive energy expenditure. We used a clinically realistic preclinical model to investigate the molecular basis for the reduced postprandial thermogenesis (PPT) and develop a therapeutic strategy to normalize this deficit. Sheep exposed to increased androgens before birth develop the clinical features of PCOS. In adulthood they develop obesity and demonstrate an obesity-independent reduction in PPT. This is associated with reduced adipose tissue uncoupling protein expression and adipose tissue noradrenaline concentrations. These sheep are insulin resistant with reduced insulin signaling in the brain. Increasing brain insulin concentrations using intranasal insulin administration increased PPT in PCOS sheep without any effects on blood glucose concentrations. Intranasal insulin administration with food is a potential novel strategy to improve adaptive energy expenditure and normalize the responses to weight loss strategies in women with PCOS.

SUN-692 Comprehensive and Structured Care Program for Patients with Type 2 Diabetes Mellitus: A Preliminary Report from Raipur, Chhattisgarh State of India

Aim: To assess the glycemic outcomes of T2DM patients enrolled in comprehensive structured care program at the outpatient clinic of Apollo Sugar at Raipur, India. Methods: This is a preliminary, prospective, single-center, observational study on T2DM patients from Jan 2018 to December 2018. Uncontrolled diabetes or patients with comorbid conditions with the duration of disease for more than one year and age ≥18 years and who gave consent to enroll in the program were included in the study. The structured care program is a 6 months program where patients were continuously engaged by counseling them on diabetes management- diet and exercise, self-monitoring of blood glucose, health interactions with the remote health coach through a mobile app. Baseline demographics and clinical data were collected at the time of enrollment and were followed up for 6 months. HbA1c reduction is the target measurement of this program. Descriptive statistics were used to analyze and report the data. A paired t-test is used to check the significant reduction in HbA1c from baseline to follow up Results: Total 102 patients were included in this study. Mean (SD) age was 50.7 (10.5) years, males were 78 (76%) and females were 24 (24%). The mean (SD) duration of diabetes and BMI were 7.9 (7.0) years and 27.5 (4.5) kg/m2 respectively. At the time of enrollment, patients were at mean HbA1c of 9.0(2.1)%, fasting (F) and post-prandial (PP) blood (BG) glucose was 194(68) mg/dL and 247(94) mg/dL respectively. Among these patients 38% had neuropathy and 15% had retinopathy as their complications. These patients were regularly followed up over the phone call to counsel on diabetes management with a healthy diet, exercise, self-monitoring of blood glucose, and medication compliance. After 6 months followup the HbA1c, FBG, and PPBG were 7.6 (1.5) %, 139 (50) mg/dL, and 196 (75) mg/dL, respectively with a significant mean reduction of 1.4%, 56 mg/dL, and 51 mg/dL (p <0.001). Further analysis of glycemic outcomes between these patients on oral hypoglycemic agents (OHAs) and OHAs+insulin, the reduction in HbA1c (1.5%) was not significant. Conclusion: Our study demonstrates that a structured care program might bring a clinically significant glycemic control through tight adherence to SMBG, diet, exercise, and medication. To establish these results a study in large sample is in progress.

An Unusual Presentation of Insulinoma: Confusion With Psychiatric Symptoms

Insulinoma is a rare but common functional neuroendocrine tumor that secretes an excess amount of insulin resulting in mostly fasting hypoglycemia but can also cause postprandial hypoglycemia. It usually presents with neuroglycopenic and autonomic sympathetic symptoms that resolve following the administration of dextrose. The patients may remain symptomatic from 1 week to as long as several decades before diagnosis. Insulinoma presenting with psychiatric symptoms has been documented in case/case series reports. Laboratory findings of elevated insulin and C-peptide level in the presence of hypoglycemia and absence of plasma sulfonylurea are suggestive of the diagnosis. Localization of the tumor is essential preoperatively. Surgery usually cures most of the patients, but a minority will have a recurrence especially with malignant insulinoma. The manuscript presents a case of insulinoma presenting with psychiatric symptoms without sympathetic symptoms that led to the delay of the diagnosis for 3 months as initially thought to be related to psychiatric problems. Pancreatic insulinoma was localized by computed tomography (CT) scan and confirmed with endoscopic ultrasound (EUS). The patient underwent successful resection of the tumor, and her symptoms were completely resolved. J Med Cases. 2020;11(5):142-144 doi: https://doi.org/10.14740/jmc3477

Biochemical Parameters in Obese Egyptian Patients as a Non-Invasive Marker for Disease Screening in Early Diagnosis of Non-Alcoholic Fatty Liver Disease

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has recently been considered as the most public liver problem worldwide and a major clinicopathologic health burden in the developed countries. Biochemical tests are important in verifying a better understanding of many diseases and hence help to have the right decisions for achieving better management.&#x0D; AIM: This study was conducted to assess biochemical markers in NAFLD Egyptian patients.&#x0D; METHODS: Forty obese subjects (32 females and 8 males, mean age was 42.32 ± 9.12 years) (20 with NAFLD and 20 without NAFLD) and 20 normal participants were selected.&#x0D; RESULTS: Body mass index (BMI) was 40.86 ± 5.45 in obese FL versus 22.07 ± 2.10 in control, p &lt; 0.001 and versus 35.83 ± 5.94 in obese non-FL, p = 0.003. Alanine aminotransferase (ALT) was 57.30 ± 46.24 in obese FL versus 25.45 ± 7.12 in control, p = 0.003 and versus 27.35 ± 11.09 in obese non-FL, p = 0.005. Aspartate aminotransferase (AST) (41.40 ± 36.09 in obese FL vs. 21.7 ± 3.81 in control, p = 0.015 and vs. 24.05 ± 7.50 in obese non-FL, p = 0.032). Total bilirubin (T.Bil) (0.62 ± 0.25 in obese FL vs. 0.47 ± 0.15 in control, p = 0.014). Prothrombin time (PT) (86.80 ± 11.32 in obese FL vs. 97.86 ± 4.31 in control, p &lt; 0.001) and International Normalization Ratio (INR) (1.11 ± 0.13 in obese FL vs. 1.01 ± 0.02 in control, p = 0.002). Triglycerides (TGs) (128.20 ± 43.49 in obese FL vs. 88.35 ± 24.26 in control, p &lt; 0.001 and vs. 94.50 ± 31.65 in obese non-FL, p = 0.003). Ferritin (88.21 ± 54.88 in obese FL vs. 47.65 ± 32.07 in obese non-FL, p = 0.006). Alpha-fetoprotein (AFP) (2.42 ± 1.67 in obese FL vs. 1.20 ± 0.75 in control, p = 0.001). Fasting blood sugar (FBS) (119.70 ± 49.11 in obese FL vs. 84.10 ± 7.19 in control, p &lt; 0.001 and vs. 80.50 ± 8.84 in obese non-FL, p &lt; 0.001) and postprandial (P.P) (152.80 ± 82.86 in obese FL vs. 94.35 ± 3.70 in control, p &lt; 0.001 and vs. 93.35 ± 7.77 in obese non-FL, p &lt; 0.001). Serum high-density lipoprotein (HDL) level was significantly lower in NAFLD patients compared to obese non-FL (40.05 ± 5.81 vs. 41.9 ± 4.85, p &lt; 0.001).&#x0D; CONCLUSION: NAFLD is associated with changes in biochemical parameters. Its early assessment can help in modifying the disease course and delaying complications.

High or low glycemic index (GI) meals at dinner results in greater postprandial glycemia compared with breakfast: a randomized controlled trial

IntroductionWhile circadian control of glucose metabolism is well known, how glycemic index (GI) of carbohydrate-rich meals interacts with time of consumption (breakfast or dinner) to influence postprandial (PP) glucose homeostasis...

Phenotyping Left Ventricular Obstruction With Postprandial Re-Test Echocardiography in Hypertrophic Cardiomyopathy

Dynamic left ventricular (LV) obstruction has important clinical and therapeutic implications in patients with hypertrophic cardiomyopathy (HC). Although absent at rest, LV obstruction may be elicited using varying stressors. Meal-related hemodynamic changes may favor LV obstruction and support postprandial (PP) symptoms in HC patients. The aim of this study was to evaluate PP-LV obstruction inducibility in HC patients in comparison with fasting Valsalva maneuver and exercise test. Ninety-two HC patients without LV obstruction underwent at-rest Transthoracic Echocardiography (TTE) during Valsalva maneuver and exercise test under fasting condition followed by at-rest re-test PP-TTE 30 to 60 minutes after a standardized midday meal. LV obstruction was noted and classified as being related to systolic anterior motion (SAM) of the mitral valve (SAM-related) and/or non-SAM-related (mid-cavity or apical), and intraventricular gradient was measured. At-rest re-test PP-TTE showed significant intraventricular gradient (>30 mm Hg) in 68 patients (60 SAM-related, 8 non-SAM related, 30 combined) with a higher prevalence (74%) of HC phenotype re-classified as obstructive compared with the fasting Valsalva maneuver (23%) or exercise test (33%) (p < 0.001). At multivariate analysis, a clinical history of PP symptoms and mitral anterior leaflet length and/or LV outflow ratio >2 were independently correlated with PP-TTE obstruction. In conclusion, PP TTE re-test is a simple and effective approach to unmask latent LV dynamic obstruction in daily clinical practice over fasting Valsalva maneuver or exercise test. PP clinical phenotype refinement may be relevant in targeting and evaluating HC therapy.