Preprandial Glucose Research Articles

Pengaruh Progressive Muscle Relaxation terhadap Stres dan Penurunan Kadar Gula Darah pada Pasien Diabetes Melitus Tipe 2

Introduction: Diabetes Mellitus is a disease that occurs because the body is unable to produce insulin or the body cannot use insulin effectively. The purpose of this study was to find out the effect of Progressive Muscle Relaxation (PMR) on stress and blood glucose decrease in patients who have diabetes mellitus type 2 disease.Method: The design of this study is quasi-experimental study. The population of this study were the patients who have type 2 of diabetes mellitus disease at Puskesmas Kedungdoro and Puskesmas Medokan Ayu. There would be 70 respondents chosen based on inclusion and exclusion criteria. The researcher chose the purpose sampling technique in choosing the participants in this research. The independent variable in this study was Progressive Muscle Relaxation (PMR). The dependent variable in this study were stress and blood glucose decrease. The data in this study were collected using questionnaires and measurement of pre-prandial blood glucose level. Data were analyzed using analysis of Wilcoxon and paired t-test for pre-post measurements, then for the inter groups the researcher used Mann-Whitney analysis.Results: The results showed that there was an effect of PMR on stress (p = 0.001) and in decreasing blood glucose (p = 0.021).Discussion: PMR is a relaxation focused on the patient’s attention in distinguishing the group of muscle when they relaxed than while in contraction condition. Thus, the patients are expected to be able to manage the body condition in managing stress and blood sugar decrease. For health officers, they are expected to use the PMR as the combination in reducing stress and blood glucose to improve the quality of life of the patients who have diabetes type 2 disease.

916-P: Comparison of Personal vs. Professional Continuous Glucose Monitoring Related to Calibration

Sensor glucose levels (SGs) after the capillary blood glucose level used to calibrate (BGc) are not influenced by the future BGc in personal continuous glucose monitoring (CGM) (psCGM), but by the future BGc in professional CGM (pfCGM). This leads to a stronger influence of the BGc on SG just after the BGc (SGja) in psCGM than that in pfCGM. Inaccurate SGs or BGc causes dissociation. We investigated the accuracy of psCGM and pfCGM. We cross-sectionally investigated 192 sets including the BGc and SGs before and after the BGc in 12 patients (pts) with type 2 diabetes (96 sets in 6 pts with psCGM (GUARDIAN CONNECT) and pfCGM each). Preprandial and bedtime glucose levels on days 2-5 (of wearing CGM devices) were evaluated in all pts. We calculated the degree of dissociation between the BGc and nearest SGs (DBS) using the following formula: |[(SG just before BGc (SGjb) - BGc) + (SGja - BGc)]/2| = calibration index (CaI) A. We calculated the effect of the BGc on post-SGs (EBpS) using the following formulae: |(SGja - SGjb) - [(SGjb - SG 15 min before SGjb)/3]| = a, |(SGjb - BGc)|/|(SGja - BGc) (if 0, 1)| = b, √(a × b) = CaI B. CaI C was defined as CaI A + CaI B. We defined cases wherein the BGc had dissociation cause potential (CBGc) as both I and II in psCGM group (psCGMg) (I: CaI B > mean in each of two consecutive sets, II: magnitude relation between SGjb and BGc was different between two consecutive sets). CaI B was significantly higher in psCGMg than in pfCGM group (pfCGMg) (p < 0.001), but CaI A and CaI C were not different. CaI A and CaI B were significantly correlated in psCGMg (r = 0.54, p < 0.001), but did not correlate in pfCGMg. High CaI B was significantly associated with high CBGc (p = 0.002). The optimal cutoff value for CBGc in CaI B was 5.5 (sensitivity: 88%, specificity: 85%, area under the curve: 0.87 p < 0.001) in psCGMg. The EBpS was stronger in psCGMg than in pfCGMg, while the DBS was not different. The result of CaI C shows equal accuracy of psCGM to pfCGM in terms of retrospective data. At CaI B > 5.5, recalibration is necessary. Disclosure S. Takeishi: None. H. Tsuboi: None.

2442-PUB: Religion and Religiosity Are Associated with Hyperglycemia in Adults without Diabetes in Northern Israel

Background: Northern Israel is characterized by a multi-ethnic population. We looked for differences in the risk factors for hyperglycemia in Jews, Muslims and Druze without diabetes. Methods: Adult visitors to our Medical Center without known diabetes were included in the study. A point-of-care (POC) capillary blood glucose level with institutional glucometer and a seated blood pressure were measured and additional data were collected from an interview. We excluded people with hypoglycemic drug usage, acute disease, glucocorticoid usage, pregnancy and capillary blood glucose in the diabetes range. The blood glucose levels were divided according to last caloric intake to postprandial (4 hours or less) or pre-prandial (more than 4 hours). Hyperglycemia was defined as pre-prandial blood glucose level ≥100 mg/dl or postprandial glucose level ≥140 mg/dl. High systolic blood pressure was defined as ≥140 mm Hg. Backward stepwise logistic regression was used to identify the factors independently associated with hyperglycemia. Results: A total of 1062 Jews, 419 Muslims and 341 Druze were included in the analysis. 57% of Muslims, 44% of Jews and 34% of Druze reported that they are religious. Compare to Jews, Muslims had increased risk for hyperglycemia (OR 1.73, 95% CI 1.22-2.43, p=0.002) and Druze had no significant difference. After adjusting for sex, high systolic blood pressure and fewer than 12 years of education, age was a significant risk factor for hyperglycemia in all three religions and obesity was an independent risk factor for Druze (OR 2.45, 95% CI 1.28-4.69, p=0.07) and Muslims (OR 2.25, 95% CI 1.31-3.86). Only religious Muslims had an independently lower risk for hyperglycemia than non-religious Muslims (OR 0.5, 95% CI 0.29-0.86, p=0.012). Conclusion: Religion and religiosity are independently associated with hyperglycemia in people without diabetes. Muslims in north Israel have increased risk for hyperglycemia compared to Jews but this risk is lower in religious people. Disclosure A. Bashkin: None. M. Shehadeh: None. R. Yaacovy: None. M. Nodelman: None. A. Zur: None. M. Barhoum: None.

Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes.

There are a number of ways of monitoring blood glucose in women with diabetes during pregnancy, with self-monitoring of blood glucose (SMBG) recommended as a key component of the management plan. No existing systematic reviews consider the benefits/effectiveness of different techniques of blood glucose monitoring on maternal and infant outcomes among pregnant women with pre-existing diabetes. The effectiveness of the various monitoring techniques is unclear. This review is an update of a review that was first published in 2014 and subsequently updated in 2017. To compare techniques of blood glucose monitoring and their impact on maternal and infant outcomes among pregnant women with pre-existing diabetes. For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 November 2018), and reference lists of retrieved studies. Randomised controlled trials (RCTs) and quasi-RCTs comparing techniques of blood glucose monitoring including SMBG, continuous glucose monitoring (CGM), automated telemedicine monitoring or clinic monitoring among pregnant women with pre-existing diabetes mellitus (type 1 or type 2). Trials investigating timing and frequency of monitoring were also eligible for inclusion. RCTs using a cluster-randomised design were eligible for inclusion but none were identified. Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. This review update includes a total of 12 trials (863) women (792 women with type 1 diabetes and 152 women with type 2 diabetes). The trials took place in Europe, the USA and Canada. Three of the 12 included studies are at low risk of bias, eight studies are at moderate risk of bias, and one study is at high risk of bias. Four trials reported that they were provided with the continuous glucose monitors free of charge or at a reduced cost by the manufacturer.Continuous glucose monitoring (CGM) versus intermittent glucose monitoring, (four studies, 609 women)CGM may reduce hypertensive disorders of pregnancy (pre-eclampsia and pregnancy-induced hypertension) (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.85; 2 studies, 384 women; low-quality evidence), although it should be noted that only two of the four relevant studies reported data for this composite outcome. Conversely, this did not translate into a clear reduction for pre-eclampsia (RR 0.65, 95% CI 0.39 to 1.08; 4 studies, 609 women, moderate-quality evidence). There was also no clear reduction in caesarean section (average RR 0.94, 95% CI 0.75 to 1.18; 3 studies, 427 women; I2 = 41%; moderate-quality evidence) or large-for-gestational age (average RR 0.84, 95% CI 0.57 to 1.26; 3 studies, 421 women; I2 = 70%; low-quality evidence) with CGM. There was not enough evidence to assess perinatal mortality (RR 0.82, 95% CI 0.05 to 12.61, 71 infants, 1 study; low-quality evidence), or mortality or morbidity composite (RR 0.80, 95% CI 0.61 to 1.06; 1 study, 200 women) as the evidence was based on single studies of low quality. CGM appears to reduce neonatal hypoglycaemia (RR 0.66, 95% CI 0.48 to 0.93; 3 studies, 428 infants). Neurosensory disability was not reported.Other methods of glucose monitoringFor the following five comparisons, self-monitoring versus a different type of self-monitoring (two studies, 43 women); self-monitoring at home versus hospitalisation (one study, 100 women), pre-prandial versus post-prandial glucose monitoring (one study, 61 women), automated telemedicine monitoring versus conventional system (three studies, 84 women), and constant CGM versus intermittent CGM (one study, 25 women), it is uncertain whether any of the interventions has any impact on any of our GRADE outcomes (hypertensive disorders of pregnancy, caesarean section, large-for-gestational age) because the quality of the evidence was found to be very low. This was due to evidence largely being derived from single trials, with design limitations and limitations with imprecision (wide CIs, small sample sizes, and few events). There was not enough evidence to assess perinatal mortality and neonatal mortality and morbidity composite. Other important outcomes, such as neurosensory disability, were not reported in any of these comparisons. Two new studies (406 women) have been incorporated to one of the comparisons for this update. Although the evidence suggests that CGM in comparison to intermittent glucose monitoring may reduce hypertensive disorders of pregnancy, this did not translate into a clear reduction for pre-eclampsia, and so this result should be viewed with caution. No differences were observed for other primary outcomes for this comparison. The evidence base for the effectiveness of other monitoring techniques analysed in the other five comparisons is weak and based on mainly single studies with very low-quality evidence. Additional evidence from large well-designed randomised trials is required to inform choices of other glucose monitoring techniques and to confirm the effectiveness of CGM.

In a Free-Living Setting, Obesity Is Associated With Greater Food Intake in Response to a Similar Premeal Glucose Nadir.

Changes in blood glucose levels have been shown to influence eating in healthy individuals; however, less is known about effects of glucose on food intake in individuals who are obese (OB). The goal of this study was to determine the predictive effect of circulating glucose levels on eating in free-living OB and normal weight (NW) individuals. Interstitial glucose levels, measured with a continuous glucose monitor (CGM) system, were obtained from 15 OB and 16 NW volunteers (age: 40 ± 14 and 37 ± 12 years; weight: 91 ± 13 and 68 ± 12 kg; hemoglobin A1c: 5.1% ± 0.7% and 5.2% ± 0.4%, respectively). While wearing the CGM, participants filled out a food log (mealtime, hunger rating, and amount of food). Glucose profiles were measured in relation to their meals [macro program (CGM peak and nadir analysis) using Microsoft® Excel]. OB and NW individuals showed comparable CGM glucose levels: mean [OB = 100 ± 8 mg/dL; NW = 99 ± 13 mg/dL; P = nonsignificant (NS)] and SD (OB = 18 ± 5 mg/dL, NW = 18 ± 4 mg/dL; P = NS). Obesity was associated with slower postprandial rate of changing glucose levels (P = 0.04). Preprandial nadir glucose levels predicted hunger and food intake in both groups (P < 0.0001), although hunger was associated with greater food intake in OB individuals than in NW individuals (P = 0.008 for group interaction). Premeal glucose nadir predicted hunger and food intake in a group of free-living, healthy, nondiabetic NW and OB individuals; however for a similar low glucose level stimulus, hunger-induced food intake was greater in OB than NW individuals.

Water-soluble polyphenol-rich clove extract lowers pre- and post-prandial blood glucose levels in healthy and prediabetic volunteers: an open label pilot study

Background/objectivesType 2 diabetes (T2D) is a global pandemic, and contributes significantly to the increasing incidence of conditions such as cardiovascular disease (CVD). Postprandial plasma glucose measured 2-h after the start of a meal is a good indicator of the overall status of glucose homeostasis. Clove (Syzygium aromaticum L.) and its essential oils (eugenol and acetyl eugenol) have been shown in preclinical studies to modulate pathways involved in glucose homeostasis. In addition, a water-soluble polyphenolic extract of unopened clove buds was recently shown to benefit liver function and redox status. Therefore, we conducted an open-label pilot study to test whether this polyphenolic clove extract (PCE) could influence glucose metabolism.MethodsWe evaluated the effect of PCE supplementation (250 mg once daily for 30 days) on preprandial glucose levels and 2-h postprandial glucose levels in 13 otherwise healthy volunteers who were stratified into two groups according to their initial preprandial glucose levels: Group I (n = 7) ≤100 mg/dL, Group II (n = 6) – between 101 and 125 mg/dL. In an effort to elucidate the molecular mechanisms of PCE action, we tested in vitro the effects of PCE on glucose uptake, hepatocyte glucose production, and carbohydrate hydrolyzing enzymes.ResultsAt day 12 of supplementation, we observed statistically significant reductions in mean postprandial glucose levels in both groups [(Group I: Initial - Day 12 PPG = 13.29 mg/dL, 95% CI: 3.329–23.24) (Group II: Initial – Day 12 PPG = 16.67 mg/dL, 95% CI: 4.687–28.65, P = 0.0159)], which continued through study completion at day 30. PCE supplementation significantly decreased mean preprandial glucose levels only in Group II at Days 24 (Initial – Day 24 = 13.00 mg/dL, 95% CI: 1.407–24.59, P = 0.0345) and 30 (Initial – Day 30 = 13.67 mg/dL, 95% CI: 5.766–21.57, P = 0.0067). In cell-based assays, PCE enhanced glucose uptake in L6 myocytes and inhibited hepatocyte glucose production HepG2 cells. In cell-free assays, PCE inhibited α-amylase activity and α-glucosidase activity.ConclusionsThese findings underscore the therapeutic utility of PCE for maintaining healthy glucose metabolism and warrant further larger-scale clinical trials.Trial registrationThis trial was retrospectively registered in the ISRCTN registry on September 29, 2018 (ISRCTN15680985).

SUN-126 Discordantly High Hemoglobin A1c Caused by Hemoglobin Wayne Variant

Background: The Hemoglobin A1c is a commonly test used for the diagnosis of diabetes mellitus. It does not require fasting and can be drawn at any time of day, making it more convenient for providers to use as compared to the fasting plasma glucose and the oral glucose tolerance test. Certain pitfalls exist in the use of its measurement. We present a case of a patient who had a falsely elevated HbA1c as a result of an uncommon hemoglobin variant interfering with the measurement. Clinical Case: A 55-year-old Caucasian male was diagnosed with type 2 diabetes mellitus based on A1c value of 10%. He was started on metformin 500 mg twice daily. He subsequently lost 40 pounds through lifestyle modifications. His blood glucose log showed excellent glycemic control with both fasting and pre-prandial blood glucose values mostly running between 80-120 mg/dL. However, his repeat Hb-A1c was 10.5% and 10% three and eight months later using high performance liquid chromatography (HPLC) method. This did not correlate with his current finger blood glucose level. Therefore, he was referred to our clinic for further management. He did not report any hypoglycemic episodes. There was no history of microvascular or macrovascular complications. Basic metabolic panel showed random blood glucose of 98 and a normal creatinine of 0.9 with GFR of > 60. Liver function tests, fasting lipid and CBC were all within the normal range. Serum folic acid, vitamin B12 level and iron studies were also normal. GAD-65 autoantibody and anti-pancreatic islet cell antibodies were negative. Due to the discrepancy between the A1c and the blood glucose levels, more testing was done including Serum fructosamine level which was 224 (0-285) and Hemoglobin electrophoresis. Hemoglobinopathy panel showed Hb-variant consistent with Hb-Wayne. Pattern and concentrations consistent with heterozygous hemoglobin Wayne. He also had a 7 day Continuous glucose monitoring done which showed a Blood glucose average of 95. Repeat Hb-A1c using baronate affinity method was 5.3%. Conclusion: Hemoglobin A1c is a convenient and reliable test for diagnosis of diabetes mellitus and to monitor the impact of management. However, in patients with hemoglobin Wayne variant, there is an overestimation of A1c because of an amino acid substitution that confers a similar charge to A1c. An increased awareness is needed about different Hemoglobin variants which can affect the A1c result. Alternate methods to assess glycemic control will be needed in these cases.

Frequency of CYP2C9 (*2, *3 and IVS8-109A>T) allelic variants, and their clinical implications, among Mexican patients with diabetes mellitus type 2 undergoing treatment with glibenclamide and metformin.

The majority of Mexican patients with diabetes mellitus type 2 (DMT2) (67.9-85.0%) are prescribed sulphonylureas (SUs), which are metabolized by cytochrome P450 2C9 (abbreviated as CYP2C9). SUs are a type of oral anti-diabetic compound which inhibit ATP-sensitive potassium channels, thus inducing glucose-independent insulin release by the β-pancreatic cells. The wide variability reported in SU responses has been attributed to the polymorphisms of CYP2C9. The present study aimed to describe CYP2C9 polymorphisms (*2, *3 and IVS8-109T) within a sample of Mexican patients with DMT2, while suggesting the potential clinical implications in terms of glibenclamide response variability. From a sample of 248 patients with DMT2 who initially consented to be studied, those ultimately included in the study were treated with glibenclamide (n=11), glibenclamide combined with metformin (n=112) or metformin (n=76), and were subsequently genotyped using a reverse transcription-quantitative polymerase chain reaction (PCR), end-point allelic discrimination and PCR amplifying enzymatic restriction fragment long polymorphism. Clinical data were gathered through medical record revision. The frequencies revealed were as follows: CYP2C9*1/*1, 87.5%; *1/*2, 6.5%; *1/*3, 5.2%; and CYP2C9, IVS8-109A>T, 16.1%. Glibenclamide significantly reduced the level of pre-prandial glucose (P<0.01) and the percentage of glycated hemoglobin (%HbA1c; P<0.01) for IVS8-109A>T compared with combined glibenclamide and metformin treatment. Concerning the various treatments with respect to the different genotypes, the percentages obtained were as follows: Glibenclamide A/A, HbA1c<6.5=33.3%; glibenclamide + metformin A/A, HbA1c<6.5=24.6%; glibenclamide A/T, HbA1c<6.5=33.3%; glibenclamide + metformin A/T, HbA1c<6.5=25%; glibenclamide T/T, HbA1c<6.5=100%; and glibenclamide + metformin T/T, HbA1c<6.5=12.5%. Altogether, these results revealed that, although genetically customized prescriptions remain a desirable goal to increase the chances of therapeutic success, within the studied population neither allelic variants nor dosages demonstrated a clear association with biomarker levels. A key limitation of the present study was the lack of ability to quantify either the plasma concentrations of SU or their metabolites; therefore, further, precise experimental and observational studies are required.

The Effect of Different Amounts of Cinnamon Consumption on Blood Glucose in Healthy Adult Individuals.

Background This study was aimed at investigating the effect of consumption of different amounts of cinnamon on preprandial blood glucose (PrBG), postprandial blood glucose (PoBG), glycosylated hemoglobin (HbA1c), and body mass index (BMI). Methods This study was carried out on 41 healthy adult individuals. The individuals were divided into 3 groups and monitored for 40 days. The first, second, and third groups were given 1 g/day, 3 g/day, and 6 g/day cinnamon, respectively. Before the beginning of the consumption of cinnamon, HbA1c and PrBG blood tests of the individuals were examined on an empty stomach at family practice centers. Two hours after these tests were carried out and breakfast, PoBG tests were performed. Results According to the findings of the study, the differences between the average weight measurements, BMI values, and HbA1c values before consumption on days 20 and 40 were not statistically significant in the individuals consuming 1 g, 3 g, and 6 g of cinnamon a day. The difference between the average PrBG measurements was found to be significant in the individuals consuming 6 g of cinnamon per day. The difference between the average PoBG measurements before consumption on days 20 and 40 was significant in the individuals consuming 1 g, 3 g, and 6 g of cinnamon per day. Conclusions In particular a 3–6 g of cinnamon consumption was found to affect certain blood parameters of individuals positively. Therefore, it is considered to be beneficial to raise awareness of individuals to be conscious to regularly consume cinnamon.

Sustained fasting glucose oxidation and postprandial lipid oxidation associated with reduced insulin dose in type2 diabetes with sodium-glucose cotransporter2 inhibitor: A randomized, open-label, prospective study.

Aims/IntroductionHyperglycemia impairs energy substrate oxidation as a result of glucotoxicity. We examined whether the reduction of plasma glucose using a sodium–glucose cotransporter 2 inhibitor, in inpatient diabetes management, has any effect on: (i) treatment period and basal–bolus dosage of insulin that achieve euglycemia; (ii) fasting/postprandial energy expenditure (EE); and (iii) energy substrate oxidation.Materials and MethodsThis was a randomized, open‐label, 7‐day prospective study. Participants were type 2 diabetes patients with hyperglycemia, aged >20 years, with glycated hemoglobin >10%, daily mean preprandial blood glucose >11 mmol/L (200 mg/dL) and no previous antidiabetic medication. A total of 18 type 2 diabetes patients were randomized (1:1) to basal–bolus insulin titration algorithm (INS) alone or INS + dapagliflozin 5 mg/day (INS/DAPA). The main outcome measures were total daily insulin dose to achieve euglycemia, as well as EE and respiratory quotient during fasting and postprandial states, measured by indirect calorimetry.ResultsThe rate of euglycemia was higher in the INS/DAPA compared with INS group (100 vs 55.6%, P = 0.04), whereas the total daily dose of insulin was 19% lower and was accompanied by a decreased basal–bolus ratio (P = 0.02). Fasting and postprandial EE elevation were similar in both groups. The post‐treatment fasting respiratory quotient significantly increased in the INS/DAPA group (0.72 ± 0.05 vs 0.79 ± 0.08, P = 0.04), and the postprandial respiratory quotient elevation was abolished; the opposite trend was observed in the INS group (P < 0.02).ConclusionsINS/DAPA sustained fasting carbohydrate oxidation, postprandial lipid‐derived EE (failed to increase carbohydrate‐derived EE) and reduced basal insulin requirement might be related to further bodyweight loss.Clinical Trial Registry National University Hospital Medical Information Network UMIN000018997

Non-traditional risk factors for coronary calcification and its progression in patients with type 2 diabetes: The impact of postprandial glycemia and fetuin-A.

ObjectiveThis study was performed to assess the impact of risk factors on the presence and progression of coronary calcification in patients with type 2 diabetes.MethodsWe prospectively enrolled 45 patients without cardiovascular or kidney disease. Coronary calcification was measured with multidetector computed tomography at baseline and 18 months. We also measured blood pressure; body mass index; serum levels of calcium, phosphate, and 25-hydroxyvitamin D; mineral bone density; and levels of alkaline phosphatase, parathormone, fetuin-A, high-sensitivity C-reactive protein, fibrinogen, albumin, homocysteine, lipids, HbA1c, and average preprandial and postprandial blood glucose at 18 months. Information about severe hypoglycemia and smoking was recorded. Spearman’s correlation coefficients were calculated. Multiple linear regression was used for the multivariate analysis.ResultsThe median baseline calcium score was 63, and that at 18 months was 100. In the univariate analysis, albumin was significantly correlated with the baseline calcium score. Fetuin-A and postprandial glycemia were correlated with calcium score progression. In the multivariate model, postprandial glycemia and fetuin-A were independently associated with calcium score progression.ConclusionsFetuin-A and postprandial glycemia influence coronary calcification progression in patients with type 2 diabetes. The absence of some correlations could be due to pharmacological treatments for cardiovascular risk reduction.

Subjective Lowering of Preprandial Blood Glucose and Cancer Prevention by Planning and Recognizing Initial Hunger

We recently described the training of the passage from scheduled to demanded meals in infants and adults. Subjects reduced energy intake by subjectively abolishing conditioned meals and by allowing intake only after demand by the infant or after hunger perception by the adult (Initial Hunger Meal Pattern; IHMP). Conditioned meals were those scheduled and/or presented to the infant as well to the adult by sight, smell, mentioning, gesturing or simply at a fixed mealtime. During IHMP instead, meals were suspended until the first infant’s demand or until an adult’s self-noticing arousal of hunger. IHMP was checked by measuring blood glucose before three meals per day (MBG) and was associated with significant decreases in diary-reported energy-intake, MBG, glycated hemoglobin, body weight, insulin AUC in glucose tolerance tests and in days with diarrhea as compared to randomized control subjects who maintained conditioned meals. Although generalized, conditioned eating is a modern aberration that is associated with development of insulin resistance and overall inflammation. These associations are well demonstrated independently from the implicated mechanism. A state of Overall Subclinical Inflammation greatly increases cell and DNA replications and replication errors. After decades of DNA errors, oncogenic cells arise and cumulate. A prevention of malignancies is possible by interrupting the development of conditioned eating, insulin resistance and associated overall inflammation.

Glycemic variability as a predictor of major adverse cardiac events after percutaneous coronary intervention

Background: The endothelial dysfunction was greater by glucose fluctuation than by chronic hyperglycemia. The glycemic variability (GV) may be an independent risk factor for atherosclerotic coronary artery disease in diabetic patients. The cardiovascular complications are higher following myocardial infarction in diabetic patients than nondiabetic individuals. Aim of the Work: Our aim is to prove that good controlling of acute shooting of blood glucose level up and down will improve the outcome in patient undergoing percutaneous coronary intervention (PCI). Subjects and Methods: GV is evaluated using intraday variability by fasting, preprandial, and postprandial blood glucose levels in 120 patients. Hemoglobin A1c was used to evaluate glycemic control. The relationship between GV and development of major adverse cardiac events (MACE) in patients undergoing PCI is studied. Results: There is a statistically significant difference between the relation of GV and MACE within 1 month after PCI in uncontrolled diabetes compared to controlled group. There is no statistically significant difference found between the two groups regarding age, gender, risk factors (hypertension, smoking and dyslipidemia), and laboratory parameters including triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein. Conclusions: Uncontrolled GV is associated with poor short-term outcome after PCI in controlled diabetic patients compared to nondiabetic individuals undergoing PCI. Greater GV is associated with composite MACE, especially for uncontrolled diabetic patients. After multivariable logistic analysis, GV remains an independent prognostic factor for composite MACE after 3 months in patients undergoing PCI.

Antidiabetic Activity of Sargassum hystrix Extracts in Streptozotocin-Induced Diabetic Rats.

The objective of this research was to determine the potential effects of Sargassum hystrix extracts (SHE) on the glucose levels, lipid profile, and pancreas of streptozotocin (STZ)-induced diabetic rats. SHE at 200, 300, and 400 mg/kg was administered orally to STZ-induced diabetic rats once daily for 15 days. Glucose levels, lipid profile, and weight of rats were measured in the normal state and on the 15th day. The histology of the pancreas was observed on the 15th day. The results showed that the preprandial and postprandial glucose levels in the group treated with SHE at 300 mg/kg were significantly reduced compared with those of the diabetes group. Additionally, the levels of triglycerides and cholesterol in the 300 mg/kg SHE group were significantly different from those in the diabetes group. However, the levels of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol across the treatment groups did not have significant differences. Necrosis was found in all STZ-induced rats. SHE at a dose of 300 mg/kg had the best capability to lower the levels of preprandial and postprandial glucose and to prevent necrosis in diabetic rats.

Comparison of Efficacy and Economic Value of Prandilin 25 and Humalog Mix 25 in Patients with Newly Diagnosed Type 2 Diabetes by a Continuous Glucose Monitoring System.

IntroductionTo determine the clinical efficacy and economic value of insulin lispro 25-Prandilin 25 vs. insulin lispro 25-Humalog mix 25 in treatment of newly diagnosed type 2 diabetes mellitus (T2DM) by a continuous glucose monitoring system (CGMS).MethodsThis was a single-center, randomized, case-crossover clinical trial. Participants were randomly allocated to two groups and underwent two kinds of insulin lispro 25 treatment separated by a 1-day washout period. In total, 81 patients with newly diagnosed T2DM with hemoglobin A1c (HbA1c) above 9% were hospitalized and randomly divided to receive Prandilin 25/Humalog mix 25 or Humalog mix 25/Prandilin 25 treatment. All participants were subjected to metformin therapy simultaneously. Glycemic control was reached after 7–8 days Prandilin 25 or Humalog mix 25 treatment; each patient received continuous glucose monitoring (CGM) for 5 consecutive days (from day 1 to day 5). On day 3 of CGM performance, Prandilin 25 treatment was switched to Humalog mix 25 treatment at the same dosage or vice versa. Parameters representing glycemic variability (GV) and postprandial glucose excursions, including 24-h mean blood glucose (24hMBG), 24-h standard deviation of blood glucose (24hSDBG), 24-h mean amplitude of glycemic excursion (24hMAGE), large amplitude of glycemic excursion (LAGE), incremental area under the curve (AUC) for different glucose levels, and postmeal relative areas under the CGM curve (AUCpp) for 1–4 h of each meal, were calculated for each patient.ResultsNo significant differences were found in the 24hMAGE, 24hMBG, 24hSDBG, LAGE, mean 1-h preprandial blood glucose and the incidence of hypoglycemia between the Prandilin 25 treatment group and Humalog mix 25 treatment group. Similarly, there were no between-treatment differences for AUC and time when blood glucose was below 3.9 mmol/l, between 3.9 mmol/l and 10.0 mmol/l, or above 10.0 mmol/l. Further analysis showed the AUCpp for 1–4 h of each meal for two kinds of treatments were similar. However, the mean estimated cost of Prandilin 25 was only 85% of Humalog mix 25 in one treatment course.ConclusionPrandilin 25 is non-inferior in clinical efficacy compared with Humalog mix 25. In view of the significant difference in the cost of the two kinds of insulin lispro 25, Prandilin 25 is a much more cost-effective anti-diabetes drug for management of T2DM.Trial RegistrationChinese Clinical Trial Register identifier, ChiCTR1800015829.

Crude glycerin in the feed supplementation of lactating goats on pasture

Eight Alpine lactating goats with a body weight of 45.2 ± 7.5 kg and average milk production of 2.3 ± 0.183 kg/day were distributed in a double 4 × 4 Latin square to evaluate the effect of levels of crude glycerin in the feed supplement on the performance and metabolic parameters managed on Panicum maximum cv. Aruana pastures. The supplement consisted of corn grain, soybean meal, crude glycerin (0, 30, 60, and 90 g/kg in the dry matter of the supplement), calcitic limestone, and a mineral mixture. There was no effect of crude glycerin (CG) addition on the intake and apparent digestibility of dry matter and nutritional components, except for the ether extract. The milk fat content increased with the CG levels. The composition of C18:1 n-9, C18:2 n-6 cis, and C18:2 n-6 trans fatty acids in the milk had a quadratic response to CG levels, and the same effect was observed for the omega 3 and omega 6 polyunsaturated acids. Preprandial glucose levels decreased linearly with the addition of CG levels to the supplement, but were reestablished postprandially. The intake and excretion of nitrogen (N) in milk and the proportions of N absorbed and retained by the animal organism were not changed with the addition of CG to their feed supplement. The proportion of retained in relation to ingested N was higher when CG was added. Crude glycerin added to the supplement of lactating goats on pasture improves the N utilization by the animal organism and acts as a source of glucose in the first hours after feeding, in addition to elevating the polyunsaturated fatty acid content of milk. Therefore, this product can be included at up to 90 g/kg in the supplement of lactating goats on pasture.

Sample of Aboriginal Australians, 2-hour post-load insulin concentrations are greatest between fasting plasma glucose values of 6.7-7.3 mmol/l

Background: Prevention of diabetic complications requires good glycaemic control. This study aimed to provide type 2 diabetes patients with remote active care and glycaemic control through the use of videophone technology without the need for them to attend hospital. The literature recommends additional research to study the impact of technical innovations on improved disease self-management and medical outcome. This is the only study to be conducted in Turkey concerning patient monitoring using videophone technology. The aim of the study was to establish the effectiveness of the use of videophone technology in the glycaemic control of patients with diabetes living in remote areas. Methods: This is a prospective, randomized control study using the systematic sampling method (using half ratio), in which 24 patients were chosen for the Experimental Group (EG) and another 24 for the Control Group (CG). All of the patients agreed to participate in the study. Patients in the CG received routine care, while the glycaemic control and consultations for patients in the EG were conducted using videophone technology. The patients were monitored by videophone for a total of 6 months. The HbA1c and blood glucose values recorded over the 6 month monitoring period were analyzed to determine the effectiveness of using a videophone. Results: The mean age of the individuals in the EG was 54.41 ± 8.54 years (Min=43 Max=78) and in the CG it was 57.25 ± 9.61 (Min=40 Max=77). In both groups, 50% of the individuals were men and 50% were women. When the two groups were compared, it was was found that the preprandial blood glucose levels of the diabetic patients in the EG (mean 159.48 ± 40.71mg/dl) were lower by 13.55 ± 52.89 mg / dl than the preprandial blood glucose levels of the diabetic patients in the CG (mean 173.03 ± 65.07 mg/dl). It was determined at the end of the six-month monitoring that the A1c levels of the individuals in the EG were significinatly lowered by 0.49% in total, and that the A1c levels of the individuals in the CG were higher by 0.17 % in total. Conclusions: It was shown that videophone technology can be useful in the glycaemic control of diabetic patients in Turkey.

Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews.

Successful treatments for gestational diabetes mellitus (GDM) have the potential to improve health outcomes for women with GDM and their babies. To provide a comprehensive synthesis of evidence from Cochrane systematic reviews of the benefits and harms associated with interventions for treating GDM on women and their babies. We searched the Cochrane Database of Systematic Reviews (5 January 2018) for reviews of treatment/management for women with GDM. Reviews of pregnant women with pre-existing diabetes were excluded.Two overview authors independently assessed reviews for inclusion, quality (AMSTAR; ROBIS), quality of evidence (GRADE), and extracted data. We included 14 reviews. Of these, 10 provided relevant high-quality and low-risk of bias data (AMSTAR and ROBIS) from 128 randomised controlled trials (RCTs), 27 comparisons, 17,984 women, 16,305 babies, and 1441 children. Evidence ranged from high- to very low-quality (GRADE). Only one effective intervention was found for treating women with GDM.EffectiveLifestyle versus usual careLifestyle intervention versus usual care probably reduces large-for-gestational age (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.50 to 0.71; 6 RCTs, N = 2994; GRADE moderate-quality).PromisingNo evidence for any outcome for any comparison could be classified to this category.Ineffective or possibly harmful Lifestyle versus usual careLifestyle intervention versus usual care probably increases the risk of induction of labour (IOL) suggesting possible harm (average RR 1.20, 95% CI 0.99 to 1.46; 4 RCTs, N = 2699; GRADE moderate-quality).Exercise versus controlExercise intervention versus control for return to pre-pregnancy weight suggested ineffectiveness (body mass index, BMI) MD 0.11 kg/m², 95% CI -1.04 to 1.26; 3 RCTs, N = 254; GRADE moderate-quality).Insulin versus oral therapyInsulin intervention versus oral therapy probably increases the risk of IOL suggesting possible harm (RR 1.3, 95% CI 0.96 to 1.75; 3 RCTs, N = 348; GRADE moderate-quality).Probably ineffective or harmful interventionsInsulin versus oral therapyFor insulin compared to oral therapy there is probably an increased risk of the hypertensive disorders of pregnancy (RR 1.89, 95% CI 1.14 to 3.12; 4 RCTs, N = 1214; GRADE moderate-quality).InconclusiveLifestyle versus usual careThe evidence for childhood adiposity kg/m² (RR 0.91, 95% CI 0.75 to 1.11; 3 RCTs, N = 767; GRADE moderate-quality) and hypoglycaemia was inconclusive (average RR 0.99, 95% CI 0.65 to 1.52; 6 RCTs, N = 3000; GRADE moderate-quality).Exercise versus controlThe evidence for caesarean section (RR 0.86, 95% CI 0.63 to 1.16; 5 RCTs, N = 316; GRADE moderate quality) and perinatal death or serious morbidity composite was inconclusive (RR 0.56, 95% CI 0.12 to 2.61; 2 RCTs, N = 169; GRADE moderate-quality).Insulin versus oral therapyThe evidence for the following outcomes was inconclusive: pre-eclampsia (RR 1.14, 95% CI 0.86 to 1.52; 10 RCTs, N = 2060), caesarean section (RR 1.03, 95% CI 0.93 to 1.14; 17 RCTs, N = 1988), large-for-gestational age (average RR 1.01, 95% CI 0.76 to 1.35; 13 RCTs, N = 2352), and perinatal death or serious morbidity composite (RR 1.03; 95% CI 0.84 to 1.26; 2 RCTs, N = 760). GRADE assessment was moderate-quality for these outcomes.Insulin versus dietThe evidence for perinatal mortality was inconclusive (RR 0.74, 95% CI 0.41 to 1.33; 4 RCTs, N = 1137; GRADE moderate-quality).Insulin versus insulinThe evidence for insulin aspart versus lispro for risk of caesarean section was inconclusive (RR 1.00, 95% CI 0.91 to 1.09; 3 RCTs, N = 410; GRADE moderate quality).No conclusions possibleNo conclusions were possible for: lifestyle versus usual care (perineal trauma, postnatal depression, neonatal adiposity, number of antenatal visits/admissions); diet versus control (pre-eclampsia, caesarean section); myo-inositol versus placebo (hypoglycaemia); metformin versus glibenclamide (hypertensive disorders of pregnancy, pregnancy-induced hypertension, death or serious morbidity composite, insulin versus oral therapy (development of type 2 diabetes); intensive management versus routine care (IOL, large-for-gestational age); post- versus pre-prandial glucose monitoring (large-for-gestational age). The evidence ranged from moderate-, low- and very low-quality. Currently there is insufficient high-quality evidence about the effects on health outcomes of relevance for women with GDM and their babies for many of the comparisons in this overview comparing treatment interventions for women with GDM. Lifestyle changes (including as a minimum healthy eating, physical activity and self-monitoring of blood sugar levels) was the only intervention that showed possible health improvements for women and their babies. Lifestyle interventions may result in fewer babies being large. Conversely, in terms of harms, lifestyle interventions may also increase the number of inductions. Taking insulin was also associated with an increase in hypertensive disorders, when compared to oral therapy. There was very limited information on long-term health and health services costs. Further high-quality research is needed.

Study of the Correlation between Tear Glucose Concentrations and Blood Glucose Concentrations

To achieve intensive glucose control for avoiding diabetic complications, it is necessary for diabetic patients to measure their blood glucose levels frequently. However, all currently available methods for blood glucose monitoring, including the finger prick method, are invasive. One of the possible noninvasive glucose monitoring approaches is tear glucose monitoring. Previous studies have showed the correlations between blood and tear glucose concentrations. But these correlations were not accurate sufficiently because the methods for tear sample collection were not standardized. For clinical development of tear glucose monitoring as a tool for predicting the blood glucose concentrations, we recruited 10 nondiabetic subjects and 20 diabetic subjects, observed the daily blood and tear glucose dynamics using samples collected under the standardized method, and determined the correlation between the blood and tear glucose concentrations. Preprandial blood glucose levels of diabetic subjects were significantly higher than those of nondiabetic subjects (p &amp;lt; 0.001), and preprandial tear glucose levels of diabetic subjects had a higher tendency than those of nondiabetic subjects (p = 0.051). Two hours postprandial blood and tear glucose levels of diabetic subjects were significantly higher than those of nondiabetic subjects (p &amp;lt; 0.001, p &amp;lt; 0.05, respectively). The blood and tear glucose dynamics showed that the behavior of the tear glucose concentrations paralleled that of the blood glucose concentrations. A linear mixed model for diabetic subjects revealed the existence of a significant association between the blood glucose concentrations and tear glucose concentrations (p &amp;lt; 0.001), and the association consisted even after adjusting for HbA1c levels and conditions of meals. In conclusion, tear glucose monitoring would be a tool for predicting the blood glucose levels noninvasively for various diabetic patients. Disclosure M. Aihara: None. N. Kubota: None. T. Kadowaki: Consultant; Self; Novo Nordisk A/S, AstraZeneca, Merck Sharp &amp; Dohme Corp.. Research Support; Self; Kissei Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Sanofi, Kyowa Hakko Kirin Co., Ltd., Novo Nordisk A/S, Astellas Pharma, Daiichi Sankyo Company, Limited, Takeda, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Merck Sharp &amp; Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd.. Speaker's Bureau; Self; Astellas Pharma, AstraZeneca, Merck Sharp &amp; Dohme Corp., Ono Pharmaceutical Co., Ltd., Takeda, Eli Lilly and Company, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk A/S.

Comparison of Ultra-Rapid-Acting Insulin’s Effect—Randomised, Triple Crossover Study

We investigated which ultra-rapid acting insulin (URI) is the most effective in improving glycemic variability (GV)- insulin glulisine (G), insulin lispro (L) or insulin aspart (A). We calculated a required sample size of 12. Thirty type 2 diabetic patients were randomly allocated to 3 groups. On admission, preprandial and bedtime glucose levels (PB)(GL) were stabilized at 80 mg/dL level with URI (before wearing continuous glucose monitoring (FreeStyle Libre Pro) device (FLP); G) and insulin glargine 300 U/ml (G300) during the study period. Group 1: PBGL were stabilized; next, the same dose G was taken, patients wore a FLP and GV was evaluated on days 3 and 4; G was then switched to the same dose L, and GV was evaluated on days 8 and 9; finally, L was switched to the same dose A and GV was evaluated on days 13 and 14. Group 2: URI was taken in the order of L, A, G, following the same regimen. Group 3, URI was taken in the order of A, G, and L, following the same regimen. URI was administered at 08:00, 12:00, 18:00. G300 was administered at 08:00. Data collected on the second evaluation day were analysed. Test meals were given. Increased postprandial (Po) GL, Po glucose gradients, area over the glucose curve (&amp;lt;70 mg/dL) were significantly lower in patients on G, L, A, in that order. Start time of hypoglycemia occurrences (HO) was significantly earlier and finish time of HO was significantly later in patients on A than L. G is the best URI to improve GV. Disclosure S. Takeishi: None. H. Tsuboi: None. S. Takekoshi: None.