Glycemic Reduction Research Articles

Participation in Diabefly® digital therapeutics program leads to significant improvement in glycemic control and reduction in weight and BMI among people with T2D

Participation in Diabefly® digital therapeutics program leads to significant improvement in glycemic control and reduction in weight and BMI among people with T2D

Caracterización del uso de tofacitinib como tratamiento para COVID-19

ObjectiveThe main purpose of this study is to characterize and compare the population that received tofacitinib with those that were not treated with the drug for COVID-19 at the Clínica Unión Médica del Norte, in 2020. MethodsAn observational, retrospective, cross-sectional, exploratory, and secondary source study was conducted. A comparison was made between clinical and sociodemographic characteristics, laboratory results and their treatment option. ResultsFive hundred and seven patients admitted to the COVID-19 unit of the Clínica Unión Médica del Norte were included. It was determined that lower death rates were registered in the group that received tofacitinib (6.45%) compared to the group that did not use the drug. Likewise, those receiving this therapy required less mechanical ventilation, however, a higher proportion of these patients were admitted to the Intensive Care Unit. In addition, a greater reduction in glycaemia was identified in the patients receiving tofacitinib, but they had higher levels of ferritin and D-dimer. ConclusionsTofacitinib may be beneficial in terms of mortality rates and reduction in the use of mechanical ventilation. Furthermore, it is promising with respect to positive patient progression. However, our research is not conclusive. Future confirmatory research is needed on the efficacy of tofacitinib therapy for COVID-19 patients.

Blood Pressure and Blood Glucose Responses to Combined Exercise Sessions of Different Intensities in Individuals with Cardiovascular Risk Factors

ABSTRACT Objective The purpose of the present study was to verify the acute effects of blood pressure and blood glucose after two sessions of combined exercise sessions performed at two levels of intensity in trained individuals with cardiovascular risk factors. Methods Eighteen individuals (66.22 ± 8.61 years) of both sexes (6 women/12 men) with cardiovascular risk factors performed two sessions of combined exercises at different levels of intensity: moderate (MOD) and high (HI). To control the intensity of the aerobic training, the Borg Rating of Perceived Exertion (RPE) Scale was used. For the strength training, the maximum number of repetitions was carried out within a predetermined duration of sets. Blood pressure and blood glucose measurements were collected before and 20 minutes after the sessions. The data were analyzed using Generalized Estimating Equations, α 5%. Results Reductions were observed in systolic blood pressure (MOD – Δ = −4.95 mmHg; HI – Δ = −3.31 mmHg) and blood glucose (MOD – Δ = −16.06 mg/dL; HI – Δ = −29.45 mg/dL) after the two sessions, with no difference between sessions. Diastolic blood pressure did not change (p < .05). Conclusion Combined exercises sessions of moderate or high intensity can promote an acute reduction in systolic blood pressure and glycemia in individuals with cardiovascular risk factors.

Continuous Glucose Monitoring-Assisted Insulin Dose Titration in the Indian Outpatient Setting

Context: Monitoring blood glucose levels is an important aspect in the overall management of an individual with diabetes mellitus. Continuous glucose monitoring (CGM) system is an effective tool that enables physicians to do so by way of regular automated checks of sensor glucose (SG). Aims: In this article, we discuss in detail on how CGM technology works, practical aspects of its application and how CGM data are interpreted. We describe the different glucose sensors available in India and suggest when and whom to use them. We also evaluate the effectiveness of CGM-assisted titration of insulin dose in our hyperglycemic patients and discuss the results. Settings and Design: This is a single-center retrospective observational study of insulin-treated patients with diabetes attending the endocrinology outpatient department, who opted for a CGM-assisted insulin dose titration. Subjects and Methods: Monitoring was done using the Freestyle libre pro™ CGM system and insulin doses were titrated on regular follow-ups every 3–4 days for a total of 2 weeks. Patients who had an average SG level of more than 250 mg/dl on day 1 of monitoring, and had CGM data for a minimum of 12 days were included (n = 73). Data were analyzed using CGM-specific glucometrics including average SG and estimated A1c (eA1c) reduction, and changes in the percentage time in range (TIR), time below range (TBR), and time above range (TAR). Statistical Analysis Used: Not applicable. Results: When compared to day 1, the last day (D12–14) of CGM-assisted insulin dose titration showed: 1. An average SG reduction of 164.1 mg/dl (321.34 mg/dl → 157.24 mg/dl). 2. An eA1c reduction of 4.98% (12.08% → 7.1%). 3. An average TIR improvement of 51.21% (3.8% → 55.01%). 4. An average TAR reduction of 62.06% (96.12% → 34.06%). 5. An average increase in TBR from 0% to 10.21%. Target TIR &gt;70% was achieved by 31/73 patients on D12-14, compared to 0/73 on day 1. Target TAR &lt;25% was achieved by 43/73 patients on D12-14, compared to 0/73 on day 1. Target TBR &lt;5% was not achieved by 21/73 patients on D12-14 when compared to 0/73 on day 1. Conclusions: CGM is a novel, easy-to-use, useful technology easily available in India for all patients with diabetes. We have demonstrated that quick and effective glycemic reduction is possible with CGM-assisted insulin dose titration within a short period of 2 weeks.

Effects of Cnidoscolus Quercifolius Pohl leaves extracts on glucemia reduction in diabetic mice / Efeitos das folhas de Cnidoscolus Quercifolius Pohl sobre a redução da glucemia em ratos diabéticos

Obesity, metabolic syndrome and diabetes are epidemic chronic situations in industrialized countries that are associated with the reduction of life quality and increase of patients’ mortality. Before the serious epidemiological picture and the impact that the diabetes causes in the society, the use of different therapeutic interventions is priority in the scientific community. Thus, the goal of this work valued the hypoglycemic effect of the aqueous and methanolic extracts of the leaves of Cnidoscolus quercifolius Pohl (faveleira). The phytochemical analysis demonstrated the carbolic acids presence, flavonols, xanthone, catechin, triterpenoids, tannin and coumarins in both extracts and the liquid chromatography of high efficiency revealed the presence of the gallic acid; a powerful metabolite antioxidant. The Diabetes was induced in mice Swiss with alloxan that they did not present mortality when treated with 100, 200 mg / kg of methanolic extract and 100, 200 and 400 mg / kg of aqueous extract for 30 days. Histopathological analysis of the animal’s organs (kidney, pancreas, liver) did not reveal architectural alteration. All the diabetic animals submmited to the extracts presented a higher reduction on the blood sugar level percentage than the ones which were undergone to the standard drug. It is important to highlight that the blood sugar level - of the diabetic animals undergone to 400 mg / kg of weight of the aqueous extract - presented glycemic reduction of 39,81 % after 30 days of treatment. These results are very promising because they show great potential for the use of this typical Brazilian Caatinga plant as an alternative therapeutic option to slow down or reduce the risk of hyperglycemia and oxidative stress in diabetic patients.

Impact of Mediterranean Diet Food Choices and Physical Activity on Serum Metabolic Profile in Healthy Adolescents: Findings from the DIMENU Project.

Adolescent nutrition and healthy dietary patterns, particularly the Mediterranean diet (MD), have been associated with improved health status and decreased risk of various chronic and metabolic diseases later in life. The aim of this study was to evaluate the impact of the Mediterranean food choices on lipid and glycemic metabolic profile in the total population and in adolescents grouped according to their physical activity (PA) levels at the time of recruitment (T0) and after six months from the administration of a personalized Mediterranean meal plan (T1). As part of the DIMENU study, 85 adolescents underwent measurements of lipid and glucose metabolic profile at T0 and T1. Using three positive items from KIDMED test related to the consumption of typical Mediterranean food (olive oil, fish, and nuts) and three negative items on dietary habits (going to fast-food, consuming biscuits, and candies), we categorized adolescents into six sets in which biochemical parameters were analyzed. In the total sample, significant reductions in serum total cholesterol, LDL, and glucose concentrations were observed for all the sets over the study period. Notably, active subjects, who had a better serum metabolic profile, showed significant improvements of glycemic control after 6 month follow up, while in sedentary adolescents and in those performing moderate PA significant reduction in glycemia, total cholesterol, and LDL was found in all sets. In conclusion, adopting the typical Mediterranean food choices led to a significant reduction in glucose and lipid profile in healthy adolescents, thus making the MD and PA a winning combination for health status.

Effect of swimming exercise, insulin-associated or not, on inflammatory cytokines, apoptosis, and collagen in diabetic rat placentas.

Physical exercise is an important therapeutic agent for women with diabetes during gestation. However, its histophysiological consequences for the placenta remain unclear. In this study, we evaluated the expression of VEGF-A, IL1ß, TNFα, and type I collagen in the placentas of diabetic rats subjected to a swimming program. Thirty rats were divided into the following groups: CG, pregnant nondiabetic rats; CEG, nondiabetic pregnant rats subjected to swimming; DG, pregnant diabetic rats; DEG, pregnant diabetic rats subjected to swimming; DIG, pregnant diabetic rats treated with insulin; DIEG, pregnant diabetic rats treated with insulin and subjected to swimming. Diabetes was induced using streptozotocin [50mg/kg intraperitoneally (i.p.)], and insulin was administered at a dose of 5U/day i.p. (2U at 10am and 3U at 7pm) in the DIG group; in the DIEG group, insulin was administered at a dose of only 2U/day at 7pm. The rats were sacrificed on the 20th day of gestation. There was an increase in the expression of IL-1β, TNF-α, VEGF-A, and type I collagen and a higher apoptotic index in the placentas of the DG and DEG groups, but there was a reduction in glycemia in the latter group. In the DIG and DIEG groups, the levels remained similar to those of the control; however, in these groups the reduction was more significant for all analyzed parameters. Therefore, in rats induced to diabetes during pregnancy, swimming, although reducing glycemic levels, did not prevent immunohistochemical changes in the placenta, suggesting the need for a multidisciplinary protocol associated with traditional pharmacological treatment.

Gut Microbial Signatures for Glycemic Responses of GLP-1 Receptor Agonists in Type 2 Diabetic Patients: A Pilot Study.

BackgroundsGlucagon-like peptide-1 receptor agonist (GLP-1 RA) is probably one of more effective antidiabetic agents in treatment of type 2 diabetes mellitus (T2D). However, the heterogenicity in responses to GLP-1 RA may be potentially related to gut microbiota, although no human evidence has been published. This pilot study aims to identify microbial signatures associated with glycemic responses to GLP-1 RA.Materials and MethodsMicrobial compositions of 52 patients with T2D receiving GLP-1 RA were determined by 16S rRNA amplicon sequencing. Bacterial biodiversity was compared between responders versus non-responders. Pearson’s correlation and random forest tree algorithm were used to identify microbial features of glycemic responses in T2D patients and multivariable linear regression models were used to validate clinical relevance.ResultsBeta diversity significantly differed between GLP-1 RA responders (n = 34) and non-responders (n = 18) (ADONIS, P = 0.004). The top 17 features associated with glycohemoglobin reduction had a 0.96 diagnostic ability, based on area under the ROC curve: Bacteroides dorei and Roseburia inulinivorans, the two microbes having immunomodulation effects, along with Lachnoclostridium sp. and Butyricicoccus sp., were positively correlated with glycemic reduction; Prevotella copri, the microbe related to insulin resistance, together with Ruminococcaceae sp., Bacteroidales sp., Eubacterium coprostanoligenes sp., Dialister succinatiphilus, Alistipes obesi, Mitsuokella spp., Butyricimonas virosa, Moryella sp., and Lactobacillus mucosae had negative correlation. Furthermore, Bacteroides dorei, Lachnoclostridium sp. and Mitsuokella multacida were significant after adjusting for baseline glycohemoglobin and C-peptide concentrations, two clinical confounders.ConclusionsUnique gut microbial signatures are associated with glycemic responses to GLP-RA treatment and reflect degrees of dysbiosis in T2D patients.

Supplementation with Moringa oleifera leaves flour prevents fructose-based metabolic disorders in young rats

Moringa oleifera leaves flour is amply used to treat metabolic conditions. The aim was to assess the M. oleifera flour (MOF) on metabolic changes induced by fructose. Phenolic compounds were determined by LC-ESI-MS/MS. Wistar rats were distributed in groups: 1) Control (normal-chow + water); 2) Fructose (normal-chow + fructose (20%) in water) and 3) Feed with MOF20% + fructose (20%) in water. At the end of the 4th week of treatment, the animals were submitted to insulin resistance (IR) test, blood collection and histological evaluation. MOF contains phenolic compounds such as quercetin and chlorogenic acid. MOF supplementation promotes reduction in glycemia, insulin, triglycerides. The supplementation improved the insulin sensitivity. In the histological analysis, MOF supplementation reduced the adipocyte hypertrophy and the lipid deposition in the liver. The data obtained showed that MOF supplementation presented a protective effect against the harmful consequences of excessive fructose consumption. Keywords: Moringa oleifera, metabolic syndrome, diabetes, fructose, mice

Preliminary Assessment of Glycemic Control and Body Fat Reduction Effects of Terminalia chebula Retz. Extract on Pre-diabetic Subjects

Preliminary Assessment of Glycemic Control and Body Fat Reduction Effects of Terminalia chebula Retz. Extract on Pre-diabetic Subjects

Antioxidant effect of Arrabideae chica (crajiru) extract on oxidative stress in diabetic rats

Objective: This study aimed to investigate the effects of the antioxidant potential of Arrabideae chica (crajiru) extract on oxidative stress in diabetic rats. Methods: Adult Wistar rats (Rattus norvegicus), weighing 238±12g were divided into three groups of six rats each: CN normal untreated control; DIAB+NS diabetic rats treated with normal saline; and diabetic rats treated with crajiru extract, DIAB+CR. The CN and DIAB+NS groups (control groups) received normal saline solution (NS) orally (gavage); rats in the DIAB+CR group received crajiru extract (300 mg/kg) once a day by gavage for 6 weeks. Measurements of urea and creatinine in serum, and kidney tissue catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were performed. The variables were assessed using the Tukey test, significance p&lt;0.05. Results: All animals survived the experiments. In the CN group, compared with the DIAB+NS group, there was significant difference between the levels of glycemia on the second day of dosing and on the 10th day (p&lt;0.05). No difference was observed on glycemia comparing the 2th and 10th day on the rats of group C+NS (p&gt;0.05). Diabetic animals from DIAB+CR group had a significant reduction in glycemia on 10th day of treatment, comparing the 2nd day (p&lt;0.05). There was a significant reduction in glycemia in the DIAB+CR group, comparing with the DIAB+NS group (p&lt;0.05). There was an increase in urea and creatinine levels in rats DIAB+SN when compared to controls, C+SN (p&lt;0.001). Rats from the DIAB+CR group had a significant reduction in urea and creatinine, compared to the DIAB+NS group (p&lt;0.001). There were no significant differences in urea and creatinine comparing the C+NS and DIAB+CR groups. The rats from the DIAB+NS group had significantly lower levels of CAT, GSH-px and SOD when compared to the normal control rats (p&lt;0.001). In animals from the DIAB+SN group, the levels of these antioxidant enzymes were significantly reduced (p&lt;0.001). The treatment of diabetics with crajiru extract caused a significant increase (p&lt;0.001) in the levels of CAT, GSH-px and SOD, when compared to rats in the BIAB+SN group. Conclusion: The data of the present study confirms that the crajiru extract positively influenced the control of hyperglycemia in diabetic rats. More research is needed to provide a better understanding of the mechanisms of diabetes treatment using crajiru extract and its flavonoids.

Hydropinotherapy with Sulphurous Mineral Water as Complementary Treatment to Improve Glucose Metabolism, Oxidative Status, and Quality of Life.

Hydropinotherapy is a salus per aquam (Spa) treatment suitable as a complementary approach to treat several diseases, which strongly affect the quality of life (QoL). Hydropinotherapy with sulphurous mineral water exerts benefits thanks to components, such as hydrogen sulphide, which is considered mainly responsible for antioxidant and hypoglycaemic effects. Such properties, linked from each other, could favour an improvement in patients’ QoL. However, data on humans are scarce. This study aimed to investigate whether a cycle of sulphurous hydropinotherapy was able to modify plasma levels of glucose and reactive oxygen metabolites (ROMs) and improve QoL in patients suffering from several chronic disorders. A prospective, observational study involved patients with gastrointestinal diseases who received a prescription of a cycle of sulphurous hydropinotherapy (S-HT). Age- and sex-matched control group was enrolled (No S-HT). Glycaemia and plasma concentration of ROMs were measured in all subjects. The impact of spa treatment on the QoL was assessed using the Short Form 36 Health Status Survey questionnaire (SF-36). All parameters were measured at baseline and at the end of a 2-week treatment. Between the groups, no differences were found in glycaemia and ROMs at baseline. In the S-HT group, a reduction in glycaemia and ROMs, both in respect to baseline (p = 0.005 and p = 0.031, respectively) and to control group, as shown by the delta value calculated, as the difference between the values at 2 weeks and baseline (p = 0.0009 and p = 0.0001, respectively). In the S-HT, delta ROMs was the best predictor of delta glycaemia with a direct linear correlation (beta = 0.559, 95% CI 0.471 to 0.647, p < 0.0001). In the S-HT, the SF-36 total score was improved both when compared with baseline (p = 0.002) and with No S-HT (p = 0.001). Sulphurous hydropinotherapy induces a decrease in glycaemia and ROM levels, also ameliorating the patients’ QoL. Therefore, it could be considered a useful complementary therapeutic approach.

PHYTOPHARMACOLOGICAL EVALUATION OF DALBERGIA LATIFOLIA ROXB FOR ANTIDIABETIC ACTIVITY AND ITS EFFECT ON LIPID PROFILE AND HEPATIC ENZYMES OF GLUCOSE METABOLISM IN DIABETIC RATS

It is essential to gauge the herbal plants scientifically and proper documentation should be made to understand their medicinal properties. In current scenario there exists a very high demand for the herbal products in the entire world that led to the extensive research in many pharmaceutical industries on plant materials for the exploration of potential medicinal value. This inclination seems to be a result of people finding various alternative systems of drugs. A large number of drugs are reported to have excellent medicinal value and are in use for the treatment of diabetes. Dalbergia latifolia Roxb is evergreen, deciduous tree belongs to fabaceae family, it consist of white small flower and identified by grey bark which peels in long fibers. In the present study, qualitative and quantitative phytochemical screening of Hydroalcoholic extract of bark of Dalbergia latifolia (DLExt) and pharmacological studies involved acute oral toxicity study, oral glucose tolerance test (OGTT) hypoglycemic activity and antidiabetic activity of DLExt was done. The results suggested that Dalbergia latifolia (DLExt) induced a potent reduction in glycaemia exhibited potential to reduce the blood glucose level (BGL). The study showed that Hydroalcoholic extract of bark of Dalbergia latifolia protect massive body weight loss significantly decreased MDA in pancreas and in kidney and enhances SOD, CAT, GPx and GST activity. The involvement of DLExt reduction in level of TG, TC, LDL, VLDL and elevation in HDL level in diabetic rats was also demonstrated. The study was supported with histopathology studies and showed remarkable improvement in pancreatic tissues, normal architecture of hepatocytes and normal architecture of bowman’s capsule and renal tubules.

A Behavioral Economics-Electronic Health Record Module to Promote Appropriate Diabetes Management in Older Adults: Protocol for a Pragmatic Cluster Randomized Controlled Trial.

BackgroundThe integration of behavioral economics (BE) principles and electronic health records (EHRs) using clinical decision support (CDS) tools is a novel approach to improving health outcomes. Meanwhile, the American Geriatrics Society has created the Choosing Wisely (CW) initiative to promote less aggressive glycemic targets and reduction in pharmacologic therapy in older adults with type 2 diabetes mellitus. To date, few studies have shown the effectiveness of combined BE and EHR approaches for managing chronic conditions, and none have addressed guideline-driven deprescribing specifically in type 2 diabetes. We previously conducted a pilot study aimed at promoting appropriate CW guideline adherence using BE nudges and EHRs embedded within CDS tools at 5 clinics within the New York University Langone Health (NYULH) system. The BE-EHR module intervention was tested for usability, adoption, and early effectiveness. Preliminary results suggested a modest improvement of 5.1% in CW compliance.ObjectiveThis paper presents the protocol for a study that will investigate the effectiveness of a BE-EHR module intervention that leverages BE nudges with EHR technology and CDS tools to reduce overtreatment of type 2 diabetes in adults aged 76 years and older, per the CW guideline.MethodsA pragmatic, investigator-blind, cluster randomized controlled trial was designed to evaluate the BE-EHR module. A total of 66 NYULH clinics will be randomized 1:1 to receive for 18 months either (1) a 6-component BE-EHR module intervention + standard care within the NYULH EHR, or (2) standard care only. The intervention will be administered to clinicians during any patient encounter (eg, in person, telemedicine, medication refill, etc). The primary outcome will be patient-level CW compliance. Secondary outcomes will measure the frequency of intervention component firings within the NYULH EHR, and provider utilization and interaction with the BE-EHR module components.ResultsStudy recruitment commenced on December 7, 2020, with the activation of all 6 BE-EHR components in the NYULH EHR.ConclusionsThis study will test the effectiveness of a previously developed, iteratively refined, user-tested, and pilot-tested BE-EHR module aimed at providing appropriate diabetes care to elderly adults, compared to usual care via a cluster randomized controlled trial. This innovative research will be the first pragmatic randomized controlled trial to use BE principles embedded within the EHR and delivered using CDS tools to specifically promote CW guideline adherence in type 2 diabetes. The study will also collect valuable information on clinician workflow and interaction with the BE-EHR module, guiding future research in optimizing the timely delivery of BE nudges within CDS tools. This work will address the effectiveness of BE-inspired interventions in diabetes and chronic disease management.Trial RegistrationClinicalTrials.gov NCT04181307; https://clinicaltrials.gov/ct2/show/NCT04181307International Registered Report Identifier (IRRID)DERR1-10.2196/28723

A Systematic Review to Assess the Impact of Hyperbaric Oxygen Therapy on Glycaemia in People with Diabetes Mellitus.

Background and Objectives: Hyperbaric oxygen is a recognised treatment for a range of medical conditions, including treatment of diabetic foot disease. A number of studies have reported an impact of hyperbaric oxygen treatment on glycaemic control in patients undergoing treatment for diabetic foot disease. There has been no systematic review considering the impact of hyperbaric oxygen on glycaemia in people with diabetes. Materials and Methods: A prospectively PROSPERO-registered (PROSPERO registration: CRD42021255528) systematic review of eligible studies published in English in the PUBMED, MEDLINE, and EMBASE databases, based on the following search terms: hyperbaric oxygen therapy, HBO2, hyperbaric oxygenation, glycaemic control, diabetes, diabetes Mellitus, diabetic, HbA1c. Data extraction to pre-determined piloted data collection form, with individual assessment of bias. Results: In total, 10 eligible publications were identified after screening. Of these, six articles reported a statistically significant reduction in blood glucose from hyperbaric oxygen treatment, while two articles reported a statistically significant increase in peripheral insulin sensitivity. Two articles also identified a statistically significant reduction in HbA1c following hyperbaric oxygen treatment. Conclusions: There is emerging evidence suggesting a reduction in glycaemia following hyperbaric oxygen treatment in patients with diabetes mellitus, but the existing studies are in relatively small cohorts and potentially underpowered. Additional large prospective clinical trials are required to understand the precise impact of hyperbaric oxygen treatment on glycaemia for people with diabetes mellitus.

Insulin/IGF-1 Signaling Is Downregulated in Barrett's Esophagus Patients Undergoing a Moderate Calorie and Protein Restriction Program: A Randomized 2-Year Trial.

Obesity and associated insulin resistance (Ins-R) have been identified as important risk factors for esophageal adenocarcinoma development. Elevated calories and protein consumption are also associated with Ins-R and glucose intolerance. We investigated the effect of a 24-month moderate calorie and protein restriction program on overweight or obese patients affected by Barrett’s esophagus (BE), as no similar dietary approach has been attempted to date in this disease context. Anthropometric parameters, levels of serum analytes related to obesity and Ins-R, and the esophageal insulin/IGF-1 signaling pathway were analyzed. This study is registered with ClinicalTrials.gov, number NCT03813381. Insulin, C-peptide, IGF-1, IGF-binding protein 3 (IGFBP3), adipokines, and esophageal expression of the main proteins involved in insulin/IGF-1 signal transduction were quantified using Luminex-XMAP® technology in 46 patients who followed the restriction program (IA) and in 54 controls (CA). Body mass index and waist circumference significantly decreased in 76.1% of IA and 35.2% of CA. IGF-1 levels were reduced in 71.7% of IA and 51.8% of CA. The simultaneous reduction of glycaemia, IGF-1, the IGF-1/IGFBP3 ratio, and the improvement in weight loss-dependent insulin sensitivity, were associated with the downregulation of the insulin/IGF-1 signal on BE tissue. The proposed intervention program was an effective approach to counteract obesity-associated cancer risk factors. The improvement in metabolic condition resulted in a downregulation of the ERK-mediated mitogenic signal in 43.5% of patients, probably affecting the molecular mechanism driving adenocarcinoma development in BE lesions.

Alanine alters the carbohydrate metabolism of rainbow trout: glucose flux and cell signaling.

In rainbow trout, dietary carbohydrates are poorly metabolized compared with other macronutrients. One prevalent hypothesis suggests that high dietary amino acid levels could contribute to the poor utilization of carbohydrates in trout. In mammals, alanine is considered an important gluconeogenic precursor, but has recently been found to stimulate AMP-activated protein kinase (AMPK) to reduce glucose levels. In trout, the effect of alanine on glucose flux is unknown. The goal of this study was to determine the effects of 4 h exogenous alanine infusion on glucose metabolism in rainbow trout. Glucose flux, and the rate of glucose appearance (Ra) and disposal (Rd) were measured in vivo. Key glycolytic and gluconeogenic enzyme expression and activity, and cell signaling molecules relevant to glucose metabolism were assessed in the liver and muscle. The results show that alanine inhibits glucose Ra (from 13.2±2.5 to 7.3±1.6 μmolkg-1 min-1) and Rd (from 13.2±2.5 to 7.4±1.5 μmolkg-1 min-1) and the slight mismatch between Ra and Rd caused a reduction in glycemia, similar to the effects of insulin in trout. The reduction in glucose Rd can be partially explained by a reduction in glut4b expression in red muscle. In contrast to mammals, trout alanine-dependent glucose-lowering effects did not involve hepatic AMPK activation, suggesting a different mechanistic basis. Interestingly, protein kinase B (AKT) activation increased only in muscle, similar to effects observed in insulin-infused trout. We speculate that alanine-dependent effects were probably mediated through stimulation of insulin secretion, which could indirectly promote alanine oxidation to provide the needed energy.

Effect of a Smartphone App on Weight Change and Metabolic Outcomes in Asian Adults With Type 2 Diabetes

Lifestyle interventions are effective in diabetes management, with smartphone apps that manage health data and dietary and exercise schedules gaining popularity. However, limited evidence from randomized clinical trials exists regarding the effectiveness of smartphone-based interventions among Asian adults with type 2 diabetes. To compare the effects of a culturally contextualized smartphone-based intervention with usual care on weight and metabolic outcomes. This randomized clinical trial conducted at multiple primary care centers in Singapore included 305 adults with type 2 diabetes and body mass index (BMI) of 23 or greater who had literacy in English and smartphone access. Participants were recruited between October 3, 2017, and September 9, 2019, and were randomly assigned (1:1; stratified by gender, age, and BMI) to intervention (99 participants) or control (105 participants) groups. Participants' data were analyzed using intention-to-treat analysis. Both control and intervention participants received diet and physical activity advice from a dietitian at a baseline face-to-face visit. Intervention participants additionally used a smartphone app to track weight, diet, physical activity, and blood glucose and then communicated with dietitians for 6 months. Primary outcome was change in body weight, while secondary outcomes were changes in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, lipids, and diet. Post hoc analyses included glycemic changes in the subgroup with HbA1c levels of 8% or greater and diabetes medication changes. Among the 204 randomized participants (mean [SD] age, 51.2 [9.7] years; 132 [64.7%] men), baseline mean (SD) BMI was 30.6 (4.3). Compared with the control group, intervention participants achieved significantly greater reductions in weight (mean [SD] change, -3.6 [4.7] kg vs -1.2 [3.6] kg) and HbA1c levels (mean [SD] change, -0.7% [1.2] vs -0.3% [1.0]), with a greater proportion having a reduction in diabetes medications (17 participants [23.3%] vs 4 participants [5.4%]) at 6 months. The intervention led to a greater HbA1c reduction among participants with HbA1c levels of 8% or higher (mean [SD] change, -1.8% [1.4] vs -1.0% [1.4]; P = .001). Intergroup differences favoring the intervention were also noted for fasting blood glucose, diastolic blood pressure, and dietary changes. In this study, a smartphone-based lifestyle intervention was more effective in achieving weight and glycemic reductions among Asian adults with type 2 diabetes compared with usual care, supporting the use of apps in lifestyle intervention delivery. anzctr.org.au Identifier: ACTRN12617001112358.

1209-P: Profound Metabolic Benefits Observed in an Eight-Week GK Rat Study of a Novel Orally Administered Polymeric Duodenal Exclusion Therapy: Implications for Type 2 Diabetes (T2D) Therapy

Background: Roux-en-Y gastric bypass surgery produces significant weight loss and improvement in T2D and insulin resistance, attributed predominantly to duodenal exclusion. To mimic this effect non-invasively, we developed an oral, gut-restricted, inert polymer (GLY-POL) that interacts with mucus in the proximal small intestine to form a dynamic barrier excluding the duodenal lining from luminal contents. We therefore hypothesized that such treatment would result in significant improvement in glycemia and weight loss in a rodent model of type 2 diabetes. Methods: Goto-kakizaki (GK) rats were gavaged daily for 8 weeks. The treatment group (n = 7) received 1.5 ml of GLY-POL (8 wt %) solution and control group (n=7) received saline. Five metabolic responses were evaluated weekly: body weight, food intake, oral glucose (oGTT) and mixed meal tolerance (mMTT) tests, and HOMA-IR. Results: oGTT performed after chronic GLY-POL therapy produced a profound reduction of post-prandial glycemia (PPG) (incremental area under curve (iAUC)  = 60 – 70%, p&amp;lt;0.0005) compared to control; the PPG reduction amplified with duration of therapy through the study period. Similar robust reduction in PPG iAUC was evident during mMTT (iAUC  &amp;gt; 55%, p &amp;lt; 0.005). Fasting plasma glucose was lower in GLY-POL group (p&amp;lt;0.05) with improvement in HOMA-IR (p&amp;lt;0.005). GLY-POL therapy resulted in 6% weight loss compared to control (p&amp;lt;0.005), without a difference in food intake between the groups. Conclusion: Our results confirm a key role for chronic duodenal exclusion in improving the systemic metabolic milieu. Chronic once daily oral GLY-POL therapy results in a profound reduction in FPG, PPG, insulin resistance and weight loss. GLY-POL therapy offers the potential for a novel non-invasive approach for glycemic and weight control in T2D patients that mimics the effects of gastric bypass without the adverse effects associated with this surgery. Disclosure A. Nimgaonkar: Employee; Self; Glyscend Inc. S. Kulkarni: None. J. S. Petersen: Employee; Self; Glyscend Inc. S. Polomoscanik: Employee; Self; Glyscend Inc. P. J. Pasricha: Stock/Shareholder; Self; Glyscend. K. Colbert: Employee; Self; Glyscend Inc., LifeSprout, Inc. T. H. Jozefiak: Employee; Self; Glyscend Inc., Stock/Shareholder; Self; GLYCOLOGIX LLC. J. Vora: Advisory Panel; Self; Bayer Inc., Other Relationship; Self; AstraZeneca. M. Vieira: Employee; Self; AstraZeneca. T. Carlson: None. L. Liu: None. Funding National Science Foundation (1521347)

Effects of Whole Grain Intake, Compared to Refined Grain, on Glycemia and Insulinemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Objectives Epidemiological study results suggest that whole grain (WG) consumption is associated with a reduced risk of type 2 diabetes; however, the potential mechanism behind this observation is unclear. WG intake may lower postprandial glycemia and insulinemia and improve insulin sensitivity, thereby contributing to a reduced risk of type 2 diabetes. The objective of this systematic review and meta-analysis was to evaluate the impact of WG on postprandial glycemia and insulinemia and markers of glycemic control and insulin sensitivity/resistance. Methods A systematic review and meta-analysis was conducted on randomized controlled trials (RCTs) evaluating the effect of WG intake, compared to refined grain (RG) intake, on postprandial glycemia and insulinemia area under the curve and markers of glycemic control and insulin sensitivity/resistance in adults. A search of PubMed and Scopus yielded 80 relevant RCTs. Pooled estimates were expressed as standardized mean differences (SMD) between the WG intervention and RG control group. Results WG intake resulted in a significant reduction of postprandial glycemia (SMD: −0.46, 95% CI: −0.59, −0.33, P &amp;lt; 0.001) and insulinemia (SMD: −0.29, 95% CI: −0.39, −0.20, P &amp;lt; 0.001), compared to RG intake. There were no significant effects of WG on fasting glucose, fasting insulin, or homeostatic model assessment of insulin resistance (HOMA-IR); however, there was a marginally significant benefit of WG intake for glycated hemoglobin (HbA1c) (P = 0.050). Conclusions Compared to RG foods, WG foods improve postprandial glycemia and insulinemia which may partially explain the association of WG intake and reduced risk of type 2 diabetes. However, WG intake did not impact long-term markers of glycemic and insulinemic control, except for a marginally significant effect on HbA1c. While short term improvements in glycemic response may be beneficial, more investigations are needed to determine if these lead to long-term benefits in reducing the risk of type 2 diabetes. PROSPERO Registration: CRD42020180069 Funding Sources This research was funded by General Mills, Inc.