Glycemic Regulation Research Articles

The Association of Personality Traits and Parameters of Glycemic Regulation in Type 1 Diabetes Mellitus Patients Using isCGM.

This study aimed to examine the impact of personality on glycemic regulation in adult patients with type 1 diabetes mellitus (T1DM). The study group consisted of subjects with T1DM, who were ≥ 18 years of age. The study was conducted in two phases: At baseline, subjects completed the Croatian version of the International Personality Item Pool scale (IPIP50s) and a questionnaire designed to gather socioeconomic data, duration of diabetes, presence of chronic complications, presence of cardiovascular risk factors, frequency, and type of pre-existing hypoglycemic episodes per week. Blood and urine samples were collected and body mass index (BMI) was calculated. Each participant was provided with the intermittently scanned glucose monitoring system (isCGM) Freestyle Libre. During the second visit (3 months from the start of the trial), glycemic parameters were collected from the reports generated from the Freestyle Libre system. Estimated glycated hemoglobin (HbA1c) values were significantly lower after three months compared to baseline HbA1c (Wilcoxon test, p < 0.001). An inverse correlation between the number of daily scans and degree of extraversion among subjects was observed, e.g., higher degrees of extraversion resulted in lower numbers of daily scans, while lower degrees of extraversion, i.e., introvertedness, resulted in higher numbers of daily scans (Rho = −0.238 p = 0.009). There was a positive correlation between emotional stability and time spent in hypoglycemia (Rho = 0.214; p = 0.02). In addition, a shorter duration of diabetes was associated with higher percentages of TIR and vice versa (p = 0.02). Investigating personality traits can be a useful tool for identifying patients predisposed to hypoglycemia and lower scanning frequency. Patients with a longer history of T1DM require closer follow-up and should be re-educated when necessary.

Technological Developments and Quality of Life in Type 1 Diabetes Mellitus Patients: A Review of the Modern Insulin Analogues, Continuous Glucose Monitoring and Insulin Pump Therapy.

Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disease, which is characterized by an increased prevalence worldwide, which, in fact, tends to take extensive dimensions. The recent rapid development of science and technology has significantly contributed to the improvement of the management of type 1 diabetes mellitus, both in achieving the required euglycaemic regulation and reducing the psychological burden associated with the disease, consequently improving the quality of life of the patients with type 1 diabetes mellitus. A literature review from 2010, related to the contribution of the modern insulin analogues, continuous glucose monitoring and the insulin pump, was performed using Scopus, ScienceDirect and PubMed databases. Studies included in the review support a direct and indirect association of technological innovations with the quality of life. The use of type 1 diabetes mellitus technology was negatively associated with the frequency of the hypoglycaemias and the value of the glycosylated hemoglobin, while at the same time, the development and use of the related technology were highly associated with an improvement in the quality of life. Patients' quality of life is an indicator of the management of type 1 diabetes mellitus, and it is just as important as glycaemic regulation. Through this review, it was concluded that a better quality of life of T1DM patients was associated with the improvement of glycosylated hemoglobin and hypoglycemic episodes.

Effects of Gestational Sleep Patterns and Their Changes on Maternal Glycemia and Offspring Physical Growth in Early Life.

Maternal sleep patterns during pregnancy are drawing increased attention to examine its role in the regulation of maternal glycemia and physical growth of offspring within 24 months. Among 3329 eligible mother–child pairs included in the Shanghai Maternal–Child Pairs Cohort, sleep patterns of pregnant women were assessed by Pittsburgh Sleep Quality Index and objective measurement in early and late pregnancy. Offspring physical growth within 24 months was primarily indicated by the body mass index Z-score (BAZ), catch-up growth, and overweight/obesity. In total, 3329 and 382 pregnant women were included with subjectively assessed and objectively measured sleep pattern, respectively. The increased risk of GDM was associated with maternal night-time sleep duration ≥8.5 h in early pregnancy, or sleep quality change from poor to good during pregnancy (OR = 1.48; 95% CI, 1.06 to 2.07). In the GDM group, the effect of sleep duration in early pregnancy on overweight/obesity in offspring within 24 months showed a U-shaped curve, with a 1.73-fold and 1.43-fold increased risk of overweight/obesity of offspring in pregnant women with <7.5 or ≥8.5 h of sleep duration, respectively. A good gestational sleep pattern was required to reduce the risk of GDM and offspring overweight/obesity within 24 months.

The Mediterranean Diet and glycemic regulation in patients with dyslipidemia and diabetes mellitus type 2

Background and Aims : The Mediterranean diet is considered a cornerstone in the regulation of the person with dyslipidemia and diabetes mellitus. The aim of the study is to record the eating habits of patients with dyslipidemia and type 2 diabetes mellitus and to correlate these habits with their regulation.

Gluconeogenesis: Adding a new piece to the puzzle of malaria parasitism

Disorders of carbohydrate metabolism, including hypoglycemia and lactic acidosis, are common features of malaria. In this issue of Cell Metabolism, Ramos etal. report that regulation of gluconeogenesis and glycemia by the host glucose-6-phosphatase catalytic subunit 1 (G6Pc1) is a key metabolic step that affects both Plasmodium replication and clinical outcome of disease.

Antidiabetic treatment in elderly patients with low performance status admitted to internal medicine ward

Background and Aims : The prevalence of diabetes mellitus (DM) increases with age. According to the 2021 American Diabetes Association (ADA) guidelines, elderly patients with multiple comorbidities may have less stringent glycemic targets. The aim of this study was to record the medication and the glycemic regulation of patients with DM admitted to the Internal Medicine Department of the University Hospital of Heraklion, Crete.

Short Term Glucose Prediction in Patients with Type 1 Diabetes Mellitus.

Glucose prediction is used in diabetes self-management as it allows to take suitable actions for proper glycemic regulation of the patient. The aim of this work is the short-term personalized glucose prediction in patients with Type 1 diabetes mellitus (T1DM). In this scope, we compared two different models, an autoregressive moving average (ARMA) model and a long short-term memory (LSTM) model for different prediction horizons. The comparison of two models was performed using the evaluation metrics of root mean square error (RMSE) and mean absolute error (MAE). The models were trained and tested in 29 real patients. The results shown that the LSTM model had better performance than ARMA with RMSE 3.13, 6.41 and 8.81 mg/dL and MAE 1.98, 5.06 and 6.47 mg/dL for 5-, 15- and 30-minutes prediction horizon.

Structural Perspectives and Advancement of SGLT2 Inhibitors for the Treatment of Type 2 Diabetes.

Diabetes mellitus is an ailment that affects a large number of individuals worldwide and its pervasiveness has been predicted to increase later on. Every year, billions of dollars are spent globally on diabetes-related health care practices. Contemporary hyperglycemic therapies to rationalize Type 2 Diabetes Mellitus (T2DM) mostly involve pathways that are insulin-dependent and lack effectiveness as the pancreas' β-cell function declines more significantly. Homeostasis via kidneys emerges as a new and future strategy to minimize T2DM complications. This article covers the reabsorption of glucose mechanism in the kidneys, the functional mechanism of various Sodium- Glucose Cotransporter 2 (SGLT2) inhibitors, their structure and driving profile, and a few SGLT2 inhibitors now accessible in the market as well as those in different periods of advancement. The advantages of SGLT2 inhibitors are dose-dependent glycemic regulation changes with a significant reduction both in the concentration of HbA1c and body weight clinically and statistically. A considerable number of SGLT2 inhibitors have been approved by the FDA, while a few others, still in preliminaries, have shown interesting effects.

Nutritional strategies to attenuate postprandial glycemic response.

SummaryMaintaining good glycemic control to prevent complications is crucial in people with type 2 diabetes and in people with prediabetes and in the general population. Different strategies to improve glycemic control involve the prescription of blood glucose‐lowering drugs and the modulation of physical activity and diet. Interestingly, lifestyle intervention may be more effective in lowering hyperglycemia than pharmaceutical intervention. Regulation of postprandial glycemia is complex, but specific nutritional strategies can be applied to attenuate postprandial hyperglycemia. These strategies include reducing total carbohydrate intake, consuming carbohydrates with a lower glycemic index, the addition of or substitution by sweeteners and fibers, using food compounds which delay or inhibit gastric emptying or carbohydrate digestion, and using food compounds which inhibit intestinal glucose absorption. Nevertheless, it must be noted that every individual may respond differently to certain nutritional interventions. Therefore, a personalized approach is of importance to choose the optimal nutritional strategy to improve postprandial glycemia for each individual, but this requires a better understanding of the mechanisms explaining the differential responses between individuals.

Metabolic actions of the growth hormone-insulin growth factor-1 axis and its interaction with the central nervous system.

The growth hormone/insulin growth factor-1 axis is a key endocrine system that exerts profound effects on metabolism by its actions on different peripheral tissues but also in the brain. Growth hormone together with insulin growth factor-1 perform metabolic adjustments, including regulation of food intake, energy expenditure, and glycemia. The dysregulation of this hepatic axis leads to different metabolic disorders including obesity, type 2 diabetes or liver disease. In this review, we discuss how the growth hormone/insulin growth factor-1 axis regulates metabolism and its interactions with the central nervous system. Finally, we state our vision for possible therapeutic uses of compounds based in the components of this hepatic axis.

Exercise and Nutrition Strategies for Combating Sarcopenia and Type 2 Diabetes Mellitus in Older Adults.

Medical and technology development have drastically the improved quality of life and, consequently, life expectancy. Nevertheless, the more people who enter the third-age, the more geriatric syndromes expand in the elderly. Sarcopenia and Type 2 diabetes mellitus (T2DM) are common diseases among the elderly and the literature has extensively studied these two diseases separately. Recent evidence, however, revealed that there is a bidirectional relationship between sarcopenia and T2DM. The aims of the present review were: (1) to present diet and exercise interventions for the management of sarcopenia and T2DM and (2) identify which diet and exercise interventions can be used simultaneously in order to effectively deal with these two disorders. Exercise and a balanced diet are used as effective countermeasures for combating sarcopenia and T2DM in older adults based on their bidirectional relationship. Lifestyle changes such as exercise and a balanced diet seem to play an important role in the remission of the diseases. Results showed that chronic exercise can help towards glycemic regulation as well as decrease the incidence rate of muscle degradation, while diet interventions which focus on protein or amino acids seem to successfully treat both disorders. Despite the fact that there are limited studies that deal with both disorders, it seems that a combined exercise regime (aerobic and resistance) along with protein intake > 1gr/kg/d is the safest strategy to follow in order to manage sarcopenia and T2DM concurrently.

Abscisic Acid Improves Insulin Action on Glycemia in Insulin-Deficient Mouse Models of Type 1 Diabetes.

Abscisic acid (ABA), a plant hormone, has recently been shown to play a role in glycemia regulation in mammals, by stimulating insulin-independent glucose uptake and metabolism in skeletal muscle. The aim of this study was to test whether ABA could improve glycemic control in a murine model of type 1 diabetes (T1D). Mice were rendered diabetic with streptozotocin and the effect of ABA administration, alone or with insulin, was tested on glycemia. Diabetic mice treated with a single oral dose of ABA and low-dose subcutaneous insulin showed a significantly reduced glycemia profile compared with controls treated with insulin alone. In diabetic mice treated for four weeks with ABA, the effect of low-dose insulin on the glycemia profile after glucose load was significantly improved, and transcription both of the insulin receptor, and of glycolytic enzymes in muscle, was increased. Moreover, a significantly increased transcription and protein expression of AMPK, PGC1-α, and GLUT4 was observed in the skeletal muscle from diabetic mice treated with ABA, compared with untreated controls. ABA supplementation in conjunction with insulin holds the promise of reducing the dose of insulin required in T1D, reducing the risk of hypoglycemia, and improving muscle insulin sensitivity and glucose consumption.

Cross Talk Between Insulin and Glucagon Receptor Signaling in the Hepatocyte.

While the consumption of external energy (i.e., feeding) is essential to life, this action induces a temporary disturbance of homeostasis in an animal. A primary example of this effect is found in the regulation of glycemia. In the fasted state, stored energy is released to maintain physiological glycemic levels. Liver glycogen is liberated to glucose, glycerol and (glucogenic) amino acids are used to build new glucose molecules (i.e., gluconeogenesis), and fatty acids are oxidized to fuel long-term energetic demands. This regulation is driven primarily by the counterregulatory hormones epinephrine, growth hormone, cortisol, and glucagon. Conversely, feeding induces a rapid influx of diverse nutrients, including glucose, that disrupt homeostasis. Consistently, a host of hormonal and neural systems under the coordination of insulin are engaged in the transition from fasting to prandial states to reduce this disruption. The ultimate action of these systems is to appropriately store the newly acquired energy and to return to the homeostatic norm. Thus, at first glance it is tempting to assume that glucagon is solely antagonistic regarding the anabolic effects of insulin. We have been intrigued by the role of glucagon in the prandial transition and have attempted to delineate its role as beneficial or inhibitory to glycemic control. The following review highlights this long-known yet poorly understood hormone.

Non-alcoholic fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus: where do we stand today?

Non-alcoholic fatty liver disease (NAFLD), metabolic syndrome (MetS), and type 2 diabetes (T2DM) are metabolic disorders that belong to a highly prevalent disease cluster with a significant impact on public health worldwide. MetS is a complex condition characterized by metabolism perturbations that include glucose intolerance, insulin resistance, dyslipidaemia, associated pro-inflammatory state, and arterial hypertension. Because the components of MetS commonly co-occur, the management of these disorders cannot be considered separate issues. Thus NAFLD, recognized as a hepatic manifestation of MetS, is frequently associated with T2DM. This review analyses the underlying connections between these diseases and the risks associated with their co-occurrence. The effective management of NAFLD associated with MetS and T2DM involves an early diagnosis and optimal treatment of each condition leading to improvement in glycaemic and lipid regulation, liver steatosis, and arterial hypertension. The net effect of such treatment is the prevention of atherosclerotic cardiovascular diseases and liver fibrosis.

636-P: The Effect of Cognitive Behavioral Therapy for Insomnia on Cardiometabolic Health: A Systematic Review of Randomized Controlled Trials

Observational studies link poor sleep and insomnia with worse cardiometabolic health. Few studies have examined the effect of insomnia treatment on cardiometabolic health. This systematic review of randomized controlled trials (RCTs) aims to assess the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) on cardiometabolic health. Medline, EMBASE, PsycINFO, and Cochrane CENTRAL databases were searched using relevant terms and articles were screened by two independent reviewers. Eligibility criteria were adult population, the delivery of CBT-I, reporting of ≥1 cardiometabolic health marker, and peer-review. Standardized mean differences (Cohen’s d) in outcomes between groups post-intervention were calculated. Studies were appraised for quality by two independent raters using the Cochrane Risk of Bias 2.0 tool. After screening 1290 articles, 13 unique studies (15 publications) met inclusion criteria. Markers of inflammation (CRP, IL-6, TNF-α) , systolic and diastolic blood pressure (SBP, DBP) , and glycemic regulation (HbA1c) were reported most frequently, in ≥3 studies each. Most studies that examined HbA1c and CRP found reductions in the CBT-I group compared to the control group and effect sizes ranged from small (d = -0.27) to medium (d = -0.66) . Effects varied widely for IL-6, TNF-α, SBP, and DBP, with most studies finding null results. Two studies were judged as having low risk of bias and the remaining as moderate to high risk of bias. CBT-I was most consistently associated with improvements in HbA1c and CRP, which are relatively temporally stable, suggesting that CBT-I may influence enduring habits rather than short term behavior changes. Interpretation of studies is limited by high risk of bias (e.g., baseline differences between groups despite randomization, lack of prespecified analytic plan) . High quality studies are needed to better understand and quantitatively synthesize effects. Disclosure K.L.Savin: None. T.Clark: None. P.Perez-ramirez: None. M.Tristăo parra: None. L.Gallo: None.

Whey Protein Supplementation and Type 2 Diabetes Mellitus Risk Factors: A Scoping Review of Systematic Reviews and/or Meta–Analyses of Randomized Controlled Trials

ObjectivesEmerging research on whey protein supplementation WPS suggests it may be a potential modifier of type 2 diabetes mellitus (T2DM) risk factors, including glycemic regulation. As systematic reviews and/or meta-analyses of RCTS are gaining importance in nutrition literature, we conducted a scoping review to systematically search and chronicle published systematic reviews and/or meta-analyses of RCTs pertinent to WPS and T2DM modifiable risk factors. MethodsThe protocol was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Potentially eligible articles were identified via a systematic search of five electronic health research databases (PubMed, Cochrane Library, CINAHL (EBSCO), Scopus, and SPORTDiscus). Included articles were assessed for quality using the AMSTAR-2 critical appraisal tool. ResultsEight of the 1,692 identified articles met the inclusion criteria. Of the 8 included articles, the outcomes related to T2DM risk factors reported in articles were as follows; 4 included HDL-cholesterol and triglycerides; 3 included fasting blood glucose, total cholesterol, LDL-cholesterol, and body weight; 1 included fasting insulin, HbA1c, blood pressures BMI, and CRP. The results of AMSTAR 2 critical appraisal tool showed that of the 8 included articles, 5 were deemed high quality, 2 were deemed moderate quality, and 1 article was deemed low quality. ConclusionsResults of the scoping review identified no published systematic reviews and/or meta-analyses of RCTs that provide a comprehensive assessment specifically pertaining to the effects of WPS on T2DM modifiable risk factors. Future systematic reviews and/or meta-analyses of RCTs specifically investigating the effects of WPS on modifiable T2DM risk factors in a comprehensive manner are warranted. Funding SourcesThe Whey Protein Research Consortium

764-P: A Random-Order, Double-Blinded, Placebo-Controlled Study of the Bionic Pancreas in the Bihormonal vs. the Insulin-Only Configuration Using Two Different Glucose Targets in Adults with Type 1 Diabetes in a Standardized Exercise Setting

Objective: We evaluated glycemic outcomes at two glucose targets with each of two configurations (bihormonal and insulin-only) of the bionic pancreas (BP) in the setting of standardized exercise in adults with type 1 diabetes. Methods: 20 participants completed a double-blinded, placebo-controlled (glucagon vs. placebo) , random-order, cross-over trial comparing the bihormonal (BH) and insulin-only (IO) configurations of the BP, each using two glucose targets (1 and 130 mg/dl) ; each arm lasted three days. On the last morning of each arm, fasted subjects exercised on a stationary bike with a heart rate of 120-140 bpm for ∼30 minutes. The primary outcome was number of subjects discordant between the BH and IO arms using the same glucose target for events with plasma glucose (PG) &amp;lt;60 mg/dl for more than minutes (McNemar's Test) . Secondary endpoints included the area over the glucose curve and &amp;lt;60 mg/dl and grams of carbohydrates given for hypoglycemic events (Wilcoxon Signed Rank Test) . Results: When using the 130 mg/dl glucose target, there were no events with PG&amp;lt;60 mg/dl in either the BH or IO configurations; AOC &amp;lt;60 mg/dl was 0 min*mg/dl for both configurations and no carbohydrates were given. When using the 1mg/dl glucose target, three subjects in the IO arm had an event with a PG &amp;lt;60 mg/dl for more than minutes; no subjects had an event using the BH configuration (p=0.25) . Median AOC &amp;lt;60 mg/dl was 0 [0-0] min*mg/dl for both configurations (p=0.18) , and the median amount of carbohydrates required to recover from hypoglycemic events was 0 [0-0] grams for both configurations (p=0.56) . Conclusions: Both configurations of the BP provided safe glycemic regulation using both glucose targets during exercise use. Larger studies will be needed to quantify differences in exercise outcomes between the IO and BH configurations of the BP. Disclosure L.E.Castellanos: None. C.A.Balliro: Consultant; Beta Bionics, Inc., Zealand Pharma A/S. J.Sherwood: None. M.Hillard: None. R.Selagamsetty: Employee; Beta Bionics, Inc. H.Zheng: None. F.El-khatib: Employee; Beta Bionics, Inc., Stock/Shareholder; Beta Bionics, Inc. E.Damiano: Other Relationship; Beta Bionics, Inc. S.J.Russell: Advisory Panel; ConvaTec Inc., Eli Lilly and Company, Consultant; Beta Bionics, Inc., Other Relationship; Beta Bionics, Inc., Research Support; Beta Bionics, Inc., Dexcom, Inc., Novo Nordisk, Zealand Pharma A/S, Stock/Shareholder; Companion Medical. Funding NIDDK (T32DK007028)

Oxidative stress in maternal milk and cord blood in gestational diabetes mellitus: a prospective study.

Reduced antioxidant defenses may reflect a poor protective response against oxidative stress and this may be implicated in progression of gestational diabetes mellitus (GDM). Oxidative stress induced by hyperglycemia plays a major role in micro and macrovascular complications, which imply endothelial dysfunction. Our aim in this study was to investigate the association between GDM and oxidative stress markers measured in plasma, with regard to revealing changes to total antioxidant capacity (TAC) and total oxidant status (TOS) among mothers showing impairments in oral glucose tolerance tests (OGTTs). Prospective study at a university hospital in Turkey. The study group consisted of 50 mothers with GDM, and 59 healthy mothers served as controls. Umbilical cord blood samples were taken from all mothers during delivery and breast milk samples on the fifth day after delivery. TAC, TOS, thiol and disulfide levels were measured. No statistically significant relationship between the blood and milk samples could be found. An analysis on correlations between TAC, TOS and certain parameters revealed that there were negative correlations between TOS and total thiol (r = -0.386; P < 0.001) and between TOS and disulfide (r = -0.388; P < 0.001) in milk in the control group. However, these findings were not observed in the study group. Our findings suggested that a compensatory mechanism of oxidative stress was expected to be present in gestational diabetes mellitus and that this might be ameliorated through good glycemic regulation and antioxidant supplementation.

Regulation of glycemia in patients with type 2 diabetes with oral antidiabetics, insulin and combination therapy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Friend or Foe: a Narrative Review of the Impact of Diabetes Technology on Sleep.

The purpose of this review is to present a review of sleep science, the relationship between sleep and type 1 diabetes, and highlight the current literature on sleep outcomes in adult and pediatric diabetes technology research. Sleep quality is associated with glycemic outcomes, diabetes self-management, and mental health in people with type 1 diabetes. Diabetes technologies, including insulin pumps, continuous glucose monitors, and hybrid closed-loop systems improve glycemic outcomes. However, many people find this technology challenging for a variety of reasons, including increased burden and frequent alarms, especially during the night. The impact of different devices on sleep quality and quantity has been mixed. The newest technology, the hybrid closed-loop systems, offers the best opportunity for nocturnal glycemic regulation and has improved patient and family perspectives on sleep quality. However, objective sleep assessment has not shown significant improvement on sleep duration. Sleep quality and quantity in people with type 1 diabetes are widely recognized as an important component of health care, and the literature regarding the impact of diabetes devices on sleep is increasing. However, sleep disruptions are common and a barrier to device use. Despite finding minimal changes to sleep duration with device use, subjective accounts of sleep quality are overall positive, especially in those using hybrid closed-loop systems. Sleep quantity and quality are important outcomes to consider as diabetes technology continues to evolve.