scholarly journals Triangulating evidence for the causal impact of single-dose zinc supplement on glycemic control for type-2 diabetes

2021 ◽  
Author(s):  
Zhiyang Wang ◽  
Carine Ronsmans ◽  
Benjamin Woolf
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Fasting Glucose ◽  
Causal Effect ◽  
Fasting Blood Glucose ◽  
Zinc Supplement ◽  
Diabetes Patients

Background: Although previous studies suggested the protective effect of zinc for type-2 diabetes, the unitary causal effect remains inconclusive. Objective: We investigated the causal effect of zinc as a single intervention on glycemic control in type-2 diabetes patients, using a systematic review of RCTs and two-sample Mendelian randomization (MR). Methods: Four outcomes were identified: fasting blood glucose/fasting glucose, hemoglobin A1c (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), and serum insulin/fasting insulin level. In the systematic review, four databases were searched up to June 2021. Results were synthesized through the random-effects meta-analysis. Single nucleotide polymorphisms (SNPs) that are independent and are strongly related to zinc supplements were selected from MR-base to perform the two-sample MR with inverse-variance weighted (IVW) coefficient. Results: In the systematic review, 14 trials were included. The zinc supplement led to a significant reduction in the post-trial mean of fasting blood glucose (mean difference (MD): -26.52, 95%CI: -35.13, -17.91), HbA1C (MD: -0.52, 95%CI: -0.90, -0.13), and HOMA-IR (MD: -1.65, 95%CI: -2.62, -0.68), compared to the control group. In the two-sample MR, zinc supplement with 2 SNPs associated with lower fasting glucose (IVW coefficient: -2.04, 95%CI: -3.26, -0.83), but not specified type-2 diabetes. Conclusion: Although the study was limited by the few trials (review) and SNPs (two-sample MR), we demonstrated that the single zinc supplementary improved glycemic control among type-2 diabetes patients with causal evidence to a certain extent.

scholarly journals The Effects of Almonds on Gut Microbiota, Glycometabolism, and Inflammatory Markers in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3377
Author(s):  
Omorogieva Ojo ◽  
Xiao-Hua Wang ◽  
Osarhumwese Osaretin Ojo ◽  
Amanda Rodrigues Amorim Adegboye
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Gut Microbiota ◽  
Inflammatory Markers ◽  
Meta Analysis ◽  
Fasting Blood Glucose ◽  
Glycated Haemoglobin ◽  
Postprandial Blood Glucose

The use of nutritional interventions for managing diabetes is one of the effective strategies aimed at reducing the global prevalence of the condition, which is on the rise. Almonds are the most consumed tree nut and they are known to be rich sources of protein, monounsaturated fatty acids, essential minerals, and dietary fibre. Therefore, the aim of this review was to evaluate the effects of almonds on gut microbiota, glycometabolism, and inflammatory parameters in patients with type 2 diabetes. Methods: This systematic review and meta-analysis was carried out according to the preferred reporting items for systematic review and meta-analysis (PRISMA). EBSCOhost, which encompasses the Health Sciences Research Databases; Google Scholar; EMBASE; and the reference lists of articles were searched based on population, intervention, control, outcome, and study (PICOS) framework. Searches were carried out from database inception until 1 August 2021 based on medical subject headings (MesH) and synonyms. The meta-analysis was carried out with the Review Manager (RevMan) 5.3 software. Results: Nine randomised studies were included in the systematic review and eight were used for the meta-analysis. The results would suggest that almond-based diets have significant effects in promoting the growth of short-chain fatty acid (SCFA)-producing gut microbiota. Furthermore, the meta-analysis showed that almond-based diets were effective in significantly lowering (p < 0.05) glycated haemoglobin (HbA1c) levels and body mass index (BMI) in patients with type 2 diabetes. However, it was also found that the effects of almonds were not significant (p > 0.05) in relation to fasting blood glucose, 2 h postprandial blood glucose, inflammatory markers (C-reactive protein and Tumour necrosis factor α, TNF-α), glucagon-like peptide-1 (GLP-1), homeostatic model assessment of insulin resistance (HOMA–IR), and fasting insulin. The biological mechanisms responsible for the outcomes observed in this review in relation to reduction in HbA1c and BMI may be based on the nutrient composition of almonds and the biological effects, including the high fibre content and the low glycaemic index profile. Conclusion: The findings of this systematic review and meta-analysis have shown that almond-based diets may be effective in promoting short-chain fatty acid-producing bacteria and lowering glycated haemoglobin and body mass index in patients with type 2 diabetes compared with control. However, the effects of almonds were not significant (p > 0.05) with respect to fasting blood glucose, 2 h postprandial blood glucose, inflammatory markers (C-reactive protein and TNF-α), GLP-1, HOMA–IR, and fasting insulin.

scholarly journals The Effect of Diabetes-Specific Enteral Nutrition Formula on Cardiometabolic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta–Analysis of Randomised Controlled Trials

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1905 ◽  
Author(s):  
Omorogieva Ojo ◽  
Sharon Marie Weldon ◽  
Trevor Thompson ◽  
Rachel Crockett ◽  
Xiao-Hua Wang
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Sensitivity Analysis ◽  
Blood Glucose ◽  
Enteral Nutrition ◽  
Lipid Profile ◽  
Meta Analysis ◽  
Fasting Blood Glucose ◽  
Hdl Cholesterol

Background: The prevalence of diabetes is on the increase in the UK and worldwide, partly due to unhealthy lifestyles, including poor dietary regimes. Patients with diabetes and other co-morbidities such as stroke, which may affect swallowing ability and lead to malnutrition, could benefit from enteral nutrition, including the standard formula (SF) and diabetes-specific formulas (DSF). However, enteral nutrition presents its challenges due to its effect on glycaemic control and lipid profile. Aim: The aim of this review was to evaluate the effectiveness of diabetes-specific enteral nutrition formula versus SF in managing cardiometabolic parameters in patients with type 2 diabetes. Method: This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses. Three databases (Pubmed, EMBASE, PSYCInfo) and Google scholar were searched for relevant articles from inception to 2 January 2019 based on Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. Key words, Medical Subject Heading (MeSH) terms, and Boolean operators (AND/OR) formed part of the search strategy. Articles were evaluated for quality and risks of bias. Results: Fourteen articles were included in the systematic review and five articles were selected for the meta-analysis. Based on the findings of the review and meta-analysis, two distinct areas were evident: the effect of DSF on blood glucose parameters and the effect of DSF on lipid profile. All fourteen studies included in the systematic review showed that DSF was effective in lowering blood glucose parameters in patients with type 2 diabetes compared with SF. The results of the meta-analysis confirmed the findings of the systematic review with respect to the fasting blood glucose, which was significantly lower (p = 0.01) in the DSF group compared to SF, with a mean difference of −1.15 (95% CI −2.07, −0.23) and glycated haemoglobin, which was significantly lower (p = 0.005) in the DSF group compared to the SF group following meta-analysis and sensitivity analysis. However, in relation to the sensitivity analysis for the fasting blood glucose, differences were not significant between the two groups when some of the studies were removed. Based on the systematic review, the outcomes of the studies selected to evaluate the effect of DSF on lipid profile were variable. Following the meta-analysis, no significant differences (p > 0.05) were found between the DSF and SF groups with respect to total cholesterol, LDL cholesterol and triglyceride. The level of the HDL cholesterol was significantly higher (p = 0.04) in the DSF group compared to the SF group after the intervention, with a mean difference of 0.09 (95% CI, 0.00, 0.18), although this was not consistent based on the sensitivity analysis. The presence of low glycaemic index (GI) carbohydrate, the lower amount of carbohydrate and the higher protein, the presence of mono-unsaturated fatty acids and the different amounts and types of fibre in the DSF compared with SF may be responsible for the observed differences in cardiometabolic parameters in both groups. Conclusion: The results provide evidence to suggest that DSF is effective in controlling fasting blood glucose and glycated haemoglobin and in increasing HDL cholesterol, but has no significant effect on other lipid parameters. However, our confidence in these findings would be increased by additional data from further studies.

Management of Patients with Type 2 Diabetes by Pharmacists in Primary Care Clinics

1998 ◽  
Vol 32 (6) ◽  
pp. 636-641 ◽  
Author(s):  
Elizabeth A Coast-Senior ◽  
Beverly A Kroner ◽  
Catherine L Kelley ◽  
Lauren E Trilli
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Face To Face ◽  
Primary Care Clinics ◽  
Blood Glucose Concentrations

OBJECTIVE: To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus. DESIGN: Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose. The pharmacists provided diabetes education, medication counseling, monitoring, and insulin initiation and/or adjustments. All initial patient interactions with the pharmacists were face-to-face. Thereafter, patient–pharmacist interactions were either face-to-face or telephone contacts. SETTING: Two primary care clinics in a university-affiliated Veterans Affairs Medical Center. PARTICIPANTS: Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control. OUTCOME MEASURES: Primary outcome variables were changes from baseline in glycosylated hemoglobin, fasting blood glucose, and random blood glucose measurements. Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia, and the number of emergency room visits or hospitalizations related to diabetes. Twenty-three veterans aged 65 ± 9.4 years completed the study. Fifteen (65%) patients were initiated on insulin by the pharmacists; 8 (35%) were already using insulin. Patients were followed for a mean ± SD of 27 ± 10 weeks. Glycosylated hemoglobin, fasting blood glucose concentrations, and random blood glucose concentrations significantly decreased from baseline by 2.2% (p = 0.00004), 65 mg/dL (p < 0.01), and 82 mg/dL (p = 0.00001), respectively. Symptomatic hypoglycemic episodes occurred in 35% of patients. None of these episodes required physician intervention. CONCLUSIONS: This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin.

scholarly journals Alterations in Serum Electrolyte Homeostasis in Type-2 Diabetes Mellitus Patients - A Cross-Sectional Study in VIMSAR, Burla

2020 ◽  
Vol 7 (52) ◽  
pp. 3148-3152
Author(s):  
Labanyabati Pattanaik ◽  
Madhusmita Acharya ◽  
Manoj Kumar Yadav ◽  
Prafulla Kumar Mishra ◽  
Madhab Nayak
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Fasting Blood Glucose ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Electrolyte Disturbances ◽  
Uncontrolled Diabetes ◽  
Diabetes Patients

BACKGROUND Type 2 diabetes mellitus is a widely prevalent lifestyle disease associated with high morbidity and mortality due to dead end complications like acute coronary syndrome, chronic kidney failure and acute stroke. Diabetes mellitus patients frequently develop problems of dyselectrolytemia which is common among hospitalised patients with decompensated diabetes. But there is little information on the prevalence of electrolyte disturbances among diabetes patients. Our aim is to find out the pattern of dyselectrolytemia among type 2 diabetes patients and to know if there is any association of blood glucose level with dyselectrolytemia. METHODS An analytical cross-sectional study was done among type 2 diabetes patients admitted in the department of medicine. Fasting blood glucose (FBG), glycosylated haemoglobin level (HbA1c), blood sodium (Na+), potassium (K+) and calcium (Ca2+) were analysed. Occurrence of dyselectrolytemia was compared between patients of very much controlled versus uncontrolled blood glucose levels. RESULTS Out of 199 patients included in the study, 112 (56 %) had uncontrolled diabetes mellitus (DM) with HbA1c level > / = 7.0 %. Occurrence of hyponatremia, hypokalaemia, hyperkalaemia, hypocalcaemia and hypercalcemia were 35 %, 13 %, 7 %, 16 % and 2 % respectively. In diabetes patients, hyponatremia was seen more commonly in patients with uncontrolled DM than those with very much controlled blood glucose (52.67 % versus 12.64 %, p < 0.001). The extent of patients with hypokalaemia or hyperkalaemia didn't vary between the two groups. Patients on insulin treatment were more likely to have hyponatremia than noninsulin patients (p < 0.001). CONCLUSIONS Type 2 DM patients specifically those who have uncontrolled diabetes mellitus have an increased chance to develop dyselectrolytemia. The most well-known electrolyte disturbances seen were hyponatremia followed by hypocalcaemia in our study and they were generally predominant among patients with uncontrolled DM. KEYWORDS Type 2 Diabetes, Dyselectrolytemia, Hyperglycaemia, Fasting Blood Glucose, Hyponatremia

scholarly journals Pre-impaired Fasting Glucose State Is A Risk Factr for Endothelial Dysfunction Flow-mediated Dilation Japan (FMD-J) Study

2020 ◽  
Author(s):  
Takayuki Yamaji ◽  
Takahiro Harada ◽  
Yu Hashimoto ◽  
Yuji Takaeko ◽  
Masato Kajikawa ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Endothelial Dysfunction ◽  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Fasting Blood Glucose ◽  
Large Sample Size ◽  
Clinical Trial Registry ◽  
Significant Difference

Abstract Background There is little information on the relationships of fasting blood glucose (FBG) including high normal blood glucose and impaired fasting glucose (IFG) with endothelial function. The purpose of this study was to evaluate the relationship between FBG level and flow-mediated vasodilation (FMD) in detail using a large sample size. Methods This study was a cross-sectional study. We measured FMD in 7265 subjects at 31 general hospitals. The subjects were divided into four groups based on FBG levels: <5.55 mmol/L, 5.55–6.05 mmol/L, 6.11–6.94 mmol/L, and ≥ 6.99 mmol/L or known type 2 diabetes. The subjects were also divided into six groups based on FBG levels: <5.00 mmol/L, 5.00-5.22 mmol/L, 5.27–5.50 mmol/L, 5.55–6.05 mmol/L, 6.11–6.94 mmol/L, and ≥ 6.99 mmol/L or known type 2 diabetes. Results FMD decreased in relation to increase in FBG level. There was a significant difference in FMD between the FBG of < 5.55 mmol/L group and the other three groups (6.7 ± 3.1% vs. 5.9 ± 2.8%, 5.7 ± 3.1%, and 5.1 ± 2.6%; p < 0.001, respectively). After adjustment for confounding factors, the odds of having the lowest quartile of FMD was significantly higher in the FBG of 5.27–5.50 mmol/L, 5.55–6.05 mmol/L, 6.11–6.94 mmol/L, and ≥ 6.99 mmol/L or known type 2 diabetes groups than in the FBG of < 5.00 mmol/L, group. Conclusions These findings suggest that FBG of 5.55–6.05 mmol/L and FBG of 6.11–6.94 mmol/L are similarly associated with endothelial dysfunction and that a pre-IFG state (FBG of 5.27–5.50 mmol/L) is also a risk for endothelial dysfunction compared with FBG of < 5.00 mmol/L. Clinical Trial Registry Information: http://www.umin.ac.jp (UMIN000012950, UMIN000012951, UMIN000012952, and UMIN000003409)

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