Impact of Diabetic Ketoacidosis on Thyroid Function in Patients with Diabetes Mellitus

Background. Changes in thyroid function in diabetes patients who developed diabetic ketoacidosis (DKA) still need to be fully elucidated. The aim of this study was to systematically review available data on the relationship between thyroid function and DKA in diabetes patients who developed DKA. Methods. Electronic databases (PubMed, EMBASE, Cochrane Library, and China Academic Journal Full-text Database (CNKI)) were searched systematically to search relevant literature before December 2020. The mean ± standard deviation and 95% confidence interval (95% CI) were used for evaluation, and sensitivity analysis was performed. Publication bias was estimated by funnel plot, Egger’s test, and Begger’s test. Results. 29 studies were included in the meta-analysis, and the indicators (T4, T3, FT3, FT4, TSH, T3RU, and rT3) of patients with DKA were compared and analyzed. The results of this study showed that the levels of T4, T3, FT3, FT4, and TSH were decreased and the level of rT3 was increased in patients with DKA. Compared with after treatment, the levels of T4, T3, FT3, and FT4 in patients with DKA were decreased before treatment, while the levels of rT3 were increased, and there was no significant difference in changes of TSH. With the aggravation of DKA, the levels of T4, T3, FT3, and FT4 will further decrease, while the changes of TSH have no statistical difference. Conclusion. Thyroid function changed in diabetic patients with DKA. It changed with the severity of DKA. This condition may be transient, preceding further recovery of DKA.

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The Association Between Hypoglycemic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

10.1101/2021.01.26.21250506 ◽

2021 ◽

Author(s):

Tiantian Han ◽

Shaodi Ma ◽

Chenyu Sun ◽

Huimei Zhang ◽

Guangbo Qu ◽

...

Keyword(s):

Fixed Effects ◽

Meta Analysis ◽

Relevant Literature ◽

Hypoglycemic Agents ◽

Cochrane Library ◽

Diabetic Patients ◽

China National Knowledge Infrastructure ◽

Service Platform ◽

Patients With Diabetes ◽

Composite Outcomes

AbstractBackgroundDuring the current Coronavirus Disease 2019 (COVID-19) pandemic, diabetic patients face disproportionately more. Anti-inflammatory effects of hypoglycemic agents have been reported, and their beneficial or harmful effects in patients with diabetes and COVID-19 remain controversial.PurposeThis study was performed to clarify this association.Data SourcesRelevant literature was searched on China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, Chinese periodical service platform VIP Database, Sinomed (China Biology Medicine, CBM), MedRxiv, PubMed, ScienceDirect, Web of Science, Ovid Databases (LWW), Springer Link, Wiley Online Library, Oxford Academic, Nature Press Group, Cochrane Library and BMJ Evidence-Based Medicine up to November 14, 2020.Study SelectionOnly observational studies of hypoglycemic agents vs. drugs or therapy without hypoglycemic agents in adult diabetic patients with COVID-19 were included.Data ExtractionData of death and poor composite outcomes were extracted.Data SynthesisThe pooled effects were calculated using the fixed-effects or random-effects models based on heterogeneity assessment.LimitationMost studies were retrospective cohort studies with relative weak capability to verify causality.ConclusionHome use of metformin might be beneficial in decreasing mortality in diabetic patients infected with SARS-CoV-2. There is insufficient evidence to conclude that metformin and other hypoglycemic agents are associated with poor composite outcomes. More prospective studies, especially RCTs are needed.Registration-PROSPEROCRD42020221951.

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Combined Therapy of Hypertensive Nephropathy with Breviscapine Injection and Antihypertensive Drugs: A Systematic Review and a Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/2958717 ◽

2018 ◽

Vol 2018 ◽

pp. 1-17 ◽

Cited By ~ 8

Author(s):

Lihua Wu ◽

Ming Liu ◽

Zhuyuan Fang

Keyword(s):

Clinical Efficacy ◽

Antihypertensive Drugs ◽

Combined Therapy ◽

Meta Analysis ◽

Relevant Literature ◽

Cochrane Library ◽

Lower Systolic Blood Pressure ◽

Hypertensive Nephropathy ◽

Chinese Populations ◽

Significant Difference

Objective. To evaluate the beneficial and adverse effects of breviscapine injection in combination with antihypertensive drugs for treating hypertensive nephropathy in clinical practice. Methods. We searched PubMed, the Cochrane Library, Embase, CNKI, Sino Med, VIP, and Wanfang Data for relevant literature. The timeframe of retrieval was set from the founding date of each database to September 28, 2018. Results. Fourteen papers were included in this study. The quality of all the studies included was determined to be low. All studies were conducted with Chinese populations. Meta-analysis showed that, compared with single-use antihypertensive drugs, using breviscapine injection in combination with antihypertensive drugs to treat hypertensive nephropathy can reduce serum creatinine (Scr) [WMD = –35.16, 95% CI(–50.01, –20.31), P ≤ 0.001], blood urea nitrogen (BUN) [WMD = –2.00, 95% CI(–3.07, –0.94), P ≤ 0.001], 24-hour urinary total protein (24 h UTP) [WMD = –0.04, 95% CI(–0.05, –0.02), P ≤ 0.001], and the beta-2-microglobulin (B2M) [WMD = –0.09, 95% CI(–0.11, –0.07), P ≤ 0.001], improve creatinine clearance rate (Ccr) [WMD = 7.84, 95% CI(5.20, 10.49), P ≤ 0.001], and increase the clinical efficacy [RR = 1.27, 95% CI(1.05, 1.53), P = 0.014], but does not lower systolic blood pressure (SBP) [WMD = –1.02, 95% CI(–2.88, 0.84), P = 0.281]. There was no significant difference in adverse events between experimental groups and control groups. Conclusion. Breviscapine injection in combination with antihypertensive drugs can improve clinical efficacy and Ccr and reduce Scr, BUN, 24 h UTP, and B2M in patients with hypertensive nephropathy. The present meta-analysis indicated that breviscapine injection can serve as a renal protective effect to patients with hypertensive nephropathy. However, the evidence of methodological quality and sample sizes is weak, and thus, further standardized research is required.

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Association of Preadmission Metformin Use and Prognosis in Patients With Sepsis and Diabetes Mellitus: A Systematic Review and Meta-Analysis

Frontiers in Endocrinology ◽

10.3389/fendo.2021.811776 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yuanzhe Li ◽

Huayan Zhao ◽

Yalin Guo ◽

Yongtao Duan ◽

Yanjun Guo ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Lactic Acid ◽

Serum Creatinine ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Difference ◽

Patients With Diabetes ◽

Newcastle Ottawa Scale

Background and AimA growing body of evidence suggests that preadmission metformin use could decrease the mortality of septic patients with diabetes mellitus (DM); however, the findings remain controversial. Therefore, this meta-analysis was conducted on available studies to confirm the relationship between preadmission metformin use and mortality in patients with sepsis and DM.MethodsA comprehensive search of the PubMed, Embase, and Cochrane Library databases was performed for studies published before August 8, 2021. Observational studies assessing the correlation between metformin use and mortality in patients with sepsis and DM were considered eligible studies. We used the Newcastle–Ottawa Scale (NOS) to assess the outcome quality of each included article. Furthermore, the odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed using the inverse variance method with random effects modeling.ResultsEleven articles including 8195 patients were analyzed in this meta-analysis. All the included articles were scored as low risk of bias. Our results showed that preadmission metformin use had a lower mortality rate (OR, 0.74; 95% CIs, 0.62–0.88, P < 0.01) in patients with sepsis and DM. Surprisingly, there was no statistically significant difference in the levels of serum creatinine (weighted mean difference (WMD), 0.36; 95% CIs, −0.03–0.75; P = 0.84) and lactic acid (WMD, −0.16; 95% CIs, −0.49–0.18; P = 0.07) between preadmission metformin use and non-metformin use.ConclusionsThis study is the most comprehensive meta-analysis at present, which shows that preadmission metformin use may reduce mortality and not increase the levels of serum creatinine and lactic acid in adult patients with sepsis and DM. Therefore, these data suggest that the potential efficacy of metformin could be assessed in future clinical studies.Systematic Review Registrationhttps://inplasy.com/?s=INPLASY2021100113, identifier INPLASY2021100113.

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Prevalence of Erectile Dysfunction in Patients with Diabetes Mellitus and Its Association with Body Mass Index and Glycated Hemoglobin in Africa: A Systematic Review and Meta-Analysis

International Journal of Endocrinology ◽

10.1155/2020/5148370 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Wondimeneh Shibabaw Shiferaw ◽

Tadesse Yirga Akalu ◽

Yared Asmare Aynalem

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Erectile Dysfunction ◽

Body Mass ◽

Glycated Hemoglobin ◽

Meta Analysis ◽

Cochrane Library ◽

Diabetic Patients ◽

Pooled Prevalence ◽

Patients With Diabetes

Background. Mortality and morbidity in patients with diabetes mellitus (DM) are attributed to both microvascular and macrovascular complications. However, there is a significant amount of variation in the primary studies on DM regarding the prevalence of erectile dysfunction (ED) in Africa. Therefore, this study was aimed to estimate the pooled prevalence of ED patients with DM and its association with body mass index (BMI) and glycated hemoglobin in Africa. Methods. PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were searched for studies that looked at ED in DM patients. A funnel plot and Egger’s regression test were used to determine publication bias. The I2 statistic was used to check heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. The subgroup and meta-regression analyses were conducted by country, sample size, and year of publication. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. STATA version 14 statistical software was used for the meta-analysis. Result. A total of 13 studies with 3,501 study participants were included in this study. We estimated that the pooled prevalence of ED in patients with DM in Africa was 71.45% (95% CI: 60.22–82.69). Diabetic patients whose BMI was ≥30 kg/m2 were 1.26 times more likely to develop ED (AOR = 1.26; 95% CI: 0.73–2.16) and whose glycated hemoglobin was <7% were 7% less likely to develop ED (AOR = 0.93; 95% CI: 0.5–5.9), although they were not significantly associated with ED. Conclusions. The prevalence of ED in DM patients in Africa remains high. Therefore, situation-based interventions and country context-specific preventive strategies should be developed to reduce the prevalence of ED among patients with DM.

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The Effects of Exenatide Once Weekly (EXQW) and Exenatide Twice a Day (EXBID) on Beta-Cell Function in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis

Journal of Diabetes Research ◽

10.1155/2019/8083417 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Jie Wang ◽

Xinye Jin ◽

Ping An ◽

Songyan Yu ◽

Yiming Mu

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Cell Function ◽

Meta Analysis ◽

Cochrane Library ◽

Diabetic Patients ◽

Antidiabetic Agents ◽

Significant Difference ◽

Glucagon Like Peptide 1

Background. In patients with type 2 diabetes mellitus (T2DM) and poor glycemic control receiving metformin (MET), glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recommended as the adjunctive therapy. However, there are only a few studies involving the comparative effects of exenatide twice a day (EXBID) and exenatide once weekly (EXQW) on HOMA-β. This meta assessed the comparative effects of EXQW and EXBID on HOMA-β among T2DM patients. Materials and Methods. PubMed, Cochrane Library, and Embase databases were searched to collect randomized controlled trials (RCTs). Network meta-analysis was performed, and network diagrams were constructed to evaluate the effects. The primary outcome is HOMA-β, and the secondary outcomes are fasting blood glycose (FBG), glycated hemoglobin (HbA1c), and weight loss. Results. A total of 8 studies with 3506 subjects were included. Compared with other antidiabetic agents, EXQW has a greater improvement in HOMA-β than EXBID (weight mean difference WMD=‐0.46, 95% confidence interval (CI) [-0.64, -0.28], P=0.001). The effect of EXQW on HbA1c is superior to that of sitagliptin (SITA) (WMD=0.51, 95% CI [0.03, 0.99], P=0.037). The significant reduction of weight was detected for EXBID in comparison with EXQW (WMD=‐0.73, 95% CI [-1.13, -0.33], P=0.001), and no significant difference was found between EXQW and MET. Conclusions. EXQW shows a greater improvement in HOMA-β than EXBID. Moreover, the efficacy of EXQW on glycemic control is similar to other antidiabetic agents including EXBID. It is an advisable treatment for diabetic patients to improve HOMA-β and has an advantage of fewer number of injections compared with EXBID, to increase patients’ adherence and quality of life.

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Systematic review and meta-analysis for prevention of cardiovascular complications using GLP-1 receptor agonists and SGLT-2 inhibitors in obese diabetic patients

Scientific Reports ◽

10.1038/s41598-021-89620-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kazushi Uneda ◽

Yuki Kawai ◽

Takayuki Yamada ◽

Sho Kinguchi ◽

Kengo Azushima ◽

...

Keyword(s):

Meta Analysis ◽

Indirect Comparison ◽

Cardiovascular Complications ◽

Cochrane Library ◽

Major Adverse Cardiovascular Events ◽

Diabetic Patients ◽

Receptor Agonists ◽

Sodium Glucose Cotransporter ◽

Significant Difference ◽

Glucagon Like Peptide 1

AbstractPatients with type 2 diabetes mellitus (T2DM) and obesity are at high risk of developing cardiovascular disease (CVD). Both glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter (SGLT-2) inhibitors have been shown to prevent CVD in T2DM patients. Additionally, the two drugs reduce body mass. However, it is unknown which drug is more effective at reducing the risk of CVD in such patients. We searched Medline, EMBASE, and Cochrane Library records to February 20, 2021 and performed a network meta-analysis to compare the efficacy with which the drugs reduced the risk of major adverse cardiovascular events (MACE). We included 102,728 patients in 12 studies containing data of obesity subgroup analyses. In T2DM patients with obesity, GLP-1 RAs significantly reduced the risk of MACE versus placebo (relative risk, RR [95% confidence interval, CI]: 0.88 [0.81–0.96]), whereas SGLT-2 inhibitors showed a tendency (RR [95% CI]: 0.91 [0.83–1.00]). In an indirect comparison, GLP-1 RAs were not associated with a significant difference in MACE compared with SGLT-2 inhibitors (RR [95% CI]: 0.97 [0.85–1.09]). Thus, GLP-1 RAs are effective at preventing MACE than placebo in T2DM patients with obesity, although further studies are warranted to conclude their superiority to SGLT-2 inhibitors.

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Burden and Determinants of Chronic Kidney Disease Among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis

Public Health Reviews ◽

10.3389/phrs.2021.1603969 ◽

2021 ◽

Vol 42 ◽

Author(s):

Tadesse Tolossa ◽

Getahun Fetensa ◽

Bikila Regassa ◽

Mekdes Tigistu Yilma ◽

Merga Besho ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Random Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Diabetic Patients ◽

Special Focus ◽

Significant Heterogeneity ◽

Random Effects Model ◽

Patients With Diabetes

Background: Chronic kidney disease (CKD) among diabetic patients is becoming a global health burden with a high economic cost to health systems. The incidence of CKD is higher in low-income countries such as Ethiopia. In Ethiopia, there is no national representative evidence on the burden and determinants of CKD among patients with diabetes. Therefore, this review aimed to estimates the pooled burden and determinants of CKD among patients with diabetes.Methods: Published articles from various electronic databases such as Pub Med, Google Scholar, CINAHL, Scopes, Cochrane library, the Web of Science, and African Journals Online were accessed. Also, unpublished studies from Addis Ababa digital library were identified. We included all observational studies (cross-sectional, case-control, and cohort) in the review. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled burden and determinants of chronic kidney disease among diabetic patients. The presence of publication bias was assessed by funnel plots and Egger’s statistical tests.Results: Published (297) and unpublished (2) literature were identified from several databases and digital libraries, of which twelve articles were selected for final meta-analysis. Significant heterogeneity was observed across studies (I2 = 85.2%), which suggests a random-effects model to estimate pooled burden. The analysis found that the pooled burden of CKD among patients with diabetes was 18.22% (95% CI: 15.07–21.38). Factors such as hypertension (OR = 2.65, 95%, CI: 1.38, 5.09), type of DM (OR = 0.33, 95%, CI: 0.14–0.76), and duration of DM (OR = 0.51, 95%, CI: 0.34–0.77) were found to have significant association with CKD.Conclusion: The current review revealed a higher burden of CKD among patients with diabetes in Ethiopia. The presence of hypertension, type II diabetes, and duration of diabetes for a longer duration were found to be independent determinants of CKD among patients with diabetes. For better control of chronic kidney disease, integrated management of hypertension and DM should be designed with a special focus on chronic diabetic patients.

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Is Use of Topical Vancomycin in Pediatric Spine Surgeries a Safe Option in the Prevention of Surgical Site Infections? A Meta-analysis and Systematic Review of the Literature

Global Spine Journal ◽

10.1177/2192568220937286 ◽

2020 ◽

pp. 219256822093728

Author(s):

Muthu Sathish ◽

Chellamuthu Girinivasan

Keyword(s):

Systematic Review ◽

Safety Profile ◽

Meta Analysis ◽

Relevant Literature ◽

Surgical Site Infections ◽

Reoperation Rate ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Pediatric Spine ◽

Significant Difference

Study Design: Systematic review and meta-analysis. Objective: To systematically review the available articles on topical vancomycin powder (TVP) use in pediatric spine surgeries exploring the usefulness and safety of such practice. Methods: We conducted an independent and duplicate electronic database search in PubMed, EMBASE, and Cochrane Library till March 2020 to identify all relevant literature on the use of TVP for pediatric spine surgeries. Surgical site infection (SSI) rate, specific reported complications, reoperation rate, microbial flora pattern in reported SSIs, and safety profile were the outcomes analyzed. Analysis was performed with the R platform using OpenMeta[Analyst] software. Results: No prospective studies were available to evaluate the use of TVP in pediatric spine surgeries for the prevention of SSIs. Neither standardized protocol, nor drug dosage, nor safety profile was established for pediatric use. Three retrospective cohort studies including 824 patients (TVP/control: 400/424) were included in the meta-analysis. There was low-quality evidence suggesting no significant difference between the 2 groups in SSI rate (RR = 0.474; 95% CI = [0.106,2.112]; P = .327) with significant heterogeneity ( I 2 = 70.14; P = .035). The TVP group showed a significant benefit on cost analysis in one of the included studies. However, TVP did not prevent gram-negative coinfection on SSI in the TVP group. Conclusion: From the literature available at present, TVP does not qualify to be recommended as a safe and useful option to prevent SSI following pediatric spine surgeries. High-quality prospective interventional studies are needed to arrive at a consensus on its use along with appropriate dosage and method of application.

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Candida species oral detection and infection in patients with diabetes mellitus: a meta-analysis

Iberoamerican Journal of Medicine ◽

10.53986/ibjm.2021.0020 ◽

2021 ◽

Vol 3 (2) ◽

pp. 115-121

Author(s):

Alberto Rodríguez-Archilla ◽

◽

Claudia Piedra-Rosales ◽

Keyword(s):

Diabetes Mellitus ◽

Candida Species ◽

Fungal Infections ◽

Meta Analysis ◽

Oral Candidiasis ◽

Cochrane Library ◽

Diabetic Patients ◽

Oral Infections ◽

Glucose Levels ◽

Patients With Diabetes

Introduction: Diabetes mellitus is a chronic metabolic disorder that induces elevated plasma glucose levels. Diabetic patients are more susceptible to infections, especially fungal infections. There is a direct relationship between increased blood glucose levels and the number of Candida hyphae in the oral mucosa. This study aimed to evaluate oral candidiasis and the different Candida species found in patients with and without diabetes mellitus. Methods: A search for studies on oral candidiasis and diabetes mellitus was carried out in the following databases: PubMed (MEDLINE, Cochrane Library), Web of Science (WoS) and Google Scholar. For dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios (OR) using the Mantel-Haenszel (M-H) method with 95% confidence intervals. Results: 25 studies were included in this meta-analysis. Diabetes Mellitus patients tripled the probability of being infected by Candida species (OR:3.16, p<0.001). Likewise, Candida species infections were more likely in patients with poor glycemic control (OR:2.94, p<0.001) and with dentures (OR:2.22, p<0.001). In contrast, neither gender nor diabetes mellitus type of diabetes conditioned fungal infections (p>0.05). The most prevalent Candida species in both diabetics and controls were C. albicans and C. tropicalis. Diabetics had significantly fewer C. non-albicans species oral infections than non-diabetics (p=0.04). Conclusions: Diabetics are more prone to oral candidiasis, especially C. albicans infections.

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Role of Whole Grain Consumption in Glycaemic Control of Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutrients ◽

10.3390/nu14010109 ◽

2021 ◽

Vol 14 (1) ◽

pp. 109

Author(s):

Dengfeng Xu ◽

Lingmeng Fu ◽

Da Pan ◽

Yifei Lu ◽

Chao Yang ◽

...

Keyword(s):

Systematic Review ◽

Glycaemic Control ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Diabetic Patients ◽

Controlled Trials ◽

Whole Grain ◽

Randomized Controlled ◽

Significant Difference

Background: Observational studies have indicated beneficial effects of whole grain consumption on human health. However, no evidence based on randomized controlled trials has been established. Our objective was to perform a systematic review and meta-analysis of randomized controlled trials to assess the effects of whole grain consumption in glycaemic control of diabetic patients. Methods: A comprehensive search in four databases (Web of Science, Pubmed, Scopus and Cochrane library) was conducted to collect potential articles which measured the roles of whole grain consumption on glycaemic control up to October 2021. Results: A total of 16 eligible trials involving 1068 subjects were identified to evaluate the pooled effect. The overall results indicated that compared with the control group, whole grain intake presented a significantly reduced concentration in fast plasma glucose (WMD = −0.51mmol/L, 95% CI: −0.73, −0.28; = 88.6%, p < 0.001), a homeostasis model assessment of insulin resistance (WMD = −0.39μU × mol/L2, 95% CI: −0.73, −0.04; = 58.4%, p = 0.014), and glycosylated haemoglobin (WMD = −0.56%, 95% CI: −0.88, −0.25, = 88.5%, p < 0.001), while no significant difference was observed in fast plasma insulin level between groups (SMD = −0.05, 95% CI: −0.25, 0.14; = 40.7%, p = 0.120). In terms of incremental area under the curve (iAUC), data suggested that whole grain effected a significant decrease in Glucose-iAUC (WMD = −233.09 min × mmol/L, 95% CI: −451.62, −14.57; = 96.1%, p < 0.001) and Insulin-iAUC (SMD = −4.80, 95% CI: −8.36, −1.23; = 89.9%, p = 0.002), although only in a small number of studies. Of note, there is evidence for modest unexplained heterogeneity in the present meta-analysis. Conclusion: Whole grain consumption confers a beneficial effect on glucose metabolism in patients with diabetes. Regrettably, since relevant studies were scarce, we failed to provide confident evidence of whole grain consumption on acute effects including Glucose-iAUC and Insulin-iAUC, which should be addressed in further trials.

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