Postprandial plasma glucose excursion is associated with an atherogenic lipid profile in individuals with type 2 diabetes mellitus: A cross-sectional study

Coronary heart disease (CHD) is a prevalent complication of type 2 diabetes mellitus (T2DM). The atherogenic low-density lipoprotein (LDL) cholesterol is an established risk factor of cardiovascular disease, and evidence also suggests that postprandial plasma glucose (PPG) levels closely delineate CHD mortality in diabetes. The investigators hypothesized that postprandial plasma glucose excursion (PPGE), defined as the difference between 2-hour PPG and fasting plasma glucose (FPG), may be associated with plasma LDL cholesterol levels in patients with T2DM. This study enrolled diabetic participants for whom FPG and lipid profile were sampled after a 12-hour fast, followed by PPG sampling two hours after consuming a standard meal with 75 grams of carbohydrates. The study enrolled 379 participants who were divided into PPGE tertiles according to the difference between their 2-hour PPG and FPG. Participants in the highest PPGE tertile had considerably greater plasma LDL cholesterol levels than patients in the lowest tertile (126.7 mg/dL vs. 99.5 mg/dL, P <0.001). Linear regression analysis also demonstrated that the PPGE was positively correlated with plasma LDL cholesterol levels (β coefficient: 0.165, P < 0.001). Postprandial glucose excursion positively correlated with plasma LDL cholesterol levels in individuals with T2DM. Participants with raised PPGE harbored greater LDL cholesterol levels than those with lower postprandial glucose fluctuations. Therefore, postprandial glucose excursion is associated with an atherogenic lipid profile and may be a modifiable risk factor of diabetic CHD.

Riceberry rice (Oryza sativa L.) slows gastric emptying and improves the postprandial glycemic response

Postprandial glycemia is a key determinant of overall glycemic control. One mechanism by which dietary strategies can reduce postprandial glycemic excursions is by slowing gastric emptying. This study aimed to evaluate the acute effect of ingesting riceberry rice (RR) compared to that of ingesting white rice (WR) on gastric emptying rate (GER), plasma glucose, and glucose-regulating hormones, including insulin, glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like peptide 1 (GLP-1), in healthy subjects. A randomized, open-label, within-subject, crossover study was performed in 6 healthy men. GER was measured by scintigraphy over 240 minutes, and plasma concentrations of glucose, insulin, GLP-1 and GIP were measured at multiple time points over 180 minutes. This study revealed that RR slows GER with a reduction in postprandial plasma glucose concentrations compared to WR. Plasma insulin and GLP-1 concentrations did not differ between RR and WR. However, plasma GIP concentrations were markedly increased after WR ingesting versus after RR ingestion. We conclude that RR attenuates postprandial glycemia by slowing GER without altering plasma insulin or GLP-1. Plasma GIP concentrations are likely related to differences in GER and carbohydrate absorption. We propose that dietary fiber-enriched foods, including RR, could contribute to improvement in postprandial glycemia via delayed gastric emptying.

Shenzhuo Formula Treatment in Patients With Macroalbuminuria Secondary to Diabetic Kidney Disease: Protocol Update and Statistical Analysis Plan

BackgroundDiabetic kidney disease (DKD), as one of the significant complications of diabetes, has been the focus of attention. Our previous retrospective study indicated that Shenzhou Formula (SZF) might reduce the macroalbuminuria secondary to the DKD.Methods and designThis trial is a 24-week, randomized, multicentric, double-blinded, double-dummy clinical trial. 120 DKD patients (60 in each group) will be randomly divided randomized into two groups: SZF+ Irbesartan Simulator or Irbesartan + SZF Simulator. 24-h UP is the primary outcome measure is. The secondary outcome measures include Serum creatinine, estimated glomerular filtration rate, urinary albumin excretion rate, improvement in TCM symptoms, FBG, 2-h postprandial plasma glucose, HbA1C, Cholesterol, triglycerides, HDL, LDL, blood pressure, albumin to creatinine ratio, and the audit of diabetes-dependent quality of life 19 . Our recruitment began in May 2015, and we have enrolled 100 participants in this ongoing study, with a designed maximum sample size of 120. The interim results have been reviewed at N = 60 and continuing recruitment was recommended. This statistical analysis plan includes our approach to impute missing data, analysis primary, secondary outcomes, and safety endpoints.ConclusionThis SAP will standardize the clinical trial's statistical analysis, avoid outcome selective reporting bias and data-driven analysis. This trial will provide further clinical evidence for SZF treatment of macroalbuminuria secondary to DKD.Trial registrationChinese Clinical Trial Registry, ID: ChiCTR-ICR-15006311, registered on 26 May 2013. http://www.chictr.org.cn/showproj.aspx?proj=10862

Effectiveness and safety of Bifidobacterium and berberine in human hyperglycemia and their regulatory effect on the gut microbiota: a multi-center, double-blind, randomized, parallel-controlled study

Background Berberine and Bifidobacterium have been reported to improve glucose tolerance in people with hyperglycemia or other metabolic disorders. This study aimed to assess the hypoglycemic effect and the regulation of the gut microbiota caused by berberine and Bifidobacterium and the possible additive benefits of their combination. Methods This was an 18-week, multi-center, randomized, double-blind, parallel-controlled study of patients newly diagnosed with hyperglycemia. After a 2-week run-in period, 300 participants were randomly assigned to the following four groups for 16 weeks of treatment: berberine (Be), Bifidobacterium (Bi), berberine and Bifidobacterium (BB), and placebo group. The primary efficacy endpoint was the absolute value of fasting plasma glucose (FPG) compared with baseline after 16 weeks of treatment. Results Between October 2015 and April 2018, a total of 297 participants were included in the primary analysis. Significant reductions of FPG were observed in the Be and BB groups compared with the placebo group, with a least square (LS) mean difference of − 0.50, 95% CI [− 0.85, − 0.15] mmol/L, and − 0.55, 95% CI [− 0.91, − 0.20] mmol/L, respectively. The Be and BB groups also showed significant reductions in 2-h postprandial plasma glucose. A pronounced decrease in HbA1c occurred in the BB group compared to the placebo group. Moreover, compared with the Bi and placebo groups, the Be and BB groups had more changes in the gut microbiota from the baseline. Conclusions Berberine could regulate the structure and function of the human gut microbiota, and Bifidobacterium has the potential to enhance the hypoglycemic effect of berberine. These findings provide new insights into the hypoglycemic potential of berberine and Bifidobacterium. Trial registration ClinicalTrials.gov, NCT03330184. Retrospectively registered on 18 October 2017

Advantages of Screening for Glucose Tolerance in the Sequential Weeks of Gestation

Prelife exposure relates to development during the time preceding the first appearance of life, a time course from “conception to confinement.” From single cell zygote to finally formed fetus at confinement, a remarkable change occurs due to maternal fuels and hormonal influence on the fetal development. The crucial period in the fetal development is the first trimester. Early exposure to aberrant maternal metabolism in the embryonic developmental stage would result in congenital malformation and fetal wastage. Maintaining maternal glucose at the recommended level of fasting 80 to 90 mg and 2 hours postprandial plasma glucose 110 to 120 mg/dL during preconceptional period and throughout pregnancy is the assurance for the healthy offspring with ideal birth weight of 2.5 to 3.5 kg and prevention of noncommunicable diseases in the future.

A real-world clinical experience on the effectiveness of remogliflozin etabonate in management of Indian patients with type II diabetes mellitus

Background: The aim of the study was to evaluate effectiveness and safety of remogliflozin etabonate in a real-world outpatient setting in type 2 diabetes mellitus (T2DM) patients in India.Methods: A retrospective, observational, single-center study wherein medical records of adult patients (≥18 years old) with T2DM managed with remogliflozin 100 mg for at least three months at the diabetes care center in Jharkhand were retrieved. The effectiveness was assessed in terms of change from baseline in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), total body weight, blood pressure (BP, systolic and diastolic), kidney function tests, and lipid parameters after three months of treatment. Safety was assessed by adverse events (AEs) and serious AEs.Results: Half of the patients received ≥3 concomitant antidiabetic drugs, common being sulphonylureas (92%), and metformin (91%). Remogliflozin treatment resulted in a significant mean reduction from baseline in HbA1c [-1.99 (0.12%); p<0.001], FPG [-52.3 (4.31) mg/dl; p<0.001] and PPG [-103.6 (7.10) mg/dl; p<0.001). Bodyweight reduction was not statistically significant [-0.1 (10.12) kg]. A significant reduction was observed in the systolic BP [-15.9 (2.21) mmHg; p<0.001] and diastolic BP [-3.3 (0.95) mmHg; p=0.001]. Commonly reported AE was heartburn (51.4%) and urinary tract infections (34.2%). No serious AEs were reported. The mean estimated glomerular filtration rate showed a statistically significant reduction of -1.55 (0.61) ml/min. The lipid parameter findings were non-significant.Conclusions: The real-world experience of remogliflozin administered concomitantly with other antidiabetic drugs was effective and well-tolerated in Indian patients with T2DM.

Dates fruits effects on blood glucose among patients with diabetes mellitus: A review and meta-analysis

Background & Objective: Dates fruit is known for its great nutritional value and two to three servings of dates fruit/day are beneficial for patients with diabetes. However, some may advice against this cheap and widely available fruit consumption. Besides, 12% of the population Worldwide are either suffering or are at risk of developing diabetes, but no previous meta-analysis has assessed this important issue. Thus, the study aimed to investigate the effects of date’s fruit on glycemia among patients with diabetes. Methods: A systematic literature search was conducted in PubMed, Medline, EBSCO, Cochrane, and Google Scholar databases for trials published in English from the first published article up to December 2020. The following keywords were used: “dates fruit and glycemic control”, “dates fruit and blood glucose”, “dates fruit and HbA1c” without limitations regarding the date of publication. Results: Out of the 942 references identified, only 10 cohorts from five full texts were included, a reduction of Fasting plasma glucose (FPG), odd ratio, -24.79, 95% CI=-34.75, -14.83 P =0.002. I2 for heterogeneity=79%, P <0.00001 and postprandial plasma glucose (PPPG), odd ratio -28.19, 95% CI=-60.66-4.29, P =<0.0001. I2 for heterogeneity=92%, P=0.09) was observed. While the effect on HbA1c was neutral, odd ratio, -.20, 95% CI=-.46 -.06, P=0.13. I2 for heterogeneity=0. %, P=0.55. Conclusion: Dates fruit was beneficial regarding glycemic control among patients with diabetes, physician may not need to restrict its use among patients with diabetes. The small number of the included studies and the heterogeneity observed in PPPG and FPG sub-analysis limited the current results. Further trials assessing the glycemic indices of various types of dates fruit are needed. doi: https://doi.org/10.12669/pjms.37.4.4112 How to cite this:Mirghani HO. Dates fruits effects on blood glucose among patients with diabetes mellitus: A review and meta-analysis. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.4112 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effect of Sea Buckthorn on Plasma Glucose in Individuals with Impaired Glucose Regulation: A Two-Stage Randomized Crossover Intervention Study

Sea buckthorn (SB) has been indicated to have hypoglycemic potential, but its effects on glucose in people with impaired glucose regulation (IGR) are still unclear. This work presents a randomized, double-blinded, two-way crossover study. A total of 38 subjects with IGR completed the intervention of consuming sea buckthorn fruit puree (SBFP, 90 mL/day, five weeks), washing out (four weeks), and then consuming placebo (90 mL/day, five weeks) or in reverse order. In our methodology, a unified questionnaire was used to gather information on physical activity and dietary intakes, and physical examinations were performed to measure blood pressure, height, and weight. Fasting blood samples were collected to detect the fasting plasma glucose (FPG) and glycated serum protein (GSP). To calculate the area under the curve of 2 h postprandial plasma glucose (2 h PG-AUC), blood samples at t = 30, 60, and 120 min were also collected and analyzed. Effects of the intervention were evaluated by paired-sample Wilcoxon test and mixed model analyses. Our results show that the FPG in subjects with IGR decreased by a median reduction of 0.14 mmol/L after five weeks’ consumption of SBFP, but increased by a median of 0.07 mmol/L after placebo intervention, and the comparison of these two interventions was statistically significant (p = 0.045). During the wash-out period, a similar difference was observed as the FPG decreased in the group that received SBFP intervention first, but increased in another group (p = 0.043). Both SBFP and placebo significantly raised GSP during the intervention period, but lowered it in the wash-out period (p < 0.05), while no significant difference was found between the two interventions. The 2 h PG-AUC remained relatively stable throughout the study. Our results indicated that consumption of SBFP for five weeks showed a slight downward trend on FPG in subjects with IGR.

Correlation of Fasting and Postprandial Glucose Levels with Glycosylated Hemoglobin in Diagnosis of Diabetes

Introduction: Diabetes Mellitus describes a group of metabolic disorders characterized by hyperglycemia. Uncontrolled glycemic state often leads to micro and macro vascular complications. Diabetes is the foremost cause of new blindness in adults. Constant screening of the diabetic profile through blood tests of the affected people and prompt actions to control them can help to improve the quality of life of these patients. The study was done to evaluate the correlation between fasting and postprandial plasma glucose levels with glycosylated hemoglobin for diagnosis of diabetes and to determine the prevalence of diabetes in different age groups with sex predilection. Methods: A descriptive cross sectional study was conducted and the data collection was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine, Biratnagar Eye Hospital. Ethical approval was obtained from Institutional Review Committee of this hospital. All 275 patients who attended the laboratory from January 2019 to June 2019 for fasting plasma glucose, postprandial plasma glucose and glycosylated hemoglobin values estimation were included in this study. The data obtained were computed and analyzed using Statistical Package for the Social Sciences version 20.0 Results: A significant correlation between fasting plasma glucose, postprandial plasma glucose and glycosylated hemoglobin was observed in this study (p value <0.001). The correlation coefficient between fasting plasma glucose and glycosylated hemoglobin (r= 0.728) is stronger than the correlation coefficient between postprandial plasma glucose and glycosylated hemoglobin (r= 0.709). Conclusions: Fasting plasma glucose correlated better than postprandial plasma glucose with glycosylated hemoglobin.