Determination of the differences in 2-h plasma glucose values after ingestion of carbohydrate foods and oral glucose in Caribbean non-diabetic subjects

It has been reported that mixed meals are used in clinics in developing and developed countries in screening and diagnosis of diabetes. Thus, we aimed to determine the differences in 2-h plasma glucose values after non-diabetic subjects ingested 75 g pure glucose and its equivalent content in frequently consumed carbohydrate foods in Caribbean subjects. Twenty-seven apparently healthy non-diabetic subjects (nine males, 18 females) consumed 75 g pure glucose and its carbohydrate equivalent in three ethnic test foods (bread, rice and roti) at 7 days apart. Plasma glucose and insulin levels were determined in blood samples collected before and after 60, 90, 120 and 150 min of ingestion of these foods. In comparison with each of the test foods, the postprandial 1-h and 2-h plasma glucose values and the 60, 90, 120 and 150 min incremental glucose concentrations after oral glucose load were significantly higher than the corresponding values for each of the test foods (all P<0.01). In spite of these higher postprandial glucose concentrations, the postprandial insulin responses following the oral glucose load and the test foods did not significantly differ at any time point (all P>0.05). However, the test food, roti, tended to stimulate higher absolute and incremental insulin secretions than pure glucose or any other test food (all P>0.05). Generally, the correlation between 2-h plasma glucose value after the ingestion of the pure glucose and each of the test foods was significant (all correlation coefficients were greater than 0.70, P<0.01). In conclusion, different ethnic mixed meals could serve as an alternative to glucose in routine screening and diagnosis of diabetes if its available carbohydrate content is known and quantified.     

Use of low-glycaemic index bread to reduce 24-h blood glucose: implications for dietary advice to non-diabetic and diabetic subjects

The present study investigated the effect of a simple dietary change on 24-h blood glucose. In a randomized cross-over design, 10 healthy subjects were prescribed a low-glycaemic-index (LGI) diet and a high-glycaemic-index (HGI) diet. The diets were identical with the exception of the type of bread consumed (LGI or HGI). Glucose concentrations over 24 h were measured using a continuous glucose monitoring system. The LGI diet resulted in a lower mean glucose response compared with the HGI diet over 24 h (P=0.135), during the day (P=0.171) and at night (P=0.100). Similarly, the 24-h, daytime and overnight incremental area under the curve for glucose following the LGI diet was consistently lower than following the HGI diet (P=0.093, P=0.132 and P=0.061, respectively). The results demonstrate how a very simple dietary change can favourably alter overall blood glucose concentrations. Such small modifications to the diet, if adopted in the long term, could improve glucose control and consequently reduce the risk of chronic disease in both diabetic and non-diabetic individuals.     

早餐后2h血糖筛查糖尿病的切点及其应用

目的探讨早餐后2h血糖（2hPG）在糖尿病筛查中合适的切点及其在糖尿病筛查中的应用.方法选择四川泸天化集团公司6 387名职工的糖尿病流行病学调查数据,以WHO诊断标准作为金标准,采用诊断试验评价方法及标准工作曲线（ROC）进行分析.结果与检测空腹血糖（FPG）比较,检测早餐后2hPG具有更好的灵敏度和特异度;FPG和早餐后2hPG的ROC曲线下面积,男性分别为0.79,0.962,女性分别为0.77,0.957,两者间差异有统计学意义（P=0.000）;当早餐后2hPG取6.65 mmol/L时,具有最大的灵敏度和特异度,其中男性为97.2和84.4,在女性为93.5和89.1;一致性率（Youden＇s index）男性为0.83,女性为0.82;当早餐后2hPG取＞6.65 mmol/L时,所筛查出的糖耐量减低（IGT）人数几乎是FPG＞5.6mmol/L筛查出的2倍.结论早餐后2hPG比FPG在筛查早期糖尿病人时有更好的灵敏度和特异度,当切点取6.65时能更好的筛查出IGT人群,建议将早餐后2hPG作为糖尿病筛查的指标.     

缓释糖类系统对高龄2型糖尿病管饲病人糖脂代谢的影响

目的:探讨缓释糖类系统对高龄2型糖尿病管饲病人糖脂代谢的影响. 方法:选择确诊为2型糖尿病的住院高龄老年管饲病人11例.在等能量的情况下,用含有缓释糖类系统的肠内营养制剂(益力佳)替代或部分替代原有的肠内营养支持液,1～3个月,观察病人血红蛋白、淋巴细胞计数、血清清蛋白、总蛋白、血糖、餐后2 h血糖、糖化血红蛋白、血脂、肾功能、电解质及胃肠道的变化. 结果:应用含缓释糖类系统的肠内营养制剂后病人的肾功能和电解质均无影响,总蛋白有所上升,使用前、后有显著性差异(P＜0.05).空腹血糖、餐后2 h血糖均有下降,差异有显著性意义(P＜0.05,＜0.001).血清三酰甘油、低密度脂蛋白、胆固醇、糖化血红蛋白均有下降,但差异无显著性意义(P＞0.05).高密度脂蛋白未出现明显的变化.肠内营养支持后,胃肠道不适症状均有不同程度的改善. 结论:含缓释糖类系统的肠内营养制剂,不仅能改善老年2型糖尿病管饲病人的糖代谢和脂代谢,还能帮助改善病人应用肠内营养后出现的胃肠道不适症状.     

Distribution of fasting plasma glucose and prevalence of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes in the Mexican paediatric population

Published data on the distribution of fasting plasma glucose (FPG) in children are scarce. We therefore set out to examine the distribution of FPG and determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes (T2-DM) in Mexican children aged 6–18 years in a community-based cross-sectional study. A total of 1534 apparently healthy children were randomly enrolled and underwent an oral glucose tolerance test. IFG was defined by an FPG value between ≥100 and <126 mg/dL, IGT by glucose concentration 2-h post-load between ≥140 and <200 mg/dL, and T2-DM by glucose concentration 2-h post-load ≥200 mg/dL.
The FPG level at the 75^th percentile of distribution was 98.0, 100.0 and 99.0 mg/dL for children aged 6–9, 10–14 and 15–18 years, respectively; the 95^th percentile of FPG was greater than 100 mg/dL for all the age strata. In the population overall, the prevalences of IFG, IGT, and T2-DM were 18.3%, 5.2% and 0.6%, respectively. Among obese children and adolescents, the prevalences of IFG, IGT, IFG + IGT and T2-DM were 19.1%, 5.7%, 2.5% and 1.3%. Our study shows a high prevalence of prediabetes and is the first that reports the distribution of FPG in Mexican children and adolescents.     

毛细管气相色谱法同时检测保健食品中的肌醇和葡萄糖

目的：建立毛细管气相色谱法同时测定保健食品中肌醇和葡萄糖的分析方法。方法：肌醇和葡萄糖能在无水乙酸钠催化下与乙酸酐反应，生成相应的酯。采用程序升温，经SPB-5毛细管色谱柱分离，火焰离子化检测器检测，根据保留时间定性，峰面积定量。结果：优化了衍生化反应和气相色谱的操作条件，肌醇和葡萄糖的线性范围为0．1～5mg／ml，肌醇的检出限为5．5μg／ml，葡萄糖为4．2μg/ml。日内精密度为3．45％～3．62％，加标回收率在87．7％～105．0％。结论：本方法采用的衍生化反应操作简便，所建立的检测方法的精密度和准确度均能满足食品分析的要求，对实际保健食品样品进行了测定，取得了满意的结果。     

The effect of altered dietary carbohydrate content on the metabolic responses to physical exercise in insulin-dependent diabetic subjects

The effects of two isoenergetic 8.4 MJ (2000 kcal) diets containing 40% and 65% of total energy from carbohydrate, respectively, were studied in six insulindependent diabetics in relation to the metabolic responses to physical exercise. Each subject followed both diets in turn for one week. Additionally, the effects of a pre-exercise supplement of either 50 g carbohydrate (as glucose polymer) or placebo were measured.
Exercise induced a marked fall in blood glucose levels of similar magnitude on both diets ( P < 0.05) in the absence of supplementary carbohydrate and a significant increase ( P < 0.01) when the supplement was provided. Insulin concentrations were virtually unaltered on either diet or supplement when compared before and after exercise ( P < 0.5).
Blood levels of the gluconeogenic precursors (lactate, pyruvate, alanine and glycerol) were significantly increased after exercise in the case of both diets with or without supplementary carbohydrate (0.02 < P < 0.05).
Basal and post-exercise levels of glucagon, cortisol, 3-hydroxybutyrate, catecholamines and free fatty acids (FFA) were generally similar and not significantly different in any of the treatment conditions.
These data demonstrate that the metabolic and hormonal response to exercise is similar in insulin-dependent diabetics receiving conventional injection therapy on standard diets (40% carbohydrate) and high carbohydrate containing diets (65% carbohydrate).     

自然人群糖尿病空腹血糖和糖化血红蛋白筛查效果评价

目的 评价空腹血糖（FPG）和糖化血红蛋白（HbA1c）在自然人群中糖尿病（DM）的筛查效果,为DM流行病学调查中DM筛查方法的选择提供参考依据。方法 于2010年10-12月采用多阶段分层随机整群抽样方法抽取云南省6个国家级死因登记报告县/区的3 489名≥18岁自然人群进行FPG、服糖后2 h血糖（2hPG）和HbA1c实验室检测,并应用受试者工作特征（ROC）曲线获得FPG、HbA1c与DM的最佳临界点及其灵敏度、特异度和曲线下面积。结果 按照世界卫生组织1999年标准,云南省3 489名≥18岁自然人群中正常血糖、空腹血糖受损（IFG）、糖耐量减低（IGT）和DM者分别为2 975人（85.3%）、230例（6.6%）、176例（5.0%）和108例（3.1%）;FPG诊断DM的最佳临界点为6.4 mmol/L,灵敏度和特异度分别为86.1%和96.5%,曲线下面积为0.926（95%CI=0.887~0.965）,阳性似然比为24.60,阴性似然比为0.14,约登指数为0.83;HbA1c诊断DM的最佳临界点为6.15%,灵敏度和特异度分别为66.7%和87.1%,曲线下面积为0.814（95%CI=0.762~0.867）,阳性似然比为5.18,阴性似然比为0.38,约登指数为0.53。结论 在DM流行病学调查中采用FPG筛查DM效果优于HbA1c。     

Variability in measurements of blood glucose response to foods in human subjects is not reduced after a standard breakfast

Measurements of blood glucose response to food are highly variable. We determined whether within-individual variability in data for blood glucose responses were reduced if individuals consumed a standard meal 2 hours before testing and investigated the effect of serving size. Blood glucose responses to muesli and macaroni cheese were determined in 13 individuals by taking 2 fasting capillary blood samples. Food was then consumed, and capillary blood samples were taken every 15 minutes for the first hour and every 30 minutes for the second hour. The incremental area under the blood glucose response curve was determined, and glycemic glucose equivalents (GGEs) were calculated. The GGE values were not significantly different whether the muesli and macaroni cheese were fed fasting or after a standard breakfast (29.2 vs 34.5 g for muesli and 11.0 vs 14.6 g for macaroni cheese). Within-individual coefficients of variation were not significantly different whether the food was consumed fasting or after a standard breakfast (24.9% and 32.5% for muesli and 38.1% and 59.4% for macaroni cheese). Differences in GGE between measured and estimated half serving size for macaroni cheese were 0.8 g (P = .6) and for muesli, 3 g (P = .2); for the double serving size for macaroni cheese, 1.7 g (P = .7); and for muesli, 6.7 g (P = .06). The GGE values for foods and variability in blood glucose response within individuals were not significantly different whether individuals fasted or consumed a standard breakfast before testing. However, blood glucose levels tended to differ significantly after consumption of the double serving size of muesli compared with other serving sizes.     

静脉滴注木糖醇和葡萄糖对2型糖尿病患者血糖波动的影响

,and 17.47%.Conclusions Xylitol can lower the blood glucose a littte but without significant difference.It has little effect on blood glucose variability of patients with type 2 diabetes mellitus and can be safely used for rehydration.     

A review of nateglinide in the management of patients with type 2 diabetes

Impaired insulin secretion occurs early in the pathogenesis of type 2 diabetes mellitus (T2DM) and is chronic and progressive, resulting initially in impaired glucose tolerance (IGT) and eventually in T2DM. As most patients with T2DM have both insulin resistance and insulin deficiency, therapy for T2DM should aim to control not only fasting, but also postprandial plasma glucose levels. While oral glucose-lowering treatment with metformin and thiazolidinediones corrects fasting plasma glucose, these agents do not address the problem of mealtime glucose spikes that have been shown to trigger atherogenic processes. Nateglinide is a derivative of the amino acid D-phenylalanine, which acts directly on the pancreatic beta-cells to stimulate insulin secretion. Nateglinide monotherapy controls significantly mealtime hyperglycemia and results in improved overall glycemic control in patients with T2DM by reducing glycosylated hemoglobin (HbA1c) levels. The combination of nateglinide with insulin-sensitising agents, such as metformin and thiazolidinediones, targets both insulin deficiency and insulin resistance and results in reductions in HbA1c that could not be achieved by monotherapy with other antidiabetic agents. In prediabetic subjects with IGT, nateglinide restores early insulin secretion and reduces postprandial hyperglycemia. Nateglinide has an excellent safety and tolerability profile and provides a lifetime flexibility that other antidiabetic agents could not accomplish. The aim of this review is to identify nateglinide as an effective "gate-keeper" in T2DM, since it restores early-phase insulin secretion and prevents mealtime glucose spikes throughout the day and to evaluate the results of ongoing research into its potential role in delaying the progression to overt diabetes and reducing its complications and mortality.     

糖化血红蛋白及入院时血糖对无糖尿病病史急性ST段抬高性心肌梗死的近期预后价值

目的 比较糖化血红蛋白(HbA1c)及入院时血糖对无糖尿病病史急性ST段抬高性心肌梗死的近期预后价值.方法 选取2010年1月至2011年6月住院的无糖尿病病史急性ST段抬高性心肌梗死患者84例,测定HbA1c及入院时血糖,随访30 d内的心血管事件.结果 以所测得的HbA1c及入院时血糖的均值为截断点,按HbA1c水平分为HbA1c＜5.5％组40例及HbA1c≥5.5％组44例,按入院时血糖水平分为人院时血糖≤8.6 mmol/L组42例及入院时血糖＞8.6mmo1/L组42例.入院时血糖＞8.6mmol/L组随访30 d内的心血管事件发生率高于入院时血糖≤8.6mmol/L组[19.0％(8/42)比2.4％(1/42)],差异有统计学意义(P＜0.05).HbA1c≥5.5％组随访30 d内的心血管事件发生率与HbA1c＜5.5％组比较差异无统计学意义(P＞0.05).入院时血糖与血肌酸激酶同工酶MB峰值有弱相关性(r=0.233,P＜0.05).结论 入院时血糖升高预示无糖尿病病史急性ST段抬高性心肌梗死的近期心血管事件增多.     

A study of the effect of oral glucose loading on plasma oxidant:antioxidant balance in normal subjects

Summary Background Antioxidant defence has been reported to decrease, and oxidative stress to increase, after oral glucose loading in both normal and diabetic subjects. If confirmed in normal subjects, glucose–induced antioxidant depletion has important implications for health in relation to the modern, sugar–rich diet. Aim of the study To investigate changes in plasma biomarkers of oxidant:antioxidant balance in non–diabetic subjects following oral glucose loading. Baseline inter–relationships between biomarkers of glycaemic control, oxidant:antioxidant balance and inflammation were also explored. Methods A singleblinded, placebo–controlled, crossover intervention trial involving 10 healthy, consenting subjects. Venous blood was collected after ingestion of 75 g glucose in 300 mL water, or of water alone. Blood was collected at 0 time (fasting) and 30, 60, 90, 120 min post–ingestion. Within 2 weeks the procedure was repeated with volunteers crossedover onto the other treatment. Plasma total antioxidant capacity (as the FRAP value), ascorbic acid, –tocopherol, uric acid, malondialdehyde (MDA), allantoin and high sensitivity C–reactive protein (hsCRP), glucose and insulin, were measured in all samples. Paired results post–glucose and post–water at each time interval were compared using the Wilcoxon matched–pairs signed–ranks test. Results Normal glucose tolerance was observed in all subjects, although, as expected, plasma glucose and insulin increased significantly (p < 0.05, n = 10) after glucose loading. Post–glucose responses in plasma FRAP and the individual antioxidants tested were not significantly different to the responses seen post–water, although both FRAP and –tocopherol decreased slightly. Neither were postglucose changes in plasma MDA and allantoin, putative biomarkers of oxidative stress, significantly different to those after intake of water alone. Plasma FRAP and -tocopherol also decreased slightly, but not significantly, after intake of water. A significant direct correlation (r = 0.867, p < 0.001, n = 10) was found between fasting allantoin and (log transformed) hsCRP concentrations. Conclusions These new data from a controlled intervention trial indicate that acute, transient increases in plasma glucose following oral intake of a large glucose load do not, as previously reported, cause a significant decrease in plasma antioxidants or increase oxidative stress in non–diabetic subjects. This is reassuring given the large quantities of sugar ingested by children and adolescents. However, a small decrease in plasma antioxidant capacity was seen after ingestion of water and of glucose, and it is possible that intake of glucose without concomitant intake of antioxidants in susceptible individuals may cause oxidative stress. Further work is needed in relation to diabetic subjects and a possible glucose threshold for this. The finding of a direct relationship between allantoin, a biomarker of oxidative stress, and hsCRP, a marker of inflammation and CHD predictor, in healthy subjects is interesting and indicates a link between sub–clinical inflammation and oxidative stress.     

Effects of changes in obesity and exercise on the development of diabetes and return to normal fasting plasma glucose levels at one-year follow-up in middle-aged subjects with impaired fasting glucose

Objectives  Borderline diabetes, a precursory condition of diabetes, is an important issue in the prevention of diabetes. The aim of the present study was to clarify the effects of one-year changes in obesity and exercise on the development of diabetes or return to normal fasting plasma glucose (FPG) levels among middle-aged people with impaired fasting glucose (IFG) at baseline. Methods  Among those who attended a basic health examination in 1997, we selected 1,620 subjects who showed impaired fasting glucose (FPG of 110 mg/dl or higher) and had complete data on height, weight and exercise. At the one-year follow-up (in 1998), 1,099 of those subjects attended a health examination; FPG, height, weight and exercise were evaluated for 731 subjects. Subjects were classified into the following three groups, on the basis of changes in FPG during the year between the two examinations: developing diabetes (DM), remaining IFG, and returning to normal (WNL). Results  Among those who were initially obese, there was a significant difference in the proportions of DM, IFG and WNL between those with and without improvement in obesity in the year preceding the follow-up (p<0.05). Those with improvement in obesity showed a significantly higher tendency to return to WNL than those without improvement in obesity. Multiple logistic regression analysis showed that those with improvement in obesity had a significantly higher odds ratio (2.17) to return to WNL (p=0.015). Among those who were initially not obese, there was no significant association between changes in obesity and developing DM or returning to WNL. No significant association was observed between changes in exercise and developing DM or returning to WNL. Conclusion  The present findings suggest that, among obese IFG subjects, improvement in obesity is associated with returning to normal plasma glucose. Weight control may be important for the normalization of borderline diabetes.     

A glucose reference curve is the optimum method to determine the glycemic glucose equivalent values of foods in humans

The glycemic index ranks carbohydrates in foods on the basis of the blood glucose response they produce for a given amount of carbohydrate. The glycemic glucose equivalents (GGEs) is the blood glucose response to a defined portion of food. The purpose of this study was to determine the best method by which to measure the GGE of a food; whether it can be estimated from 1 or 2 glucose references or if a range of glucose references should be measured. Twenty individuals without diabetes participated. The incremental area under the curve (iAUC) from fasting to at least 120 minutes after consumption of 5 foods was determined. The iAUC for different glucose amounts was also determined and a standard glucose curve of glucose level against iAUC generated. The GGE of each food was estimated from iAUC of test food using the standard curve. The study found that using a glucose reference closest to the available carbohydrate content of the food gave a mean difference (95% confidence interval) in GGEs of 3.4 (2.0-4.8) g in comparison to the standard curve. Using a 50-g glucose reference gave a mean difference in GGEs of 5.2 (4.7-5.6) g and interpolating from 2 glucose references, 3.5 (1.9-5.2) g in comparison to the standard curve. In conclusion, the best method to determine the GGE value of a food is to use the standard glucose reference curve and estimate the response of the food directly from this.     

Effects of fructo-oligosaccharides on blood glucose and serum lipids in diabetic subjects

Daily intake of 8.0 g per day of fructo-oligosaccharides for fourteen days significantly reduced mean fasting blood glucose levels by 15 mg/dl, mean serum total cholesterol levels by 19 mg/dl and LDL-cholesterol levels by 17 mg/dl in diabetic subjects (n=18), while the control diabetic subjects (n=10) who were given 5.0 g per day of sucrose showed no significant changes. The levels of serum HDL-cholesterol, triglycerides or free fatty acids were not significantly affected either by fructo-oligosaccharides or sucrose. These results indicate that the daily intake of fructo-oligosaccharides ameliorates the derangements of carbohydrate and lipid metabolism in diabetic subjects.     

2007年江苏省居民血糖水平及糖尿病患病情况监测分析

目的:了解江苏省城乡居民血糖水平及糖尿病患病情况.方法: 采用多阶段随机整群抽样方法,在全省14个疾病监测点共监测4 318名15～69岁城乡居民.空腹血糖应用德国罗氏血糖仪采无名指末梢血测得.结果:江苏省城乡居民血糖平均水平为5.12 mmol/L(标化后为5.02 mmol/L);糖尿病、空腹血糖受损患病率分别为8...     

静脉滴注木糖醇和葡萄糖对2型糖尿病患者血糖波动的影响

目的比较静脉滴注木糖醇和葡萄糖对2型糖尿病患者血糖波动的影响,以期为糖尿病患者静脉载体液的选择提供依据。方法稳定期2型糖尿病患者22例,采用自身对照方法,分别在试验第1、2、3天上午9：00-11：00匀速静脉滴注生理盐水200ml、10％木糖醇溶液100ml、5％葡萄糖200ml＋胰岛素2．5U,同时采用动态血糖监测系统每5min记录1次血糖,比较血糖变化情况。结果静脉滴注生理盐水、木糖醇和葡萄糖＋胰岛素2h及输液结束后1h共180min内血糖平均值分别为（7．74±0．84）mmol／L、（7．83±1．01）mmol／L和（7．84±1．37）mmol／L（P〉0．05）,血糖曲线下面积分别为（1429．16±340．79）mmol·min／L、（1449．25±192．28）mmol·min／L和（1447．59±317．94）mmol·min／L（P〉0．05）,血糖变异度分别为10．9％、12．88％和17．47％。结论静脉滴注木糖醇后血糖略有下降,对血糖波动性的影响较葡萄糖注射液小。小剂量木糖醇注射液可替代葡萄糖注射液作为稳定期2型糖尿病患者的静脉载体液。     

A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes

Background Recent evidence from randomized controlled trials of hypocaloric low carbohydrate diets in people without diabetes has shown that they promote significant weight loss over the short term. There is very little evidence for any effects of reduced carbohydrate intakes on body weight, glycaemia and cardiovascular risk in people with type 2 diabetes. Methods An electronic search was performed using MEDLINE (1966 to March 2007), EMBASE (1988 to March 2007) and Cochrane Central Register of Controlled Trials (1991 to March 2007) using the keywords low carbohydrate, type 2 diabetes and weight loss. Studies including subjects with type 2 diabetes who adopted a reduced carbohydrate weight loss diet were identified. Data were extracted on study design, weight loss, effects on glycaemia and cardiovascular risk and potential adverse effects. Results Six studies investigating the effects of hypocaloric reduced carbohydrate diets in people with type 2 diabetes were identified. The studies were heterogenous and most included small numbers, were short‐term and provided varying amounts of carbohydrate. No studies were identified that were both low carbohydrate (<50 g day^?1) and also designed as randomized controlled trials. All studies reported reductions in both body weight and glycated haemoglobin, with no deleterious effects on cardiovascular risk, renal function or nutritional intake. Conclusions Conclusions are limited by study design and small numbers, but it appears that reduced carbohydrate diets are safe and effective over the short term for people with type 2 diabetes.