Plasma glucose responses to glucose, sucrose, and honey in patients with diabetes mellitus: an analysis of glycaemic and peak incremental indices

We have studied the hyperglycaemic effect of the carbohydrate of glucose, sucrose, and honey equivalent to 20 g in twelve normal volunteers, eight patients with insulin-dependent diabetes mellitus (IDDM), and six patients with non-insulin-dependent diabetes mellitus (NIDDM). Honey produced an attenuated postprandial glycaemic response in normal volunteers (vs glucose p less than 0.005; vs sucrose p less than 0.05) and IDDMs (vs glucose p less than 0.005; vs sucrose p less than 0.05). The glycaemic index (GI) showed considerable variability within each subject group. Combined with a peak incremental index (PI), the two indices appear to be more valuable in predicting the glycaemic effects of carbohydrates rather than either one alone. We suggest that honey may prove to be a valuable sugar substitute in diabetics, and that both the GI and PI should be used in the analysis of food.     

Influence of non-carbohydrate foods on glucose and insulin responses to carbohydrates of different glycaemic index in type 2 diabetic patients.

In order to study the influence of non-carbohydrate foods on responses to carbohydrates during mixed meals, 30 Type 2 (non-insulin-dependent) diabetic patients followed a standardized diet for 5 consecutive days. On days 2, 3, 4, and 5, four different lunches were eaten in a randomized order. Lunches consisted of rice or glucose (50 g carbohydrate) eaten either alone, or as part of a mixed meal (32 g protein, 20 g fat). Glucose and insulin levels prior to the lunches did not differ significantly. Glucose and insulin responses differed (p less than 0.001), responses to rice being lower than responses to glucose, and responses to the meal plus rice lower than responses to the meal plus glucose. The ratios of glucose responses to rice and glucose (glycaemic index) were similar (alone, 47 +/- 4%; meal, 47 +/- 4%; NS). The ratios of the insulin responses did not differ (78 +/- 8 vs 96 +/- 7%; NS). The blood glucose responses to mixed meals were lower than responses to the carbohydrates eaten alone, the ratios being similar (rice, 52 +/- 3%; glucose, 58 +/- 5%; NS). Serum insulin responses were however higher, and the ratios differed (172 +/- 13 vs 138 +/- 14%; p = 0.05). These results suggest that the glycaemic index of isolated carbohydrate foods can predict the relative response to mixed meals in the same individuals with Type 2 diabetes. They also support the insulin secretagogue effect of non-carbohydrate foods, which may vary according to the source of carbohydrate in the meal.     

Diabetes,glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

Aims/hypothesis There are few data on the target level of glycaemic control among patients with diabetes on haemodialysis. We investigated the impact of glycaemic control on mortality risk among diabetic patients on haemodialysis. Subjects and methods Data were analysed from the Dialysis Outcomes Practice Pattern Study (DOPPS) for randomly selected patients on haemodialysis in Japan. The diagnosis of diabetes at baseline and information on clinical events during follow-up were abstracted from the medical records. A Cox proportional hazards model was used to evaluate the association between presence or absence of diabetes, glycaemic control (HbA_1c quintiles) and mortality risk. Results Data from 1,569 patients with and 3,342 patients without diabetes on haemodialysis were analysed. Among patients on haemodialysis, those with diabetes had a higher mortality risk than those without (multivariable hazard ratio 1.37, 95% CI 1.08–1.74). Compared with those in the bottom quintile of HbA_1c level, the multivariable-adjusted hazard ratio for mortality was not increased in the bottom second to fourth quintiles of HbA_1c (HbA_1c 5.0–5.5% to 6.2–7.2%), but was significantly increased to 2.36 (95% CI 1.02–5.47) in the fifth quintile (HbA_1c ≥ 7.3%). The effect of poor glycaemic control did not statistically correlate with baseline mortality risk (p = 0.27). Conclusions/interpretation Among dialysis patients, poorer glycaemic control in those with diabetes was associated with higher mortality risk. This suggests a strong effect of poor glycaemic control above an HbA_1c level of about 7.3% on mortality risk, and that this effect does not appear to be influenced by baseline comorbidity status.     

The use of low glycaemic index foods improves metabolic control of diabetic patients over five weeks.

The aim of the present study was to determine whether any benefit might occur from lowering the glycaemic index of diet in the medium term in diabetic patients. Eighteen well-controlled diabetic patients (12 Type 1 and 6 Type 2 non-insulin-treated), were assigned to either a high mean glycaemic index or low mean glycaemic index diet for 5 weeks each in a random order using a cross-over design. The two diets were equivalent in terms of nutrient content and total and soluble fibre content. The glycaemic indices were 64 +/- 2 (mean +/- SD) % and 38 +/- 5% for the two diets. The high glycaemic index diet was enriched in bread and potato and the low glycaemic index diet in pasta, rice, and legumes. At the end of the study periods, the following variables were improved on the low compared to the high glycaemic index diet: fructosamine (3.9 +/- 0.9 vs 3.4 +/- 0.4 mmol l-1, p less than 0.05); fasting blood glucose (10.8 +/- 2.8 vs 9.6 +/- 2.7 mmol l-1, p less than 0.02); 2-h postprandial blood glucose (11.6 +/- 2.9 vs 10.3 +/- 2.5 mmol l-1, p less than 0.02); mean daily blood glucose (12.0 +/- 2.5 vs 10.4 +/- 2.7 mmol l-1, p less than 0.02); serum triglycerides (1.5 +/- 0.9 vs 1.2 +/- 0.6 mmol l-1, p less than 0.05). No significant differences were found in body weight, HbA1C, insulin binding to erythrocytes, insulin and drug requirements, and other circulating lipids (cholesterol, HDL-cholesterol, phospholipids, Apolipoprotein A1, Apolipoprotein B). Thus the inclusion of low glycaemic index foods in the diet of diabetic patients may be an additional measure which slightly but favourably influences carbohydrate and lipid metabolism, requires only small changes in nutritional habits and has no known deleterious effects.     

Insulin requirement of simple and complex carbohydrate foods in type 1 (insulin-dependent) CSII-treated diabetic subjects,obtained by Biostator. Correlation with glycaemic index

Summary The aim of this work was to observe whether different types of carbohydrates might require different insulin doses. Five type 1 CSII-treated diabetic subjects (age 39±4 years), C-peptide negative and in optimal metabolic control (HbA_1c 7.5±0.2) were selected for the study. They were connected to the Biostator 6 times with an interval of 4–10 days between sessions and fed a meal containing 75 g of carbohydrates of different types: bread, pasta, potatoes, apples, oranges and sucrose. The following net (above basal) insulin requirement for the 30 meals were found (IU-mean+SD): bread 9.15±1.97; pasta 6.00±1.37; potatoes 7.05±2.58; apples 4.54±1.42; oranges 6.21±2.62; sucrose 7.83±2.33. A statistically significant difference was found by ANOVA among insulin requirements for foods (p<0.05). Single comparisons between bread and the other foods showed a statistically significant difference only between bread and apple (p<0.05). Mean coefficient of variation was 33.9% for the subjects and 30.7% for the meals. A significant correlation was found between Jenkins’ glycaemic index and insulin requirement (r=0.897; p<0.001). In conclusion, the high intraindividual variability of insulin requirement does not advice the use of the glycaemic index during optimized insulin therapy.     

降糖治疗影响糖尿病患者眼屈光度的相关因素分析

目的 分析降糖治疗对糖尿病患者眼屈光度的影响,探讨其发生机制.方法 选择20例新诊断的糖尿病患者,检测治疗前随机血糖、糖化血红蛋白(HbA1c)、空腹及餐后2 h C肽等生化指标.测定双眼屈光度、角膜曲率、前房深度、晶状体厚度等,并在降糖治疗的第1、2、3、4周分别复测以上眼部指标.分析屈光度改变与各生化指标的相关性及降糖治疗前后各眼部指标的变化.结果 降糖治疗后所有患者均出现远视性屈光改变,平均最大远视改变幅度1.6 D(0.50 D～3.20 D),改变幅度与HbA1c、治疗第1周的降糖速度呈正相关(r值分别为0.84,0.53;P值均＜0.05),与治疗前随机血糖、空腹及餐后2 h C肽无相关性,持续约2～4周逐渐恢复治疗前屈光水平.治疗前后角膜曲率、前房深度、晶状体厚度等眼部指标未见显著性变化.结论 降糖治疗导致糖尿病患者出现暂时性远视改变,改变幅度主要与治疗前HbA1c水平及治疗的前7天的降糖速度有关.其发生机制可能与晶状体水合化导致的屈光力降低有关,而非晶状体形态的改变.     

Glycaemic effects of bread and marmalade in insulin-dependent diabetes

The glycaemic responses of 12 C-peptide negative insulin-dependent diabetics were studied following four breakfasts with different carbohydrate sources. Total energy content of the meals was the usual for each subject, carbohydrate supplying 55% and fat 32%. The meals comprised: wholemeal bread with margarine; white bread with margarine; marmalade made with sucrose, and cheddar cheese; and marmalade (22% of total energy) on wholemeal bread with margarine. The study demonstrated powerfully that there were no statistically significant or clinically relevant differences between the meals in post-prandial glucose peak elevation, or in incremental area under the blood glucose curve to 120 mins. On these grounds, sucrose, in amounts considered acceptable to the general population, need not be prohibited from diabetic diets.     

Diastolic dysfunction is not related to changes in glycaemic control over 6 months in type 2 (non-insulin-dependent) diabetes mellitus

Diastolic dysfunction may be the earliest marker of a diabetes-induced heart muscle disease which leads to the progressive development of cardiac failure. Left ventricular diastolic function was indirectly assessed using pulsed wave Doppler ultrasound mitral-flow velocities in 20 normotensive patients with a new diagnosis of type 2 diabetes mellitus, normal cardiac function and no evidence of coronary artery disease and in 16 age-matched normal subjects. Peak velocities of early (E) and late (A) left ventricular filling were measured. The median (interquartile ranges) peak E/A ratio was significantly reduced in the diabetic group 0.96 (0.8–1.2) vs 1.2 (1.1–1.3),P<0.01. Despite improvements in glycaemic control over 3 months, HbA_1c 9.9% (7.6%–10.5%) to 7.4% (6.5%–7.9%),P<0.001, maintained at 6 months, HbA_1c 7.0% (6.4%–7.3%), there were no changes in the E/A ratio, 0.96 (0.83–1.15) and 0.95 (0.83–1.17), respectively. Furthermore, there was no correlation between percentage change in HbA_1c and E/A ratio over 6 months. The results of this study suggest that in patients with type 2 diabetes mellitus and normal systolic function, diastolic function was impaired at diagnosis and was not affected by an improvement in the glycaemic control.     

糖尿病病人短期饮食控制效果观察

经普查确诊为非胰岛素依赖型糖尿病患者６２例，其中对ＢＭＩ〉２５肥胖者４６例进行单纯饮食控制，控制４０天后的结果表明，摄入的碳水化合物、热量下降（Ｐ〈０．０５，Ｐ〈０．０１）；ＭＢＩ〉２５的病例体重下降（Ｐ〈０．００１）。空腹、餐后１、２小时血糖及糖基化血红蛋白下降（Ｐ〈０．０５，Ｐ〈０．００２）说明在没有服药的情况下，单纯饮食控制短期内确实有效的。     

Effectiveness of intervention program on the change of glycaemic control in diabetes with depression patients: A meta-analysis of randomized controlled studies

AimThe glycaemic control of diabetes with depression was inconsistent from randomized controlled studies. This meta-analysis aimed to explore the effectiveness of intervention methods in diabetes with depression.MethodsThis study systematically searched electronic databases (PubMed, EBSCO, Elsevier, Springer, Wiley, and Cochrane) for studies published up to August 17, 2020. Standardized mean difference (SMD) and 95%CI were used to evaluate the effectiveness of interventions on HbA1c. Heterogeneity was estimated using the I² statistic. Begg’s test was used to assess the possible publication bias among studies.ResultsTwelve studies of 2444 cases were included in this study. The overall SMD is ?0.22 and 95%CI ?0.33 to ?0.10 in 0–6 months of intervention group. The I² and P were 18.4% and 0.26. There are no publication bias tested (z = 0.37, P = 0.72).ConclusionCognitive behavioral therapy and mindful self-compassion might be effective method to improve glycaemic control of diabetes with depression in 0–6 months.     

Type 1 diabetes and living without a partner: Psychological and social aspects,self-management behaviour,and glycaemic control

Aims

(1) To investigate the association between cohabitation status and psychological aspects of living with diabetes (diabetes distress, diabetes empowerment, quality of life), self-management behaviours, and glycaemic control and (2) to explore whether potential associations are mediated by social support.

Methods

Cross-sectional survey of 2419 adult outpatients with type 1 diabetes from a specialized diabetes clinic in Denmark. Stepwise multiple regression gender-stratified analyses assessed the association between cohabitation status and the variables of interest and the influence of social support.

Results

Significant associations existed between living without a partner and low quality of life, low diabetes empowerment and HbA1c for both men and women. For women, living without a partner was significantly associated with higher diabetes distress and poor self-management behaviours. All associations were mediated by social support to varying degrees.

Conclusions

Social network and social support are related to important diabetes outcomes in type 1 diabetes. Living without a partner indicates a need for support to prevent poorer diabetes outcomes. Women appear more susceptible to living without a partner in terms of psychosocial diabetes outcomes and glycaemic control. Generally, social support is a mediator in the association between cohabitation status and diabetes outcomes, but social support, as well as cohabitation status, are also independently associated with poorer diabetes outcomes. Assessment of cohabitation status as an indicator of psychosocial capabilities and glycaemic control may be useful in diabetes care and support.     

Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia

Aim

The objectives of this pilot study were to determine the feasibility and effect on glycaemic control of a low-glycaemic-index (GI) diet in women with gestational diabetes or impaired glucose tolerance of pregnancy.

Methods

Participants, recruited from the Diabetes-in-Pregnancy Clinic of an inner-city teaching hospital serving a predominantly non-Caucasian population, were randomized to a low-GI (n = 23) or control (n = 24) diet and followed from 28 weeks gestation until delivery. Self-monitored-blood-glucose (SMBG), maternal and infant weight were collected from medical charts. Dietary intakes were assessed using diet records and questionnaires.

Results

Diet GI on control (58, 95% CI: 56,60) was significantly higher than on low-GI (49, 95% CI: 47,51; p = 0.001). Glycaemic control improved on both diets, but more postprandial glucose values were within target on low-GI (58.4% of n = 1891) than control (48.7% of n = 1834; p < 0.001). SMBG post-breakfast was directly related to pre-pregnancy BMI in the control, but not the low-GI group (BMI * diet interaction; p = 0.021). Participants accepted the study foods and were willing to consume them post-intervention.

Conclusions

A low-GI diet was feasible and acceptable in this sample and facilitated control of postprandial glucose. A larger study is needed to determine the effect of a low-GI diet on maternal and infant outcomes.     

Assessment of kidney function and associated risk factors among type 2 diabetic patients

Aimdiabetic patients are required for continuous monitoring programs hence continuous assessment of kidney function parameters is crucial. So, we aimed to determine the prevalence of Chronic Kidney Disease (CKD) and abnormal renal parameters, with poorly controlled type 2 diabetes mellitus pateintsMaterials and methodsA cross-sectional study was carried out at private health care centre. A total of 300 diabetic patients aged 18 years and above attended the clinic from February 2018 to Dec 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using (SPSS, version 23).Resultsout of the 300 diabetes patients recruited 42% of patients with type 2 diabetes had abnormal Creatinine Serum levels and 22.3% had abnormal glomerular filtration rate (GFR). Abnormal albumin urine levels were found in 28.3% and 11.3% had abnormal creatinine in urine. Abnormal Albumin: Creatinine Ratios (Alb/Cr), were found in 23%. Of the total, 77% (n = 231) had normal Alb: Cr Ratio, 20% had risk of nephropathy and 9% had nephropathy.ConclusionCurrent study revealed a high prevalence of abnormal renal parameters in patients with type 2 diabetes Mellitus. This necessitates the need for early and universal screening of renal functions. There is also an urgent demand for measures that target tight glycaemic, Vitamin D level and life style modifications is also required to all diabetic patients to achieve target value of HbA1C ≤ 7.     

Khat chewing leads to increase in glycaemic parameters in patients with type 2 diabetes mellitus in Jazan region,Saudi Arabia and Yemen

BackgroundKhat is known to have a stimulating effect on the sympathetic nervous system by producing a temporary sensation of activeness and happiness, along with mood disturbance and anxiety. Despite growing evidence of the association between khat chewing and glycaemic control in patients with diabetes, the position of khat chewing in DM is not fully recognised.AimTo evaluate the association of khat chewing with the risk of elevated blood glucose levels among patients with type 2 diabetes mellitus.MethodA web-based literature search was performed using the electronic databases PubMed, EMBASE and Google Scholar. Databases were searched for studies published about khat chewing and diabetes mellitus in the Jazan region, Saudi Arabia and Yemen.ResultTwenty-five published articles studying the relation between khat chewing and diabetes mellitus were identified, but only 10 studies reported an association between khat chewing and blood glucose levels and were included.ConclusionKhat chewing increases fasting blood glucose, post-prandial blood glucose and HbA1c levels in patients with diabetes in the Jazan region, Saudi Arabia and Yemen.     

Beneficial effect of a low glycaemic index diet in type 2 diabetes.

Low glycaemic index foods produce low blood glucose and insulin responses in normal subjects, and improve blood glucose control in Type 1 and well-controlled Type 2 diabetic patients. We studied the effects of a low glycaemic index diet in 15 Type 2 diabetic patients with a mean fasting blood glucose of 9.5 mmol l-1 using a randomized, crossover design. Patients were given pre-weighed diets (59% energy as carbohydrate, 21% fat, and 24 g 1000-kcal-1 dietary fibre) for two 2-week periods, with a diet glycaemic index of 60 during one period and 87 during the other. On the low glycaemic index diet, the blood glucose response after a representative breakfast was 29% less than on the high glycaemic index diet (874 +/- 108 (+/- SE) vs 204 +/- 112 mmol min l-1; p less than 0.001), the percentage reduction being almost identical to the 28% difference predicted from the meal glycaemic index values. After the 2-week low glycaemic index diet, fasting serum fructosamine and cholesterol levels were significantly less than after the high glycaemic index diet (3.17 +/- 0.12 vs 3.28 +/- 0.16 mmol l-1, p less than 0.05, and 5.5 +/- 0.4 vs 5.9 +/- 0.5 mmol l-1, p less than 0.02, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Carbohydrate nutrition, glycaemic load, and plasma lipids: the Insulin Resistance Atherosclerosis Study.

AIMS: We evaluated the relationship of carbohydrate nutrition and selected food groups with lipids using data from the Insulin Resistance Atherosclerosis Study (IRAS Exam I, 1992-1994). METHODS AND RESULTS: A total of 1026 middle-aged adults with normal or impaired glucose tolerance had complete data on fasting lipids and usual dietary intake from an interviewer-administered, validated food frequency questionnaire. Published glycaemic index (GI) values were assigned to food items and average dietary GI and glycaemic load (GL) were calculated per participant. Intake of carbohydrates differed by gender, men consuming more absolute digestible carbohydrates with higher GI and GL than women. In multivariate models adjusting for energy intake, in men, GL and carbohydrates were associated positively with total and LDL cholesterol, and inversely with HDL. In women, associations were limited to triglycerides. We estimated that a 100 g higher intake in GL or carbohydrates was associated with a 7-8 mg/dL higher total or LDL cholesterol level in men, and a 13-17 mg/dL higher triglyceride level in women. In the combined sample, GL and carbohydrates were consistently associated with all lipid levels and GI was inversely associated with HDL cholesterol. CONCLUSION: Our findings underscore the importance of carbohydrate nutrition for plasma lipids.     

Hormonal and glycaemic responses to serial meals in newly diagnosed non insulin dependent diabetic patients

The hormonal and glycaemic responses to serial test meals have been well documented in normal subjects and in patients with insulin dependent diabetes. There is less information in patients with non-insulin dependent diabetes. We studied 39 newly diagnosed previously untreated non-insulin dependent diabetics. Each patient received four identical test meals over a 24 hour period and their plasma glucose and insulin levels were determined at frequent intervals throughout the study period. The results show that all the non-insulin dependent patients at diagnosis had large post-prandial glucose excursions, and that the post-prandial rise in insulin was delayed. The study also demonstrates that glucose and insulin profiles are dependent on the degree of obesity of the patient. Patients with non-insulin dependent diabetes have a greater degree of glucose intolerance in the morning in contrast to normal subjects whose glucose tolerance is best in the morning.