Suppression of nocturnal fatty acid concentrations by bedtime carbohydrate supplement in type 2 diabetes: effects on insulin sensitivity, lipids, and glycemic control

BACKGROUND: Bedtime ingestion of slow-release carbohydrates leads to sustained nocturnal fatty acid suppression and improved glucose tolerance in type 2 diabetic patients. OBJECTIVE: This study assessed the effects of 2 different doses of bedtime carbohydrate supplement (BCS) on morning glycemic control and glycated hemoglobin (Hb A(1c)) in type 2 diabetic patients. In addition, the effects of the high-dose BCS on insulin sensitivity and postprandial glucose and triacylglycerol concentrations were assessed. DESIGN: Two BCS doses were studied separately in 7-wk randomized, placebo-controlled, double-blind studies with either a parallel (low-dose BCS; n = 24 patients) or crossover (high-dose BCS; n = 14 patients) design. The effects of the low and high doses (0.30 and 0.55 g uncooked cornstarch/kg body wt, respectively) were compared with those of a starch-free placebo. RESULTS: Compared with the starch-free placebo, the high-dose BCS ( approximately 45 g) produced enhanced nocturnal glucose (P < 0.01) and insulin (P < 0.01) concentrations as well as a 32% suppression of fatty acid concentrations (P < 0.01). Moreover, glucose tolerance (P < 0.05) and C-peptide response (P < 0.05) improved after breakfast the next morning. The low-dose BCS ( approximately 25 g) improved fasting blood glucose concentrations (P < 0.05). However, there were no improvements in insulin sensitivity, postprandial triacylglycerol concentrations, or Hb A(1c) after 7 wk. CONCLUSION: Nocturnal fatty acid suppression by BCS improved fasting and postprandial blood glucose concentrations in type 2 diabetic patients the next morning. In contrast, no improvements in insulin sensitivity, postprandial triacylglycerol concentrations, or long-term glycemic control assessed by Hb A(1c) were seen after BCS supplementation.     

甘精胰岛素联合口服药物治疗2型糖尿病的疗效及安全性分析

目的评价甘精胰岛素联合口服降糖药物（oral hypoglycemic drugs,OADs）治疗方案对使用预混胰岛素血糖控制欠佳的2型糖尿病患者的疗效及安全性。方法预混胰岛素30/70单独或联合使用OADs血糖控制不良的2型糖尿病患者50例,随机分为治疗组（停用预混胰岛素,改为皮下注射甘精胰岛素联合OADs）（n=30）和对照组（继续使用预混胰岛素早晚餐前皮下注射联合OADs）（n=20）,各组均依据血糖监测水平调整胰岛素及OADs用量。12周后对比两组患者空腹血糖（fasting blood glucose,FBG）、三餐后2 h血糖（2-hour postprandial blood glucose,2hPG）、糖化血红蛋白A1c（glycated hemoglobin A1c,HbA1c）、体重指数（body mass index,BMI）及试验期间低血糖发生次数。结果与治疗前相比,治疗组及对照组治疗后HbA1c、FBG、三餐2hPG均有所下降（P均〈0.01）;治疗组BMI无明显变化（P〉0.05）,对照组BMI较治疗前增加（P〈0.01）。与对照组相比,治疗组治疗后FBG、午餐2hPG及HbA1c均低于对照组（P均〈0.01）;治疗组治疗后BMI低于对照组（P〈0.01）;试验期间治疗组低血糖发生次数低于对照组（P〈0.01）。结论预混胰岛素血糖控制欠佳的2型糖尿病患者,改为甘精胰岛素联合OADs治疗,可使FBG和HbA1c显著改善,不增加体重,简便易行,且降低了低血糖风险。     

Glucose metabolism and hyperglycemia

Islet dysfunction and peripheral insulin resistance are both present in type 2 diabetes and are both necessary for the development of hyperglycemia. In both type 1 and type 2 diabetes, large, prospective clinical studies have shown a strong relation between time-averaged mean values of glycemia, measured as glycated hemoglobin (HbA1c), and vascular diabetic complications. These studies are the basis for the American Diabetes Association's current recommended treatment goal that HbA1c should be <7%. The measurement of the HbA1c concentration is considered the gold standard for assessing long-term glycemia; however, it does not reveal any information on the extent or frequency of blood glucose excursions, but provides an overall mean value only. Postprandial hyperglycemia occurs frequently in patients with diabetes receiving active treatment and can occur even when metabolic control is apparently good. Interventional studies indicate that reducing postmeal glucose excursions is as important as controlling fasting plasma glucose in persons with diabetes and impaired glucose tolerance. Evidence exists for a causal relation between postmeal glucose increases and microvascular and macrovascular outcomes; therefore, it is not surprising that treatment with different compounds that have specific effects on postprandial glucose regulation is accompanied by a significant improvement of many pathways supposed to be involved in diabetic complications, including oxidative stress, endothelial dysfunction, inflammation, and nuclear factor-kappaB activation. The goal of therapy should be to achieve glycemic status as near to normal as safely possible in all 3 components of glycemic control: HbA1c, fasting glucose, and postmeal glucose peak.     

老年2型糖尿病患者应用罗格列酮治疗前后血清C反应蛋白的改变

目的观察盐酸罗格列酮治疗老年2型糖尿病（T2DM）前后血清高敏C反应蛋白（hsCRP）的变化及其影响因素,探讨糖脂代谢与炎症因子的关系。方法将85例已合用磺脲类和双胍类药物的T2DM患者随机分为盐酸罗格列酮组（4mg/d）及对照组,进行为期12周的临床观察。结果基线hsCRP水平与糖化血红蛋白（HbA1c）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）水平、体质指数均相关。罗格列酮治疗后患者hsCRP水平明显下降（P=0.003）。而对照组无改变。餐后血糖变化（P〈0.01）及空腹血糖水平的变化（P〈0.01）与hsCRP变化最相关,其次为LDL-C（P〈0.01）、HbA1c（P=0.031）及HDL-C（P=0.045）的改变。结论老年T2DM患者慢性高血糖状态与炎症关系密切。罗格列酮治疗在改善糖脂代谢的同时,还具有明显的抗炎作用使hsCRP水平明显下降。     

The effect of combination treatment with acarbose and glibenclamide on postprandial glucose and insulin profiles: additive blood glucose lowering effect and decreased hypoglycaemia

This study compared the effects of acarbose plus glibenclamide combination therapy with acarbose or glibenclamide treatment alone on postprandial blood glucose, serum insulin and C-peptide levels, and the tendency to develop hypoglycaemia. A total of 84 patients with Type 2 diabetes (fasting blood glucose: 120-180 mg/dl; postprandial blood glucose: 140-240 mg/dl) was included in this two-centre, double-blind, double-dummy, placebo-controlled study. Patients were randomised to one of 4 treatment groups: acarbose (100 mg); glibenclamide (3.5 mg); acarbose plus glibenclamide; or placebo. Treatment was administered before a standard breakfast, and fasting (07.30 h, 08.00 h) and postprandial (09.00, 10.00, 11.00, 12.00 h) blood glucose, serum insulin and C-peptide levels were determined. Acarbose plus glibenclamide treatment significantly reduced the mean increase in postprandial blood glucose levels (23.7+/-17.3 mg/dl) compared with either acarbose (58.4+/-31.6 mg/dl), glibenclamide (56.9+/-42.8 mg/dl) or placebo (101.6+/-49.2 mg/dl) (p<0.05 for all). Serum insulin levels (mean AUC(7.30-12 h)) observed with acarbose plus glibenclamide combination therapy were significantly lower than those observed with glibenclamide monotherapy (243.5+/-161.1 vs 383.4+/-215.8 hr x microU/ml; p=0.02), and comparable with the values seen with placebo (226.0+/-166.6 hr x microU/ml), suggesting that acarbose modifies the insulin secretion induced by glibenclamide. Glibenclamide monotherapy resulted in a significantly higher rate of decrease in blood glucose level than with acarbose plus glibenclamide (71.8+/-29.9 vs 46.2+/-18.0 mg/dl x h(-1); p=0.0003), and blood glucose levels at 11.00 h were also markedly lower with glibenclamide (84.4+/-29 mg/dl) than acarbose plus glibenclamide (102.0+/-41 mg/dl), suggesting a reduced tendency for hypoglycaemic episodes with acarbose plus glibenclamide than with glibenclamide alone. In all, 6 (29%) hypoglycaemic episodes occurred with glibenclamide, 2 (10%) with acarbose plus glibenclamide and none with acarbose. Acarbose plus glibenclamide combination therapy results in an additive glucose lowering effect and reduced risk for hypoglycaemia. Acarbose modifies the insulin secretion induced by glibenclamide, which explains the lower risk of hypoglycaemia compared with glibenclamide monotherapy.     

Efficacy and Safety of Omija (Schisandra chinensis) Extract Mixture on the Improvement of Hyperglycemia: A Randomized,Double-Blind,and Placebo-Controlled Clinical Trial

A previous animal study demonstrated that the administration of Omija extract and soybean mixture (OSM) improved glycemic control in the type 2 diabetes model. In this study, we conducted a 12-week, randomized, double-blinded, and placebo-controlled clinical trial to determine the effects of OSM in humans with hyperglycemia. Participants with fasting plasma concentrations of 100–140 mg/dL were enrolled (n = 80) and administered either OSM or placebo products for 12 weeks. The outcomes included measurements of efficacy (fasting plasma glucose (FPG), postprandial glucose (PPG), fasting plasma insulin (FPI), postprandial insulin (PPI), hemoglobin A1c (HbA1c), C-peptide, fructosamine, and lipid parameters) and safety at baseline and at 12 weeks. After the intervention, the OSM group showed significantly decreased levels of FPG, PPG (30, 60 min), PPI (60 min), insulin area under the curve (AUC), fructosamine, and low-density-lipoprotein (LDL) cholesterol compared to the placebo group. No clinically significant changes in any safety parameter were observed. Therefore, it is hypothesized that OSM supplementation is an effective and safe functional food supplement for humans with hyperglycemia.     

A simple meal plan of 'eating vegetables before carbohydrate' was more effective for achieving glycemic control than an exchange-based meal plan in Japanese patients with type 2 diabetes

This study aimed to determine whether educating diabetic patients to 'eat vegetables before carbohydrate' was as effective on long-term glycemic control as a traditional exchange-based meal plan. To test this hypothesis, we carried out a randomized, controlled trial in patients with type 2 diabetes that compared changes in HbA1c as the primary outcome. A total of 101 patients were stratified according to sex, age, BMI, duration of diabetes, and HbA1c, and then randomized to receive instructions to eat either vegetables before carbohydrate (VBC, n=69) or an exchange-based meal plan (EXB, n=32). The impact of the two plans on glycemic control was compared over 24 months of follow-up. Significant improvements in HbA1c over 24 months were observed in both groups (VBC, 8.3 to 6.8% vs EXB, 8.2 to 7.3%). HbA1c levels were significantly lower in the VBC group than in the EXB group after 6, 9, 12 and 24 months of the study. Both groups exhibited similar improvements in dietary practices with respect to intake of carbohydrate, fats and sweets, while the VBC group had a significant increase in consumption of green vegetables and a significant decrease in fruit consumption. A simple meal plan of 'eating vegetables before carbohydrate' achieved better glycemic control than an exchange-based meal plan in Japanese patients with type 2 diabetes over a 24-month period.     

诺和锐30联合亚莫利治疗2型糖尿病临床观察

目的观察42例单应用诺和锐30（2次/d,皮下注射）血糖控制不佳的2型糖尿患者,联合应用亚莫利治疗的临床效果。方法采用自身前后对照,临床观察42例2型糖尿病患者,应用诺和锐30（2次/d,皮下注射）,疗程在〉4～8周,诺和锐30用量已调至48～62u,血糖仍未达标（且有5例患者于午餐前及下午出现轻度低血糖症状）。联合口服亚莫利（2～4mg次/d）治疗2～4周,比较治疗前后空腹血糖（FPG）、餐后2h血糖（PPG）、糖化血红蛋白（HbA1c）水平、低血糖发生及胰岛素用量变化情况。结果诺和锐30联合亚莫利治疗后FPG、2hPG、HbA1C均有明显下降,FPG（P〈0.05）,2h PG（P〈0.01,HbA1C（P〈0.05）,平均全日胰岛素用量较前减少12%,无低血糖发生。结论诺和锐30联合亚莫利治疗2型糖尿病与单用胰岛素治疗相比更能有效地使血糖平稳达标,胰岛素用量较前减少16%,无低血糖发生。     

Predictive factors of glycemic control in patients with type 2 diabetes mellitus in primary health care

PURPOSE: To determine the factors associated with poor glycemic control in type 2 diabetic patients followed in primary care units in Sousse, Tunisia. METHODS: A cross-sectional study was conducted on a representative sample of type 2 diabetic patients followed at least two years in primary health care units in Sousse, Tunisia. Data were gathered from three sources: a self-administrated questionnaire, analysis of patient files and HbA1c level. HbA1c level was measured with turbidimetric immunoinhibition assay. Patients were considered well-controlled if glycated hemoglobin (HbA1c) was less than 7%, according to the American Diabetics Association (ADA) recommendations. RESULTS: The study enrolled 404 type 2 diabetic patients. The mean age was 60.5+/-10.89 years, sex-ratio was 0.5, and mean disease duration 8.7+/-6.1 years. ADA recommendations were met by 16.7% of patients. Multivariate analysis using variables in relation with the patient, his/her family, the disease, the treatment and the health care unit, showed that only poor geographic access to the care center (adjusted OR: 1.89, p=0.009) and Body Mass Index (BMI) less than 30 kg/m2 (adjusted OR: 2.21, p=0.034) were significantly and independently associated with poor glycemic control. CONCLUSION: Glycemic control in type 2 diabetic patients is poor. It depends strongly on geographic access to health care. Type 2 diabetic patients should be referred, as much as possible, to the nearest health care unit.     

门冬胰岛素应用于胰岛素泵对餐后血糖和血糖波动的影响

目的 探讨门冬胰岛素与可溶性人胰岛素在持续皮下胰岛素输注(CSII)中对餐后血糖和血糖波动的影响.方法 选择345例2型糖尿病患者,随机以门冬胰岛素(门冬胰岛素组173例)和可溶性人胰岛素(人胰岛素组172例)作为泵用胰岛素进行CSII强化治疗,监测1d 9次末梢血糖(三餐前后、22:00、0:00和3:00),比较两组餐后血糖和血糖波动情况.结果 门冬胰岛素组较人胰岛素组对空腹和早、晚餐后血糖控制更好,餐后血糖波动更小,达标时间较短[分别为(4.40±2.16)、(5.68±2.29)d](P<0.05),且低血糖的发生率明显较低(P<0.05).结论 在CSII强化治疗中,门冬胰岛素可更快、更有效降低血糖,尤其有利于餐后血糖控制和减少整体的血糖波动.     

Glucose and lipid metabolism and insulin sensitivity in type 1 diabetes: the effect of guar gum

The effect of guar gum on glucose and lipid metabolism and on body insulin sensitivity was examined in nine type 1 diabetic patients treated with continuous subcutaneous insulin infusion. The study was done in a randomized, double-blind, crossover fashion with either guar gum or a placebo added to the usual diet four times per day for 4 wk each. Blood glucose levels after breakfast and lunch and daily insulin requirements were significantly lower during the guar-gum than the placebo diet. After a 4-wk guar-gum supplementation, blood glucose response to a test meal was significantly reduced by guar gum compared with the placebo. Hemoglobin A1 (HbA1) and insulin sensitivity remained unchanged. Serum total cholesterol fell by 21% (p less than 0.025). Thus, guar gum can reduce postprandial blood glucose, insulin requirements, and serum total cholesterol levels in type 1 diabetic patients.     

Effect of sodium metavanadate supplementation on lipid and glucose metabolism biomarkers in type 2 diabetic patients

Type 2 diabetes mellitus is a chronic, progressive illness that causes considerable morbidity and premature mortality. Vanadium is a trace mineral that has been claimed to be effective in controlling blood glucose levels in diabetic patients. A randomised placebo-controlled study was conducted to evaluate the effect of sodium metavanadate on selected biochemical markers in type 2 diabetic patients. Forty patients were enrolled and half of them received 100 mg sodium metavanadate daily for 6 weeks while the other half were placebo subjects. The mean age of the patients was 53.1 ± 8.5 years. Body mass index (BMI), blood pressure(BP), fasting blood sugar (FBS), 2-h postprandial glucose, glycated hemoglobin (HbA1C), triglyceride(TG), total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoproteins (HDL) were determined before the start and at the end of the study. Levels of FBS, HbA1C, TC and LDL in the diabetic subjects decreased after six weeks on sodium metavanadate, but the differences were not statistically significant on comparing between pre- and posttrial levels. Based on the results, this study did not find sodium metavanadate of beneficial use as a form of vanadium supplementation among patients with type 2 diabetes.     

Management of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a progressive disease with an insidious onset. It is thought to affect up to 10% of European and North American populations with a significantly higher incidence in non-White than in White populations. Complications of the disease are associated with considerable morbidity and mortality and their management consumes significant healthcare resources.Data from the United Kingdom Prospective Diabetes Study have shown that intensive glycemic control reduces the microvascular complications of type 2 disease and that intensive management of fasting plasma glucose (FPG) levels is insufficient over time to provide such control. Recent studies have demonstrated that lowering postprandial plasma (PPG) glucose levels provides some additional glycemic control and recent epidemiologic data suggest reducing PPG levels may be associated with a reduction in mortality.In patients with type 2 diabetes mellitus inadequately controlled by diet and exercise, nateglinide significantly improved glycemic control compared with placebo; a beneficial effect on both FPG and PPG levels was observed. In active comparator studies, nateglinide has been shown to be as effective as metformin (in pharmacotherapy-naïve patients), acarbose and troglitazone in reducing glycosylated hemoglobin (HbA_1c) levels.When used in combination with metformin (in patients inadequately controlled on maximum dosages of metformin monotherapy) nateglinide significantly improves glycemic control compared with placebo. In addition, nateglinide has been shown to display pronounced additive effects when added to troglitazone or metformin in patients inadequately controlled by diet and exercise alone.Nateglinide was generally well tolerated in clinical trials. The most common adverse event was hypoglycemia, although the incidence was low in comparison with sulfonylureas. The incidence of hypoglycemia was increased in patients using nateglinide in combination with metformin.By controlling HbA_1c and PPG, nateglinide has the potential to provide substantial health and quality-of-life benefits; however, long-term outcome data and validated quality-of-life assessments are lacking. In economic modelling studies, the estimated cost-effectiveness ratios observed with nateglinide were well within the range for therapies considered to be cost-effective.In conclusion, nateglinide is a useful addition to the available treatments for type 2 diabetes mellitus. It significantly improved glycemic control in pharmacotherapy-naïve patients as well as in patients not adequately controlled by metformin alone; however, until long-term clinical data become available, nateglinide can only be considered as an adjunct to metformin in patients inadequately controlled on metformin alone in whom PPG levels are elevated. Nateglinide is well tolerated and has low potential to cause hypoglycemia and bodyweight gain.     

基于智能手机的青中年2型糖尿病患者健康管理的效果观察

目的:观察基于智能手机对青中年2型糖尿病患者进行健康管理的效果。方法:选择126例青中年2型糖尿病出院患者,随机分为健康管理组和对照组。健康管理组除常规临床治疗外,在智能手机上下载使用交流软件和常见的糖尿病相关应用软件,随访后观察健康管理效果。结果:2组基线水平无统计学差异,具有可比性。干预后健康管理组空腹血糖、餐后2 h血糖和糖化血红蛋白水平比对照组显著改善,差异有统计学意义(P值均<0.000 1);健康管理组能够改善饮食结构、运动坚持情况,患者对治疗依从性和健康满意度均较高,差异均有统计学意义(P<0.05)。结论:与单纯常规应用临床治疗2型糖尿病相比,联合智能手机平台进行健康管理的方式可为青中年2型糖尿病的健康管理提供一个新的思路。     

PROFAST: A Randomized Trial Assessing the Effects of Intermittent Fasting and Lacticaseibacillus rhamnosus Probiotic among People with Prediabetes

Both intermittent fasting and specific probiotics have shown promise in improving glucose tolerance with a potential for synergistic effects through alterations to gut microbiota. In this randomized, double-blinded, two-arm feasibility study, we investigated whether intermittent fasting, supplemented with Lacticaseibacillus rhamnosus HN001 probiotic, reduces HbA1c in individuals with prediabetes. All participants with HbA1c 40–50 mmol/mol commenced intermittent fasting (2 days per week of calorie restriction to 600–650 kcal/day) and were randomized 1:1 to either daily probiotic (Lacticaseibacillus rhamnosus HN001) or placebo for 12 weeks. The primary outcome was a change in HbA1c. Secondary outcomes included changes in anthropometry, body composition, glucoregulatory markers, lipids, hunger hormones, liver enzymes, inflammatory markers, gut hormones, calorie and macronutrient intake, quality of life, hunger, mood and eating behavior. Of 33 participants who commenced the trial, 26 participants (mean age 52 years, body mass index (BMI) 34.7 kg/m²) completed the intervention (n = 11 placebo, n = 15 probiotic). HbA1c decreased from 43 ± 2.7 mmol/mol to 41 ± 2.3 mmol/mol, p < 0.001, with average of 5% weight loss. No significant between-group differences were seen in primary or secondary outcomes except for social functioning (p = 0.050) and mental health (p = 0.007) scores as improvements were seen in the probiotic group, but not in the placebo group. This study shows additional psychological benefits of probiotic supplementation during intermittent fasting to achieve weight loss and glycemic improvement in prediabetes.     

不同时长运动联合二甲双胍对2型糖尿病血糖控制效果的meta分析

目的 探讨不同时长运动疗法联合二甲双胍治疗对2型糖尿病患者血糖控制的不同疗效。方法 计算机检索 PubMed、EMbase、Elsevier、CNKI、WanFang Data、Web of Science等数据库,检索相关随机对照试验（RCTs）,采用RevMan 5.3 软件进行meta分析。结果 共纳入10个 RCTs,包括974例患者。meta分析结果显示,与单纯二甲双胍治疗相比,运动疗法联合二甲双胍治疗2～3个月后,空腹血糖（FBG）显著下降（SMD = - 1.61,95%CI: - 2.68～- 0.53,P = 0.003）,糖化血红蛋白（HbA1c）明显降低（SMD = - 1.41,95%CI: - 1.75～- 1.07,P＜0.001）,空腹胰岛素（FINS）含量降低至更接近于正常范围（SMD = - 1.14,95%CI: - 2.15～- 0.13,P = 0.03）;胰岛素抵抗指数（HOMA - IR）（SMD = - 0.75,95%CI:- 1.32～- 0.18,P = 0.010）与餐后两小时血糖（2hPBG）明显降低（SMD = - 1.42,95%CI:- 2.46～- 0.39,P = 0.007）;运动疗法联合二甲双胍治疗6个月后,FBG（SMD = - 0.74,95%CI: - 1.97～0.49,P = 0.24）及2hPBG（SMD = - 1.24,95%CI: - 2.23～- 0.26,P = 0.01）的控制效果未表现出显著差异。结论 2～3个月运动联合二甲双胍治疗在控制血糖、减低胰岛素抵抗方面比单纯二甲双胍治疗效果更为显著,而干预时长延长至6个月时,运动联合二甲双胍治疗在糖尿病患者血糖控制上的叠加效应消失。由于纳入的文章数目及质量有限,上述结论还需更多高质量研究进一步论证。     

Inclusion of guar gum and alginate into a crispy bar improves postprandial glycemia in humans

A novel induced viscosity fiber (IVF) crispy bar was formulated with the viscous dietary fibers alginate and guar gum. To evaluate the glycemic response and gastrointestinal tolerance to IVF crispy bars, nondiabetic healthy adult subjects (n = 48) were studied in a randomized, double-masked, crossover design. The control crispy bars and IVF crispy bars were identical except for the 2 dietary fibers contained in the experimental (IVF) bars. After an overnight fast, subjects consumed test bars containing 50 g carbohydrate. Their capillary blood glucose response was determined for 180 min postprandially. When subjects consumed IVF, the incremental blood glucose excursions were reduced (P < 0.05) at 15, 30, 45, and 120 min. At 180 min, the subjects' blood glucose concentration was maintained above the basal blood glucose concentration for both bars. Compared with controls, the incremental peak blood glucose concentration was reduced (P < 0.001) 30% when subjects consumed IVF. When subjects consumed IVF, the positive incremental area under the curve for glucose was reduced (P < 0.01) by 33% compared with controls. In the 24-h postprandial period after each treatment, the frequency and intensity of gastrointestinal tolerance symptoms did not differ. In conclusion, compared with a control crispy bar, the IVF crispy bar attenuated the postprandial glycemic excursion without gastrointestinal intolerance in healthy adult subjects.     

胃转流术对2型糖尿病患者糖代谢影响的初步观察:八例临床资料分析并文献复习

目的 观察胃转流术对2型糖尿病患者糖代谢相关指标的影响,并评价胰岛β细胞功能及胰岛素抵抗的改善情况.方法 前瞻性研究8例2型糖尿病患者合并胃癌等胃肠道疾病行胃转流术治疗,术前和术后1周、2周、1个月、3个月的空腹血糖(FPG)及糖负荷后2 h血糖(2hPG)、空腹血浆胰岛素(Fins)、糖负荷后2 h血浆胰岛素(2hIns)、空腹血浆C肽(空腹C肽)、糖负荷后2 h血浆C肽(2hC肽)、体质指数(BMI)的变化,术前、术后3个月糖化血红蛋白(HbA1c)的变化及术后3个月糖尿病的转归情况.结果 胃转流术后1周所有患者的FPG及2hPG均较术前明显下降(P＜0.05),术后1个月Fins、2hIns、空腹C肽、2hC肽均较术前明显升高(P＜0.05);术后3个月HbA1c水平较术前明显下降(P＜0.05);患者术后各时间段BMI较术前均无明显变化(P＞0.05).术后3个月8例患者均达到糖尿病治疗有效标准,其中6例患者达到临床缓解标准.结论 胃转流术能明显降低2型糖尿病患者的血糖水平,其对血糖的控制不依赖于体重的降低;胃转流术控制血糖可能与胰岛β细胞功能改善、内源性胰岛素分泌增加有关.

Abstract：

Objective To investigate the effects of gastric bypass on glycometabolism and improvement of islet β cell function and insulin resistance in patients with type 2 diabetes. Methods Eight patients with type 2 diabetes combined with gastric carcinoma who treated with gastric bypass were studied prospectively. Fasting and postprandial plasma glucose levels, fasting and postprandial insulin C-peptide levels, and body mass index (BMI) were measured right before the surgery and at intervals of 1 week, 2 weeks, 1 month and 3 months after the surgery. Glycosylated hemoglobin (HbA1c) levels were measured before and 3 months after the surgery. The outcome of the diabetes after 3 months of the surgery was also monitored. Results Fasting and postprandial plasma glucose levels decreased (P ＜ 0.05) and fasting and postprandial insulin C-peptide levels increased (P ＜ 0.05) after the surgery. HbA1c levels also decreased (P ＜ 0.05) after 3 months of the surgery. There was no significant change of BMI at all intervals after the surgery(P＞ 0.05). All of the 8 patients reached the total effective standard and 6 patients reached the clinical remission standard after 3 months of the surgery. Conclusions It suggests that gastric bypass can significantly lower plasma glucose levels in type 2 diabetes, which does not depend on the loss of weight. The control of plasma glucose by gastric bypass may be due to the improvement of islet β cell function and increasing secretion of endogenous insulin.     

Metabolic effects of the incretin mimetic exenatide in the treatment of type 2 diabetes

Interventional studies have demonstrated the impact of hyperglycemia on the development of vascular complications associated with type 2 diabetes, which underscores the importance of safely lowering glucose to as near-normal as possible. Among the current challenges to reducing the risk of vascular disease associated with diabetes is the management of body weight in a predominantly overweight patient population, and in which weight gain is likely with many current therapies. Exenatide is the first in a new class of agents termed incretin mimetics, which replicate several glucoregulatory effects of the endogenous incretin hormone, glucagon-like peptide-1 (GLP-1). Currently approved in the US as an injectable adjunct to metformin and/or sulfonylurea therapy, exenatide improves glycemic control through multiple mechanisms of action including: glucose-dependent enhancement of insulin secretion that potentially reduces the risk of hypoglycemia compared with insulin secretagogues; restoration of first-phase insulin secretion typically deficient in patients with type 2 diabetes; suppression of inappropriately elevated glucagon secretion to reduce postprandial hepatic output; and slowing the rate of gastric emptying to regulate glucose appearance into the circulation. Clinical trials in patients with type 2 diabetes treated with subcutaneous exenatide twice daily demonstrated sustained improvements in glycemic control, evidenced by reductions in postprandial and fasting glycemia and glycosylated hemoglobin (HbA(1c)) levels. Notably, improvements in glycemic control with exenatide were coupled with progressive reductions in body weight, which represents a distinct therapeutic benefit for patients with type 2 diabetes. Acute effects of exenatide on beta-cell responsiveness along with significant reductions in body weight in patients with type 2 diabetes may have a positive impact on disease progression and potentially decrease the risk of associated long-term complications.