Effects of pomegranate juice consumption on oxidative stress in patients with type 2 diabetes: a single-blind,randomized clinical trial

Increased free radicals production due to hyperglycemia produces oxidative stress in patients with diabetes. Pomegranate juice (PJ) has antioxidant properties. This study was conducted to determine the effects of PJ consumption in oxidative stress in type 2 diabetic patients.

This study was a randomized clinical trial performed on 60, 40–65 years old diabetic patients.

The patients were randomly allocated either to PJ consumption group or control. Patients in PJ group consumed 200?ml of PJ daily for six weeks. Sex distribution and the mean age were not different between two groups. After six weeks intervention, oxidized LDL and anti-oxidized LDL antibodies decreased and total serum antioxidant capacity and arylesterase activity of paraoxonase increased significantly in the PJ-treated group compared to the control group. Our data have shown that six weeks supplementation of PJ could have favorable effects on oxidative stress in patients with type 2 diabetes (T2D).     

Effect of dairy products on oxidative stress in type 2 diabetic patients: A randomized controlled clinical trial

ObjectiveThe aim of this randomized control trial was to assess the effect of dairy product (milk and yogurt) consumption on oxidative stress biomarkers in diabetic patients.Material and methodsNinety-one diabetic patients were randomly assigned to one of the three following intervention groups: group A (<1 serving of dairy products), group B (2 to 3 servings), and group C (4 to 5 servings). Biomarkers of oxidative stress including, serum total antioxidant capacity, catalase activity, malondialdehyde (MDA) were measured at baseline and after the 8-week intervention.ResultsNo significant difference was found in oxidative stress between groups, except for MDA that significantly decreased in group C.ConclusionsConsumption of dairy products including milk and yogurt, ≥ 4 servings per day, reduced MDA concentration, however consumption ≤ 3 serving per day had no significant effect on oxidative stress among diabetic patients.     

Effect of basic periodontal treatment on glycemic control and inflammation in patients with diabetes mellitus type 1 and type 2: controlled clinical trial

Objective

Compare the response of basic periodontal therapy in diabetes patients with diabetes type 1 and type 2.

Materials and methods

We selected 70 patients with periodontitis; these were divided into three groups: the control group (n?=?11), systemically healthy patients; test group 1 (n?=?14), patients with type 1 diabetes mellitus; test group 2 (n?=?27), patients with type 2 diabetes mellitus. The groups received basic periodontal treatment after clinical examination. The analyses were performed at 0, 3 and 6 months; clinical parameters included the amount of periodontal and gingival crevicular fluid. Glycated hemoglobin (HbA1c) levels and prostaglandin E2 (PGE2) expression were measured.

Results

All clinical periodontal parameters evaluated improved in both groups, as did the amount of gingival crevicular fluid. A more significant decrease in HbA1c and PGE2 expression (p?<?0.05) occurred in test group 1 after 6 months.

Conclusion

The basic periodontal treatment was more effective for glycemic control in patients with type 1 diabetes mellitus.

     

胰岛素强化治疗对初诊2型糖尿病患者血清氧化应激水平的影响

目的 观察初诊2型糖尿病(T2DM)患者与糖代谢正常的健康者血清氧化应激水平的差异,比较持续皮下胰岛素注射(CSII)和多次皮下胰岛素注射(MSII)两种强化治疗方案对初诊T2DM患者血清氧化应激水平变化的差异,进一步探讨CSII优于MSII的可能机制.方法 选取初诊为T2DM的患者60例,按随机数字表法分为CSII组和MSII组,每组30例,分别给予为期14d的CSII和MSII治疗,于治疗前后分别测定血清空腹血糖(FPG)、餐后2h血糖(2 hPG)、糖化血清蛋白(GA)、空腹胰岛素(FINS)、超氧化物歧化酶(SOD)、还原型谷胱甘肽(rGSH)、丙二醛(MDA),并与同期30例健康体检者(对照组)进行比较.结果 治疗前CSII组、MSII组FPG、2 h PG、GA、HOMA模型胰岛素抵抗指数(HOMA-IR)、MDA明显高于对照组[FPG:(13.81±3.14)、(13.58±2.10)mmol/L比(5.21±0.42) mmol/L;2 hPG:(21.72±4.43)、(22.07±3.86) mmol/L比(6.19±0.47) mmol/L;GA:(28.74±4.40)、(28.83±5.01) mmol/L比(13.24±1.26) mmol/L; HOMA-IR:0.45±0.13、0.43±0.12比0.20±0.15;MDA:(4.37±1.13)、(4.44±1.07)mmol/L比(2.37±0.58) mmol/L],差异均有统计学意义(P＜0.01),HOMA模型β细胞功能指数(HOMA-β)、SOD、rGSH明显低于对照组[HOMA-β:0.98±0.17、0.96±0.12比1.91±0.19;SOD:(29.63±9.29)、(28.07±9.62) mU/L比(41.00±12.89)mU/L; rGSH:(157.03±46.58)、(165.23±45.66) ng/L比(212.00±61.67) ng/L],差异均有统计学意义(P＜ 0.01);CSII组各项指标与MSII组比较差异均无统计学意义(P＞0.05).CSII组治疗后FPG、HOMA-β、SOD、MDA与对照组比较差异无统计学意义(P＞0.05);同时,MSII组治疗后FPG、MDA明显高于对照组,HOMA-β、SOD明显低于对照组,差异均有统计学意义(P＜ 0.01或＜0.05).CSII组治疗后FPG、2 h PG、GA、MDA明显低于MSII组,HOMA-β明显高于MSII组,差异均有统计学意义(P＜ 0.01或＜0.05).多因素分析结果表明,HOMA-β与FPG(r=-0.919,P＜0.01)、2 h PG(r=-0.904,P＜0.01)、GA(r=-0.830,P＜0.01)及MDA(r=-0.653,P＜0.01)呈负相关,与SOD(r=0.454,P＜ 0.01)及rGSH(r=0.394,P＜0.01)呈正相关.结论 初诊T2DM患者的氧化应激水平明显高于健康人群.对于初诊T2DM患者,两种胰岛素强化治疗方案都可以使血糖、氧化应激水平明显下降,改善胰岛素抵抗和胰岛β细胞功能.CSII比MSII能更有效降低血糖、脂质过氧化水平,改善胰岛β细胞功能.     

2型糖尿病患者膳食纤维摄入量与肠道菌群的关联——基于一项随机对照试验的数据再分析

目的  分析2型糖尿病患者膳食纤维摄入量与肠道菌群的关联, 发现相关差异菌群, 为改善患者日常饮食, 调节肠道菌群, 促进健康提供依据。方法  采用横断面研究设计, 以参与一项健康素养和体力活动干预随机对照试验的356名2型糖尿病患者为研究对象。总热能和膳食纤维摄入量基于3 d 24 h膳食调查数据和中国食物成分表计算。对粪便菌群DNA进行16S rDNA V4高变区测序, 采用Qiime2软件进行生物信息学分析。多变量线性回归模型(multivariate analysis by linear models, MaAsLin)方法和广义线性模型用于获得与膳食纤维摄入量有关的肠道菌群。结果  研究对象的膳食纤维摄入量处于较低水平, 中位摄入量(四分位间距)仅7.4(5.5, 9.7) g/d。未发现膳食纤维摄入量高低与肠道菌群Alpha多样性有关, 但基于Jaccard距离矩阵(PERMANOVA P=0.016)计算的Beta多样性在两组间差异有统计学意义。低膳食纤维摄入组有较高丰度的梭杆菌属(Fusobacterium)、柯林斯菌属(Collinsella)和普雷沃菌属(Prevotella), 而高膳食纤维摄入组则有较高丰度的黄体链球菌(Streptococcus Luteciae)、脆弱拟杆菌(Fragilis)和双歧杆菌属(Bifidobacterium)。结论  2型糖尿病患者膳食纤维摄入量与肠道菌群组成有关联。较低膳食纤维摄入量与高丰度的有害菌有关, 而较高摄入量与较高的双歧杆菌属丰度有关, 提示增加膳食纤维摄入可能对患者的肠道菌群和健康有积极作用。     

Protein restriction,glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: a randomized trial

OBJECTIVE: Protein restriction delays the progression of non-diabetic and type 1 diabetic renal disorders. This study assessed whether protein restriction delays the onset or early progression of renal disorders in type 2 diabetes. DESIGN: Randomized controlled trial. Outcomes were albuminuria (mg/24 h) and, as an estimate of the glomerular filtration rate, cimetidine-influenced creatinine clearance. SETTING: Primary care. SUBJECTS: Patients with type 2 diabetes and microalbuminuria or at least detectable albuminuria, or a diabetes duration >5 y. INTERVENTIONS: The experimental group received dietary counselling on protein restriction (n=63); a control group (n=68) received the usual dietary advice. The duration of intervention and follow-up was 28+/-7 months. RESULTS: After 6 months, protein intake differed only by 0.08 g/kg/day between the study groups. Subsequently, this difference decreased and eventually disappeared. An initial effect of protein restriction on albuminuria in favor of the experimental group was not sustained, and the glomerular filtration rate decreased in the experimental group at a 1.6+/-2.2 ml/min/1.73 m(2) y lower rate than in the control group (P=0.5). Comparison of patients in the experimental group with a decrease in protein intake of at least 0.20 g/kg/day, with controls with no decrease, indicated a similarly small and insignificant effect on glomerular filtration rate. CONCLUSIONS: It is concluded that, in the longer term prevention or delay of renal damage in patients with type 2 diabetes, protein restriction is neither feasible nor efficacious.     

Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial

PURPOSE

Depression commonly accompanies diabetes, resulting in reduced adherence to medications and increased risk for morbidity and mortality. The objective of this study was to examine whether a simple, brief integrated approach to depression and type 2 diabetes mellitus (type 2 diabetes) treatment improved adherence to oral hypoglycemic agents and antidepressant medications, glycemic control, and depression among primary care patients.

METHODS

We undertook a randomized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care. Patients were randomly assigned to an integrated care intervention or usual care. Integrated care managers collaborated with physicians to offer education and guideline-based treatment recommendations and to monitor adherence and clinical status. Adherence was assessed using the Medication Event Monitoring System (MEMS). We used glycated hemoglobin (HbA_1c) assays to measure glycemic control and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression.

RESULTS

Intervention and usual care groups did not differ statistically on baseline measures. Patients who received the intervention were more likely to achieve HbA_1c levels of less than 7% (intervention 60.9% vs usual care 35.7%; P <.001) and remission of depression (PHQ-9 score of less than 5: intervention 58.7% vs usual care 30.7%; P <.001) in comparison with patients in the usual care group at 12 weeks.

CONCLUSIONS

A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources.     

The effect of monomeric and oligomeric FLAVAnols in patients with type 2 diabetes and microalbuminuria (FLAVA-trial): A double-blind randomized controlled trial

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A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance,inflammation, and oxidative stress in gestational diabetes

ObjectiveTo our knowledge, no reports are available indicating the effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance, inflammation, and oxidative stress among pregnant women with gestational diabetes mellitus (GDM).This study was designed to investigate the effects of the DASH diet on insulin resistance, serum high-sensitivity C-reactive protein (hs-CRP) and biomarkers of oxidative stress among pregnant women with GDM.MethodsThis randomized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation. Participants were randomly assigned to consume either the control (n = 16) or DASH diet (n = 16) for 4 wk. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and was low in saturated fats, total fats, cholesterol, refined grains, and sweets, with a total of 2400 mg/d of sodium. The control diet contained 40% to 55% of its energy as carbohydrates, 10% to 20% as proteins, and 25% to 30% as total fats. Fasting blood samples were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose (FPG), serum insulin, and hs-CRP, Homeostasis Model of Assessment—Insulin Resistance (HOMA-IR), plasma total antioxidant capacity (TAC), and total glutathione levels (GSH).ResultsConsumption of the DASH diet compared with the control diet resulted in decreased FPG (–7.62 versus 3.68 mg/dL; P = 0.02), serum insulin levels (–2.62 versus 4.32 μIU/mL, P = 0.03), and HOMA-IR score (–0.8 versus 1.1; P = 0.03). Increased concentrations of plasma TAC (45.2 versus –159.2 mmol/L; P < 0.0001) and GSH (108.1 versus –150.9 μmol/L; P < 0.0001) also were seen in the DASH group compared with control group. We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets. Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet, while a significant increase in these biomarkers in the DASH diet.ConclusionConsumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG, serum insulin levels, HOMA-IR score, plasma TAC, and total GSH levels. The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies.     

Inulin controls inflammation and metabolic endotoxemia in women with type 2 diabetes mellitus: a randomized-controlled clinical trial

There is limited evidence on the effects of prebiotics on inflammation. Therefore, the aim of this study was to evaluate the effects of inulin supplementation on inflammatory indices and metabolic endotoxemia in patients with type 2 diabetes mellitus. The participants included diabetic females (n?=?49). They were divided into an intervention group (n?=?24) as well as a control group (n?=?25) and received 10?g/d inulin or maltodextrin for 8 weeks, respectively. Fasting blood sugar (FBS), HbA1c, insulin, high-sensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), and plasma lipopolysaccharide (LPS) were measured pre and post intervention. Inulin-supplemented patients exhibited a significant decrease in FBS (8.5%), HbA1c (10.4%), fasting insulin (34.3%), homeostasis model assessment of insulin resistance (HOMA-IR) (39.5%), hs-CRP (35.6%), TNF-α (23.1%), and LPS (27.9%) compared with the maltodextrin group (p?0.05). Increase in IL-10 was not significant in inulin compared with the maltodextrin group. It can be concluded that inulin supplementation seems to be able to modulate inflammation and metabolic endotoxemia in women with type 2 diabetes.     

还原型谷胱甘肽对2型糖尿病患者氧化应激水平的影响

目的观察还原型谷胱甘肽对2型糖尿病以及伴有尿白蛋白排泄率（UAER）升高患者氧化应激水平的影响。方法选择62例2型糖尿病患者,根据UAER是否升高分为两组,单纯糖尿病组（DM组）30例,糖尿病合并UAER升高组（DM2组）32例,所有患者在降糖治疗的基础上,给予还原型谷胱甘肽治疗。观察还原型谷胱甘肽治疗前后患者空腹血糖（FPG）、总胆固醇（Tc）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、肌酐（Cr）、血尿素氮（BUN）、UAER、丙二醛（MDA）、超氧化物歧化酶（SOD）等水平的变化,并与同期健康体检者25例（对照组）比较。结果三组治疗前TG、HDL-C、LDL-C水平比较差异无统计学意义（P〉0．05）,DM2组治疗前TC较对照组、DM组有明显升高,差异有统计学意义（P〈0．05）;DM组和DM2组治疗后TC、LDL-C均较治疗前有明显降低,差异有统计学意义（P〈0．05）,TG有下降趋势,而HDL-C有升高趋势,但差异无统计学意义（P〉0．05）。与对照组比较,DM组和DM2组治疗前血清SOD水平明显下降,而MDA水平明显升高,差异有统计学意义（P〈0．05）;与DM组比较,DM2组治疗前血清SOD水平进一步下降,而MDA水平进一步升高,差异有统计学意义（P〈0．05）;DM组和DM2组治疗后血清SOD水平有所升高,而MDA水平有所下降,与治疗前比较差异有统计学意义（P〈0．05）。DM组和DM2组治疗后UAER水平均较治疗前有不同程度的降低,差异有统计学意义（P〈0．05）。以SOD、MDA为应变量,UAER为自变量,经相关分析发现SOD与UAER呈负相关（r=一0．64,P〈0．05）,而MDA与UAER呈正相关（r=0．56,P〈0．05）。在校正年龄、TC、TG、HDL-C、LDL-C、FPG等因素的影响后,SOD与UAER仍呈负相关（r=一0．41,P〈0．05）,而MDA与UAER仍呈正相关（r=0．37,P〈0．05）。结?     

Glycemic control in medical inpatients with type 2 diabetes mellitus receiving sliding scale insulin regimens versus routine diabetes medications: a multicenter randomized controlled trial

PURPOSE Hospitalized patients with type 2 diabetes mellitus traditionally receive insulin on a sliding-scale regimen, but the benefits of this approach are unclear. The purpose of this study was to compare the effects of the sliding scale insulin regimen with those of routine diabetes medications on hyperglycemia, hypoglycemia and length of hospitalization in diabetic patients hospitalized for other conditions.     

1型糖尿病儿童氧化应激水平的研究

目的 比较1型糖尿病患儿与健康儿童血清中氧化应激标志物水平,探讨1型糖尿病患儿氧化及抗氧化能力的改变。方法 选取62例1型糖尿病患儿为病例组,36例健康儿童为对照组。病例组根据病程分为初发组和病程稍长组;根据感染情况分为感染组和非感染组。测定各组血清中氧化标志物丙二醛(MDA),一氧化氮(NO)及抗氧化标志物超氧化物歧化酶(SOD),谷胱甘肽过氧化物酶(GPx)水平,同时常规测定病例组空腹血糖、C-肽、糖化血红蛋白(HbA1_C)、尿素氮,并对结果进行差异性和相关性分析。结果 1型糖尿病患儿血清MDA,NO,SOD水平显著高于对照组(P<0.05),GPx水平显著低于对照组(P<0.01)。初发组MDA、NO、SOD水平显著高于对照组(P<0.05),GPx水平显著低于对照组(P<0.01)。病程稍长组SOD水平与对照组比较、感染组与非感染组间各指标比较,差异均无统计学意义(P>0.05)。MDA水平与HbA1_C水平呈显著正相关(r=0.377,P<0.01)。结论 1型糖尿病患儿发病初期及病程进展过程中存在明显的氧化应激水平升高和抗氧化保护能力下降,提示氧化应激可能在儿童1型糖尿病中起着重要作用。     

Oligofructose-enriched inulin improves some inflammatory markers and metabolic endotoxemia in women with type 2 diabetes mellitus: A randomized controlled clinical trial

ObjectivesAnti-inflammatory therapeutic approaches are considered for the management of type 2 diabetes and for the prevention of its complications. There is limited evidence regarding the effects of prebiotics on inflammation, especially in patients with type 2 diabetes. This trial aims to examine the effects of oligofructose-enriched inulin on glycemic status, inflammation markers, and metabolic endotoxemia in female patients.MethodsOver a period of 8 wk, 52 women with body mass indices of >25 kg/m² but <35 kg/m² with type 2 diabetes were randomly assigned to either an intervention group, in which participants were given oligofructose-enriched inulin (n = 27, consuming 10 g/d of oligofructose-enriched inulin), or to a control group, in which participants were given maltodextrin (n = 25, consuming 10 g/d of maltodextrin). Fasting plasma glucose, glycosylated hemoglobin, high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-α, interferon-γ, interleukin-10, and plasma lipopolysaccharide were measured before and after the intervention. Data were analyzed with the use of SPSS software version 13. Paired and unpaired Student t tests and analysis of covariance were used to compare quantitative variables.ResultsOligofructose-enriched inulin caused a significant decrease in the levels of fasting plasma glucose (19.2 mg/dL; 9.50%), glycosylated hemoglobin (1.0%; 8.40%), interleukin-6 (1.3 pg/mL; 8.15%), tumor necrosis factor-α (3.0 pg/mL; 19.80%) and plasma lipopolysaccharide (6.0 EU/mL; 21.95%) as compared with maltodextrin (P < 0.05). Decreases in levels of interferon-γ (0.3 pg/mL; 16.50%) and high-sensitivity C-reactive protein (3.9 ng/mL; 31.70%) and an increase in the level of interleukin-10 (0.4 pg/mL, 11.50%) were not significant in the oligofructose-enriched inulin group as compared with the maltodextrin group.ConclusionsIn women with type 2 diabetes and suboptimal daily dietary fiber intake, oligofructose-enriched inulin may help to modulate some inflammatory markers.     

血糖稳定的2型糖尿病患者的静息能量消耗

目的观察血糖控制良好的2型糖尿病患者静息能量消耗（REE）的特点。方法采用代谢车测量45例血糖稳定的2型糖尿病患者的REE，记录其一般情况、生化指标、Harris-Benedict和Owen公式计算基础能量消耗预测值，并进行比较分析。结果血糖稳定的2型糖尿病患者的静息能量消耗实测值与Harris-Benedict及Owen公式预测值比较差异无统计学意义（P〉0．05），相关分析显示REE与性别、年龄、体重、身高、体表面积、去脂组织显著相关（P〈0．05），与体重指数、脂肪组织、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、三酰甘油、总蛋白、白蛋白、血红蛋白无相关性（P〉0．05），多元逐步回归分析显示去脂组织和年龄与REE关系最密切。结论血糖良好的2型糖尿病患者的REE并不增高，决定其REE的因素与健康个体相似，测定REE能更好地指导糖尿病的医学营养治疗。     

血糖稳定的2型糖尿病患者的静息能量消耗

Objective To investigate the features of resting energy expenditure (REE) in patients with well controlled type 2 diabetes mellitus (T2DM). Methods Totally 45 T2DM patients with stable blood glucose were enrolled. The general conditions, biochemical indicators, measurements of REE ( MREE), and basal energy expenditure (BEE) calculated with Harris-Benedict formula (HBEE) and Owen formula (OBEE) were recorded and compared. Results MREE had no significant difference with HBEE or OBEE in T2DM patients with stable blood glucose (P ＞ 0. 05). Correlation analysis showed that REE was significantly correlated with gender, age, body weight, body height, body surface area, and fat-free mass ( all P ＜ 0.05 ), but was not correlated with body mass index, fat mass, fasting plasma glucose, postprandial plasma glucose, haemoglobin Alc, total cholesterol, triglyceride, total protein, albumin, and haemoglobin (P ＞ 0. 05 ). Multiple regression analysis showed that fat free mass and age had the closest correlation with REE. Conclusions REE does not increase in T2DM patients with well controlled blood glucose. Factors that influence their REE are similar with healthy individuals. Determi nation of REE can provide useful information for the nutrition treatment of T2DM.