BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown s...BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular(CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes(T2D).METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease(CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.RESULTS Eight clinical studies were included in the narrative descriptive analysis(gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin(CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D(CAROLINA)trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials,they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out.However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.展开更多
Background: Diet plays a vital role in managing diabetes. Foods with a low glycemic index provide lower postprandial glucose spikes and induce satiety. The objective of this study was to assess the Glycemic index (GI)...Background: Diet plays a vital role in managing diabetes. Foods with a low glycemic index provide lower postprandial glucose spikes and induce satiety. The objective of this study was to assess the Glycemic index (GI) without milk and Glycemic response (GR) with milk of two different flavours of a plant-based supplement which is high in protein and fibre, along with a subjective assessment of satiety. Methods: Fifteen overweight/obese subjects aged 18 - 45 years were recruited. After overnight fasting, blood samples were drawn at 5 mins before food consumption (-5), 0, 15, 30, 45, 60, 90 and 120 minutes. Participants underwent 3 days of reference food testing and 1 day of test food in random order with 2 days of wash-out period. The GI was assessed using a validated protocol recognized by FAO/WHO, as well as the guidelines by the International Dietary Carbohydrate Task Force for GI Methodology. The satiety index was measured using the Visual Analog Scale (VAS). The dietary intake of the subjects was measured by 24-hour dietary recall. The Incremental Area Under the Curve (IAUC) was calculated using the trapezoid rule. Results: Both the flavours of the supplement had low GI & GR. The GI and GR of Flavour 1 were 27.3 ± 4.8 & 16.4 ± 2.6 (Mean ± SEM) respectively. For Flavour 2 the GI and GR were 36.7 ± 4.4 & 25.7 ± 2.3 (Mean ± SEM). For Flavour 1, 60% and for flavour 2 66.7% of subjects reported feeling hungry only after 3 hours, showing good satiety. Conclusion: The plant-based high fibre high protein supplement in both flavours showed a low glycemic index and hence may be useful to include in the diets to reduce the postprandial glycemic response and could improve satiety.展开更多
With increasing incidence of diabetes, use of diabetes specific nutrition supplements (DSNS) is common for better management of the disease. To study effect of 12-week DSNS supplementation on glycemic markers, anthrop...With increasing incidence of diabetes, use of diabetes specific nutrition supplements (DSNS) is common for better management of the disease. To study effect of 12-week DSNS supplementation on glycemic markers, anthropometry, lipid profile, SCFAs, and gut microbiome in individuals with diabetes. Markers studied were glycemic [Fasting Blood Glucose (FBG), Post Prandial Glucose (PPG), HbA1c, Incremental Area under curve (iAUC), Mean Amplitude of Glycemic Excursions (MAGE), Time in/above Range (TIR/TAR)], anthropometry [weight, Body Mass Index (BMI), waist circumference (WC)], lipid profile, diet and gut health [plasma short chain fatty acids (SCFAs)]. N = 210 adults were randomized to receive either DSNS with standard care (DSNS + SC;n = 105) or standard care alone (SC alone;n = 105). After 12 weeks, significant differences between DSNS + SC versus SC alone was observed in FBG [−3 ± 6 vs 14 ± 6 mg/dl;p = 0.03], PPG [−35 ± 9 vs −3 ± 9 mg/dl;p = 0.01], weight [−0.6 ± 0.1 vs 0.2 ± 0.1 kg;p = 0.0001], BMI [−0.3 ± 0.1 vs 0.1 ± 0.1 kg/m2;p = 0.0001] and WC [−0.3 ± 0.2 vs 0.2 ± 0.2 cm;p = 0.01]. HbA1C and low-density lipoprotein (LDL) were significantly reduced in DSNS + SC [−0.2 ± 0.9;p = 0.04 and −5 mg/dl;p = 0.03] respectively with no change in control. Continuous Glucose Monitoring (CGM) reported significant differences between DSNS + SC versus SC alone for mean glucose [−12 ± 65 vs 28 ± 93 mg/dl;p < 0.01], TAR 180 [−9 ± 42 vs 7 ± 45 mg/dl;p = 0.04], TAR 250 [−3 ± 27 vs 9 ± 38 mg/dl;p = 0.05], iAUC [−192 (1.1) vs −48 (1.1) mg/dl;p = 0.03]. MAGE was significantly reduced for both DSNS + SC (−19 ± 67;p < 0.001) and SC alone (−8 ± 70;p = 0.04), with reduction being more pronounced for DSNS + SC. DSNS + SC reported a decrease in carbohydrate energy % [−9.4 (−11.3, −7.6) %;p < 0.0001] and amount [−47.4 (−67.1, −27.7) g;p < 0.0001], increased dietary fiber [9.5 (7.2, 11.8) g;p < 0.0001] and protein energy % [0.9 (0.5, 1.3) %;p < 0.0001] versus SC alone. DSNS + SC reported significant increases versus SC alone in total (0.3 ng/ml;p = 0.03) and individual plasma SCFAs. The consumption of DSNS significantly improves the glycemic, anthropometric, dietary, and gut health markers in diabetes.展开更多
Background and Objectives:Evidence suggests that bioactive components present in plant foods have beneficial effects.Fenugreek is commonly used in Indian culinary practices and can help to keep blood sugar levels unde...Background and Objectives:Evidence suggests that bioactive components present in plant foods have beneficial effects.Fenugreek is commonly used in Indian culinary practices and can help to keep blood sugar levels under control.The objective of this study was to assess the efficacy of defatted fenugreek seed flakes(Fenuflakes^(TM))on the 24-hour glycaemic response(Incremental Area Under the Curve,iAUC),variability(Mean Amplitude Glycaemic Excursion assessed by Continuous Glucose Monitoring system)in participants with type 2 diabetes.展开更多
Nita G Forouhi和同事们认为,我们可以找到预防、管理和可能缓解2型糖尿病的饮食方法基本要点。饮食因素在2型糖尿病的预防和管理中至关重要。尽管在制定循证饮食指南方面取得了进展,但争议和困惑依然存在。在本文中,我们研究了现有证据...Nita G Forouhi和同事们认为,我们可以找到预防、管理和可能缓解2型糖尿病的饮食方法基本要点。饮食因素在2型糖尿病的预防和管理中至关重要。尽管在制定循证饮食指南方面取得了进展,但争议和困惑依然存在。在本文中,我们研究了现有证据,确定2型糖尿病饮食指南中哪些领域取得了共识,哪些还存在不确定性或争议。展开更多
文摘BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular(CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes(T2D).METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease(CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.RESULTS Eight clinical studies were included in the narrative descriptive analysis(gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin(CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D(CAROLINA)trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials,they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out.However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.
文摘Background: Diet plays a vital role in managing diabetes. Foods with a low glycemic index provide lower postprandial glucose spikes and induce satiety. The objective of this study was to assess the Glycemic index (GI) without milk and Glycemic response (GR) with milk of two different flavours of a plant-based supplement which is high in protein and fibre, along with a subjective assessment of satiety. Methods: Fifteen overweight/obese subjects aged 18 - 45 years were recruited. After overnight fasting, blood samples were drawn at 5 mins before food consumption (-5), 0, 15, 30, 45, 60, 90 and 120 minutes. Participants underwent 3 days of reference food testing and 1 day of test food in random order with 2 days of wash-out period. The GI was assessed using a validated protocol recognized by FAO/WHO, as well as the guidelines by the International Dietary Carbohydrate Task Force for GI Methodology. The satiety index was measured using the Visual Analog Scale (VAS). The dietary intake of the subjects was measured by 24-hour dietary recall. The Incremental Area Under the Curve (IAUC) was calculated using the trapezoid rule. Results: Both the flavours of the supplement had low GI & GR. The GI and GR of Flavour 1 were 27.3 ± 4.8 & 16.4 ± 2.6 (Mean ± SEM) respectively. For Flavour 2 the GI and GR were 36.7 ± 4.4 & 25.7 ± 2.3 (Mean ± SEM). For Flavour 1, 60% and for flavour 2 66.7% of subjects reported feeling hungry only after 3 hours, showing good satiety. Conclusion: The plant-based high fibre high protein supplement in both flavours showed a low glycemic index and hence may be useful to include in the diets to reduce the postprandial glycemic response and could improve satiety.
文摘With increasing incidence of diabetes, use of diabetes specific nutrition supplements (DSNS) is common for better management of the disease. To study effect of 12-week DSNS supplementation on glycemic markers, anthropometry, lipid profile, SCFAs, and gut microbiome in individuals with diabetes. Markers studied were glycemic [Fasting Blood Glucose (FBG), Post Prandial Glucose (PPG), HbA1c, Incremental Area under curve (iAUC), Mean Amplitude of Glycemic Excursions (MAGE), Time in/above Range (TIR/TAR)], anthropometry [weight, Body Mass Index (BMI), waist circumference (WC)], lipid profile, diet and gut health [plasma short chain fatty acids (SCFAs)]. N = 210 adults were randomized to receive either DSNS with standard care (DSNS + SC;n = 105) or standard care alone (SC alone;n = 105). After 12 weeks, significant differences between DSNS + SC versus SC alone was observed in FBG [−3 ± 6 vs 14 ± 6 mg/dl;p = 0.03], PPG [−35 ± 9 vs −3 ± 9 mg/dl;p = 0.01], weight [−0.6 ± 0.1 vs 0.2 ± 0.1 kg;p = 0.0001], BMI [−0.3 ± 0.1 vs 0.1 ± 0.1 kg/m2;p = 0.0001] and WC [−0.3 ± 0.2 vs 0.2 ± 0.2 cm;p = 0.01]. HbA1C and low-density lipoprotein (LDL) were significantly reduced in DSNS + SC [−0.2 ± 0.9;p = 0.04 and −5 mg/dl;p = 0.03] respectively with no change in control. Continuous Glucose Monitoring (CGM) reported significant differences between DSNS + SC versus SC alone for mean glucose [−12 ± 65 vs 28 ± 93 mg/dl;p < 0.01], TAR 180 [−9 ± 42 vs 7 ± 45 mg/dl;p = 0.04], TAR 250 [−3 ± 27 vs 9 ± 38 mg/dl;p = 0.05], iAUC [−192 (1.1) vs −48 (1.1) mg/dl;p = 0.03]. MAGE was significantly reduced for both DSNS + SC (−19 ± 67;p < 0.001) and SC alone (−8 ± 70;p = 0.04), with reduction being more pronounced for DSNS + SC. DSNS + SC reported a decrease in carbohydrate energy % [−9.4 (−11.3, −7.6) %;p < 0.0001] and amount [−47.4 (−67.1, −27.7) g;p < 0.0001], increased dietary fiber [9.5 (7.2, 11.8) g;p < 0.0001] and protein energy % [0.9 (0.5, 1.3) %;p < 0.0001] versus SC alone. DSNS + SC reported significant increases versus SC alone in total (0.3 ng/ml;p = 0.03) and individual plasma SCFAs. The consumption of DSNS significantly improves the glycemic, anthropometric, dietary, and gut health markers in diabetes.
基金funded by Indus Biotech,Ltd.(India)(Study number:IBS448)。
文摘Background and Objectives:Evidence suggests that bioactive components present in plant foods have beneficial effects.Fenugreek is commonly used in Indian culinary practices and can help to keep blood sugar levels under control.The objective of this study was to assess the efficacy of defatted fenugreek seed flakes(Fenuflakes^(TM))on the 24-hour glycaemic response(Incremental Area Under the Curve,iAUC),variability(Mean Amplitude Glycaemic Excursion assessed by Continuous Glucose Monitoring system)in participants with type 2 diabetes.
文摘Nita G Forouhi和同事们认为,我们可以找到预防、管理和可能缓解2型糖尿病的饮食方法基本要点。饮食因素在2型糖尿病的预防和管理中至关重要。尽管在制定循证饮食指南方面取得了进展,但争议和困惑依然存在。在本文中,我们研究了现有证据,确定2型糖尿病饮食指南中哪些领域取得了共识,哪些还存在不确定性或争议。
