BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of ...BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.展开更多
BACKGROUND The interplay between abnormal glucose metabolism and the progression of liver fibrosis in patients with both chronic hepatitis B(CHB)and type 2 diabetes mellitus(T2DM)remains unclear.Previous studies have ...BACKGROUND The interplay between abnormal glucose metabolism and the progression of liver fibrosis in patients with both chronic hepatitis B(CHB)and type 2 diabetes mellitus(T2DM)remains unclear.Previous studies have suggested that the coexistence of these conditions may exacerbate liver inflammation and fibrosis;however,the impacts of dynamic changes in glucose metabolism indicators,hypoglycemic medication regimens,and glycemic control status on liver fibrosis require further elucidation.AIM To explore the effect of glycemic control on hepatic fibrosis in patients with CHB and T2DM.METHODS A total of 420 patients with CHB and T2DM admitted to the Public Health Clinical Center of Chengdu between October 2018 and January 2022 were retrospectively included and classified according to liver stiffness measurement and glycemic control for between-group comparisons.RESULTS Significant differences were observed in the alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase,AST/ALT ratio,total bilirubin,direct bilirubin,diabetes treatment program,and thrombin time values among the liver fibrosis groups(adjusted P<0.05).Significant differences in albumin and gamma-glutamyl transferase levels were observed among the groups categorized by glucose status at admission(adjusted P<0.05).A positive correlation between fasting plasma glucose(FPG)and liver stiffness measurement was found to be mediated by ALT and AST.Fibrinogen and the international normalized ratio were positively correlated with glycated hemoglobin A1c,while the fibrosis-4 score,ALT,AST/ALT ratio,type III procollagen N-terminal peptide,ferritin,and activated partial thromboplastin time were correlated with FPG at admission.Additionally,AST was positively correlated with FPG at discharge(P<0.05).CONCLUSION Specific glucose metabolic parameters,hypoglycemic agents,and glycemic control status markers are associated with hepatic fibrosis in patients with both CHB and T2DM.Close blood glucose monitoring,optimized use of hypoglycemic agents,and continuous maintenance of good glycemic control may slow the progression of liver fibrosis in patients with CHB and T2DM.展开更多
BACKGROUND Adults with type 2 diabetes mellitus(T2DM)in Malaysia continue to have substantial comorbidities and struggle to achieve glycemic targets.AIM To comprehensively evaluate diabetes self-care and glycemic cont...BACKGROUND Adults with type 2 diabetes mellitus(T2DM)in Malaysia continue to have substantial comorbidities and struggle to achieve glycemic targets.AIM To comprehensively evaluate diabetes self-care and glycemic control using multiple self-reporting questionnaires.METHODS Adults diagnosed with T2DM attending the Seremban Health Clinic were recruited in this cross-sectional study.Eligible participants were recruited based on a consecutive sampling technique,first-come-first-served-basis if they fulfilled the inclusion and exclusion criteria.In addition to the usual sociodemographic,clinical,and laboratory data,the participants answered seven specific self-reporting questionnaires.This report was focused on six key variables:Glycemic control;self-care;self-efficacy;diabetes knowledge;health literacy;and medication adherence.RESULTS A total of 100 adults with T2DM participated.The proportions of participants achieving specific thresholds in the key variables were:Acceptable glycemic control 39.4%;adequate diabetes knowledge 59.6%;sufficient or higher health literacy 80.2%;and medication adherence 51.0%.The mean self-efficacy score was 110.6(73.3%of maximum),and the mean self-care score was 30.7(43.9%of maximum).A statistically significant linear correlation was observed for eight pairs of key variables with Pearson’s correlation values varying between 0.21 to 0.55.Selfefficacy had a relatively higher correlation while glycated hemoglobin was not correlated with other key variables.Path analysis was conducted to examine the relationships among diabetes self-efficacy(Diabetes Management Self Efficacy scale score),self-care behavior(Summary of Diabetes Self-Care Activities score),and glycemic control,but the model demonstrated a poor fit(χ^(2)=28.1,P<0.001).CONCLUSION We found substantial suboptimal glycemic control and low self-care practices but acceptable levels of diabetes knowledge,self-efficacy,health literacy and medication adherence among the patients with T2DM.In spite of the correlations between self-care,self-efficacy,and medication adherence,it was surprising that self-care did not correlate with glycemic control.Prospective cohort studies are needed to explore whether these factors influence diabetes outcomes.展开更多
BACKGROUND Colorectal cancer(CRC)is the third most diagnosed malignancy worldwide and a frequent comorbidity among these patients is type 2 diabetes mellitus(T2DM).The coexistence of these conditions poses significant...BACKGROUND Colorectal cancer(CRC)is the third most diagnosed malignancy worldwide and a frequent comorbidity among these patients is type 2 diabetes mellitus(T2DM).The coexistence of these conditions poses significant challenges to glycemic management,particularly during chemotherapy.AIM To assess the effects of individualized exercise training(IET)on glycemic control and nutritional status in patients with T2DM undergoing chemotherapy for CRC.METHODS In this retrospective study,clinical data from 245 patients with T2DM and on chemotherapy for CRC between November 2023 and December 2024 were analyzed.Patients were stratified into two groups according to their treatment regimens:The standard care(SC)group(n=111),which received conventional chemotherapy and diabetes management,and an IET group(n=134),which received additional personalized exercise interventions alongside SC.Parameters assessed included fasting plasma glucose,glycosylated hemoglobin,glycemic variability indices,nutritional biomarkers,markers of intestinal permeability,and adverse events.RESULTS Patients in the IET group demonstrated significant improvements in glycemic control,nutritional biomarkers,and glycemic variability(all P<0.05),compared with the SC group.The markers of intestinal permeability also improved significantly in the IET group(P<0.05).Meanwhile,no statistically significant difference in the incidence of adverse events was found between the two groups(P>0.05).These findings suggest that individualized exercise interventions can enhance metabolic,nutritional,and gastrointestinal outcomes without increasing treatment-related risks.CONCLUSION Personalized exercise training may offer clinically meaningful benefits in glycemic regulation and nutritional status for patients with T2DM and on chemotherapy for CRC.展开更多
Managing type 2 diabetes mellitus remains a significant challenge,particularly for individuals with persistently poor glycemic control.Although inadequate glycemic regulation is a well-established public health concer...Managing type 2 diabetes mellitus remains a significant challenge,particularly for individuals with persistently poor glycemic control.Although inadequate glycemic regulation is a well-established public health concern and a major contributor to diabetes-related complications,evidence on the effectiveness of intensive and supportive interventions across diverse patient subgroups is scarce.This editorial examines findings from a prospective study evaluating the influence of glycemic history on treatment outcomes in poorly controlled diabetes.The study highlights that personalized care models outperform generalized approaches by addressing the unique trajectories of glycemic deterioration.Newly diagnosed patients demonstrated the most favorable response to intervention,while those with consistently elevated glycated hemoglobin(≥10%)faced the greatest challenges in achieving glycemic control.These findings underscore the limitations of a onesize-fits-all strategy,reinforcing the need for patient-centered care that integrates individualized monitoring and timely intervention.Diabetes management requires prioritizing personalized treatment strategies that mitigate therapeutic inertia and ensure equitable,effective care for all patients.展开更多
This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients.These amputations,often necessitated by severe ...This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients.These amputations,often necessitated by severe diabetic foot ulcers,carry significant risks of postoperative complications such as infection and delayed wound healing.Elevated hemoglobin A1c levels,indicative of poor glycemic control,and a history of kidney transplantation,due to required immunosuppressive therapy,are key factors influencing these outcomes.This paper emphasizes the need for enhanced glycemic management and personalized postoperative care,particularly for immunocompromised individuals,to minimize complications and improve patient prognosis.Future research should focus on prospective studies to validate targeted interventions and optimize care strategies,ultimately aiming to reduce the healthcare burden associated with diabetic foot complications.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease characterized by combinations of insulin resistance and insulin deficiency.Non-alcoholic fatty liver disease(NAFLD)is emerging as a public health...BACKGROUND Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease characterized by combinations of insulin resistance and insulin deficiency.Non-alcoholic fatty liver disease(NAFLD)is emerging as a public health problem worldwide and affects up to 70%of patients with T2DM.Although patients with T2DM have an increased risk of developing advanced liver disease compared to healthy individuals,varying prevalence rates of NAFLD among patients with T2DM,ranging from 34%to 94%,have been reported.AIM To determine prevalence and identify associated factors of NAFLD among Limbe patients with T2DM and evaluate correlation with glycemic control.METHODS A cross-sectional study was carried out from February to June 2024 among patients with T2DM.Gamma-glutamyl transferase(GGT)activity and serum triglycerides(TGs)were measured by spectrophotometry.NAFLD was diagnosed using the fatty liver index score.Data were analyzed using SPSS version 26.0 for Windows.Student’s t-test was used to compare the means of two groups.The χ^(2) test was applied to determine the association of NAFLD and T2DM.Logistic regression analysis was performed to identify predictors of NAFLD.P<0.05 was considered statistically significant.RESULTS Of the 150 patients with T2DM recruited for this study,63(58%)were females and the majority(84.7%)had good glycemic control(glycated hemoglobin<7%).Prevalence of NAFLD among patients with T2DM was 19%.Patients with NAFLD had significantly elevated levels of TGs,GGT,and increased body mass index and waist circumference compared to those without NAFLD.There was a significant association between NAFLD and glycemic control.Predictive factors of NAFLD among patients with T2DM were vegetable intake of less than three times per week[adjusted odds ratio(aOR):0.131,95%CI:0.020-0.839;P=0.032],central obesity(aOR:0.167,95%CI:0.037-0.748;P=0.019),and metformin treatment for T2DM(aOR:0.167,95%CI:0.037-0.718;P<0.001).CONCLUSION The prevalence of NAFLD in patients with T2DM in Limbe Regional Hospital was 19%.Age,central obesity,metformin use,and infrequent consumption of vegetables were important predictors of NAFLD.展开更多
BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients wi...BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.展开更多
Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a...Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a network meta-analysis was conducted to evaluate the comparative efficacy of various vitamin D supplementation strategies on glucose indicators in adults with T2DM.Methods Eligible studies published before September 12,2024,were retrieved from PubMed,EMBASE,Cochrane Library,and Web of Science.A network meta-analysis of multiple dosage strategies—low(<1,000 IU/day,LDS),medium(1,000–2,000 IU/day,MDS),high(2,000–4,000 IU/day,HDS),and extremely high(≥4,000 IU/day,EHDS)—was performed.Results The network meta-analysis of 40 RCTs indicated that,compared with placebo,vitamin D_(3)supplementation increased 25-hydroxyvitamin D[25-(OH)-D]levels,with pooled mean difference(MD)showing a stepwise increase from LDS to EHDS.Ranking probabilities showed a corresponding rise in 25-(OH)-D levels from LDS(46.7%)to EHDS(91.2%).EHDS reduced fasting blood glucose(FBG)relative to no treatment.LDS significantly decreased hemoglobin A1c(HbA1c),and vitamin D_(2) significantly affected FBG levels.MDS led to a significant change in fasting insulin(FIN)compared to both placebo(MD:-4.76;95%CI-8.91 to-0.61)and no treatment(MD:-7.30;95%CI-14.44 to-0.17).Conclusion The findings suggest that vitamin D supplementation may be a viable approach for improving glycemic control in adults with T2DM,with lower doses potentially offering benefit.The analysis also showed a dose-dependent increase in 25-(OH)-D levels.展开更多
The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin(Hb A1c). Despite its importance as an indicator for the development of diabeticcomplications...The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin(Hb A1c). Despite its importance as an indicator for the development of diabeticcomplications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between Hb A1 c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to Hb A1 c in routine diabetes care is selfmonitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize glucose dynamics. Several continuous glucose monitoring(CGM) systems, which have shown usefulness in clinical practice, are presently on the market. They can broadly be divided into systems providing retrospective or real-time information on glucose patterns. The widespread clinical application of CGM is still hampered by the lack of generallyaccepted measures for assessment of glucose profiles and standardized reporting of glucose data. In this article, we will discuss advantages and limitations of various metrics for glycemic control as well as possibilities for evaluation of glucose data with the special focus on glycemic variability and application of CGM to improve individual diabetes management.展开更多
AIM:To determine the glycemic index(GI)and glycemic load(GL)values of Chinese traditional foods in Hong Kong.METHODS:Fifteen healthy subjects(8 males and 7 females)volunteered to consume either glucose or one of 23 te...AIM:To determine the glycemic index(GI)and glycemic load(GL)values of Chinese traditional foods in Hong Kong.METHODS:Fifteen healthy subjects(8 males and 7 females)volunteered to consume either glucose or one of 23 test foods after 10-14 h overnight fast.The blood glucose concentrations were analyzed immediately before,15,30,45,60,90 and 120 min after food consumption using capillary blood samples.The GI value of each test food was calculated by expressing the incremental area under the blood glucose response curve(IAUC)value for the test food as a percentage of each subject's average IAUC value for the glucose.The GL value of each test food was calculated as the GI value of the food multiplied by the amount of the available carbohydrate in a usual portion size,divided by 100.RESULTS:Among all the 23 Chinese traditional foods tested,6 of them belonged to low GI foods(Tuna Fish Bun,Egg Tart,Green Bean Dessert,Chinese Herbal Jelly,Fried Rice Vermicelli in Singapore-style,and Spring Roll),10 of them belonged to moderate GI foods(Baked Barbecued Pork Puff,Fried Fritter,"Mai-Lai"Cake,"Pineapple"Bun,Fried Rice Noodles with Sliced Beef,Barbecue Pork Bun,Moon Cakes,Glutinous Rice Ball,Instant Sweet Milky Bun,and Salted Meat Rice Dumpling),the others belonged to high GI foods(Fried Rice in Yangzhou-Style,Sticky Rice Wrapped in Lotus Leaf,Steamed Glutinous Rice Roll,Jam and Peanut Butter Toast,Plain Steamed Vermicelli Roll,Red Bean Dessert,and Frozen Sweet Milky Bun).CONCLUSION:The GI and GL values for these Chinese traditional foods will provide some valuable information to both researchers and public on their food preference.展开更多
Objective The relationship between serum uric acid(SUA)levels and glycemic indices,including plasma glucose(FPG),2-hour postload glucose(2 h-PG),and glycated hemoglobin(HbA1 c),remains inconclusive.We aimed to explore...Objective The relationship between serum uric acid(SUA)levels and glycemic indices,including plasma glucose(FPG),2-hour postload glucose(2 h-PG),and glycated hemoglobin(HbA1 c),remains inconclusive.We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.Methods The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study.A total of 105,922 community-dwelling adults aged≥40 years underwent the oral glucose tolerance test and uric acid assessment.The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.Results A total of 30,941 men and 62,361 women were eligible for the current analysis.Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels,but with different inflection points in men and women.The thresholds for FPG,2 h-PG,and HbA1 c for men and women were 6.5/8.0 mmol/L,11.0/14.0 mmol/L,and 6.1/6.5,respectively(SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).Conclusion An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes,while the inflection points were reached earlier in men than in women.展开更多
This study aimed to investigate the effect of yam flour substitution (Dioscorea alata L.) and moringa powder in wheat bread on glycemic response. Glycemic index (GI) and glycemic load (GL) of pieces of bread were dete...This study aimed to investigate the effect of yam flour substitution (Dioscorea alata L.) and moringa powder in wheat bread on glycemic response. Glycemic index (GI) and glycemic load (GL) of pieces of bread were determined. A mixture plan design was used to determine the optimal formulation of bread made of yam flour, wheat flour and moringa powder. The mixture of 79.4% soft wheat flour, 20% yam flour and 0.6% moringa leaves powder has a good potential in bread preparation and was used in this study. 100% wheat bread was used as control. Postprandial blood glucose response (glycemic response) was evaluated with the glucose used as a reference food. Blood glucose responses were measured at different intervals for 2 hours. The results indicated that composite bread had low GI and GL values than wheat bread. Values are GI = 80 and GL = 61.2 for wheat bread and GI = 37.78 and GL = 29.65 for the composite bread. This study demonstrated that the inclusion of yam flour of moringa leaves powder in bread production might not pose a threat to blood glucose response compared to wheat bread. These pieces of bread could be included easily in diabetics’ and non-diabetics diet.展开更多
Food intake has a great influence on blood glucose in patients with diabetes. This study was to determine the glycemic index（GI） and glycemic load（GL） of a particular pomelo named Majia pomelo and its effects on p...Food intake has a great influence on blood glucose in patients with diabetes. This study was to determine the glycemic index（GI） and glycemic load（GL） of a particular pomelo named Majia pomelo and its effects on postprandial glucose（PPG） in patients with type 2 diabetes（T2D）. Twenty healthy subjects and 20 T2D patients（controlled on lifestyle measures and/or metformin） were tested on 2 separate days with 50 g of glucose and 50 g equivalent of carbohydrates from Majia pomelo for GI measurement. To test effects of Majia pomelo on PPG, 19 hospitalized T2D patients（controlled on insulin therapy） were selected for a 9-day study. The dose of insulin for each patient was adjusted on the first 3 days. A total of 100 g Majia pomelo was consumed per meal in the last 3 tested days. Blood glucose was measured to evaluate the glycemic excursions. The GIs for Majia pomelo in healthy individuals and T2D patients were 78.34±1.88 and 72.15±1.95 respectively. The value of GL was as low as 4.23 in diabetic patients with serving size of 100 g pomelo, indicting Majia pomelo as a high GI but low GL fruit. Consumption of Majia pomelo in hospitalized T2D patients did not cause significant glucose fluctuation. It was concluded that high GI pomelo can serve as a low GL fruit if it is consumed with a limited daily amount and thus can be supplied to diabetic patients. These results may mean more varieties of food choices for T2D patients.展开更多
In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoi...In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.展开更多
Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO...Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO), have been formulated to blunt postprandial hyperglycemia. The objective of this research was to evaluate the effectiveness of these products on postprandial glycemic and hormonal responses based on comparisons of GTSN with differing carbohydrate quantities or types. Methods: In two randomized, double-blind, crossover studies, participants (mean age 61 years) with type 2 diabetes consumed GTSN in a meal tolerance test. In the CHO Quantity Study, a standard nutritional beverage (STD) was compared to a low carbohydrate nutritional beverage with tapioca dextrin (GTSN-TDX) and a balanced carbohydrate nutritional beverage containing a blend of the slowly-digesting carbohydrates maltodextrin and sucromalt (GTSN-SDC). In the CHO Type Study, the GTSN beverages had similar carbohydrate quantities but varied in carbohydrate composition with GTSN-SDC compared to a formula with tapioca starch and fructose (GTSN-TS&F), and one with isomaltulose and resistant starch (GTSN-I&RS). Postprandial (0-240 min) concentrations of blood glucose, insulin (CHO Quantity Study only) and glucagon-like-peptide (GLP)-1 (CHO Quantity Study only) were measured. Results: Despite having substantially different carbohydrate quantities, the GTSN blunted the glucose positive area under the curve (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 min tended to be lower for GTSN-SDC (1477 ± 460) than GTSN-TS&F (2203 ± 412;p = 0.062) and GTSN-I&RS (2190 ± 412;p = 0.076). No differences were observed between GTSN-TS&F and GTSN-I&RS. Conclusions: These results demonstrate the effectiveness of several GTSN products and suggest that both CHO quantity and type play important roles in postprandial glycemic response in men and women with type 2 diabetes. Furthermore, GTSN products containing slow-digesting carbohydrates can blunt postmeal glucose and insulin concentration despite delivering greater total grams of CHO, which provides a dietary benefit for people with diabetes.展开更多
Integrating information on the glycemic index (GI) and the glycemic load (GL) of diet is limited in C?te d’Ivoire because of the lack of data. Thus, this study was undertaking for the local management and prevention ...Integrating information on the glycemic index (GI) and the glycemic load (GL) of diet is limited in C?te d’Ivoire because of the lack of data. Thus, this study was undertaking for the local management and prevention of diabetes mellitus and its complications based on nutritional data (GI and GL values). The study included ten healthy subjects with 7 males, 3 females (28 ± 2 years on average age and 20.5 ± 1.7 on average BMI). Participants tested three different meals with equal carbohydrate load (50 g). Blood samples were obtained at 0, 15, 30, 45, 60, 90 and 120 min before and after consumption for glucose levels determination. GIs were determined using a standard method with glucose as reference food and data were used for GLs calculating. Data showed that GIs value of pounded yam with eggplant sauce and cassava paste with granulates palm nut sauce were high ranging to 94 to 86 respectively while rice with groundnut sauce, have a low GI (GI = 45). Nevertheless, the GLs of the all the test foods are high with the values of 47, 43 and 23 (g) for pounded yam with eggplant sauce, cassava paste with granulates palm nut sauce and rice with groundnut sauce respectively. According to GIs and GLs data, the three test foods must be consumed moderately in a diet. So, it is important to associate GL data to GI data of Ivorian traditional foods for the management and the prevention of diabetes mellitus in C?te d’Ivoire and in others countries sharing the same food tradition.展开更多
In order to identify those potatoes which exert a low glycemic impact after processing, eight early potato varieties and four processing methods were evaluated for their total starch content, amylose content, rapidly ...In order to identify those potatoes which exert a low glycemic impact after processing, eight early potato varieties and four processing methods were evaluated for their total starch content, amylose content, rapidly digestible starch (RDS), slowly digestible starch (SDS), and resistant starch (RS), estimated glycemic index (eGI), glycemic load (eGL) as well as their relationship among each other. While all these profiles were highly dependent on the potato variety and processing methods, all the eight varieties were classified as low GL foods (p ≤ 0.05). A strong positive correlation was observed between eGI and RDS (r = 0.84, 0.79, and 0.74) for retrograded and reheated, baked and microwaved varieties, respectively), whereas a moderate negative correlation was observed between eGI and RS for retrograded and reheated (r = -0.39) and microwaved (-0.37) varieties (p ≤ 0.05). On the basis of these findings, it can be concluded that potato variety, processing methods, and starch characteristics define the eGI and eGL. Furthermore, for the varieties examined, the present study identified RDS as a major starch factor contributing to eGI.展开更多
The “bai?o de dois” is a typical Brazilian dish and a rich combination of rice and beans. This preparation has a high nutritional value but its effect on glycemic response is not yet studied. To determine the glycem...The “bai?o de dois” is a typical Brazilian dish and a rich combination of rice and beans. This preparation has a high nutritional value but its effect on glycemic response is not yet studied. To determine the glycemic index and glycemic load of foods can help prescribing diets and as a result, improving the treatment and prevention of chronic diseases. This study aimed to access the glycemic index (GI) and glycemic load (GL) of “bai?o de dois”. Following the protocol recommended by the Food and Agriculture Organization, 6 volunteers were recruited to perform blood glucose tests. Each volunteer performed three glucose tolerance tests and a test with “bai?o de dois”. All tests were undertaken in separate weeks. Through the calculation of the areas under each of the curves, it was possible to access the GI of “bai?o de dois” by the average values of six GIs found for each volunteer. It was calculated that the GL of each portion tested and recommended servings per capita. It was found that “bai?o de dois” had low GI (44) and GL (6) at the recommended per capita, but high GL (22) at the portion tested (bigger than the recommended). The “bai?o de dois” do not present a potential risk for developing chronic diseases, but it is recommended consumption to be monitored.展开更多
The diabetes mellitus is a public health problem in C?te d’Ivoire. The Glycemic index (GI) and the Glycemic load (GL) determination of commonly consumed foods such as juice fruits is an alternative to prevent metabol...The diabetes mellitus is a public health problem in C?te d’Ivoire. The Glycemic index (GI) and the Glycemic load (GL) determination of commonly consumed foods such as juice fruits is an alternative to prevent metabolic diseases. This study carried out three wild fruits locally named Baobab (Adansonia digitata), Tomi (Tamarindus indica) and Néré (Parkia biglobosa) collected at maturity stage. The juices from the pulp of fruits have been elaborated, pasteurized, submitted to microbiological and physicochemical analysis before GIs/GLs determination. Ten healthy subjects with body mass index and age average respectively 21.57 ± 1.06 and 28 ± 2 years old tested the three juices and glucose (50 g) as reference food. Blood samples have been collected at 0, 15, 30, 45, 60, 90 and 120 min after foods consumption. The GIs/GLs has been determined according to ISO/FDI 26642:2010 protocol. Data showed that pasteurized juices has a weak microbiologic load (1.0102 - 2.4102 of Mesophylls Aerobic Germs) and not contain pathogen germs. The GI and GL of Néré juice are high with respective values of 89.54 ± 1.63 and 29.22 ± 4.09 whereas those of Baobab and Tomi juice are moderate with respective GI/GL values of 66.48 ± 2.12/13.24 ± 1.99 and 60.41 ± 2.63/12.87 ± 1.67. The juice of Néré should be consumed occasionally when those of Baobab and Tomi should be consumed with moderation. It would be suitable to know more about the GI and GL of all the juice fruits produced locally so as to prevent efficiently diabetes mellitus in the country.展开更多
文摘BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.
基金Supported by Natural Science Foundation of Sichuan Province,No.2023NSFSC0682.
文摘BACKGROUND The interplay between abnormal glucose metabolism and the progression of liver fibrosis in patients with both chronic hepatitis B(CHB)and type 2 diabetes mellitus(T2DM)remains unclear.Previous studies have suggested that the coexistence of these conditions may exacerbate liver inflammation and fibrosis;however,the impacts of dynamic changes in glucose metabolism indicators,hypoglycemic medication regimens,and glycemic control status on liver fibrosis require further elucidation.AIM To explore the effect of glycemic control on hepatic fibrosis in patients with CHB and T2DM.METHODS A total of 420 patients with CHB and T2DM admitted to the Public Health Clinical Center of Chengdu between October 2018 and January 2022 were retrospectively included and classified according to liver stiffness measurement and glycemic control for between-group comparisons.RESULTS Significant differences were observed in the alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase,AST/ALT ratio,total bilirubin,direct bilirubin,diabetes treatment program,and thrombin time values among the liver fibrosis groups(adjusted P<0.05).Significant differences in albumin and gamma-glutamyl transferase levels were observed among the groups categorized by glucose status at admission(adjusted P<0.05).A positive correlation between fasting plasma glucose(FPG)and liver stiffness measurement was found to be mediated by ALT and AST.Fibrinogen and the international normalized ratio were positively correlated with glycated hemoglobin A1c,while the fibrosis-4 score,ALT,AST/ALT ratio,type III procollagen N-terminal peptide,ferritin,and activated partial thromboplastin time were correlated with FPG at admission.Additionally,AST was positively correlated with FPG at discharge(P<0.05).CONCLUSION Specific glucose metabolic parameters,hypoglycemic agents,and glycemic control status markers are associated with hepatic fibrosis in patients with both CHB and T2DM.Close blood glucose monitoring,optimized use of hypoglycemic agents,and continuous maintenance of good glycemic control may slow the progression of liver fibrosis in patients with CHB and T2DM.
基金Supported by the IMU University Internal Grant,No.CSc-Sem6(12)2022.
文摘BACKGROUND Adults with type 2 diabetes mellitus(T2DM)in Malaysia continue to have substantial comorbidities and struggle to achieve glycemic targets.AIM To comprehensively evaluate diabetes self-care and glycemic control using multiple self-reporting questionnaires.METHODS Adults diagnosed with T2DM attending the Seremban Health Clinic were recruited in this cross-sectional study.Eligible participants were recruited based on a consecutive sampling technique,first-come-first-served-basis if they fulfilled the inclusion and exclusion criteria.In addition to the usual sociodemographic,clinical,and laboratory data,the participants answered seven specific self-reporting questionnaires.This report was focused on six key variables:Glycemic control;self-care;self-efficacy;diabetes knowledge;health literacy;and medication adherence.RESULTS A total of 100 adults with T2DM participated.The proportions of participants achieving specific thresholds in the key variables were:Acceptable glycemic control 39.4%;adequate diabetes knowledge 59.6%;sufficient or higher health literacy 80.2%;and medication adherence 51.0%.The mean self-efficacy score was 110.6(73.3%of maximum),and the mean self-care score was 30.7(43.9%of maximum).A statistically significant linear correlation was observed for eight pairs of key variables with Pearson’s correlation values varying between 0.21 to 0.55.Selfefficacy had a relatively higher correlation while glycated hemoglobin was not correlated with other key variables.Path analysis was conducted to examine the relationships among diabetes self-efficacy(Diabetes Management Self Efficacy scale score),self-care behavior(Summary of Diabetes Self-Care Activities score),and glycemic control,but the model demonstrated a poor fit(χ^(2)=28.1,P<0.001).CONCLUSION We found substantial suboptimal glycemic control and low self-care practices but acceptable levels of diabetes knowledge,self-efficacy,health literacy and medication adherence among the patients with T2DM.In spite of the correlations between self-care,self-efficacy,and medication adherence,it was surprising that self-care did not correlate with glycemic control.Prospective cohort studies are needed to explore whether these factors influence diabetes outcomes.
文摘BACKGROUND Colorectal cancer(CRC)is the third most diagnosed malignancy worldwide and a frequent comorbidity among these patients is type 2 diabetes mellitus(T2DM).The coexistence of these conditions poses significant challenges to glycemic management,particularly during chemotherapy.AIM To assess the effects of individualized exercise training(IET)on glycemic control and nutritional status in patients with T2DM undergoing chemotherapy for CRC.METHODS In this retrospective study,clinical data from 245 patients with T2DM and on chemotherapy for CRC between November 2023 and December 2024 were analyzed.Patients were stratified into two groups according to their treatment regimens:The standard care(SC)group(n=111),which received conventional chemotherapy and diabetes management,and an IET group(n=134),which received additional personalized exercise interventions alongside SC.Parameters assessed included fasting plasma glucose,glycosylated hemoglobin,glycemic variability indices,nutritional biomarkers,markers of intestinal permeability,and adverse events.RESULTS Patients in the IET group demonstrated significant improvements in glycemic control,nutritional biomarkers,and glycemic variability(all P<0.05),compared with the SC group.The markers of intestinal permeability also improved significantly in the IET group(P<0.05).Meanwhile,no statistically significant difference in the incidence of adverse events was found between the two groups(P>0.05).These findings suggest that individualized exercise interventions can enhance metabolic,nutritional,and gastrointestinal outcomes without increasing treatment-related risks.CONCLUSION Personalized exercise training may offer clinically meaningful benefits in glycemic regulation and nutritional status for patients with T2DM and on chemotherapy for CRC.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287。
文摘Managing type 2 diabetes mellitus remains a significant challenge,particularly for individuals with persistently poor glycemic control.Although inadequate glycemic regulation is a well-established public health concern and a major contributor to diabetes-related complications,evidence on the effectiveness of intensive and supportive interventions across diverse patient subgroups is scarce.This editorial examines findings from a prospective study evaluating the influence of glycemic history on treatment outcomes in poorly controlled diabetes.The study highlights that personalized care models outperform generalized approaches by addressing the unique trajectories of glycemic deterioration.Newly diagnosed patients demonstrated the most favorable response to intervention,while those with consistently elevated glycated hemoglobin(≥10%)faced the greatest challenges in achieving glycemic control.These findings underscore the limitations of a onesize-fits-all strategy,reinforcing the need for patient-centered care that integrates individualized monitoring and timely intervention.Diabetes management requires prioritizing personalized treatment strategies that mitigate therapeutic inertia and ensure equitable,effective care for all patients.
基金Supported by Henan Province Key Research and Development Program,No.231111311000Henan Provincial Science and Technology Research Project,No.232102310411+2 种基金Henan Province Medical Science and Technology Key Project,No.LHGJ20220566 and No.LHGJ20240365Henan Province Medical Education Research Project,No.WJLX2023079Zhengzhou Medical and Health Technology Innovation Guidance Program,No.2024YLZDJH022.
文摘This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients.These amputations,often necessitated by severe diabetic foot ulcers,carry significant risks of postoperative complications such as infection and delayed wound healing.Elevated hemoglobin A1c levels,indicative of poor glycemic control,and a history of kidney transplantation,due to required immunosuppressive therapy,are key factors influencing these outcomes.This paper emphasizes the need for enhanced glycemic management and personalized postoperative care,particularly for immunocompromised individuals,to minimize complications and improve patient prognosis.Future research should focus on prospective studies to validate targeted interventions and optimize care strategies,ultimately aiming to reduce the healthcare burden associated with diabetic foot complications.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease characterized by combinations of insulin resistance and insulin deficiency.Non-alcoholic fatty liver disease(NAFLD)is emerging as a public health problem worldwide and affects up to 70%of patients with T2DM.Although patients with T2DM have an increased risk of developing advanced liver disease compared to healthy individuals,varying prevalence rates of NAFLD among patients with T2DM,ranging from 34%to 94%,have been reported.AIM To determine prevalence and identify associated factors of NAFLD among Limbe patients with T2DM and evaluate correlation with glycemic control.METHODS A cross-sectional study was carried out from February to June 2024 among patients with T2DM.Gamma-glutamyl transferase(GGT)activity and serum triglycerides(TGs)were measured by spectrophotometry.NAFLD was diagnosed using the fatty liver index score.Data were analyzed using SPSS version 26.0 for Windows.Student’s t-test was used to compare the means of two groups.The χ^(2) test was applied to determine the association of NAFLD and T2DM.Logistic regression analysis was performed to identify predictors of NAFLD.P<0.05 was considered statistically significant.RESULTS Of the 150 patients with T2DM recruited for this study,63(58%)were females and the majority(84.7%)had good glycemic control(glycated hemoglobin<7%).Prevalence of NAFLD among patients with T2DM was 19%.Patients with NAFLD had significantly elevated levels of TGs,GGT,and increased body mass index and waist circumference compared to those without NAFLD.There was a significant association between NAFLD and glycemic control.Predictive factors of NAFLD among patients with T2DM were vegetable intake of less than three times per week[adjusted odds ratio(aOR):0.131,95%CI:0.020-0.839;P=0.032],central obesity(aOR:0.167,95%CI:0.037-0.748;P=0.019),and metformin treatment for T2DM(aOR:0.167,95%CI:0.037-0.718;P<0.001).CONCLUSION The prevalence of NAFLD in patients with T2DM in Limbe Regional Hospital was 19%.Age,central obesity,metformin use,and infrequent consumption of vegetables were important predictors of NAFLD.
基金Supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project,No.2023ZD0508201the National Key R and D Program of China,No.2022YFC2010100+3 种基金the National Natural Science Foundation of China,No.82070812the Natural Science Foundation of Hunan Province,No.2024JJ9049,No.2023JJ30762 and No.2021JC0003Sinocare Diabetes Foundation,No.2020SD08the National Clinical Research Center for Metabolic Diseases Clinical Diagnosis and Treatment Capacity Enhancement Program,No.2023ZLNL003.
文摘BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.
文摘Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a network meta-analysis was conducted to evaluate the comparative efficacy of various vitamin D supplementation strategies on glucose indicators in adults with T2DM.Methods Eligible studies published before September 12,2024,were retrieved from PubMed,EMBASE,Cochrane Library,and Web of Science.A network meta-analysis of multiple dosage strategies—low(<1,000 IU/day,LDS),medium(1,000–2,000 IU/day,MDS),high(2,000–4,000 IU/day,HDS),and extremely high(≥4,000 IU/day,EHDS)—was performed.Results The network meta-analysis of 40 RCTs indicated that,compared with placebo,vitamin D_(3)supplementation increased 25-hydroxyvitamin D[25-(OH)-D]levels,with pooled mean difference(MD)showing a stepwise increase from LDS to EHDS.Ranking probabilities showed a corresponding rise in 25-(OH)-D levels from LDS(46.7%)to EHDS(91.2%).EHDS reduced fasting blood glucose(FBG)relative to no treatment.LDS significantly decreased hemoglobin A1c(HbA1c),and vitamin D_(2) significantly affected FBG levels.MDS led to a significant change in fasting insulin(FIN)compared to both placebo(MD:-4.76;95%CI-8.91 to-0.61)and no treatment(MD:-7.30;95%CI-14.44 to-0.17).Conclusion The findings suggest that vitamin D supplementation may be a viable approach for improving glycemic control in adults with T2DM,with lower doses potentially offering benefit.The analysis also showed a dose-dependent increase in 25-(OH)-D levels.
文摘The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin(Hb A1c). Despite its importance as an indicator for the development of diabeticcomplications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between Hb A1 c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to Hb A1 c in routine diabetes care is selfmonitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize glucose dynamics. Several continuous glucose monitoring(CGM) systems, which have shown usefulness in clinical practice, are presently on the market. They can broadly be divided into systems providing retrospective or real-time information on glucose patterns. The widespread clinical application of CGM is still hampered by the lack of generallyaccepted measures for assessment of glucose profiles and standardized reporting of glucose data. In this article, we will discuss advantages and limitations of various metrics for glycemic control as well as possibilities for evaluation of glucose data with the special focus on glycemic variability and application of CGM to improve individual diabetes management.
基金Supported by General Research Fund from Research Grants Committee of The Government of the Hong Kong SAR,China, No.4440178
文摘AIM:To determine the glycemic index(GI)and glycemic load(GL)values of Chinese traditional foods in Hong Kong.METHODS:Fifteen healthy subjects(8 males and 7 females)volunteered to consume either glucose or one of 23 test foods after 10-14 h overnight fast.The blood glucose concentrations were analyzed immediately before,15,30,45,60,90 and 120 min after food consumption using capillary blood samples.The GI value of each test food was calculated by expressing the incremental area under the blood glucose response curve(IAUC)value for the test food as a percentage of each subject's average IAUC value for the glucose.The GL value of each test food was calculated as the GI value of the food multiplied by the amount of the available carbohydrate in a usual portion size,divided by 100.RESULTS:Among all the 23 Chinese traditional foods tested,6 of them belonged to low GI foods(Tuna Fish Bun,Egg Tart,Green Bean Dessert,Chinese Herbal Jelly,Fried Rice Vermicelli in Singapore-style,and Spring Roll),10 of them belonged to moderate GI foods(Baked Barbecued Pork Puff,Fried Fritter,"Mai-Lai"Cake,"Pineapple"Bun,Fried Rice Noodles with Sliced Beef,Barbecue Pork Bun,Moon Cakes,Glutinous Rice Ball,Instant Sweet Milky Bun,and Salted Meat Rice Dumpling),the others belonged to high GI foods(Fried Rice in Yangzhou-Style,Sticky Rice Wrapped in Lotus Leaf,Steamed Glutinous Rice Roll,Jam and Peanut Butter Toast,Plain Steamed Vermicelli Roll,Red Bean Dessert,and Frozen Sweet Milky Bun).CONCLUSION:The GI and GL values for these Chinese traditional foods will provide some valuable information to both researchers and public on their food preference.
基金supported by grants from the Ministry of Science and Technology of the People’s Republic of China[grant nos.2016YFC1305600,2016YFC1305202,2016YFC1304904,2017YFC1310700,2018YFC1311800]the National Natural Science Foundation of China[grant nos.81970706,81970691,81970728,81800683]。
文摘Objective The relationship between serum uric acid(SUA)levels and glycemic indices,including plasma glucose(FPG),2-hour postload glucose(2 h-PG),and glycated hemoglobin(HbA1 c),remains inconclusive.We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.Methods The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study.A total of 105,922 community-dwelling adults aged≥40 years underwent the oral glucose tolerance test and uric acid assessment.The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.Results A total of 30,941 men and 62,361 women were eligible for the current analysis.Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels,but with different inflection points in men and women.The thresholds for FPG,2 h-PG,and HbA1 c for men and women were 6.5/8.0 mmol/L,11.0/14.0 mmol/L,and 6.1/6.5,respectively(SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).Conclusion An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes,while the inflection points were reached earlier in men than in women.
文摘This study aimed to investigate the effect of yam flour substitution (Dioscorea alata L.) and moringa powder in wheat bread on glycemic response. Glycemic index (GI) and glycemic load (GL) of pieces of bread were determined. A mixture plan design was used to determine the optimal formulation of bread made of yam flour, wheat flour and moringa powder. The mixture of 79.4% soft wheat flour, 20% yam flour and 0.6% moringa leaves powder has a good potential in bread preparation and was used in this study. 100% wheat bread was used as control. Postprandial blood glucose response (glycemic response) was evaluated with the glucose used as a reference food. Blood glucose responses were measured at different intervals for 2 hours. The results indicated that composite bread had low GI and GL values than wheat bread. Values are GI = 80 and GL = 61.2 for wheat bread and GI = 37.78 and GL = 29.65 for the composite bread. This study demonstrated that the inclusion of yam flour of moringa leaves powder in bread production might not pose a threat to blood glucose response compared to wheat bread. These pieces of bread could be included easily in diabetics’ and non-diabetics diet.
基金supported by grants from National Natural Science Foundation of China(No.81570740 and No.81100581)the Ministry of Science and Technology of China(No.2011CB100600)+3 种基金the Science and Technology Projects of Wuhan(No.201060938360-04 from the Wuhan Science and Technology Bureau)China International Medical Foundation(CIMF)--Novo Nordisk China Diabetes Yingcai Funding(No.2014)CIMF-Novo Nordisk China β Academy Funding(No.20110059)the Fundamental Research Funds for the Central Universities(No.0118540208)
文摘Food intake has a great influence on blood glucose in patients with diabetes. This study was to determine the glycemic index（GI） and glycemic load（GL） of a particular pomelo named Majia pomelo and its effects on postprandial glucose（PPG） in patients with type 2 diabetes（T2D）. Twenty healthy subjects and 20 T2D patients（controlled on lifestyle measures and/or metformin） were tested on 2 separate days with 50 g of glucose and 50 g equivalent of carbohydrates from Majia pomelo for GI measurement. To test effects of Majia pomelo on PPG, 19 hospitalized T2D patients（controlled on insulin therapy） were selected for a 9-day study. The dose of insulin for each patient was adjusted on the first 3 days. A total of 100 g Majia pomelo was consumed per meal in the last 3 tested days. Blood glucose was measured to evaluate the glycemic excursions. The GIs for Majia pomelo in healthy individuals and T2D patients were 78.34±1.88 and 72.15±1.95 respectively. The value of GL was as low as 4.23 in diabetic patients with serving size of 100 g pomelo, indicting Majia pomelo as a high GI but low GL fruit. Consumption of Majia pomelo in hospitalized T2D patients did not cause significant glucose fluctuation. It was concluded that high GI pomelo can serve as a low GL fruit if it is consumed with a limited daily amount and thus can be supplied to diabetic patients. These results may mean more varieties of food choices for T2D patients.
文摘In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.
文摘Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO), have been formulated to blunt postprandial hyperglycemia. The objective of this research was to evaluate the effectiveness of these products on postprandial glycemic and hormonal responses based on comparisons of GTSN with differing carbohydrate quantities or types. Methods: In two randomized, double-blind, crossover studies, participants (mean age 61 years) with type 2 diabetes consumed GTSN in a meal tolerance test. In the CHO Quantity Study, a standard nutritional beverage (STD) was compared to a low carbohydrate nutritional beverage with tapioca dextrin (GTSN-TDX) and a balanced carbohydrate nutritional beverage containing a blend of the slowly-digesting carbohydrates maltodextrin and sucromalt (GTSN-SDC). In the CHO Type Study, the GTSN beverages had similar carbohydrate quantities but varied in carbohydrate composition with GTSN-SDC compared to a formula with tapioca starch and fructose (GTSN-TS&F), and one with isomaltulose and resistant starch (GTSN-I&RS). Postprandial (0-240 min) concentrations of blood glucose, insulin (CHO Quantity Study only) and glucagon-like-peptide (GLP)-1 (CHO Quantity Study only) were measured. Results: Despite having substantially different carbohydrate quantities, the GTSN blunted the glucose positive area under the curve (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 min tended to be lower for GTSN-SDC (1477 ± 460) than GTSN-TS&F (2203 ± 412;p = 0.062) and GTSN-I&RS (2190 ± 412;p = 0.076). No differences were observed between GTSN-TS&F and GTSN-I&RS. Conclusions: These results demonstrate the effectiveness of several GTSN products and suggest that both CHO quantity and type play important roles in postprandial glycemic response in men and women with type 2 diabetes. Furthermore, GTSN products containing slow-digesting carbohydrates can blunt postmeal glucose and insulin concentration despite delivering greater total grams of CHO, which provides a dietary benefit for people with diabetes.
基金financed within the Agricultural Produc-tivity Program in West Africa(PPAAO/WAAPP 1B.)Don IDA N˚6260 CI et Don N˚TF 098014 CI by FIRCA(Fonds Interprofessionnel pour la Recherche et le Conseil Agricoles).
文摘Integrating information on the glycemic index (GI) and the glycemic load (GL) of diet is limited in C?te d’Ivoire because of the lack of data. Thus, this study was undertaking for the local management and prevention of diabetes mellitus and its complications based on nutritional data (GI and GL values). The study included ten healthy subjects with 7 males, 3 females (28 ± 2 years on average age and 20.5 ± 1.7 on average BMI). Participants tested three different meals with equal carbohydrate load (50 g). Blood samples were obtained at 0, 15, 30, 45, 60, 90 and 120 min before and after consumption for glucose levels determination. GIs were determined using a standard method with glucose as reference food and data were used for GLs calculating. Data showed that GIs value of pounded yam with eggplant sauce and cassava paste with granulates palm nut sauce were high ranging to 94 to 86 respectively while rice with groundnut sauce, have a low GI (GI = 45). Nevertheless, the GLs of the all the test foods are high with the values of 47, 43 and 23 (g) for pounded yam with eggplant sauce, cassava paste with granulates palm nut sauce and rice with groundnut sauce respectively. According to GIs and GLs data, the three test foods must be consumed moderately in a diet. So, it is important to associate GL data to GI data of Ivorian traditional foods for the management and the prevention of diabetes mellitus in C?te d’Ivoire and in others countries sharing the same food tradition.
文摘In order to identify those potatoes which exert a low glycemic impact after processing, eight early potato varieties and four processing methods were evaluated for their total starch content, amylose content, rapidly digestible starch (RDS), slowly digestible starch (SDS), and resistant starch (RS), estimated glycemic index (eGI), glycemic load (eGL) as well as their relationship among each other. While all these profiles were highly dependent on the potato variety and processing methods, all the eight varieties were classified as low GL foods (p ≤ 0.05). A strong positive correlation was observed between eGI and RDS (r = 0.84, 0.79, and 0.74) for retrograded and reheated, baked and microwaved varieties, respectively), whereas a moderate negative correlation was observed between eGI and RS for retrograded and reheated (r = -0.39) and microwaved (-0.37) varieties (p ≤ 0.05). On the basis of these findings, it can be concluded that potato variety, processing methods, and starch characteristics define the eGI and eGL. Furthermore, for the varieties examined, the present study identified RDS as a major starch factor contributing to eGI.
文摘The “bai?o de dois” is a typical Brazilian dish and a rich combination of rice and beans. This preparation has a high nutritional value but its effect on glycemic response is not yet studied. To determine the glycemic index and glycemic load of foods can help prescribing diets and as a result, improving the treatment and prevention of chronic diseases. This study aimed to access the glycemic index (GI) and glycemic load (GL) of “bai?o de dois”. Following the protocol recommended by the Food and Agriculture Organization, 6 volunteers were recruited to perform blood glucose tests. Each volunteer performed three glucose tolerance tests and a test with “bai?o de dois”. All tests were undertaken in separate weeks. Through the calculation of the areas under each of the curves, it was possible to access the GI of “bai?o de dois” by the average values of six GIs found for each volunteer. It was calculated that the GL of each portion tested and recommended servings per capita. It was found that “bai?o de dois” had low GI (44) and GL (6) at the recommended per capita, but high GL (22) at the portion tested (bigger than the recommended). The “bai?o de dois” do not present a potential risk for developing chronic diseases, but it is recommended consumption to be monitored.
文摘The diabetes mellitus is a public health problem in C?te d’Ivoire. The Glycemic index (GI) and the Glycemic load (GL) determination of commonly consumed foods such as juice fruits is an alternative to prevent metabolic diseases. This study carried out three wild fruits locally named Baobab (Adansonia digitata), Tomi (Tamarindus indica) and Néré (Parkia biglobosa) collected at maturity stage. The juices from the pulp of fruits have been elaborated, pasteurized, submitted to microbiological and physicochemical analysis before GIs/GLs determination. Ten healthy subjects with body mass index and age average respectively 21.57 ± 1.06 and 28 ± 2 years old tested the three juices and glucose (50 g) as reference food. Blood samples have been collected at 0, 15, 30, 45, 60, 90 and 120 min after foods consumption. The GIs/GLs has been determined according to ISO/FDI 26642:2010 protocol. Data showed that pasteurized juices has a weak microbiologic load (1.0102 - 2.4102 of Mesophylls Aerobic Germs) and not contain pathogen germs. The GI and GL of Néré juice are high with respective values of 89.54 ± 1.63 and 29.22 ± 4.09 whereas those of Baobab and Tomi juice are moderate with respective GI/GL values of 66.48 ± 2.12/13.24 ± 1.99 and 60.41 ± 2.63/12.87 ± 1.67. The juice of Néré should be consumed occasionally when those of Baobab and Tomi should be consumed with moderation. It would be suitable to know more about the GI and GL of all the juice fruits produced locally so as to prevent efficiently diabetes mellitus in the country.
