Diurnal glycemic pattern on inclusion of sucrose in daily meals in type 2 diabetes: Reflection of antecedent glycemic control

Background: Inclusion of sucrose in diabetic diets is not recommended in subjects with diabetes since effects of such diets on glycemic indices are not established. Some studies have documented lapse in metabolic control on consumption of these diets type 2 diabetes. However, most studies examined plasma glucose only for a few hours after ingestion of a single meal containing sucrose after an overnight fast whereas others recommended increasing insulin dose prior to the meal. None of these studies examined influence of inclusion of sucrose in daily meals in subjects with new onset diabetes at diagnosis and again after achieving desirable glycemic control. Objective : Study was conducted to assess glycemic responses to ingestion of all meals containing sucrose constituting 50% of carbohydrate calories. Methods: 12 subjects with new onset type 2 diabetes participated. They were administered the following isocaloric diets for 4 days each prior to and after achieving desirable glycemic control; Diet 1- Diabetic diet recommended by American Diabetes Association (ADA), diet 2- test diet containing sucrose, diet 3- ADA diet. Glycemic control was assessed by diurnal glycemia (average of pre-prandial, postprandial and bedtime blood glucose), fasting plasma glucose, HbA1c and fructosamine on 4th day of each dietary period. Results: All glycemic indices deteriorated after consumption of sucrose containing meals prior to initiation of treatment and remained worsened on return to ingestion of ADA diet. Glycemic responses after all meals improved markedly on achieving desirable glycemic control. Moreover, glycemic indices remained unaltered on consumption of sucrose containing meals after attaining and maintaining desirable glycemic control. Conclusion: Diurnal glycemic responses deteriorate on ingestion of daily meals containing sucrose in subjects with new onset uncontrolled type 2 diabetes. In contrast, diurnal glycemic pattern is unaltered following consumption of daily meals containing sucrose after attaining and maintaining desirable glycemic control.

High-Dose Once-Weekly Semaglutide: A New Option for Obesity Management

Objective To review the pharmacology, efficacy, and safety of high-dose once-weekly semaglutide for chronic weight management. Data Sources PubMed/MEDLINE and ClinicalTrials.gov were searched (inception to September 8, 2021) using keywords “semaglutide” and “obesity,” “weight,” “high dose,” “high-dose,” or “2.4.” Study Selection and Data Extraction Clinical trials with published results were included. Publications studying the oral or <2.4 mg formulation of semaglutide were excluded. Data Synthesis Four phase 3, multicenter, randomized, double-blind trials demonstrated efficacy of high-dose once-weekly semaglutide compared with placebo for weight loss. Study populations included patients with overweight or obesity (STEP 1, STEP 3, and STEP 4) or patients with diabetes and with overweight or obesity (STEP 2). Lifestyle interventions for diet and exercise were included for all participants. Weight loss from baseline was significant for all studies, and secondary outcomes demonstrated cardiometabolic improvements including waist circumference, systolic blood pressure, and lipid profiles. Gastrointestinal adverse effects were common, but the medication was otherwise well tolerated. Relevance to Patient Care and Clinical Practice High-dose semaglutide offers significant weight-lowering potential and favorable effects on cardiometabolic risk factors and glycemic indices. Clinicians and patients should consider the route and frequency of administration, adverse effect profile, and cost when choosing an antiobesity medication. The importance of concomitant lifestyle interventions should be emphasized. Conclusions High-dose once-weekly semaglutide can significantly reduce weight, and although gastrointestinal adverse effects were common, it is generally well tolerated.

The Effects of Sesame Consumption on Glycemic Control in Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trial

Objectives. In recent years, diabetes has become a global health problem that creates a tremendous economic burden for many countries. Clinical trials evaluating the hypoglycemic effects of sesame consumption have produced conflicting results. This systematic review and meta-analysis was conducted to evaluate the effectiveness of sesame as a popular natural herb on glycemic indices in adults. Methods. The search for related articles in PubMed, Scopus, Google Scholar, and Cochrane library was conducted through May 2021. Results were reported as weighted mean differences (WMD) with 95% confidence intervals (CI) using a random-effects model. Results. A total of 605 studies were identified through online searching, and a total of eight RCTs representing 382 participants were included in this study. The meta-analyses revealed that sesame consumption significantly decreases serum fasting blood sugar (FBS): (WMD: −28.23 mg/dl; 95% CI (−39.16, −17.13), I2 = 97.6%; 95% CI (96, 98)), and hemoglobin A1c (HbA1c): (WMD: −1.00%; 95% CI (−1.11, −0.88), I2 = 0%; 95% CI (0, 79)) as compared to the control group. Conclusion. This study provides evidence of the hypoglycemic effects of sesame consumption, particularly in diabetic patients. Additional RCTs on sesame and its preparations should be conducted in different populations to increase generalizability.

Effect of Haemoglobin Variants on Glycemic Indices

Haemoglobin genotypes have been known to be linked with groups of diseases such as diabetes. The aim of this study is to assess the impact of haemoglobin variants on glycemic indices (fasting blood glucose and glycated haemoglobin) in subjects in Bayelsa State, Nigeria. A total of 150subjects were enrolled for the study with AA group = 99 subjects and AS group = 51 subjects. 4mls of blood was collected into EDTA bottle for each subject and was assayed for Hb electrophoresis and glycated haemoglobin (HbA1C) using electrophoretic method and automated CLOVER A1c Analyser respectively. 2mls was collected into fluoride oxalate bottle for spectrophotometric analysis of fasting blood glucose (FBG). Results revealed that there were no significant differences in the FBG and HbA1C mean levels of the two studied groups (AA and AS). This study has shown that AA and AS blood genotypes may not have any impact on FBG and HbA1C glycemic parameters.

Comparing Glycemic Indices among Different Ethnic Groups Residing in Yenegoa, Bayelsa State, Nigeria

Increased prevalence and incidence rates within ethnic minorities have been reported by numerous studies on tribal differences in type 2 diabetes patients, sharing a western setting. This study was aimed at comparing glycemic indices among different ethnic groups residing in Yenegoa, Bayelsa State. The study population consisted of apparently150 healthy male and female subjects; 116 Ijaws, 21 Igbos and 13 Yorubas residing in Yenagoa Local Government Area, Bayelsa State of Nigeria. All subjects were aged between 16 and 48 years. 4 mls of Blood samples was collected from each subject. 2mls of the blood was withdrawn into EDTA for HbA1c estimation while the other 2mls was withdrawn into fluoride oxalate for fasting blood glucose. Glycated haemoglobin (HbA1c) was determined using the automated CLOVER A1c Analyser while FBG was assayed using Glucose Oxidase Method. Results revealed that there was a significant difference in the mean levels of FBG among the studied groups (P-value < 0.05) but there was no significant difference in the HbA1c mean levels (P-value > 0.05). This study has revealed that ethnic differences may cause significant changes on fasting blood glucose but may not in HbA1c.

Dichotomy in the Impact of Elevated Maternal Glucose Levels on Neonatal Epigenome

CONTEXT Antenatal hyperglycemia is associated with increased risk of future adverse health outcomes in both mother and child. Variations in offspring’s epigenome can reflect the impact and response to in utero glycemic exposure, and may have different consequences for the child. OBJECTIVE We examined possible differences in associations of basal glucose status and glucose handling during pregnancy with both clinical covariates and offspring cord tissue DNA methylation. RESEARCH DESIGN AND METHODS This study included 830 mother-offspring dyads from the GUSTO cohort. The fetal epigenome of umbilical cord tissue was profiled using Illumina HumanMethylation450 arrays. Associations of maternal mid-pregnancy fasting (FPG) and 2h plasma glucose (2hPG) post-75g oral glucose challenge (OGTT) with both maternal clinical phenotypes and offspring epigenome at delivery were investigated separately. RESULTS Maternal age, pre-pregnancy BMI and blood pressure measures were associated with both FPG and 2hPG; while Chinese ethnicity (p=1.9×10 -4), maternal height (p=1.1×10 -4), pregnancy weight gain (p=2.2×10 -3), pre-pregnancy alcohol consumption (p=4.6×10 -4), and tobacco exposure (p=1.9×10 -3) showed significantly opposite associations between the two glucose measures. Most importantly, we observed a dichotomy in the effects of these glycemic indices on the offspring epigenome. Offspring born to mothers with elevated 2hPG showed global hypomethylation. CpGs most associated with the two glucose measures also reflected differences in gene ontologies and had different associations with offspring birthweight. CONCLUSIONS Our findings suggest that two traditionally used glycemic indices for diagnosing gestational diabetes may reflect distinctive pathophysiologies in pregnancy, and have differential impacts on the offspring’s DNA methylome.

Impact of PCSK9 Immunization on Glycemic Indices in Diabetic Rats

Background and Aim. The impact of Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition on glycemic indices in diabetes mellitus remains far from clear. We explored the effects of PCSK9 inhibition on glycemic indices in the diabetes rat model. Methods. To prepare the anti-PCSK9 vaccine, a peptide construct called Immunogenic Fused PCSK9-Tetanus (IFPT) was linked to the surface of nanoliposome carriers. Healthy rats received four subcutaneous injections of the vaccine at biweekly intervals. Two weeks after the last vaccination, anti-PCSK9 antibody titers, PCSK9 targeting, and inhibition of PCSK9–low-density lipoprotein receptor (LDLR) interaction were evaluated. After verification of antibody generation, the immunized rats were intraperitoneally treated with a single dose (45 mg/kg) of streptozotocin (STZ) to induce diabetes mellitus. The levels of fasting blood glucose (FBG) were measured, and the oral glucose tolerance test (OGTT) as well as the insulin tolerance test (ITT) were carried out to assess glycemic status. At the end of the study, the total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride, and high-density lipoprotein cholesterol concentrations were assayed. Histopathology examination of the liver and pancreas was also performed using the hematoxylin-eosin staining method. Results. The prepared nanoliposomal vaccine could strongly induce anti-PCSK9 antibodies in the vaccinated rats. Within one week following the STZ injection, the FBG level was lower in the vaccinated group vs. diabetic control group (49% ( − 171.7 ± 35 mg / dL , p < 0.001 )). In the OGTT, the injected rats showed improved glucose tolerance as reflected by the reduction of blood glucose levels over 180 min, compared with the diabetic controls. Moreover, the ITT demonstrated that, after the insulin injection, blood glucose concentration declined by 49.3% in the vaccinated group vs. diabetic control group. Expectedly, the vaccinated rats exhibited lower (-26.65%, p = 0.03 ) plasma LDL-C levels compared with the diabetic controls. Histopathology examination of pancreas tissue demonstrated that the pancreatic islets of the vaccinated rats had a slight decline in the population of β-cells and few α-cells. Normal liver histology was also observed in the vaccinated rats. Conclusion. PCSK9 inhibition through the liposomal IFPT vaccine can improve the glucose and insulin tolerance impairments as well as the lipid profile in diabetes.

The Effect of Combined Herbal Capsule on Glycemic Indices and Lipid Profile in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Clinical Trial

Objectives: The present study aimed to investigate the potential effects of the combined herbal capsule (CHC), as a nutritional supplement, on glycemic indices (GIs) and lipid profile (LP) of patients with type 2 diabetes mellitus (T2DM). Methods: Following a randomized, single-blind, placebo-controlled clinical trial, the current study was conducted on 80 cases with T2DM who were randomly assigned into two groups of treatment (CHCs; n = 40) and control (placebo; n = 40). Both groups received the intervention (500 mg capsules) twice a day for three months, without changes in the previous dose of oral anti-hyperglycemic drugs. The GI and LP levels were measured before the intervention and three months later to investigate the potential efficacy of the interventions. Results: For those in the intervention group, the mean GI [i.e., fasting blood sugar, two hours postprandial (2hpp), and HbA1c] was significantly different after 3 months (P < 0.05). The GI- and LP-related outcomes (TG, LDL-C except for TC) were improved after 3-month of receiving the intervention compared to the control group; however, the observed improvement was no statistically significant (P > 0.05). The HDL-C level was also significantly improved in the intervention group compared to the control group (P < 0.05). Conclusions: This study demonstrated that receiving CHCs could improve GI and LP levels (TG, LDL-C, and HDL-C, except for TC), which indicates its potential to control T2DM. Moreover, no significant side effect was observed in the intervention group. It can be argued that the use of CHCs, as adjuvant therapy, in combination with conventional hypoglycemic and lipid-lowering drugs, as well as following a modified lifestyle, not only can significantly enhance glycemic control but also may prevent T2DM complications.