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Aim: To evaluate the effect on glucose control of professional continuous glucose monitoring (p-CGM)-based care as compared with standard care in the management of patients with type 1 and type 2 diabetes., Materials and Methods: The PubMed database was searched comprehensively to identify prospective or retrospective studies evaluating p-CGM as a diagnostic tool for subsequent implementation of lifestyle and/or medication changes and reporting glycated haemoglobin (HbA1c) as an outcome measure., Results: We found 872 articles, 22 of which were included in the meta-analysis. Overall, the use of p-CGM was associated with greater HbA1c reduction from baseline (-0.28%, 95% confidence interval [CI] -0.36% to -0.21%, I 2  = 0%, P < 0.00001) than usual care, irrespective of type of diabetes, length of follow-up, frequency of continuous glucose monitoring (CGM) use and duration of CGM recording. In the few studies describing CGM-derived glucose metrics, p-CGM showed a beneficial effect on change in time in range from baseline (5.59%, 95% CI 0.12 to 11.06, I 2  = 0%, P = 0.05) and a neutral effect on change in time below the target range from baseline (-0.11%, 95% CI -1.76% to 1.55%, I 2  = 33%, P = 0.90)., Conclusions: In patients with type 1 and type 2 diabetes, p-CGM-driven care is superior to usual care in improving glucose control without increasing hypoglycaemia., (© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

This study was designed to improve blood glucose level predictability and future hypoglycemic and hyperglycemic event alerts through a novel patient-specific supervised-machine-learning (SML) analysis of glucose level based on a continuous-glucose-monitoring system (CGM) that needs no human intervention, and minimises false-positive alerts. The CGM data over 7 to 50 non-consecutive days from 11 type-1 diabetic patients aged 18 to 39 with a mean HbA1C of 7.5% ± 1.2% were analysed using four SML models. The algorithm was constructed to choose the best-fit model for each patient. Several statistical parameters were calculated to aggregate the magnitudes of the prediction errors. The personalised solutions provided by the algorithm were effective in predicting glucose levels 30 minutes after the last measurement. The average root-mean-square-error was 20.48 mg/dL and the average absolute-mean-error was 15.36 mg/dL when the best-fit model was selected for each patient. Using the best-fit-model, the true-positive-hypoglycemia-prediction-rate was 64%, whereas the false-positive- rate was 4.0%, and the false-negative-rate was 0.015%. Similar results were found even when only CGM samples below 70 were considered. The true-positive-hyperglycemia-prediction-rate was 61%. State-of-the-art SML tools are effective in predicting the glucose level values of patients with type-1diabetes and notifying these patients of future hypoglycemic and hyperglycemic events, thus improving glycemic control. The algorithm can be used to improve the calculation of the basal insulin rate and bolus insulin, and suitable for a closed loop "artificial pancreas" system. The algorithm provides a personalised medical solution that can successfully identify the best-fit method for each patient., (© 2020 John Wiley & Sons Ltd.)

Objective: Diabetes mellitus is a prevalent endocrine disorder worldwide. Citrulline is an α-amino acid, which is abundant in watermelon, and a precursor of arginine and nitric oxide. Decreased bioavailability of nitric oxide is associated with insulin resistance. The present systematic review focused on the existing evidence of citrulline and watermelon extract effects on metabolic and inflammatory parameters in diabetes mellitus., Methods: A systematic search of the databases PubMed, Scopus, EMBASE, ProQuest and Google Scholar was conducted for relevant papers published from inception until October 2018. All clinical trials, animal and in vitro studies published in the English language that assessed the role of citrulline and watermelon extract on diabetes mellitus, were eligible. Studies providing inadequate information were excluded., Results: Out of 1262 articles we found, only eight articles met the inclusion criteria for analysis. In three studies an increase in the synthesis of nitric oxide was reported with citrulline and watermelon extract supplementation. Four studies showed a significant reduction in blood glucose after supplementation with watermelon extract, and two studies reported a decrease in a number of inflammatory biomarkers following citrulline supplementation. Although citrulline intake caused a significant reduction in HOMA-IR in one study, inconsistent results were revealed on the effects of citrulline and watermelon extract on insulin levels and lipid profile., Conclusion: Citrulline and watermelon extract could improve nitric oxide synthesis, glycaemic status and inflammation in diabetes mellitus. However, further studies are required to shed light on the underlying mechanisms., (© 2019 John Wiley & Sons Australia, Ltd.)

Type 1 diabetes mellitus (T1DM) remains one of the most challenging long-term conditions to manage. Despite robust evidence to demonstrate that near normoglycaemia minimizes, but does not completely eliminate, the risk of complications, its achievement has proved almost impossible in a real-world setting. HbA1c to date has been used as the gold standard marker of glucose control and has been shown to reflect directly the risk of diabetes complications. However, it has been recognized that HbA1c is a crude marker of glucose control. Continuous glucose monitoring (CGM) provides the ability to measure and observe inter- and intraday glycaemic variability (GV), a more meaningful measure of glycaemic control, more relevant to daily living for those with T1DM. This paper reviews the relationship between GV and hypoglycaemia, and micro- and macrovascular complications. It also explores the impact on GV of CGM, insulin pumps, closed-loop technologies, and newer insulins and adjunctive therapies. Looking to the future, there is an argument that GV should become a key determinant of therapeutic success. Further studies are required to investigate the pathological and psychological benefits of reducing GV., (© 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Summary: The aim of this paper is to promote the development of new biological models and the application of optimization methods to these models. Fast and cheap computing power allows for the ready implementation of increasingly complex dynamic models in biology. However, these models are normally developed in isolation, and their highly coupled nature can make it difficult to incorporate features from one model into another. In addition, there are many recent advances in numerical optimal control, which have not yet been applied to biological models. In this paper, we illustrate how an existing biological model can be extended to incorporate features from other models, and we demonstrate that numerical optimal control techniques can readily determine optimal strategies for managing the resulting system. In particular, we develop a new composite dynamic model for the blood glucose regulatory system by incorporating the effects of exercise and insulin injections into an existing model with 8 state variables. We formulate an optimal control problem, in which the aim is to determine optimal injection times, optimal injection volumes, and an optimal exercise regime to regulate the blood glucose level. A numerical approach, based on the concept of control parameterization and a time‐scaling transformation, is then developed for solving the optimal control problem. Numerical results for 5 scenarios show that optimal treatment regimes can be readily determined via the proposed approach. [ABSTRACT FROM AUTHOR]

Closed-loop insulin delivery system, also known as artificial pancreas (AP), provides the blood glucose control in diabetic patients, enabling the automatic blood-sugar management and reducing the risks and improving the lives of people with diabetes. A new three-compartmental model of glucose-insulin interaction for AP is presented and tested in this paper. The glucose and insulin "spaces" are split into a plasma compartment and interstitial fluids compartment, respectively. The model includes an additional subcutaneous compartment and provides three explicit delays and three parameters influencing the regulatory system and correlating with the physiopathology of the patients. Two delays are related with hepatic glucose production and insulin secretion; the third delay represents the lag time in the absorption of exogenous insulin in subcutaneous tissue. The parameters regulate the system dynamics acting on the glucose utilization and the insulin secretion. The clinical data (including information on food ingestion and exogenous insulin injection) from five case studies of Type 1 diabetics are presented and used to validate the mathematical model. After training the parameters for each case study, the model well simulates the glucose level during a 4-day test. The estimated values are physiologically meaningful and provide a further insight on the subject's dysfunctions and on the state of the disease. The results have been also compared with a parallel simulation carried out by implementing a previous two-compartmental model. The proposed algorithm produces a lower sum of the squared error between the simulated and the measured glucose concentrations over time., (© 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

The quantitative detection of biomarkers in protein‐rich samples using fluorescent probes is usually hampered by nonspecific fluorescence as a result of nonspecific probe–protein interactions. In this paper, we report a biotinylated fluorescent probe that is encapsulated in avidin protein, which can generate very specific fluorescence in blood serum by blocking out nonspecific dye–protein interactions. This approach was applied successfully to quantify glucose concentrations in blood serum. A biotinylated fluorescent probe that is encapsulated in avidin protein generates very specific fluorescence in blood serum by blocking out nonspecific dye–protein interactions. [ABSTRACT FROM AUTHOR]

Aims: Although there are reports that β-adrenoceptor antagonists (beta-blockers) and diuretics can affect glycaemic control in people with diabetes mellitus, there is no clear information on how blood glucose concentrations may change and by how much. We report results from a systematic review to quantify the effects of these antihypertensive drugs on glycaemic control in adults with established diabetes., Methods: We systematically reviewed the literature to identify randomized controlled trials in which glycaemic control was studied in adults with diabetes taking either beta-blockers or diuretics. We combined data on HbA1c and fasting blood glucose using fixed effects meta-analysis., Results: From 3864 papers retrieved, we found 10 studies of beta-blockers and 12 studies of diuretics to include in the meta-analysis. One study included both comparisons, totalling 21 included reports. Beta-blockers increased fasting blood glucose concentrations by 0.64 mmol l(-1) (95% CI 0.24, 1.03) and diuretics by 0.77 mmol l(-1) (95% CI 0.14, 1.39) compared with placebo. Effect sizes were largest in trials of non-selective beta-blockers (1.33, 95% CI 0.72, 1.95) and thiazide diuretics (1.69, 95% CI 0.60, 2.69). Beta-blockers increased HbA1c concentrations by 0.75% (95% CI 0.30, 1.20) and diuretics by 0.24% (95% CI -0.17, 0.65) compared with placebo. There was no significant difference in the number of hypoglycaemic events between beta-blockers and placebo in three trials., Conclusions: Randomized trials suggest that thiazide diuretics and non-selective beta-blockers increase fasting blood glucose and HbA1c concentrations in patients with diabetes by moderate amounts. These data will inform prescribing and monitoring of beta-blockers and diuretics in patients with diabetes., (© 2014 The British Pharmacological Society.)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders associated with a high risk of diabetes, atherosclerosis, and cardiovascular disease. The purpose of this study was to determine the effect of sumac powder on clinical symptoms and laboratory parameters in women with PCOS. The double‐blind randomized controlled clinical trial was conducted on 88 women with PCOS randomly assigned to the intervention and control groups. The intervention group received three capsules each containing 1 g of sumac powder for 12 weeks. All data and serum levels of sex hormone, hs‐CRP, glucose, and lipid profiles were measured at the baseline and at the end of the study. Data were analyzed using SPSS version 25 software. The ANCOVA test results showed that hs‐CRP level was significantly reduced in the intervention group (p =.008). Blood glucose and lipid profiles in the intervention group were significantly reduced compared to the placebo group (p <.05). Insulin sensitivity and HDL levels were increased significantly in the Sumac group after the intervention (p <.05). Sumac powder can reduce the inflammatory effects, and glycemic status and lipid profile of polycystic ovaries in affected women, but has no significant effect on anthropometric parameters and sex hormones. [ABSTRACT FROM AUTHOR]

Saffron and fenugreek have been shown to have an effect on lowering blood glucose; therefore, this study aims to evaluate the effects of using saffron and fenugreek on blood glucose control. PubMed, Cochrane Library, Scopus, and Web of Science databases were searched for relevant articles. Articles on the use of saffron or fenugreek to control blood glucose were selected in compliance with PRISMA guidelines. R software was used for statistical analysis. The mean difference (MD) and the standardized MD (SMD) were adopted, and subgroup analyses were performed according to patient's clinical condition. Nineteen studies comprised this meta‐analysis. Overall, using fenugreek decreased fasting blood glucose (FBG) (SMD: −0.90; 95%CI: −1.43 to −0.38; I2 = 87%; p < 0.001), postprandial blood glucose (PPBG) (SMD: −1.13; 95%CI: −1.99 to −0.28; I2 = 94%; p < 0.001), and glycated hemoglobin (HbA1c) (SMD: −0.43; 95%CI: −0.75 to −0.12; I2 = 20%; p = 0.29). Saffron supplementation reduced FBG (MD: −9.06 mg/dl; 95%CI: −16.25 to −1.86; I2 = 40%; p = 0.12) and HbA1c (MD: −0.19%; 95%CI: −0.23 to −0.14; I2 = 0%; p > 0.99). Our results show that using saffron and fenugreek can reduce FBG, PPBG, and HbA1c; however, there are some shortcomings that require attention for these results. Further high‐quality studies should be conducted to establish the clinical efficacy of herbal medicines. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether co‐ingestion of dietary protein with, or before, carbohydrate may be a useful strategy to reduce postprandial hyperglycaemia in older men with type 2 diabetes (T2D). Materials and Methods: Blood glucose, plasma insulin and glucagon concentrations were measured for 180 minutes following ingestion of a drink containing 30 g of glucose (G; 120 kcal), 30 g of whey protein (120 kcal), 30 g of glucose plus 30 g of whey protein (GP; 240 kcal), or control (~2 kcal) in older men with T2D (n = 10, 77 ± 1 years; 31 ± 1.7 kg/m2) and without T2D (n = 10, 78 ± 2 years; 27 ± 1.4 kg/m2). Mixed model analysis was used. Results: GP versus G markedly reduced the increase in blood glucose concentrations (P <.001) and had a synergistic effect on the increase in insulin concentrations (P <.001), in men both with and without T2D. Glucose concentrations were higher in men with T2D compared with those without T2D, whereas insulin and glucagon concentrations were largely unaffected by the presence of T2D. Gastric emptying was faster in men with T2D than in those without T2D. Conclusions: The ability of whey protein to reduce carbohydrate‐induced, postprandial hyperglycaemia is retained in older men with T2D compared with those without T2D, and whey protein supplementation may be a useful strategy in the prevention and management of T2D in older people. [ABSTRACT FROM AUTHOR]

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BACKGROUND: In this study, the duration of high‐pressure processing (HPP) required to achieve a 5 log reduction of Escherichia coli O157:H7 in fruit purees was evaluated. Banana, cantaloupe, and dragon fruit purees were subjected to HPP at 600 MPa for 300, 270, and 270 s, respectively, and their physicochemical properties and enzyme activities were then analysed. Diabetic mice were fed fresh and HPP‐treated purees to observe their effects on the glycemic index (GI) and postprandial blood glucose response. RESULTS: Compared with their fresh counterparts, the HPP‐treated banana and dragon fruit purees exhibited significantly higher viscosities, lower glucose concentrations, and higher glucose dialysis retardation indices and showed disrupted sucrose invertase and polygalacturonase activities. The GI and postprandial blood glucose response were not significantly different between the fresh and HPP‐treated cantaloupe purees. By contrast, the peak time of glucose response (Tmax) was delayed from 30 min to 60 min, and the area under the receiver operating characteristic curve was reduced by 40% in the mice fed HPP‐treated banana and dragon fruit purees. The GIs of the HPP‐treated banana and dragon fruit purees (were 50.3 and 44.8, respectively) were significantly lower than those of their fresh counterparts (85.1 and 75.2, respectively). CONCLUSION: HPP can change the physicochemical properties of fruit purees, resulting in stabilized blood glucose levels and lower GIs after consumption. Therefore, purees processed in this manner would benefit consumers and patients with diabetes/pre‐diabetes who need to maintain stable blood glucose levels (Fig. S1). © 2022 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Aims: Elevated fasting blood glucose in gestational diabetes (GDM) is a key predictor of high birthweight babies and adverse pregnancy outcomes but is hard to treat. We implemented a simple, patient‐led, insulin dose titration algorithm aiming to improve fasting glycaemic control in GDM. Methods: In women with GDM, initiating basal insulin, we recommended a daily four‐unit dose increase after every fasting glucose value ≥5.0 mmol/mol (90 mg/dl). This approach augmented our pre‐existing intensive (weekly) specialist nursing input. Using a before‐and‐after retrospective observational study design, we examined insulin doses and glucose values at 36 weeks gestation and maternal and neonatal outcomes in 105 women completing pregnancy before and 93 women after the intervention. Results: The baseline characteristics of women in the before and after groups were the same. Women initiated on insulin after implementation (n = 30 before, n = 43 after) achieved substantially higher doses at 36 weeks (53 vs. 36 units/day; 0.56 vs. 0.37 units/kg/day; p = 0.027). 36‐week mean fasting glucose was lower in those on insulin after implementation (4.6 vs. 5.1 mmol/L [83 vs. 92 mg/dl]; p = 0.031). Birthweight was significantly reduced (birthweight Z‐scores 0.34 vs. 0.92; p = 0.005). There was no significant difference in macrosomia (after; 2% vs. before; 17% p = 0.078) or caesarean sections (after; 33% vs. before; 47%; p = 0.116). No women experienced severe hypoglycaemia. There were no outcome differences before versus after intervention in women not treated with insulin. Conclusions: Patient‐led daily insulin titration in gestational diabetes leads to higher insulin dose use lower fasting glucose and is associated with lower birthweight without causing significant hypoglycaemia. [ABSTRACT FROM AUTHOR]

Background: No previous studies have quantified tear glucose (TG) levels in dogs or compared changes in TG and blood glucose (BG) concentrations. Objective: To quantify TG concentration and evaluate its correlation with BG level in dogs. Methods: Twenty repetitive tests were performed in alternate eyes of four dogs, with a minimum washout period of 1 week. Tears and blood were collected at 30‐min intervals with successive glucose injections (1 g/kg) every 30 min. Cross‐correlations of BG and TG levels were assessed. The delay and association between TG and corresponding BG levels were analysed for each dog; samples were collected at 5‐min intervals. The tears were collected using microcapillary tubes. Collected tears and blood were analysed for glucose concentration using a colorimetric assay and commercially available glucometer, respectively. Results: The average baseline BG and TG levels were 4.76 ± 0.58 and 0.39 ± 0.04 mmol/L, respectively. Even with highly fluctuating BG levels, a significant cross‐correlation coefficient (r = 0.86, p < 0.05) was observed between changes of BG and TG levels. The delay time between BG and TG levels was 10 min. On average, BG levels were 16.34 times higher than TG levels. There was strong correlation between BG and TG levels (rs = 0.80, p < 0.01). Significant differences in TG concentrations between normoglycaemia, mild hyperglycaemia, and severe hyperglycaemia were found (p < 0.05). Conclusions: Canine TG concentrations have not been quantified previously. Our findings suggest preliminary data for future research on TG levels in dogs and show TG measurement could be used to screen for diabetes mellitus in dogs. [ABSTRACT FROM AUTHOR]

Aim: We observed wide variation in the management of babies at risk of hypoglycaemia who participated in the hPOD (hypoglycaemia Prevention with Oral Dextrose gel) multicentre trial of prophylactic dextrose gel. The aim of this study was to identify whether this may be due to variations in the clinical guidelines used by participating hospitals.Methods: Guidelines for management of neonatal hypoglycaemia used by participating hospitals were reviewed. Recommendations regarding definition, risk factors, monitoring and treatment were compared between countries, hospital type (tertiary or secondary) and neonatal intensive care unit size (≤12 cots and >12 cots).Results: The 18 hospitals used 20 guidelines. The recommended diagnostic threshold for hypoglycaemia ranged from <2.0 mmol/L to <2.6 mmol/L, and glucose oxidase method of testing was recommended in seven (47%) of 15 guidelines. There was broad agreement about which infants should be monitored. Oral dextrose was the recommended first line of treatment in 17 of 20 guidelines, but the glucose threshold at which this should be used varied (≤2.6 mmol/L in New Zealand, 1.5-2.6 mmol/L in Australia). Re-checking blood glucose concentrations after oral dextrose was recommended at 30 min in most (10/11, 91%) New Zealand guidelines but at 60 min in most (4/6, 67%) Australian guidelines. There was greatest variation in recommended thresholds for referral to paediatric services or neonatal intensive care unit, and administration of intravenous dextrose. There were no significant differences between guidelines used by tertiary and secondary hospitals, or large and small hospitals.Conclusion: There is wide variation in guideline recommendations for the management of neonatal hypoglycaemia across New Zealand and Australian neonatal units. [ABSTRACT FROM AUTHOR]

Aim: In‐hospital blood glucose testing is commonplace, particularly in acute care. In‐hospital screening for hyperglycaemia may present a valuable opportunity for early diabetes diagnosis by identifying at‐risk individuals. This systematic review investigates the extent to which random blood glucose testing in acute and inpatient hospital settings predicts undiagnosed diabetes. Methods: Two databases were systematically searched for studies in which adult patients received an in‐hospital random blood glucose test, followed by a diagnostic HbA1c test. The primary outcome was the proportion of hyperglycaemic individuals diagnosed with diabetes by HbA1c. Results: A total of 3245 unique citations were identified, and 12 were eligible for inclusion. Ten different blood glucose thresholds, ranging from 5.5 to 11.1 mmol/L, were used to detect hyperglycaemia, indicating that there is no consistent clinical definition for hyperglycaemia. The proportion of participants with hyperglycaemia in each study ranged from 3.3% to 62.1%, with a median (Q1, Q3) of 34.5% (5.95%, 61.1%). The proportion of hyperglycaemic participants found to have a diabetes‐range HbA1c varied from 4.1% to 90%, with a median (Q1, Q3) of 18.9% (11.5%, 61.1%). Meta‐analysis was not possible due to substantial heterogeneity between study protocols. Conclusions: All studies consistently identified a proportion of hyperglycaemic hospital patients as having a diabetes‐range HbA1c, showing that in‐hospital blood glucose screening can facilitate diabetes diagnosis. The proportion of hyperglycaemic participants with undiagnosed diabetes varied substantially, indicating a need for further research and consistency in defining in‐hospital hyperglycaemia. This may aid the development of a standardised screening protocol to identify people with possible undiagnosed diabetes. [ABSTRACT FROM AUTHOR]

The medical applications of glucagon‐like peptide‐1 receptor (GLP‐1R) agonists is evergrowing in scope, highlighting the urgent need for a comprehensive understanding of the mechanisms through which GLP‐1R activation impacts physiology and behaviour. A new area of research aims to elucidate the role GLP‐1R signalling in glia, which play a role in regulating energy balance, glycemic control, neuroinflammation and oxidative stress. Once controversial, existing evidence now suggests that subsets of glia (e.g. microglia, tanycytes and astrocytes) and infiltrating macrophages express GLP‐1Rs. In this review, we discuss the implications of these findings, with particular focus on the effectiveness of both clinically available and novel GLP‐1R agonists for treating metabolic and neurodegenerative diseases, enhancing cognition and combating substance abuse. LINKED ARTICLES: This article is part of a themed issue on GLP1 receptor ligands (BJP 75th Anniversary). To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.4/issuetoc [ABSTRACT FROM AUTHOR]

We aimed to conduct a systematic review and meta‐analysis of randomized controlled trials (RCTs) to examine the effect of cumin supplementation on markers of glycemic control in adults. A comprehensive literature search was conducted up from inception to November 2020 on PubMed, Scopus, Web of Sciences, and Cochrane electronic databases. Studies that compared the effect of cumin with placebo on fasting blood sugar (FBS), serum insulin, and homeostasis model assessment‐estimated insulin resistance (HOMA‐IR) index in adults were considered eligible. Weighted mean difference (WMD) (with 95% confidence intervals) for endpoints were calculated using the random‐effects model. Finally, a total of eight RCT studies involving 552 participants were included in the review. The results of the meta‐analysis suggest that cumin supplementation did not significantly alter serum FBS (WMD: −17.77 mg/dl; 95% CI: −36.42 to 0.87, p =.06), insulin (WMD: −0.49 Hedges' g; 95% CI: −1.19 to 0.21, p =.16) levels and HOMA‐IR (WMD: ‐0.06; 95% CI: −0.21 to 0.10, p = 0.48) index. These results do not support the use of cumin supplementation for improving glycemic markers in adults. However, further high‐quality trials are still needed to confirm these results. [ABSTRACT FROM AUTHOR]

Inulin‐type fructan (ITF) intake has been suggested to alleviate several features of metabolic syndrome including obesity, diabetes, and hyperlipidemia; yet, results from the human trials remained inconsistent. We aimed to systematically evaluate the effects of ITF intake on body weight, glucose homeostasis, and lipid profile on human subjects with different health status, including healthy, overweight and obese, prediabetes and diabetes, and hyperlipidemia. Weighted mean differences (WMDs) between ITF and control groups were calculated by a random‐effects model. A total of 33 randomized controlled human trials were included. Significant effect of ITF intake was only observed in the diabetics, but not in the other subject groups. Specifically, ITF intervention significantly decreased the WMD of blood glucose (−0.42 mmol/L; 95% CI: −0.71, −0.14; p =.004), total cholesterol (−0.46 mmol/L; 95% CI: −0.75, −0.17; p =.002), and triglycerides (TAG) (−0.21 mmol/L; 95% CI: −0.37, −0.05; p =.01) compared with the control. The stability of these favorable effects of ITF on diabetics was confirmed by sensitivity analysis. Also, ITF tends to lower LDL cholesterol (p =.084). But body weight and blood insulin were not affected by ITF intake. It should be noted that blood glucose, total cholesterol, and LDL cholesterol exhibited high unexplained heterogeneity. In conclusion, ITF intake lowers blood glucose, total cholesterol, and TAG in the people with diabetes, and they may benefit from addition of inulin into their diets, but the underlying mechanisms responsible for these effects are inconclusive. [ABSTRACT FROM AUTHOR]

Acute phase hyperglycemia and exaggerated glucose fluctuation may be associated with poor outcomes in diabetic patients after acute myocardial infarction (AMI). This study aimed to determine whether intervention by clinical pharmacists can mitigate blood glucose and glucose fluctuations in these fragile patients. This retrospective study enrolled patients with diabetes and AMI, from 1 January 2019 to 30 June 2020 in our institution. Blood glucose and glucose fluctuations were calculated before and after the pharmacist's intervention and between patients who underwent intervention and those who did not. Propensity score matching (PSM) was used to reduce the impact of patient characteristics on the results. A total of 170 patients were included in our primary analysis, including 29 patients who received the pharmacist intervention and 141 patients who did not. After the pharmacist's intervention, blood glucose (fasting blood glucose-FBG, from 11.9 to 9.8; postprandial blood glucose-PBG, from 15.3 to 13.2; mean blood glucose-BG, 14.5 to 12.3 mmol/L; p < .001), and glucose fluctuations (standard deviation of blood glucose-SDBG, from 3.8 to 3.0, mmol/L, p = .005) were significantly improved. Before PSM, no clear effects were found in intervention versus nonintervention patients, in terms of blood glucose and glucose fluctuation indicators, except for FBG (9.3 vs. 8.0. mmol/L, p = .005). Further analysis indicated a high incidence of FBG <7.8 mmol/L in nonintervention versus intervention patients (51.5% vs. 27.6%, p = .003). After PSM, a significant reduction in blood glucose fluctuation (SDBG, 3.0 vs. 4.1, p = .031; PBGE, 2.1 vs. 4.1, p = .017; LAGE, 4.7 vs. 7.2, mmol/L, p = .004), and PBG (11.1 vs. 13.0, mmol/L, p = .048) was observed in the intervention group than in the nonintervention group. The clinical pharmacist intervention contributed to improved outcomes, specifically, in reducing blood glucose fluctuations and potential hypoglycemia risk. [ABSTRACT FROM AUTHOR]

It is widely recognized that hypertension is one of the major risk factor for disease severity and mortality in patients with coronavirus disease 2019 (COVID‐19). However, type 2 diabetes mellitus (T2DM) and hypertension are frequent comorbid conditions, complicating the assessment of hypertension's individual contribution to the risk. The aims of this study were to evaluate the contributions of hypertension alone, T2DM alone, or their combination to the risk of death, acute respiratory distress syndrome (ARDS)/respiratory failure, and severe COVID‐19 infection. Additionally, we assessed risks associated with elevated blood pressure and fasting blood glucose on the same three clinical outcomes. Multivariate logistic models were used for these analyses. Among the 3400 patients, 3327(97.9%) survived and 73(2.1%) died. Compared to patients having neither hypertension nor T2DM (n = 1392), the risk of mortality was significantly higher in patients with T2DM alone (n = 226, OR 5.26 [95% CI: 2.39–11.58]) or with T2DM in combination with hypertension (n = 507, OR 3.02, [95% CI: 1.48–6.15]). Similarly, T2DM was a risk factor for development of ARDS/respiratory failure and severe infection. Hypertension alone (n = 1275) only conferred additional risk for the development of severe infection (OR 1.22 [95% CI: 1.00–1.51]). In conclusion, neither hypertension nor elevated blood pressure was independent risk factors for death or ARDS/respiratory failure but hypertension marginally increased the risk of severe COVID‐19 infection. The risk associated with hypertension is accentuated through its confounding effect on T2DM. [ABSTRACT FROM AUTHOR]

Aims: To estimate the relative treatment effect between the fixed-ratio combinations iGlarLixi and IDegLira (glucagon-like peptide 1 receptor agonist with basal insulin) in people with type 2 diabetes inadequately controlled on a glucagon-like peptide 1 receptor agonist. Materials and Methods: A systematic literature review of randomized controlled trials followed by an indirect treatment comparison was performed to compare the efficacy and safety of the available fixed-ratio combinations. Main outcomes were glycated haemoglobin (HbA1c) change and target achievement [<6.5% and <7.0% (<48 and <53 mmol/mol)], fasting plasma glucose, self-monitored plasma glucose, body weight, and incidence and rate of hypoglycaemia. Results: From 4850 abstracts screened, 78 qualified for full-text article review and two randomized controlled trials were included. Baseline characteristics were similar in the two studies. The mean difference at 26 weeks between IDegLira and iGlarLixi was -0.36 (95% credible intervals -0.58, -0.14) % [-3.9 (-6.3, -1.5) mmol/mol] for HbA1c and -1.0 (-1.6, -0.4) mmol/L for fasting plasma glucose. No significant differences were found in HbA1c target attainment, preprandial or postprandial selfmonitored plasma glucose, or body weight change. Formal comparisons of hypoglycaemia were limited by differences in definitions between the studies: in non-sulphonylurea users, incidence was 28% for IDegLira ('confirmed' at ≤3.1 mmol/ L); for iGlarLixi, incidence was 9% ('documented symptomatic' at <3.0 mmol/L). Conclusions: Results of this indirect treatment comparison using two studies suggest iGlarLixi and IDegLira appear to offer similar benefits for HbA1c target achievement. However, the findings suggest differences in other glycaemia results and hypoglycaemia, which may reflect differences in study design and titration approaches. [ABSTRACT FROM AUTHOR]

Studies regarding the influence of green coffee extract (GCE) on blood glucose levels are conflicting. Thus, we sought to conduct a meta-analysis and systematic review of all available randomized controlled trials (RCTs) to quantify the effects of GCE and CGA intervention on blood glucose and insulin levels. We performed systematic online searches in Scopus, Web of science, and PubMed databases, from inception to July 2019. Data were combined analyzed using a random effects model (Der Simonian-Laird method) and reported as weighted mean differences (WMD). Ten trials reported the influences of GCE on FBS and insulin and were subsequently entered into the meta-analysis. Combined results highlighted that FBS was significantly altered after GCE consumption (WMD: -1.791 mg/dl, 95% CI -3.404, -0.177), with no significant heterogeneity among the studies (I2 = 35.0%, p = .128). However, overall results demonstrated that GCE administration did not result in any significant alteration in insulin levels (WMD: -0.925 μU/ml, 95% CI:-1.915, 0.064), with significant heterogeneity found across studies (I2 = 87.9%). In sub-group analysis, insulin levels were significantly reduced when GCE was supplemented in dosages of ≥400 mg/day (WMD:-1.942 mg/dl, 95% CI:-1.184, -0.975; I2 = 0.0%). The results of present study support the use of GCE for the enhancement of blood glucose, while subgroup analysis highlighted significant improvements in insulin levels when GCE is supplemented in doses ≥400 mg/day. [ABSTRACT FROM AUTHOR]

This study elaborates on the design of artificial pancreas using model predictive control algorithm for a comprehensive physiological model such as the Sorensen model, which regulates the blood glucose and can have a longer control time in normal glycaemic region. The main objective of the proposed algorithm is to eliminate the risk of hyper and hypoglycaemia and have a precise infusion of hormones: insulin and glucagon. A single model predictive controller is developed to control the bihormones, insulin, and glucagon for such a development unmeasured disturbance is considered for a random time. The simulation result for the proposed algorithm performed good regulation lowering the hypoglycaemia risk and maintaining the glucose level within the normal glycaemic range. To validate the performance of the tracking of output and setpoint, average tracking error is used and 4.4 mg/dl results are obtained while compared with standard value (14.3 mg/dl). [ABSTRACT FROM AUTHOR]

Summary: Background: Non‐alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood. Objectives: The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases. Methods: Data from the observational multicentre (n = 51), cross‐sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines. Results: The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0–12.8) and 1.4% (95% CI: 1.1–1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI‐SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1–15.4) in the mild, 21.9% (95% CI: 18.8–25.1) in the advanced group, 10.7% (95% CI: 9.4–11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17–1.72, 2.26‐fold; (1.78–2.86), respectively], the advanced group also for T2DM [2.39 (1.36–4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%). Conclusions: Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM. [ABSTRACT FROM AUTHOR]

Maintaining glycemic control in diabetes and prediabetes is necessary to prevent many health complications and mortality. Although different hypoglycemic drugs are used for this purpose, there is still a growing interest in the use of medicinal plants due to their low price, easy availability, and fewer or no side effects. Moringa (Moringa oleifera Lam.) is a medicinal plant that has been traditionally used in the management of diabetes. This review aims to present the existing literature published until February 2019 on the role of moringa leaves in glycemia and their physiological mechanisms. In the conducted studies, moringa leaves have shown to reduce glycemia, without causing any adverse effects. The proposed mechanisms for reducing glycemia include inhibition of α-amylase and α-glucosidase activities, increased glucose uptake in the muscles and liver, inhibition of glucose uptake from the intestine, decreased gluconeogenesis in the liver, and increased insulin secretion and sensitivity. However, these studies are limited in numbers and mostly conducted in animals, in vitro and in vivo. Therefore, long-term human studies are required to determine the hypoglycemic effect of moringa leaves, their physiological mechanisms, active ingredients, and safety. Overall, this review provides evidence that moringa leaves have the possibility to be used as a glycemic control agent in diabetes and prediabetes. [ABSTRACT FROM AUTHOR]

Aim: This systematic review aimed to evaluate the impact of diabetes mellitus on clinical outcomes of non‐surgical periodontal therapy. Materials and Methods: Searches were conducted in electronic databases to screen studies published from January 1960 to August 2018. The included studies had at least two groups of patients: chronic periodontitis only (P) or both diabetes and chronic periodontitis (DMP). Outcomes of interest included the difference between the two groups in probing depth (PD) reduction and clinical attachment level (CAL) gain following non‐surgical periodontal therapy. Meta‐regression was conducted to evaluate the correlation between the outcomes of interest and contributing factors. Results: A total of 12 studies with a follow‐up period up to 6 months were included. There was no significant difference in PD reduction (p = 0.55) or CAL gain (p = 0.65) between the two groups. A positive association between PD reduction and baseline PD difference (p = 0.03), and a negative association between PD reduction and age (p = 0.04) were found. The level of HbA1c at baseline did not significantly affect the difference in PD reduction (p = 0.39) or CAL gain (p = 0.44) between two groups. Conclusions: Recognizing the study's limitations, we conclude that diabetes mellitus (HbA1c ≤ 8.5%) does not appear to significantly affect short‐term clinical periodontal outcomes of non‐surgical periodontal treatment. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Diabetes is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Gestational diabetes mellitus (GDM) is an increasingly prevalent disorder, associated with low blood vitamin D level.Objectives: To evaluate the relationship between vitamin D and GDM.Search Strategy: EMBASE, MEDLINE, Cochrane Library and China Biology Medicine disc were searched up to May 2017. The references of previous studies were screened.Selection Criteria: Observational studies on the relationship between vitamin D and GDM free from Hawthorne effect and randomised controlled trials of vitamin D supplementation during pregnancy for preventing or treating GDM were included.Data Collection and Analysis: Data and information of included articles were extracted by duplicate using piloted tables. Newcastle-Ottawa Scale and Cochrane Handbook were used for quality assessment. Random-effects models were used for meta-analyses. Heterogeneity tests, sensitivity analysis and analysis of publication bias were conducted.Main Results: Eighty-seven observational studies and 25 randomised controlled trials involving 55 859 and 2445 women, respectively, were included. Low blood vitamin D level during pregnancy was associated with a higher risk of GDM (OR 1.850, 95% CI 1.471-2.328). Blood vitamin D level for women with GDM were lower than in the control women. Blood vitamin D level was associated with fasting plasma glucose (FPG) and homeostasis model of assessment for insulin resistance index (HOMA-IR) (r = -0.100 and r = -0.351), whereas the correlation between blood vitamin D level and fasting insulin (FINS) might be concealed by publication bias. Vitamin D intervention during pregnancy could change the blood levels of vitamin D, FINS, FPG, HOMA-IR, glutathione, C-reactive protein and lipid.Conclusions: Low blood vitamin D level could increase the risk of GDM, and vitamin D supplementation during pregnancy could ameliorate the condition of GDM.Tweetable Abstract: Low blood vitamin D increases gestational diabetes mellitus (GDM) risk. Vitamin D supplementation ameliorates GDM condition. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Diabetes is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Our previous studies have raised the possibility that altered blood glucose levels may influence and/or be predictive of methamphetamine ( METH) neurotoxicity. This study evaluated the effects of exogenous glucose and corticosterone ( CORT) pretreatment alone or in combination with METH on blood glucose levels and the neural and vascular toxicity produced. METH exposure consisted of four sequential injections of 5, 7.5, 10, and 10 mg/kg (2 h between injections) D- METH. The three groups given METH in combination with saline, glucose ( METH+Glucose), or CORT ( METH+ CORT) had significantly higher glucose levels compared to the corresponding treatment groups without METH except at 3 h after the last injection. At this last time point, the METH and METH+Glucose groups had lower levels than the non- METH groups, while the METH+ CORT group did not. CORT alone or glucose alone did not significantly increase blood glucose. Mortality rates for the METH+ CORT (40%) and METH+Glucose (44%) groups were substantially higher than the METH (< 10%) group. Additionally, METH+ CORT significantly increased neurodegeneration above the other three METH treatment groups (≈ 2.5-fold in the parietal cortex). Thus, maintaining elevated levels of glucose during METH exposure increases lethality and may exacerbate neurodegeneration. Neuroinflammation, specifically microglial activation, was associated with degenerating neurons in the parietal cortex and thalamus after METH exposure. The activated microglia in the parietal cortex were surrounding vasculature in most cases and the extent of microglial activation was exacerbated by CORT pretreatment. Our findings show that acute CORT exposure and elevated blood glucose levels can exacerbate METH-induced vascular damage, neuroinflammation, neurodegeneration and lethality. [ABSTRACT FROM AUTHOR]

In this article, two adaptive model predictive controllers (AMPC) are applied to regulate the blood glucose in type 1 diabetic patients. The first controller is constructed based on a linear model, while the second one is designed by using a nonlinear Hammerstein model. The adaptive version of these control schemes is considered to make them more robust against model mismatches and external disturbances. The least squares method with forgetting factor is used to update the model parameters. For simulation study, two wellknown mathematical models namely, Puckett and Hovorka which describe the dynamical behavior of patient's body have been selected. The performances and robustness of the proposed controllers are tested for regulating the blood glucose of diabetic patients in presences of model mismatches and measurement noises. Simulation results indicate that the non-linear model predictive controller (NMPC) outperforms the linear one. To improve the performance of the NMPC in rejecting the meal disturbances, two different feedforward control strategies have been considered. Simulation results indicate that the combined adaptive NMPC with feedforward controller has a better performance over the other considered control schemes. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to assist individuals with type 2 diabetes (T2D) better manage blood glucose control using food. Given that white rice is a commonly consumed staple food for Asian cultures, the aim of this study was to develop a nutritious and easy‐to‐prepare alternative meal using culturally tailored ingredients. Methods: A ‘rice mix’ comprising 60% white rice and 40% a mix of legumes, nuts and seeds was developed. Eighty‐one participants of Asian ethnicity and with T2D were screened with 13 subjects randomised and given the rice mix or white rice (control) as an evening meal. Blood glucose responses were compared between meals and to the American Diabetes Association guidelines together with responses to satiety and desire‐to‐eat questions. Results: Over a 3‐hour period following consumption, blood glucose concentrations were 21% (95% CI: 6, 36) lower for the rice mix compared with white rice (P < 0.001). The mean length of time that blood glucose exceeded 10 mmol/L was 30 minutes (95% CI: 6, 54) less; and the maximum glycaemic increment above 10 mmol/L was 1.4 mmol/L (95% CI: 0.3, 2.5) less; for the rice mix compared with the white rice. There was no effect on appetite as satiety was not different between meals, although there was a lesser desire to eat fatty foods after consuming the rice mix (P = 0.02). Conclusions: The rice mix as an alternative to white rice could be a practical self‐help approach to improve blood glucose control in people with T2D. Using education and culturally tailored ingredients may help overcome barriers to dietary change. [ABSTRACT FROM AUTHOR]

BACKGROUND Sorghum, a small-seeded grass, is an important food crop and chief energy source for the people of semi-arid regions of the world. In India, sorghum production/consumption decreased after the 'green revolution', but it is now regaining momentum owing to numerous health and nutritional benefits. An understanding of the glycaemic index (GI) and glycaemic load (GL) of staples can help in choosing suitable foods for the prevention and control of diabetes. In view of this, the present study was undertaken to evaluate the GI and GL of different sorghum foods and compare them with those of wheat/rice based foods. RESULTS The GI of sorghum-based foods such as coarse semolina upma ( P < 0.05), fine semolina upma ( P < 0.01), flakes poha ( P < 0.01) and pasta ( P < 0.01) was significantly lower than that of their respective control (wheat/rice-based) foods. All sorghum-based foods showed significantly lower GL ( P < 0.01) than their respective control (wheat/rice-based) foods. CONCLUSION A few sorghum-based products have low GI (<55; coarse semolina upma, fine semolina upma, flakes poha and pasta) and all sorghum-based products (with the exception of sorghum roti) tested in the present study have lower GL than their respective wheat/rice-based foods. Consumption of low-GI and low-GL sorghum-based foods may help in decreasing postprandial blood glucose levels. © 2014 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

Background Psychosocial job factors (PJF) have been implicated in the development of cardiovascular disease. The paucity of data from developing economies including Mexico hampers the development of worksite intervention efforts in those regions. Methods This cross-sectional study of 2,330 Mexican workers assessed PJF (job strain [JS], social support [SS], and job insecurity [JI]) and biological cardiovascular disease risk factors [CVDRF] by questionnaire and on-site physical examinations. Alternative formulations of the JS scales were developed based on factor analysis and literature review. Associations between both traditional and alternative job factor scales with CVDRF were examined in multiple regression models, adjusting for physical workload, and socio-demographic factors. Results Alternative formulations of the job demand and control scales resulted in substantial changes in effect sizes or statistical significance when compared with the original scales. JS and JI showed hypothesized associations with most CVDRF, but they were inversely associated with diastolic blood pressure and some adiposity measures. SS was mainly protective against CVDRF. Conclusion Among Mexican workers, alternative PJF scales predicted health outcomes better than traditional scales, and psychosocial stressors were associated with most CVDRF. Am. J. Ind. Med. 58:331-351, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Diabetes is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objectives of this study were to compare glucometer experience and attitudes toward counseling, monitoring, and screening for diabetes between two classes of graduating students at one dental school to determine if there were differences by experience and year of graduation. Dental students graduating in 2010 and 2013 completed a survey about their experience with use of a glucometer as well as their attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling. Response rates for the two classes were 100 percent and 95.7 percent, respectively. Students in the two classes were in general agreement that activities related to glucose monitoring and counseling of patients with diabetes are within the scope and responsibility of the dental profession. Examination of their attitudes toward diabetes monitoring and counseling activities by level of glucometer experience indicated that students with more experience using a glucometer were more likely to consider these activities to be within the scope of dental practice and less likely to perceive barriers to such activities compared to those with little or no experience. In addition, regardless of experience, there was significantly higher endorsement for monitoring of patients who had already been diagnosed than for screening of patients who had not been diagnosed. This study suggests that any strategy to encourage dental students' and dentists' involvement in nontraditional health promotion activities should include ample direct clinical experience with these activities. [ABSTRACT FROM AUTHOR]

Hepatitis C is the leading indication for liver transplantation in the USA and recurrence is universal. The impact of preexisting diabetes, new-onset diabetes after transplant (NODAT), and glycemic control on fibrosis progression has not been studied. This retrospective longitudinal cohort study included adult liver recipients with hepatitis C transplanted between 2000 and 2011. Patients were divided into three groups: preexisting diabetes (n = 41), NODAT (n = 59), and no diabetes (n = 103). Patients with preexisting diabetes (70%) or NODAT (59%) were more likely to develop hepatitis C recurrence (≥stage 1 fibrosis), as compared to non-diabetics (36%, p = 0.006). There was also a trend toward a higher incidence of at least Stage 2 fibrosis (36% and 48% vs. 23%, respectively; p = 0.063). Patients with tight glycemic control had a lower rate of Stage 2 fibrosis development (78% vs. 60%, p = 0.027), while those with good control (<150 mg/ dL) also had lower rates of Stage 2 fibrosis (84% vs. 62%, p = 0.004). Multivariable analysis verified a decreased rate of recurrence for patients with blood glucose <138 mg/ dL (p = 0.021), after controlling for confounders. These results demonstrate that diabetes is strongly associated with an increased risk of hepatitis C virus-related fibrosis development and glycemic control may reduce the risk and severity of recurrence. [ABSTRACT FROM AUTHOR]

The article presents information on a study on diabetes. It focuses on the association between blood glucose and estimated glomerular filtration rate (eGFR) changes and the risk of chronic kidney disease (CKD) in impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). The study was conducted on random 10028 middle-aged subjects from China.