Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review.

Evidence suggests that low carbohydrate (<130 g/day of carbohydrate) (LCD) and very low carbohydrate, ketogenic diets (typically <50 g/day of carbohydrate) (VLCKD) can be effective tools for managing diabetes given their beneficial effects on weight loss and glycemic control. VLCKD also result in favorable lipid profile changes. However, these beneficial effects can be limited by poor dietary adherence. Cultural, religious, and economic barriers pose unique challenges to achieving nutritional compliance with LCD and VLCKD. We review the various methods for assessing adherence in clinical studies and obstacles posed, as well as potential solutions to these challenges.

Low-Carbohydrate and Very-Low-Carbohydrate Diets in Patients With Diabetes.

Low-carbohydrate diets have been advocated as an effective method for promoting weight loss in overweight and obese individuals and preventing and treating type 2 diabetes. This article reviews the differences between various low-carbohydrate eating plans and discusses the benefits and drawbacks of such a diet based on available evidence. It also offers practical pointers for clinicians.

Hypoglycaemia in hospitalized patients with or without heart failure.

Hospitalized patients with heart failure (HF) undergoing bedside glucose monitoring with subcutaneous insulin orders were retrospectively identified over 2 years. Hypoglycaemia was defined as any glucose value <3.9 mmol/L (70 mg/dL) within 24 hours of admission (Hypo1day ) or throughout the hospitalization (HypoT ) or any glucose value <2.2 mmol/L (40 mg/dL) throughout the hospitalization (HypoSevere ). A total of 13 424 patients were included, of whom 2484 had HF. Patients with HF were more likely to have Hypo1day (9.1% vs 7.0%, P = .0003), HypoT (28% vs 18.5%, P < .0001), or Hypo Severe (3.4% vs 2.1%, P = .0001). After controlling for other variables, the odds of Hypo1day were similar between the HF and non-HF groups (odds ratio [OR] 1.14, 95% CI 0.94-1.39, P = .18, fully adjusted model), slightly lower for HypoT (OR 0.85, 95% CI 0.73-0.99, P = .03, fully adjusted model), and similar for HypoSevere (OR 1.25, 95% CI 0.91-1.70, P = .17). Hypo1day , HypoT and HypoSevere were all associated with increased mortality; there was no evidence of an interaction by HF status. Hypoglycaemia occurred at a similar or lower frequency in hospitalized patients with HF compared to those without HF. Hypoglycaemia was associated with increased hospital mortality, regardless of HF status.

Geographic selection in the small heat shock gene complex differentiating populations of Drosophila pseudoobscura.

Environmental temperature plays a crucial role in determining a species distribution and abundance by affecting individual physiological processes, metabolic activities, and developmental rates. Many studies have identified clinal variation in phenotypes associated with response to environmental stresses, but variation in traits associated with climatic adaptation directly attributed to sequence variation within candidate gene regions has been difficult to identify. Insect heat shock genes are possible agents of thermal tolerance because of their involvement in protein folding, traffic, protection, and renaturation at the cellular level in response to temperature stress. Previously, members of the Drosophila small heat shock protein (sHSP) complex (Hsp23, Hsp26, Hsp27, Hsp67Ba) have been implicated as candidate climatic adaptation genes; therefore, this research examines sequence variation at these genes in 2 distant populations of Drosophila pseudoobscura. Flies from Tempe, AZ (n = 30) and Cheney, WA (n = 17) were used in the study. We identify high differentiation in the heat-shock complex (F(ST) : 0.219**, 0.262*, 0.279***, 0.166 not significant) as compared with neighboring genes and Tajima's D values indicative of balancing selection (Mann-Whitney U = 38, n(1) = 10 n(2) = 4, P < 0.05 two-tailed), both of which are suggestive of such climatic adaptation.