Influence of oral antidiabetic drugs on hyperglycemic response to foods in persons with type 2 diabetes mellitus as assessed by continuous glucose monitoring system: a pilot study.

BACKGROUND: The purpose of this prospective open-label trial was (1) to assess the influence of oral antidiabetic drugs (OAD) on the glycemic index (GI), glucose response curves (GRCs), daily mean plasma glucose (MPG) and (2) to compare the GI of foods in persons with OAD-treated type 2 diabetes mellitus (T2DM) with the respective GI in healthy persons (HP). METHODS: Tested foods containing 50 g of carbohydrates were eaten for breakfast and dinner after 10 and 4 h of fasting, respectively. Glycemic index, GRC, and MPG were obtained using the CGMS System Gold (CGMS). In T2DM patients [n = 16; age (mean +/- standard error) 56.0 +/- 2.25 years], foods were tested four times: tests 1, 2, and 3 were performed within one week in which placebo was introduced on day 2, and test 4 was carried out five weeks after reintroduction of OAD. Glycemic indexes, GRC, and MPG from tests 1, 2, 3, and 4 were compared. In a control group of 20 HP (age 24.4 +/- 0.71 years), the mean GIs were calculated as the mean from 20 subject-related GIs. RESULTS: In T2DM patients, subject-related assessment of GIs, GRC, and MPG distinguished persons with and without OAD effect. Nevertheless, the group-related GIs and the MPG on days 2, 8, and 39 showed no significant difference. There was no significant difference between the GIs in OAD-treated T2DM patients (test 4) versus HP (except in apple baby food). Glucose response curves were significantly larger in T2DM patients (test 4) versus HP. CONCLUSIONS: Determination of GRC and subject-related GI using the CGMS appears to be a potential means for the evaluation of efficacy of OAD treatment. Further studies are underway.

Extended prandial glycemic profiles of foods as assessed using continuous glucose monitoring enhance the power of the 120-minute glycemic index.

BACKGROUND: The glycemic index (GI) is routinely measured 120 minutes after food intake (GI120). The purpose of this prospective open label study was to assess (1) the dynamics of glycemia over the 210 minutes following food consumption and (2) the evolution of GIs based on 120-, 150-, 180-, and 210-minute glycemic profiles. METHOD: Twenty healthy subjects (mean +/- SE; 21.9 +/- 1.39 years of age; body mass index 23.6 +/- 0.63 kg/m(2); 7 men and 13 women) completed the study. Each subject consumed 10 different foods with known GI120 on three separate occasions at four different times of day according to a defined meal plan over a 9-day period; 32 meals were evaluated. The GIs for intervals of 120, 150, 180 and 210 minutes after food consumption were determined using a continuous glucose monitoring system (CGMS) to measure glycemia. The Wilcoxon signed-rank test was applied to compare the GIs. RESULTS: Glycemia returned to baseline within 120 minutes for honey and tomato soup; within 210 minutes for white bread, choco-rice cookies, fish and potatoes, wafers, and meat ravioli with cheese; and later for dark chocolate, apricot dumplings, and choco-wheat cookies. The extended GIs were higher than the respective GI120s in eight of the foods. CONCLUSIONS: The 120-minute glycemic index fails to fully account for changes in glycemia after ingestion of a mixed meal because glycemia remains above baseline for a longer period. The CGMS is a convenient method to determine the glucose response/GIs over intervals extended up to 210 minutes, which is adequate time for the absorption of most foods.

Automated computation of glycemic index for foodstuffs using continuous glucose monitoring.

BACKGROUND: The glycemic index (GI) is a measure of the ability of a food to raise glucose levels after it is eaten. Continuous glucose monitoring (CGM) has been shown to give identical values of GI when compared to traditional methods. However, there has been no standardized protocol for measuring GI that takes into account interindividual variability and chronophysiological glycemic response to food. Our aim was (1) to create and describe software based on a Microsoft Excel 2000 spreadsheet to facilitate rapid, automated, accurate, and standardized processing of data obtained using recent CGM methodology to measure GI and its variability and (2) to assess the benefits of this new approach. METHOD: Twenty healthy subjects consumed 50 grams of glucose or four alternative foodstuffs (chocolate, apple baby food, rice squares, or yogurt) at breakfast and dinner during 1 week, resulting in 300 CGMS glucose profiles; 92% of meal tests were satisfactory for evaluation. Application and functions of the software DegifXL are described. RESULTS: Using the new spreadsheet software DegifXL, time required for data processing for the 15 data sets for each subject was reduced from 2000 to 160 minutes relative to previously used manual methods. We characterized the GI for four foodstuffs with three replicate measurements in each of 20 subjects and evaluated between person, between time period, and between replicate GI variabilities. CONCLUSION: DegifXL, combined with CGM, was an efficient and effective tool for routine measurement of group- and subject-related GI.

Benefits of complementary therapy with insulin aspart versus human regular insulin in persons with type 2 diabetes mellitus.

BACKGROUND: Absorption rates of the phosphate-buffered insulin analogs aspart, lispro, and glulisine prevail over that of regular human insulin. The aim of this prospective observational open-label controlled study was to compare the effects of aspart and human regular insulin resulting from their sequential long-lasting routine administration in small preprandial boluses to individuals with type 2 diabetes according to identical algorithms. METHODS: Fifty-seven individuals with type 2 diabetes 64.0 +/- 1.29 (mean +/- SE) years old with diabetes' duration of 12.4 +/- 1.06 years, treated with human regular insulin for 5.2 +/- 0.44 years, and a serum C-peptide level of 1.1 +/- 0.10 nmol/L were enrolled into the study. Following two checkups performed in the course of the 364 +/- 17.9-day baseline period, human regular insulin was replaced with aspart in equivalent boluses, and two checkups in the course of 330 +/- 11.1-day sequential period were performed. The control group consisted of 17 individuals with type 2 diabetes 68.4 +/- 2.36 years old with diabetes' duration of 9.9 +/- 1.57 years, treated with insulin for 4.2 +/- 0.57 years, and a C-peptide level of 1.1 +/- 0.11 nmol/L. Data were analyzed using the statistical program SPSS version 10.1. (SPSS, Inc., Chicago, IL). RESULTS: Following the switch from human regular insulin to aspart, hemoglobin A1c (HbA1c) decreased from 8.4 +/- 0.23% at baseline to 7.9 +/- 0.17% (P = 0.031), and thereafter to 7.5 +/- 0.20% (P < 0.001), while plasma glucose concentrations in 10-point profiles, daily insulin dose (37.1 +/- 1.39 IU/day), body mass index (BMI) (30.5 +/- 0.82 kg/m(2)), and frequency of hypo- and hyperglycemic episodes did not change (P > 0.05). Patients quote satisfaction was good. No adverse events were recorded. In the control group, no significant change of baseline HbA1c (8.4 +/- 0.54%), insulin dose (33.1 +/- 3.17 IU/day), and BMI (32.1 +/- 1.12 kg/m(2)) was found. CONCLUSION: Aspart appears to be more effective than human regular insulin for complementary insulin treatment in individuals with type 2 diabetes.

Results of selfmonitoring on glucometer systems Advance and Optium in daily routine.

The aim of this prospective clinical study was to compare the results of B-glucose estimations performed simultaneously on glucometer Advance (with Micro-draw strips) and Optium (G3 strips) by lay healthy volunteers under non-standardized conditions of everyday life, to assess the difficulties dealing with lay-handling of these systems and to demonstrate the possibilities of the software Glucobalance (Hypoguard) and PC-Link (Medisense/Abbott) for the analysis of selfmonitoring. In the course of 5 days, a total of 721 pairs of measurements were carried out on 10 pairs of glucometer Advance and Optium by 10 healthy volunteers aged 16-40 years. The data transfer of all values into computer from glucometer Advance using the Glucobalance software and from glucometer Optium using the PC-Link was carried out to determine the results. The correlation of B-glucose measured on the glucometer Advance and Optium was strong (r = 0.73). Glucometer Advance brings values about 0.21 +/- 0.06 mmol/l lower than glucometer Optium. The average difference found within each pairs of glucometers Advance - Optium varied. Nevertheless, these differences are acceptable for routine selfmonitoring. The handling of glucometer Advance is not difficult for lay persons. The Glucobalance software simplifies the result evaluation by each tested person. Even though there are some advantages in comparison with the PC-Link, it should be further developed.

Determination of the glycaemic index of selected foods (white bread and cereal bars) in healthy persons.

UNLABELLED: The glycaemic index (GI) is a measure of the food power to raise blood glucose (B-glucose) concentration after a meal. For healthy eating, foods with low GI are recommended. However, for many foods in the European Union the GI has not been defined yet. The aims of this prospective open-label study were: (1) to determine the GI of white bread and juicy cereal bars FIT (Usovsko, Czech Republic) by means of the glucometer Optium (Abbott/Medisense); (2) to compare the GI of tested foods determined in the morning and in the evening hours; (3) to compare the GI of tested foods in men and women and (4) to assess the variability of the GI. METHODS: To determine the GI, measured portions of food containing 50 g of carbohydrates were eaten by 11 healthy volunteers. B-glucose curves were constructed from B-glucose values at time 0, 15, 30, 45, 60, 60, 120 min after the meal. The GI was calculated by dividing the incremental area under the curve (IAUC) for the tested food by that for the standard food (IAUCS). In each volunteer each food was tested 5 times so that 5 GI's was obtained and the average was calculated. The GI for each tested food was calculated as the mean from the respective average GI's of the 11 volunteers. MS Excel and the statistical program SPSS v. 10.1 were used to analyze the data. RESULTS: (1) The mean values of the GI for white bread was 70.3 % and for juicy cereal bars was 101.0 %, as determined in a total of 139 tests in the whole group of 11 volunteers. There was a difference when comparing white bread vs. glucose (p = 0.012) and white bread vs. cereal bars (p = 0.026) but no difference between glucose and cereal bars. (2) There was no significant difference between the GI determined in the morning and in the evening hours either for the total of 139 tests or for the individual tested foods. (3) No significant difference could be seen between the GI in men and women when comparing glucose, cereal bars and white bread. (4) There was a wide variability of GI in all tested foods: the standard deviation of GI for white bread was 30.7 %, for juicy cereal bars 38.0 %. CONCLUSIONS: The GI's for white bread and juicy cereal bars were determined. There was no difference either between the GI values determined in the morning vs. the evening hours or between the values in men vs. women. The results show wide variability. An accurate standard method for the determination of GI needs to be defined, carefully used and re-evaluated to enable a comparison of the results with various methods of other working groups.

Benefits of insulin aspart vs phosphate-buffered human regular insulin in persons with type 1 Diabetes treated by means of an insulin pump.

UNLABELLED: Absorption rates of phosphate buffered insulin analogs aspart and lispro prevail over regular human insulin. However, insulin aspart has not been widely used. The aim of this open controlled clinical study is to compare the metabolic effects of insulin aspart and phosphate buffered insulin when both are used in insulin pumps according to the identical algorithms. METHODS: Twenty one persons aged 39.9 +/- 2.89 (mean +/- SE) years (y) with type 1 diabetes mellitus duration of 17.9 +/- 2.21 y treated by an insulin pump for 4.3 +/- 0.53 y (at least 3 months), educated in self monitoring, entered the study. Mean plasma glucose, rates of hypo- and hyperglycaemias from the glucometer memory and other data from the first 256 +/- 19.97 days period with regular human insulin (check-up 1 and 2) and consequent 364 +/- 8.78 days long period with insulin aspart (check-up 3 and 4) were compared (paired t-test). Replacement of human regular insulin with insulin aspart after two check-ups was the only change in the treatment of diabetes. No special therapeutic education or training was made during the study. RESULTS: In persons with type 1 diabetes treated by an insulin pump with insulin aspart, despite the lower daily dose of insulin aspart vs human regular insulin, the HbA1c decreased; the frequency of hypo- and hyperglycaemias and the BMI did not change. CONCLUSIONS: Insulin analog aspart appears to be more effective for continuous subcutaneous insulin infusion than regular human insulin.

Computer literacy enhancement in the Teaching Hospital Olomouc. Part I: project management techniques. Short communication.

Information explosion and globalization make great demands on keeping pace with the new trends in the healthcare sector. The contemporary level of computer and information literacy among most health care professionals in the Teaching Hospital Olomouc (Czech Republic) is not satisfactory for efficient exploitation of modern information technology in diagnostics, therapy and nursing. The present contribution describes the application of two basic problem solving techniques (brainstorming, SWOT analysis) to develop a project aimed at information literacy enhancement.