Cinnamomum cassia on Arterial Stiffness and Endothelial Dysfunction in Type 2 Diabetes Mellitus: Outcomes of a Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Cinnamomum cassia is a medicinal plant whose use has demonstrated benefits on body weight, blood pressure, glucose, and lipids. This study aimed to evaluate the effect of C. cassia on arterial stiffness and endothelial dysfunction (ED) in patients with type 2 diabetes mellitus (T2DM). A randomized, double-blind, placebo-controlled clinical trial was carried out in 18 subjects aged 40-65 years, with a diagnosis of T2DM of one year or less since diagnosis and treated with Metformin 850 mg daily. Patients were randomly assigned to receive either C. cassia or a placebo in 1000 mg capsules, thrice a day, before each meal for 12 weeks. At baseline and after 12 weeks of intervention, brachial-ankle pulse wave velocity and Flow Mediated Dilation were measured, as well as body weight, body mass index (BMI), blood pressure (BP), fasting glucose (FG), glycated hemoglobin A1c (HbA1c), total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and very low density lipoprotein cholesterol, respectively, triglycerides, creatinine, and transaminases. The Mann-Whitney U test for differences between groups and the Wilcoxon signed-rank test for intragroup differences were used, and a P ≤ .05 was considered statistically significant. After C. cassia administration, statistically significant reductions in body weight (81.4 ± 10.4 kg vs. 79.9 ± 9.0 kg, P = .037), BMI (30.6 ± 4.2 kg/m2 vs. 30.1 ± 4.2 kg/m2, P = .018), and HbA1c (53 ± 5.4 mmol/mol vs. 45 ± 2.1 mmol/mol, P = .036) were observed. No changes statistically significant on arterial stiffness, ED, FG, BP, and lipids were observed. C. cassia administration decreases body weight, BMI, and HbA1c without statistically significant changes on arterial stiffness, ED, FG, BP, and lipids. CTR Number: NCT04259606.

Percentage of change and increment of the glucose level after a normal oral tolerance curve between 24 and 28 weeks of pregnancy.

AIM: To determine the percentage of change and increment in glucose levels after a normal oral glucose tolerance test between 24 and 28 weeks of pregnancy. METHODS: We studied 3510 pregnant women who attended their obstetric delivery at a tertiary care hospital in Guadalajara, Mexico in 2018, according to characteristics and risk 1647 (47%) patients were screened for diabetes diagnosis using the oral glucose tolerance test, 501 patients reported normal values between their 24th and 28th week of pregnancy, only 400 patients had their fasting glucose level measured on the same day of their obstetric delivery, to be compared. RESULTS: Average age was 30 years, with an average of 25.3 weeks of pregnancy. The fasting serum glucose levels taken after 28 weeks of pregnancy and before the obstetrical delivery showed an increase of 1.1 mmol/L in women who develop gestational diabetes mellitus, in contrast to women who did not develop gestational diabetes mellitus after 28 weeks their blood glucose only increased on average 0.4 mmol/L. The incidence of gestational diabetes mellitus in the study population during 2018 was 32.7%. Patients who developed gestational diabetes mellitus after a normal oral glucose tolerance test had greater body mass index before the pregnancy and newborns had a higher weight than babies born to mothers without gestational diabetes mellitus. CONCLUSION: Changes in glucose levels after the oral tolerance test of normal glucose require strict monitoring, in that it was demonstrated that 3% of patients developed gestational diabetes mellitus after week 28 of gestation.

Association of Netrin 1 with hsCRP in Subjects with Obesity and Recent Diagnosis of Type 2 Diabetes.

Netrin 1 (Ntn1) is a cell migration protein with an anti-inflammatory effect, which may play a key role in the pathological development of type 2 diabetes (T2D). In this study, we evaluate the relationships between the serum concentrations of Ntn1, glucose, and high-sensitivity C-reactive Protein (hsCRP). We carried out a cross-sectional study including 90 individuals divided into three groups (n = 30): healthy subjects, individuals with obesity without glucose alterations, and individuals with newly diagnosed T2D. Serum concentrations of Ntn1 and hs-CRP were determined by enzyme-linked immunosorbent assay (ELISA). The serum concentration of Ntn1 was higher in individuals with newly diagnosed T2D (0.33 ± 0.22 ng/mL), in comparison to healthy subjects and individuals with obesity (0.13 ± 0.06 and 0.15 ± 0.07 ng/mL, respectively). In addition, we observed a positive association between the levels of Ntn1 and hsCRP (rho = 0.443; p < 0.001) as well as with serum glucose (rho = −0.110; p = 0.05). The serum concentration of Ntn1 was higher in individuals with T2D, in comparison with the other groups in this study, and presented a positive correlation with hsCRP. Therefore, Ntn1 can be considered a promising risk biomarker and a potential therapeutic target for T2D.

Effect of metformin glycinate on glycated hemoglobin A1C concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus.

AIM: This study evaluated the effect of metformin glycinate on glycated hemoglobin A1c (A1C) concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 patients with drug-naive T2DM. Ten subjects received metformin glycinate (1,050.6 mg) once daily during the first month and force-titrated twice daily during the second month. Ten additional patients received placebo as the control group. Before and after the intervention, metabolic profile including A1C and insulin sensitivity (euglycemic-hyperinsulinemic clamp technique) was estimated. RESULTS: A1C concentrations decreased significantly with metformin glycinate administration (8.0 ± 0.7% vs. 7.1 ± 0.9%, P = 0.008) before and after the intervention, respectively. There were significant differences in changes from baseline of A1C between groups (0.0 ± 0.7% vs. -1.0 ± 0.5% for placebo and metformin glycinate groups, respectively; P = 0.004). A reduction of ≥1% in A1C levels was reached in 60.0% of patients with metformin glycinate administration (P = 0.02). Insulin sensitivity was not modified by the intervention. CONCLUSIONS: Administration of metformin glycinate during a 2-month period showed a greater decrease in A1C concentrations than placebo in a selected group of drug-naive adult patients with T2DM.

Effect of diacerein on insulin secretion and metabolic control in drug-naive patients with type 2 diabetes: a randomized clinical trial.

OBJECTIVE: To assess the effect of diacerein on insulin secretion and metabolic control in drug-naïve patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in 40 drug-naïve adult patients with type 2 diabetes. A metabolic profile including interleukin (IL)-1ß, tumor necrosis factor-α, IL-6, and fasting insulin levels was carried out before the intervention and 2 months afterward. A hyperglycemic-hyperinsulinemic clamp technique was performed to assess the phases of insulin secretion and insulin sensitivity. After randomization, 20 patients received diacerein (50 mg once daily) for the first 15 days and twice daily for 45 additional days. The remaining patients received placebo. Intra- and intergroup differences were calculated by Wilcoxon signed rank and Mann-Whitney U tests. RESULTS: There were significant increases in first (102±63 vs. 130±75 pmol/L; P<0.01), late (219±111 vs. 280±135 pmol/L; P<0.01), and total insulin (178±91 vs. 216±99 pmol/L; P<0.01) secretions without changes in insulin sensitivity after diacerein administration. There were significant decreases in fasting glucose (7.9±1.4 vs. 6.8±1.0 mmol/L; P<0.01) and in A1C levels (8.3±1.0 vs. 7.0±0.8%; P<0.001) after diacerein administration. There were no significant changes after placebo administration in the above-mentioned evaluations. CONCLUSIONS: Insulin secretion increased and metabolic control improved after diacerein administration in drug-naïve patients with type 2 diabetes.

Effect of exenatide on fat deposition and a metabolic profile in patients with metabolic syndrome.

BACKGROUND: The aim of this study was to evaluate the effect of exenatide on fat deposition and a metabolic profile in patients with metabolic syndrome. METHODS: An uncontrolled, open clinical study was carried out in 10 patients with metabolic syndrome and without pharmacological treatment. Patients received exenatide (5 µg) subcutaneously twice daily for 1 month. Before and after the intervention, metabolic profile and phases of insulin secretion and insulin sensitivity were estimated. To assess insulin secretion and sensitivity, the hyperglycemic-hyperinsulinemic clamp technique was performed. Computed tomography was performed to evaluate both subcutaneous and visceral fat. The Wilcoxon signed-rank test and Mann-Whitney U-test were used for statistical analyses. RESULTS: Weight, body mass index, waist circumference, and systolic blood pressure were decreased by exenatide. Subcutaneous fat deposition decreased by 4.4% compared to the basal value. There were significant decreases in total cholesterol and low-density lipoprotein cholesterol, as well as an increment in the first phase of insulin secretion after the intervention. CONCLUSION: One-month administration of exenatide significantly decreased subcutaneous fat deposition by 4.4%, improving the metabolic profile in patients with metabolic syndrome.

Effect of thiamine administration on metabolic profile, cytokines and inflammatory markers in drug-naïve patients with type 2 diabetes.

PURPOSE: To evaluate the effect of thiamine administration on metabolic profile, cytokines and inflammatory markers in drug-naïve patients with type 2 diabetes mellitus (T2DM). METHODS: A randomized, double-blind, placebo-controlled, pilot-scale clinical trial was carried out in 24 patients with T2DM. Twelve subjects received thiamine orally (150 mg), once daily during a fasting state for 1 month. An additional 12 patients (control group) were given placebo for the same period of time. Before and after the intervention, fasting glucose, A1C, creatinine, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, very low-density lipoprotein, high-sensitive C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin and adiponectin levels were estimated. Wilcoxon's signed-rank and Mann-Whitney U test were used for statistical analyses. RESULTS: There were significant decreases in glucose (6.7 ± 1.0 mmol/l vs. 6.0 ± 1.0 mmol/l, p = 0.024) before and after the intervention, respectively, and leptin concentrations (32.9 ± 13.3 ng/ml vs. 26.9 ± 12.8 ng/ml, p = 0.027) before and after the intervention, respectively, with thiamine administration. There were no changes with the rest of the measurements. CONCLUSIONS: Thiamine administration for 1 month decreased glucose and leptin concentrations in drug-naïve patients with T2DM.

The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp.

CONTEXT: To meet the worldwide challenge of emerging diabetes, accessible and inexpensive tests to identify insulin resistance are needed. OBJECTIVE: To evaluate the sensitivity and specificity of the product of fasting, we compared the triglycerides and glucose (TyG) index, a simple measure of insulin resistance, with the euglycemic-hyperinsulinemic clamp test. DESIGN AND SETTING: We conducted a cross-sectional study of the general population and outpatients of the Internal Medicine Department at the Medical Unit of High Specialty of the Specialty Hospital at the West National Medical Center in Guadalajara, Mexico. PATIENTS: Eleven nonobese healthy subjects, 34 obese normal glucose tolerance individuals, 22 subjects with prediabetes, and 32 diabetic patients participated in the study. INTERVENTION: We performed a euglycemic-hyperinsulinemic clamp test. MAIN OUTCOME MEASURES: Sensitivity and specificity of the TyG index [Ln(fasting triglycerides) (mg/dl) x fasting glucose (mg/dl)/2] were measured, as well as the area under the curve of the receiver operating characteristic scatter plot and the correlation between the TyG index and the total glucose metabolism (M) rates. RESULTS: Pearson's correlation coefficient between the TyG index and M rates was -0.681 (P < 0.005). Correlation between the TyG index and M rates was similar between men (-0.740) and women (-0.730), nonobese (-0.705) and obese (-0.710), and nondiabetic (-0.670) and diabetic (-0.690) individuals. The best value of the TyG index for diagnosis of insulin resistance was 4.68, which showed the highest sensitivity (96.5%) and specificity (85.0%; area under the curve + 0.858). CONCLUSIONS: The TyG index has high sensitivity and specificity, suggesting that it could be useful for identification of subjects with decreased insulin sensitivity.

Effect of 2 liquid nutritional supplements for diabetes patients on postprandial glucose, insulin secretion, and insulin sensitivity in healthy individuals.

AIM: To compare the effect of 2 liquid nutritional supplements (Enterex Diabetic and Glucerna SR) designed for the patient with diabetes mellitus on postprandial glucose, insulin secretion, and insulin sensitivity in healthy individuals. PATIENTS AND METHODS: A randomized, double-blind, crossover clinical trial was carried out in 14 healthy, young (average age 21.7+/-2.8 years) volunteers. Each individual received a single administration of 232 kcal in 232 mL of Enterex Diabetic or in 237 mL of Glucerna SR. Three days later, the intervention was crossed using the opposite supplement. At the beginning of each administration and later at 30, 60, 90, and 120 minutes, glucose and insulin concentrations were measured. Triglyceride concentrations were measured at the beginning and at 120 minutes. Area under the curve of glucose and insulin was calculated. First-phase and total insulin secretion, as well as insulin sensitivity, were assessed. RESULTS: Glucose concentration at 120 minutes was significantly lower after the administration of Enterex Diabetic in comparison with Glucerna SR (4.3+/-0.6 vs 4.7+/-0.4 mmol/L; P=.012). Enterex Diabetic compared with Glucerna SR showed a greater change of the glucose concentration from 0 to 120 minutes (-0.7+/-0.6 vs -0.0+/-0.4 mmol/L; P=.002). Administration of Enterex Diabetic decreased insulin concentrations at 120 minutes (60+/-18 vs 48+/-19 pmol/L; P=.013). Administration of Glucerna SR increased triglyceride concentration at 120 minutes (1.0+/-0.3 vs 1.1+/-0.4 mmol/L; P=.026). CONCLUSION: A single administration of Enterex Diabetic in healthy individuals decreased glucose and insulin concentrations at 120 minutes without any modification in triglyceride levels.

Efficacy of glimepiride/metformin combination versus glibenclamide/metformin in patients with uncontrolled type 2 diabetes mellitus.

AIM: The aim of this study was to compare the efficacy of glimepiride/metformin combination versus glibenclamide/metformin for reaching glycemic control in patients with uncontrolled type 2 diabetes mellitus. PATIENTS AND METHODS: A randomized, double-blind, multicenter clinical trial was performed in 152 uncontrolled type 2 diabetic patients. Serum fasting and postprandial glucose, hemoglobin A1c (A1C), high-density lipoprotein cholesterol, and triglycerides were measured. After random allocation, all patients received two pills of glimepiride (1 mg)/metformin (500 mg) or glibenclamide (5 mg)/metformin (500 mg) po once a day. Dosage was increased to a maximum of four pills in order to reach the glycemic control goals (fasting glucose or=1% reduction). Statistical analyses were carried out using chi-square, ANOVA, or Student's t test. The protocol was approved by an ethics committee and met all requirements needed to perform research in human subjects; all patients gave written informed consent. RESULTS: Each study group included 76 patients. No significant differences in basal clinical and laboratory characteristics between groups were found. At the end of the study, A1C concentration was significantly lower in the glimepiride/metformin group (P=.025). A higher proportion of patients from the glimepiride group (44.6% vs. 26.8%, P<.05) reached the goal of A1C <7% at 12 months of treatment. A higher proportion of hypoglycemic events were observed in the glibenclamide group (28.9% vs. 17.1%, P<.047). CONCLUSION: Glimepiride/metformin demonstrated being more efficacious than glibenclamide/metformin at reaching the glycemic control goals with less hypoglycemic events in patients with uncontrolled type 2 diabetes mellitus.