Beneficial effects of a T. monococcum wheat cultivar on diabetes incidence evaluated in non-obese diabetic mice and after in vitro simulated gastroduodenal digestion.

Wheat consumption can represent one of the nutritional factors involved in the onset of diabetes. We specifically investigated the potential diabetogenic effects of Hammurabi, a T. monococcum wheat cultivar, in non-obese diabetic (NOD) mice and analysed the levels of resistant starch in pasta manufactured with Hammurabi after in vitro gastroduodenal digestion. NOD mice were fed with Hammurabi, bread wheat or rice flour to evaluate diabetes incidence and insulitis score. An enzymatic method was applied to compare the content of resistant starch in Hammurabi pasta and durum wheat pasta (control). In NOD mice, the Hammurabi-based diet significantly delayed diabetes onset (p = 0.0042) and reduced insulitis score compared to rice or wheat-based diet. Furthermore, the resistant starch value following in vitro digestion of Hammurabi pasta was significantly higher (4.08%) than that of durum wheat pasta (2.28%). Taken together, these results highlighted the potential positive effects of the Hammurabi-based diet on diabetes incidence.

Body mass index is inversely associated with capillary ketones at the time of colonoscopy: Implications for SGLT2i use.

OBJECTIVE: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with diabetic ketoacidosis at the time of colonoscopy. This study aimed to identify factors associated with ketone concentrations in SGLT2i-treated type 2 diabetes compared with non-SGLT2i-treated diabetes, and those with impaired fasting glycaemia (IFG) and normoglycaemia. DESIGN: Cross-sectional, multicentre, observational study June-December 2020 in four Australian tertiary hospitals. PARTICIPANTS: Capillary glucose and ketones were measured in people undergoing colonoscopy: 37 SGLT2i-treated and 105 non-SGLT2i-treated type 2 diabetes, 65 IFG and 151 normoglycaemia. MEASUREMENTS: Body mass index (BMI), age, glucose, fasting duration and where relevant, HbA1c and time since last SGLT2i dose. RESULTS: In SGLT2i-treated diabetes, BMI (ρ = -0.43 [95% confidence interval: -0.67, -0.11]) and duration since last SGLT2i dose (ρ = -0.33 [-0.60, 0.00]) correlated negatively with increasing ketones, but there was no correlation with fasting duration. In non-SGLT2i-treated diabetes, BMI correlated negatively (ρ = -0.24 [-0.42, -0.05]) and fasting duration positively (ρ = 0.26 [0.07, 0.43]) with ketones. In IFG participants, only fasting duration correlated with ketones (ρ = 0.28 [0.03, 0.49]). In normoglycaemic participants, there were negative correlations with BMI (ρ = -0.20 [-0.35, -0.04]) and fasting glucose (ρ = -0.31 [-0.45, -0.15]) and positive correlations with fasting duration (ρ = 0.20 [0.04, 0.35]) and age (ρ = 0.19 [0.03, 0.34]). Multiple regression analysis of the entire cohort showed BMI, age and fasting glucose remained independently associated with ketones, but in SGLT2i-treated participants only BMI remained independently associated. CONCLUSIONS: In SGLT2i-treated diabetes, lower BMI was a novel risk factor for higher ketones precolonoscopy. Pending larger confirmatory studies, extra vigilance for ketoacidosis is warranted in these people.

The Growing Epidemic of Diabetes Mellitus.

BACKGROUND: During the past decades, the prevalence of diabetes (DM) has increased significantly, mainly as a result of continuous rise in the incidence of type 2 DM. According to World Health Organization statistics, >422 million adults globally were suffering from DM in 2014 and a continuous rise in DM prevalence is expected. OBJECTIVE: The present review considers recent epidemiological data providing worldwide estimates regarding the incidence of DM. METHODS: A comprehensive literature search was conducted to identify available data from epidemiological studies evaluating the current burden of DM. RESULTS: Over the past few decades the prevalence of DM has risen significantly in nearly all countries and may be considered as a growing epidemic. Urbanization and income status are major factors which influence current rates in the prevalence studies introducing interesting differences between several population groups. CONCLUSION: Having recognized the global burden of DM, we now realize the urgent need for effective interventions. In order to monitor the public-health strategies and design effective future interventions we need reliable global estimates regarding the prevalence of DM.

Prevalence of prediabetes and type 2 diabetes in two non-random populations aged 44-77 years in the Faroe Islands.

AIMS: The prevalence of type 2 diabetes is increasing worldwide but little known about the status in the Faroe Islands. The aim was therefore to determine the prevalence of type 2 diabetes mellitus and prediabetes in two non-random populations aged 44-77 years. METHODS: This cross-sectional survey was conducted between 2011 and 2012 and included two sub-populations, namely 518 Septuagenarians aged 74-77 years (84% of the invited) and 401 Mark aged 44-73 years (87% of the invited). Subjects were screened for glycosylated haemoglobin, type A1c, non-fasting random plasma glucose, fasting plasma glucose followed by an oral glucose tolerance test. The screening was based on a diagnostic algorithm that included screening, diagnostic and confirmatory steps. RESULTS: Each group was analysed separately. In the Septuagenarian group 20.4% had type 2 diabetes, with 5.2% being newly detected and a total of 59% had prediabetes. In the Mark group 4.1% had diabetes, with 2.1% being newly detected and 22.3% had prediabetes. Diabetes increased with age and was significantly more prevalent among men. Women had lower mean fasting plasma glucose concentrations and men had lower values for 2-hours plasma glucose. Significant predictors associated with diabetes mellitus included obesity (BMI ≥ 30, abnormal waist/hip ratio and vegetable consumption. CONCLUSIONS: Among the Faroese populations studied, the prevalence of type 2 diabetes increased with age and was more prevalent among men. The detected prevalence was comparable to other Nordic countries for all age-groups.

Risk factors analysis for developing diabetes based on its 3-year outcome in an elderly population with impaired fasting glucose / 中华内分泌代谢杂志

To examine the risk factors for developing diabetes on its 3-year outcome in an elderly population with impaired fasting glucose (IFG). We selected the 328 elderly with impaired fasting glucose in Binhai new area of Tianjin as the research object. All subjects participated in objective examinations such as physical activity ability tests, blood tests and anthropometric examinations, and completed the questionnaire survey. Between baseline and 3-year outcome, 56 of the subjects with IFG at baseline have developed diabetes. After multivariate adjustments, we found that higher incidence of diabetes was associated with higher fasting plasma glucose (OR=9.30, 95%CI 2.84-30.48, P<0.01) and reduced grip strength/weight (OR=0.88, 95%CI 0.82-0.94, P<0.01). Moreover, the combination of higher fasting plasma glucose and lower grip strength/weight would lead to higher incidence of diabetes compared with higher fasting plasma glucose or lower grip strength/weight alone (P<0.05). In this study, high fasting plasma glucose and low muscle strength were associated with blood glucose worsening in three years in IFG patients. In addition to blood glucose levels, physical activity is also a risk factor for diabetes in older adults.

Risk factors analysis for developing diabetes based on its 3-year outcome in an elderly population with impaired fasting glucose / 中华内分泌代谢杂志

To examine the risk factors for developing diabetes on its 3-year outcome in an elderly population with impaired fasting glucose ( IFG) . We selected the 328 elderly with impaired fasting glucose in Binhai new area of Tianjin as the research object. All subjects participated in objective examinations such as physical activity ability tests, blood tests and anthropometric examinations, and completed the questionnaire survey. Between baseline and 3-year outcome, 56 of the subjects with IFG at baseline have developed diabetes. After multivariate adjustments, we found that higher incidence of diabetes was associated with higher fasting plasma glucose (OR=9.30, 95％CI 2.84-30.48, P<0.01) and reduced grip strength/weight ( OR=0.88, 95％CI 0.82-0.94, P<0.01) . Moreover, the combination of higher fasting plasma glucose and lower grip strength/weight would lead to higher incidence of diabetes compared with higher fasting plasma glucose or lower grip strength/weight alone ( P<0.05) . In this study, high fasting plasma glucose and low muscle strength were associated with blood glucose worsening in three years in IFG patients. In addition to blood glucose levels, physical activity is also a risk factor for diabetes in older adults.

Blood Glucose Disorders and Access to Health Care Services Among Adults Aged 30 to 69 Years in Chi Linh, Hai Duong, Vietnam.

Planning for control of diabetes in Vietnam needs valid information about the burden of diseases in general population. This study employed a cross-sectional design among population aged 30 to 69 years to measure the burden of type 2 diabetes and gaps in access to health care to explore the negative effects of rapid economic growth and urbanization in Chi Linh in recent years. A total of 594 adults were interviewed and had their fasting blood glucose tested. Results indicated that the prevalence of impaired fasting glycaemia was 11.8% and of diabetes was 12.1%. Only 16.8% diabetes cases detected in this study were diagnosed before, indicating a high level of unmet needs for detecting/managing diabetes in Chi Linh population. Significant associated factors with abnormal blood glucose included age and body mass index level. Without effective intervention programs for diabetes control and management, its burden will continue raising in the coming years. Chi Linh need to strengthen the diagnostic/treatment services at primary health care levels to ensure that people at early stage of raised blood pressure, raised blood glucose can be detected and provided with proper management to avoid serious complications, and to reduce hospital overload at central level.

Peripheral insulin resistance rather than beta cell dysfunction accounts for geographical differences in impaired fasting blood glucose among sub-Saharan African individuals: findings from the RODAM study.

AIMS/HYPOTHESIS: The aim of this study was to assess the extent to which insulin resistance and beta cell dysfunction account for differences in impaired fasting blood glucose (IFBG) levels in sub-Saharan African individuals living in different locations in Europe and Africa. We also aimed to identify determinants associated with insulin resistance and beta cell dysfunction among this population. METHODS: Data from the cross-sectional multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study were analysed. Participants included Ghanaian individuals without diabetes, aged 18-96 years old, who were residing in Amsterdam (n = 1337), Berlin (n = 502), London (n = 961), urban Ghana (n = 1309) and rural Ghana (n = 970). Glucose and insulin were measured in fasting venous blood samples. Anthropometrics were assessed during a physical examination. Questionnaires were used to assess demographics, physical activity, smoking status, alcohol consumption and energy intake. Insulin resistance and beta cell function were determined using homeostatic modelling (HOMA-IR and HOMA-B, respectively). Logistic regression analysis was used to study the contribution of HOMA-IR and inverse HOMA-B (beta cell dysfunction) to geographical differences in IFBG (fasting glucose 5.6-6.9 mmol/l). Multivariate linear regression analysis was used to identify determinants associated with HOMA-IR and inverse HOMA-B. RESULTS: IFBG was more common in individuals residing in urban Ghana (OR 1.41 [95% CI 1.08, 1.84]), Amsterdam (OR 3.44 [95% CI 2.69, 4.39]) and London (OR 1.58 [95% CI 1.20 2.08), but similar in individuals living in Berlin (OR 1.00 [95% CI 0.70, 1.45]), compared with those in rural Ghana (reference population). The attributable risk of IFBG per 1 SD increase in HOMA-IR was 69.3% and in inverse HOMA-B was 11.1%. After adjustment for HOMA-IR, the odds for IFBG reduced to 0.96 (95% CI 0.72, 1.27), 2.52 (95%CI 1.94, 3.26) and 1.02 (95% CI 0.78, 1.38) for individuals in Urban Ghana, Amsterdam and London compared with rural Ghana, respectively. In contrast, adjustment for inverse HOMA-B had very minor impact on the ORs of IFBG. In multivariate analyses, BMI (ß = 0.17 [95% CI 0.11, 0.24]) and waist circumference (ß = 0.29 [95%CI 0.22, 0.36]) were most strongly associated with higher HOMA-IR, whereas inverse HOMA-B was most strongly associated with age (ß = 0.20 [95% CI 0.16, 0.23]) and excess alcohol consumption (ß = 0.25 [95% CI 0.07, 0.43]). CONCLUSIONS/INTERPRETATION: Our findings suggest that insulin resistance, rather than beta cell dysfunction, is more important in accounting for the geographical differences in IFBG among sub-Saharan African individuals. We also show that BMI and waist circumference are important factors in insulin resistance in this population.

Fasting glycaemia to simplify screening for gestational diabetes.

OBJECTIVE: Recommendations in Switzerland on screening for gestational diabetes endorse the International Association of Diabetes in Pregnancy Study Group consensus. As universal testing is time consuming and glucose loading is unpleasant, the recommendations include a simplification, not performing the glucose loading in women with fasting glycaemia <4.4 mmol/l. Our objective was to evaluate the diagnostic performance of this simplified strategy, compared with the complete test, in our population with a low prevalence of gestational diabetes. DESIGN: We collected 2298 complete 75-g glucose tolerance tests. We simulated stopping the test, so avoiding the glucose loading and further glycaemia, if fasting glycaemia was <4.4 or ≥5.1 mmol/l. SETTING AND POPULATION: Unselected pregnant women from Geneva and Basel, at 24-28 weeks of gestation. METHODS: We calculated the sensitivity, and the percentage of women who would avoid the complete test with the strategy based on fasting glycaemia. RESULTS: The prevalence of gestational diabetes was 10.9% in our population. Among 251 women with gestational diabetes, fasting glycaemia was ≥5.1 mmol/l in 119 women (47.4%), between 4.4 and <5.1 mmol/l in 78 women (31.1%) and <4.4 mmol/l in 54 women (21.5%). Proceeding with the complete test only in women with fasting glycaemia between 4.4 and <5.1 mmol/l will result in a sensitivity of 78.5%. This strategy would avoid glucose loading in 63.8% of women. CONCLUSIONS: Screening with fasting glycaemia is an attractive alternative to universal screening with the complete 75-g glucose tolerance test. This strategy is, however, slightly less sensitive than previously reported in higher-risk populations. TWEETABLE ABSTRACT: Fasting glycaemia can be considered as an alternative to the complete test for gestational diabetes screening.

Metabolic management in overweight subjects with naive impaired fasting glycaemia by means of a highly standardized extract from Cynara scolymus: a double-blind, placebo-controlled, randomized clinical trial.

The aim of this study is to evaluate the efficacy of a dietary supplementation with an extract from Cynara scolymus (Cs) on the glucose pattern in a group of patients with naïve impaired fasting glycaemia (IFG). A randomized, double-blind, placebo-controlled trial has been performed in 55 overweight subjects with IFG (fasting blood glucose [FBG]: 6.11 ± 0.56 mmol/l). These subjects were randomly assigned to supplement their diet with either an extract from Cs (600 mg/d) (26 subjects) or placebo (29 matched subjects) for 8 weeks. The decrease of FBG was the primary endpoint. The assessment of Homeostatic Metabolic Assessment (HOMA), glycosylated haemoglobin, A1c-Derived Average Glucose (ADAG), lipidic pattern and anthropometric parameters were the secondary endpoints. The within groups and percent changes from baseline were analyzed by the signed rank test. The comparison between groups was performed by Wilcoxon's two sample test. The supplemented group had significant decreases of: FBG (-9.6%), HOMA (-11.7%), glycosylated haemoglobin (-2.3%), ADAG (-3.1%) and lipidic pattern. The placebo group did not show any significant difference. Compared with the placebo, the supplemented group showed a significant difference in FBG, HOMA and lipidic pattern. These data demonstrate the efficacy of Cs extract on the reduction of glycometabolic parameters in overweight subjects with IFG.

Estimates of the relative and absolute diurnal contributions of fasting and post-prandial plasma glucose over a range of hyperglycaemia in type 2 diabetes.

AIMS: To re-examine the relative and absolute contributions of fasting/pre-prandial glucose (FPG) and post-prandial glucose (PPG) to 24-h hyperglycaemia and HbA1c respectively in non-insulin treated subjects with type 2 diabetes (T2DM). MATERIALS AND METHODS: A total of 52 T2DM subjects (37 men) had daytime 12h plasma glucose (PG) profiles determined in response to three serial identical test meals commencing at 08 00h with pre-prandial and frequent post-prandial blood samples collected. The overnight PG profile was derived by projecting the 20 00h glucose concentration to the pre-breakfast value at 08 00h. PPG exposure was calculated above fasting/pre-prandial value for each meal. Excess hyperglycaemia was calculated based on a PG>5.5mmol/L with fasting hyperglycaemia being the difference between the two measurements. The subjects were divided into five groups according to the HbA1c (Group 1<7.0%; Group 2: 7.0-<7.5; Group 3: 7.5-<8.0%; Group 4: 8.0-<9.0%; Group 5:≥9.0%). The 24h relative contribution of PPG exposure and fasting hyperglycaemia to excess hyperglycaemia and the absolute contribution of PPG and fasting hyperglycaemia to excess HbA1c (HbA1c - 5.1%) was calculated. RESULTS: With deteriorating glycaemia, the relative contribution of PPG exposure decreased across the groups from 43.5% (HbA1c<7.0%) to 17.8% (HbA1c≥9.0%), whilst the contributions of fasting hyperglycaemia increased from 56.5% to 82.2% (P=0.004), respectively. The absolute contributions of PPG to excess HbA1c was 0.7%, which remained relatively stable across the spectrum of HbA1c, whilst fasting hyperglycaemia increased significantly from groups 1 to 5 (P<0.001). CONCLUSIONS: Fasting hyperglycaemia contributes substantially in all groups, increasing as HbA1c deteriorates. The absolute contribution of PPG to excess HbA1c did not vary across the range of HbA1c, representing a significant relative contribution even in well-controlled subjects with a HbA1c<7.0%.

Efeito de 12 semanas de hidroginástica sobre a glicemia capilar em portadores de diabetes mellitus tipo II / Effect of 12 weeks of water aerobics on capillary glycemia among individuals with type II diabetes mellitus

O crescente aumento da obesidade tem levado cada vez mais pessoas a ter algum tipo de doença crônica não transmissível como o diabetes mellitus tipo II, cujo número de portadores vem aumentando nos últimos anos. Portanto, o presente trabalho objetivou avaliar a glicemia capilar em jejum após 12 semanas de aulas de hidroginástica em homens e mulheres com diabetes mellitus tipo II. O estudo contou com a participação de 29 indivíduos de ambos os sexos, distribuídos em um grupo masculino (n=10) e outro feminino (n=5) exercitados com hidroginástica, e, dois grupos controles, um masculino (n=5) e outro feminino (n=9). Foram avaliados a massa corporal (MC), o índice de massa corporal (IMC) e a glicemia capilar em jejum (GJ) no início do estudo (M0), após seis (M1) e 12 semanas de acompanhamento (M2). As aulas tiveram duração de uma hora, três sessões semanais, durante 12 semanas. Houve redução na MC entre (M0: 78,0±8,6kg e M2: 75,5±8,5 kg; p=0,01) e GJ entre (M0: 199,8±87,5mg/dL; M1: 125,0±38,6 mg/dL e M2: 138,0±40,4mg/dL; p=0,003), ambos para o grupo masculino exercitado. Quanto ao grupo hidroginástica feminino, houve redução significativa apenas para a GJ entre (M0: 213,8±77,1mg/dL e M2: 134,0±38,2mg/dL; p=0,04). Não houve diferença estatística quando comparados os grupos entre si. Em conclusão, a prática regular de hidroginástica favorece o controle da massa corporal assim como da glicemia em jejum de diabéticos tipo II. No entanto, tais efeitos necessitam ser melhor investigados quanto à influência do gênero e à idade dos indivíduos, particularmente em mulheres no climatério.

The growing increase in obesity has led more and more people to some kind of cronic non-transmittable disease such as diabetes mellitus type II, whose number of patients has increased in recent years. Thus, this paper aimed to evaluate the fasting glycaemia after 12 weeks of hydrogymnastics classes in men and women with diabetes mellitus type II. The study counted on the participation of 29 individuals from both sexes, distributed in a male group (n=10) and in a female (n=5) exercised with water aerobics, and two control groups, a male (n=5) and a female (n=9). Body mass (BM), body mass index (BMI) and fasting glycaemia (FG) were assessed at the beginning of the study (M0), after six (M1) and 12 weeks of follow-up (M2). Classes lasted for an hour, three week sessions, for twelve weeks. There was a reduction on BM between (M0: 78.0±8.6 and M2: 75.5±8.5kg; p=0.01) and FG between (M0: 199.8±87.5; M1: 125.0±38.6 mg/dL and M2: 138.0±40.4 mg/dL; p=0.03), both for the male group exercised. About the female hydrogymnastics group, there was significative reduction only for the FG between (M0: 213.8±77.1mg/dL and M2: 134.0±38.2mg/dL; p=0.04). There was no statistical difference when the groups were compared among themselves. In conclusion, the regular practice of hydrogymnastics favors the body mass control just like the fasting glycaemia in diabetes type II porters, however, such effects need an in depth investigation, about the influence of gender and age of the individuals, particularly in women on climacteric.

Study on the risk of age-related diabetes mellitus among 8280 cases with metabolic syndrome patients and normal persons in Beijing / 中华流行病学杂志

Objective To investigate the impact of age on patients with metabolic syndrome (MS) and normal persons. Methods Data was gathered from 8280 persons including 4873 males and 3407 females who were randomly selected. All subjects were devided into normal group and MS group. According to the interval of ten years, the subjects were devided into seven age groups, to calculate the difference of impaired fasting glycaemia (IFG) between patients with diabetes mellitus (DM) and normal people, as well as the related portions. Results (1) The risk of IFG and DM appeared to be different among age groups among the target subjects as well as in the normal and the MS groups (P<0.05). (2) Among the whole subjects, the overall prevalence of IFG was increasing with age. The prevalence of DM had an increasing trend with age augment in 20-79 years group, whereas a decreasing trend appeared in people over 80 years of age. (3) For normal persons, the prevalence of IFG and DM were all increasing with age augment in 20-79 years group, and then decreasing with age augment in the over-80-years group. (4)For MS patients, the prevalence of IFG had an increasing trend with age augment in 20-69 years group, whereas a decreasing trend appeared in people over 70 years of age. There was no tendency of variation with age augment in DM.Conclusions (1) For normal persons, high prevalence rates of IFG and DM were correlated to age augment, especially in senior persons. (2) For MS patients, high prevalence of IFG was also correlated to age augment, but no association between prevalence of DM and age augment was seen. (3)Age from 70 to 79 years appeared to be in high risk with MS.

A cross-sectional study of impaired fasting glycaemia and diabetes mellitus in rural residents of Lanxi,Heilongjiang / 中华流行病学杂志

Objective To investigate the current status of impaired fasting glycaemia (IFG),diabetes mellitus(DM) and correlated factors, as well as on the awareness, treatment and control rate of diabetes mellitus in rural residents of Lanxi, Heilongjiang. Methods Cross-sectional and cluster sampling method was carried out on 3480 residents over 35 years of age, in rural residents of Lanxi Pingshan,Heilongjiang province. Results To male, female and all, the detecting rate of IFG were 5.06%,4.38% and 4.68% respectively, and the standardization rate of IFG became 4.71%, 4.24% and 4.47% respectively. The prevalence rates of DM were 7.85%, 6.57% and 7.15% but after standardization, they became 7.22%, 6.62% and 6.80% respectively. Results did not show statistical difference between sex and the level of fasting glycaemia (χ2 = 2. 725, P = 0. 256). The prevalence rates of IFG and DM increased with age and difference was seen between age and fasting glycaemia level (χ2 = 58.115, P = 0. 000). Data from multivariable stepwise analysis showed that age, smoking, BMI and high triglyceride were the significant factors in fasting glycaemia level, and the ORs (95% CI) were 1. 518 ( 1. 360-1. 694), 1. 277(1.134-1.439),1.187(1.014-1.391) and 1.754(1.385-2.220) respectively. The rates of awareness,treatment and control rate in DM were 12.74%, 9.43% and 4.72% respectively while the treatment rate among those who knew the disease was 74.07%. Conclusion Our result showed that the isolating rate of IFG and the prevlence rate DM were high in this region, but the awareness, treatment and control rate in DM were low. It is essential to strengthen health promotion program on diabetic knowledge and to elevate the primary and secondary prevention in the rural of Heilongjiang,so as to raise the rate of control.

Analysis of onset characteristics and clinical features in Chinese population with impaired glucose regulation / 中国实用内科杂志

65 years and 55~65 years respectively,whereas the frequency of IFG in each age group was close,which was more than IGT in the age group of 25~34 years only.The differences of many clinical indexs among 3 groups were significant.The change tendecny of indexs in IFG/IGT group was more obvious.Conclusion The onset characteristics of age and sex are significantly different between IFG and IGT groups,and the latter is more strongly associated with cardiovascular risk factors than the former.Undoubtedly,IFG/IGT group has the highest cardiovascular risk factors.