Comparison of Intranasal and Injectable Glucagon Administration Among Pediatric Population Responders.

Aims: Ease of use and acceptability of nasal versus injectable glucagon (IG) among pediatric responders have been little investigated. This study compared the performance of administering nasal and IG in parents of youth with type 1 diabetes (T1D) and in school workers. Enablers and barriers associated with each glucagon and preferred glucagon administration learning modality were also evaluated. Methods: Three months after watching short pedagogical videos, 30 parents and 30 school workers performed simulated scenarios where they administered both glucagon. Completion time and successful execution of critical steps were collected. Interviews assessed preferred learning modalities, barriers, and enablers associated with each glucagon. Results: Both groups administered nasal glucagon faster than IG (median [interquartile range]: parents 19 [12-29] vs. 97 [71-117] s, P < 0.001; school workers 24 [16-33] vs. 129 [105-165] s, P < 0.001). A lower proportion of participants successfully executed all critical steps for injectable versus nasal glucagon (significant difference for school workers [53% vs. 90%; P = 0.007] but not for parents [68% vs. 83%; P = 0.227]). Nasal glucagon was preferred for ease of use and acceptability. Preferred learning modalities were a combination of videos and workshops, but videos alone could suffice for nasal glucagon. Conclusions: Nasal glucagon is faster to use, more likely to be successfully administered, and more acceptable than IG for parents of children with T1D and school workers. Nasal glucagon training with videos could improve school workers' involvement in severe hypoglycemia management. Clinical Trial number, URL to the registration: NCT05395000, https://clinicaltrials.gov/ct2/show/NCT05395000.

Prebiotics in the management of components of the metabolic syndrome.

Components of the metabolic syndrome (MetS), including abdominal obesity, low-grade chronic systemic inflammation, altered glucose metabolism, dyslipidemia and high blood pressure, are major threats to healthy aging in modern societies. The connection between MetS components and gut microflora is now acknowledged and multiple therapeutic strategies have been proposed to change the composition of the gut microbiota in order to promote optimal metabolic health. Prebiotics have the ability to favour growth of beneficial bacteria, especially short-chain fatty-acids (SCFA) producers. Increased SCFA in the gut is associated with improved satiety and weight loss, reduced systemic inflammation by increasing the gut barrier function, and improved glucose and lipid metabolism. The objective of this review is to examine the recent literature in order to determine the types and doses of prebiotics that could be recommended for the management of MetS. A review of the literature was executed using the MEDLINE database and clinical trials from 2013 to 2017 were selected for analysis. In conclusion, a daily supplementation of 10g of inulin, resistant starches or fructo-oligosaccharide-enriched inulin could have beneficial effects on MetS components in individuals with type 2 diabetes. In healthy subjects or in individuals with the MetS, the results are too heterogeneous and scarce to be able to set any specific recommendations. More clinical studies are needed to better understand the role of prebiotics in the management of MetS components.

Relationship between lactation duration and insulin and glucose response among women with prior gestational diabetes.

BACKGROUND: Few studies have investigated whether favorable effects of lactation persist after weaning and protect women with prior gestational diabetes mellitus (GDM) against later development of insulin resistance and insulin secretion defects. OBJECTIVE: To investigate the impact of lactation duration on insulin and glucose response among women with prior GDM. DESIGN/METHODS: The study group comprised 144 women with a history of GDM between 2003 and 2010. Plasma insulin and glucose concentrations were obtained from a 75 g oral glucose tolerance test (OGTT). Total lactation duration (exclusive breastfeeding and breast and bottle-feeding) for all infants was self-reported in months. RESULTS: Mean age was 36.5±5.0 years. Time between delivery and metabolic testing was 4.0±1.9 years. Women breastfed for an average of 13.9±16.8 months. Most women (80.6%) reported a history of lactation. Women who lactated had higher homeostasis model assessment for insulin sensitivity (HOMA-IS) and Matsuda indices and lower fasting and 2-h post-OGTT insulin concentrations as well as area under the curve (AUC) for insulin (P≤0.01 for all). Compared with women who lactated for <10 months, women who lactated for ≥10 months had improved insulin sensitivity-secretion index, higher HOMA-IS and Matsuda indices, lower fasting and 2-h post-OGTT insulin concentrations as well as AUC for insulin, and lower incidence of impaired glucose intolerance (P≤0.05 for all). In multiple linear regression analyses, lactation duration emerged as an independent predictor of fasting insulin concentrations (ß=-0.02) and insulin sensitivity indices (ß=0.02) (P≤0.05 for all). CONCLUSIONS: These results suggest that longer duration of lactation is associated with improved insulin and glucose response among women with prior GDM.