Epigenome-Wide Meta-analysis Reveals Associations Between Dietary Glycemic Index and Glycemic Load and DNA Methylation in Children and Adolescents of Different Body Sizes.

OBJECTIVE: Dietary glycemic index (GI) and glycemic load (GL) are associated with cardiometabolic health in children and adolescents, with potential distinct effects in people with increased BMI. DNA methylation (DNAm) may mediate these effects. Thus, we conducted meta-analyses of epigenome-wide association studies (EWAS) between dietary GI and GL and blood DNAm of children and adolescents. RESEARCH DESIGN AND METHODS: We calculated dietary GI and GL and performed EWAS in children and adolescents (age range: 4.5-17 years) from six cohorts (N = 1,187). We performed stratified analyses of participants with normal weight (n = 801) or overweight or obesity (n = 386). We performed look-ups for the identified cytosine-phosphate-guanine (CpG) sites (false discovery rate [FDR] <0.05) with tissue-specific gene expression of 832 blood and 223 subcutaneous adipose tissue samples from children and adolescents. RESULTS: Dietary GL was positively associated with DNAm of cg20274553 (FDR <0.05), annotated to WDR27. Several CpGs were identified in the normal-weight (GI: 85; GL: 17) and overweight or obese (GI: 136; GL: 298; FDR <0.05) strata, and none overlapped between strata. In participants with overweight or obesity, identified CpGs were related to RNA expression of genes associated with impaired metabolism (e.g., FRAT1, CSF3). CONCLUSIONS: We identified 537 associations between dietary GI and GL and blood DNAm, mainly in children and adolescents with overweight or obesity. High-GI and/or -GL diets may influence epigenetic gene regulation and thereby promote metabolic derangements in young people with increased BMI.

Short-term effects of goat milk yogurt-containing angiotensin-converting enzyme inhibitory peptides and two raisin varieties on subjective appetite, blood pressure and glycaemic responses in healthy adults. Results from a randomised clinical trial.

Goat milk yogurt (GMY) and raisins are popular foods with a favourable nutrient profile. Our aim was to determine the glycaemic index (GI) and postprandial responses to GMY-containing angiotensin-converting enzyme inhibitory (ACE-I) peptides carrying the RPKHPINHQ isracidin fragment and two Greek raisin varieties in an acute feeding setting. A total of twelve healthy participants (four male and eight female) consumed breakfast study foods containing 25 g available carbohydrate on seven occasions over a 3- to 9-week period: food 1: D-glucose (25 g) served as the control and was consumed on three separate occasions; food 2: GMY (617·28 g); food 3: Corinthian raisins (37·76 g); food 4: Sultana raisins (37·48 g) and food 5: GMY & C (308·64 g GMY and 18·88 g C). Postprandial glucose was measured over a 2 h period for the determination of GI and glycaemic load (GL). Subjective appetite ratings (hunger, fullness and desire to eat) were assessed by visual analogue scales (100 mm) at 0­120 min. Blood pressure (systolic and diastolic; BP) was measured at baseline and 120 min. GMY provided low GI (26), C and S provided high GI/low GL (75/10 and 70/9, respectively) and GMYC provided low GI (47) values on glucose scale compared with D-glucose. Peak blood glucose rise was significantly lower only for GMY and GMYC compared with reference food (D-Glucose), as well as C and S (Pfor all < 0·05). No differences were observed between test foods for fasting glucose, BP and subjective appetite. In conclusion, GMY and GMYC attenuated postprandial glycaemic responses, which may offer advantages to glycaemic control.

Satiety, glycemic profiles, total antioxidant capacity, and postprandial glycemic responses to different sugars in healthy Malaysian adults.

OBJECTIVES: We investigated a low-glycemic index (GI), minimally refined brown sugar (MRBS) that retains a consistent amount of antioxidant polyphenols. This study aimed to determine whether MRBS has a lower postprandial glycemic response and GI value compared with other types of refined sugar (RS). Low glycemic response foods are also reported to increase satiety. Accordingly, we also evaluated satiety profiles, glycemic profiles (glucose, insulin, and glucagon), and total antioxidant capacity (TAC). METHODS: This work shows the results of two single-blind, cross-over studies (studies 1 and 2). For each study 14 healthy Malay individuals with a normal body mass index were recruited. In study 1, capillary blood samples were used to determine the GI of the tested sugars. Venous blood samples were used in study 2 to measure the concentrations of satiety hormones (peptide tyrosine, C-peptide, glucagon-like peptide-1, and leptin), TAC, plasma glucose, insulin, and glucagon concentrations at baseline (0 min) and at 60 and 120 min after consumption of the MRBS and RS formulated jellies. RESULTS: The incremental area under the curve of glucose positive control (312 ± 62.54 mmol.min/L) was significantly higher than that of other types of sucrose (P < 0.05). MRBS (GI: 54 ± 4.5 mmol.min/L) and brown sugar (GI: 50 ± 5.0 mmol.min/L) were categorized as low GI, and RS (GI: 64 ± 5.73 mmol.min/L) was in the medium category, which was significantly lower than the GI of glucose (GI: 100 mmol.min/L; P < 0.05). Likewise, there was a significant difference in satiety profiles (peptide tyrosine and C-peptide), glycemic profile (glucagon), and TAC (P < 0.05) between RS and MRBS jellies. CONCLUSIONS: The results of our work show that MRBS had a lower GI (study 1), and better satiety, glycemic profiles, and TAC (study 2) compared with RS.

The Use of Iron-Enriched Yeast for the Production of Flatbread.

The most common cause of iron deficiency is an improperly balanced diet, in which the body's need for iron cannot be met by absorption of this element from food. Targeted iron supplementation and food fortification may be the main treatments for iron deficiency in the population. However, many iron-rich supplements and foods have low bioavailability of this element. In our study, we used yeast enriched with iron ions to produce flatbread. The yeast cells accumulated iron ions from the medium supplemented with Fe(NO3)3·9H2O, additionally one of the cultures was treated with pulsed electric field in order to increase the accumulation. The potential bioavailability of iron from flatbread containing 385.8 ± 4.12 mg of iron in 100 g dry mass was 10.83 ± 0.94%. All the flatbreads had a moderate glycemic index. There were no significant differences in antioxidant activity against DPPH• between flatbread with iron-enriched and non-iron-enriched yeast. Sensory evaluation showed that this product is acceptable to consumers since no metallic aftertaste was detected. Iron enriched flatbread can potentially be an alternative to dietary supplements in iron deficiency states.

Perioperative Glycemia Management in Patients Undergoing Craniotomy for Brain Tumor Resection: A Global Survey of Neuroanesthesiologists' Perceptions and Practices.

OBJECTIVE: There is a paucity of clinical evidence that guides perioperative glycemia management in patients undergoing craniotomy for brain tumor resection. The purpose of this study was to better understand global perceptions and practices related to glycemia management in these patients. METHODS: Neuroanesthesiologists throughout North America, South America, Europe, and Asia filled out a brief online questionnaire related to their perceptions and practices regarding glycemia management in patients undergoing craniotomy for brain tumor resection. RESULTS: Over 4 weeks, 435 participants practicing in 34 countries across 6 continents participated in this survey. Although responders in North America were found to perceive a higher risk hyperglycemia compared with those practicing in European (P = 0.024) and South Asian (P = 0.007) countries, responders practicing in South Asian countries (P = 0.030), Middle Eastern countries (P = 0.029), and South American (P = 0.005) countries were more likely than those from North America to remeasure glucose after an initial normal glucose measurement at incision. Responders from North America reported that a higher blood glucose threshold was necessary for them to delay or cancel the surgery compared with responders in Slavic (P < 0.001), European (P = 0.002), South American (P = 0.002), and Asian and Pacific (P < 0.001) countries. Responders from North America were more likely to report that they would delay or cancel the surgery because of a higher blood glucose threshold. CONCLUSIONS: Our survey results suggest that perceptions and practices related to blood glucose management in patients undergoing brain tumor resection are variable. This study highlights the need for stronger clinical evidence and guidelines to help guide decisions for when and how to manage blood glucose derangements in these patients.

Copper, Iron, Selenium and Lipo-Glycemic Dysmetabolism in Alzheimer's Disease.

The aim of the present review is to discuss traditional hypotheses on the etiopathogenesis of Alzheimer's disease (AD), as well as the role of metabolic-syndrome-related mechanisms in AD development with a special focus on advanced glycation end-products (AGEs) and their role in metal-induced neurodegeneration in AD. Persistent hyperglycemia along with oxidative stress results in increased protein glycation and formation of AGEs. The latter were shown to possess a wide spectrum of neurotoxic effects including increased Aß generation and aggregation. In addition, AGE binding to receptor for AGE (RAGE) induces a variety of pathways contributing to neuroinflammation. The existing data also demonstrate that AGE toxicity seems to mediate the involvement of copper (Cu) and potentially other metals in AD pathogenesis. Specifically, Cu promotes AGE formation, AGE-Aß cross-linking and up-regulation of RAGE expression. Moreover, Aß glycation was shown to increase prooxidant effects of Cu through Fenton chemistry. Given the role of AGE and RAGE, as well as metal toxicity in AD pathogenesis, it is proposed that metal chelation and/or incretins may slow down oxidative damage. In addition, selenium (Se) compounds seem to attenuate the intracellular toxicity of the deranged tau and Aß, as well as inhibiting AGE accumulation and metal-induced neurotoxicity.

The effect of 6-day subcutaneous glucose-dependent insulinotropic polypeptide infusion on time in glycaemic range in patients with type 1 diabetes: a randomised, double-blind, placebo-controlled crossover trial.

AIMS/HYPOTHESIS: Type 1 diabetes is characterised by reduced glucagon response to hypoglycaemia, increasing the risk of insulin treatment-associated hypoglycaemia known to hamper glycaemic control. We previously reported a glucagonotropic effect of exogenous glucose-dependent insulinotropic polypeptide (GIP) during insulin-induced hypoglycaemia in individuals with type 1 diabetes. Here we investigate the effect of a 6-day s.c. GIP infusion on time in glycaemic range as assessed by continuous glucose monitoring (CGM) in individuals with type 1 diabetes. METHODS: In a randomised, placebo-controlled, double-blind crossover study, time in glycaemic range (assessed by double-blinded CGM) was evaluated in 20 men with type 1 diabetes (18-75 years, stable insulin treatment ≥3 months, diabetes duration 2-15 years, fasting plasma C-peptide below 200 pmol/l, BMI 20-27 kg/m2, HbA1c <69 mmol/mol [8.5%]) during two × 6 days of continuous s.c. GIP (6 pmol kg-1 min-1) and placebo (saline [154 mmol/l NaCl]) infusion, respectively, with an interposed 7-day washout period. The primary outcome was glycaemic time below range, time in range and time above range. RESULTS: There were no significant differences in time below range (<3.9 mmol/l, p = 0.53) or above range (>10 mmol/l, p = 0.32) during night-time or daytime, in mean glucose, or in hypoglycaemic events as assessed by CGM. GIP altered neither self-reported hypoglycaemia nor safety measures. Compared with placebo, GIP significantly increased time in tight range (3.9-7.8 mmol/l) during daytime (06:00-23:59 hours) by [mean ± SEM] 11.2 ± 5.1% [95% CI 0.41, 21.9] (p = 0.02). CONCLUSIONS/INTERPRETATION: Six-day s.c. GIP infusion in men with type 1 diabetes did not procure convincing effect on overall time in range, but increased time in tight glycaemic range during daytime by ~2 h per day. TRIAL REGISTRATION: ClinicalTrials.gov NCT03734718. FUNDING: The study was funded by grants from The Leona M. and Harry B. Helmsley Charitable Trust and Aase og Ejnar Danielsens Fond.

The genetic association of the transcription factor NPAT with glycemic response to metformin involves regulation of fuel selection.

The biguanide, metformin, is the first-choice therapeutic agent for type-2 diabetes, although the mechanisms that underpin metformin clinical efficacy remain the subject of much debate, partly due to the considerable variation in patient response to metformin. Identification of poor responders by genotype could avoid unnecessary treatment and provide clues to the underlying mechanism of action. GWAS identified SNPs associated with metformin treatment success at a locus containing the NPAT (nuclear protein, ataxia-telangiectasia locus) and ATM (ataxia-telangiectasia mutated) genes. This implies that gene sequence dictates a subsequent biological function to influence metformin action. Hence, we modified expression of NPAT in immortalized cell lines, primary mouse hepatocytes and mouse tissues, and analysed the outcomes on metformin action using confocal microscopy, immunoblotting and immunocytochemistry. In addition, we characterised the metabolic phenotype of npat heterozygous knockout mice and established the metformin response following development of insulin resistance. NPAT protein was localised in the nucleus at discrete loci in several cell types, but over-expression or depletion of NPAT in immortalised cell models did not change cellular responses to biguanides. In contrast, metformin regulation of respiratory exchange ratio (RER) was completely lost in animals lacking one allele of npat. There was also a reduction in metformin correction of impaired glucose tolerance, however no other metabolic abnormalities, or response to metformin, were found in the npat heterozygous mice. In summary, we provide methodological advancements for the detection of NPAT, demonstrate that minor reductions in NPAT mRNA levels (20-40%) influence metformin regulation of RER, and propose that the association between NPAT SNPs and metformin response observed in GWAS, could be due to loss of metformin modification of cellular fuel usage.

Validation of the Enriching New-Onset Diabetes for Pancreatic Cancer Model in a Diverse and Integrated Healthcare Setting.

BACKGROUND: The risk of pancreatic cancer is elevated among people with new-onset diabetes (NOD). Based on Rochester Epidemiology Project Data, the Enriching New-Onset Diabetes for Pancreatic Cancer (END-PAC) model was developed and validated. AIMS: We validated the END-PAC model in a cohort of patients with NOD using retrospectively collected data from a large integrated health maintenance organization. METHODS: A retrospective cohort of patients between 50 and 84 years of age meeting the criteria for NOD in 2010-2014 was identified. Each patient was assigned a risk score (< 1: low risk; 1-2: intermediate risk; ≥ 3: high risk) based on the values of the predictors specified in the END-PAC model. Patients who developed pancreatic ductal adenocarcinoma (PDAC) within 3 years were identified using the Cancer Registry and California State Death files. Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated. RESULTS: Out of the 13,947 NOD patients who were assigned a risk score, 99 developed PDAC in 3 years (0.7%). Of the 3038 patients who had a high risk, 62 (2.0%) developed PDAC in 3 years. The risk increased to 3.0% in white patients with a high risk. The AUC was 0.75. At the 3+ threshold, the sensitivity, specificity, PPV, and NPV were 62.6%, 78.5%, 2.0%, and 99.7%, respectively. CONCLUSIONS: It is critical that prediction models are validated before they are implemented in various populations and clinical settings. More efforts are needed to develop screening strategies most appropriate for patients with NOD in real-world settings.

El efecto agudo sobre niveles de glucemia en adultos mayores con el Entrenamiento Interválico de Alta Intensidad / Acute effect of High-Intensity Interval Training on glycemia levels in elderly people

Introducción: El Entrenamiento Interválico de Alta Intensidad durante los últimos años ha sido postulado como tratamiento no farmacológico para enfermedades como la diabetes tipo II en diferentes poblaciones, sin embargo, son pocos los estudios que se han realizado en adultos mayores. Objetivo: Determinar el efecto agudo de una sesión de Entrenamiento Interválico de Alta Intensidad sobre los niveles de glucosa en adultos mayores físicamente activos. Métodos: Se realizó un estudio experimental. La muestra estuvo conformada por 19 adultos mayores (60-85 años). El grupo fue sometido a una sesión de Entrenamiento Interválico de Alta Intensidad, en la que se combinaron ejercicios de fuerza con resistencia cardiovascular, y se realizaron 12 ejercicios con duración de 30 segundos de trabajo por 10 de descanso. La intensidad de la sesión fue controlada a través de la Escala de Percepción del Esfuerzo OMNI-GSE. Se midió la talla (cm), el peso (kg) e índice de masa corporal. Los niveles de glucosa en sangre fueron determinados antes y después de la sesión. Resultados: Se obtuvo una disminución significativa en los niveles de glucosa en sangre posterior a la realización de la sesión de Entrenamiento Interválico de Alta Intensidad (pre: 140,5 mg/dL y post: 116,1 mg/dL; p < 0,01) Conclusiones: El Entrenamiento Interválico de Alta Intensidad reduce en una sola sesión los niveles de glucosa en sangre en adultos mayores(AU)

Introduction: in recent years, High-Intensity Interval Training has been recognized as a non-pharmacological treatment for diseases like type II diabetes in a variety of populations. However, few studies about this topic have been conducted with elderly people. Objective: determine the acute effect of a High-Intensity Interval Training session on glucose levels in physically active elderly people. Methods: an experimental study was conducted. The sample was 19 elderly people aged 60-85 years. The group participated in a High-Intensity Interval Training session in which strength and cardiovascular resistance exercises were combined. The 12 exercises performed had a duration of 30 seconds' work and 10 seconds' rest. The intensity of the session was controlled with the OMNI-GSE Effort Perception Scale. Measurements were taken of the height (cm), weight (kg) and body mass index of participants. Blood glucose levels were gauged before and after the session. Results: a significant reduction in blood glucose levels was obtained after the conduct of the High-Intensity Interval Training session (pre: 140.5 mg/dl and post: 116.1 mg/dl; p < 0.01). Conclusions: in only one session, High-Intensity Interval Training reduces blood glucose levels in elderly people(AU)

Assessment of the glycemic index of groats available on the Polish food market

Background: Glycemic index (GI) and glycemic load (GL) are often used to assess diet quality in relation to the risk of diabetes, cardiovascular diseases and cancer development. Taking into account differences in nutritional value of food products in different countries it is often suggested to used national databases to assess dietary intake in different populations. Objective: To assess the glycemic index and glycemic load of the selected groats available on the Polish food market. Material and methods: GI of the following groats available on the Polish food market was assessed: couscous, buckwheat (roasted) groats, millet groats, spelt groats, barley (hulled) groats and bulgur groats. The GI was assessed as the incremental area under the blood glucose response curve of a 50g carbohydrate portion of a test food expressed as a percent of the response to the same amount of carbohydrate from a standard food taken by the same subject. GL was calculated for the 100 g of the cooked product. Results: The lowest GI was found for buckwheat (34.7±8.2%) and barley (31.3±13.4%) groats. The GL for these groats was 8.1±1.9 and 8.0±3.4, respectively. The GI for millet, spelt and bulgur groats amounted to 56.2±20.6%, 69.8±35.0%, 64.5±36.8%, respectively, while for couscous amounted to 99.0± 36.0%. The highest GL was observed for couscous (24.7±9.0). Conclusions: The groats tested in this study can be classified as follows: barley and buckwheat as a low GI food, millet and bulgur as a medium GI food, spelt and couscous as a high GI food. Buckwheat and barley groats should be chosen the most often among these products, while the intake of couscous should be limited especially by people with diabetes.

Índice glucosa-triglicéridos como marcador de resistencia a la insulina en pacientes con diagnóstico de hipertensión arterial esencial / Glycemia-triglyceride index as marker of insulin resistance in essential hypertensive patients

Introducción: El índice glucemia-triglicéridos se utiliza para el diagnóstico presuntivo de la resistencia insulínica, que en los pacientes hipertensos se relaciona con la severidad de la hipertensión arterial. Objetivo: Determinar la utilidad del índice glucemia-triglicéridos como marcador de resistencia a la insulina en pacientes adultos con diagnóstico de hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo transversal en 232 pacientes con diagnóstico de hipertensión arterial esencial. Se calculó el índice glucemia-triglicéridos y se comparó con el índice HOMA. Para este análisis se utilizó la curva ROC, la correlación de Pearson y el Índice de Kappa, se consideró significativo un valor de p menor a 0,05. Resultados: Se obtuvo un punto de corte de 8,1 que mostró una sensibilidad de 98,6 con una especificidad de 41,4. La curva ROC mostró un área bajo la curva con valor de 0,694 ≈ 0,7. Se observó correlación positiva (p=0,008) Índice de Kappa=88,4 por ciento. Conclusiones: El índice glucemia-triglicéridos resulto ser útil en pacientes con hipertensión arterial como marcador de resistencia a la insulina con un punto de corte de 8,1(AU)

Introduction: The glycemia-triglyceride index is used for the presumptive diagnosis of insulin resistance, which in hypertensive patients is related to the severity of high blood pressure. Objective: To determine the utility of the glycemia-triglyceride index as a marker of insulin resistance in adult patients diagnosed with essential arterial hypertension. Methods: A descriptive cross-sectional study was carried out in 232 patients diagnosed with essential arterial hypertension. The glycemia-triglyceride index was calculated and compared with HOMA index. For this analysis, ROC curve, Pearson correlation and Kappa index were used, p value less than 0.05 was considered significant. Results: We obtained an 8.1 cut-off point, showing 98.6 sensitivity and 41.4 specificity. The area below the ROC curve showed 0.694 ≈ 0.7 value. Positive correlation was observed (p = 0.008). Kappa index = 88.4 percent. Conclusions: The glycemia-triglyceride index turned out to be useful in patients with essential hypertension as a marker of insulin resistance with a cut-off point of 8.1(AU)

Dietary glycaemic index, glycaemic load and head and neck cancer risk: a pooled analysis in an international consortium.

High dietary glycaemic index (GI) and glycaemic load (GL) may increase cancer risk. However, limited information was available on GI and/or GL and head and neck cancer (HNC) risk. We conducted a pooled analysis on 8 case-control studies (4081 HNC cases; 7407 controls) from the International Head and Neck Cancer Epidemiology (INHANCE) consortium. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) of HNC, and its subsites, from fixed- or mixed-effects logistic models including centre-specific quartiles of GI or GL. GI, but not GL, had a weak positive association with HNC (ORQ4 vs. Q1 = 1.16; 95% CI = 1.02-1.31). In subsites, we found a positive association between GI and laryngeal cancer (ORQ4 vs. Q1 = 1.60; 95% CI = 1.30-1.96) and an inverse association between GL and oropharyngeal cancer (ORQ4 vs. Q1 = 0.78; 95% CI = 0.63-0.97). This pooled analysis indicates a modest positive association between GI and HNC, mainly driven by laryngeal cancer.

Heterogeneity in liver histopathology is associated with GSK-3ß activity and mitochondrial dysfunction in end-stage diabetic rats on differential diets.

While liver histopathology is heterogeneous in diabetes, the underlying mechanisms remain unclear. We investigated whether glycemic variation resulting from differential diets can induce heterogeneity in diabetic liver and the underlying molecular mechanisms. We generated end-stage non-obese diabetic model rats by subtotal-pancreatectomy in male Sprague- Dawley rats and ad libitum diet for 7 weeks (n = 33). The rats were then divided into three groups, and fed a standard- or a low-protein diet (18 or 6 kcal%, respectively), for another 7 weeks: to maintain hyperglycemia, 11 rats were fed ad libitum (18AL group); to achieve euglycemia, 11 were calorierestricted (18R group), and 11 were both calorie- and proteinrestricted with the low-protein diet (6R group). Overnightfasted liver samples were collected after the differential diets together with sham-control (18S group), and histology and molecular changes were compared. Hyperglycemic-18AL showed glycogenic hepatopathy (GH) without steatosis, with the highest GSK-3ß inactivation because of Akt activation during hyperglycemia; mitochondrial function was not impaired, compared to the 18S group. Euglycemic-18R showed neither GH nor steatosis, with intermediate GSK-3ß activation and mitochondrial dysfunction. However, euglycemic-6R showed both GH and steatosis despite the highest GSK-3ß activity and no molecular evidence of increased lipogenesis or decreased ApoB expression, where mitochondrial dysfunction was highest among the groups. In conclusion, heterogeneous liver histopathology developed in end-stage non-obese diabetic rats as the glycemic levels varied with differential diets, in which protein content in the diets as well as glycemic levels differentially influenced GSK-3ß activity and mitochondrial function in insulin-deficient state. [BMB Reports 2020; 53(2): 100-105].

Esteatosis hepática en pacientes con diabetes tipo 2 y su relación con el control glucémico / Hepatic steatosis in type 2 diabetes patients and its relationship with glycemic control

Introducción: La esteatosis hepática no alcohólica es la enfermedad con mayor frecuencia en el mundo, esta se asocia a diabetes mellitus tipo 2; padecimiento con gran impacto económico-social. Objetivo: Describir el comportamiento de esteatosis hepática en una población de pacientes con diagnóstico de diabetes mellitus tipo 2. Métodos: Se realizó un estudio observacional, descriptivo, transversal en 94 pacientes diabéticos atendidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el periodo comprendido entre febrero 2016- febrero 2018. Resultados: La esteatosis fue leve en 42,6 por ciento, moderada (44,7 por ciento) y severa en 12,8 por ciento, en ambos casos, con un NAFLD score principalmente indeterminado (72,3 por ciento). Se detectó fibrosis F0-1 en 58,5 por ciento de los pacientes, F2 (29,8 por ciento) y significativa (F3 y F4) en 11,7 por ciento). Se detectó asociación entre ecogenicidad hepática aumentada, patrón hepático difuso y grado severo de esteatosis por ecografía con mayor grado de fibrosis según elastografía. Se detectó relación significativa de niveles elevados de HBA1C con fibrosis significativa medida tanto por NAFLD score como por elastografía. Conclusiones: La esteatosis hepática presente en los pacientes con diabetes mellitus fue principalmente leve a moderada con prevalencia de fibrosis leve, el grado de fibrosis significativa se asoció con ecogenicidad hepática aumentada, patrón hepático difuso, grado severo de esteatosis por ecografía y niveles elevados de hemoglobina glucosilada(AU)

Introduction: Non-alcoholic liver steatosis is the most frequent disease in the world. It is associated with type 2 diabetes mellitus, representing great economic-social impact. Objective: To describe the behavior of hepatic steatosis in a population of patients diagnosed with type 2 diabetes mellitus. Methods: An observational, descriptive, cross-sectional study was conducted in 94 diabetic patients treated at Hermanos Ameijeiras Clinical Surgical Hospital, from February 2016 to February 2018. Results: Steatosis was mild in 42.6 percent, moderate (44.7 percent) and severe in 12.8 percent, with a mainly indeterminate NAFLD score (72.3 percent). F0-1 fibrosis was detected in 58.5 percent of the patients, F2 (29.8 percent) and significant (F3 and F4) in 11.7 percent). Association between increased liver echogenicity, diffuse liver pattern and severe degree of steatosis were ostensible by ultrasound with higher degree of fibrosis according to elastography. Significant relationship of elevated levels of HBA1C with significant fibrosis was detected, measured both by NAFLD score and by elastography. Conclusions: Hepatic steatosis present in patients with diabetes mellitus was mainly mild to moderate with prevalence of mild fibrosis, the degree of significant fibrosis was associated with increased liver echogenicity, diffuse liver pattern, severe degree of steatosis by ultrasound and high levels of hemoglobin. glycosylated(AU)

Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan.

AIMS: The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.

Hipovitaminose D e índices glicêmicos em trabalhadores de turno alternante de empresa de mineração / Hypovitaminosis D and glycemic index in individuals working in rotate shifts of a mining company

Objetivo: Demonstrar a prevalência da hipovitaminose D em trabalhadores de turno de uma empresa de mineração e verificar se, nesta população, há correlação entre as variáveis glicêmicas (hemoglobina glicada e glicemia de jejum) e os níveis séricos de vitamina D. Métodos: Estudo transversal observacional realizado por 2 anos consecutivos com trabalhadores de turno. No primeiro ano, foram analisados os níveis séricos de vitamina D (25(OH)D) e glicemia de jejum, excluindo indivíduos que realizavam tratamento para controle glicêmico, suplementação de vitamina D e/ou participantes do sexo feminino, totalizando 548 trabalhadores. No ano seguinte, foram selecionados da amostra anterior apenas os indivíduos que apresentaram hipovitaminose D (25(OH) D<30ng/mL). Nestes, foram analisados os níveis de 25(OH)D, glicemia de jejum e hemoglobina glicada. Foram aplicados o teste de normalidade Kolmogorov-Smirnov e a correlação de Spearman. Resultados: A idade média dos participantes foi de 38,2 anos. No primeiro ano, 80,8% dos trabalhadores apresentaram hipovitaminose D e 10,8% apresentavam glicemia de jejum fora dos níveis de normalidade. Dentre a amostra do ano seguinte, 81,1% permaneceram com hipovitaminose D, 18,2% apresentaram glicemia de jejum fora dos níveis de normalidade e 15,8% apresentaramhemoglobina glicada alterada. Não foram encontradas correlações significativas entre a 25(OH)D e a glicemia de jejum e hemoglobina glicada. Conclusão: Foi observada alta prevalência de hipovitaminose nos trabalhadores de turno. Diferentemente de outros estudos, não foram encontradas correlações significativas entre as variáveis glicêmicas e a concentração sérica da vitamina D. (AU)

Objective: To demonstrate the prevalence of hypovitaminosis D in shift workers of a mining company, and to check whether, in this population, there is a correlation between glycemic variables (glycosylated hemoglobin and fasting plasma glucose)- and serum levels of vitamin D. Methods: These are cross-sectional observational studies performed in two consecutive years with shift workers. In the first year, the serum levels of vitamin D (25(OH)D) and fasting plasma glucose were analyzed, with people who underwent treatment for glycemic control, vitamin D supplementation, and/or female participants being excluded, totalizing 548 workers. In the following year, only those individuals who presented hypovitaminosis D (25 (OH) D <30 ng/dL) were selected from the previous sample. The levels of 25 (OH) D, fasting plasma glucose, and HbA1C of these individuals were analyzed. The Kolmorogov-Smirnov normality test and the Spearman correlation were applied. Results: Th e m ean a ge o f participants was 38.2 years. In the first year, 80.8% (n=442) of the workers presented hypovitaminosis D, and 10.8% had fasting plasma glucose out of normal levels. Among the sample of the following year, 81.1% remained with hypovitaminosis D, 18.2% (n=51) had fasting glycemia out of normal levels, and 15.8% (n=44) had altered glycosylated hemoglobin. Conclusion: A high prevalence of hypovitaminosis in shift workers was observed. Differently from other studies, no significant correlations were found between glycemic variables and serum vitamin D concentration. (AU)

Phytomodulatory proteins promote inhibition of hepatic glucose production and favor glycemic control via the AMPK pathway.

Phytomodulatory proteins from the latex of the medicinal plant Calotropis procera has been shown to be implicated in many pharmacological properties. However there is no current information about their activity on glucose metabolism, although the latex is used in folk medicine for treating diabetes. In this study the phytomodulatory proteins (LP) from C. procera latex were assessed on glycemic homeostasis. Control animals received a single intravenous dose (5 mg/kg) of LP or saline solution (CTL). Four hours after treatment, the animals were euthanized and their livers were excised for analysis by western blot and RT-PCR AMP-activated protein kinase (AMPK), phosphoenolpyruvate carboxykinase (PEPCK) and tumor necrosis factor alpha (TNF-α). In vivo tests of intraperitoneal tolerance to insulin, glucose and pyruvate were also performed, and the effect of LP administration on fed glycemia was studied followed by blood analysis to determine serum insulin levels. Treatment with LP reduced glycemia two hours after glucose administration (LP: 87.2 ± 3.70 mg/dL versus CTL: 115.6 ± 8.73 mg/dL). However, there was no change in insulin secretion (CTL: 14.16 ± 0.68 mUI/mL and LP: 14.96 ± 0.55 mUI/mL). LP improved the insulin sensitivity, represented by a superior glucose decay constant during an insulin tolerance test (kITT) (4.17 ± 0.94%/min) compared to the CTL group (0.82 ± 0.72%/min), and also improved glucose tolerance at 30 min (105.2 ± 12.4 mg/dL versus 154.2 ± 18.51 mg/dL), while it decreased hepatic glucose production at 15 and 30 min (LP: 75.5 ± 9.31 and 52.5 ± 12.05 mg/dL compared to the CTL: 79.0 ± 3.02 and 84.5 ± 7.49 mg/dL). Furthermore, there was a significant inhibition of gene expression of PEPCK (LP: 0.66 ± 0.06 UA and CTL: 1.14 ± 0.22 UA) and an increase of phosphorylated AMPK (LP: 1.342 ± 0.21 UA versus CTL: 0.402 ± 0.09 UA). These findings confirm the effect of LP on glycemic control and suggest LP may be useful in diabetes treatment. However, the pharmacological mechanism of LP in PEPCK modulation still needs more clarification.

Early worsening of diabetic retinopathy due to intensive glycaemic control.

The prevalence of diabetes and diabetic retinopathy is increasing around the world. Glycaemic control is important in reducing the long-term risk of complications of diabetes, however intensive glycaemic control, particularly in patients with longstanding and poorly controlled diabetes, is associated with the risk of early worsening of diabetic retinopathy and vision loss. We present two clinical cases to illustrate the presentation of early worsening and to highlight a role for intravitreal anti-vascular endothelial growth factor therapies in ameliorating this phenomenon, as well as a review of the current understanding of this phenomenon. We emphasise the importance of identifying individuals at risk of early worsening of diabetic retinopathy and recommend regular ophthalmological review during the period of intensive glycaemic control to ensure optimal visual outcomes.

Glycated hemoglobin A1c level on the day of emergency surgery is a marker of premorbid glycemic control: a retrospective observational study.

BACKGROUND: Current international guideline recommends to maintain blood glucose level ≤ 180 mg/dL in acute ill patients, irrespective of presence of premorbid diabetes. However, there are studies suggested that optimal acute glycemic control should be adjusted according to premorbid glycemic control in patients with chronic hyperglycemia. Accordingly, to obtain the information of premorbid glycemic control would be relevant. However, the HbA1c level on the day of the emergency operation (HbA1c-ope) might not be useful as a surrogate of premorbid chronic glycemic control, since glucose metabolism can be affected by inflammation, severity of illness and surgical invasion. METHODS: We hypothesized that HbA1c-ope reflects pre-morbid glycemic control. To assess this hypothesis, we conducted a single-center retrospective observational study to assess the association between HbA1c-ope and HbA1c level measured within 30 days before the operation (HbA1c-pre). We screened patients who had been admitted to the ICU of our hospital after emergency surgery during the period from January 2008 to December 2016. Patients in whom both of HbA1c-ope and HbA1c-pre were measured were included in this study. We compared HbA1c-ope and HbA1c-pre using the paired t-test. The correlation between the two HbA1c measurements was assessed using Pearson's correlation coefficient. Its agreement was assessed using the Bland-Altman approach with 95% confidence intervals. RESULTS: We included 48 patients in this study. The mean value of HbA1c-pre was 6.3%, which was not significantly different from the mean value of 6.2% for HbA1c-ope (p = 0.12). There was a significant correlation between HbA1c-pre and HbA1c-ope (r2 = 0.70, p < 0.001). The mean difference between two HbA1c measurements was 0.12% (95% CI: -0.03% to 0.27%). The limit of agreement ranged from - 0.9% to +1.1%. CONCLUSIONS: We found that there was a significant correlation between HbA1c-ope and HbA1c-pre. Our findings suggest that HbA1c-ope can be used to estimate previous glycemic control with an acceptable degree of accuracy, enabling personalized glycemic control in the perioperative period.