Postprandial hyperglycemia after ingestion of peeled and non-peeled fruits in type-2 diabetics.

Should diabetics prefer nonpeeled fruits in their diet? To answer this question 27 type-2 diabetics divided into three groups were examined on two different occasions under the same fasting conditions. The first group of patients received 300g of pears with peel and on another day 300g of peeled pears. The second group ate 300g of pears with peel and 230g of peeled pears (the 70g difference represents the weight of the peel). The third group of diabetics consumed 300g of apples with peel and 300g of apples without peel. Blood samples were collected before and 20, 40, 60, 80, 100, 120 and 140 min after fruit ingestion. No significant differences were noted in terms of mean blood glucose, serum insulin and serum triglyceride levels among the two meals (fruits with or without peel). This observation was confirmed in all groups studied. Peeled and nonpeeled fruits appear to produce the same hyperglycemia in type-2 diabetics, in spite of the high fiber content of the peel. Therefore, the suggestion of reducing postprandial hyperglycemia in diabetics by eating nonpeeled fruits does not seem to be justified.

Metabolic effects of honey (alone or combined with other foods) in type II diabetics.

The metabolic effects of honey - alone or combined with other foods - were investigated in type II diabetics using 2 protocols: A) 33 g honey and 50 g bread (same amounts of carbohydrate) were given on alternate days to 12 patients. Blood levels of glucose, insulin and triglycerides were determined in venous samples before and every 30 min after meal ingestion (for a total of 3h). Areas under glucose curves were equal, although honey - compared to bread - resulted in higher blood sugar concentrations at 30 min (p less than 0.01) and lower at 90 min (p less than 0.05). B) Another 19 type II diabetics consumed on separate days 3 different meals: H (30 g honey), HA (30 g honey, 100 g almonds), HB (30 g honey, 125 g cheese, 10 g bread, 10 g butter). HA and HB contained the same amount of fat, but were different in fiber. No significant differences in the areas under glucose curves were observed. However, meal H produced earlier hyperglycemia than HA and HB (30 min: p less than 0.01). Insulin levels were higher after HB compared to H (p less than 0.05). Meals HA and HB were followed by higher triglyceride levels than H (p less than 0.05). It is concluded that: 1) honey and bread produce similar degrees of hyperglycemia in type II diabetics. 2) Fat-rich foods added to honey do not alter the total hyperglycemic effect but result in higher triglyceride and insulin serum concentrations.

A double-blind study on the efficacy and tolerance of a new alpha-glucosidase inhibitor in type-2 diabetics.

Miglitol (Bay m 1099), a deoxynojirimycin derivative, is a new glucosidase inhibitor. The possible hypoglycemic effect of this new product was tested in 12 volunteer noninsulin-dependent diabetics (NIDDs) in a double-blind crossover acute study. The patients twice received a test meal (1554 kJ including 34 g carbohydrates), once with placebo and on another day with a 50-mg tablet of Bay m 1099. A wash-out period of 2 to 7 days separated the test days. Venous blood samples were collected before and every 30 min for a total of 3 h after the drug administration. Mean blood sugar values were in general lower after the meal + Bay m 1099 than the meal + placebo. The differences were statistically significant at the 60- and 90-min time intervals (8.43 versus 11.17 and 9.24 versus 11.59 mmol/l, respectively, p less than 0.05). No flatulence, diarrhea or other untoward effects were observed. Furthermore no changes in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, creatinine, alkaline phosphatase, bilirubin, haemoglobin, white blood count and differential counts were noted. Thus, in a one-day study 50 mg of Bay m 1099 reduced the postprandial hyperglycemia in NIDDs. No signs of any acute renal, liver and blood toxicity were observed.

Comparison of risk factors for foot problems in diabetic patients attending teaching hospital outpatient clinics in four different European states.

Although the St Vincent declaration calls for common European action in order to reduce major amputations, the differences in the incidence of foot problems and the prevalence of risk factors has not been fully investigated. We have examined the risk factors for foot ulceration and amputation in 278 consecutive patients (mean age 50.4 years, range 18-79 years) attending outpatient clinics of four teaching hospitals: Athens, Manchester, Rome, and Antwerp. There were no differences in age, weight or sex among the four groups but the percentage of patients with Type 1 diabetes was higher in Rome and Antwerp. Patients in Rome and Antwerp also had a longer duration of diabetes compared to Athens and Manchester. Mean vibration perception threshold was similar in all groups. No differences were found in the number of patients with moderate or severe clinical neuropathy (neuropathy disability score > 5), severe sensory loss (VPT > 25 V), and limited joint mobility. Symptomatic peripheral vascular disease was more frequent in Antwerp (p < 0.05) compared to the other three centres and foot ulceration in Rome compared to Manchester (p < 0.05). The number of smokers or ex-smokers and the average alcohol consumption were similar in all centres. We conclude that, despite a few differences mainly in Type 1 diabetic patients, there are no major differences in the risk factors for foot ulceration and that, therefore, similar strategies for the prevention of foot problems may be equally successful in different European countries.