The association between rest-activity parameters and hemoglobin A1c in patients with prediabetes.

Circadian abnormalities can adversely affect glucose metabolism. This study determined whether behavioral circadian parameters, as assessed by rest-activity rhythm, were predictors of glycemic control in patients with prediabetes. Seventy-nine patients with prediabetes participated. Nonparametric rest-activity rhythm parameters, sleep duration and efficiency were obtained from 7-d actigraphy recordings. Sleep-disordered breathing severity was assessed using a home sleep apnea test. Hemoglobin A1c (HbA1c) was obtained to evaluate glycemic control. The results revealed that shorter sleep duration, lower relative amplitude and higher L5 (average activity of the least active 5-h period) were associated with higher HbA1c, while other sleep variables were not related to HbA1c. Multiple stepwise regression analysis adjusting for age, sex, body mass index and sleep duration revealed that lower relative amplitude, but not L5, was independently associated with higher HbA1c (B = -0.027, p = 0.031). In summary, among patients with prediabetes, an abnormal circadian rhythm was associated with higher HbA1c, implying a greater risk of developing diabetes. These results support the role of circadian rhythmicity in glucose control among those with prediabetes.

Implementation of diabetes care and educational program via telemedicine in patients with COVID-19 in home isolation in Thailand: A real-worldexperience.

BACKGROUND: The coronavirus disease (COVID-19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self-management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home-isolated patients with COVID-19 infection. METHODS: A retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed. RESULTS: A volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high-risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same-day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE® platform) to assess the patient's clinical status and need. Real-time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin-naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home. CONCLUSION: Diabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID-19 pandemic was safe and effective.

The glucose-lowering effect of low-dose diacerein and its responsiveness metabolic markers in uncontrolled diabetes.

OBJECTIVE: Diacerein inhibits the synthesis and activity of pro-inflammatory cytokines, decreases macrophage infiltration in adipose tissue and thus increases insulin sensitivity and signalling. We conducted this study to determine the efficacy of low-dose diacerein in improving glycaemic control in type 2 diabetes mellitus (T2DM) patients with inadequate glycaemic control and to identify the metabolic determinants for such improvement. We randomised 25 T2DM patients with poor glycaemic control, despite being treated with at least three glucose-lowering agents, to receive diacerein 50 mg once-daily (n = 18) or placebo (n = 17) for 12 weeks. Changes in glycated haemoglobin (HbA1c) were evaluated at the 4th and 12th weeks. Metabolic profiling was performed using liquid chromatography electrospray ionisation quadrupole time-of-flight mass spectrometry. RESULTS: HbA1c levels were significantly reduced from baseline in the diacerein group at 12 weeks (- 0.6%, p < 0.05), whereas fasting plasma glucose (FPG) levels were not significantly decreased (- 18.9 mg/dl, p = 0.06). Partial least squares-discriminant analysis demonstrated an association between the serum abundance of threo-isocitric acid (ICA) and HbA1c response in the diacerein group. After adjusting for serum high-sensitivity C-reactive protein, ICA was still significantly related to the change in HbA1c. Retrospective trial registration Current Controlled Trials TCTR20200820004, 20 August 2020.

A Comparison of Bone Mineral Density and Its Predictors in HIV-Infected and HIV-Uninfected Older Men.

OBJECTIVE: Bone health in older individuals with HIV infection has not been well studied. This study aimed to compare bone mineral density (BMD), trabecular bone score (TBS), and bone markers between HIV-infected men and age- and body mass index (BMI)-matched HIV-uninfected men aged ≥60 years. We investigated the associations of risk factors related to fracture with BMD, TBS, and bone markers in HIV-infected men. METHODS: This cross-sectional study included 45 HIV-infected men receiving antiretroviral therapy and 42 HIV-uninfected men. Medical history, BMD and TBS measurements, and laboratory tests related to bone health were assessed in all the participants. HIV-related factors known to be associated with bone loss were assessed in the HIV-infected men. RESULTS: The mean BMD, TBS, and osteopenia or osteoporosis prevalence were similar among the cases and controls. The HIV-infected men had significantly higher mean N-terminal propeptide of type 1 procollagen and C-terminal cross-linking telopeptide of type I collagen levels. Stepwise multiple linear regression analysis demonstrated that low BMI (lumbar spine, P = .015; femoral neck, P = .018; and total hip, P = .005), high C-terminal cross-linking telopeptide of type I collagen concentration (total hip, P = .042; and TBS, P = .010), and low vitamin D supplementation (TBS, P = .035) were independently associated with low BMD and TBS. CONCLUSION: In older HIV-infected men with a low fracture risk, the mean BMD and TBS were similar to those of the age- and BMI-matched controls. The mean bone marker levels were higher in the HIV group. Traditional risk factors for fracture, including low BMI, high C-terminal cross-linking telopeptide of type I collagen level, and low vitamin D supplementation, were significant predictors of low BMD and TBS.

Metabolomic profile associated with obstructive sleep apnoea severity in obese pregnant women with gestational diabetes mellitus: A pilot study.

Obstructive sleep apnoea (OSA) is prevalent in obese women with gestational diabetes mellitus (GDM). The present pilot study explored associations between OSA severity and metabolites in women with GDM. A total of 81 obese women with diet-controlled GDM had OSA assessment (median gestational age [GA] 29 weeks). The metabolic profile was assayed from fasting serum samples via liquid chromatography-mass spectrometry (LC-MS) using an untargeted approach. Metabolites were extracted and subjected to an Agilent 1,290 UPLC coupled to an Agilent 6,545 quadrupole time-of-flight (Q-TOF) MS. Data were acquired using electrospray ionisation in positive and negative ion modes. The raw LC-MS data were processed using the OpenMS toolkit to detect and quantify features, and these features were annotated using the Human Metabolite Database. The feature data were compared with OSA status, apnea-hypopnea index (AHI), body mass index (BMI) and GA using "limma" in R. Correlation analyses of the continuous covariates were performed using Kendall's Tau test. The p values were adjusted for multiple testing using the Benjamini-Hochberg false discovery rate correction. A total of 42 women (51.8%) had OSA, with a median AHI of 9.1 events/hr. There were no significant differences in metabolomics profiles between those with and without OSA. However, differential analyses modelling in GA and BMI found 12 features that significantly associated with the AHI. These features could be annotated to oestradiols, lysophospholipids, and fatty acids, with higher levels related to higher AHI. Metabolites including oestradiols and phospholipids may be involved in pathogenesis of OSA in pregnant women with GDM. A targeted approach may help elucidate our understanding of their role in OSA in this population.

Effects of an intensive lifestyle intervention and the role of sleep in people living with HIV and prediabetes: a pilot and feasibility study.

OBJECTIVES: Prediabetes is prevalent in people living with HIV (PLWH). Insufficient and irregular sleep are linked to abnormal glucose metabolism. This study aimed to investigate the differences in sleep characteristics between PLWH with and without prediabetes, determine the acceptability/feasibility and effects of a pilot six-month intensive lifestyle intervention (ILI) program on glucose metabolism in those with prediabetes, and determine how sleep modulates these effects. RESULTS: Thirty-nine PLWH (20 normoglycemia and 19 prediabetes) participated. There were no differences in sleep characteristics between individuals with normoglycemia and prediabetes. Next, thirteen individuals with prediabetes completed a six-month ILI program. The ILI program resulted in significant body weight reduction at 6 months (63.5 ± 13.9 to 61.9 ± 14.0 kg, p = 0.012), which was maintained at 12 months (p < 0.001). Waist circumferences were significantly decreased at 12 months (85.4 ± 11.7 to 82.9 ± 12.7 cm, p = 0.014). An increase in sleep variability was significantly associated with an increase in 2-h plasma glucose, independent of changes in BMI (b = 0.603), and physical activity (b = 0.774). This pilot study suggested that ILI in PLWH with prediabetes is feasible and effective in improving metabolic control, with its effects possibly modulated by sleep variability. These findings should be confirmed in a larger study to reduce diabetes risk in this population. Trail registration: ClinicalTrial.gov, NCT03545217 (date of registration: May 22, 2018).

Vitamin D supplementation is associated with serum uric acid concentration in patients with prediabetes and hyperuricemia.

AIMS: Vitamin D deficiency is associated with a number of noncommunicable conditions. We conducted a randomised controlled trial to determine the effect of vitamin D supplementation on serum uric acid concentration in patients with prediabetes, in whom hyperuricaemia is common. METHODS: Seventy-one volunteers (35-80 years), with impaired fasting glucose and/or impaired glucose tolerance were randomised to three groups, vitamin D3, vitamin D2 and control, and followed for 12 months. RESULTS: After 12 weeks, vitamin D supplementation was associated with a reduction in serum uric acid concentration in participants with baseline uric acid concentration > 6 mg/dL, but no significant change was observed in controls. We then assessed the dose-response relationship between vitamin D supplementation and the change in serum uric acid concentration and found that the change in serum total 25-hydroxyvitamin D did not correlate with the change in serum uric acid that occurred during vitamin D supplementation. The factors associated with larger reductions in serum uric acid were a higher baseline serum uric acid and a larger increase in serum 1,25-dihydroxyvitamin D. CONCLUSIONS: Vitamin D supplementation lowers serum uric acid in prediabetic patients with hyperuricaemia, and supplementation might be considered to help alleviate hyperuricaemia in these patients.

Sleep variability, 6-sulfatoxymelatonin, and diabetic retinopathy.

PURPOSE: Recent evidence suggests that diabetic retinopathy (DR) is associated with abnormal melatonin regulation, possibly related to dysfunction of the melanopsin-expressing intrinsically photosensitive retinal ganglion cells. This study explored melatonin regulation in type 2 diabetes (T2D) patients with DR and its relation to sleep and circadian functioning. METHODS: Thirty-five participants (10 non-diabetic controls, 10 T2D without DR, and 15 T2D with DR) were recruited. Overnight urine 6-sulfatoxymelatonin (aMT6s) and objective sleep and wrist activity (7-day actigraphy) were obtained. RESULTS: After adjusting for covariates, having T2D with DR was significantly associated with lower urinary aMT6s (ß = - 1.369, p = 0.004) compared with controls, while having T2D without DR was not (p = 0.418). T2D patients with DR reported poorer sleep quality (p = 0.014) and had greater variability of sleep duration (p = 0.017) than others, while no differences were found in sleep duration, efficiency, and rest-activity rhythm. After adjusting for covariates, lower nocturnal aMT6s was significantly associated with greater sleep variability. CONCLUSION: T2D patients with DR exhibited low overnight production of aMT6s which likely contributed to sleep irregularities possibly due to weak circadian signaling. Whether or not melatonin supplementation could improve health in T2D patients with DR remains to be explored.

Glycemic effect of post-meal walking compared to one prandial insulin injection in type 2 diabetic patients treated with basal insulin: A randomized controlled cross-over study.

Studies demonstrate that post-meal walking decreases postprandial hyperglycemia in type 2 diabetic patients but it has never been tested with the active treatment comparator. The objective of this study was to determine the effect of post-meal walking on glycemic control compared with one prandial insulin in type 2 diabetic patients who failed basal insulin. A randomized controlled cross-over study of post-meal walking or one prandial insulin was done in type 2 diabetic patients who were being treated with basal insulin between May 2017 and March 2018. In post-meal walking group, patients walked after meal for 15-20 minutes one meal a day every day for 6 weeks. In prandial insulin (basal plus) group, one prandial insulin was injected before breakfast or main meal with rapid-acting insulin. The primary outcome was a difference in HbA1c reduction in post-meal walking compared with basal plus groups. Fourteen patients completed the study. By intention-to-treat analysis, HbA1c was reduced by -0.05(range:-1.08 to 0.74) and -0.19(range:-0.8 to 0.56) % in post-meal walking and basal plus groups respectively. By per-protocol analysis, post-meal walking and basal plus groups decreased HbA1c by 0.13(range:-0.74 to 1.08) and 0.2(range:-0.56 to 0.8) %, respectively. There was were no significant differences in HbA1c reduction from baseline in each group and between groups in both intention-to-treat and per-protocol analysis. Fructosamine levels were decreased by 17.5(-59 to 43) and 10(-15 to 40) µmol/L, respectively at 3 and 6 weeks in post-meal walking group whereas the respective changes in basal plus group were 12.5(-17 to 64) and 17.5(-28 to 38) µmol/L and there were no significant differences in fructosamine reduction from baseline in each group and between groups. In conclusion, although post-meal walking might be as effective as one prandial insulin to improve glycemic control in type 2 diabetic patients who failed basal insulin but the magnitude of reduction was small. A longer-term study with a larger sample size or with a different walking protocol is required.

No changes in gut microbiota after two-week sleep extension in chronically sleep-deprived individuals.

BACKGROUND: Gut microbiota has been linked to obesity and glucose metabolism. Insufficient sleep is also known to be associated with insulin resistance, and sleep extension was reported to improve glucose metabolism in short sleepers. This study aimed to explore whether sleep extension was associated with changes in gut microbiota and whether there was a relationship with glucose parameters. METHODS: We performed a secondary analysis of eight short-seeping but otherwise healthy subjects who participated in a cross over study of two-week home sleep extension and two weeks of habitual sleep. After each sleep condition, stool samples were collected and glucose parameters were obtained. Stool DNA extraction was performed and 16S rRNA was sequenced by MiSeq™. The resulting sequence data were processed to infer relative abundances of taxa present and then analyzed to detect any differences in the abundances of the taxa or overall diversity of the microbiome. RESULTS: Mean (SD) sleep duration during habitual sleep and sleep extension was 5.58 (0.53) and 6.60 (0.43) hours/night, respectively. Using the Bray-Curtis index, there was no significant dissimilarity of the genus-level microbial community between the two sleeping conditions (ADONIS, R2 = 0.017, p = 0.988 and ANOSIM, R = -0.131, p = 0.991). Within-sample microbial diversity (ie, the Shannon index) also did not find significant differences (p = 0.861). There was no significant relationship between per-individual dissimilarity and objective and subjective sleep variables, or glycemic parameters. Only higher sleep efficiency was related to higher abundance of the phyla Tenericutes. CONCLUSION: Two-week sleep extension in short sleepers was not associated with changes in gut microbiota.

The differences in the relationship between obstructive sleep apnea severity and trabecular bone score in men and women with type 2 diabetes.

AIMS: Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) may adversely affect bone. Gender is a well-established factor influencing bone health. We investigated the impact of OSA on bone mineral density (BMD) and trabecular bone score (TBS) in T2DM. METHODS: Eighty-one T2DM patients [33 men and 48 women] participated. OSA was diagnosed using an overnight monitor, with its severity assessed by an apnea hypopnia index (pAHI). The measurements of hypoxia, including the percentage of total sleep time in which oxygen saturation remains below 90% (pT90), the oxygen desaturation index (pODI) and minimum O2 (min O2), were reported. Lumbar spine (L1-4) and femoral neck (FN) BMD were measured using dual-energy X-ray absorptiometry (DXA). TBS was computed from DXA images. RESULTS: Sixty-five patients (80.2%) had OSA. pAHI, pT90, pODI and min O2 were not correlated to L1-4 BMD, FN BMD or TBS in all participants by multiple regression analyses adjusting for age, gender and BMI. However, an interaction between gender and pAHI, and gender and pODI were significantly associated with TBS (b = 0.003, p = 0.034 and b = 0.004, p = 0.046, respectively). We therefore reassessed an association between pAHI or pODI and TBS separately between men and women. After adjusting for age and BMI, more severe OSA (higher pAHI) and higher pODI significantly associated with lower TBS (b = -0.002, p = 0.034 and b = -0.003, p = 0.021, respectively) in men. On the other hand, higher pAHI non-significantly associated with better trabecular microarchitecture as indicated by higher TBS (b = 0.002, p = 0.059) in women. When considered only postmenopausal (n = 33), higher pAHI and higher pODI were significantly associated with higher TBS (b = 0.004, p = 0.003 and b = 0.004, p = 0.008, respectively). CONCLUSIONS: In T2DM patients, there is a complex interrelationship among OSA severity, gender and TBS. More severe OSA predicted lower TBS in men, but predicted higher TBS in postmenopausal women.

Urinary metabolic profiles after vitamin D2 versus vitamin D3 supplementation in prediabetes.

AIM: To assess the potential biological differences between vitamin D2 and D3 using urinary metabolite profiles in response to vitamin D3 or D2 supplementation. METHOD: Subjects consisted of 29 subjects with impaired fasting glucose and/or impaired glucose tolerance. Subjects were randomized into two groups, vitamin D2 (20,000 IU weekly, n = 14) or vitamin D3 (15,000 IU weekly, n = 15). Urine and serum samples were taken at two different time points for each subject (at baseline and at 12 weeks). Urinary metabolite profiling was performed by liquid chromatography electrospray ionization quadrupole time-of-flight mass spectrometry (LC-ESI-QTOF-MS). Serum calcium was analyzed on an automated biochemical analyzer and serum intact parathyroid hormone was determined by electrochemiluminescence immunoassay. RESULTS: At baseline, there was no statistically significant difference in clinical characteristics including age, gender, body mass index, waist circumference and 25-hydroxyvitamin D (25(OH)D) levels between the 2 groups. Weekly administration of 20,000 U D2 for 12 weeks resulted in comparable 25(OH)D concentrations as compared to weekly 15,000 U D3 supplementation (97.8 ±â€¯305 vs. 96.8 ±â€¯3.4 nmol/L, p = 0.84). No difference in serum calcium (2.3 ±â€¯0.03 vs. 2.2 ±â€¯0.03 nmol/L, p = 0.52) or intact parathyroid hormone (5.3 ±â€¯0.3 vs. 4.9 ±â€¯0.5 pmol/L, p = 0.54) at 12 weeks was found. Principle component analysis did not reveal apparent segregation of metabolites according to D2 or D3 supplementation. Moreover, using partial least square regression, no apparent separation between the D2 and the D3 group was found. No important metabolite influencing the separation of the D2 from the D3 group was found using variables importance on projection analysis. CONCLUSIONS: At comparable circulating 25(OH)D concentrations, vitamin D2 or D3 supplementation does not appear to result in different urinary metabolite profiles. Our finding does not support a biological difference between vitamin D2 and D3.

Effects of Two-Week Sleep Extension on Glucose Metabolism in Chronically Sleep-Deprived Individuals.

STUDY OBJECTIVES: Sleep deprivation is known to be associated with insulin resistance and diabetes risk. This study investigated whether 2-week sleep extension in chronically sleep-deprived individuals would improve glucose metabolism. METHODS: A crossover study was conducted in volunteers without diabetes who reported sleeping ≤ 6 h/night. They were randomized to maintain their habitual sleep or extend sleep time for 2 weeks, then crossed over after a washout period. Sleep was monitored by actigraphy. Oral glucose tolerance tests (75 g) with insulin levels was performed at the end of each period. Mixed-effect linear regression analysis, adjusting for sequence and period effects, was applied. RESULTS: A total of 21 participants (19 females) with mean (standard deviation) age of 33.1 (6.1) years completed the protocol. Mean sleep duration during habitual sleep was 318.7 (44.3) minutes and the participants extended their sleep by 36.0 (45.2) minutes during sleep extension. The average washout period was 21 (11) days. There were no significant effects of sleep extension on any metabolic parameters. The per-protocol analysis included eight participants who could sleep more than 6 hours during sleep extension (mean sleep duration 396 [25] minutes, extended by 60.1 [28.5] minutes). Among these individuals, sleep extension improved Homeostatic Model Assessment of Insulin Resistance (adjusted mean difference -0.50 [95% confidence interval [CI] -0.89, -0.11, P = .013]), early insulin secretion (insulinogenic index; mean difference 0.39 [95% CI 0.15, 0.63, P = .001]), and ß-cell function (disposition index, mean difference 1.07 [95% CI 0.17, 1.97, P = .02]). CONCLUSIONS: Sleep extension in chronically sleep-deprived individuals improved glucose metabolism in only those who could objectively extend their sleep to more than 6 h/night. Our findings suggest that a critical amount of sleep is needed to benefit metabolic outcomes.

Relationship between depression, sleep quality, and hypoglycemia among persons with type 2 diabetes.

OBJECTIVE: We analyzed two cohorts of people with type 2 diabetes to evaluate the relationships between depression, sleep quality, and history of hypoglycemia. RESEARCH DESIGN AND METHODS: Two adult cohorts from Chicago (n = 193) and Bangkok, Thailand (n = 282) with type 2 diabetes completed questionnaires to assess sleep quality, depressive symptoms, and hypoglycemia frequency. Proportional odds logistic regression models for each cohort adjusted for duration of therapy, insulin and sulfonylurea management, and other factors. RESULTS: Those with hypoglycemia in both cohorts had a longer duration of diabetes, greater use of insulin, and worse sleep quality. The Chicago cohort used less sulfonylureas but had higher depressive symptom scores. The Thailand cohort had greater sulfonylurea use. In the final Thailand regression model, depressive symptoms were independently associated with hypoglycemia frequency. In both final Chicago and Thailand models, sleep quality was not associated with hypoglycemia frequency. CONCLUSIONS: In the Thailand cohort, depressive symptoms were associated with hypoglycemia frequency.

Eveningness Is Associated With Greater Depressive Symptoms in Type 2 Diabetes Patients: A Study in Two Different Ethnic Cohorts.

BACKGROUND: Eveningness is associated with greater depressive symptoms in the general population. Depression and type 2 diabetes (T2D) commonly coexist. We aimed to explore the association between morningness-eveningness and depressive symptoms in T2D patients in the United States and in Thailand. PARTICIPANTS: T2D patients (n = 182) from an endocrinology clinic in Chicago, Illinois, and six hospitals in Thailand (n = 251) were enrolled. METHODS: Diabetes history was collected. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale (CES-D). The Chicago cohort completed the Morningness-Eveningness Questionnaire (MEQ) and the Thai cohort completed the Composite Scale of Morningness (CSM). Sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). RESULTS: The mean (SD) CES-D score was 13.7 (9.1) in Chicago and 11.9 (6.4) in Thailand. In Chicago participants, after adjusting for age, sex, ethnicity, hemoglobin A1c, insulin use, and PSQI score, greater eveningness (lower MEQ scores) was associated with higher CESD scores (B = -0.117, p = 0.048). In Thai participants, after adjusting for age, sex, and PSQI score, eveningness (lower CSM score) was associated with higher CES-D score (B = -0.147, p = 0.016). In both cohorts, however, eveningness was not independently associated with the likelihood of being in the at-risk range for clinical depression (CES-D ≥ 16). CONCLUSIONS: Eveningness is independently associated with greater depressive symptoms in T2D in two different ethnic cohorts. The results support the association between individual differences in circadian rhythms and psychological functioning in T2D.

More evening preference is positively associated with systemic inflammation in prediabetes and type 2 diabetes patients.

Currently it is not known whether morningness-eveningness preference in non-night shift working population is associated with systemic inflammation. This study investigated the relationship between morningness-eveningness and systemic inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP) in 163 non-night shift working patients with abnormal glucose tolerance (86 type 2 diabetes and 77 prediabetes). Morningness-eveningness was assessed by Composite Scale of Morningness, and participants were screened for Obstructive sleep apnea (OSA). Sleep duration, efficiency, and variability were obtained using actigraphy, and depressive symptoms and dietary patterns were also captured. Participants' mean age was 54.7 ± 10.4 years and median hs-CRP was 1.39 (interquartile range 0.82, 3.33) mg/L. More evening preference was significantly associated with higher natural log transformed (ln) hs-CRP (B = -0.051, p = 0.001). Diabetes status, glycemic control, OSA severity, sleep duration, caloric consumption and timing were not related to hs-CRP. After adjusting for age, sex, body mass index, depressive symptoms, sleep efficiency, sleep variability, percentage of daily caloric intake from protein, and statin use, more evening preference was independently associated with higher ln hs-CRP (B = -0.032, p = 0.014). In summary, in non-night shift working patients with abnormal glucose tolerance, more evening preference was independently associated with higher systemic inflammation. This finding underscore the importance of circadian regulation on cardiovascular health.

Effects of sucralose on insulin and glucagon-like peptide-1 secretion in healthy subjects: a randomized, double-blind, placebo-controlled trial.

OBJECTIVES: Emerging evidence shows that non-nutritive sweeteners might induce glucose intolerance. This study aims to determine the effects of chronic exposure to sucralose on glycemic response, insulin secretion and sensitivity, and glucagon-like peptide-1 (GLP-1) release in healthy subjects. METHODS: Healthy volunteers who did not use non-nutritive sweeteners and were normoglycemia after oral glucose tolerance test (OGTT) were recruited. Subjects underwent a 75-g OGTT on two separate occasions, preceded by blindly consuming pills containing either 200 mg sucralose or placebo for 4 wk in a randomized crossover trial. Plasma glucose, insulin, and active GLP-1 levels were obtained after ingesting 75-g glucose. On the following day, intravenous glucose tolerance test (IVGTT) was performed to evaluate the acute insulin response (AIR). RESULTS: Fifteen participants (11 females, age 31.9 ± 10 y, body mass index 23.1 ± 3 kg/m2) participated in the study. AIR was lower after exposure to sucralose than placebo (58.9 ± 48.61 versus 69.94 ± 73.81 µU/mL, P < 0.001). Whole-body insulin sensitivity (estimated using the Matsuda index) was lower in sucralose than placebo (4.69 ± 1.67 versus 5.31 ± 2.56, P < 0.005). AUC of active GLP-1 was significantly higher in the sucralose than placebo (23.16 ± 18.86 versus 18.5 ± 22.22 pmol/L ⋅ 120 min, P < 0.001). CONCLUSIONS: The continuous exposure to sucralose reduced AIR, decreased insulin sensitivity, and enhanced GLP-1 release in healthy subjects. However, the clinical significance of these results needs to be investigated in longer follow-up studies.

The Association between Daytime Napping Characteristics and Bone Mineral Density in Elderly Thai Women without Osteoporosis.

Low bone mass is more prevalent with increasing age. Studies have found associations between sleep duration, sleep quality and obstructive sleep apnea and bone mineral density (BMD). However, less is known about the relationship between daytime napping and BMD. We aimed to investigate the association between daytime napping and BMD in elderly Thai women. Demographic data, lifestyle information and sleep characteristics were obtained by interviewing 387 elderly women. Weight and height were measured. Serum 25-hydroxyvitamin D [25(OH)D] was measured by radioimmunoassay. BMD was measured by dual-energy X-ray absorptiometry (DXA). Higher BMI and having type 2 diabetes (T2DM) were correlated with higher lumbar spine 2-4 (L2-4) BMD, while younger age, higher BMI and higher serum 25(OH)D level were correlated with higher femoral neck (FN) and total hip (TH) BMD. After adjusting for age, age at menopause, BMI, 25(OH)D level and T2DM, a higher frequency of weekly daytime napping was associated with lower FN and TH BMD but not at L2-4 BMD. Additionally, longer daytime napping duration was negatively associated with BMD at TH. In summary higher frequency and longer duration of daytime napping are associated with lower femoral BMD in elderly women. Mechanisms underlying these associations should be further explored.

The relationship between sleep and cognitive function in patients with prediabetes and type 2 diabetes.

AIMS: Diabetes is linked to cognitive impairment. Sleep plays a role in memory consolidation. Sleep disturbances, commonly found in patients with diabetes, were shown to be related to cognitive dysfunction. This study explored the role of sleep in cognitive function of patients with abnormal glucose tolerance. METHODS: A total of 162 patients (81 type 2 diabetes and 81 prediabetes) participated. Sleep duration and sleep efficiency (an indicator of sleep quality) were obtained using 7-day actigraphy recordings. Obstructive sleep apnea (OSA) was screened using an overnight in-home monitor. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Three sub-scores of MoCA, visuoexecutive function, attention and delayed recall, were also analyzed. RESULTS: Mean age was 54.8 (10.2) years. OSA was diagnosed in 123 participants (76.9%). Mean sleep duration was 6.0 (1.0) h and sleep efficiency was 82.7 (8.1) %. Sleep duration and OSA severity were not related to MoCA scores. Higher sleep efficiency was associated with higher MoCA scores (p = 0.003), and having diabetes (vs. prediabetes) was associated with lower MoCA scores (p = 0.001). After adjusting covariates, both having diabetes (vs. prediabetes) (B = - 1.137, p = 0.002) and sleep efficiency (B = 0.085, p < 0.001) were independently associated with MoCA scores. In addition, diabetes (B = - 0.608, p < 0.001) and sleep efficiency (B = 0.038, p < 0.001) were associated with visuoexecutive function. Sleep parameters were not related to delayed recall or attention scores. CONCLUSION: Lower sleep efficiency is independently associated with lower cognitive function in patients with abnormal glucose tolerance. Whether sleep optimization may improve cognitive function in these patients should be explored.