Efectos del suplemento de probióticos en pacientes con diabetes mellitus tipo 2: metaanálisis de ensayos aleatorizados / Effects of probiotics supplement in patients with type 2 diabetes mellitus: A meta-analysis of randomized trials

Fundamento y objetivo: Evaluar objetivamente los efectos de los suplementos de probióticos sobre el control glucémico y el metabolismo de los lípidos en pacientes con diabetes mellitus tipo 2 (DM2). Material y métodos: Ensayos controlados aleatorizados (ECA) con respecto a los probióticos o simbióticos para el tratamiento de la DM2, recogidos a través de la recuperación de 5 bases de datos, desde su creación hasta el mes de marzo de 2016. Tras el estudio y la selección, la evaluación de la calidad y la extracción de datos fueron realizadas por 2 autores independientes, utilizándose el software STATA para realizar el análisis estadístico. El nivel de evidencia se evaluó mediante la aplicación del sistema GRADE. Resultados: Fueron 12 ECA, en los que se incluyó a 770 participantes. Los resultados del metaanálisis reflejaron que los probióticos podrían reducir significativamente la glucosa en sangre en ayunas en −11,27mg/dl (IC 95% −21,76 a −0,79; p<0,001) y la concentración de insulina sérica en −2,36μU/ml (IC 95% −4,01 a −0,72; p=0,005), aunque el valor de HbA1c no mostró una reducción significativa (−0,19%; IC 95% −0,49 a 0,12; p=0,23). El probiótico podría reducir significativamente el HOMA-IR de los pacientes con DM2 (−1,05; IC 95% −1,52 a −0,59; p<0,001). Sin embargo, el efecto sobre QUICKI fue insignificante (0,00; IC 95% −0,00 a 0,01; p=0,27). Los resultados confirmaron el efecto de disminución significativa de los probióticos en el colesterol total (−8,49mg/dl; IC 95% −15,24 a −1,73; p=0,014) y en los triglicéridos (TG; −23,66mg/dl; IC 95% −40,26 a −7,05; p<0,001), así como el efecto de elevación del c-HDL (3,92mg/dl; IC 95% 2,14 a 5,7; p<0,01). Sin embargo, no se produjo ningún cambio significativo en el c-LDL (−0,84mg/dl; IC 95% −5,84 a 4,17; p=0,75). Se realizó un análisis de subgrupos para los 2 resultados (concentración de insulina en suero y TG), cuya heterogeneidad fue demasiado alta. Los resultados mostraron que multitud de probióticos tuvieron un mayor efecto de reducción de la concentración de insulina en suero (−3,32μU/ml; IC 95% −5,89 a −0,75; p=0,001) y TG (−25,94mg/dl; IC 95% −65,33 a 13,44; p<0,001). Además, también evidenciaron que solo la duración del tratamiento no inferior a 8 semanas podría reducir significativamente TG en un −24,47mg/dl (IC 95% −40,15 a −8,78; p=0,001). La duración del tratamiento inferior a 8 semanas no produjo una reducción significativa de los TG (−4,31mg/dl; IC 95% −37,69 a 29,06; p=0,8). Finalmente, según el sistema GRADE, todas las evidencias fueron de nivel moderado y bajo. Conclusión: Como tipo de bioterapéutica potencial para el tratamiento de la DM2, los probióticos pueden mejorar el control de la glucosa y el metabolismo lipídico (AU)

Background and objective: To objectively evaluate the effects of probiotics supplement on glycemic control and lipid metabolism in patients with type 2 diabetes mellitus (T2DM). Material and methods: The randomized controlled trials (RCTs) with regard to the probiotics or synbiotics for the treatment of T2DM were collected through retrieving 5 databases from their establishment to March 2016. After study selection, quality assessment and data extraction were performed by 2 authors independently; and STATA software was used for statistical analysis. The level of evidence was evaluated by applying the GRADE system. Results: Twelve RCTs involving 770 participants were enrolled. The results of the meta-analysis showed that probiotics could significantly reduce fasting blood glucose by −11.27mg/dL (95% CI −21.76 to −0.79; P<.001) and serum insulin concentration by −2.36μU/mL (95% CI −4.01 to −0.72; P=.005), but with no significant reduction on HbA1c (−0.19%; 95% CI −0.49 to 0.12; P=.23). Probiotics could significantly reduce HOMA-IR of T2DM patients (−1.05; 95% CI −1.52 to −0.59; P<.001). Nevertheless, the effect on QUICKI was negligible (0.00; 95% CI −0.00 to 0.01; P=.27). Results also confirmed the significant lowering effect of probiotics on total cholesterol (−8.49mg/dL; 95% CI −15.24 to −1.73; P=.014) and triglycerides (TG; −23.66mg/dL; 95% CI −40.26 to −7.05; P<.001), as well as the elevating effect on HDL-c (3.92mg/dL; 95% CI 2.14 to5.7; P<.01). However, there was no significant change on LDL-c (−0.84mg/dL; 95% CI −5.84 to 4.17; P=.75). Subgroup analysis was conducted for 2 outcomes, that is, serum insulin concentration and TG, whose heterogeneity was too high. The results showed multiple species of probiotics had stronger reduction effect on serum insulin concentration (−3.32μU/mL; 95% CI −5.89 to−0.75; P=.001) and TG (−25.94mg/dL; 95% CI −65.33 to 13.44; P<.001). In addition, it also suggested that only the duration of treatment for≥8 weeks could significantly reduce TG by −24.47mg/dL (95% CI −40.15 to −8.78; P=.001). The duration of treatment for<8 weeks didn’t result in significant reduction on TG (−4.31mg/dL; 95% CI −37.69 to 29.06; P=.8). Finally, all the evidences were at moderate and low levels according to the GRADE system. Conclusion: As a kind of the potential biotherapeutics in the management of T2DM, probiotics can improve glucose control and lipid metabolism (AU)

A cross-sectional study on serum uric acid level and the distribution of metabolic syndrome among Uigur, Han and Kazak prediabetic groups in Xinjiang / 中华流行病学杂志

Objective To explore thelevels of uric acid,blood pressure,serum lipid metabolic disorders and the distribution of obesity and metabolic syndrome (MS) among Uygur,Han and Kazak pre-diabetic groups in Xinjiang.Methods A cross-sectional study was conducted on 2053 Uygur residents,2219 Kazak residents and 2656 Han residents aged 30-80,all with prediabectic syndromes.The pre-dialectic patients were divided into three groups for analysis on metabolic features and inter-group comparisons.Results (1)In total,1934 pre-diabetic cases (28.3％) were diagnosed,with the highest prevalence (31.6％) seen in Uygurs and the lowest (25.5％) in Kazaks and medium (27.0％) in Hans.Data from the inter-group comparison showed statistically significant differences (P=0.00).(2) Prevalence of high LDL-C was 80.5％,with hyperuricemia as 30.3％ and MS as 58.3％,while the inter-group comparison did not show any statistically significant differences (P＞0.05).(3)Prevalence of pre-diabetic when combined with hypertension or earlier-stage hypertension,reached 88.0％,with the highest (96.8％) among Kazak group,85.1％ in Uygurs and 83.7％ in Han population.Data from the inter-group comparison showed statistically significant difference (x2 =59.959,P=0.00).(4)The overall prevalence of prediabectic,when combined with obesity was 35.4％,with 29.6％ in Han,36.8％ in Uygur and 41.0％ in Kazak groups.Data from the inter-group comparison showed statistically significant difference (x2=19.097,P=0.00).Conclusion According to results from this cross-sectional study regarding the metabolic features of Uygur,Kazak and Han prediabectic groups,differences were seen in the prevalence rates of pre-diabetic among Uygur,Kazak and Han ethnic groups,with the highest seen in Uygurs and the lowest in Kazaks.Hyperlipidemia,hypertension,hyperuricemia,MS and obesity were commonly seen in all the prediabectic groups,with the highest prevalence of hypertension seen in the Kazak group and the highest rate of obesity in Uygur group.

Secretion and action of insulin among Han and Uygur subjects with impaired fasting glucose and impaired glucose tolerance,from Xinjiang / 中华流行病学杂志

Objective To compare insulin secretion and action with impaired fasting glucosc (IFG),impaircd glucose tolerance (IGT) and combined glucose intolerance (CGI,IFG and IGT) between Han and Uygur populations living in Xinjiang.Methods A multicenter cross-section survey (The Third Diabetes Epidemiological Survey in China) was conductcd in Xinjiang from 2007 to 2008 including 2203 subjects (Han 1118,Uygur 1085) underwent an oral glucosc test (OGTT).Homeostasis model assessment on insulin resistance (HOMA-IR) and β cell function (HOMA-β)were calculated.The ratio of incrcmcntal insulin(Δ130 ) and glucose (ΔG30)response was used to evaluate the early insulin secretion.ΔI30/ΔG30/HOMA-IR was used to evaluate the glucosc disposition index (DI).Results There were differences noticed regarding the waist circumstances (WC),body mass index (BMI),lipids,0 and 120 min insulin lcvcls in different glucose tolerance status between the Hans and Uygurs.Data related to NGT,IFG,CGI,WC from the Uygurs was significantly diffcrcnt from that of the Hans (P＜0.01),while the NGT,IFG,IGT and 120-minute plasna insulin levels of the Hans were significantly different from that of the Uygurs (P＜0.01).HOMA-IR and HOMA-β in Hans were significantly different from those of the Uygurs (P＜0.01).There were significant differences noticed on data reoated to Δ130/ΔG30,and DI among the two populations with different ethnicities.Conclusion Regarding the regulation of impaired glucose,the insulin resistance among the Hans was significantly different from that of the Uygurs,while there seemed to be a compensatory secretion of pancreatic β cells which played the role of maintaining blood glucose homeostasis.

Improvement in blood glucose fluctuations of insulin-treated type 1 diabetic patients with additional use of acarbose and assessed by continuous blood glucose monitoring program / 中华流行病学杂志

Objective To investigate the effect of combined use of insulin and acarbose on glucose excursion in type 1 diabetic patients.Methods 120 cases were randomly divided into control group and observation group.The control group received preprandial ultra-short effect insulin and long-acting insulin before bedtime while the observation group received acarbose 50 mg added to the medicine taken by the control group.Continuous Glucose Monitoring System (CGMS) was used to watch the blood glucose fluctuations.Data related to blood glucose level,glucose excursions after meals and hypoglycemia at night were compared between patients in the two groups.Results The average blood glucose (9.37 ± 1.70) mmol/L,the largest amplitude of glycemic excursions (LAGE) ( 11.42 ± 2.73 ) mmol/L,hyperglycemia-area under curve 0.89 ± 0.54,mean amplitude of glycemic excursions (MAGE) (5.13 ± 2.23) mmol/L,M-value (18.93 ± 11.43) mmol/L and insulin dosage (42.11 ± 14.42)U/day of observation group were significantly lower than in the control group (P＜0.05 ).Glucose excursions after meals and the times( 0.33 ± 0.50 )/day,the maintenance time (43.75 ± 43.50)/min and low glycemic index ( LBGI ) (0.005 ± 0.002 ) mmol/L of hypoglycemia at night were also significantly lower than in the control group,with statistically significant (P＜0.05) differences.Conclusion The blood glucose fluctuation was significantly improved,with the decrease of insulin dosage while both glucose excursions and hypoglycemia at night reduced in patients with typel diabetes mellitus after the acarbose treatment.We suggested that this program deserve further observation.

A new tumor necrosis factor (TNF)-α regulator, lipopolysaccharides-induced TNF-α factor, is associated with obesity and insulin resistance / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tumor necrosis factor (TNF)-α plays an important role in mediating inflammatory state in obesity and related disorders. Lipopolysaccharides (LPS)-induced TNF-α factor (LITAF) is recently verified as a regulator of TNF-α and other inflammatory cytokines, and maybe act as a transcriptional factor. The aim of this study was to confirm the association between LITAF and obesity and insulin resistance.</p><p><b>METHODS</b>Forty-seven subjects with a wide range of body mass index (BMI) were included. Subjects were divided into three groups according to the criteria of normal weight, overweight and obese. Anthropometrics and metabolic profile were tested for all the subjects. Peripheral monocytes were isolated and purified. LITAF transcription was detected by real time PCR, and the protein expression in whole cell and nucleus extracts was detected by Western blotting analysis; transcriptional activity of LITAF was detected by ELISA like assay using a probe containing the DNA binding sequence of LITAF. Plasma TNF-α and interleukin (IL)-6 concentrations were determined with ELISA kit.</p><p><b>RESULTS</b>The LITAF mRNA and protein expression in whole cell were higher in overweight (P < 0.05) and obese group (P < 0.05) compared with that in normal weight group. The LITAF protein expression in the nucleus and transcriptional activity could not be detected. LITAF protein expression was positively correlated with BMI (r = 0.541, P < 0.001), waist circumference (r = 0.391, P = 0.007), the homeostasis model assessment for insulin resistance (r = 0.372, P = 0.011) and fasting insulin levels (r = 0.359, P = 0.013). As a regulator of inflammatory cytokines, LITAF protein expression was positively correlated with plasma TNF-α (r = 0.621, P = 0.002) and IL-6 (r = 0.407, P = 0.039) concentration. Multiple variant regression analysis indicated that BMI (P = 0.002) and waist circumference (P = 0.017) were independent predictors of LITAF protein expression.</p><p><b>CONCLUSIONS</b>LITAF is associated with obesity and insulin resistance, as well as inflammatory cytokine secretion. The results indicate LITAF to be a new mediator between inflammation and the obesity related disorders.</p>

Anti-diabetic effects of cinnamaldehyde and berberine and their impacts on retinol-binding protein 4 expression in rats with type 2 diabetes mellitus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Retinol binding protein 4 (RBP4), as an adipocyte secreted cytokine, was recently found to be inversely correlated with expression of glucose transporter 4 (GLUT4) in insulin resistance (IR) state and to have an intimate relationship with IR and type 2 diabetes mellitus (T2DM). The present study aimed to evaluate the anti-diabetic efficacy of cinnamaldehyde (Cin), berberine (Ber), and metformin (Met) as well as their impacts on the RBP4-GLUT4 system.</p><p><b>METHODS</b>Rat models of T2DM were established by combination of intraperitoneal injection of low-dose streptozotocin and high fat diet induction. Rats were divided into five groups: the control group, the diabetes group, the diabetes + Ber group, the diabetes + Cin group, and the diabetes + Met group. Western blotting was used to detect the serum or tissue RBP4 and GLUT4 protein levels.</p><p><b>RESULTS</b>After treatment for four weeks, both Cin and Ber displayed significant hypolipidemic, hypoglycemic, and insulin sensitizing functions (P < 0.01) compared with the control group. Their effects on lowering fasting plasma glucose (FPG), low density lipoprotein-cholesterol (LDL-C) and homeostasis model assessment of insulin resistance (HOMA-IR) seem even better than that of Met. Cin and Ber markedly lowered serum RBP4 levels and up-regulated the expression of tissue GLUT4 protein, and Cin seemed more notable in affecting these two proteins.</p><p><b>CONCLUSIONS</b>Both Cin and Ber display an exciting anti-diabetic efficacy in this study and may be of great value for the treatment of type 2 diabetes. Their mechanisms involve the RBP4-GLUT4 system, during which the serum RBP4 levels are lowered and the expression of tissue GLUT4 protein is up-regulated.</p>

Improvement of diabetic peripheral neuropathy using monochromatic infrared energy / 中华物理医学与康复杂志

Objective To observe the effect of monochromatic infrared energy(MIRE)on diabetic periphe- ral neuropathy(DPN).Methods Seventy-four subjects with diabetic peripheral neuropathy who were tested by Semmes-Weinstein monofilaments(SWM)were randomized into 2 groups:a conventional management group and a conventional management plus MIRE group.Then the patients'sensory function and other DPN symptoms were evalu- ated by the SWME and the score of Michigan Neuropathy Screening Instrument.Results After treatments,there was a decrease(P＜0.01)in the number of the sites insensitive to SWME(grade 5.07),and MNSI scores were sig- nificantly decreased(P＜0.01).The MIRE management was more effective than conventional management.Con- clusion Monochromatic infrared energy is perhaps a safe,non-pharmaceutical and non-invasive method for the treat- ment of diabetic peripheral neuropathy.