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1.
J Coll Physicians Surg Pak ; 31(9): 1015-1019, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34500513

RESUMO

OBJECTIVES: To determine the diagnostic accuracy of HOMA-IR, and QUICKI in diagnosing gestational diabetes mellitus (GDM) considering oral glucose tolerance test (OGTT) as gold standard. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi from September 2020 to February 2021. METHODOLOGY: Pregnant women with gestational age between 24 to 28 weeks, who reported to Endocrine Clinic of AFIP for OGTT, were included in the study. OGTT was performed by following ADA guidelines. Sample for fasting insulin was collected along with first fasting sample of OGTT. HOMA-IR and QUICKI were calculated simultaneously. Percentage was used for qualitative variable while median (IQR 25th-75th) was applied for quantitative variables. OGTT was used as gold standard for calculation of diagnostic accuracy of HOMA-IR and QUICKI. RESULTS: Out of 182 patients, 74 (40.6%) were found to have GDM on OGTT while 108 (59.4%) had normal OGTT. Women with GDM (n=74) had median values of fasting insulin 15.9 (IQR 11.2-17.77), HOMA-IR 3.5 (IQR 2.6-4.1) and QUICKI 0.31 (IQR 0.30-0.33) as compared to median values of fasting insulin 8.0 (IQR 5.9-10.3), HOMA-IR 1.60 (IQR 1.12-2.03) and QUICKI 0.35 (IQR 0.34-0.37) in patients (n=108) with normal response to OGTT, (p <0.001). On logistic regression analysis, there was a strong association of HOMA-IR and QUICKI with gestational diabetes mellitus (p <0.001, accuracy 84.6%). HOMA-IR at cutoff of ≤2 had 94.5% sensitivity, 72.2% specificity, 70% PPV, 95.1% NPV, and 81.31% overall diagnostic accuracy with 0.913 AUC. QUICKI at cutoff of 0.34 had 86.4% sensitivity, 83.3% specificity, 78.0% PPV, 90.0% NPV, and 84.61% overall diagnostic accuracy with 0.905 AUC. CONCLUSION: Fasting insulin and HOMA-IR were significantly higher while QUICKI was lower in patients of GDM as compared to non-GDM pregnant patients at 24 to 28 weeks of gestation. Being more convenient for patients, it has the potential to be used as screening tool for gestational diabetes. Key Words: HOMA IR, QUICKI, Gestational diabetes mellitus, Insulin.


Assuntos
Diabetes Gestacional , Resistência à Insulina , Glicemia , Estudos Transversais , Diabetes Gestacional/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Lactente , Insulina , Gravidez
2.
Nutrients ; 13(7)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34371847

RESUMO

A recent animal study demonstrated that administration of Lactobacillus plantarum HAC01 isolated from Korean kimchi improved glycemic control in type 2 diabetic mice. In the present study, we evaluated Lactobacillus plantarum HAC01's effects on metabolic parameters of prediabetic human subjects. Forty subjects with isolated impaired glucose tolerance were randomly assigned to receive a daily placebo (n = 20) or a dose of Lactobacillus plantarum HAC01 (n = 20) over eight weeks. The primary endpoint was a change in 2 h postprandial glucose (2h-PPG) levels and the secondary endpoints were assessment of other glucose metabolism parameters, including HbA1c, gut microbiota composition, and fecal short-chain fatty acids (SCFAs). The group with a diet supplemented with Lactobacillus plantarum HAC01 saw a significant reduction in 2h-PPG and HbA1c levels compared to the placebo group. Fasting plasma glucose, insulin, HOMA-IR, QUICKI, microbiota composition, and fecal SCFAs, however, were not significantly altered. No serious adverse effects were reported. This is the first clinical trial to show a beneficial effect of single-strain probiotic supplementation administered over eight weeks on HbA1c levels in prediabetic subjects.


Assuntos
Intolerância à Glucose/microbiologia , Controle Glicêmico/métodos , Lactobacillus plantarum , Estado Pré-Diabético/microbiologia , Probióticos/administração & dosagem , Adulto , Glicemia/metabolismo , Método Duplo-Cego , Ácidos Graxos Voláteis/análise , Fezes/química , Feminino , Microbioma Gastrointestinal , Intolerância à Glucose/sangue , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Estado Pré-Diabético/sangue , Resultado do Tratamento
3.
FASEB J ; 35(9): e21847, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34405464

RESUMO

Mounting evidence demonstrates that paternal diet programs offspring metabolism. However, the contribution of a pre-conception paternal high protein (HP) diet to offspring metabolism, gut microbiota, and epigenetic changes remains unclear. Here we show that paternal HP intake in Sprague Dawley rats programs protective metabolic outcomes in offspring. Compared to paternal high fat/sucrose (HF/S), HP diet improved body composition and insulin sensitivity and improved circulating satiety hormones and cecal short-chain fatty acids compared to HF/S and control diet (P < .05). Further, using 16S rRNA gene sequencing to assess gut microbial composition, we observed increased alpha diversity, distinct bacterial clustering, and increased abundance of Bifidobacterium, Akkermansia, Bacteroides, and Marvinbryantia in HP fathers and/or male and female adult offspring. At the epigenetic level, DNMT1and 3b expression was altered intergenerationally. Our study identifies paternal HP diet as a modulator of gut microbial composition, epigenetic markers, and metabolic function intergenerationally.


Assuntos
Composição Corporal , Dieta Rica em Proteínas , Epigênese Genética , Pai , Microbioma Gastrointestinal , Insulina/metabolismo , Exposição Paterna , Tecido Adiposo/metabolismo , Adiposidade , Envelhecimento , Animais , Peso Corporal , DNA (Citosina-5-)-Metiltransferases/metabolismo , Dieta Hiperlipídica , Sacarose na Dieta , Ingestão de Energia , Metabolismo Energético , Ácidos Graxos/metabolismo , Feminino , Fertilidade , Teste de Tolerância a Glucose , Hormônios/metabolismo , Resistência à Insulina , Fígado/metabolismo , Masculino , Tamanho do Órgão , Gravidez , Pequeno RNA não Traduzido/metabolismo , Ratos , Ratos Sprague-Dawley , Resposta de Saciedade , Desmame
4.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(3): 305-312, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34402253

RESUMO

To investigate the effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus (GDM). One hundred and twelve patients with GDM in the second trimester of pregnancy were recruited from Women's Hospital, Zhejiang University School of Medicine. Patients were randomized into two groups with 56 in each group: the control group received basic nutrition support; while the dietary fiber group were given additional dietary fiber ( total dietary fiber per day) before meals in addition to basic nutrition support. Intervention for all cases lasted for 8 weeks. Fasting blood glucose and postprandial blood glucose (2 h BG) were measured every week, and oral glucose tolerance test (OGTT) was performed at 42 d postpartum to evaluate the glycemic outcomes. Perinatal outcomes were recorded. The dietary fiber intervention markedly improved 2 h BG in patients with GDM and significantly elevated the glucose compliance rate from the 3rd to 8th week compared to the control group ( <0.05 or <0.01). OGTT 2 h glucose and the incidence of impaired glucose tolerance in the dietary fiber group were significantly lower than those in the control group, while the glucose compliance rate was significantly higher than that in the control group (all <0.01). Moreover, the rates of adverse perinatal outcomes, such as premature rupture of membranes and neonatal hyperbilirubinemia were declined in the dietary fiber group (<0.05 or <0.01). Dietary fiber intervention can ameliorate hyperglycemia in GDM patients, improve perinatal outcomes and reduce the incidence of postpartum impaired glucose tolerance.


Assuntos
Diabetes Gestacional , Glicemia , Fibras na Dieta , Feminino , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez
5.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(3): 313-319, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34402256

RESUMO

To explore the correlation of mid-term oral glucose tolerance test (OGTT) and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). A total of 2611 pregnant women with GDM who were examined and delivered in Women's Hospital, Zhejiang University School of Medicine from July 1st 2017 to 30th June 2018 were enrolled in this study. According to the number of abnormal items of mid-term OGTT results or maternal gestational weight gain (GWG), patients were classified. The incidence of adverse perinatal outcomes in each group and its relation with OGTT results and GWG were analyzed. The incidence of gestational hypertension, premature delivery, macrosomia and large for gestational age infant (LGA) in three abnormal items GDM patients were significantly higher than those in one or two abnormal items GDM patients (all <0.017). The incidence of gestational hypertension and premature delivery in two abnormal items GDM patients were higher than those in one abnormal item GDM patients (all <0.017). The incidence of gestational hypertension and macrosomia in excessive GWG patients were significantly higher than those in inadequate and appropriate GWG patients (all <0.017), and the incidence of LGA were higher than that in inadequate GWG patients (all <0.017). The incidence of premature delivery and low birth weight infants in appropriate GWG patients were significantly lower than those in inadequate and excessive GWG patients, and the incidence of small for gestational age infant (SGA) were significantly lower than that in inadequate GWG patients (all <0.017). In one abnormal item GDM patients, inadequate GWG was a risk factor for premature delivery and SGA (=1.66, 95%: 1.10-2.52; =2.20, 95%: 1.07-4.53), and protective factor for LGA (=0.40, 95%: 0.27-0.59). And excessive GWG was a risk factor for gestational hypertension, premature delivery and low birth weight infants (=2.15, 95%: 1.35-3.41; =1.80, 95%: 1.20-2.72; =2.18, 95%: 1.10-4.30).In two abnormal items GDM patients, inadequate GWG was a protective factor for macrosomia and LGA (=0.24, 95%: 0.09-0.67; =0.54, 95%: 0.34-0.86), while excessive GWG was risk factor for premature delivery (=1.98, 95%: 1.23-3.18).In three abnormal items GDM patients, there was no significant relationship between GWG and adverse pregnancy outcomes. For GDM women with one or two items of elevated blood glucose in OGTT, reasonable weight management during pregnancy can reduce the occurrence of adverse pregnancy outcomes. For those with three items of elevated blood glucose in OGTT, more strict blood glucose monitoring and active intervention measures should be taken in addition to weight management during pregnancy.


Assuntos
Diabetes Gestacional , Ganho de Peso na Gestação , Glicemia , Automonitorização da Glicemia , Índice de Massa Corporal , Diabetes Gestacional/epidemiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Gravidez , Resultado da Gravidez
6.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(3): 329-334, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34402261

RESUMO

To investigate the impact of family history of diabetes (FHD) on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus (GDM). A total of 1265 GDM women who gave childbirth in Women's Hospital, Zhejiang University School of Medicine during January to December 2019 were enrolled in the study, including 253 women with FHD and 1012 women without FHD. The -test or test were used to compare the blood lipid, blood glucose levels and perinatal outcomes including large for gestational age infant, small for gestational age infant, macrosomia, cesarean delivery, preeclampsia, preterm labor, postpartum hemorrhage, fetal distress. The correlation between FHD and perinatal outcomes were estimated by Logistic regression analysis. The high density lipoprotein level at third-trimester was significantly lower in GDM women with FHD (<0.05); and the women with FHD also had higher fasting blood glucose oral glucose tolerance test (OGTT)1 h, OGTT 2 h and glycosylated hemoglobin level (all <0.01). In GDM women, FHD was an independent risk factor for preeclampsia (=3.27, 95%: 1.39-7.68). GDM women with FHD have lower high density lipoprotein and higher glucose levels. FHD is an independent risk factor for preeclampsia in GDM women.


Assuntos
Diabetes Gestacional , Glicemia , Feminino , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Lipídeos , Gravidez , Gestantes , Fatores de Risco
7.
Nat Commun ; 12(1): 4768, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362888

RESUMO

Bariatric surgeries such as the Vertical Sleeve Gastrectomy (VSG) are invasive but provide the most effective improvements in obesity and Type 2 diabetes. We hypothesized a potential role for the gut hormone Fibroblast-Growth Factor 15/19 which is increased after VSG and pharmacologically can improve energy homeostasis and glucose handling. We generated intestinal-specific FGF15 knockout (FGF15INT-KO) mice which were maintained on high-fat diet. FGF15INT-KO mice lost more weight after VSG as a result of increased lean tissue loss. FGF15INT-KO mice also lost more bone density and bone marrow adipose tissue after VSG. The effect of VSG to improve glucose tolerance was also absent in FGF15INT-KO. VSG resulted in increased plasma bile acid levels but were considerably higher in VSG-FGF15INT-KO mice. These data point to an important role after VSG for intestinal FGF15 to protect the organism from deleterious effects of VSG potentially by limiting the increase in circulating bile acids.


Assuntos
Fatores de Crescimento de Fibroblastos/genética , Fatores de Crescimento de Fibroblastos/metabolismo , Fatores de Crescimento de Fibroblastos/farmacologia , Gastrectomia/efeitos adversos , Tecido Adiposo , Animais , Cirurgia Bariátrica , Ácidos e Sais Biliares/sangue , Glicemia , Densidade Óssea , Medula Óssea , Diabetes Mellitus Tipo 2 , Dieta Hiperlipídica , Modelos Animais de Doenças , Teste de Tolerância a Glucose , Homeostase , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Obesidade/cirurgia , Perda de Peso
9.
JAMA ; 326(6): 539-562, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34374717

RESUMO

Importance: Gestational diabetes is associated with several poor health outcomes. Objective: To update the 2012 review on screening for gestational diabetes to inform the US Preventive Services Task Force. Data Sources: MEDLINE, EMBASE, and CINAHL (2010 to May 2020), ClinicalTrials.gov, reference lists; surveillance through June 2021. Study Selection: English-language intervention studies for screening and treatment; observational studies on screening; prospective studies on screening test accuracy. Data Extraction and Synthesis: Dual review of titles/abstracts, full-text articles, and study quality. Single-reviewer data abstraction with verification. Random-effects meta-analysis or bivariate analysis (accuracy). Main Outcomes and Measures: Pregnancy, fetal/neonatal, and long-term health outcomes; harms of screening; accuracy. Results: A total of 76 studies were included (18 randomized clinical trials [RCTs] [n = 31 241], 2 nonrandomized intervention studies [n = 190], 56 observational studies [n = 261 678]). Direct evidence on benefits of screening vs no screening was limited to 4 observational studies with inconsistent findings and methodological limitations. Screening was not significantly associated with serious or long-term harm. In 5 RCTs (n = 25 772), 1-step (International Association of Diabetes and Pregnancy Study Group) vs 2-step (Carpenter and Coustan) screening was significantly associated with increased likelihood of gestational diabetes (11.5% vs 4.9%) but no improved health outcomes. At or after 24 weeks of gestation, oral glucose challenge tests with 140- and 135-mg/dL cutoffs had sensitivities of 82% and 93%, respectively, and specificities of 82% and 79%, respectively, against Carpenter and Coustan criteria, and a test with a 140-mg/dL cutoff had sensitivity of 85% and specificity of 81% against the National Diabetes Group Data criteria. Fasting plasma glucose tests with cutoffs of 85 and 90 mg/dL had sensitivities of 88% and 81% and specificities of 73% and 82%, respectively, against Carpenter and Coustan criteria. Based on 8 RCTs and 1 nonrandomized study (n = 3982), treatment was significantly associated with decreased risk of primary cesarean deliveries (relative risk [RR], 0.70 [95% CI, 0.54-0.91]; absolute risk difference [ARD], 5.3%), shoulder dystocia (RR, 0.42 [95% CI, 0.23-0.77]; ARD, 1.3%), macrosomia (RR, 0.53 [95% CI, 0.41-0.68]; ARD, 8.9%), large for gestational age (RR, 0.56 [95% CI, 0.47-0.66]; ARD, 8.4%), birth injuries (odds ratio, 0.33 [95% CI, 0.11-0.99]; ARD, 0.2%), and neonatal intensive care unit admissions (RR, 0.73 [95% CI, 0.53-0.99]; ARD, 2.0%). The association with reduction in preterm deliveries was not significant (RR, 0.75 [95% CI, 0.56-1.01]). Conclusions and Relevance: Direct evidence on screening vs no screening remains limited. One- vs 2-step screening was not significantly associated with improved health outcomes. At or after 24 weeks of gestation, treatment of gestational diabetes was significantly associated with improved health outcomes.


Assuntos
Diabetes Gestacional/diagnóstico , Programas de Rastreamento , Diabetes Gestacional/terapia , Feminino , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Medição de Risco
10.
JAMA ; 326(6): 531-538, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34374716

RESUMO

Importance: Gestational diabetes is diabetes that develops during pregnancy. Prevalence of gestational diabetes in the US has been estimated at 5.8% to 9.2%, based on traditional diagnostic criteria, although it may be higher if more inclusive criteria are used. Pregnant persons with gestational diabetes are at increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia (which can cause shoulder dystocia and birth injury), and neonatal hypoglycemia. Gestational diabetes has also been associated with an increased risk of several long-term health outcomes in pregnant persons and intermediate outcomes in their offspring. Objective: The USPSTF commissioned a systematic review to evaluate the accuracy, benefits, and harms of screening for gestational diabetes and the benefits and harms of treatment for the pregnant person and infant. Population: Pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes. Evidence Assessment: The USPSTF concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes. The USPSTF concludes that the evidence on screening for gestational diabetes before 24 weeks of gestation is insufficient, and the balance of benefits and harms of screening cannot be determined. Recommendation: The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons before 24 weeks of gestation. (I statement).


Assuntos
Diabetes Gestacional/diagnóstico , Programas de Rastreamento/normas , Feminino , Teste de Tolerância a Glucose , Humanos , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Gravidez , Segundo Trimestre da Gravidez , Trimestres da Gravidez , Medição de Risco , Fatores de Risco
12.
Nutrients ; 13(7)2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34371972

RESUMO

Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55-70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.


Assuntos
Composição Corporal , Fatores de Risco Cardiometabólico , Ácidos Docosa-Hexaenoicos/administração & dosagem , Sobrepeso/terapia , Pós-Menopausa , Treinamento de Força , Idoso , Glicemia/análise , Suplementos Nutricionais , Método Duplo-Cego , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Teste de Tolerância a Glucose , Humanos , Metabolismo dos Lipídeos , Pessoa de Meia-Idade , Força Muscular , Obesidade/fisiopatologia , Obesidade/terapia , Sobrepeso/fisiopatologia , Placebos
14.
Nutrients ; 13(7)2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34202194

RESUMO

Although lifestyle interventions can lead to diabetes remission, it is unclear to what extent type 2 diabetes (T2D) remission alters or improves the underlying pathophysiology of the disease. Here, we assess the effects of a lifestyle intervention on T2D reversal or remission and the effects on the underlying pathology. In a Dutch primary care setting, 15 adults with an average T2D duration of 13.4 years who were (pharmacologically) treated for T2D received a diabetes subtyping ("diabetyping") lifestyle intervention (DLI) for six months, aiming for T2D remission. T2D subtype was determined based on an OGTT. Insulin and sulphonylurea (SU) derivative treatment could be terminated for all participants. Body weight, waist/hip ratio, triglyceride levels, HbA1c, fasting, and 2h glucose were significantly improved after three and six months of intervention. Remission and reversal were achieved in two and three participants, respectively. Indices of insulin resistance and beta cell capacity improved, but never reached healthy values, resulting in unchanged T2D subtypes. Our study implies that achieving diabetes remission in individuals with a longer T2D duration is possible, but underlying pathology is only minimally affected, possibly due to an impaired beta cell function. Thus, even when T2D remission is achieved, patients need to continue adhering to lifestyle therapy.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Dieta Saudável/métodos , Estilo de Vida Saudável , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Jejum/sangue , Estudos de Viabilidade , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Indução de Remissão , Fatores de Tempo , Resultado do Tratamento
15.
Int J Mol Sci ; 22(14)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34299070

RESUMO

The aim of the current study was to test the hypothesis that maternal lipid metabolism was modulated during normal pregnancy and that these modulations are altered in gestational diabetes mellitus (GDM). We tested this hypothesis using an established mouse model of diet-induced obesity with pregnancy-associated loss of glucose tolerance and a novel lipid analysis tool, Lipid Traffic Analysis, that uses the temporal distribution of lipids to identify differences in the control of lipid metabolism through a time course. Our results suggest that the start of pregnancy is associated with several changes in lipid metabolism, including fewer variables associated with de novo lipogenesis and fewer PUFA-containing lipids in the circulation. Several of the changes in lipid metabolism in healthy pregnancies were less apparent or occurred later in dams who developed GDM. Some changes in maternal lipid metabolism in the obese-GDM group were so late as to only occur as the control dams' systems began to switch back towards the non-pregnant state. These results demonstrate that lipid metabolism is modulated in healthy pregnancy and the timing of these changes is altered in GDM pregnancies. These findings raise important questions about how lipid metabolism contributes to changes in metabolism during healthy pregnancies. Furthermore, as alterations in the lipidome are present before the loss of glucose tolerance, they could contribute to the development of GDM mechanistically.


Assuntos
Diabetes Gestacional/patologia , Metabolismo dos Lipídeos , Lipidômica/métodos , Lipídeos/análise , Obesidade/fisiopatologia , Animais , Glicemia/análise , Diabetes Gestacional/etiologia , Diabetes Gestacional/metabolismo , Feminino , Teste de Tolerância a Glucose , Camundongos , Gravidez
16.
J Int Med Res ; 49(7): 3000605211032849, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34320857

RESUMO

OBJECTIVE: To investigate the ability of kobusone to reduce high glucose levels and promote ß-cell proliferation. METHODS: Four-week-old female db/db mice were assigned to the kobusone (25 mg/kg body weight, intraperitoneally twice a day) or control group (same volume of PBS). Glucose levels and body weight were measured twice a week. After 6 weeks, intraperitoneal glucose tolerance tests and immunohistochemical studies were performed, and insulin levels were determined. The expression of mRNAs involved in cell proliferation, such as PI3K, Akt, cyclin D3 and p57Kip2, was measured by quantitative reverse transcription polymerase chain reaction (RT-qPCR). RESULTS: Kobusone reduced blood glucose levels after 3 weeks and more strongly increased serum insulin levels than the vehicle. Immunohistochemistry illustrated that kobusone increased 5-bromo-2'-deoxyuridine incorporation into islet ß-cells, suggesting that it can stimulate islet ß-cell replication in vivo. RT-qPCR indicated that kobusone upregulated the mRNA expression of PI3K, Akt, and cyclin D3 and downregulated that of p57Kip2. CONCLUSION: Our findings suggest that kobusone is a potent pancreatic islet ß-cell inducer that has the potential to be developed as an anti-diabetic agent.


Assuntos
Células Secretoras de Insulina , Ilhotas Pancreáticas , Animais , Glicemia , Proliferação de Células , Feminino , Teste de Tolerância a Glucose , Hipoglicemiantes , Insulina , Camundongos
17.
Math Biosci Eng ; 18(4): 4628-4647, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-34198457

RESUMO

This paper proposes a model that considers the action and timing of insulin and glucagon in glucose homeostasis after an oral stimulus. We use the Bayesian paradigm to infer kinetic rates, namely insulin and glucagon secretion, gastrointestinal emptying, and basal glucose concentration in blood. We identify two insulin scores related to glucose concentration in both blood and the gastrointestinal tract. The scores allow us to suggest a classification for individuals with impaired insulin sensitivity.


Assuntos
Diabetes Mellitus Tipo 2 , Glucose , Teorema de Bayes , Glicemia , Teste de Tolerância a Glucose , Humanos , Insulina
18.
Nutrients ; 13(6)2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34204042

RESUMO

A randomized, double-blind, placebo-controlled study was conducted with the primary objective of assessing the effect of a natural extract of Sclerocarya birrea on glucose metabolism in subjects with prediabetes. The duration of the study was 90 days. Thirty-three subjects assigned to the experimental group (daily ingestion of 100 mg of the nutraceutical product) and 34 assigned to the placebo group completed the study. There were 36 men and 31 women with a mean age of 32.3 ± 14.1 years. In the area under the curve (AUC) of the oral glucose tolerance test (OGTT), statistically significant decreases in the experimental group at 40 and 90 days as compared with baseline were found, whereas significant changes in the placebo group were not observed. Within-group differences were statistically significant in favor of the experimental group for glucose peak at OGTT, serum insulin, insulin resistance markers, and flow-mediated dilation. Changes in lipid and anthropometric parameters were not observed, although there was a trend for lower cholesterol levels and a decrease in body weight in the experimental group. Decreases in systolic blood pressure were also higher among subjects in the experimental group. This exploratory study confirms the antidiabetic activity of Sclerocarya birrea in prediabetes. Further studies using better measurements of beta-cell function are needed to clarify the underlying mechanisms of the hypoglycemic effect of this natural compound.


Assuntos
Anacardiaceae , Suplementos Nutricionais , Hipoglicemiantes/administração & dosagem , Extratos Vegetais/administração & dosagem , Estado Pré-Diabético/terapia , Adulto , Área Sob a Curva , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Colesterol/sangue , Método Duplo-Cego , Feminino , Teste de Tolerância a Glucose , Controle Glicêmico/métodos , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue
19.
FASEB J ; 35(8): e21828, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34325494

RESUMO

Since prenatal glucocorticoids (GC) excess increases the risk of metabolic dysfunctions in the offspring and its effect on ß-cell recovery capacity remains unknown we investigated these aspects in offspring from mice treated with dexamethasone (DEX) in the late pregnancy. Half of the pups were treated with streptozotocin (STZ) on the sixth postnatal day (PN). Functional and molecular analyses were performed in male offspring on PN25 and PN225. Prenatal DEX treatment resulted in low birth weight. At PN25, both the STZ-treated offspring developed hyperglycemia and had lower ß-cell mass, in parallel with higher α-cell mass and glucose intolerance, with no impact of prenatal DEX on such parameters. At PN225, the ß-cell mass was partially recovered in the STZ-treated mice, but they remained glucose-intolerant, irrespective of being insulin sensitive. Prenatal exposition to DEX predisposed adult offspring to sustained hyperglycemia and perturbed islet function (lower insulin and higher glucagon response to glucose) in parallel with exacerbated glucose intolerance. ß-cell-specific knockdown of the Hnf4α in mice from the DS group resulted in exacerbated glucose intolerance. We conclude that high GC exposure during the prenatal period exacerbates the metabolic dysfunctions in adult life of mice exposed to STZ early in life, resulting in a lesser ability to recover the islets' function over time. This study alerts to the importance of proper management of exogenous GCs during pregnancy and a healthy postnatal lifestyle since the combination of adverse factors during the prenatal and postnatal period accentuates the predisposition to metabolic disorders in adult life.


Assuntos
Dexametasona/toxicidade , Glucocorticoides/toxicidade , Células Secretoras de Insulina/efeitos dos fármacos , Células Secretoras de Insulina/fisiologia , Animais , Animais Geneticamente Modificados , Animais Recém-Nascidos , Dexametasona/administração & dosagem , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Glucocorticoides/administração & dosagem , Teste de Tolerância a Glucose , Insulina/farmacologia , Camundongos , Neoplasias Experimentais , Gravidez , Efeitos Tardios da Exposição Pré-Natal , RNA Mensageiro/genética , RNA Mensageiro/metabolismo
20.
Nutrients ; 13(6)2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34073610

RESUMO

Vegetables rich in bitter-tasting phytochemicals may exert enhanced beneficial effects against key factors associated with type two diabetes (T2D). This study investigates whether selected cultivars of bitter and strong-tasting (BST) Brassica and root vegetables exert greater health benefits on T2D patients compared to equivalent modern mild and sweet tasting (MST) vegetables. A 12-week randomized, controlled, parallel intervention study involved 92 T2D patients, who were allocated three different diets: (1) 500 g daily of bitter and strong-tasting (BST) vegetables; (2) 500 g daily of mild and sweet-tasting (MST) vegetables; (3) 120 g daily MST normal diet (control). Both vegetable diets contained root vegetables and cabbages selected based on sensory differences and content of phytochemicals. Prior to and after the study, all participants underwent an oral glucose tolerance test (OGTT), 24 h blood pressure measurements, DEXA scans, and fasted blood samples. Both diets high in vegetables significantly reduced the participants' BMI, total body fat mass, and HbA1c levels compared to control, but in the BST group, significant differences were also found regarding incremental area under the curve glucose 240 min (OGTT) and fasting glucose levels. A high daily intake of root vegetables and cabbages showed significant health improvements in both vegetable groups. BST vegetables had the greatest impact on insulin sensitivity, body fat mass, and blood pressure compared to control; moreover, they further improved glycemic control compared to MST vegetables.


Assuntos
Diabetes Mellitus Tipo 2 , Nível de Saúde , Paladar , Verduras , Glicemia , Pressão Sanguínea , Composição Corporal , Brassica , Jejum , Glucose , Teste de Tolerância a Glucose , Controle Glicêmico , Humanos , Resistência à Insulina
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