The effect of sodium-glucose cotransporter-2 inhibitors on inflammatory biomarkers: A meta-analysis of randomized controlled trials.

AIMS: To conduct a meta-analysis of randomized controlled trials (RCTs) to assess the effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on inflammatory biomarkers. METHODS: Medline, Embase and the Cochrane Library were searched for RCTs investigating the effect of SGLT2 inhibitors on inflammatory biomarkers, adipokine profiles and insulin sensitivity. RESULTS: Thirty-eight RCTs were included (14 967 participants, 63.3% male, mean age 62 ± 8.6 years) with a median (interquartile range) follow-up of 16 (12-24) weeks. Meta-analysis showed that SGLT2 inhibitors significantly improved adiponectin, interleukin-6, tumour necrosis factor receptor-1 (vs. placebo alone: standardized mean difference [SMD] 0.34 [95% confidence interval {CI} 0.23, 0.45], mean difference [MD] -0.85 pg/mL [95% CI -1.32, -0.38], SMD -0.13 [95% CI -0.20, -0.06], respectively), leptin and homeostatic model assessment of insulin resistance index (vs. CONTROL: SMD -0.20 [95% CI -0.33, -0.07], MD -0.83 [95% CI -1.32, -0.33], respectively). There were no significant changes in C-reactive protein (CRP), tumour necrosis factor-α, plasminogen activator inhibitor-1, fibroblast growth factor-21 or monocyte chemoattractant protein-1. CONCLUSIONS: Our analysis shows that SGLT2 inhibitors likely improve adipokine biomarkers and insulin sensitivity, but there is little evidence that SGLT2 inhibitors improve other inflammatory biomarkers including CRP.

Glucagon-like peptide-1 receptor agonists improve biomarkers of inflammation and oxidative stress: A systematic review and meta-analysis of randomised controlled trials.

AIM: To conduct a meta-analysis and systematic review to examine the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on clinical biomarkers of inflammation and oxidative stress in patients with type 2 diabetes. METHODS: Medline, Embase and the Cochrane Library were searched for randomised controlled trials (RCTs) that examined changes with GLP-1RAs in a priori selected biomarkers of inflammation: C-reactive protein (CRP), adiponectin, tumour necrosis factor-alpha (TNFα), plasminogen activator inhibitor-1, interleukin-6, leptin; and of oxidative stress: malondialdehyde (MDA); 8-iso-prostaglandin F2α; and 8-hydroxy-2'-deoxyguanosine (8-OHdG). RESULTS: We included 40 eligible RCTs (n = 6749) with a median follow-up of 6 months, a mean participant age of 53.1 years, 56.3% females, glycated haemoglobin (HbA1c) 55.6 mmol/mol, body mass index 28.8 kg/m2 and diabetes duration 7.46 years. Analysis of GLP-1RAs versus standard diabetes therapies or placebo revealed significant reductions in CRP, TNFα and MDA, and significant increases in adiponectin for (mean difference -0.54 mg/L [-0.75, -0.34]; standard mean difference [SMD] -0.39 [-0.62, -0.15]; SMD -0.84 [-1.61, -0.06] and SMD 0.30 [0.12, 0.49], respectively [95% confidence intervals]). Systolic blood pressure decreased significantly and was significantly and strongly correlated with a reduction in CRP. Homeostatic model assessment of insulin resistance was also significantly correlated with a reduction in CRP, but HbA1c was not. CONCLUSIONS: There is strong evidence supporting clinically relevant anti-inflammatory and antioxidant effects of GLP-1RAs. This may be used to guide future targeted clinical use of GLP-1RAs and the development of medications seeking to target the cardioprotective properties of GLP-1RAs.

Chronic kidney disease in type 2 diabetes: Implications for managing glycaemic control, cardiovascular and renal risk.

This review examines the current literature relating to diabetes related kidney disease (DKD) and the optimal management of cardio-renal risk. DKD develops in approximately 40% of patients with type 2 diabetes mellitus. The mainstay of therapy is to reduce the progression of DKD by optimising hyperglycaemia, blood pressure, lipids and lifestyle. Evidence supports the role for renin-angiotensin system blockade in limiting the progression of DKD. Recent data from diabetes related cardiovascular outcome trials and renal specific trials have provided a novel insight on the additional benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing the progression of DKD as well as cardiovascular risk. Lessons have been learnt from CREDENCE and there are expectations that DAPA-CKD and EMPA-KIDNEY will further support the benefits of SGLT2 inhibition in relation to DKD. As a consequence, international guidelines have been updated to reflect the positive benefits. In addition, novel steroidal mineralocorticoid receptor antagonists offer a potential role in future years. The review examines the current evidence and future approach to optimising outcomes for renal protection in patients with diabetes.

The influence of attachment orientation on weight loss, eating behaviour and other health outcomes among patients undergoing bariatric surgery: A scoping review.

Attachment orientation is a psychological factor concerning our expectations of ourselves and others in interpersonal relationships. An emerging literature has suggested that attachment orientation may influence a range of outcomes associated with bariatric surgery. The purpose of this scoping review was to map the literature and examine the role of attachment orientation in the context of bariatric surgery. Studies conducted with patients who are undergoing or have undergone bariatric surgery, with a measure of attachment orientation and published by 21st July 2019, were located through electronic searches including Scopus, PubMed and Web of Science. 21180 studies were identified, of which 18 were retained for narrative synthesis. The major outcome themes reported were (1) post-surgery weight-loss/body mass index (k = 10), (2) eating behaviour (k = 9), (3) attachment orientation differences in bariatric surgery patients compared with control groups (k = 4) and 4) other mental and physical health outcomes (k = 12). Overall, the results showed that there was little evidence to suggest that poor attachment orientation is predictor of weight-loss following surgery. There was evidence to suggest that poorer attachment orientation relates to poorer eating behaviours both before and after surgery, that patients undergoing bariatric surgery are more likely to have a poorer attachment orientation and attachment orientation is related to mental health outcomes but not physical health outcomes for patients. However, where relationships were identified, there were considerable inconsistencies regarding the dimension of attachment orientation that drove the relationship. Future studies should consider appropriate sample sizes for studies, replication of key findings and longer durations for longitudinal studies.

PHACOEMULSIFICATION CATARACT SURGERY WITH PROPHYLACTIC INTRAVITREAL BEVACIZUMAB FOR PATIENTS WITH COEXISTING DIABETIC RETINOPATHY: A Meta-Analysis.

PURPOSE: To evaluate the clinical effectiveness of intravitreal bevacizumab (IVB) injection combined with cataract surgery in the treatment of patients with cataract and coexisting diabetic retinopathy (DR). METHODS: Pertinent comparative studies were identified through systemic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register up to March 1, 2016. Outcome measures included corrected distance vision acuity, central macular thickness, and progression of DR and maculopathy. A meta-analysis was performed using RevMan (Cochrane Collaboration, Oxford, United Kingdom). RESULTS: Six studies describing a total of 283 eyes were identified. The meta-analysis results showed that corrected distance vision acuity measured at 1 month and 3 months after cataract surgery was significantly better in the IVB groups than in the control groups (P < 0.00001 and P = 0.01), whereas the corrected distance vision acuity at 6 months did not vary significantly between the 2 groups (P = 0.24). Similarly, the central macular thickness at 1, 3, and 6 months after surgery was significantly thinner in the IVB groups than in the control groups (P = 0.01, P = 0.0004, and P = 0.01, respectively). At 6 months, the progression of postoperative DR and maculopathy occurred more frequently in the control group than in the IVB group (P = 0.0001 and P < 0.0001, respectively). CONCLUSION: Our meta-analysis indicates that cataract surgery combined with IVB seems to be an effective treatment in patients with coexisting DR in the short term (up to 6 months). More randomized, prospective, and large-sample-sized trials are needed to evaluate the long-term effects of IVB at the time of cataract surgery in patients with DR.

Associations between metabolic syndrome components and markers of inflammation in Welsh school children.

We investigated the multivariate dimensionality and strength of the relationship between metabolic syndrome (MetS) and inflammation in children. Caucasian school children (N = 229; 12-14 years) from Wales were tested on several health indicators including measures of body composition, inflammation, fasting glucose regulation, blood pressure, and lipids. The multivariate association between MetS and inflammation was investigated via canonical correlation analysis. Data were corrected for non-normality by log transformation, and sex-specific z-scores computed for variables where there was a significant sex difference. Structure r's were interpreted to determine the dimensions of MetS and inflammation responsible for significant canonical variates. The overall multivariate association between MetS and inflammation was significant (Wilks' Lambda = 0.54, p < 0.001). The relationship was explained primarily by the waist circumference dimension of MetS (CC = 0.87) and inflammatory markers of fibrinogen (CC = 0.52) and C-reactive protein (CC = 0.50). The pattern of results was similar regardless of whether variables were adjusted for sex differences. CONCLUSION: Central adiposity is the strongest predictor of the inflammatory aspect of cardiovascular disease risk in Caucasian adolescents. Future research into MetS and cardiometabolic risk should consider multivariate statistical approaches, in order to identify the separate contributions of each dimension in interrelationships and to identify which dimensions are influenced by preventive interventions. What is Known: • Metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease (CVD) and type 2 diabetes. Markers of inflammation are also potential predictors of later development of CVD and type 2 diabetes. • The contribution of individual markers in interrelationships between MetS and inflammation is unknown. What is New: • We uniquely demonstrate that within a multivariate model, waist circumference is the primary link between MetS variables and markers of inflammation in children. • Waist circumference may therefore be a useful population-level screening tool to identify future risk of CVD.

The clinical management of hyponatraemia.

Hyponatraemia is the most common electrolyte disorder seen in clinical practice and the consequences can range from minor symptoms to life-threatening complications including seizures and cardiorespiratory distress. These effects occur as a result of fluid shifts due to deranged serum tonicity and subsequent cerebral oedema. The appropriate assessment and management of patients with hyponatraemia is not always achieved in clinical practice, which is partly related to challenges in teaching with limited clinical guidance. Recently, the European Society of Endocrinology, European Society of Intensive Care Medicine and European Renal Association-European Dialysis and Transplant Association produced clinical practice guidelines to focus on appropriate investigation and management of these patients. Within this manuscript, we highlight the key points from these guidelines, which are most pertinent to doctors of all specialties to improve the care of patients with this common electrolyte disorder.

Changes in Cognitive Function Following Bariatric Surgery: An Updated Systematic Review.

Since a previous systematic review published in 2016, there have been further studies investigating the association of changes in cognitive function following bariatric surgery. All studies since the original review that reported at least one element of cognitive function before and after bariatric surgery were eligible. A total of 137 additional studies were identified; 13 were included in addition to the 18 studies previously. Almost all studies reported improvements in at least one domain. Most revealed improvements were limited to a few domains and were not universal. Further findings investigated cognitive function improvement in relation to procedure choice, and mental health or quality of life post-surgery. Further high-powered studies are still necessary, but these findings support the impact of bariatric surgery on cognitive function in obesity.

Benefits in routinely measured liver function tests following bariatric surgery: a retrospective cohort study.

Background: Bariatric surgery is well-established to support long-term metabolic health benefits associated with considerable weight loss. Here, we aim to determine the longer-term impact of bariatric surgery on liver enzymes and associations with other metabolic improvements. Methods: One hundred patients who underwent bariatric surgery between 2007 and 2014 were included, and changes in liver enzymes, anthropometric measures and other parameters were observed over a mean 9.8 years. Results: At the time of surgery, the mean age was 45.4 ± 9.6 years, weight 141.2 ± 31.6 kg, and body mass index (BMI) 50.2 ± 10.1 kg/m2. Most patients underwent sleeve gastrectomy [n = 71] with a mean follow-up duration 9.8 ± 2.3 years. From baseline, alanine transaminase (ALT) reduced by 41.3% within 12 months post-operatively (36.6 ± 29.2 U/L to 21.5 ± 14.9 U/L, p < 0.001), which was sustained at recent follow-up (20.2 ± 10.7 U/L, p < 0.001). There were associated reductions in body weight, BMI, HbA1c, blood pressure and triglycerides. Patients with greater baseline ALT had the greatest reduction in ALT over follow-up. Conclusions: Bariatric surgery is associated with rapid and sustained improvements in routine liver enzymes at 10 years, and sustained improvements in features of the metabolic syndrome. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01311-4.

Achievement of the ESC recommendations for secondary prevention of cardiovascular risk factors in high-risk patients with type 2 diabetes: A real-world national cohort analysis.

AIM: To assess compliance with European Society of Cardiology (ESC) secondary prevention recommendations in a nationwide contemporary population with diabetes mellitus (DM) and coronary artery disease. METHOD: We conducted a retrospective observational study using linked health data in patients across Wales with DM undergoing percutaneous coronary intervention (2012-2017). The follow-up was for one year. We analysed the clinical characteristics, medications, target levels for HbA1c, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) and blood pressure against the ESC prevention guidelines. RESULTS: Overall, 3478 patients with diabetes had available data at 1-year post-PCI. Only 43% had HbA1c levels <53 mmol/L, but 81% had blood pressure < 140/80 (current ESC targets). Prescribing frequency of the newer hypoglycaemic agents (glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors) was suboptimal, with a higher rate in patients with HbA1c ≥53 mmol/mol. Only 51% & 27% of the patients had LDL-C levels <1.8 &1.4 mmol/L (2016 & 2019 guidelines recommendations respectively), and 55% & 34% had non-HDL-C levels <2.6 & 2.2 mmol/L (2016 & 2019 guidelines respectively). Of the uncontrolled LDL-C patients, 42% (2016 target) and 35% (2019 target) were prescribed high-intensity statins. Females were more likely to have LDL-C targets above the recommended level. CONCLUSION: Achievement of ESC treatment goals in this very-high risk cohort for DM and hyperlipidaemia was far from optimal, with a low prescription rate of the guidelines-recommended therapy. Target goals for hypertension were met more frequently. An up-to-date analysis reflecting the current practice against the most recent guidelines is warranted.

Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department.

INTRODUCTION: Type 2 diabetes mellitus (T2D) is associated with poor health outcomes whilst tight glycaemic targets are questionable in those aged over 70 years with increased frailty. Our aim was to examine whether people with T2D admitted to hospital with a fall, were more likely to have greater frailty, increased mortality and co-morbidity burden, or risk factors for falls than people without T2D, and whether these differences were associated with medications used for the treatment of T2D. METHODS: The Older Persons Assessment Service (OPAS) is a local emergency department (ED) service, which accepts patients on frailty criteria. The OPAS accepts patients primarily aged over 70 years who present with frailty and geriatric syndromes such as falls, with retrieval from the ED department directly to the service from triage. The OPAS databank was analysed for people with T2D admitted with a fall between June 2020-September 2022. We examined clinical outcomes relating to medication, age, Charlson co-morbidity index (CCI) and clinical frailty score (CFS). RESULTS: 1081 patients were included: 294 (27.2%) with T2D and a mean HbA1c of 53.9 (± 15.8) mmol/mol [7.1%]. People with T2D had a similar mean CFS and age compared to those without T2D, but higher mean CCI (7.0 ± 2.2 vs 5.9 ± 2.1, p < 0.001). Of those people with T2D, 175 (59.5%) and 240 (81.6%) had a HbA1c ≤ 53 mmol/mol [7.0%] and ≤ 64 mmol/mol [8.0%], respectively. In total, 48 (16.3%) people with T2D were identified to have a capillary blood glucose below 4.0 mmol/L on admission to the ED. At 12 months' follow-up, 831 (76.9%) patients were alive and 250 (23.1%) had died. People with T2D treated with insulin and/or gliclazide had a greater 1-year mortality (36.6% vs 23.6%, p < 0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p < 0.001), and greater HbA1c (65.5 ± 17.2 mmol/mol [8.2] vs 48.9 ± 12.1 mmol/mol [6.6%]) compared to those who used other agents. Logistic regression confirmed a diagnosis of T2D was associated with 1-year mortality, but mortality was not significantly associated with hypoglycaemic-inducing agents. People with T2D were not more likely to live in deprived areas. CONCLUSIONS: A diagnosis of T2D is associated with greater 1-year mortality, and may be influenced by use of hypoglycaemia-inducing diabetes medications. Clinician awareness can support de-prescribing for patients with frailty and HbA1c < 64 mmol/mol.

Personalized Type 2 Diabetes Management: An Update on Recent Advances and Recommendations.

Previous guidelines for the treatment of people with type 2 diabetes mellitus (T2D) have relied heavily upon rigid algorithms for the sequential addition of pharmacotherapies to achieve target glycemic control. More recent guidelines advocate a personalized approach for diabetes treatment, to improve patient satisfaction, quality of life, medication adherence and overall health outcomes. Clinicians should work with patients to develop personalized goals for their treatment, including targeted glycemic control, weight management, prevention and treatment of associated comorbidities and avoidance of complications such as hypoglycemia. Factors that affect the intensity of treatment and choice of pharmacotherapy should include medical and patient influences. Medical considerations include the diabetes phenotype, biomarkers including genetic tests, and the presence of comorbidities such as cardiovascular, renal, or hepatic disease. Patient factors include their treatment preference, age and life expectancy, diabetes duration, hypoglycemia fear and unawareness, psychological and social circumstances. The use of a personalized approach in the management of people with T2D can reduce the cost and failure associated with the algorithmic "one-size-fits-all" approach, to anticipate disease progression, improve the response to diabetes pharmacotherapy and reduce the incidence of diabetes-associated complications. Ultimately, the use of personalized medicine in people with T2D should improve medication adherence, patient satisfaction and quality of life to reduce diabetes distress and improve physical health outcomes.

A series of diabetic ketoacidosis associated with the use of sodium-glucose co-transporter-2 inhibitors in secondary care.

BACKGROUND AND AIMS: Sodium-glucose co-transporter-2 inhibitors (SGLT-2i) are associated with diabetic ketoacidosis (DKA), however limited case series are published. METHODS: We evaluated the characteristics of patients admitted with SGLT-2i associated DKA. RESULTS: Over 4 months, 22 patients were identified; 45.5% of DKA was not associated with concurrent illness. CONCLUSION: DKA is not uncommonly associated with SGLT2i with no clear patient factors associated with severity.

A combined insulin reduction and carbohydrate feeding strategy 30 min before running best preserves blood glucose concentration after exercise through improved fuel oxidation in type 1 diabetes mellitus.

In this study, we examined the glycaemic and fuel oxidation responses to alterations in the timing of a low glycaemic index carbohydrate and 75% reduced insulin dose, prior to running, in type 1 diabetes individuals. After carbohydrate (75 g isomaltulose) and insulin administration, the seven participants rested for 30 min, 60 min, 90 min or 120 min (conditions 30MIN, 60MIN, 90MIN, and 120MIN, respectively) before completing 45 min of running at 70% peak oxygen uptake. Carbohydrate and lipid oxidation rates were monitored during exercise and blood glucose and insulin were measured before and for 3 h after exercise. Data were analysed using repeated-measures analysis of variance. Pre-exercise blood glucose concentrations were lower for 30MIN compared with 120MIN (P < 0.05), but insulin concentrations were similar. Exercising carbohydrate and lipid oxidation rates were lower and greater, respectively, for 30MIN compared with 120MIN (P < 0.05). The drop in blood glucose during exercise was less for 30MIN (3.7 mmol · l(-1), s(x) = 0.4) compared with 120MIN (6.4 mmol · l(-1), s(x) = 0.3) (P = 0.02). For 60 min post-exercise, blood glucose concentrations were higher for 30MIN compared with 120MIN (P < 0.05). There were no cases of hypoglycaemia in the 30MIN condition, one case in the 60MIN condition, two in the 90MIN condition, and five in the 120MIN condition. In conclusion, a low glycaemic index carbohydrate and reduced insulin dose administered 30 min before running improves pre- and post-exercise blood glucose responses in type 1 diabetes.

Real-World Clinical Experience of Semaglutide in Secondary Care Diabetes: A Retrospective Observational Study.

INTRODUCTION: The glucagon-like peptide-1 receptor analogue (GLP-1RA) semaglutide is associated with improvements in glycaemia and cardiovascular risk factors in clinical trials. The aim of this study was to examine the real-world impact of semaglutide administered by injection in people with type 2 diabetes (T2D) across three secondary care sites in Wales. METHODS: A retrospective evaluation of 189 patients with T2D initiated on semaglutide between January 2019 and June 2020 with at least one follow-up visit was undertaken. RESULTS: At baseline, participants had a mean age of 61.1 years, mean glycated haemoglobin (HbA1c) of 77.8 mmol/mol (9.3%) and mean body weight of 101.8 kg. At 6 and 12 months of follow-up, mean HbA1c reductions of 13.3 mmol/mol (1.2%) and 16.4 mmol/mol (1.5%), respectively, were observed, and mean weight loss at 6 months was 3.0 kg (all p < 0.001). At 12 months, there were significant reductions in total cholesterol (0.5 mmol/L) and alanine transaminase (4.8 IU/L). Patients naïve to GLP-1RAs or with higher baseline HbA1c at baseline had greater glycaemic reductions, although clinically significant HbA1c reductions were also observed in those who switched from other GLP-1RAs, whose body mass index was < 35.0 and > 35.0 kg/m2 or who had lower baseline HbA1c. Semaglutide was generally well tolerated, although adverse-effects limited use in 18 patients (9.5%). CONCLUSION: Semaglutide provided clinically and statistically significant reductions in HbA1c, body weight, lipids and liver enzymes.

Association between the adiponectin promoter rs266729 gene variant and oxidative stress in patients with diabetes mellitus.

AIMS: Low levels of adiponectin are associated with type 2 diabetes and coronary heart disease (CHD). Recent evidence also suggests that low levels of adiponectin are associated with increased oxidative stress. Our aim was to examine the association between the rs266729 promoter gene variant (-11377C > G) and plasma markers of oxidative stress in diabetes subjects. METHODS AND RESULTS: Seven hundred and sixty-seven Caucasian subjects with diabetes were successfully genotyped (CC/CG/GG). Genotype data were analysed in relation to plasma total antioxidant status (TAOS) and Oxidized-LDL (Ox-LDL). Plasma adiponectin measurements were available in 206 samples. There was a significant association between genotype and plasma TAOS (CC: 42.1 +/- 13.4% vs. CG: 42.0 +/- 12.0% vs. GG: 47.9 +/- 12.0%, P = 0.02; for CC/CG vs. GG, P = 0.006). With respect to Ox-LDL, CC subjects had 8% higher plasma Ox-LDL compared with CG/GG [CC vs. CG vs. GG: 48.5 (36.3-60.2) U/L vs. 44.8 (35.6-54.1) U/L vs. 44.9 (41.2-49.1) U/L, for CC vs. CG/GG P = 0.03]. For plasma adiponectin, GG subjects had the highest levels [CC vs. CG vs. GG: 8.18 (5.69-15.38) microg/mL vs. 7.12 (5.34-12.97) microg/mL vs. 11.84 (6.98-25.25) microg/mL, P = 0.09; for CC/CG vs. GG, P = 0.05]. CONCLUSION: This study shows an association between a promoter variant in the adiponectin gene and plasma markers of oxidative stress. In line with previous studies, this work supports an antioxidant role for adiponectin which may explain its cardioprotective effect. Further prospective study is necessary to explore the effect of this gene variant in diabetes in relation to CHD risk and oxidative stress.

Heart rate prescribed walking training improves cardiorespiratory fitness but not glycaemic control in people with type 2 diabetes.

In this study, we examined the effects of a supervised, heart rate intensity prescribed walking training programme on cardiorespiratory fitness and glycaemic control in people with type 2 diabetes mellitus. After receiving local ethics approval, 27 individuals (21 males, 6 females) with type 2 diabetes were randomly assigned to an experimental ("walking") or control group. Participants completed a Balke-Ware test to determine peak heart rate, peak oxygen consumption (VO(2peak)), and peak gradient. The walking group then completed a 7-week (four sessions a week) supervised, heart rate prescribed walking training programme, whereas the control group continued daily life. After training, participants completed another Balke-Ware test. Fasting blood glucose and glycosylated haemoglobin were measured at rest. The results showed that walking training elicited 80% (s = 2) of peak heart rate and a rating of perceived exertion of 11 (s = 1). Peak heart rate and VO(2peak) were higher in the walking than in the control group after training (P < 0.05). Based on the peak gradient before training, the respiratory exchange ratio was significantly lower (P < 0.05) and there was a strong trend for VO(2) (P = 0.09) and heart rate (P = 0.09) to be lower after training at the same gradient in the walking compared with the control group. These improvements increased walking peak gradient by 5 min (s = 4 min) compared with the control (P < 0.05). There was no change in fasting blood glucose or glycosylated haemoglobin after training. Despite no change in glycaemic control, heart rate prescribed walking improved peak and sub-maximal cardiorespiratory responses. The beneficial adaptations support the use of heart rate monitoring during walking in people with type 2 diabetes mellitus.

Blood glucose responses to reductions in pre-exercise rapid-acting insulin for 24 h after running in individuals with type 1 diabetes.

In this study, we examined pre-exercise insulin reductions on consequent metabolic and dietary patterns for 24 h after running in individuals with type 1 diabetes. Seven participants self-administered their Full rapid-acting insulin dose or 75%, 50% or 25% of it, immediately before consuming a 1.12-MJ meal. After 2 h, participants completed 45 min of running at 70% peak oxygen uptake ([Vdot]O(2peak)). Blood glucose and insulin were measured for 2 h before and 3 h after exercise. Blood glucose, diet, and administered insulin were self-recorded for 24 h after exercise. Data were analysed using repeated-measures analysis of variance. Pre-exercise peak insulin concentrations were greatest with the Full dose and consequently elicited the lowest blood glucose concentrations (P < 0.05). Blood glucose decreased under all conditions with exercise, with the fall with the Full dose (-6.1 mmol . l(-1), s(x) = 0.4) greater than with 25% insulin (-3.2 mmol . l(-1), s(x) = 0.4; P < 0.05). There was little change in blood glucose from 0 to 3 h post-exercise under all conditions (P > 0.05). Blood glucose at 3 h post-exercise was greatest with the 25% dose. Over the next 21 h, blood glucose area under the curve was greater with the 25% dose compared with all other trials despite consuming less energy and fewer carbohydrates (P < 0.05). A 75% reduction to pre-exercise insulin results in the greatest preservation of blood glucose, and a reduced dietary intake, for 24 h after running in individuals with type 1 diabetes.