Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study.

AIM: To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare. METHODS: We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c , mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change. RESULTS: Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = -0.30) and mean amplitude of glycaemic excursion (r = -0.26), but not with J-index; HbA1c correlated with J-index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J-index reduction (r = -0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia. CONCLUSION: Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.

Green synthesis, characterization and functional validation of bio-transformed selenium nanoparticles.

Selenium, an essential micronutrient with potent anticancer and antioxidant properties, the inorganic form of selenium is highly toxic, while organic and elemental nanoforms are more bioavailable and less toxic and have gained attention owing to their dietary and clinical relevance. This study aims to optimize conditions for the biosynthesis and production of elemental selenium nanoparticles for selenium supplements using marine microalgae, Nannochloropsis oceanica CASA CC201. The 10 mM precursor solution treated with 1 % of the algal extract (10:1 ratio of precursor and algal extract, respectively) was shown to be the optimal concentration for synthesizing highly stable selenium nanoparticles with a size of 183 nm and a zeta potential of -38.5 mV. AFM and TEM analysis suggest that the spherical-shaped nanoparticles with smooth surfaces were polydispersely distributed. The nanoparticles are well characterized using various analytical and advanced techniques, including Raman spectroscopy and X-ray photoelectron spectroscopy. FT-IR analyses reveal the presence of microalgae proteins and peptides as stabilizing and fabricating agents of Se-NPs to further understand the mode of bioreduction. The synthesized elemental nanoform (Se0) has been validated for its biological functions, showing enhanced radical scavenging activity (74 % in a concentration-dependent manner). Subsequently, algal-mediated selenite reduction and nanoparticle synthesis is an eco-friendly, non-toxic, and sustainable method for the large-scale production of highly stable Se-NPs for niche applications as dietary and feed supplements.

In vitro and in vivo evaluation of locust bean gum and chitosan combination as a carrier for buccal drug delivery.

The object of the study was to evaluate locust bean gum and chitosan in ratios of 2:3; 3:2 and 4:1 (F1, F2 and F3) as a mucoadhesive component in buccal tablets and to compare the bioavailability of a propranolol hydrochloride buccal tablet with the oral tablet in healthy human volunteers. Propranolol hydrochloride buccal tablets containing various weight ratios of locust bean gum and chitosan were prepared and coated with 5% w/v ethyl cellulose on one face, and oral tablets containing 10 mg propranolol hydrochloride alone were formulated using a direct compression technique. The strength of mucoadhesion of the tablets was quantified based on the tensile force required to break the adhesive bond between a model membrane (porcine buccal mucosa) and the test polymer. The forces of detachment for the mucoadhesive buccal tablets were 14.61 +/- 0.14, 13.21 +/- 0.13 and 11.71 +/- 0.12. An in vitro study was carried out in pH 6.8 phosphate buffer and the cumulative percentage release of propranolol measured at 10 min intervals for 600 min was found to be 98.31 +/- 0.10, 92.24 +/- 0.41 and 90.18 +/- 0.76 respectively. A bioavailability study was conducted with the prepared formulation in 16 healthy human volunteers to determine the plasma concentration of propranolol at 0, 1, 2, 3, 4, 6, 8, 10 and 12 h. The bioavailability (AUC(0-t*) ng x h/ml) of the buccal propranolol hydrochloride tablets (F1, F2 and F3) and oral tablet (F4) was found to be 2244.18 +/- 210, 3580.69 +/- 460, 3889.19 +/- 290 and 1732 +/- 96 ng x hr/ml respectively. The study indicates that locust bean gum and chitosan in a weight ratio of 2:3 (F1) not only releases the drug unidirectionally from the dosage form, but also gives buccal tablets which are sufficiently mucoadhesive for clinical applications.

Does feeding regime affect physiologic and thermal responses during exposure to 8, 20, and 27 degrees C?

When the loss of body heat is accelerated by exposure to low environmental temperatures, additional substrates must be oxidized to provide energy to sustain temperature homeostasis. Therefore, the present investigation examined the relation between feeding regime [pre-experimental carbohydrate feeding (FED) vs a fast (FAST)], during 120 min of exposure to 8, 20, and 27 degrees C in well-nourished men. The following were examined: tissue insulation (I; degrees C.m2:W-1), rectal temperature (Tre; degrees C), and oxygen consumption (VO2; ml,kg-1.min-1). VO2, Tre, and I revealed no significant differences between treatments (FED vs FAST) at any temperature. At 27 degrees C, I was less (P < 0.05) than at 20 and 8 degrees C, and decreased (P < 0.05) as exposure time increased. At 8 degrees C, VO2 was higher (P < 0.5) than at 20 or 27 degrees C, and VO2 increased as time increased (P < 0.05). Tre decreased (P < 0.05) as time increased for all conditions. Respiratory exchange ration (R) differed (P < 0.05) between treatments (FED vs FAST), temperature (8 vs 20 degrees C), and across time. Values for R suggests that carbohydrate accounted for 56% and 33% of caloric utilization during the FED vs FAST conditions, respectively. At 8 vs 20 degrees C, R represented 54% vs 30% of carbohydrate utilization. Across time, R demonstrated that in both conditions (FED vs FAST) there was a decreased reliance on carbohydrate utilization for energy provision.(ABSTRACT TRUNCATED AT 250 WORDS)