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Metabolic Syndrome and Exercise - NED Infobite
Infobite 56_September 2024. Summaries of key research on metabolic syndrome and exercise
2024
Abstract
This NED Infobite features nutrition science on the impact of exercise on leptin levels, glycemic responses, cardiac health, obesity and overweight. BANT's scientific NED InfoBites are designed to provide key elements of the latest research using plain language. They provide quick overviews on particular health issues and nutrition topics for a speedy introduction to the science. Visually attractive and easily shareable with clients and social media followers.
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T2DM and the Microbiome - NED Infobite
Infobite 46_January 2024. Summaries of key research on type 2 diabetes mellitus and the microbiome
2024
Abstract
Accumulating studies have shown a strong correlation between Type 2 diabetes mellitus and the gut microbiome. This NED Infobite includes studies comparing probiotics and glucose-lowering drugs, the effects or probiotics and synbiotics on inflammation and oxidative stress in T2DM subjects, as well as the impacts of dietary interventions on gut bacterial profiles in those with dysregulated blood glucose markers. BANT's scientific NED InfoBites are designed to provide key elements of the latest research using plain language. They provide quick overviews on particular health issues and nutrition topics for a speedy introduction to the science. Visually attractive and easily shareable with clients and social media followers.
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Feasibility and preliminary efficacy of different intensities of functional training in elderly type 2 diabetes patients with cognitive impairment: a pilot randomised controlled trial.
Ghahfarrokhi, MM, Shirvani, H, Rahimi, M, Bazgir, B, Shamsadini, A, Sobhani, V
BMC geriatrics. 2024;24(1):71
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Aging is associated with an increased risk of metabolic diseases, including diabetes. The prevalence of type 2 diabetes (T2D) is directly related to increasing age. The aim of this study was to investigate the feasibility and preliminary effectiveness of six weeks of different intensities of functional exercises in elderly T2D patients with cognitive impairment. This study was a randomised controlled trial. Subjects were randomly assigned into high-intensity functional training (HIFT), low-intensity functional training (LIFT) and control groups. The subjects were allocated to a 2:2:2 ratio. Results showed that high-intensity low-volume vs. low-intensity high-volume functional training is a safe, feasible, and effective way to enhance aspects of physical, biochemical, and cognitive function in older T2D patients who have cognitive impairment. Additionally, HIFT can improve variables related to cognitive function in elderly T2D patients. Authors concluded that HIFT vs. LIFT is a safe, feasible, and effective approach for improving some aspects of physical, biochemical, and cognitive function in elderly T2D patients with cognitive impairment.
Abstract
BACKGROUND Aging and type-2 diabetes (T2D) are the most important risk factors for cognitive impairment and Alzheimer's disease. Exercise training is an effective, safe, and practical intervention in improving glucose metabolism, physical function, and cognitive disorders. This pilot study investigated the feasibility and preliminary efficacy of high-intensity low-volume (HIFT) vs. low-intensity high-volume (LIFT) functional training in elderly T2D patients with cognitive impairment. METHODS Forty-eight elderly T2D patients (31 female, 17 male, age 67.5 ± 5.8 years, MMSE score 18.8 ± 2.6, FBG 209.5 ± 37.9) were randomly assigned to HIFT, LIFT and control groups. Cognitive impairment was diagnosed with MMSE ≤ 23 based Iranian society. The SDMT, CVLT-II, BVMT-R, and Stroop tests were used to evaluated processing speed, learning, memory and attention respectively. Physical fitness tests include: tandem stance and walk test; TUG; 6MWT, 10MWT; SSST; 5TSTS; and hand grip was used to evaluated static and dynamic balance, agility, walking endurance, gait speed, lower limb function and lower and upper body strength respectively. As well as, Biochemical (FBG, insulin, HOMA-IR, HbA1c) and physiological outcomes (SBP, and DBP) were assessed. The HIFT group performed six weeks of functional training (three sessions per week) with 120-125% of the lactate threshold. The LIFT group performed six weeks of functional training (five sessions per week) with a 70-75% lactate threshold. Feasibility, safety, and acceptability of exercise programs were assessed at the end of the study. RESULT HIFT showed a higher adherence rate (91% vs. 87.5%), safety, and acceptability compared to LIFT. MMSE and Stroop scores, 6MWT, FBG, insulin, HOMA-IR, HbA1c, SBP, and DBP significantly improved in HIFT (all, P ≤ 0.004) and LIFT (all, P ≤ 0.023). Changes in 6MWT, FBG, insulin, HOMA-IR, and HbA1c in HIFT (all, P ≤ 0.001) and LIFT (all, P ≤ 0.008) were significant compared to the control group. Changes in Stroop scores were significant only in the HIFT group compared to the control group (P = 0.013). SDMT, CVLT-II, BVMT-R, balance test, 10MWT, SSST, TUG and hang grip significantly improved only in HIFT (all, P ≤ 0.038). CONCLUSION HIFT vs. LIFT is a safe, feasible, and effective approach for improving some aspects of physical, biochemical, and cognitive function in elderly T2D patients with cognitive impairment. This pilot study provides initial proof-of-concept data for the design and implementation of an appropriately powered randomised controlled trial (RCT) of HIFT vs. LIFT in a larger sample of elderly T2D patients with cognitive impairment. TRIAL REGISTRATION Randomized controlled trial (RCT) (Iranian Registry of Clinical Trials, trial registration number: IRCT20230502058055N1. Date of registration: 11/06/2023.
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Glycemic variability assessed using continuous glucose monitoring in individuals without diabetes and associations with cardiometabolic risk markers: A systematic review and meta-analysis.
Hjort, A, Iggman, D, Rosqvist, F
Clinical nutrition (Edinburgh, Scotland). 2024;43(4):915-925
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Chronic hyperglycaemia, assessed by HbA1c, is a risk factor for complications in individuals with diabetes. However, HbA1c does not reflect short-term fluctuations in blood glucose, which can vary a lot between individuals despite similar HbA1c. Glycaemic variability (GV) is a term used to describe such fluctuations, reflecting both hypoglycaemic events and postprandial spikes as well as fluctuations that are repeated at the same time on different days. The aim of this study was to assess whether GV is associated with cardiometabolic risk markers or outcomes in individuals without diabetes. Researchers examined data from continuous glucose monitoring studies. This study was a systematic review of 71 studies, primarily cross-sectional in design. Results showed that GV measures were higher in individuals with prediabetes compared to those without, potentially related to beta cell dysfunction. However, GV was not clearly associated with insulin sensitivity, adiposity, blood lipids, or blood pressure. Interestingly, GV may predict coronary atherosclerosis development and cardiovascular events, as well as type 2 diabetes. Authors concluded that although GV is elevated in prediabetes, its association with traditional risk factors remains less clear. Prospective studies are needed to explore GV’s predictive power in relation to incident disease.
Expert Review
Conflicts of interest:
None
Take Home Message:
Continuous glucose monitors are widely available. They could help nutritionists and nutritional therapists to personalise nutrition plans and reduce risk factors for cardiovascular disease and type 2 diabetes when working with a qualified health care practitioner.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
Glycaemic variability (GV) has been associated with increased risk of cardiovascular disease (CVD) in individuals with type 2 diabetes (T2D). It is not known whether there are similar risks for individuals without T2D. Continuous blood glucose monitors (CGM) measure short-term GV and may be a potential tool for assessing these risks.
Methods
- 71 worldwide studies with diverse populations were included in this systematic review and meta-analysis. Most studies were cross sectional and included CGM use for 24 hours or longer.
- Measurement data included: standard deviation (SD) and coefficient of variation (CV) of GV, mean amplitude of glycaemic excursions (MAGE), mean of daily differences (MODD), continuous overlapping net glycaemic action (CONGA), M-value, lability index (L-index), J-index or glycaemic risk assessment in diabetes equation (GRADE).
- Outcome measurements were any associated with cardiometabolic risk markers.
Results
- Adults with prediabetes had greater SD (p <0.0001), CV (p =0.008) and MAGE (p<0.0001) values. SD, MODD, and MAGE were also higher in individuals with normal glucose tolerance (NGT) and a previous history of gestational diabetes.
- SD was higher in children and adolescents with prediabetes. SD and CV were also higher in adolescents with cystic fibrosis. An inverse association was found in adolescents for MAGE and soluble receptor of advanced glycation end-products (sRAGE) (P=<0.05).
- 6 studies found measures of beta-cell function were inversely associated with GV.
- Higher levels of MAGE were positively associated with a higher incidence of cardiovascular events (p=0.004), higher C-reactive protein and PAI-1 (p<0.001).
- No differences were found in GV between obese, overweight and normal weight individuals, nor correlations with body composition for all populations (p>0.05 for all).
Conclusion
This study found that GV is elevated in adults with prediabetes compared to individuals with NGT and may be linked with beta-cell dysfunction. The evidence for children and adolescents was less clear. GV was also positively associated with the development of atherosclerosis and an increased risk of cardiovascular events. GV may therefore be an effective proxy for cardiovascular risk in adults without diabetes.
Clinical practice applications:
- There is a large variability in postprandial response between individuals consuming the same foods.
- HbA1C does not include short term variability in blood glucose levels.
- CGMs are widely available and easily accessible and could help nutritionists and nutritional therapists to provide personalised nutrition plans.
- This study found that changes in GV were not associated with HbA1c, fasting glucose, homeostatic model assessment of insulin resistance or oral glucose tolerance test-derived measures.
- GV was also not associated with adiposity, blood pressure, blood fatty liver disease, blood lipid profile or oxidative stress.
Considerations for future research:
- Limitations of this study were the inclusion of mainly cross-sectional data as well as the heterogeneity between outcome measures, study durations, populations and sample sizes.
- Further prospective studies are needed in healthy individuals.
- Future studies should focus on measurements that specifically assess GV and cardiometabolic risk markers.
Abstract
BACKGROUND & AIMS Continuous glucose monitoring (CGM) provides data on short-term glycemic variability (GV). GV is associated with adverse outcomes in individuals with diabetes. Whether GV is associated with cardiometabolic risk in individuals without diabetes is unclear. We systematically reviewed the literature to assess whether GV is associated with cardiometabolic risk markers or outcomes in individuals without diabetes. METHODS Searches were performed in PubMed/Medline, Embase and Cochrane from inception through April 2022. Two researchers were involved in study selection, data extraction and quality assessment. Studies evaluating GV using CGM for ≥24 h were included. Studies in populations with acute and/or critical illness were excluded. Both narrative synthesis and meta-analyzes were performed, depending on outcome. RESULTS Seventy-one studies were included; the majority were cross-sectional. Multiple measures of GV are higher in individuals with compared to without prediabetes and GV appears to be inversely associated with beta cell function. In contrast, GV is not clearly associated with insulin sensitivity, fatty liver disease, adiposity, blood lipids, blood pressure or oxidative stress. However, GV may be positively associated with the degree of atherosclerosis and cardiovascular events in individuals with coronary disease. CONCLUSION GV is elevated in prediabetes, potentially related to beta cell dysfunction, but less clearly associated with obesity or traditional risk factors. GV is associated with coronary atherosclerosis development and may predict cardiovascular events and type 2 diabetes. Prospective studies are warranted, investigating the predictive power of GV in relation to incident disease. GV may be an important risk measure also in individuals without diabetes.
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Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis.
Jancev, M, Vissers, TACM, Visseren, FLJ, van Bon, AC, Serné, EH, DeVries, JH, de Valk, HW, van Sloten, TT
Diabetologia. 2024;67(5):798-810
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Continuous glucose monitoring (CGM) is increasingly used in the treatment of type 2 diabetes, but its effects on glycaemic control remain unclear. Fingerstick-based self-monitoring of blood glucose (SMBG) has been the most used method for measuring daily glucose levels. However, this method does not provide continuous data about glucose levels, and, thus, may miss asymptomatic hypo- or hyperglycaemia and does not provide information about the direction of change in glucose levels. The aim of this study was to give an up-to-date comprehensive overview of the effect of CGM (rtCGM or isCGM) comparison with SMBG on glycaemic control, as quantified by HbA1c, in adults with type 2 diabetes treated with or without insulin. This study was a systematic review and meta-analysis, analysing randomised controlled trials comparing real-time CGM or intermittently scanned CGM with SMBG in adults with type 2 diabetes. Results showed that: - CGM use (rtCGM or isCGM) led to a modest reduction in HbA1c (mean difference of −3.43 mmol/mol or −0.31%). - CGM also improved time in range and reduced time below range, time above range and glycaemic variability. Authors concluded that CGM shows promise in improving glycaemic control for adults with type 2 diabetes.
Abstract
AIMS/HYPOTHESIS Continuous glucose monitoring (CGM) is increasingly used in the treatment of type 2 diabetes, but the effects on glycaemic control are unclear. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the effect of CGM on glycaemic control in adults with type 2 diabetes. METHODS We performed a systematic review using Embase, MEDLINE, Web of Science, Scopus and ClinicalTrials.gov from inception until 2 May 2023. We included RCTs investigating real-time CGM (rtCGM) or intermittently scanned CGM (isCGM) compared with self-monitoring of blood glucose (SMBG) in adults with type 2 diabetes. Studies with an intervention duration <6 weeks or investigating professional CGM, a combination of CGM and additional glucose-lowering treatment strategies or GlucoWatch were not eligible. Change in HbA1c and the CGM metrics time in range (TIR), time below range (TBR), time above range (TAR) and glycaemic variability were extracted. We evaluated the risk of bias using the Cochrane risk-of-bias tool version 2. Data were synthesised by performing a meta-analysis. We also explored the effects of CGM on severe hypoglycaemia and micro- and macrovascular complications. RESULTS We found 12 RCTs comprising 1248 participants, with eight investigating rtCGM and four isCGM. Compared with SMBG, CGM use (rtCGM or isCGM) led to a mean difference (MD) in HbA1c of -3.43 mmol/mol (-0.31%; 95% CI -4.75, -2.11, p<0.00001, I2=15%; moderate certainty). This effect was comparable in studies that included individuals using insulin with or without oral agents (MD -3.27 mmol/mol [-0.30%]; 95% CI -6.22, -0.31, p=0.03, I2=55%), and individuals using oral agents only (MD -3.22 mmol/mol [-0.29%]; 95% CI -5.39, -1.05, p=0.004, I2=0%). Use of rtCGM showed a trend towards a larger effect (MD -3.95 mmol/mol [-0.36%]; 95% CI -5.46 to -2.44, p<0.00001, I2=0%) than use of isCGM (MD -1.79 mmol/mol [-0.16%]; 95% CI -5.28, 1.69, p=0.31, I2=64%). CGM was also associated with an increase in TIR (+6.36%; 95% CI +2.48, +10.24, p=0.001, I2=9%) and a decrease in TBR (-0.66%; 95% CI -1.21, -0.12, p=0.02, I2=45%), TAR (-5.86%; 95% CI -10.88, -0.84, p=0.02, I2=37%) and glycaemic variability (-1.47%; 95% CI -2.94, -0.01, p=0.05, I2=0%). Three studies reported one or more events of severe hypoglycaemia and macrovascular complications. In comparison with SMBG, CGM use led to a non-statistically significant difference in the incidence of severe hypoglycaemia (RR 0.66, 95% CI 0.15, 3.00, p=0.57, I2=0%) and macrovascular complications (RR 1.54, 95% CI 0.42, 5.72, p=0.52, I2=29%). No trials reported data on microvascular complications. CONCLUSIONS/INTERPRETATION CGM use compared with SMBG is associated with improvements in glycaemic control in adults with type 2 diabetes. However, all studies were open label. In addition, outcome data on incident severe hypoglycaemia and incident microvascular and macrovascular complications were scarce. REGISTRATION This systematic review was registered on PROSPERO (ID CRD42023418005).
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Continuous Glucose Monitoring-Based Metrics and Hypoglycemia Duration in Insulin-Experienced Individuals With Long-standing Type 2 Diabetes Switched From a Daily Basal Insulin to Once-Weekly Insulin Icodec: Post Hoc Analysis of ONWARDS 2 and ONWARDS 4.
Bajaj, HS, Ásbjörnsdóttir, B, Carstensen, L, Laugesen, C, Mathieu, C, Philis-Tsimikas, A, Battelino, T
Diabetes care. 2024;47(4):729-738
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This study’s aim was to assess CGM-based metrics and hypoglycaemia duration with once-weekly insulin icodec [a basal insulin analog in clinical development with a mean half-life of 1 week, allowing for once weekly dosing] versus once-daily basal insulin analogs in insulin-experienced individuals with long-standing type 2 diabetes from two 26-week phase 3a trials ONWARDS 2 (n=525) and ONWARDS 4 (n=582). This study was a post hoc analysis of data from ONWARDS 2 and ONWARDS 4. Results showed that: - in insulin-experienced participants with long-standing type 2 diabetes, compared with once-daily basal insulin analogs, switching from daily basal insulin to once-weekly icodec was associated with similar mean percentages of CGM-based time in range and time above range when assessed across three separate time periods in ONWARDS 2 and ONWARDS 4. - mean CGM based time below range remained within the recommended targets in both arms in both trials. - the duration of CGM-derived overall hypoglycaemic episodes (sensor glucose <3.9 mmol/L) was comparable for icodec versus once-daily basal insulins, with median duration of about 40 min. Authors concluded that their findings are relevant to clinical practice, where reduced injection burden and greater treatment satisfaction could contribute to improved adherence to basal insulin treatment.
Abstract
OBJECTIVE This post hoc analysis assessed continuous glucose monitoring (CGM)-based metrics and hypoglycemia duration with once-weekly insulin icodec versus once-daily basal insulin analogs in insulin-experienced individuals with long-standing type 2 diabetes from two 26-week phase 3a trials (ONWARDS 2 and ONWARDS 4). RESEARCH DESIGN AND METHODS Time in range (TIR) (3.9-10.0 mmol/L), time above range (TAR) (>10.0 mmol/L), and time below range (TBR) (<3.9 mmol/L and <3.0 mmol/L) were assessed during three CGM time periods (switch [weeks 0-4], end of treatment [weeks 22-26], and follow-up [weeks 27-31]) for icodec versus comparators (ONWARDS 2, insulin degludec [basal regimen]; ONWARDS 4, insulin glargine U100 [basal-bolus regimen]) using double-blind CGM data. CGM-derived hypoglycemic episode duration (<3.9 mmol/L) was assessed. RESULTS In both trials, there were no statistically significant differences in TIR, TAR, or TBR (<3.0 mmol/L) for icodec versus comparators across all time periods. In the end-of-treatment period, mean TIR was 63.1% (icodec) vs. 59.5% (degludec) in ONWARDS 2 and 66.9% (icodec) vs. 66.4% (glargine U100) in ONWARDS 4. Mean TBR <3.9 mmol/L and <3.0 mmol/L remained within recommended targets (<4% and <1%, respectively) across time periods and treatment arms. Hypoglycemic episode duration (<3.9 mmol/L) was comparable across time periods and treatment arms (median duration ≤40 min). CONCLUSIONS In insulin-experienced participants with long-standing type 2 diabetes, CGM-based TIR, TAR, and CGM-derived hypoglycemia duration (<3.9 mmol/L) were comparable for icodec and once-daily basal insulin analogs during all time periods. TBR remained within recommended targets.
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Oral magnesium supplementation does not affect insulin sensitivity in people with insulin-treated type 2 diabetes and a low serum magnesium: a randomised controlled trial.
Drenthen, LCA, de Baaij, JHF, Rodwell, L, van Herwaarden, AE, Tack, CJ, de Galan, BE
Diabetologia. 2024;67(1):52-61
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Low serum magnesium has been implicated in the pathogenesis of type 2 diabetes and its cardiovascular complications. However, whether magnesium supplementation improves insulin sensitivity in individuals with type 2 diabetes and low serum magnesium levels remains uncertain. This study’s aim was to examine the effect of magnesium supplementation on insulin resistance using the euglycemic [target glucose concentration of 5.5 mmol/l for 120 min] clamp technique. This study was a randomised, double-blind, placebo-controlled, two-period, crossover intervention study. The enrolled participants had insulin-treated type 2 diabetes, were aged ≥18 years, had a body mass index of 18–40 kg/m², and a serum magnesium level ≤0.79 mmol/l. Oral magnesium supplementation (15 mmol/day) was compared to a matched placebo over 6 weeks. Results showed that magnesium supplementation increased serum magnesium levels but did not improve insulin sensitivity. Furthermore, glucose control, insulin need, blood pressure, lipid profile, and hypomagnesaemia-related symptoms remained similar between the magnesium and placebo groups. Authors concluded that their findings do not support routine use of magnesium supplementation in people with insulin-treated type 2 diabetes.
Abstract
AIMS/HYPOTHESIS Hypomagnesaemia has been associated with insulin resistance and an increased risk of type 2 diabetes. Whether magnesium supplementation improves insulin sensitivity in people with type 2 diabetes and a low serum magnesium level is unknown. METHODS Using a randomised, double-blind (both participants and investigators were blinded to the participants' treatment sequences), placebo-controlled, crossover study design, we compared the effect of oral magnesium supplementation (15 mmol/day) for 6 weeks with that of matched placebo in individuals with insulin-treated type 2 diabetes (age ≥18 years, BMI 18-40 kg/m2, HbA1c <100 mmol/mol [11.3%], serum magnesium ≤0.79 mmol/l). Participants were recruited from the outpatient clinic and through advertisements. Randomisation to a treatment sequence order was done using a randomisation list. We used block randomisation and the two possible treatment sequences were evenly distributed among the trial population. The primary outcome was the mean glucose infusion rate during the final 30 min of a hyperinsulinaemic-euglycaemic clamp (i.e. M value). Secondary outcomes included variables of glucose control, insulin need, BP, lipid profile and hypomagnesaemia-related symptoms during follow-up. RESULTS We recruited 14 participants (50% women, 100% White, mean ± SD age 67±6 years, BMI 31±5 kg/m2, HbA1c 58±9 mmol/mol [7.4±0.9%]) with insulin-treated type 2 diabetes. Magnesium supplementation increased both mean ± SEM serum magnesium level (0.75±0.02 vs 0.70±0.02 mmol/l, p=0.016) and urinary magnesium excretion (magnesium/creatinine ratio, 0.23±0.02 vs 0.15±0.02, p=0.005), as compared with placebo. The M value of the glucose clamp did not differ between the magnesium and placebo study arms (4.6±0.5 vs 4.4±0.6 mg kg-1 min-1, p=0.108). During the 6 weeks of treatment, continuous glucose monitoring outcomes, HbA1c, insulin dose, lipid profile and BP also did not differ, except for a lower HDL-cholesterol concentration after magnesium compared with placebo (1.14±0.08 vs 1.20±0.09 mmol/l, p=0.026). Symptoms potentially related to hypomagnesaemia were similar for both treatment arms. CONCLUSIONS/INTERPRETATION Despite an albeit modest increase in serum magnesium concentration, oral magnesium supplementation does not improve insulin sensitivity in people with insulin-treated type 2 diabetes and low magnesium levels. TRIAL REGISTRATION EudraCT number 2021-001243-27. FUNDING This study was supported by a grant from the Dutch Diabetes Research Foundation (2017-81-014).
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Lifestyle Intervention With Smartphone App and isCGM for People at High Risk of Type 2 Diabetes: Randomized Trial.
Kitazawa, M, Takeda, Y, Hatta, M, Horikawa, C, Sato, T, Osawa, T, Ishizawa, M, Suzuki, H, Matsubayashi, Y, Fujihara, K, et al
The Journal of clinical endocrinology and metabolism. 2024;109(4):1060-1070
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Diabetes mellitus is a risk factor for cardiovascular disease and has been associated with 2- to 4-fold higher mortality than in those without diabetes. Intermittently scanned continuous glucose monitoring (isCGM), which is minimally invasive, is used to manage diabetes. Monitoring blood glucose with isCGM not only provides health care providers with information but patients with appropriate feedback on diet, exercise, and medications. This study’s aim was to investigate the effectiveness of a lifestyle intervention programme, that combines lifestyle coaching via a smartphone application with isCGM, for blood glucose control and body weight reduction in people at high risk of type 2 diabetes. This study was a 12-week prospective, randomised, unblinded 1-to-1 allocation trial. Participants were randomly assigned to either the intervention group (using the smartphone app) or the control group. Results showed that: - the intervention group showed significant improvement in time spent in the target blood glucose range. - time below the range (blood glucose <70 mg/dL) improved in the intervention group. - body mass index reduction was observed in the intervention group compared to the control group. Authors concluded that a lifestyle intervention using isCGM and a smartphone app improved glycaemic fluctuations and increased weight loss in people at high risk of type 2 diabetes. However, further studies are needed to confirm whether these interventions can prevent the incidence of type 2 diabetes.
Abstract
AIMS: Although conventional interventions for people at high risk of developing type 2 diabetes are usually conducted face-to-face, such interventions are burdensome for health care providers. We developed a lifestyle intervention program combining lifestyle coaching via a smartphone application augmented by intermittently scanned continuous glucose monitoring without burdening health care providers. Its effectiveness for glycemic control and body weight reduction in people at risk of type 2 diabetes was investigated. MATERIALS AND METHODS For this 12-week randomized unblinded trial with offline recruitment, participants with a hemoglobin A1c level of 5.6% to 6.4% or a fasting blood glucose of 110 to 125 mg/dL and body mass index (BMI) >23 kg/m2 but <40 kg/m2 were randomly assigned to the intervention group (App) and control group (C). The primary endpoint was the difference in time in range of blood glucose between 70 and 140 mg/dL (3.9-7.8 mmol/L) before and after the study period between the 2 groups. RESULTS Among 168 patients (mean age, 48.1 years; mean BMI, 26.6 kg/m2; and male, 80.4%), 82 and 86 were assigned to the App group and C group, respectively. After 12 weeks, time in range of blood glucose at 70 to 140 mg/dL significantly improved in the App group compared with the C group (-2.6 minutes/day vs +31.5 minutes/day, P = .03). Changes in time above range did not differ, whereas time below range (blood glucose <70 mg/dL; +23.5 minutes/day vs -8.9 minutes/day, P = .02) improved in the App group. BMI (-0.26 vs -0.59, P = .017) was reduced in the App group compared with the C group. CONCLUSION Intervention with a smartphone app and intermittently scanned continuous glucose monitoring increased glycemic control accompanied by decreased carbohydrate intake and weight loss. Further trials are needed to confirm whether these interventions can reduce incident type 2 diabetes.
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Exercise-induced improvement of glycemic fluctuation and its relationship with fat and muscle distribution in type 2 diabetes.
Liu, D, Zhang, Y, Wu, Q, Han, R, Cheng, D, Wu, L, Guo, J, Yu, X, Ge, W, Ni, J, et al
Journal of diabetes. 2024;16(4):e13549
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Exercise plays a crucial role in managing type 2 diabetes (T2DM). However, the impact of exercise on blood glucose fluctuation and its relationship with body fat and muscle distribution remains an area of interest. The aim of this study was to investigate the effect of combined aerobic and resistance exercise training on blood glucose fluctuation in type 2 diabetes patients and explore the predictors of exercise-induced glycaemic response. This study was a two-arm randomised controlled trial with an exercise group and a control group. The study included 50 patients with T2DM. Results showed that: - exercise training led to decreased 24-hour blood glucose fluctuations in the exercise group. - baseline visceral fat area and mid-thigh muscle area were significant predictors of glycaemic variability changes. Authors concluded that acute combined aerobic and resistance exercise training could improve glycemic fluctuation in T2D patients, and baseline fat and muscle distribution play a role in this effect.
Abstract
AIMS: Management of blood glucose fluctuation is essential for diabetes. Exercise is a key therapeutic strategy for diabetes patients, although little is known about determinants of glycemic response to exercise training. We aimed to investigate the effect of combined aerobic and resistance exercise training on blood glucose fluctuation in type 2 diabetes patients and explore the predictors of exercise-induced glycemic response. MATERIALS AND METHODS Fifty sedentary diabetes patients were randomly assigned to control or exercise group. Participants in the control group maintained sedentary lifestyle for 2 weeks, and those in the exercise group specifically performed combined exercise training for 1 week. All participants received dietary guidance based on a recommended diet chart. Glycemic fluctuation was measured by flash continuous glucose monitoring. Baseline fat and muscle distribution were accurately quantified through magnetic resonance imaging (MRI). RESULTS Combined exercise training decreased SD of sensor glucose (SDSG, exercise-pre vs exercise-post, mean 1.35 vs 1.10 mmol/L, p = .006) and coefficient of variation (CV, mean 20.25 vs 17.20%, p = .027). No significant change was observed in the control group. Stepwise multiple linear regression showed that baseline MRI-quantified fat and muscle distribution, including visceral fat area (β = -0.761, p = .001) and mid-thigh muscle area (β = 0.450, p = .027), were significantly independent predictors of SDSG change in the exercise group, as well as CV change. CONCLUSIONS Combined exercise training improved blood glucose fluctuation in diabetes patients. Baseline fat and muscle distribution were significant factors that influence glycemic response to exercise, providing new insights into personalized exercise intervention for diabetes.
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Effects of Garlic on Glucose Parameters and Lipid Profile: A Systematic Review and Meta-Analysis on Randomized Controlled Trials.
Zhao, X, Cheng, T, Xia, H, Yang, Y, Wang, S
Nutrients. 2024;16(11)
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Glucose and lipids are essential nutrients that provide energy to cells. In healthy individuals, glucose and lipid metabolism is precisely regulated. Disorders of glucose and lipid metabolism can lead to several chronic diseases. The aim of this study was to investigate the effects of garlic on blood lipid and glucose levels. This study was a systematic review and meta-analysis of 22 randomised controlled trials. Results showed that garlic consumption improved some lipid indices and outperformed the control group in various aspects. However, there was no significant difference in the effect of garlic intervention on patients' triglyceride levels. Authors concluded that garlic therapy should be considered as beneficial for patients with disorders related to glucose and lipid metabolism. However, larger sample size trials in other populations may be needed to confirm these findings.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Garlic may help lower high blood sugar levels, especially for people with type 2 diabetes.
- It can reduce LDL cholesterol and increase the beneficial HDL cholesterol, supporting heart and vascular health.
- For best results, garlic should be used consistently over time.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
- This study aimed to assess the effects of garlic consumption on glucose parameters and lipid profiles in humans.
- It sought to resolve conflicting evidence regarding garlic's impact on fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), HDL, LDL, and triglycerides (TG).
- The research applied a systematic review and meta-analysis approach to randomised controlled trials (RCTs).
Methods
RCTs from four databases (PubMed, Embase, Web of Science, Cochrane Library) were reviewed until February 2024, in accordance with the PRISMA 2020 guidelines. The review included 22 studies with a total of 1567 participants. The trials used different forms of garlic mainly in supplement form (e.g., tablets, powder, aged garlic extract) and various doses over intervention durations ranging from 3 weeks to 1 year.
Results
Garlic significantly:
- reduced FBG (mean difference: -7.01 mg/dL, 95% CI: -8.53 to -5.49, p < 0.001) and HbA1c (mean difference: -0.66%, 95% CI: -0.76 to -0.55, p < 0.001).
- decreased TC (mean difference: -14.17 mg/dL, p < 0.001) and LDL (mean difference: -8.20 mg/dL, p = 0.03)
- increased HDL (mean difference: +2.06 mg/dL, p < 0.001).
Subgroup analyses suggested more pronounced effects for longer intervention durations (>8 weeks) and in participants with type 2 diabetes (T2DM).
Garlic had no significant effect on TG levels (p = 0.125).
Conclusion
- In studies with intervention durations >= 8 weeks, garlic was effective in improving blood glucose and lipid profiles, particularly in lowering FBG, HbA1c, TC, and LDL, while raising HDL.
- Garlic may be beneficial for conditions related to glucose and lipid metabolism, even though it had no significant effect on TG levels.
Clinical practice applications:
- Garlic supplementation can be recommended to lower FBG and HbA1c, aiding in glycemic control for patients with T2DM through enhanced insulin sensitivity, stimulation of insulin secretion and reduced oxidative stress that may benefit glycaemic control.
- Practitioners can use garlic as part of nutritional strategies to reduce TC and LDL, potentially reducing cardiovascular risk.
- Garlic may increase HDL levels, making it a useful addition to lipid management protocols, though an effective minimum dose is unclear due to study variations (300–22,400 mg daily) and differing active compounds such as allicin and S-allyl cysteine. This variability limits specific dosing recommendations.
- Garlic use longer than 8 weeks is more effective, suggesting sustained dietary supplementation for enhanced benefits.
- No significant impact on triglycerides indicates practitioners should combine garlic with other interventions for TG management.
Considerations for future research:
- Investigate the long-term effects of garlic on TG levels, given the lack of significant findings in current studies.
- Explore the mechanisms behind garlic’s differential impact on FBG in non-diabetic populations.
- Conduct trials with standardised garlic formulations to reduce variability in active compounds.
- Examine garlic’s role in improving insulin sensitivity and HOMA-IR across various metabolic conditions.
- Study the effects of combining garlic with other dietary interventions to enhance lipid profile improvements such as omega-3 fatty acids, fibre supplements, and plant sterols.
Abstract
(1) Background: The effect of garlic on glucose and lipid metabolism in humans remains controversial. The aim of this study was to investigate the effects of garlic on blood lipid levels and glucose levels in humans through a systematic review and meta-analysis. (2) Methods: We extensively searched four databases, including PubMed, Web of Science, Embase, and the Cochrane Library, up to February 2024. To assess the collective impact of garlic and its supplements on fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), an analysis was conducted using a random effects model. Subgroup analyses were performed when I2 < 50%. (3) Result: We found that the garlic intervention was effective in controlling FBG (mean difference = -7.01; 95% CI: -8.53, -5.49, p < 0.001), HbA1c (mean deviation = -0.66; 95% CI: -0.76, -0.55, p < 0.001, I2 = 62.9%), TC (mean difference = -14.17; 95% CI: -19.31, -9.03, p < 0.001), and LDL-C (mean difference = -8.20; 95% CI: -15.58, -0.81, p = 0.03); moreover, it also increased the level of HDL-C in humans (mean difference = 2.06; 95% CI: 1.54, 2.59; p < 0.001). Nonetheless, the intervention involving garlic did not yield a substantial impact on triglyceride (TG) levels. (4) Conclusion: The intervention of garlic is beneficial to control blood glucose and blood lipids in humans.