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The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized controlled clinical trial.
Gheflati, A, Bashiri, R, Ghadiri-Anari, A, Reza, JZ, Kord, MT, Nadjarzadeh, A
Clinical nutrition ESPEN. 2019;:132-138
Abstract
BACKGROUND Some foods and drinks contain special ingredients, causing impressive effects on human health. The aim of the current study was to assess the health effects of apple vinegar in patients with diabetes and dyslipidemia. METHOD Seventy participants with type 2 diabetes and hyperlipidemia were randomly assigned into an intervention and control group in order to assess the effect of 20 ml apple vinegar per day using an 8-week parallel study. Fasting blood sugar (FBS), homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for b-cell function (HOMA-B), quantitative insulin sensitivity checks index (QUICKI), insulin, malondialdehyde (MDA), 2,20-Diphenyl-1- picrylhydrazyl (DPPH), homocysteine, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at the beginning and end of the study. RESULTS The intervention with apple vinegar could significantly improve FBS (mean change: -10.16 ± 19.48 mg/dl, p = 0.006) and DPPH (mean change: 16.58 ± 11.56, p < 0.001) within intervention group and in comparison with control group (p < 0.001). Additionally, the significant increase of MDA in control group (p < 0.05) caused a considerable difference between two groups. Glycemic indices containing insulin, HOMA-IR, HOMA-B, and QUICKI decrease significantly in both groups (p < 0.05). No considerable effect was observed on blood pressure and homocysteine in intervention group as well as control group. CONCLUSION This trial provided some evidences that apple vinegar consumption may cause beneficial effects on glycemic indices and oxidative stress in individuals with diabetes and dyslipidemia. This randomized clinical trial was registered in the Iranian Registry of Clinical Trials (https://www.irct.ir/) as 2013070710826N5.
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Effect of macronutrients and fiber on postprandial glycemic responses and meal glycemic index and glycemic load value determinations.
Meng, H, Matthan, NR, Ausman, LM, Lichtenstein, AH
The American journal of clinical nutrition. 2017;(4):842-853
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Background: The potential confounding effect of different amounts and proportions of macronutrients across eating patterns on meal or dietary glycemic index (GI) and glycemic load (GL) value determinations has remained partially unaddressed.Objective: The study aimed to determine the effects of different amounts of macronutrients and fiber on measured meal GI and GL values.Design: Four studies were conducted during which participants [n = 20-22; women: 50%; age: 50-80 y; body mass index (in kg/m2): 25-30)] received food challenges containing different amounts of the variable nutrient in a random order. Added to the standard 50 g available carbohydrate from white bread was 12.5, 25, or 50 g carbohydrate; 12.5, 25, or 50 g protein; and 5.6, 11.1, or 22.2 g fat from rice cereal, tuna, and unsalted butter, respectively, and 4.8 or 9.6 g fiber from oat cereal. Arterialized venous blood was sampled for 2 h, and measured meal GI and GL and insulin index (II) values were calculated by using the incremental area under the curve (AUCi) method.Results: Adding carbohydrate to the standard white-bread challenge increased glucose AUCi (P < 0.0001), measured meal GI (P = 0.0066), and mean GL (P < 0.0001). Adding protein (50 g only) decreased glucose AUCi (P = 0.0026), measured meal GI (P = 0.0139), and meal GL (P = 0.0140). Adding fat or fiber had no significant effect on these variables. Adding carbohydrate (50 g), protein (50 g), and fat (11.1 g) increased the insulin AUCi or II; fiber had no effect.Conclusions: These data indicate that uncertainty in the determination of meal GI and GL values is introduced when carbohydrate-containing foods are consumed concurrently with protein (equal amount of carbohydrate challenge) but not with carbohydrate-, fat-, or fiber-containing foods. Future studies are needed to evaluate whether this uncertainty also influences the prediction of average dietary GI and GL values for eating patterns. This trial was registered at clinicaltrials.gov as NCT01023646.
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Improvement of Glycemic Control in Insulin-Dependent Diabetics with Depression by Concomitant Treatment with Antidepressants.
Radojkovic, J, Sikanic, N, Bukumiric, Z, Tadic, M, Kostic, N, Babic, R
Medical science monitor : international medical journal of experimental and clinical research. 2016;:2133-43
Abstract
BACKGROUND It is still disputable whether negative effects of comorbid depression in diabetics can be diminished by successful treatment of depression. The primary aim of this study was to assess whether addition of antidepressants to existing insulin treatment would further improve glycemic control in these patients. A secondary objective was to assess whether such treatment impairs their lipid and inflammatory status. MATERIAL AND METHODS Total of 192 patients with poorly controlled diabetes (defined as HbA1c ≥8%) in the absence of any uncontrolled medical condition entered the 6-month run-in phase with optimization of diabetic therapy. Depression status was screened at the end of this phase by BDI-II depression testing. Patients with BDI-II ≥14 and psychiatric confirmation of depression (58 patients) entered the 6-month interventional phase with SSRI class antidepressants. RESULTS Fifty patients completed the study. During the run-in phase, HbA1c dropped from 10.0±1.8% to 8.5±1.2% (p<0.001), and during the interventional phase it dropped from 8.5±1.2% to 7.7±0.7% (p<0.001). BDI-II scores improved significantly from 30.4±13.2 to 23.5±11.0 (p=0.02) during the interventional phase. A positive linear correlation between improvement in depression scale and improvement in glycemic control was observed (R²=0.139, p=0.008). Lipid profile and inflammatory status did not change significantly during the interventional phase. CONCLUSIONS Patients with poorly controlled diabetes and comorbid depression might benefit from screening and treatment of depression with SSRI antidepressants by achieving an incremental effect on glycoregulation. This therapy did not have any adverse effects on lipid profile or inflammatory status.
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Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus.
Mitchell, BD, Eby, EL, Lage, MJ
Current medical research and opinion. 2013;(12):1587-97
Abstract
OBJECTIVE Examine how patients diagnosed with type 2 diabetes mellitus (T2DM) are treated with oral antidiabetic (OAD) agents and the relationship between treatment patterns and glycemic control. RESEARCH DESIGN AND METHODS Data were obtained from the i3 Invision Data Mart database (OptumInsight, Eden Prairie, MN, USA). The analyses examined 4627 individuals who received a first prescription for an OAD (with first date identified as index date) and received at least one HbA1c test in both the 1 year prior and 2 years post index date. Patients were categorized based upon their level of glycemic control pre index date and logistic multivariate analyses were used to examine the probability of a patient's first treatment pattern change being a switch, augmentation, or discontinuation compared to continuation on the intent-to-treat (ITT) OAD. RESULTS Men tended to have worse glycemic control at OAD initiation. During the post-period, younger patients were more likely to switch, augment or discontinue therapy, while patients initially treated with metformin were more likely to switch or augment therapy. Results indicated that patients with moderate or poor glycemic control, compared to those with good glycemic control, were significantly more likely to switch or augment therapy. Practice patterns revealed minimal use of insulin although, on average, many patients were above target HbA1c levels at initiation. Interpretation of results are limited by the fact that only a small subset of patients had valid HbA1c data and that the analyses was not able to account for other factors, such as race and weight, that may also impact the analyses. CONCLUSIONS Patient initial level of glycemic control was associated with changes in treatment patterns in the 2 years post initiation on an OAD, with patients with moderate or poor control more likely to switch or augment their ITT therapy, compared to individuals with good control.
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Effect of Grewia asiatica fruit on glycemic index and phagocytosis tested in healthy human subjects.
Mesaik, MA, Ahmed, A, Khalid, AS, Jan, S, Siddiqui, AA, Perveen, S, Azim, MK
Pakistan journal of pharmaceutical sciences. 2013;(1):85-9
Abstract
The Grewia asiatica (commonly known as Phalsa or Fasla) is a shrub or small tree found in southern Asia. It produces purple to black color fruit when ripe. In folk medicine the edible Grewia asiatica fruit is used in a number of pathological conditions. The current study described the effects of Grewia asiatica fruit on glycemic index (GI) and phagocytosis in healthy non-diabetic human subjects. The results showed that Grewia asiatica fruit has low GI value of 5.34 with modest hypoglycemic activity. Luminol-enhanced chemiluminescence assay was carried out to determine the production of reactive oxygen species (ROS) in the oxidative burst activity of whole blood. ROS production was found to be significantly affected, having the 78.3, 58.6 and 30.8% when the subjects were fed with D-glucose, mixture of D-glucose and Grewia asiatica fruit and Grewia asiatica fruit alone respectively as compared to the control. The aqueous, methanolic and butanolic extracts of Grewia asiatica fruits were found to produce a stimulatory effect on ROS production however; the chloroform, hexane and ethanol-acetate extracted exerted significant inhibitory effect. These results demonstrated that Grewia asiatica fruit has desirable effects on blood glucose metabolism manifested as low glycemic response and modulation of ROS production.
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Improved metabolic control after 12-week dietary intervention with low glycaemic isomalt in patients with type 2 diabetes mellitus.
Holub, I, Gostner, A, Hessdörfer, S, Theis, S, Bender, G, Willinger, B, Schauber, J, Melcher, R, Allolio, B, Scheppach, W
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2009;(12):886-92
Abstract
The polyol isomalt (Palatinit) is a very low glycaemic sugar replacer. The effect of food supplemented with isomalt instead of higher glycaemic ingredients like sucrose and/or starch hydrolysates on metabolic control in patients with type 2 diabetes was examined in this open study. Thirty-three patients with type 2 diabetes received a diet with foods containing 30 g/d isomalt instead of higher-glycaemic carbohydrates for 12 weeks. Metformin and/or thiazolidindiones were the only concomitant oral antidiabetics allowed during the study. Otherwise, the participants maintained their usual diet during the test phase, but were instructed to refrain from additional sweetened foods. Before start, after 6 weeks and 12 weeks (completion of the study), blood samples were taken and analysed for clinical routine parameters, metabolic, and risk markers. Thirty-one patients completed the study. The test diet was well accepted and tolerated. After 12 weeks, significant reductions were observed for: glycosylated haemoglobin, fructosamine, fasting blood glucose, insulin, proinsulin, C-peptide, insulin resistance (HOMA-IR), and oxidised LDL (an atherosclerosis risk factor). In addition, significant lower nonesterified fatty acid concentrations were found in female participants. Routine blood measurements and blood lipids remained unchanged. The substitution of glycaemic ingredients by isomalt and the consequent on reduction of the glycaemic load within otherwise unchanged diet was accompanied by significant improvement in the metabolic control of diabetes. The present study is in agreement with findings of previous reported studies in human subjects demonstrating beneficial effects of low glycaemic diets on glucose metabolism in patients with diabetes mellitus type 2.
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Consumption of the slow-digesting waxy maize starch leads to blunted plasma glucose and insulin response but does not influence energy expenditure or appetite in humans.
Sands, AL, Leidy, HJ, Hamaker, BR, Maguire, P, Campbell, WW
Nutrition research (New York, N.Y.). 2009;(6):383-90
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Limited research in humans suggests that slowly digestible starch may blunt the postprandial increase and subsequent decline of plasma glucose and insulin concentrations, leading to prolonged energy availability and satiety, compared to more rapidly digestible starch. This study examined the postprandial metabolic and appetitive responses of waxy maize starch (WM), a slow-digestible starch. It was hypothesized that the waxy maize treatment would result in a blunted and more sustained glucose and insulin response, as well as energy expenditure and appetitive responses. Twelve subjects (6 men and 6 women) (age, 23 +/- 1 years; body mass index, 22.2 +/- 0.7 kg/m(2); insulin sensitivity [homeostatic model assessment], 16% +/- 2%; physical activity, 556 +/- 120 min/wk) consumed, on separate days, 50 g of available carbohydrate as WM, a maltodextrin-sucrose mixture (MS), or white bread (control). Postprandial plasma glucose and insulin, energy expenditure, and appetite (hunger, fullness, desire to eat) were measured over 4 hours. Compared to control, the 4-hour glucose response was not different for MS and WM, and the 4-hour insulin response was higher for MS (P < .005) and lower for WM (P < .05). Compared to MS, WM led to lower 4-hour glucose and insulin responses (P < .001). These differences were driven by blunted glucose and insulin responses during the first hour for WM. Postprandial energy expenditure and appetite were not different among treatments. These results support that WM provides sustained glucose availability in young, insulin-sensitive adults.
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Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy.
Muzykewicz, DA, Lyczkowski, DA, Memon, N, Conant, KD, Pfeifer, HH, Thiele, EA
Epilepsia. 2009;(5):1118-26
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PURPOSE To report the efficacy, safety, and tolerability of the low glycemic index treatment (LGIT) in pediatric epilepsy. METHODS A retrospective chart review was performed on patients initiating the LGIT at the Massachusetts General Hospital between January 2002 and June 2008. Demographic and clinical information including seizure type, baseline seizure frequency, medications, blood chemistries, side effects, and anthropometrics were collected. Initiation of the LGIT was done in an outpatient setting. Patients were educated by a dietitian to restrict foods with high glycemic index and to limit total daily carbohydrates to 40-60 g. Change in seizure frequency was assessed at 1-, 3-, 6-, 9-, and 12-month follow-up intervals. RESULTS Seventy-six children were included in the study. Eighty-nine percent had intractable epilepsy (>or=3 antiepileptic drugs). A greater than 50% reduction from baseline seizure frequency was observed in 42%, 50%, 54%, 64%, and 66% of the population with follow-up available at 1, 3, 6, 9, and 12 months, respectively. Increased efficacy was correlated with lower serum glucose levels at some time points, but not with beta-hydroxybutyrate (BOHB) changes or ketosis status at any time point. Only three patients reported side effects (transient lethargy). Blood urea nitrogen (BUN) was elevated in approximately one-third of follow-up laboratory studies. No significant changes were seen in body mass index (BMI) or BMI z-score at any follow-up interval. The most cited reason for treatment discontinuation was the restrictiveness of the diet, in 18 patients (24%). CONCLUSION The LGIT was associated with reduced seizure frequency in a large fraction of patients, with limited side effects.
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Evaluation of daily glycemic profiles in well controlled children with type 1 diabetes mellitus using a continuous glucose monitoring system.
Tucholski, K, Deja, G, Skała-Zamorowska, E, Jarosz-Chobot, P
Pediatric endocrinology, diabetes, and metabolism. 2009;(1):29-33
Abstract
INTRODUCTION Effective diabetes mellitus management requires to maintain blood glucose levels in a narrow range between hyperglycemia causing late complications, and danger of severe hypoglycemia. This objective may be difficult to achieve especially in small children. THE AIM OF THE STUDY Evaluation of daily glycemic profiles obtained using a continuous glucose monitoring system in well controlled children with type 1 diabetes mellitus. MATERIAL AND METHODS In 32 children (19 boys), aged 8.34+/-3.38 years, with a good metabolic control (HbA1c=6.59+/-0.66%), T1DM duration of 3.76+/-2.2 years, and daily insulin requirement of 0.69+/-0.2 U/kg, the Medtronic Guardian RT device was applied for 2.92+/-0.61 days. The data analysis performed in periods of day (7:00-22:00), night (22:00-7:00) and full recording consisted of following parameters: mean (mG) and standard deviation of glucose (sdG), excursion duration times (t) and mean glucose in following excursions (mGex): hyperglycemias >160 and >135 mg/dL (8.9 and 7.5 mmol/L), and hypoglycemias <55 and <70 mg/dL (3 and 3.9 mmol/L). RESULTS The analyzed parameters did not vary between periods of day, night and full recording. For full recording values were: mG=120.9 mg/dL (6.72 mmol/L), sdG=39.73 mg/dL (2.18 mmol/L), t>135=32.04%, t>160=17.29%, mGex>135=169,78 mg/dL (9.43 mmol/L), mGex>160=189.2 mg/dL (10.51 mmol/L), t<55=0.91%, t<70=8.78%, Gex<55=51.99 mg/dL (2.89 mmol/L), mGex<70=63.18 mg/dL (3.51 mmol/L). The correlation coefficient values between HbA1c level and calculated parameters were the highest for full recording: mG r=0.44 (p<0.02), t>135 r=0.49 (p=0.005), t>160 r=0.45 (p=0.01), mGex>135 r=0.49 (p=0.005), mGex>160 r=0.47 (p<0.01). No significant correlations between the number of calibrations per day (6.62+/-2.53), and mG, t>135 and t>160 were found. CONCLUSIONS Continuous glucose monitoring showed almost-physiological glycemic profiles in well controlled children. Glycemic excursions times were very short.
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The influence on cognition of the interaction between the macro-nutrient content of breakfast and glucose tolerance.
Nabb, S, Benton, D
Physiology & behavior. 2006;(1):16-23
Abstract
Previously it has been found that both missing breakfast and having poorer glucose tolerance were associated with better memory. The present study therefore examined the impact of eight breakfasts, in a factorial design, that contained either high or low levels of carbohydrate, fat or protein. The meals were designed to vary the rate of release of glucose into the blood stream. Memory, reaction times and vigilance were assessed 30, 75 and 120 min following breakfast. Using fasting blood glucose levels as a measure of glucose tolerance, better memory was found to be associated with better glucose tolerance and the consumption of meals that more slowly release glucose into the blood. The effects of the meals on reaction times and vigilance were opposite to those with memory in that higher levels of blood glucose tended to be associated with better performance. It was concluded that individual differences in glucose tolerance interact with the glycaemic load of a meal to influence cognitive functioning.