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1.
Diagnosis of Diabetes Mellitus in Older Adults.
Reddy, SSK
Clinics in geriatric medicine. 2020;(3):379-384
Abstract
In the United States, 4 out of 10 adults with diabetes are ≥65 years of age. The older adult with diabetes is very likely to be asymptomatic and also at higher risk of vascular disease. New concerns include new diagnosis of diabetes for older adults admitted to hospital and older adults in long-term care facilities. The pathophysiology for increased incidence of diabetes in older adults is multifactorial, but dominant features are increased likelihood of metabolic syndrome, dysfunctional insulin secretion, and peripheral insulin resistance. Society in general benefits from more cost-effective care of older adults with diabetes.
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Effects of Acute Dietary Polyphenols and Post-Meal Physical Activity on Postprandial Metabolism in Adults with Features of the Metabolic Syndrome.
Davis, DW, Navalta, JW, McGinnis, GR, Serafica, R, Izuora, K, Basu, A
Nutrients. 2020;(4)
Abstract
Approximately 22% of U.S. adults and 25% of adults globally have metabolic syndrome (MetS). Key features, such as dysglycemia and dyslipidemia, predict type 2 diabetes, cardiovascular disease, premature disability, and death. Acute supplementation of dietary polyphenols and post-meal physical activity hold promise in improving postprandial dysmetabolism. To our knowledge, no published review has described the effects of either intervention on postprandial glucose, insulin, lipids, and markers of oxidative damage and inflammation in adults with features of MetS. Thus, we conducted this review of controlled clinical trials that provided dietary polyphenols from oils, fruits, teas, and legumes during a dietary challenge, or implemented walking, cycling, and stair climbing and descending after a dietary challenge. Clinical trials were identified using ClinicalTrials.gov, PubMed, and Google Scholar and were published between 2000 and 2019. Dietary polyphenols from extra virgin olive oil, grapes, blackcurrants, strawberries, black tea, and black beans improved postprandial glucose, insulin, and markers of oxidative damage and inflammation, but results were not consistent among clinical trials. Freeze-dried strawberry powder distinctly improved postprandial insulin and markers of oxidative damage and inflammation. Post-meal physical activity attenuated postprandial glucose, but effects on postprandial lipids and markers of oxidative damage and inflammation were inconclusive. Consuming dietary polyphenols with a meal and completing physical activity after a meal may mitigate postprandial dysmetabolism in adults with features of MetS.
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New advances in the treatment of paediatric functional abdominal pain disorders.
Santucci, NR, Saps, M, van Tilburg, MA
The lancet. Gastroenterology & hepatology. 2020;(3):316-328
Abstract
This Review summarises recent pharmacological and upcoming alternative interventions for children with functional abdominal pain disorders (FAPDs). Pharmacological targets include prokinetics and drugs affecting gastric accommodation to treat postprandial distress and nausea. Similarly, anti-inflammatory agents, junctional protein regulators, analgesics, secretagogues, and serotonin antagonists have a therapeutic role for irritable bowel syndrome. Non-pharmacological treatments include peripheral electrical nerve field stimulation to the external ear, gastric electrical stimulation, dietary interventions such as low fructose and fibre based diets, and nutraceuticals, which include probiotics, prebiotics, and synbiotics. Newer psychological advances such as exposure-based cognitive behavioural therapy, acceptance and commitment therapy, and mindfulness meditation are being investigated for paediatric functional pain. Lastly, alternative therapies such as acupuncture, moxibustion, yoga, and spinal manipulation are also gaining popularity in the treatment of FAPDs.
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Food, Eating, and the Gastrointestinal Tract.
Livovsky, DM, Pribic, T, Azpiroz, F
Nutrients. 2020;(4)
Abstract
Food ingestion induces a metered response of the digestive system. Initially, the upper digestive system reacts to process and extract meal substrates. Later, meal residues not absorbed in the small bowel, pass into the colon and activate the metabolism of resident microbiota. Food consumption also induces sensations that arise before ingestion (e.g., anticipatory reward), during ingestion (e.g., gustation), and most importantly, after the meal (i.e., the postprandial experience). The postprandial experience involves homeostatic sensations (satiety, fullness) with a hedonic dimension (digestive well-being, mood). The factors that determine the postprandial experience are poorly understood, despite their potential role in personalized diets and healthy eating habits. Current data suggest that the characteristics of the meal (amount, palatability, composition), the activity of the digestive system (suited processing), and the receptivity of the eater (influenced by multiple conditioning factors) may be important in this context.
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5.
Postprandial hypoglycemia after gastric bypass surgery: from pathogenesis to diagnosis and treatment.
Honka, H, Salehi, M
Current opinion in clinical nutrition and metabolic care. 2019;(4):295-302
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Abstract
PURPOSE OF REVIEW The Roux-en-Y gastric bypass surgery (RYGB) improves glucose control in majority of patients with type 2 diabetes. However, a minority group of individuals develop a life-threatening complication of hyperinsulinemic hypoglycemia. The goal of this review is to identify underlying mechanisms by which RYGB cause hypoglycemia and describe pathogenesis-driven strategies to diagnose and treat this condition. RECENT FINDINGS Gastric bypass leads to higher and earlier peak levels of glucose and lower nadir glucose after eating along with larger insulin and glucagon-like peptide 1 (GLP-1) secretion, resetting the balance between glucose appearance and clearance after this procedure. These weight-loss independent glycemic effects of RYGB have been attributed to changes in ingested glucose appearance as a result of rapid nutrient emptying from stomach pouch to the intestine and increased glucose clearance as a result of prandial hyperinsulinemia. The exaggerated effect of RYGB on postmeal glucose metabolism is a syndrome of postprandial hyperinsulinemic hypoglycemia manifesting in a group of individuals several years after this surgery. Affected patients have larger systemic appearance of ingested glucose and greater postmeal secretion of insulin and GLP-1 compared to those with history of RYGB without symptomatic hypoglycemia. Current evidence supporting a multifactorial model of glucose dysregulation among patients with hypoglycemia will be highlighted in this review. SUMMARY Hypoglycemia after RYGB is a life-threatening condition and likely represents the extreme glycemic phenotype of this procedure. Diagnosis is challenging and treatment options are limited.
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6.
Postprandial Glucose Control in Type 1 Diabetes: Importance of the Gastric Emptying Rate.
Lupoli, R, Pisano, F, Capaldo, B
Nutrients. 2019;(7)
Abstract
The achievement of optimal post-prandial (PP) glucose control in patients with type 1 diabetes (T1DM) remains a great challenge. This review summarizes the main factors contributing to PP glucose response and discusses the likely reasons why PP glucose control is rarely achieved in T1DM patients. The macronutrient composition of the meal, the rate of gastric emptying and premeal insulin administration are key factors affecting the PP glucose response in T1DM. Although the use of continuous insulin infusion systems has improved PP glucose control compared to conventional insulin therapy, there is still need for further ameliorations. T1DM patients frequently present a delayed gastric emptying (GE) that produces a lower but more prolonged PP hyperglycemia. In addition, delayed GE is associated with a longer time to reach the glycemic peak, with a consequent mismatch between PP glucose elevation and the timing of premeal insulin action. On this basis, including GE time and meal composition in the algorithms for insulin bolus calculation of the insulin delivery systems could be an important step forward for optimization of PP glucose control in T1DM.
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7.
Molecular imaging of postprandial metabolism.
Schrauwen-Hinderling, VB, Carpentier, AC
Journal of applied physiology (Bethesda, Md. : 1985). 2018;(2):504-511
Abstract
Disordered postprandial metabolism of energy substrates is one of the main defining features of prediabetes and contributes to the development of several chronic diseases associated with obesity, such as type 2 diabetes and cardiovascular diseases. Postprandial energy metabolism has been studied using classical isotopic tracer approaches that are limited by poor access to splanchnic metabolism and highly dynamic and complex exchanges of energy substrates involving multiple organs and systems. Advances in noninvasive molecular imaging modalities, such as PET and MRI/magnetic resonance spectroscopy (MRS), have recently allowed important advances in our understanding of postprandial energy metabolism in humans. The present review describes some of these recent advances, with particular focus on glucose and fatty acid metabolism in the postprandial state, and discusses current gaps in knowledge and new perspectives of application of PET and MRI/MRS for the investigation and treatment of human metabolic diseases.
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Possible mechanisms of postprandial physiological alterations following flavan 3-ol ingestion.
Osakabe, N, Terao, J
Nutrition reviews. 2018;(3):174-186
Abstract
Foods rich in flavan 3-ols are known to prevent cardiovascular diseases by reducing metabolic syndrome risks, such as hypertension, hyperglycemia, and dyslipidemia. However, the mechanisms involved in this reduction are unclear, particularly because of the poor bioavailability of flavan 3-ols. Recent metabolome analyses of feces produced after repeated ingestion of foods rich in flavan 3-ols may provide insight into the chronic physiological changes associated with the intake of flavan 3-ols. Substantial postprandial changes have been reported after flavan 3-ol ingestion, including hemodynamic and metabolic changes as well as autonomic and central nervous alterations. Taken together, the evidence suggests that flavan 3-ols have both postprandial and chronic effects, which could involve different or common mechanisms. In general, the accumulation of acute functional changes induces chronic physiological alteration. Therefore, this review highlights the postprandial action of flavan 3-ols in order to address the yet unknown mechanism(s) for their physiological function.
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Rationale for treatment options for mealtime glucose control in patients with type 2 diabetes.
Aronoff, SL
Postgraduate medicine. 2017;(2):231-241
Abstract
While glycemic control is routinely assessed using HbA1c and fasting glucose measures, postprandial glucose (PPG) is also an important contributor of overall glycemia. Furthermore, PPG excursions have been linked to complications of diabetes. This review examines the effects of glucose-lowering therapies (including treatments administered at mealtime) on postprandial hyperglycemia in patients with type 2 diabetes. A PubMed search was conducted to identify clinical studies of treatments for mealtime glucose control in type 2 diabetes. Different treatments may have comparable effects on HbA1c but varying effects on PPG control and glucose fluctuations. Older classes of oral glucose-lowering treatments administered at mealtime to lower PPG include meglitinides and α-glucosidase inhibitors. Injectable therapies, including prandial insulin analogs, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and the amylin analog pramlintide, all effectively target postprandial hyperglycemia. Compared with longer-acting GLP-1RAs, short-acting GLP-1RAs, such as exenatide twice daily and lixisenatide once daily, have a greater effect on PPG control, which is primarily mediated by a more pronounced effect on delayed gastric emptying. Dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter 2 inhibitors also reduce postprandial hyperglycemia. To achieve more physiologically normal glycemic control, choice of therapy should ideally aim to address daily glucose fluctuations, including hyperglycemic peaks and hypoglycemic troughs, and long-term glycemic control.
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10.
Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials.
Shishehbor, F, Mansoori, A, Shirani, F
Diabetes research and clinical practice. 2017;:1-9
Abstract
OBJECTIVE Postprandial hyperglycemia plays a decisive role in the development of chronic metabolic disorders. The effect of vinegar intake with a meal on postprandial glucose has been studied in several trials with conflicting results. RESEARCH METHODS AND PROCEDURES The purpose of the current study was to systematically review control trials that report on the effect of vinegar intake on postprandial glucose response. Postprandial insulin response was considered as secondary outcome. RESULTS The pooled analysis of studies revealed a significant mean glucose and insulin area under the curve (AUC) reduction in participants who consumed vinegar compared with the control group (standard mean difference=-0.60, 95%CI -1.08 to -0.11, p=0.01 and -1.30, 95%CI -1.98 to -0.62, p<0.001, respectively). CONCLUSIONS The findings suggest that vinegar can be effective in reducing postprandial glucose and insulin levels, indicating it could be considered as an adjunctive tool for improving glycemic control.