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Weight-based carbohydrate treatment of hypoglycaemia in people with Type 1 diabetes using insulin pump therapy: a randomized crossover clinical trial.
McTavish, L, Corley, B, Weatherall, M, Wiltshire, E, Krebs, JD
Diabetic medicine : a journal of the British Diabetic Association. 2018;(3):339-346
Abstract
AIM: To test whether weight-based treatment is more effective than usual care in people with Type 1 diabetes receiving continuous subcutaneous insulin infusion therapy with regard to both hypoglycaemia and avoiding excessive rebound hyperglycaemia. METHODS Children and adults on continuous subcutaneous insulin infusion were enrolled into a study with a crossover design. Each episode of hypoglycaemia (defined as capillary glucose <4.0 mmol/l) was randomly assigned one of two treatment protocols using glucose tablets: either 0.3 g/kg body weight or usual treatment with 15 g (adults) or 10 g (children) for capillary glucose levels 3-3.9 mmol/l or twice these doses for capillary glucose levels <3 mmol/l. All participants received each treatment in random order for up to 10 hypoglycaemic episodes. Glucose levels were re-tested 10 min after treatment, with a repeat dose if still <4 mmol/l. RESULTS Of the 37 participants enrolled, 35 (aged 6-68 years) completed the study. Twenty-four participants completed all treatment episodes, while 10 participants had <10 hypoglycaemic episodes and two withdrew without data. The mean glucose difference between weight-based and usual treatment after 10 min was 0.33 mmol/l (95% CI 0.005 to 0.66; P=0.047) in adults and 0.45 (95% CI 0.18 to 0.72; P=0.001) in children. The odds ratios for resolution of hypoglycaemia at 10 min with a single treatment using weight-based compared with usual treatment were 3.12 (95% CI 1.38 to 7.02; P=0.0070) in adults and 2.61 (95% CI 1.19 to 5.74; P=0.017) in children. CONCLUSIONS Weight-based treatment using 0.3 g/kg glucose was more effective for symptomatic hypoglycaemia in children and adults with Type 1 diabetes who were using continuous subcutaneous insulin infusion than treatment based on current international recommendations.
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Chronic Low-Calorie Sweetener Use and Risk of Abdominal Obesity among Older Adults: A Cohort Study.
Chia, CW, Shardell, M, Tanaka, T, Liu, DD, Gravenstein, KS, Simonsick, EM, Egan, JM, Ferrucci, L
PloS one. 2016;(11):e0167241
Abstract
INTRODUCTION Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity, especially abdominal obesity, remain entrenched despite substantial low-calorie sweetener use. We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity. PARTICIPANTS AND METHODS We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products, from 1454 participants (741 men, 713 women) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years (range: 0-28 years). At baseline, 785 were low-calorie sweetener non-users (51.7% men) and 669 participants were low-calorie sweetener users (50.1% men). Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported. We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes-body mass index, waist circumference, obesity and abdominal obesity-with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality. All models were adjusted for year of visit, age, sex, age by sex interaction, race, current smoking status, dietary intake (caffeine, fructose, protein, carbohydrate, and fat), physical activity, diabetes status, and Dietary Approaches to Stop Hypertension score as confounders. RESULTS With median follow-up of 10 years, low-calorie sweetener users had 0.80 kg/m2 higher body mass index (95% confidence interval [CI], 0.17-1.44), 2.6 cm larger waist circumference (95% CI, 0.71-4.39), 36.7% higher prevalence (prevalence ratio = 1.37; 95% CI, 1.10-1.69) and 53% higher incidence (hazard ratio = 1.53; 95% CI 1.10-2.12) of abdominal obesity than low-calorie sweetener non-users. CONCLUSIONS Low-calorie sweetener use is independently associated with heavier relative weight, a larger waist, and a higher prevalence and incidence of abdominal obesity suggesting that low-calorie sweetener use may not be an effective means of weight control.
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3.
Sweet Taste Perception is Associated with Body Mass Index at the Phenotypic and Genotypic Level.
Hwang, LD, Cuellar-Partida, G, Ong, JS, Breslin, PA, Reed, DR, MacGregor, S, Gharahkhani, P, Martin, NG, Rentería, ME
Twin research and human genetics : the official journal of the International Society for Twin Studies. 2016;(5):465-71
Abstract
Investigations on the relationship between sweet taste perception and body mass index (BMI) have been inconclusive. Here, we report a longitudinal analysis using a genetically informative sample of 1,576 adolescent Australian twins to explore the relationship between BMI and sweet taste. First, we estimated the phenotypic correlations between perception scores for four different sweet compounds (glucose, fructose, neohesperidine dihydrochalcone (NHDC), and aspartame) and BMI. Then, we computed the association between adolescent taste perception and BMI in early adulthood (reported 9 years later). Finally, we used twin modeling and polygenic risk prediction analysis to investigate the genetic overlap between BMI and sweet taste perception. Our findings revealed that BMI in early adulthood was significantly associated with each of the sweet perception scores, with the strongest correlation observed in aspartame with r = 0.09 (p = .007). However, only limited evidence of association was observed between sweet taste perception and BMI that was measured at the same time (in adolescence), with the strongest evidence of association observed for glucose with a correlation coefficient of r = 0.06 (p = .029) and for aspartame with r = 0.06 (p = .035). We found a significant (p < .05) genetic correlation between glucose and NHDC perception and BMI. Our analyses suggest that sweet taste perception in adolescence can be a potential indicator of BMI in early adulthood. This association is further supported by evidence of genetic overlap between the traits, suggesting that some BMI genes may be acting through biological pathways of taste perception.
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MiR-21 is overexpressed in response to high glucose and protects endothelial cells from apoptosis.
Zeng, J, Xiong, Y, Li, G, Liu, M, He, T, Tang, Y, Chen, Y, Cai, L, Jiang, R, Tao, J
Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association. 2013;(7):425-30
Abstract
Diabetes was an increasing public health problem nowadays. Accumulating evidences had shed a light on the involvement of endothelial cell dysfunction in the pathogenesis of diabetes-associated vascular diseases. MiR-21, a multiple-functional miRNA, was evidenced to be involved in endothelial dysfunction, however, the underlying molecular mechanisms were still unknown. In current study, we investigated the intrinsic link between miR-21 and high glucose-induced endothelial dysfunction. We demonstrated that expression of miR-21 was elevated in circulating endothelial progenitor cells from diabetes patients. Further, inhibition of miR-21 markedly enhanced high glucose-induced endothelial cytotoxicity. Furthermore, proteomic profiling was applied to analyze the downstream effectors involved in miR-21-meidated protection of endothelial cells. A total of 31 proteins were positively identified, including Annexin A2, S100A4, SOD2, Thioredoxin and DAXX. Altered expression of these proteins was validated by immunoblot. Finally, mechanistic study showed that miR-21 protected endothelial cell against high glucose-induced endothelial cytotoxicity probably by inhibiting the expression of DAXX. Our findings were considered as a significant step toward a better understanding of diabetes-associated vascular diseases.
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Soft drinks, sweetened beverages and risk of pancreatic cancer.
Gallus, S, Turati, F, Tavani, A, Polesel, J, Talamini, R, Franceschi, S, La Vecchia, C
Cancer causes & control : CCC. 2011;(1):33-9
Abstract
Soft drinks usually contain sugar and caffeine that might influence pancreatic carcinogenesis. We considered the association between carbonated drink consumption and pancreatic cancer risk in an Italian case-control study conducted in 1991-2008 on 326 pancreatic cancer cases and 652 matched controls. We also combined the results from all the studies on soft drinks or sweetened beverages and pancreatic cancer published before June 2010, using a meta-analytic approach. In the case-control study, compared with non-drinkers, the multivariate odds ratio was 1.02 (95% confidence interval, CI, 0.72-1.44) for carbonated drink consumers and 0.89 (95% CI 0.53-1.50) for regular consumers (at least one drink/day). Besides our study, from the literature search, we identified 4 other case-control (1,919 cases) and 6 cohort studies (2,367 cases). The pooled relative risks (RR) for soft drink consumers vs. non-consumers were 0.97 (95% CI 0.81-1.16) for case-control, 1.05 (95% CI 0.94-1.17) for cohort, and 1.02 (95% CI 0.93-1.12) for all studies. The pooled RRs for heavy drinkers were 1.08 (95% CI 0.73-1.60) for case-control, 1.21 (95% CI 0.90-1.63) for cohort, and 1.16 (95% CI 0.93-1.45) for all studies. In conclusion, soft drink consumption is not materially related to pancreatic cancer risk.
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The effect of sugar-sweetened beverage intake on energy intake in an ad libitum 6-month low-fat high-carbohydrate diet.
Munsters, MJ, Saris, WH
Annals of nutrition & metabolism. 2010;(2):116-23
Abstract
BACKGROUND/AIMS: The increased incidence of obesity coincides with an increased consumption of sugar-sweetened beverages (SSBs). This study investigated the effect of SSB intake on energy intake in an ad libitum 6-month low-fat high-carbohydrate diet in a reanalysis of the CARMEN data. METHODS Forty-seven overweight-to-obese men and women participated in the Maastricht centre of the randomized controlled CARMEN study. They were allocated to a control (habitual) diet group (CD), a low-fat (-10 energy percent, En%) high simple carbohydrate (SCHO) or low-fat high complex carbohydrate group (CCHO) (SCHO vs. CCHO 1.5 vs. 0.5) using a controlled laboratory shop system. Reanalyses were made for the energy, amount and density of all drinks and in particular of sweetened beverages (SBs). The SCHO and CD group could select non-diet SBs, including soft drinks and fruit juices, while the CCHO group received SB alternatives. RESULTS Energy intake decreased in the CCHO and SCHO groups versus the CD group (-2.7 ± 0.4 MJ/day CCHO group vs. -0.2 ± 0.5 MJ/day CD group, p < 0.01; -1.4 ± 0.4 MJ/day SCHO group, not significant). Simple carbohydrate intake increased significantly in the SCHO group versus the CCHO and CD groups (+10.8 ± 1.6 vs. -2.0 ± 0.9 and -0.5 ± 1.1 En%; p < 0.001). In the SCHO and CD groups, energy intake from SBs increased significantly (+187 ± 114 and +101 ± 83 kJ/day, respectively; -432 ± 72 kJ/day in the CCHO group; p < 0.001). CONCLUSION Simple carbohydrate intake increased through enhanced intake of non-diet SBs in the SCHO group. Fat reduction combined with only diet SBs in an ad libitum situation has a greater impact on energy intake than fat reduction combined with non-diet SBs.
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Effects of admission glucose level on mortality after subarachnoid hemorrhage: a comparison between short-term and long-term mortality.
Lee, SH, Lim, JS, Kim, N, Yoon, BW
Journal of the neurological sciences. 2008;(1-2):18-21
Abstract
BACKGROUND Admission hyperglycemia is associated with poor functional outcomes and risk of death in nondiabetic patients with acute ischemic stroke. However, there is still some debate about the effects of hyperglycemia in subarachnoid hemorrhage (SAH) patients. The purpose of this study was to assess whether the admission glucose level in patients with SAH is associated with short- and/or long-term mortality. METHODS A consecutive data set of SAH patients without diabetes was obtained from a prospective multicenter cohort of hemorrhagic stroke patients. The effects of glucose level were examined in relation to short- (30 days) or long-term mortality using Cox regression analysis. To eliminate the short-term effects of glucose level, the long-term effects were analyzed in the patients who survived for more than 30 days. RESULTS A total of 803 SAH patients were followed up in this study. The 30-day and final mortalities were 7.6% and 12.0%, respectively. Throughout the entire follow-up period, glucose level was found to be significantly associated with final mortality after adjusting for potential confounders (adjusted HR, 1.10; 95% CI, 1.01 to 1.19). Moreover, glucose level was found to be associated with short-term mortality (adjusted HR, 1.15; 95% CI, 1.05 to 1.27), but not with long-term mortality (adjusted HR, 0.97; 95% CI, 0.82 to 1.14). CONCLUSIONS We demonstrated that admission hyperglycemia has a harmful effect on short-term mortality, but not with long-term mortality in SAH patients without diabetes. Our results may be used as further evidence to support a hypothesis of harmful effects of hyperglycemia in SAH patients.