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Sample records for achieving good glycemic

  1. How To Achieve Good Library Acoustics.

    ERIC Educational Resources Information Center

    Wiens, Janet

    2003-01-01

    Discusses how to create a good acoustical environment for college libraries, focusing on requirements related to the HVAC system and lighting, and noting the importance of good maintenance. A sidebar looks at how to design and achieve the most appropriate HVAC and lighting systems for optimum library acoustics. (SM)

  2. Achieving glycemic control in special populations in hospital: perspectives in practice.

    PubMed

    Cheng, Alice Y Y

    2014-04-01

    Achieving and maintaining glycemic control in patients with diabetes admitted to hospital is challenging because of the many competing factors of nutrition, pharmacotherapy and other patient-related and systemic factors. For patients receiving enteral or parenteral feeding, eating irregularly or receiving glucocorticoid therapy, the challenges are even greater. The basic principles to follow when managing glycemia in these populations are as follows: 1) Recognition of those at risk for hyperglycemia; 2) frequent bedside glucose monitoring; 3) a proactive approach with routine insulin administration based on the predicted glucose patterns; 4) constant reassessment of the glycemic status and titration of the routine insulin accordingly.

  3. Impact of Long-Term Poor and Good Glycemic Control on Metabolomics Alterations in Type 1 Diabetic People

    PubMed Central

    Dutta, Tumpa; Kudva, Yogish C.; Persson, Xuan-Mai T.; Schenck, Louis A.; Ford, G. Charles; Singh, Ravinder J.; Carter, Rickey

    2016-01-01

    Context: Poor glycemic control in individuals with type 1 diabetes (T1D) is associated with both micro- and macrovascular complications, but good glycemic control does not fully prevent the risk of these complications. Objective: The objective of the study was to determine whether T1D with good glycemic control have persistent abnormalities of metabolites and pathways that exist in T1D with poor glycemic control. Design: We compared plasma metabolites in T1D with poor (glycated hemoglobin ≥ 8.5%, T1D[−] and good (glycated hemoglobin < 6.5%, T1D[+]) glycemic control with nondiabetic controls (ND). Setting: The study was conducted at the clinical research unit. Patients or Other Participants: T1D with poor (n = 14), T1D(−) and good, T1D(+) (n = 15) glycemic control and matched (for age, sex, and body mass index) ND participants were included in the study. Intervention(s): There were no intervention. Main Outcome Measure(s): Comparison of qualitative and quantitative profiling of metabolome was performed. Results: In T1D(−), 347 known metabolites belonging to 38 metabolic pathways involved in cholesterol, vitamin D, tRNA, amino acids (AAs), bile acids, urea, tricarboxylic acid cycle, immune response, and eicosanoids were different from ND. In T1D(+),154 known metabolites belonging to 26 pathways including glycolysis, gluconeogenesis, bile acids, tRNA biosynthesis, AAs, branch-chain AAs, retinol, and vitamin D metabolism remained altered from ND. Targeted measurements of AA metabolites, trichloroacetic acid, and free fatty acids showed directional changes similar to the untargeted metabolomics approach. Conclusions: Comprehensive metabolomic profiling identified extensive metabolomic abnormalities in T1D with poor glycemic control. Chronic good glycemic control failed to normalize many of these perturbations, suggesting a potential role for these persistent abnormalities in many complications in T1D. PMID:26796761

  4. Low prevalence of glucokinase gene mutations in gestational diabetic patients with good glycemic control.

    PubMed

    Frigeri, H R; Santos, I C R; Réa, R R; Almeida, A C R; Fadel-Picheth, C M T; Pedrosa, F O; Souza, E M; Rego, F G M; Picheth, G

    2012-05-18

    Glucokinase (GCK) plays a key role in glucose homeostasis. Gestational diabetes mellitus increases the risk of gestational complications in pregnant women and fetuses. We screened for mutations in coding and flanking regions of the GCK gene in pregnant women with or without gestational diabetes in a Brazilian population. A sample of 200 pregnant women classified as healthy (control, N = 100) or with gestational diabetes (N = 100) was analyzed for mutations in the GCK gene. All gestational diabetes mellitus patients had good glycemic control maintained by diet alone and no complications during pregnancy. Mutations were detected by single-strand conformation polymorphism and DNA sequencing. Thirteen of the 200 subjects had GCK gene mutations. The mutations detected were in intron 3 (c.43331A>G, new), intron 6 (c.47702T>C, rs2268574), intron 9 (c.48935C>T, rs2908274), and exon 10 (c.49620G>A, rs13306388). None of these GCK mutations were found to be significantly associated with gestational diabetes mellitus. In summary, we report a low frequency of GCK mutations in a pregnant Brazilian population and describe a new intronic variation (c.43331A>G, intron 3). We conclude that mutations in GCK introns and in non-translatable regions of the GCK gene do not affect glycemic control and are not correlated with gestational diabetes mellitus.

  5. Barriers to achieving optimal glycemic control in a multi-ethnic society: a US focus.

    PubMed

    Dagogo-Jack, Samuel; Funnell, Martha M; Davidson, Jaime

    2006-08-01

    The increasing prevalence of diabetes is particularly apparent in certain ethnic groups, such as African and Hispanic Americans. These groups generally also have poorer glycemic control and outcomes. To better understand the issues surrounding these problems and possible methods to overcome them we performed a literature review from the past 15 years on barriers to glycemic control with a focus on US data. The literature reveals that barriers may be inherent (eg, genetic, cultural, and language/communication) or acquired (eg, those associated with changes in lifestyle and socioeconomic factors). Healthcare interventions that take into consideration cultural and population-specific characteristics can reduce the prevalence and severity of diabetes and its resulting complications. Implementing such strategies will require suitable education for patients and providers, the availability of culturally-sensitive, patient-centered healthcare teams, the creation of collaborative relationships between providers and patients, better use of community resources, and assistance for patients to make informed decisions about available treatment options. There is also evidence suggesting that at the same level of glucose control Hispanics and African Americans have the same degree of complications as whites; therefore, good control is essential for the future well-being of all patients. Addressing these issues may help to decrease the ethnic disparities that currently exist in diabetes care.

  6. A Comparative Study of Diet in Good and Poor Glycemic Control Groups in Elderly Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Woo, Mi-Hye; Park, Soojin; Woo, Jeong-Taek

    2010-01-01

    Background Identification of dietary patterns is important for glycemic management in elderly patients with type 2 diabetes mellitus (T2DM). Methods Elderly T2DM patients (> 65 years of age, n = 48) were categorized based on their concentration of glycated hemoglobin (HbA1c). Subjects with HbA1c levels below 7% were placed in the good control (GC) group and those with HbA1c levels equal to or above 8% were placed in the poor control (PC) group. Anthropometric data, blood parameters, and dietary intake records were compared between the groups. Statistical analysis included Student's t-test, chi-square test, and Pearson correlation coefficient test. Results Anthropometric data, including body mass index (24.7 ± 2.9 kg/m2), did not differ between the GC and PC groups. Significant abnormalities in blood glucose levels (P < 0.01), lean body mass (P < 0.01), and plasma protein and albumin levels (P < 0.05, P < 0.01) were found in the PC group. In contrast to the GC group, the PC group depended on carbohydrate (P = 0.014) rather than protein (P = 0.013) or fat (P = 0.005) as a major source of energy, and had a lower index of nutritional quality for nutrients such as protein (P = 0.001), and all vitamins and minerals (P < 0.001, 0.01, or 0.05 for individual nutrients), except vitamin C, in their usual diet. Negative correlations between HbA1c levels and protein (r = -0.338, P < 0.05) or fat (r = -0.385, P < 0.01) intakes were also found. Conclusions Healthcare professionals should encourage elderly diabetic patients to consume a balanced diet to maintain good glycemic control. PMID:21076578

  7. Understanding basic carbohydrate counting, glycemic index, and glycemic load for improved glycemic control in Hispanic patients with type 2 diabetes mellitus.

    PubMed

    Ortiz, Lidia Guadalupe Compeán; Berry, Diane C; Ruiz, Octelina Castillo; González, Eunice Reséndiz; Pérez, Paulina Aguilera; Rivas, Elva Del Ángel

    2014-01-01

    Hispanic patients with type 2 diabetes mellitus generally have poor glycemic control. Constant hyperglycemia in individuals with type 2 diabetes can cause microvascular and macrovascular complications that lead to early morbidity and mortality. Good glycemic control requires a balance between diet, exercise, and medication, but dietary balance is difficult to achieve for many patients. Of the macronutrients, carbohydrates mostly affect blood glucose levels. Basic carbohydrate counting, glycemic index, and glycemic load are important tools for patients to master to control their blood glucose levels.

  8. Analysis of alternatives for insulinizing patients to achieve glycemic control and avoid accompanying risks of hypoglycemia.

    PubMed

    Gao, Jialin; Xiong, Qianyin; Miao, Jun; Zhang, Yao; Xia, Libing; Lu, Meiqin; Zhang, Binhua; Chen, Yueping; Zhang, Ansu; Yu, Cui; Wang, Li-Zhuo

    2015-05-01

    The aims of the present study were to explore the efficacy of glycemic control and the risks of hypoglycemia with different methods of insulin therapy, and to provide reference data for the clinical treatment of diabetes. In this retrospective study, hospitalized patients diagnosed with type 2 diabetes between March and December 2014, in the Department of Endocrinology in the First Affiliated Hospital of Wannan Medical College, were divided into three groups, including an intensive insulin analogue therapy group, a premixed insulin analogue treatment group and a premixed human insulin therapy group. The efficacy of glycemic control and the incidence of hypoglycemia were determined in each of the insulin treatment groups. Compared with the other treatment groups, the intensive insulin analogue therapy group was associated with superior blood glucose control, shorter time to reach standard insulin regimen, shorter hospitalization time, fewer fluctuations in blood glucose levels and lower insulin dosage on discharge from hospital. However, this treatment was also associated with a high risk of hypoglycemia. In conclusion, when combined with the effective prevention of hypoglycemia and appropriate nursing care (especially in hospital care), intensive insulin analogue therapy may provide the greatest benefit to patients.

  9. The Impossibility of Achieving Consistently Good Mental Health.

    ERIC Educational Resources Information Center

    Ellis, Albert

    1987-01-01

    People disturb themselves with irrational beliefs, some of which are obvious and blatant while others are subtle and tricky. The latter type make people more disturbed than do the former kind. Even when helped by the most efficient forms of psychotherapy, humans have difficulty achieving and maintaining good mental health. (Author/VM)

  10. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options

    PubMed Central

    Du, Ye-Fong; Ou, Horng-Yih; Beverly, Elizabeth A; Chiu, Ching-Ju

    2014-01-01

    The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the elderly. Because of the unique characteristics of elderly people with T2DM, therapeutic strategy and focus should be tailored to suit this population. This article reviews the guidelines and studies related to older people with T2DM worldwide. A few important themes are generalized: 1) the functional and cognitive status is critical for older people with T2DM considering their life expectancy compared to younger counterparts; 2) both severe hypoglycemia and persistent hyperglycemia are deleterious to older adults with T2DM, and both conditions should be avoided when determining therapeutic goals; 3) recently developed guidelines emphasize the avoidance of hypoglycemic episodes in older people, even in the absence of symptoms. In addition, we raise the concern of glycemic variability, and discuss the rationale for the selection of current options in managing this patient population. PMID:25429208

  11. Assessing disproportionate costs to achieve good ecological status of water bodies in a Mediterranean river basin.

    PubMed

    Molinos-Senante, María; Hernández-Sancho, Francesc; Sala-Garrido, Ramón

    2011-08-01

    Water management is becoming increasingly important as the demand for water grows, diversifies, and includes more complex environmental concerns. The Water Framework Directive (WFD) seeks to achieve a good ecological status for all European Community water bodies by 2015. To achieve this objective, economic consideration of water management must be given to all decision-making processes. Exemption (time or level of stringency) from the objectives of the EU Directive can be justified by proving that the cost of implementing measures is disproportionate to the benefits. This paper addresses the issue of disproportionate costs through a cost-benefit analysis (CBA). To predict the costs, the function costs method is used. The quantification of environmental benefits is more complex, because they are not determined by the market. As an alternative to stated preference methods, we use the distance function approach to estimate the environmental benefits of improving water quality. We then apply this methodological approach to a Mediterranean River Basin in Spain. The results show that the achievement of good status could not be rejected based on the criterion of disproportionate costs in this river basin. This paper illustrates that CBA is a useful tool to inform policy and decision making. Furthermore, it is shown that economics, particularly the valuation of environmental benefits, plays a crucial role in fulfilling the environmental objectives of the WFD.

  12. Self-esteem memories: feeling good about achievement success, feeling bad about relationship distress.

    PubMed

    Pillemer, David B; Ivcevic, Zorana; Gooze, Rachel A; Collins, Katherine A

    2007-09-01

    College students and middle-aged adults provided memories of occasions when they felt especially good or especially bad about themselves. Probes directed the memory search to several age intervals during childhood, adolescence, and adulthood. Predominant themes represented in self-esteem memories differed consistently as a function of emotional valence. Memories of positive self-worth frequently focused on achievement/mastery themes, whereas memories of negative self-worth frequently focused on interpersonal/affiliation themes. When people evaluate the self through the lens of autobiographical memory, interpersonal distress is portrayed as especially damaging and achievement success is portrayed as especially enhancing. The asymmetry between positive and negative self-esteem memories is explained using multiple theoretical perspectives within social and personality psychology.

  13. What Makes Good Teachers Good?: A Cross-Case Analysis of the Connection between Teacher Effectiveness and Student Achievement

    ERIC Educational Resources Information Center

    Stronge, James H.; Ward, Thomas J.; Grant, Leslie W.

    2011-01-01

    This study examined classroom practices of effective versus less effective teachers (based on student achievement gain scores in reading and mathematics). In Phase I of the study, hierarchical linear modeling was used to assess the teacher effectiveness of 307 fifth-grade teachers in terms of student learning gains. In Phase II, 32 teachers (17…

  14. Who is good at this game? Linking an activity to a social category undermines children's achievement.

    PubMed

    Cimpian, Andrei; Mu, Yan; Erickson, Lucy C

    2012-05-01

    Children's achievement-related theories have a profound impact on their academic success. Children who adopt entity theories believe that their ability to perform a task is dictated by the amount of natural talent they possess for that task--a belief that has well-documented adverse consequences for their achievement (e.g., lowered persistence, impaired performance). It is thus important to understand what leads children to adopt entity theories. In the experiments reported here, we hypothesized that the mere act of linking success at an unfamiliar, challenging activity to a social group gives rise to entity beliefs that are so powerful as to interfere with children's ability to perform the activity. Two experiments showed that, as predicted, the performance of 4- to 7-year-olds (N = 192) was impaired by exposure to information that associated success in the task at hand with membership in a certain social group (e.g., "boys are good at this game"), regardless of whether the children themselves belonged to that group.

  15. Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes.

    PubMed

    Ross, Stuart A

    2013-09-01

    Approximately half of patients with type 2 diabetes (T2D) do not achieve globally recognized blood glucose targets, despite the availability of a wide range of effective glucose-lowering therapies. Failure to maintain good glycemic control increases the risk of diabetes-related complications and long-term health care costs. Patients must be brought under glycemic control to improve treatment outcomes, but existing barriers to optimizing glycemic control must first be overcome, including patient nonadherence to treatment, the failure of physicians to intensify therapy in a timely manner, and inadequacies in the health care system itself. The reasons for such barriers include treatment side effects, complex treatment regimens, needle anxiety, poor patient education, and the absence of an adequate patient care plan; however, newer therapies and devices, combined with comprehensive care plans involving adequate patient education, can help to minimize barriers and improve treatment outcomes.

  16. [Good agricultural practice (GAP) of Chinese materia medica (CMM) for ten years: achievements, problems and proposals].

    PubMed

    Guo, Lan-Ping; Zhang, Yan; Zhu, Shou-Dong; Wang, Gui-Hua; Wang, Xiu; Zhang, Xiao-Bo; Chen, Mei-Lan; He, Ya-Li; Han, Bang-Xing; Chen, Nai-Fu; Huang, Lu-Qi

    2014-04-01

    This paper aims to summarize the achievements during the implementation process of good agricultural practice (GAP) in Chinese Materia Medica (CMM), and on basis of analyzing the existing problems of GAP, to propose further implementation of GAP in TCM growing. Since the launch of GAP in CMM growing ten years ago, it has acquired great achievements, including: (1) The promulgation of a series of measures for the administration of the GAP approval in the CMM growing; (2) The expanded planting area of CMM; (3) The increased awareness of standardized CMM growing among farmers and enterprises; (4) The establishment of GAP implementation bases for CMM growing; (5) The improvement of theory and methodology for CMM growing; (6) The development of a large group of experts and scholars in GAP approval for CMM production. The problems existing in the production include: (1) A deep understanding of GAP and its certification is still needed; (2) The distribution of the certification base is not reasonable; (3) The geo-economics effect and the backward farming practices are thought to be the bottlenecks in the standardization of CMM growing and the scale production of CMM; (4) Low comparative effectiveness limits the development of the GAP; (5) The base of breeding improved variety is blank; (6) The immature of the cultivation technique lead to the risk of production process; (7) The degradation of soil microbial and the continuous cropping obstacle restrict the sustainable development of the GAP base. To further promote the health and orderly GAP in the CMM growing, the authors propose: (1) To change the mode of production; (2) To establish a sound standard system so as to ensure quality products for fair prices; (3) To fully consider the geo-economic culture and vigorously promote the definite cultivating of traditional Chinese medicinal materials; (4) To strengthen the transformation and generalization of basic researches and achievements, in order to provide technical

  17. A Conceptual Framework for Achieving Good Governance at Open and Distance Learning Institutions

    ERIC Educational Resources Information Center

    Khanna, Pankaj

    2017-01-01

    This paper describes a good governance architecture framework that would bring significant improvements in the overall working of open and distance learning institutions in a well-structured and systematic way. The good governance framework is articulated with seven basic principles which are performance, transparency, accountability,…

  18. The Nation's Report Card Goes Home: Good News and Bad about Trends in Achievement.

    ERIC Educational Resources Information Center

    Linn, Robert L.; Dunbar, Stephen B.

    1990-01-01

    When test data from different sources conflict, the truth is often found somewhere in the middle. As this article shows, reports of achievement trends can be heavily influenced by the particular definition of achievement represented and by testing conditions. Recent progress in science and mathematics must be carefully nurtured in the nineties.…

  19. A global study of the unmet need for glycemic control and predictor factors among patients with type 2 diabetes mellitus who have achieved optimal fasting plasma glucose control on basal insulin

    PubMed Central

    Chou, Engels; Colagiuri, Stephen; Gaàl, Zsolt; Lavalle, Fernando; Mkrtumyan, Ashot; Nikonova, Elena; Tentolouris, Nikolaos; Vidal, Josep; Davies, Melanie

    2016-01-01

    Abstract Background This study used data from different sources to identify the extent of the unmet need for postprandial glycemic control in patients with type 2 diabetes mellitus (T2DM) after the initiation of basal insulin therapy in Europe, Asia Pacific, the United States, and Latin America. Methods Different levels of evidence were used as available for each country/region, with data extracted from seven randomized controlled trials (RCTs), three clinical trial registries (CTRs), and three electronic medical record (EMR) databases. Glycemic status was categorized as “well controlled” (glycated hemoglobin [HbA1c] at target [<7%]), “residual hyperglycemia” (fasting plasma glucose [FPG] but not HbA1c at target [FPG <7.2/7.8 mmol/L, <130/140 mg/dL, depending on country‐specific recommendations]), or “uncontrolled” (both FPG and HbA1c above target). Predictor factors were identified from the RCT data set using logistic regression analysis. Results RCT data showed that 16.9% to 28.0%, 42.7% to 54.4%, and 16.9% to 38.1% of patients with T2DM had well‐controlled glycemia, residual hyperglycemia, and uncontrolled hyperglycemia, respectively. In CTRs, respective ranges were 21.8% to 33.6%, 31.5% to 35.6%, and 30.7% to 46.8%, and in EMR databases were 4.4% to 21.0%, 23.9% to 31.8%, and 53.6% to 63.8%. Significant predictor factors of residual hyperglycemia identified from RCT data included high baseline HbA1c (all countries/regions except Brazil), high baseline FPG (United Kingdom/Japan), longer duration of diabetes (Brazil), and female sex (Europe/Latin America). Conclusions Irrespective of intrinsic differences between data sources, 24% to 54% of patients with T2DM globally had residual hyperglycemia with HbA1c not at target, despite achieving FPG control, indicating a significant unmet need for postprandial glycemic control. PMID:27606888

  20. Psychoticism and disruptive behavior can be also good predictors of school achievement.

    PubMed

    Flores-Mendoza, Carmen; Widaman, Keith; Mansur-Alves, Marcela; Bacelar, Tatiane Dias; Saldanha, Renata

    2013-01-01

    The relations of Gf (Standard Progressive Matrices Raven), Gc (verbal scale of Wechsler Intelligence Scale for Children-Third Version), personality dimensions (Eysenck Personality Questionnaire-Junior Version), and disruptive behavior (TDAH scale) with school achievement (measured by TDE test and PISA test) were investigated. Two samples of students (total N = 534) representing a broad range of socioeconomic status (SES) participated in this study. Path models were conducted. The results demonstrated that (1) in both samples no sex differences related to school achievement were found; (2) in the first sample, after controlling for age and SES differences, Gf and psychoticism predicted (.38 and -.13, respectively) school achievement (measured by TDE test); (3) in the second sample, after controlling for SES differences to which additional measures were administered, Gf and Gc positively predicted (.22 and .40, respectively) school achievement (measured by PISA test). In addition, psychoticism and disruptive behavior also predicted school performance (-.14 and -.28, respectively). Some theoretical and practical implications are discussed.

  1. Glycemic index and disease.

    PubMed

    Pi-Sunyer, F Xavier

    2002-07-01

    It has been suggested that foods with a high glycemic index are detrimental to health and that healthy people should be told to avoid these foods. This paper takes the position that not enough valid scientific data are available to launch a public health campaign to disseminate such a recommendation. This paper explores the glycemic index and its validity and discusses the effect of postprandial glucose and insulin responses on food intake, obesity, type 1 diabetes, and cardiovascular disease. Presented herein are the reasons why it is premature to recommend that the general population avoid foods with a high glycemic index.

  2. Removing the Barriers: Raising Achievement Levels for Minority Ethnic Pupils. Exploring Good Practice.

    ERIC Educational Resources Information Center

    Department for Education and Skills, London (England).

    This resource kit, which can be used with an accompanying videotape and written materials, shows how three English secondary schools have succeeded in raising the achievement of their ethnic minority students by increasing expectations of what each student is capable of, valuing diversity, working in partnership with parents, and encouraging…

  3. Alternative Methods for Estimating Achievement Trends and School Effects: When Is Simple Good Enough?

    ERIC Educational Resources Information Center

    Warkentien, Siri; Silver, David

    2016-01-01

    Public schools with impressive records of serving lower-performing students are often overlooked because their average test scores, even when students are growing quickly, are lower than scores in schools that serve higher-performing students. Schools may appear to be doing poorly either because baseline achievement is not easily accounted for or…

  4. Integrating Economic and Social Policy: Good Practices from High-Achieving Countries. Innocenti Working Papers.

    ERIC Educational Resources Information Center

    Mehrotra, Santosh

    This paper examines the successes of 10 "high achievers," countries with social indicators far higher than might be expected, given their national wealth, pulling together the lessons learned for social policy in the developing world. The 10 countries identified are Costa Rica, Cuba, Barbados, Botswana, Zimbabwe, Mauritius, Kerala, Sri…

  5. Mister Sandman, bring me good marks! On the relationship between sleep quality and academic achievement.

    PubMed

    Baert, Stijn; Omey, Eddy; Verhaest, Dieter; Vermeir, Aurélie

    2015-04-01

    There is growing evidence that health factors affect tertiary education success in a causal way. This study assesses the effect of sleep quality on academic achievement at university. To this end, we surveyed 804 students about their sleep quality by means of the Pittsburgh Sleep Quality Index (PSQI) before the start of their first exam period in December 2013 at Ghent University. PSQI scores were merged with course marks in this exam period. Instrumenting PSQI scores by sleep quality during secondary education, we find that increasing total sleep quality with one standard deviation leads to 4.85 percentage point higher course marks. Based on this finding, we suggest that higher education providers might be incentivised to invest part of their resources for social facilities in professional support for students with sleep and other health problems.

  6. What makes a good program? A case study of a school admitting high academic achievers.

    PubMed

    Lam, Ching Man

    2008-10-10

    This paper reports the results of a qualitative study that explored the administration and implementation of the Tier 1 Program (Secondary 1 Curriculum) of the Project P.A.T.H.S. The case study method was used to explore perceptions of the teachers and the project coordinator of program effectiveness, and to identify various factors for program success. A school admitting high academic achievers was selected, and site visits, as well as individual and focus group interviews, were conducted with the program coordinator, social worker, and course teachers. The results suggested that clear vision and program goals, high quality of curriculum, helpful leadership, positive teacher attitude, and strong administrative support are factors for program success. Analyzing the data enables the researchers to understand the characteristics of a successful program as well as the interplay among factors for producing success.

  7. Public goods and private interests: The role of voluntary green power demand in achieving environmental improvements

    NASA Astrophysics Data System (ADS)

    Wiser, Ryan Hayes

    This dissertation explores the role of consumer purchasing behavior in providing public, environmental goods. It does so by empirically evaluating one market---voluntary demand for renewable energy. The dissertation addresses the following five research questions: (1) What does early experience with green power marketing tell us about the prospects for this market to deliver environmental benefits? (2) What product design and marketing approaches might be used to increase voluntary demand? (3) What motivates non-residential customers to voluntarily purchase green power? (4) What role might public policy play in the creation of the green power market? (5) What preferences do individuals hold on the most appropriate forms of support for renewable energy? By helping to answer these questions, this dissertation seeks to better understand the gap between widespread positive attitudes for the environment and an often-anemic response to green product offerings. It contributes to not only the public goods and environmental marketing literatures, but also to contingent valuation methodology and to an emerging literature on the motivations of firms to contribute to environmental causes. The analysis performed is diverse, and includes: a literature review, a mail survey of green power marketers, a mail survey of non-residential green power customers, and contingent valuation and opinion surveys of U.S. residents. Detailed statistical analysis is performed on the data collected from the residential and non-residential surveys. The analysis reveals that customer participation in green power programs to date has been weak. The possibility that the traditional economic concept of "free riding" may explain this low response is raised, and the dissertation identifies a number of marketing approaches that might be used to partially combat this problem. Analysis of survey data shows that non-residential green power purchases have been motivated principally by altruistic concerns

  8. Working and learning together: good quality care depends on it, but how can we achieve it?

    PubMed Central

    McPherson, K; Headrick, L; Moss, F

    2001-01-01

    Educating healthcare professionals is a key issue in the provision of quality healthcare services, and interprofessional education (IPE) has been proposed as a means of meeting this challenge. Evidence that collaborative working can be essential for good clinical outcomes underpins the real need to find out how best to develop a work force that can work together effectively. We identify barriers to mounting successful IPE programmes, report on recent educational initiatives that have aimed to develop collaborative working, and discuss the lessons learned. To develop education strategies that really prepare learners to collaborate we must: agree on the goals of IPE, identify effective methods of delivery, establish what should be learned when, attend to the needs of educators and clinicians regarding their own competence in interprofessional work, and advance our knowledge by robust evaluation using both qualitative and quantitative approaches. We must ensure that our education strategies allow students to recognise, value, and engage with the difference arising from the practice of a range of health professionals. This means tackling some long held assumptions about education and identifying where it fosters norms and attitudes that interfere with collaboration or fails to engender interprofessional knowledge and skill. We need to work together to establish education strategies that enhance collaborative working along with profession specific skills to produce a highly skilled, proactive, and respectful work force focused on providing safe and effective health for patients and communities. Key Words: interprofessional education; multiprofessional learning; teamwork PMID:11700379

  9. The glycemic index.

    PubMed

    Wolever, T M

    1990-01-01

    Different starchy foods produce different glycemic responses when fed individually, and there is evidence that this also applies in the context of the mixed meal. Methods of processing, and other factors unrelated to the nutrient composition of foods may also have major effects on the glycemic response. The reason for differences in glycemic response appears to relate to the rate at which the foods are digested and the many factors influencing this. The glycemic index (GI) is a system of classification in which the glycemic responses of foods are indexed against a standard (white bread). This allows the results of different investigators to be pooled. GI values also depend upon a number of nonfood-related variables. The method of calculation of the glycemic response area is most important, but the method of blood sampling and length of time of studies also may have effects. Variability of glycemic responses arises from day-to-day variation in the same subject and variation between different subjects. There is less variability between the GI values of different subjects than there is within the same subject from day to day. Therefore, the mean GI values of foods are independent of the glucose tolerance status of the subjects being tested. Potentially clinically useful starchy foods producing relatively flat glycemic responses have been identified, including legumes, pasta, barley, bulgur, parboiled rice and whole grain breads such as pumpernickel. Specific incorporation of these foods into diets have been associated with reduced blood glucose, insulin, and lipid levels. Low-GI foods may influence amino acid metabolism although the implications of these are unknown. In addition, low GI foods increase colonic fermentation. The physiologic and metabolic implications of this relate to increased bacterial urea utilization, and to the production and absorption of short chain fatty acids in the colon. The application of the GI to therapeutic diets should be in the context

  10. Glycemic variability: Clinical implications

    PubMed Central

    Satya Krishna, Surabhi Venkata; Kota, Sunil K.; Modi, Kirtikumar D.

    2013-01-01

    Glycemic control and its benefits in preventing microvascular diabetic complications are convincingly proved by various prospective trials. Diabetes control and complications trial (DCCT) had reported variable glycated hemoglobin (HbA1C) as a cause of increased microvascular complications in conventional glycemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved. Glycemic variability (GV) is one more tool to explain relation between hyperglycemia and increased cardiovascular risk in diabetic patients. In fact GV along with fasting blood sugar, postprandial blood sugar, HbA1C, and quality of life has been proposed to form glycemic pentad, which needs to be considered in diabetes management. Postprandial spikes in blood glucose as well as hypoglycemic events, both are blamed for increased cardiovascular events in Type 2 diabetics. GV includes both these events and hence minimizing GV can prevent future cardiovascular events. Modern diabetes management modalities including improved sulfonylureas, glucagon like peptide-1 (GLP-1)-based therapy, newer basal insulins, and modern insulin pumps address the issue of GV effectively. This article highlights mechanism, clinical implications, and measures to control GV in clinical practice. PMID:23961476

  11. Glycemic index, glycemic load and childhood obesity: A systematic review

    PubMed Central

    Rouhani, Mohammad Hossein; Kelishadi, Roya; Hashemipour, Mahin; Esmaillzadeh, Ahmad; Azadbakht, Leila

    2014-01-01

    Background: Several evidences have been reported so far in terms of the relationship between obesity and glycemic index and glycemic load in children. However, the number of review studies that have dealt with recent findings is quite low. The purpose of present study is to review the existing evidences in this regard. Materials and Methods: First of all, the phrases: “Glycaemic index”, “Glycaemic load”, “Glycemic index” OR “Glycemic load” accompanied by one of the words: “Adolescent”, “Young”, “Youth” “Children” OR “Child” were searched in texts of articles existing in ISI and PUBMED databases which were obtained out of 1001 articles. Among these, some articles, which reviewed the relationship of obesity with glycemic index and glycemic load, were selected. Finally, 20 articles were studied in current review study. Results: The majority of cross-sectional studies have found children's obesity directly linked with glycemic index and glycemic load; however, cohort studies found controversial results. Also, the intervention studies indicate the negative effect of glycemic index and glycemic load on obesity in children. Conclusion: Published evidences reported inconsistent results. It seems that existing studies are not sufficient and more studies are needed in this regard. PMID:24627855

  12. Goodness of fit in the home: its relationship to school behavior and achievement in children with learning disabilities.

    PubMed

    Feagans, L V; Merriwether, A M; Haldane, D

    1991-01-01

    This study examined whether a "goodness of fit" theoretical model, applied to families with and without children with learning disabilities, would be valuable in understanding the children's performance in school. A home interview was conducted with 63 families with a child with learning disabilities and 53 families with a comparable child without learning disabilities. The mothers were asked to rate how their own child fit into the family's expectations for children. It was found that, for both groups of families, children who were rated as a "poor fit" in the home demonstrated less positive behavior in the classroom and poorer achievement over the elementary school years. There was some evidence that poor fit in the home was even more negatively related to outcomes for children with learning disabilities. Discussion is centered on the importance of this theoretical model for understanding the importance of the home on successful school function.

  13. Health physics manual of good practices for reducing radiation exposure to levels that are as low as reasonably achievable (ALARA)

    SciTech Connect

    Herrington, W.N.; Higby, D.P.; Kathren,., R.L.; Merwin, S.E.; Stoetzel, G.A.

    1988-06-01

    A primary objective of the US Department of Energy (DOE) health physics and radiation protection program has been to limit radiation exposures to those levels that are as low as reasonably achievable (ALARA). As a result, the ALARA concept developed into a program and a set of operational principles to ensure that the objective was consistently met. Implementation of these principles required that a guide be produced. The original ALARA guide was issued by DOE in 1980 to promote improved understanding of ALARA concepts within the DOE community and to assist those responsible for operational ALARA activities in attaining their goals. Since 1980, additional guidance has been published by national and international organizations to provide further definition and clarification to ALARA concepts. As basic ALARA experience increased, the value and role of the original guide prompted the DOE Office of Nuclear Safety (ONS) to support a current revision. The revised manual of good practices includes six sections: 1.0 Introduction, 2.0 Administration, 3.0 Optimization, 4.0 Setting and Evaluating ALARA Goals, 5.0 Radiological Design, and 6.0 Conduct of Operations. The manual is directed primarily to contractor and DOE staff who are responsible for conduct and overview of radiation protection and ALARA programs at DOE facilities. The intent is to provide sufficient guidance such that the manual, if followed, will ensure that radiation exposures are maintained as low as reasonably achievable and will establish the basis for a formally structured and auditable program. 118 refs., 16 figs., 3 tabs.

  14. Early glycemic control in critically ill patients with burn injury.

    PubMed

    Murphy, Claire V; Coffey, Rebecca; Cook, Charles H; Gerlach, Anthony T; Miller, Sidney F

    2011-01-01

    Glucose management in patients with burn injury is often difficult because of their hypermetabolic state with associated hyperglycemia, hyperinsulinemia, and insulin resistance. Recent studies suggest that time to glycemic control is associated with improved outcomes. The authors sought to determine the influence of early glycemic control on the outcomes of critically ill patients with burn injury. A retrospective analysis was performed at the Ohio State University Medical Center. Patients hospitalized with burn injury were enrolled if they were admitted to the intensive care unit between March 1, 2006, and February 28, 2009. Early glycemic control was defined as the achievement of a mean daily blood glucose of ≤150 mg/dl for at least two consecutive days by postburn day 3. Forty-six patients made up the study cohort with 26 achieving early glycemic control and 20 who did not. The two groups were similar at baseline with regard to age, pre-existing diabetes, APACHE II score and burn size and depth. There were no differences in number of surgical interventions, infectious complications, or length of stay between patients who achieved or failed early glycemic control. Failure of early glycemic control was, however, associated with significantly higher mortality both by univariate (35.0 vs 7.7%, P = .03) and multivariate analyses (hazard ratio 6.754 [1.16-39.24], P = .03) adjusting for age, TBSA, and inhalation injury. Failure to achieve early glycemic control in patients with burn injury is associated with an increased risk of mortality. However, further prospective controlled trials are needed to establish causality of this association.

  15. Is the Study Process Questionnaire (SPQ) a Good Predictor of Academic Achievement? Examining the Mediating Role of Achievement-Related Classroom Behaviours

    ERIC Educational Resources Information Center

    Choy, Jeanette Lyn Fung; O'Grady, Glen; Rotgans, Jerome I.

    2012-01-01

    Studies have shown that the Study Process Questionnaire (SPQ)--which provides a measure of student approaches to learning--is a relatively weak predictor of academic achievement. The present study sought to explore whether students' achievement-related classroom behaviours, as observed by teachers, can be used as a mediator between student…

  16. Is Early Ability Grouping Good for High-Achieving Students' Psychosocial Development? Effects of the Transition into Academically Selective Schools

    ERIC Educational Resources Information Center

    Becker, Michael; Neumann, Marko; Tetzner, Julia; Böse, Susanne; Knoppick, Henrike; Maaz, Kai; Baumert, Jürgen; Lehmann, Rainer

    2014-01-01

    The present study investigates school context effects on psychosocial characteristics (academic self-concept, peer relations, school satisfaction, and school anxiety) of high-achieving and gifted students. Students who did or did not make an early transition from elementary to secondary schools for high-achieving and gifted students in 5th grade…

  17. What Makes a Good Student? How Emotions, Self-Regulated Learning, and Motivation Contribute to Academic Achievement

    ERIC Educational Resources Information Center

    Mega, Carolina; Ronconi, Lucia; De Beni, Rossana

    2014-01-01

    The authors propose a theoretical model linking emotions, self-regulated learning, and motivation to academic achievement. This model was tested with 5,805 undergraduate students. They completed the Self-Regulated Learning, Emotions, and Motivation Computerized Battery (LEM-B) composed of 3 self-report questionnaires: the Self-Regulated Learning…

  18. It Feels Good to Learn Where I Belong: School Belonging, Academic Emotions, and Academic Achievement in Adolescents

    ERIC Educational Resources Information Center

    Lam, Un Fong; Chen, Wei-Wen; Zhang, Jingqi; Liang, Ting

    2015-01-01

    This study examined the relationships between school belonging, academic emotions, and academic achievement in Macau adolescents. A survey of 406 junior high school students in Macau was used to collect information on the extent to which these students felt accepted and respected in their schools (school belonging), the emotions they experienced…

  19. Life Satisfaction among Highly Achieving Students in Hong Kong: Do Gratitude and the "Good-Enough Mindset" Add to the Contribution of Perfectionism in Prediction?

    ERIC Educational Resources Information Center

    Chan, David W.

    2012-01-01

    This study investigated whether gratitude and the "good-enough mindset" added to the contribution of perfectionism in predicting life satisfaction in 245 Chinese highly achieving students in Hong Kong. Participants completed self-report questionnaires that included scales on life satisfaction, positive and negative perfectionism…

  20. The glycemic index: physiological significance.

    PubMed

    Esfahani, Amin; Wong, Julia M W; Mirrahimi, Arash; Srichaikul, Korbua; Jenkins, David J A; Kendall, Cyril W C

    2009-08-01

    The glycemic index (GI) is a physiological assessment of a food's carbohydrate content through its effect on postprandial blood glucose concentrations. Evidence from trials and observational studies suggests that this physiological classification may have relevance to those chronic Western diseases associated with overconsumption and inactivity leading to central obesity and insulin resistance. The glycemic index classification of foods has been used as a tool to assess potential prevention and treatment strategies for diseases where glycemic control is of importance, such as diabetes. Low GI diets have also been reported to improve the serum lipid profile, reduce C-reactive protein (CRP) concentrations, and aid in weight control. In cross-sectional studies, low GI or glycemic load diets (mean GI multiplied by total carbohydrate) have been associated with higher levels of high-density lipoprotein cholesterol (HDL-C), with reduced CRP concentrations, and, in cohort studies, with decreased risk of developing diabetes and cardiovascular disease. In addition, some case-control and cohort studies have found positive associations between dietary GI and risk of various cancers, including those of the colon, breast, and prostate. Although inconsistencies in the current findings still need to be resolved, sufficient positive evidence, especially with respect to renewed interest in postprandial events, suggests that the glycemic index may have a role to play in the treatment and prevention of chronic diseases.

  1. Beyond good intentions: The role of proactive coping in achieving sustained behavioural change in the context of diabetes management.

    PubMed

    Thoolen, Bart Johan; de Ridder, Denise; Bensing, Jozien; Gorter, Kees; Rutten, Guy

    2009-03-01

    This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions.

  2. [Indicators of glycemic control --hemoglobin A1c (HbA1c), glycated albumin (GA), and 1,5-anhydroglucitol (1,5-AG)].

    PubMed

    Sato, Asako

    2014-01-01

    The clinical goal of diabetes management is a good quality of life that is not different from that of a healthy subjects. To fulfill the goal, prevention of complications is needed under good glycemic control. Although blood glucose measurement is essential for glycemic control, there are diurnal variations in blood glucose levels. An indicator of long-term glycemic control is necessary. HbA1c is the gold standard measurement for the assessment of glycemic control, and worldwide large scale clinical studies of diabetes complications have greatly valued HbA1c as an indicator of glycemic control. In addition, recently, HbA1c was recommended for use in the diagnosis of diabetes in Japan and in the United States. Although HbA1c is used widely and internationally, international standardization of the HbA1c value has not been achieved. In Japan, from April 2014, it has been decided to adopt the National Glycohemoglobin Standardization Program (NGSP) value, which is used by many countries globally, as the first step toward internationalization. Recently, cardiovascular disease in diabetic patients has been increasing in Japan. Relationships between postprandial hyperglycemia and cardiovascular disease have been noted. Therefore, the correction of postprandial hyperglycemia is one of the important goals of glycemic control to prevent cardiovascular disease. HbA1c or glycated albumin (GA) results from the glycation of hemoglobin or serum albumin and represents 2-month or 2-week glycemia, respectively. In addition, the glycation speed of GA is ten times faster than HbA1c, so GA is likely to reflect the variation in blood glucose and postprandial hyperglycemia in combination with HbA1c and its value. 1,5-anhydroglucitol (AG) is a marker of glycemia-induced glycosuria, since reabsorption of filtered 1,5-AG in the proximal tubule is competitively inhibited by glucose. It is an indicator to identify rapid changes in hyperglycemia. Understanding the characteristics of the

  3. Reply #1 to: Glycemic Choreoballism

    PubMed Central

    Cosentino, Carlos; Torres, Luis; Nuñez, Yesenia; Suarez, Rafael; Velez, Miriam; Flores, Martha

    2016-01-01

    In Response To: Lee D, Ahn TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QJ7HNF Original Article: Cosentino C, Torres L, Nuñez Y, et al. Hemichorea/hemiballism associated with hyperglycemia: report of twenty cases. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8DN454P PMID:28071768

  4. Reply #1 to: Glycemic Choreoballism.

    PubMed

    Cosentino, Carlos; Torres, Luis; Nuñez, Yesenia; Suarez, Rafael; Velez, Miriam; Flores, Martha

    2016-01-01

    In Response To: Lee D, Ahn TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QJ7HNF Original Article: Cosentino C, Torres L, Nuñez Y, et al. Hemichorea/hemiballism associated with hyperglycemia: report of twenty cases. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8DN454P.

  5. The glycemic index: methodology and use.

    PubMed

    Kendall, Cyril W C; Augustin, Livia S A; Emam, Azadeh; Josse, Andrea R; Saxena, Nishta; Jenkins, David J A

    2006-01-01

    The glycemic index concept owes much to the dietary fiber hypothesis that fiber would reduce the rate of nutrient absorption and increase the value of carbohydrate foods in the maintenance of health and treatment of disease. However, properties and components of food other than its fiber content contribute to the glycemic and endocrine responses postprandially. The aim of the glycemic index classification of foods was therefore to assist in the physiological classification of carbohydrate foods which, it was hoped, would be of relevance in the prevention and treatment of chronic diseases such as diabetes. Over the past two decades low glycemic index diets have been reported to improve glycemic control in diabetic subjects, to reduce serum lipids in hyperlipidemic subjects and possibly to aid in weight control. In large cohort studies, low glycemic index or glycemic load diets (glycemic index multiplied by total carbohydrate) have also been associated with higher levels of high-density lipoprotein cholesterol, reduced C-reactive protein concentrations and with a decreased risk of developing diabetes and cardiovascular disease. More recently, some case-control and cohort studies have also found positive associations between the dietary glycemic index and the risk of colon, breast and other cancers. While the glycemic index concept continues to be debated and there remain inconsistencies in the data, sufficient positive findings have emerged to suggest that the glycemic index is an aspect of diet of potential importance in the treatment and prevention of chronic diseases.

  6. Relationship between vitamin D and glycemic control in patients with type 2 diabetes mellitus.

    PubMed

    Olt, Serdar

    2015-01-01

    Herein I investigated the impact of vitamin D on glycemic control in patients with type 2 diabetes mellitus. 128 patients with type 2 diabetes mellitus were enrolled in this study (mean (S.D) age: 57.7±10 years, 26.6% were female). It was collected clinical and laboratory characteristics of patients from hospital records retrospectively. Patients were divided into two groups according to the HBA1c values: good glycemic control (HbA1c≤7%) and poor glycemic control (HbA1c>7%). It was compared 25 hydroxyvitamin (OH) D and other collected laboratory parameters between the two groups. The vitamin D deficiency rate was 98.3%. In the result with ROC curve analyzes and Mann Whitney U test vitamin D was'nt significantly associated with glycemic control (P value >0.05). Among other parameters result with ROC curve analyzes and student t test RDW-CV was found to be significantly associated with glycemic control (P value <0.05). Although high level of vitamin D deficiency, present study indicated that vitamin D was'nt significantly related to glycemic control in type 2 diyabetes mellitus. Even so RDW-CV was significantly related to glycemic control.

  7. Towards a ‘Good Life’ for Farm Animals: Development of a Resource Tier Framework to Achieve Positive Welfare for Laying Hens

    PubMed Central

    Edgar, Joanne L.; Mullan, Siobhan M.; Pritchard, Joy C.; McFarlane, Una J. C.; Main, David C. J.

    2013-01-01

    Simple Summary Farm animals can be said to have a ‘good life’ if their quality of life is substantially higher than the current legal minimum and includes positive experiences such as pleasure. In commercial farms, animals can be provided with different resources such as bedding, exercise areas and enrichment objects. We used scientific evidence and expert opinion to determine which resources laying hens need to contribute to a ‘good life’. These resources were organised into three tiers, of increasing welfare, leading towards a ‘good life’. We describe how we developed the resource tiers and suggest how the overall framework might be used to promote a ‘good life’ for farm animals. Abstract The concept of a ‘good life’ recognises the distinction that an animal’s quality of life is beyond that of a ‘life worth living’, representing a standard of welfare substantially higher than the legal minimum (FAWC, 2009). We propose that the opportunities required for a ‘good life’ could be used to structure resource tiers that lead to positive welfare and are compatible with higher welfare farm assurance schemes. Published evidence and expert opinion was used to define three tiers of resource provision (Welfare +, Welfare ++ and Welfare +++) above those stipulated in UK legislation and codes of practice, which should lead to positive welfare outcomes. In this paper we describe the principles underpinning the framework and the process of developing the resource tiers for laying hens. In doing so, we summarise expert opinion on resources required to achieve a ‘good life’ in laying hens and discuss the philosophical and practical challenges of developing the framework. We present the results of a pilot study to establish the validity, reliability and feasibility of the draft laying hen tiers on laying hen production systems. Finally, we propose a generic welfare assessment framework for farm animals and suggest directions for implementation

  8. Impact of hyperbaric oxygen on diabetic ulcers is unaffected by glycemic control.

    PubMed

    Bakhtiani, Parkash; Bahktiani, Parkash; Mansuri, Owaise; Yadav, Abhijeet; Osuoha, Chima; Knight, Patty; Baynosa, Richard; McLafferty, Robert; Jakoby, Michael

    2015-01-01

    Hyperbaric oxygen (HBO2) therapy is an established intervention for treating chronic diabetic lower extremity ulcers, but the impact of glycemic control on its efficacy has not been determined. The purpose of this study was to evaluate the impact of blood glucose control at initiation of HBO2 treatment on wound healing. Hemoglobin A1c (HbA1c) was measured at start of HBO2 therapy for 22 patients undergoing treatment of chronic lower extremity ulcers at two regional wound care centers. Patients with HbA1c < 7.5% were stratified into a "good glycemic control" group (n = 12, mean HbA1c 6.5 ± 0.8%), and patients with HbA1c ≥ 7.5% were stratified into a "poor glycemic control" group (n = 10, mean HbA1c 8.8 ± 1.4%, p = 0.004 compared to "good glycemic control group"). After 20 HBO2 sessions over 30 days in addition to standard wound care interventions, there was no difference in wound healing between the two glycemic control groups as indicated by. reduction from baseline in ulcer surface area, depth, or volume. The diabetic lower extremity wound response to HBO2 therapy is unaffected by glycemic control prior to treatment, and HBO2 treatment should not be delayed for suboptimal blood glucose control.

  9. Glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with renal complications

    PubMed Central

    Huri, Hasniza Zaman; Lim, Lay Peng; Lim, Soo Kun

    2015-01-01

    Background Good glycemic control can delay the progression of kidney diseases in type 2 diabetes mellitus (T2DM) patients with renal complications. To date, the association between antidiabetic agents and glycemic control in this specific patient population is not well established. Purpose This study aimed to identify antidiabetic regimens as well as other factors that associated with glycemic control in T2DM patients with different stages of chronic kidney disease (CKD). Patients and methods This retrospective, cross-sectional study involved 242 T2DM inpatients and outpatients with renal complications from January 2009 to March 2014 and was conducted in a tertiary teaching hospital in Malaysia. Glycated hemoglobin (A1C) was used as main parameter to assess patients’ glycemic status. Patients were classified to have good (A1C <7%) or poor glycemic control (A1C ≥7%) based on the recommendations of the American Diabetes Association. Results Majority of the patients presented with CKD stage 4 (43.4%). Approximately 55.4% of patients were categorized to have poor glycemic control. Insulin (57.9%) was the most commonly prescribed antidiabetic medication, followed by sulfonylureas (43%). Of all antidiabetic regimens, sulfonylureas monotherapy (P<0.001), insulin therapy (P=0.005), and combination of biguanides with insulin (P=0.038) were found to be significantly associated with glycemic control. Other factors including duration of T2DM (P=0.004), comorbidities such as anemia (P=0.024) and retinopathy (P=0.033), concurrent medications such as erythropoietin therapy (P=0.047), α-blockers (P=0.033), and antigouts (P=0.003) were also correlated with A1C. Conclusion Identification of factors that are associated with glycemic control is important to help in optimization of glucose control in T2DM patients with renal complication. PMID:26300627

  10. Evaluation of glycemic control in patients with type 2 diabetes mellitus in Chinese communities: a cross-sectional study.

    PubMed

    Shan, Shan; Gu, Liubao; Lou, Qinglin; Ouyang, Xiaojun; Yu, Yun; Wu, Haidi; Bian, Rongwen

    2017-02-01

    This study aimed to evaluate the glycemic levels in Chinese patients with type 2 diabetes mellitus (T2DM) and to explore the factors related to the results of glycemic control. A total of 2454 T2DM patients from 11 communities were examined for glycosylated hemoglobin levels and glycemic control options. Potential factors related to the results of glycemic control were analyzed using logistic regression. Of all the patients, 55.3 % achieved the glycemic control target of HbA1c < 7 %. Multivariate analysis showed that male sex (OR 1.345, 95 % CI 1.022-1.769; P = 0.034), higher levels of fasting blood glucose (OR 1.954, 95 % CI 1.778-2.147; P < 0.001), and low-density lipoprotein cholesterol (OR 1.181, 95 % CI 1.020-1.367; P = 0.026) were significantly associated with poor glycemic control. The complexity of antidiabetics was also associated with poor glycemic control (P < 0.05). Compared to diet and exercise, insulin injection was most strongly associated with poor glycemic control (OR 6.210, 95 % CI 4.054-9.514; P < 0.001). Male patients with higher levels of total cholesterol, lower levels of high-density lipoprotein cholesterol, or longer diabetic durations showed poor glycemic control, which was not found in female patients. Glycemic control was not satisfactory in T2DM patients of Nanjing communities. Various factors are associated with poor results of glycemic control.

  11. Glycemic Targets in Diabetes Care: Emerging Clarity after Accord

    PubMed Central

    Buse, John B.

    2015-01-01

    Through the 1990s convincing evidence emerged from studies involving relatively recent onset diabetes that glycemic control achieving glycated hemoglobin A1c levels of approximately 7% was associated with improved microvascular outcomes. Based on advocacy groups' statements encouraging lower targets and recognition of cardiovascular disease as the leading cause of death in diabetes, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was funded in 1999 to explore more intensive targets and techniques in the treatment of type 2 diabetes. Most surprisingly, intensive management targeting normal levels of glycemia was associated with increased mortality and the ACCORD trial was terminated early in 2008. Post hoc analyses have allowed the emergence of some clarity around the role of glycemic management and targets in diabetes care and are the subject of this review. PMID:26330660

  12. Decreased Sperm Motility Retarded ICSI Fertilization Rate in Severe Oligozoospermia but Good-Quality Embryo Transfer Had Achieved the Prospective Clinical Outcomes

    PubMed Central

    Zheng, Jufeng; Lu, Yongning; Qu, Xianqin; Wang, Peng; Zhao, Luiwen; Gao, Minzhi; Shi, Huijuan; Jin, Xingliang

    2016-01-01

    . Overall rates in all groups were 41.26% clinical pregnancy, 25.74% implantation and 36.32% live birth, which gave live birth to 252 girls and 252 boys. Conclusions The reduction of motile spermatozoa in severe oligozoospermia decreased the rates of fertilization and good-quality embryo. Obtaining and transfer of good-quality embryos was the good prognostic to achieve prospective clinical outcomes regardless of the severity of oligozoospermia. PMID:27661081

  13. Effect of current glycemic control on qualitative body composition in sedentary ambulatory Type 2 diabetics

    PubMed Central

    Solanki, Jayesh Dalpatbhai; Makwana, Amit H.; Mehta, Hemant B.; Kamdar, Panna; Gokhale, Pradnya A.; Shah, Chinmay J.

    2016-01-01

    Background: Obesity and Type 2 diabetes mellitus are on rise with cause–effect relationship. Diabetics monitor blood sugar, neglecting qualitative body composition, leaving residual threat of ectopic fat unattended. We tried to correlate glycemic triad with parameters of body composition derived objectively by bioelectrical impedance analysis (BIA). Materials and Methods: A sample of 78 under treatment sedentary Type 2 diabetics of either sex with known glycemic and lipidemic control from our city. Following baseline assessment measurement was done by instrument Omron Karada Scan (Model HBF-510, China) using the principle of tetra poplar BIA to derive parameters of body composition. We tried to correlate glycemic triad with these parameters, both directly as well as after defining them as per established cutoff norms. Results: We found poor glycemic control in the study group (20% for Hb1AC), high body mass index, subcutaneous fat, visceral fat (VF), total body fat (TBF), and lesser mass of skeletal muscle in Type 2 diabetics. However, there were small, insignificant, and inconsistent difference of these parameters while directly correlating with the fasting blood sugar, postprandial blood sugar, and glycosylated hemoglobin. On qualitative assessment, the impact of glycemic control as per standard norms, the risk of high VF, high TBF, low skeletal muscle mass was though high (between 1 and 2) in Type 2 diabetics with poor glycemic control as compared to good glycemics, but each strength lacks statistical significance. Conclusion: BIA reveals that Type 2 diabetics have more ectopic fat on expense of skeletal muscle that do not correlate with current glycemic status, both quantitatively and qualitatively. Measurement of body composition can be included and subjects can be motivated for lifestyle modification strategies while managing metabolic derangements of Type 2 diabetes. PMID:27185972

  14. Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru

    PubMed Central

    Crispín‐Trebejo, Brenda; Bernabé‐Ortiz, Antonio

    2015-01-01

    Abstract Introduction There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Methods Cross‐sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: < 7% versus ≥ 7%), whereas the exposure of interest was depression defined as 15 or more points in the Patient Health Questionnaire‐9 tool. The association of interest was evaluated using Poisson regression models with robust standard errors reporting prevalence ratios (PR) and 95% confidence intervals (95% CI) adjusting for potential confounders. Results A total of 277 participants, 184 (66.4%) males, mean age 59.0 (SD: 4.8), and 7.1 (SD: 6.8) years of disease were analyzed. Only 31 participants (11.2%; 95% CI: 7.5%–14.9%) had moderately severe or severe depression, whereas 70 (25.3%; 95% CI 20.3%–30.8%) had good glycemic control. Depression increased the probability of having poor glycemic control (PR = 1.32; 95% CI 1.15–1.51) after adjusting for several potential confounders. Conclusions There is an association between depression and poor glycemic control among type 2 diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. PMID:26037488

  15. Glycemic index and heart disease.

    PubMed

    Leeds, Anthony R

    2002-07-01

    A diet high in carbohydrates with high glycemic indexes (GI) and glycemic load were linked to risk of coronary heart disease development in women in a large prospective study. Two cross-sectional studies showed that low-GI diets are associated with high HDL-cholesterol concentrations, especially in women. In a tightly controlled study of patients with type 2 diabetes, serum total cholesterol, LDL cholesterol, and apolipoprotein B concentrations fell more significantly after a low-GI diet than after a high-GI diet. In the same study, plasminogen activator inhibitor-1 concentrations were reduced by 58% after the low-GI diet. Insulin-stimulated glucose uptake by adipocytes was significantly higher in patients undergoing coronary artery bypass graft surgery after 4 wk of consuming a low-GI diet than after consuming a high-GI diet. The effects of low-GI diets may be mediated by changes in postprandial fatty acid concentrations or by hormonal signals from adipocytes, but a possible association of low-GI diets with some other dietary factor such as chromium must not be excluded. Proof of the clinical value of low-GI diets awaits prospective trials, which should include short-term observations covering periods of metabolic stress induced by surgery as well as long-term trials with clinical endpoints.

  16. A Mixed Methods Study Exploring the Factors and Behaviors That Affect Glycemic Control Following a Structured Education Program: The Irish DAFNE Study

    ERIC Educational Resources Information Center

    Casey, Dympna; O'Hara, Mary Clare; Meehan, Ben; Byrne, Molly; Dinneen, Sean F.; Murphy, Kathy

    2016-01-01

    Aim: To explain the factors affecting glycemic control (measured by HbA1c) following the Dose Adjustment for Normal Eating (DAFNE) program. Background: DAFNE is a structured education program designed to assist persons with type 1 diabetes mellitus achieve optimal glycemic control. However, not all participants reach this goal. Few studies…

  17. A review of glycemic efficacy of liraglutide once daily in achieving glycated hemoglobin targets compared with exenatide twice daily, or sitagliptin once daily in the treatment of type 2 diabetes

    PubMed Central

    Alshali, Khalid Z.; Karawagh, Abdullah M.

    2016-01-01

    Incretin-based therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists (RA) and dipeptidyl peptidase-4 (DPP-4) inhibitors have gained prominence in recent years for the treatment of type 2 diabetes (T2D). Such therapies offer the potential to stimulate endogenous insulin activity in proportion to circulating glucose levels; thereby, lowering the risk of hypoglycemic episodes. The synthetic GLP-1 RA exenatide, the human GLP-1 RA liraglutide, and the DPP-4 inhibitor sitagliptin are the first agents in their respective classes to be approved for the treatment of T2D and their efficacy and safety has been studied extensively in clinical trials. This article reviewed the efficacy of liraglutide once daily in achieving clinical guidelines-recommended glycated hemoglobin A1c levels in patients with T2D compared with exenatide twice daily, or sitagliptin once daily, based on published literature, with an aim to elucidate the preferred choice of incretin-related therapy in treating uncontrolled T2D. PMID:27464858

  18. Relation of Dietary Glycemic Index and Glycemic Load to Coronary Artery Calcium in Asymptomatic Korean Adults.

    PubMed

    Choi, Yuni; Chang, Yoosoo; Ryu, Seungho; Cho, Juhee; Kim, Mi Kyung; Ahn, Younjhin; Lee, Jung Eun; Sung, Eunju; Kim, Boyoung; Ahn, Jiin; Kim, Chan-Won; Rampal, Sanjay; Zhao, Di; Zhang, Yiyi; Pastor-Barriuso, Roberto; Lima, Joao A C; Chung, Eun Chul; Shin, Hocheol; Guallar, Eliseo

    2015-08-15

    The relation between glycemic index, glycemic load, and subclinical coronary atherosclerosis is unknown. The aim of the study was to evaluate the associations between energy-adjusted glycemic index, glycemic load, and coronary artery calcium (CAC). This study was cross-sectional analysis of 28,429 asymptomatic Korean men and women (mean age 41.4 years) without a history of diabetes or cardiovascular disease. All participants underwent a health screening examination between March 2011 and April 2013, and dietary intake over the preceding year was estimated using a validated food frequency questionnaire. Cardiac computed tomography was used for CAC scoring. The prevalence of detectable CAC (CAC score >0) was 12.4%. In multivariable-adjusted models, the CAC score ratios (95% confidence intervals) comparing the highest to the lowest quintile of glycemic index and glycemic load were 1.74 (1.08 to 2.81; p trend = 0.03) and 3.04 (1.43 to 6.46; p trend = 0.005), respectively. These associations did not differ by clinical subgroups, including the participants at low cardiovascular risk. In conclusion, these findings suggest that high dietary glycemic index and glycemic load were associated with a greater prevalence and degree of CAC, with glycemic load having a stronger association.

  19. Nutrition Support Team-Led Glycemic Control Program for Critically Ill Patients.

    PubMed

    Dickerson, Roland N; Maish, George O; Minard, Gayle; Brown, Rex O

    2014-08-01

    Glycemic control is an important component of the metabolic management of the critically ill patient. Nutrition support teams are frequently challenged by complicated patients who exhibit multiple concurrent etiologies for hyperglycemia. Nutrition support teams can serve in a pivotal role in the development and evaluation of safe and effective techniques for achieving glycemic control. This review describes the efforts of a nutrition support team in achieving safe and effective glycemic control at their institution. Identification of target blood glucose concentration range, development, initiation, monitoring of a continuous intravenous insulin infusion algorithm, nursing adherence to the algorithm, modification of the algorithm based on the presence of conditions that alter insulin metabolism and glucose homeostasis, and transition of the patient who receives continuous enteral nutrition from a continuous intravenous insulin infusion to intermittent subcutaneous insulin therapy are discussed.

  20. Accuracy of Continuous Glucose Monitoring Measurements in Normo-Glycemic Individuals

    PubMed Central

    Akintola, Abimbola A.; Noordam, Raymond; Jansen, Steffy W.; de Craen, Anton J.; Ballieux, Bart E.; Cobbaert, Christa M.; Mooijaart, Simon P.; Pijl, Hanno; Westendorp, Rudi G.; van Heemst, Diana

    2015-01-01

    Background The validity of continuous glucose monitoring (CGM) is well established in diabetic patients. CGM is also increasingly used for research purposes in normo-glycemic individuals, but the CGM validity in such individuals is unknown. We studied the accuracy of CGM measurements in normo-glycemic individuals by comparing CGM-derived versus venous blood-derived glucose levels and measures of glycemia and glycemic variability. Methods In 34 healthy participants (mean age 65.7 years), glucose was simultaneously measured every 10 minutes, via both an Enlite® CGM sensor, and in venous blood sampled over a 24-hour period. Validity of CGM-derived individual glucose measurements, calculated measures of glycemia over daytime (09:00h-23:00h) and nighttime (23:00h-09:00h), and calculated measures of glycemic variability (e.g. 24h standard deviation [SD]) were assessed by Pearson correlation coefficients, mean absolute relative difference (MARD) and paired t-tests. Results The median correlation coefficient between CGM and venous glucose measurements per participant was 0.68 (interquartile range: 0.40–0.78), and the MARD was 17.6% (SD = 17%). Compared with venous sampling, the calculated measure of glycemia during daytime was 0.22 mmol/L higher when derived from CGM, but no difference was observed during nighttime. Most measures of glycemic variability were lower with CGM than with venous blood sampling (e.g., 24h SD: 1.07 with CGM and 1.26 with venous blood; p-value = 0.004). Conclusion In normo-glycemic individuals, CGM-derived glucose measurements had good agreement with venous glucose levels. However, the measure of glycemia was higher during the day and most measures of glycemic variability were lower when derived from CGM. PMID:26445499

  1. Pilot Study of the SPRINT Glycemic Control Protocol in a Hungarian Medical Intensive Care Unit

    PubMed Central

    Benyo, Balazs; Illyés, Attila; Némedi, Noémi Szabó; Le Compte, Aaron J.; Havas, Attila; Kovacs, Levente; Fisk, Liam; Shaw, Geoffrey M.; Chase, J. Geoffrey

    2012-01-01

    Introduction Stress-induced hyperglycemia increases morbidity and mortality. Tight control can reduce mortality but has proven difficult to achieve. The SPRINT (Specialized Relative Insulin and Nutrition Tables) protocol is the only protocol that reduced both mortality and hypoglycemia by modulating both insulin and nutrition, but it has not been tested in independent hospitals. Methods SPRINT was used for 12 adult intensive care unit patients (949 h) at Kálmán Pándy Hospital (Gyula, Hungary) as a clinical practice assessment. Insulin recommendations (0–6 U/h) were administered via constant infusion rather than bolus delivery. Nutrition was administered per local standard protocol, weaning parenteral to enteral nutrition, but was modulated per SPRINT recommendations. Measurement was every 1 to 2 h, per protocol. Glycemic performance is assessed by percentage of blood glucose (BG) measurements in glycemic bands for the cohort and per patient. Safety from hypoglycemia is assessed by numbers of patients with BG < 2.2 (severe) and %BG < 3.0 and < 4.0 mmol/liter (moderate and light). Clinical effort is assessed by measurements per day. Results are median (interquartile range). Results There were 742 measurements over 1088 h of control (16.4 measurements/day), which is similar to clinical SPRINT results (16.2/day). Per-patient hours of control were 65 (50–95) h. Initial per-patient BG was 10.5 (7.9–11.2) mmol/liter. All patients (100%) reached 6.1 mmol/liter. Cohort BG was 6.3 (5.5–7.5) mmol/liter, with 42.2%, 65.1% and 77.6% of BG in the 4.0–6.1, 4.0–7.0, and 4.0–8.0 mmol/liter bands. Per-patient, median percentage time in these bands was 40.2 (26.7–51.5)%, 62.5 (46.0–75.7)%, and 74.7 (61.6.8–87.8)%, respectively. No patients had BG < 2.2 mmol/liter, and the %BG < 4.0 mmol/liter was 1.9%. These results were achieved using 3.0 (3.0–5.0) U/h of insulin with 7.4 (4.4–10.2) g/h of dextrose administration (all sources) for the cohort. Per

  2. Exploration of functionality of low glycemic impact sugars and polyols using DSC, RVA, and cookie baking

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Consumers' interest in healthy cookies is increasing, including expectations for prebiotic nutritional benefits and low glycemic impact. Plasticization of flour polymers is critical to mixing and baking for baked goods. However, concentrated sugar solutions act as anti-plasticizers compared to wat...

  3. Informing food choices and health outcomes by use of the dietary glycemic index

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Considerable epidemiologic evidence links consuming lower glycemic index (GI) diets with good health, particularly upon aging. The GI is a kinetic parameter that reflects the ability of carbohydrate (CHO) contained in consumed foods to raise blood glucose in vivo. Newer nutritional, clinical, and ex...

  4. Tight glycemic control in the ICU - is the earth flat?

    PubMed

    Steil, Garry M; Agus, Michael S D

    2014-06-27

    Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.

  5. Understanding the Glycemic Index and Glycemic Load and Their Practical Applications

    ERIC Educational Resources Information Center

    Lazarim, Fernanda Lorenzi; Stancanelli, Mirtes; Brenzikofer, Rene; de Macedo, Denise Vaz

    2009-01-01

    We have introduced the study of synthesis pathways using two experiments: 1--the determination of the glycemic index (GI) of some foods and the effects of fiber and fat on the GI; 2--the determination of blood glucose levels after the ingestion of meals with high and low glycemic loads (GL). After a practice assembly, when the foods and meals that…

  6. Oxidative stress and glycemic regulation.

    PubMed

    Ceriello, A

    2000-02-01

    Oxidative stress is an acknowledged pathogenetic mechanism in diabetic complications. Hyperglycemia is a widely known cause of enhanced free radical concentration, whereas oxidative stress involvement in glycemic regulation is still debated. Glucose transport is a cascade of events starting from the interaction of insulin with its own receptor at the plasma membrane and ending with intracellular glucose metabolism. In this complex series of events, each step plays an important role and can be inhibited by a negative effect of oxidative stress. Several studies show that an acute increase in the blood glucose level may impair the physiological homeostasis of many systems in living organisms. The mechanisms through which acute hyperglycemia exerts these effects may be identified in the production of free radicals. It has been suggested that insulin resistance may be accompanied by intracellular production of free radicals. In adipocytes cultured in vitro, insulin increases the production of hydrogen peroxide, which has been shown to mimic the action of insulin. These data allow us to hypothesize that a vicious circle between hyperinsulinemia and free radicals could be operating: insulin resistance might cause elevated plasma free radical concentrations, which, in turn, might be responsible for a deterioration of insulin action, with hyperglycemia being a contributory factor. Data supporting this hypothesis are available. Vitamin E improves insulin action in healthy, elderly, and non-insulin-dependent diabetic subjects. Similar results can be obtained by vitamin C administration.

  7. Alliance for a Healthy Border: factors related to weight reduction and glycemic success.

    PubMed

    Wang, Xiaohui; Ghaddar, Suad; Brown, Cynthia; Pagán, José A; Balboa, Marvelia

    2012-04-01

    We examined the factors related to success in achieving weight reduction and glycemic control in Alliance for a Healthy Border (AHB), a chronic disease prevention program implemented from 2006 to 2009 through 12 federally qualified community health centers serving primarily Hispanics in communities located along the US-Mexico border region. We analyzed data from Phase I of AHB using logistic regression to examine the determinants of success in achieving weight reduction and glycemic control among the participants in AHB programs. Factors affecting weight reduction success were sex, age, employment status, income, insurance, diabetes, baseline body mass index (BMI), smoking status, family history of diabetes, session type, program duration, and physical activity changes. Factors affecting achievement of glycemic success included sex, age, employment status, diabetes, baseline BMI, family history of diabetes, program duration, and physical activity changes. We found that the AHB interventions were more successful in reducing participants' HbA1c level than BMI. In addition to sociodemographic factors, participants with better baseline health conditions (ie, participants without diabetes or family history of diabetes, normal BMI, former smokers) were more likely to achieve success after the interventions. Of the 4 key features defining each of the 12 interventions, session type and program duration were associated with success. Within a relatively short time period, physical activity improvements had a stronger effect on weight reduction and glycemic success than improvements in dietary habits. The effectiveness of diabetes and cardiovascular disease prevention programs can be improved substantially by considering these factors during program design and structure.

  8. Comparison between a novel and conventional artificial pancreas for perioperative glycemic control using a closed-loop system.

    PubMed

    Namikawa, Tsutomu; Munekage, Masaya; Kitagawa, Hiroyuki; Yatabe, Tomoaki; Maeda, Hiromichi; Tsukamoto, Yuuki; Hirano, Kenichi; Asano, Takuji; Kinoshita, Yoshihiko; Hanazaki, Kazuhiro

    2017-03-01

    This clinical study aimed to compare a novel and conventional artificial pancreas (AP) used in surgical patients for perioperative glycemic control, with respect to usability, blood glucose measurements, and glycemic control characteristics. From July in 2010 to March in 2015, 177 patients underwent perioperative glycemic control using a novel AP. Among them, 166 patients were eligible for inclusion in this study. Intensive insulin therapy (IIT) targeting a blood glucose range of 80-110 mg/dL was implemented in 82 patients (49 %), and the remaining 84 patients (51 %) received a less-intensive regime of insulin therapy. Data were collected prospectively and were reviewed or analyzed retrospectively. A comparison study of 324 patients undergoing IIT for glycemic control using a novel (n = 82) or conventional AP (n = 242) was conducted retrospectively. All patients had no hypoglycemia. The comparison study revealed no significant differences in perioperative mean blood glucose level, achievement rates for target blood glucose range, and variability in blood glucose level achieved with IIT between the novel AP and conventional AP groups. The usability, performance with respect to blood glucose measurement, and glycemic control characteristics of IIT were comparable between novel and conventional AP systems. However, the novel AP was easier to manipulate than the conventional AP due to its smaller size, lower weight, and shorter time for preparation. In the near future, this novel AP system might be accepted worldwide as a safe and useful device for use in perioperative glycemic control.

  9. [Glycemic variability and continuous monitoring of glycemia].

    PubMed

    Prázný, Martin; Soupal, Jan

    2014-09-01

    Blood glucose levels are not constant in ther human body even in physiological status. It fluctuates depending on food intake, exercise, psychological and other factors. Normally it fluctuates between 3.9 to 7.5 mmol/l and in fasting in the standard conditions it does not exceed even more narrow range 3.9 to 5.5 mmol/l. Fluctuations are more pronounced in patient with diabetes. Hyperglycemia is a common and basic pathology in diabetes, however, antidiabetic drug often cause hypoglycemia, both increasing the range for glucose fluctuations. The level of glucose fluctuation is called glycemic variability (GV). Glycemic variability is now a favorite target of scientific research in dia-betology. Increased glycemic variability is associated with hypoglycemia, possibly may contribute to chronic dia-betes complications and negatively influences quality of life of diabetic patients. Last but not least, thanks to the new technology of continuous glucose monitoring, we can better describe and measure it. Finally, glycemic variability emerges as a potentially important therapeutical target.Key words: continuous glucose monitoring - glycemic variability - insulin pump - sensor augmented pump.

  10. Good Agreements Make Good Friends

    PubMed Central

    Han, The Anh; Pereira, Luís Moniz; Santos, Francisco C.; Lenaerts, Tom

    2013-01-01

    When starting a new collaborative endeavor, it pays to establish upfront how strongly your partner commits to the common goal and what compensation can be expected in case the collaboration is violated. Diverse examples in biological and social contexts have demonstrated the pervasiveness of making prior agreements on posterior compensations, suggesting that this behavior could have been shaped by natural selection. Here, we analyze the evolutionary relevance of such a commitment strategy and relate it to the costly punishment strategy, where no prior agreements are made. We show that when the cost of arranging a commitment deal lies within certain limits, substantial levels of cooperation can be achieved. Moreover, these levels are higher than that achieved by simple costly punishment, especially when one insists on sharing the arrangement cost. Not only do we show that good agreements make good friends, agreements based on shared costs result in even better outcomes. PMID:24045873

  11. Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia.

    PubMed

    Cryer, Philip E

    2014-07-01

    The selection of a glycemic goal in a person with diabetes is a compromise between the documented upside of glycemic control-the partial prevention or delay of microvascular complications-and the documented downside of glycemic control-the recurrent morbidity and potential mortality of iatrogenic hypoglycemia. The latter is not an issue if glycemic control is accomplished with drugs that do not cause hypoglycemia or with substantial weight loss. However, hypoglycemia becomes an issue if glycemic control is accomplished with a sulfonylurea, a glinide, or insulin, particularly in the setting of absolute endogenous insulin deficiency with loss of the normal decrease in circulating insulin and increase in glucagon secretion and attenuation of the sympathoadrenal response as plasma glucose concentrations fall. Then the selection of a glycemic goal should be linked to the risk of hypoglycemia. A reasonable individualized glycemic goal is the lowest A1C that does not cause severe hypoglycemia and preserves awareness of hypoglycemia, preferably with little or no symptomatic or even asymptomatic hypoglycemia, at a given stage in the evolution of the individual's diabetes.

  12. Incretin therapies: effects beyond glycemic control.

    PubMed

    Mudaliar, Sunder; Henry, Robert R

    2009-07-01

    Impaired insulin secretion plays a major role in the pathogenesis of type 2 diabetes mellitus, and progressive loss of beta-cell function is a pathophysiologic hallmark of type 2 diabetes. Recent science has elaborated on the role of the incretin hormones on beta-cell function and insulin secretion, as well as the role that incretin-based pharmacotherapies may have on glycemic control and beta-cell function, possibly altering the progressive loss of beta-cell function and possibly reversing/halting disease progression. However, incretin-based therapies may also have benefits extending beyond glycemic control and insulin secretion. In this review we examine some of those "beyond-glycemic" benefits, including presentation of data on weight reduction, blood pressure lowering, beneficial changes in the lipid profile, and improvements in myocardial and endothelial function. We investigate how those effects may help ameliorate the cardiovascular burden in patients with diabetes.

  13. Effect of glycemic control on corneal nerves and peripheral neuropathy in streptozotocin-induced diabetic C57Bl/6J mice.

    PubMed

    Yorek, Matthew S; Obrosov, Alexander; Shevalye, Hanna; Lupachyk, Sergey; Harper, Matthew M; Kardon, Randy H; Yorek, Mark A

    2014-09-01

    We sought to determine the impact that duration of hyperglycemia and control has on corneal nerve fiber density in relation to standard diabetic neuropathy endpoints. Control and streptozotocin-diabetic C57Bl/6J mice were analyzed after 4, 8, 12, and 20 weeks. For the 20-week time point, five groups of mice were compared: control, untreated diabetic, and diabetic treated with insulin designated as having either poor glycemic control, good glycemic control, or poor glycemic control switched to good glycemic control. Hyperglycemia was regulated by use of insulin-releasing pellets. Loss of corneal nerves in the sub-epithelial nerve plexus or corneal epithelium progressed slowly in diabetic mice requiring 20 weeks to reach statistical significance. In comparison, slowing of motor and sensory nerve conduction velocity developed rapidly with significant difference compared with control mice observed after 4 and 8 weeks of hyperglycemia, respectively. In diabetic mice with good glycemic control, average blood glucose levels over the 20-week experimental period were lowered from 589 ± 2 to 251 ± 9 mg/dl. All diabetic neuropathy endpoints examined were improved in diabetic mice with good glycemic control compared with untreated diabetic mice. However, good control of blood glucose was not totally sufficient in preventing diabetic neuropathy.

  14. Physician and patient management of type 2 diabetes and factors related to glycemic control in Spain

    PubMed Central

    Yurgin, Nicole Rae; Boye, Kristina Secnik; Dilla, Tatiana; Suriñach, Núria Lara; Llach, Xavier Badia

    2008-01-01

    The objective of this study was to assess current treatment patterns, blood glucose test strip usage, and treatment compliance in patients with type 2 diabetes mellitus (T2DM) in primary care centers in Spain, and to assess factors related to glycemic control. We conducted a retrospective chart review of patients with T2DM and measured treatment compliance using the Morisky-Green questionnaire. 294 patients were included in the study from a population of patients attending 30 primary care centers throughout Spain. Results showed that the majority of patients were treated with oral monotherapy (36%) and oral combination therapy (35%). Less than half of the patients had good glycemic control (HbA1c ≤ 6.5%). Half of the patients treated pharmacologically reported good compliance with treatment. Logistic regression analyses performed to identify factors associated with glycemic control showed that high body mass index (BMI) and poor compliance were the strongest predictors of poor HbA1c control (OR: 2.198 and 1.789, respectively, p < 0.05). In conclusion, in the course of managing diabetes, physicians and patients should attempt to improve compliance and lower BMI, which could lead to better glycemic control. PMID:19920948

  15. Influence of glycemic index and glycemic load of the diet on the risk of overweight and adiposity in childhood

    PubMed Central

    Silva, Kellen Cristine; Nobre, Luciana Neri; Vicente, Sofia Emanuelle de Castro Ferreira; Moreira, Lidiane Lopes; Lessa, Angelina do Carmo; Lamounier, Joel Alves

    2016-01-01

    Abstract Objective: To investigate the association between the glycemic index and the glycemic load of the diet with the risk of overweight and high adiposity in children with 5 years of age. Methods: Cross-sectional study nested in a cohort of 232 children born and living in Diamantina (MG, Brazil). Parents and/or guardians provided the food intake data, using a semiquantitative food frequency questionnaire, past history and socioeconomic conditions. Anthropometric and fatness data were collected from the children. The dietary glycemic index and the glycemic load were calculated from the food intake. The glycemic index and glycemic load effect on overweight and adiposity in children was assessed by the Poisson regression (p<0.05). Results: The prevalence of overweight by body mass index was 17.3%, and high adiposity was observed in 3.4% and 6.9% by triceps skinfold and subscapular skinfold, respectively. No difference was reported between the mean body mass index, triceps skinfold and subscapular skinfold according to the glycemic index and glycemic load tertiles; however, the overweight group presented a higher carbohydrate intake (p=0.04). No association was found between glycemic index and glycemic load with overweight and adiposity among the children assessed. Conclusions: The glycemic index and glycemic load of the diet were not identified as risk factors for overweight and adiposity in this cross-sectional study. PMID:27215968

  16. Verification of glycemic profiles using continuous glucose monitoring: cases with steroid use, liver cirrhosis, enteral nutrition, or late dumping syndrome.

    PubMed

    Kishimoto, Miyako; Noda, Mitsuhiko

    2015-01-01

    Glycemic control is often difficult to achieve in patients with diabetes, especially in the presence of comorbid diseases or conditions such as steroid-use or liver cirrhosis, or in patients receiving enteral nutrition. Moreover, reactive hypoglycemia due to late dumping syndrome in people having undergone gastrectomy is also a matter of concern. Empirically and theoretically, the typical glycemic profiles associated with these conditions have been determined; however, what actually happens during a 24-h span is still somewhat obscure. In order to verify and provide information about the 24-h glycemic profiles associated with these conditions, 8 patients with the 4 above-mentioned conditions were monitored using a continuous glucose monitoring system (CGMS). For all 8 patients, CGMS provided detailed information regarding the 24-h glycemic profiles. The CGM results showed typical glycemic patterns for each condition, and we were moreover able to observe the effects of various practical treatments. Based on these cases, we conclude that the CGMS is highly useful for determining the glycemic patterns of patients with the aforementioned conditions in a practical setting; and this system may be used to monitor the treatment success of such cases.

  17. Dietary carbohydrate intake, glycemic index, and glycemic load and endometrial cancer risk: a prospective cohort study.

    PubMed

    Coleman, Helen G; Kitahara, Cari M; Murray, Liam J; Dodd, Kevin W; Black, Amanda; Stolzenberg-Solomon, Rachael Z; Cantwell, Marie M

    2014-01-01

    Endometrial cancer risk has been directly associated with glycemic load. However, few studies have investigated this link, and the etiological role of specific dietary carbohydrate components remains unclear. Our aim was to investigate associations of carbohydrate intake, glycemic index, and glycemic load with endometrial cancer risk in the US Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Recruitment took place in 1993-2001. Over a median of 9.0 years of follow-up through 2009, 386 women developed endometrial cancer among 36,115 considered in the analysis. Dietary intakes were assessed using a 124-item diet history questionnaire. Cox proportional hazards models were applied to calculate hazard ratios and 95% confidence intervals. Significant inverse associations were detected between endometrial cancer risk and total available carbohydrate intake (hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.49, 0.90), total sugars intake (HR = 0.71, 95% CI: 0.52, 0.96), and glycemic load (HR = 0.63, 95% CI: 0.46, 0.84) when women in the highest quartile of intake were compared with those in the lowest. These inverse associations were strongest among overweight and obese women. No associations with endometrial cancer risk were observed for glycemic index or dietary fiber. Our findings contrast with previous evidence and suggest that high carbohydrate intakes and glycemic loads are protective against endometrial cancer development. Further clarification of these associations is warranted.

  18. Practice of strict glycemic control in critically ill patients.

    PubMed

    Schultz, Marcus J; de Graaff, Mart J; Royakkers, Annic A N M; van Braam Houckgeest, Floris; van der Sluijs, Johannes P; Kieft, Hans; Spronk, Peter E

    2008-11-01

    Blood glucose control aiming at normoglycemia, frequently referred to as "strict glycemic control", decreases mortality and morbidity of critically ill patients. We searched the medical literature for export opinions, surveys, and clinical reports on blood glucose control in intensive care medicine. While strict glycemic control has been recommended standard of care for critically ill patients, the risk of severe hypoglycemia with strict glycemic control is frequently mentioned by experts. Some rationalize this risk, though others strongly point out the high incidence of hypoglycemia to be (one) reason not to perform strict glycemic control. Implementation of strict glycemic control is far from complete in intensive care units across the world. Frequently local guidelines accept higher blood glucose levels than those with strict glycemic control. Only a minority of retrieved manuscripts are on blood glucose regimens with the lower targets as with strict glycemic control. Hypoglycemia certainly is encountered with blood glucose control, in particular with strict glycemic control. Reports show intensive care-nurses can adequately and safely perform strict glycemic control. Implementation of strict glycemic control is far from complete, at least in part because of the feared risks of hypoglycemia. The preference for hyperglycemia over intermittent hypoglycemia is irrational, however, because there is causal evidence of harm for the former but only associative evidence of harm for the latter. For several reasons it is wise to have strict glycemic control being a nurse-based strategy.

  19. The Return of the ’Good Neighbor’: A Policy for Achieving U.S. Objectives in Latin America through the Nineties and Beyond?

    DTIC Science & Technology

    1991-12-01

    1991 Thesis Advisor Scott D. Tollefson Approved for public release; distribution is unliiited. S9? . 92-03446 11�l111111111.l (Unclassified SECURITY...AUTHORITY 3. DISTRIBUTION/ AVAILABIIITY OF REPORT Approved for public release; distribution is unlimited. -- 2b. DCL ICATION)DOWNG NGSCHEDULE 4...Approved for public release; distribution is unlimited. The Return of the RGood Neighbor": A Policy For Achieving U.S. Objectives in Latin America

  20. Prevalence of microalbuminuria in relation to glycemic control in type-2 diabetic patients in Mymensingh.

    PubMed

    Hasan, M J; Muqueet, A; Sharmeen, A; Hoque, M R

    2015-01-01

    Microalbuminuria is a renal marker of generalized vascular endothelial damage and early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and macrovascular complications of diabetes mellitus like myocardial infarction, stroke and nephropathy. Poor glycemic control increases the risk of microalbuminuria. This study was conducted to determine the frequency of microalbuminuria in type 2 diabetes and compare the frequency of microalbuminuria in poor and good glycemic control in type 2 diabetes. One Hundred and twenty two type 2 diabetic patients were included in the study. Data on age, gender, duration of diabetes, microalbuminuria and HbA1c were recorded. Urine and blood samples were collected and analyzed for microalbuminuria, blood glucose and HbA1c. All patients of both genders with type 2 diabetes for over 2 years were selected in this study. Patients with other causes of proteinuria were excluded. Out of 120 cases 93(77.5%) were male and 27(22.5%) were female. Mean age of patients was 57.8±14.7 years and average duration of diabetes was 9.2 years. Microalbuminuria was found 76.9% of male and 23.1% of female. Patients with poor glycemic control and good glycemic control have frequency of microalbuminuria of 55% and 54% respectively. Uncontrolled diabetes is strongly associated with prevalence of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done both in newly and already diagnosed type 2 diabetic patients as an early marker of renal dysfunction and glycemic control.

  1. Beyond glycemic control in diabetes mellitus: effects of incretin-based therapies on bone metabolism.

    PubMed

    Ceccarelli, Elena; Guarino, Elisa G; Merlotti, Daniela; Patti, Aurora; Gennari, Luigi; Nuti, Ranuccio; Dotta, Francesco

    2013-01-01

    Diabetes mellitus (DM) and osteoporosis (OP) are common disorders with a significant health burden, and an increase in fracture risk has been described both in type 1 (T1DM) and in type 2 (T2DM) diabetes. The pathogenic mechanisms of impaired skeletal strength in diabetes remain to be clarified in details and they are only in part reflected by a variation in bone mineral density. In T2DM, the occurrence of low bone turnover together with a decreased osteoblast activity and compromised bone quality has been shown. Of note, some antidiabetic drugs (e.g., thiazolidinediones, insulin) may deeply affect bone metabolism. In addition, the recently introduced class of incretin-based drugs (i.e., GLP-1 receptor agonists and DPP-4 inhibitors) is expected to exert potentially beneficial effects on bone health, possibly due to a bone anabolic activity of GLP-1, that can be either direct or indirect through the involvement of thyroid C cells. Here we will review the established as well as the putative effects of incretin hormones and of incretin-based drugs on bone metabolism, both in preclinical models and in man, taking into account that such therapeutic strategy may be effective not only to achieve a good glycemic control, but also to improve bone health in diabetic patients.

  2. The effect of glycemic control on CEA, CA 19-9, amylase and lipase levels

    PubMed Central

    Ata, Naim; Dal, Kürşat; Kucukazman, Metin; Karakaya, Serdar; Unsal, Oktay; Dagdeviren, Murat; Akın, Kadir O.; Baser, Salih; Beyan, Esin; Ertugrul, Derun T.

    2015-01-01

    Background Diabetes mellitus is closely related to pancreas cancer. In this study we aimed to investigate the effect of hyperglycemia on tumor and inflammation markers, as well as pancreatic exocrine functions. Methods A total of 98 consecutive diabetic patients with poor glycemic control, and 50 healthy controls were included in the study. We measured hsCRP, erythrocyte sedimentation rate (ESR), CA19-9, CEA, amylase and lipase in addition to routine biochemistry tests, before and after euglycemia was achieved. Results Fasting blood glucose, HbA1c, CA19-9, CEA, hsCRP, ESR, triglycerides, AST, ALT, GGT, ALP, total cholesterol and LDL-C levels decreased significantly with the regulation of glycemic control. Amylase and lipase levels increased with the regulation of glycemic control. After glycemic control, CA19-9 and CEA levels were still higher, whereas amylase and lipase levels were still lower in the diabetic group compared with the control group. Basal HbA1c showed significant correlation with CA19-9, CEA, amylase and lipase. Conclusions We propose to repeat observations of tumor markers after hyperglycemia is resolved, in order to avoid unnecessary invasive tests. Our data also suggest that pancreatic exocrine function was improved with lowering blood glucose in a short period of time. PMID:28352671

  3. Cross-sectional study of glycemic control among adults with type 2 diabetes.

    PubMed

    Amarasekara, Amarasekara Appuhamillage Thamara Dilhani; Fongkaew, Warunee; Wimalasekera, Savithri Wasundara; Turale, Sue; Chanprasit, Chawapornpan

    2015-06-01

    Type 2 diabetes mellitus is a chronic condition, a global concern, and a serious issue in Sri Lanka, where there is little data regarding the influence of dietary control, exercise, and adherence to medication behaviors among adults diabetes. In this cross-sectional, descriptive study, we identified current factors influencing glycemic control and glycemic control behavior among adults with diabetes. A total of 230 people attending diabetes clinics in a tertiary hospital and a primary care institute were administered the self-report Diabetes Information Form, assessing their socioeconomic and medical information and glycemic control behaviors. Data were analyzed by frequency distribution, percentages, mean scores, and standard deviation. The results indicated that most participants had not achieved the recommended fasting blood glucose level (< 126 mg/dL). Although dietary control was practised by 72%, regular exercise was not practised by 85%, and while 77% reported adhering to regular medication, they still had poor glycemic control. The findings highlight the need for health professionals to adopt new strategies for diabetes education to overcome issues related to misconceptions and barriers in providing diabetes care in Sri Lanka.

  4. Differentiating Approaches to Diabetes Self-Management of Multi-ethnic Rural Older Adults at the Extremes of Glycemic Control

    PubMed Central

    Brewer-Lowry, Aleshia Nichol; Arcury, Thomas A.; Bell, Ronny A.; Quandt, Sara A.

    2010-01-01

    Purpose of the Study: This study identified approaches to diabetes self-management that differentiate persons with well-controlled from poorly controlled diabetes. Previous research has focused largely on persons participating in self-management interventions. Design and Methods: In-depth qualitative interviews were conducted with 48 adults, drawn from a population-based sample aged 65 years or older with diabetes. The sample was stratified by sex and ethnic group (African American, American Indian, and White) from the low (A1C <6%) and high (A1C >8%) extremes of the glycemic control distribution. Case-based text analysis was guided by a model, including six self-management domains and four resource types (self-care, informal support, formal services, and medical care). Results: A “structured” approach to self-management differentiated respondents in good glycemic control from those in poor glycemic control. Those in good glycemic control were more likely to practice specific food behaviors to limit food consumption and practice regular blood glucose monitoring with specific target values. This approach was facilitated by a greater use of home aides to assist with diabetes care. Respondents in poor glycemic control demonstrated less structure, naming general food categories and checking blood glucose in reaction to symptoms. Implications: Results provide evidence that degree of structure differentiates self-management approaches of persons with good and poor glycemic control. Findings should provide a foundation for further research to develop effective self-management programs for older adults with diabetes. PMID:20110333

  5. The role of genetic factors and kidney and liver function in glycemic control in type 2 diabetes patients on long-term metformin and sulphonylurea cotreatment.

    PubMed

    Klen, Jasna; Goričar, Katja; Janež, Andrej; Dolžan, Vita

    2014-01-01

    This study investigated the influence of genetic polymorphisms of metformin transporters on long-term glycemic control and lipid status in type 2 diabetes patients in the everyday clinical setting. In total 135 patients treated with combination of metformin and sulphonylurea for at least 6 months were genotyped for SLC22A1 rs628031 and SLC47A1 rs2289669 polymorphisms. Relatively good blood glucose control with median HbA1c 6.9 (6.4-7.6) % was achieved on prescribed metformin dosage of 2550 (2000-2550) mg per day. Only 28 (20.7%) patients experienced mild hypoglycemia events, while no severe hypoglycemia events were observed. Most patients had normal or mildly impaired renal function. Parameters indicating renal function were not correlated with fasting glucose, HbA1c, or lipid parameters. Rs628031 and rs2289669 had minor allele frequencies of 0.385 and 0.355, respectively, and were not associated with HbA1c levels. Rs628031 was marginally associated with risk for hypoglycemia events (P = 0.046; OR = 0.51; 95% CI 0.26-0.99), while significant correlation was observed between rs2289669 and total cholesterol levels (P = 0.018). In conclusion, in patients on long-term metformin and sulphonylurea combination treatment, metformin transporters polymorphisms do not play a major role in glycemic control; however, they may influence lipid status.

  6. The Role of Genetic Factors and Kidney and Liver Function in Glycemic Control in Type 2 Diabetes Patients on Long-Term Metformin and Sulphonylurea Cotreatment

    PubMed Central

    Klen, Jasna; Janež, Andrej; Dolžan, Vita

    2014-01-01

    This study investigated the influence of genetic polymorphisms of metformin transporters on long-term glycemic control and lipid status in type 2 diabetes patients in the everyday clinical setting. In total 135 patients treated with combination of metformin and sulphonylurea for at least 6 months were genotyped for SLC22A1 rs628031 and SLC47A1 rs2289669 polymorphisms. Relatively good blood glucose control with median HbA1c 6.9 (6.4–7.6) % was achieved on prescribed metformin dosage of 2550 (2000–2550) mg per day. Only 28 (20.7%) patients experienced mild hypoglycemia events, while no severe hypoglycemia events were observed. Most patients had normal or mildly impaired renal function. Parameters indicating renal function were not correlated with fasting glucose, HbA1c, or lipid parameters. Rs628031 and rs2289669 had minor allele frequencies of 0.385 and 0.355, respectively, and were not associated with HbA1c levels. Rs628031 was marginally associated with risk for hypoglycemia events (P = 0.046; OR = 0.51; 95% CI 0.26–0.99), while significant correlation was observed between rs2289669 and total cholesterol levels (P = 0.018). In conclusion, in patients on long-term metformin and sulphonylurea combination treatment, metformin transporters polymorphisms do not play a major role in glycemic control; however, they may influence lipid status. PMID:25025077

  7. Glycemic control and outcome related to cardiopulmonary bypass.

    PubMed

    Thiessen, Steven; Vanhorebeek, Ilse; Van den Berghe, Greet

    2015-06-01

    Perioperative hyperglycemia, aggravated by cardiopulmonary bypass, is associated with adverse outcome in adult and pediatric patients. Whereas hyperglycemia was originally perceived as an adaptive response to surgical stress, it is now clear that glycemic control is a strategy to reduce adverse outcomes after cardiac surgery and cardiopulmonary bypass. The optimal blood glucose target, whether or not glycemic control should be initiated already intraoperatively, and whether or not perioperative glucose administration affects the impact of glycemic control on ischemia-reperfusion damage remain open questions. Hypoglycemia, the risk of which is increased with glycemic control, is also associated with adverse outcomes. However, it remains controversial whether brief episodes of hypoglycemia, rapidly corrected during glycemic control, have adverse effects on outcome. This review gives an overview of the currently available literature on glycemic control during and after cardiac surgery and focuses on the indicated open questions about this intervention for this specific patient population.

  8. [Dapagliflozin: Beyond glycemic control in the treatment of type 2 diabetes mellitus].

    PubMed

    Sanz-Serra, Pol; Pedro-Botet, Juan; Flores-Le Roux, Juana A; Benaiges, David; Chillarón, Juan J

    2015-01-01

    Patients with type 2 diabetes mellitus (T2DM) have a high or very high cardiovascular risk. The clinical practice guidelines focus on the need to achieve optimal glycemic control, and strategies for a multifactorial therapeutic approach have shown significant cardiovascular benefits in these patients. Inhibitors of sodium-glucose co-transporter 2 (SGLT-2) are a new class of orally administered drugs in the treatment of T2DM, which act by inhibiting reabsorption of glucose in the renal proximal tubule with consequent glycosuric effect and lowering of blood glucose. Dapagliflozin, SGLT-2 inhibitor marketed in Europe and Australia, has been shown to achieve glycosylated hemoglobin reductions similar to other oral agents, as well as beneficial effects on major comorbidities associated with T2DM. Therefore, it is considered of interest to review the clinical efficacy of this new oral hypoglycemic on glycemic control, risk of hypoglycemia, and its impact on body weight, blood pressure, lipid profile and renal function.

  9. Cassava Flour Substitution Modulates Glycemic Responses and Glycemic Index of Wheat Breads in Apparent Healthy Volunteers.

    PubMed

    Okafor, Ebelechukwu N; Erukainure, Ochuko L; Ozumba, Augusta U; Adewale, Chris O; Kayode, Funmi O; Asieba, Godfrey O; Adesegha, Olubukola I; Elemo, Gloria N

    2017-07-04

    Different carbohydrate foods produce different glycemic responses even with little or no difference in macronutrient composition. Cassava constitutes one of the major staples in Nigeria. Four blends of cassava-wheat bread samples with 0, 10, 15, and 20% cassava flour inclusion were fed individually to groups of healthy human volunteers. Subjects were studied on separate occasions in the morning after a 10-12-hr overnight fast. Blood glucose responses were measured at intervals of 30 min over a period of 2 hr. Glucose was used as a reference food. There were normal glucose responses to the bread samples studied. Increase in cassava incorporation led to less significant glycemic responses. The glycemic index values ranged from 91-94. Results from this study indicate that the inclusion of cassava flour in bread production might not pose a threat to blood glucose response of individuals.

  10. Effect of the glycemic index of carbohydrates on Acne vulgaris.

    PubMed

    Reynolds, Rebecca C; Lee, Stephen; Choi, James Y J; Atkinson, Fiona S; Stockmann, Karola S; Petocz, Peter; Brand-Miller, Jennie C

    2010-10-01

    Acne vulgaris may be improved by dietary factors that increase insulin sensitivity. We hypothesized that a low-glycemic index diet would improve facial acne severity and insulin sensitivity. Fifty-eight adolescent males (mean age ± standard deviation 16.5 ± 1.0 y and body mass index 23.1 ± 3.5 kg/m(2)) were alternately allocated to high or low glycemic index diets. Severity of inflammatory lesions on the face, insulin sensitivity (homeostasis modeling assessment of insulin resistance), androgens and insulin-like growth factor-1 and its binding proteins were assessed at baseline and at eight weeks, a period corresponding to the school term. Forty-three subjects (n = 23 low glycemic index and n = 20 high glycemic index) completed the study. Diets differed significantly in glycemic index (mean ± standard error of the mean, low glycemic index 51 ± 1 vs. high glycemic index 61 ± 2, p = 0.0002), but not in macronutrient distribution or fiber content. Facial acne improved on both diets (low glycemic index -26 ± 6%, p = 0.0004 and high glycemic index -16 ± 7%, p = 0.01), but differences between diets did not reach significance. Change in insulin sensitivity was not different between diets (low glycemic index 0.2 ± 0.1 and high glycemic index 0.1 ± 0.1, p = 0.60) and did not correlate with change in acne severity (Pearson correlation r = -0.196, p = 0.244). Longer time frames, greater reductions in glycemic load or/and weight loss may be necessary to detect improvements in acne among adolescent boys.

  11. Influence of high glycemic index and glycemic load diets on blood pressure during adolescence.

    PubMed

    Gopinath, Bamini; Flood, Victoria M; Rochtchina, Elena; Baur, Louise A; Smith, Wayne; Mitchell, Paul

    2012-06-01

    We aimed to prospectively examine the association between the glycemic index and glycemic load of foods consumed and the dietary intakes of carbohydrates, sugars, fiber, and principal carbohydrate-containing food groups (eg, breads, cereals, and sugary drinks) with changes in blood pressure during adolescence. A total of 858 students aged 12 years at baseline (422 girls and 436 boys) were examined from 2004-2005 to 2009-2011. Dietary data were assessed from validated semiquantitative food frequency questionnaires. Blood pressure was measured using a standard protocol. In girls, after adjusting for age, ethnicity, parental education, parental history of hypertension, baseline height, baseline blood pressure, change in body mass index, and time spent in physical and sedentary activities, each 1-SD (1-SD = 7.10 g/d) increase in baseline dietary intake of total fiber was associated with a 0.96-, 0.62-, and 0.75-mmHg decrease in mean systolic (P = 0.02), diastolic (P = 0.01), and arterial blood pressures (P = 0.002), respectively, 5 years later. In girls, each 1-SD increase in dietary glycemic index, glycemic load, carbohydrate, and fructose was concurrently related to increases of 1.81 (P = 0.001), 4.02 (P = 0.01), 4.74 (P = 0.01), and 1.80 mm Hg (P = 0.03) in systolic blood pressure, respectively, >5 years. Significant associations between carbohydrate nutrition variables and blood pressure were not observed among boys. Excessive dietary intake of carbohydrates, specifically from high glycemic index/glycemic load foods, could adversely influence blood pressure, particularly in girls, whereas fiber-rich diets may be protective against elevated blood pressure during adolescence.

  12. Ethnic Variability in Glycemic Response to Sucrose and Isomaltulose.

    PubMed

    Tan, Wei Shuan Kimberly; Tan, Sze-Yen; Henry, Christiani Jeyakumar

    2017-04-01

    The aim of this study was to compare the glycemic response of Caucasians and Asians to two disaccharides of different glycemic index (GI), and to examine if ethnic groups that showed the largest glycemic response to sucrose would benefit the most when it is replaced with isomaltulose. Forty healthy participants (10 Chinese; 10 Malays; 10 Caucasians; and 10 Indians) consumed beverages containing 50 g of sucrose or isomaltulose on two separate occasions using a randomized crossover design. Capillary blood glucose was measured in a fasted state and at 15, 30, 45, 60, 90, and 120 min after beverage ingestion. Glycemic response to sucrose was significantly higher in Malays compared to Caucasians (p = 0.041), but did not differ between Caucasians vs. Chinese (p = 0.145) or vs. Indians (p = 0.661). When sucrose was replaced with isomaltulose, glycemic responses were significantly reduced in all ethnic groups, with the largest reduction in glycemic response being observed in Malays. Malays, who had the greatest glycemic response to sucrose, also showed the greatest improvement in glycemic response when sucrose was replaced with isomaltulose. This implies that Malays who are more susceptible to type 2 diabetes mellitus may benefit from strategies that replace high GI carbohydrate with lower GI alternatives to assist in glycemic control.

  13. Glycemic Control in the Burn Intensive Care Unit: Focus on the Role of Anemia in Glucose Measurement

    PubMed Central

    Mann, Elizabeth A.; Mora, Alejandra G.; Pidcoke, Heather F.; Wolf, Steven E.; Wade, Charles E.

    2009-01-01

    Glycemic control with intensive insulin therapy (IIT) has received widespread adoption secondary to findings of improved clinical outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred benefits from IIT, our findings of poor outcomes associated with glycemic variability, advantages from preserved diurnal variation of glucose and insulin, and impacts of glucometer error and hematocrit correction factor are discussed. We conclude with direction for further study and the need for a reliable continuous glucose monitoring system. Such efforts will further the endeavor for achieving adequate glycemic control in order to assess the efficacy of target ranges and use of IIT. PMID:20144386

  14. Dietary carbohydrate intake, glycemic load, glycemic index and ovarian cancer risk in African-American women

    PubMed Central

    Qin, Bo; Moorman, Patricia G.; Alberg, Anthony J.; Barnholtz-Sloan, Jill S.; Bondy, Melissa; Cote, Michelle L.; Funkhouser, Ellen; Peters, Edward S.; Schwartz, Ann G.; Terry, Paul; Schildkraut, Joellen M.; Bandera, Elisa V.

    2016-01-01

    Epidemiologic evidence regarding the association between carbohydrate intake, glycemic load and glycemic index and risk of ovarian cancer has been mixed. Little is known about their impact on ovarian cancer risk in African-American women. Associations between carbohydrate quantity and quality and ovarian cancer risk were investigated among 406 cases and 609 controls using data from the African American Cancer Epidemiology Study (AACES). AACES is an ongoing population-based case-control study of ovarian cancer in African Americans in the US. Cases were identified through rapid case ascertainment and age- and site-matched controls were identified by random-digit-dialing. Dietary information over the year preceding diagnosis or the reference date was obtained using a food frequency questionnaire. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for covariates. The ORs comparing the highest quartile of total carbohydrate intake and total sugars intake versus the lowest quartile were 1.57 (95% CI 1.08, 2.28; p-trend=0.03) and 1.61 (95% CI 1.12, 2.30; p-trend<0.01) respectively. A suggestion of an inverse association was found for fiber intake. Higher glycemic load was positively associated with the risk of ovarian cancer (OR 1.18 for each 10 units/1,000 kcal; 95% CI 1.04, 1.33). No associations were observed for starch or glycemic index. Our findings suggest that high intake of total sugars and glycemic load are associated with greater risk of ovarian cancer in African-American women. PMID:26669283

  15. Overcoming barriers to glycemic control in African Americans with type-2 diabetes: benefits of insulin therapy.

    PubMed Central

    Marshall, Merville C.

    2007-01-01

    A disproportionate number of African-American men and women are affected by obesity and diabetes. The documented rate of poor glycemic control in the African-American population may contribute to the high rate of morbidity and mortality due to diabetes observed in these patients. Since the benefits of strict glycemic control have been demonstrated in multiple large trials, the aim of treatment should be to achieve the goals set forth by the American Diabetes Association. Insulin remains an essential therapeutic agent for helping patients achieve glycemic control and preventing long-term comorbidities. However, barriers to insulin therapy exist for both the physician and patient. Strategies to counter this resistance include identifying barriers to treatment, restoring the patient's sense of control, utilizing simple regimens, and reviewing the benefits of insulin and the risk of hypoglycemia. In treating African-American patients with diabetes, providers of various racial and ethnic backgrounds may maximize treatment efficacy by attempting to understand and practice culturally competent care. PMID:17722663

  16. Relation between Breast Cancer and High Glycemic Index or Glycemic Load: A Meta-analysis of Prospective Cohort Studies.

    PubMed

    Mullie, Patrick; Koechlin, Alice; Boniol, Mathieu; Autier, Philippe; Boyle, Peter

    2016-01-01

    Breast cancer is the commonest form of cancer in women worldwide. It has been suggested that chronic hyperinsulinemia associated with insulin resistance plays a role in breast cancer etiology. To test the hyperinsulinemia hypothesis, a dietary pattern associated with a high glycemic index and glycemic load, both proxies for chronic hyperinsulinemia, should be associated with an increased risk of breast cancer. A meta-analysis restricted to prospective cohort studies was undertaken using a random effects model with tests for statistical significance, publication bias and heterogeneity. The metric for analysis was the risk of breast cancer in the highest relative to the lowest glycemic index and glycemic load dietary pattern. A dietary pattern with a high glycemic index was associated with a summary relative risk (SRR) of 1.05 (95% CI: 1.00, 1.11), and a high glycemic load with a SRR of 1.06 (95% CI: 1.00, 1.13). Adjustments for body mass index [BMI], physical activity and other lifestyle factors did not influence the SRR, nor did menopausal status and estrogen receptor status of the tumor. In conclusion, the current evidence supports a modest association between a dietary pattern with high glycemic index or glycemic load and the risk of breast cancer.

  17. A Randomized Trial about Glycemic Index and Glycemic Load Improves Outcomes among Adults with Type 2 Diabetes

    ERIC Educational Resources Information Center

    Miller, Carla K.; Gutschall, Melissa

    2009-01-01

    Glycemic index (GI) represents the postprandial glucose response of carbohydrate foods, and glycemic load (GL) represents the quantity and quality of carbohydrate consumed. A diet lower in GI and GL may improve diabetes management. A 9-week intervention regarding GI and GL was evaluated among adults in the age range of 40-70 years who had had type…

  18. Group of Signs: A New Method to Evaluate Glycemic Variability

    PubMed Central

    Zaccardi, Francesco; Stefano, Paola Di; Busetto, Elena; Federici, Marco Orsini; Manto, Andrea; Infusino, Fabio; Lanza, Gaetano Antonio; Pitocco, Dario; Ghirlanda, Giovanni

    2008-01-01

    Background Glycemic variability is an important parameter used to resolve potential clinical problems in diabetic patients. It is known that glycemic variability generates oxidative stress and potentially contributes to the development of macro- and microvascular complications in diabetes. By controlling glycemic variability, it is possible to reduce these complications and to set the therapy for all patients with diabetes. The aims of this study were to (1) propose a new standardized, objective, and flexible approach to measure glycemic variability by a continuous glucose monitoring system (CGMS)—the group of signs (GOS) method; (2) compare the correlation between mean amplitude of glucose excursion (MAGE), a well-known index of glycemic variability calculated by the physician and the MAGE defined with the GOS method, in order to validate the GOS; and (3) suggest new indexes of glycemic variability. Methods We tested the GOS algorithm on data collected by a CGMS every 5 minutes for 24 hours on 50 patients. Consequently, for 8 patients we calculated and compared the physician's MAGE in the standard way and by the GOS method. Results Comparison between the two methods has shown high correlations, from a minimum correlation of 86% to a maximum of 98%, with p values <0.01 (Pearson test). Conclusions Preliminary data suggest that the proposed algorithm is a valid, efficient, and reliable method able to calculate the standard MAGE on CGMS data systematically and to create other alternative glycemic variability indexes. PMID:19885294

  19. Development of perioperative glycemic control using an artificial endocrine pancreas.

    PubMed

    Hanazaki, Kazuhiro; Namikawa, Tsutomu

    2013-01-01

    It is well known that tight glycemic control (TGC) in patients with diabetes mellitus is the most important to reduce complications, such as nephropathy, neuropathy, and retinopathy. Also, surgical stress induced hyperglycemia leading to glucose toxicity is the main cause of infectious complications after surgery. Recently perioperative TGC has been proven an effective method to reduce postoperative infectious complications and accelerate enhanced recovery after surgery (ERAS), with the main purpose of short staying hospital. However, conventional TGC with open-loop glycemic control system is likely to induce not only occurrence of hypoglycemia but also unstable glycemic control. To solve these problems, we have involved introduction of novel glycemic control using an artificial pancreas (AP) with closed-loop glycemic control system since 2006. To date, this novel perioperative glycemic control was performed in more than 400 surgical patients. As a result, we established stable and safe TGC using an AP to improve surgical outcomes without hypoglycemia. In this paper, we report current scientific evidence focusing on perioperative glycemic control using an AP.

  20. Sputum glucose and glycemic control in cystic fibrosis-related diabetes: a cross-sectional study.

    PubMed

    Van Sambeek, Lindsey; Cowley, Elise S; Newman, Dianne K; Kato, Roberta

    2015-01-01

    Cystic fibrosis-related diabetes affects up to half of cystic fibrosis patients and is associated with increased mortality and more frequent pulmonary exacerbations. However, it is unclear to what degree good glycemic control might mitigate these risks and clinical outcomes have not previously been studied in relation to glucose from the lower airways, the site of infection and CF disease progression. We initially hypothesized that diabetic cystic fibrosis patients with glycosylated hemoglobin (HbA(1c)) > 6.5% have worse pulmonary function, longer and more frequent exacerbations and also higher sputum glucose levels than patients with HbA(1c) ≤ 6.5% or cystic fibrosis patients without diabetes. To test this, we analyzed spontaneously expectorated sputum samples from 88 cystic fibrosis patients. The median sputum glucose concentration was 0.70 mM (mean, 4.75 mM; range, 0-64.6 mM). Sputum glucose was not correlated with age, sex, body mass index, diabetes diagnosis, glycemic control, exacerbation frequency or length, or pulmonary function. Surprisingly, sputum glucose was highest in subjects with normal glucose tolerance, suggesting the dynamics of glycemic control, sputum glucose and pulmonary infections are more complex than previously thought. Two-year mean HbA(1c) was positively correlated with the length of exacerbation admission (p < 0.01), and negatively correlated with measures of pulmonary function (p < 0.01). While total number of hospitalizations for exacerbations were not significantly different, subjects with an HbA(1c) > 6.5% were hospitalized on average 6 days longer than those with HbA(1c) ≤ 6.5% (p < 0.01). Current clinical care guidelines for cystic fibrosis-related diabetes target HbA(1c) ≤ 7% to limit long-term microvascular damage, but more stringent glycemic control (HbA(1c) ≤ 6.5%) may further reduce the short-term pulmonary complications.

  1. IMPROVING GLYCEMIC CONTROL SAFELY IN CRITICAL CARE PATIENTS A COLLABORATIVE SYSTEMS APPROACH IN NINE HOSPITALS.

    PubMed

    Maynard, Gregory A; Holdych, Janet; Kendall, Heather; Harrison, Karen; Montgomery, Patricia A; Kulasa, Kristen

    2017-02-22

    Objective Safely improve glycemic control in the critical care units of nine hospitals. Methods Critical care adult inpatients from nine hospitals with ≥ 4 point-of-care (POC) blood glucose (BG) readings over ≥ 2 days were targeted by collaborative improvement efforts to reduce hyper- and hypo-glycemia. Balanced glucometric goals for each hospital were set targeting improvement from baseline, or goals deemed desirable from Society of Hospital Medicine (SHM) benchmarking data. Collaborative interventions included standardized insulin infusion protocols, hypoglycemia prevention bundles, audit and feedback, education, and measure-vention (coupling measurement of patients "off protocol" with concurrent interventions to correct suboptimal care). Results All sites improved glycemic control. Six reached pre-specified levels of improvement of the day-weighted mean (DWM) BG. The DWM BG for the cohort decreased by 7.7 mg/dL [95% CI 7.0 - 8.4] to 151.3 mg/dL. Six of nine sites showed improvement in the percent ICU days with severe hyperglycemia (any BG > 299 mg/dL). ICU severe hyperglycemic days declined from 8.6% to 7.2% for the cohort [RR 0.84, 95% CI 0.80 - 0.88]. Patient days with any BG < 70 mg / dL were reduced by 0.4% [95% CI 0.06 - 0.6%] from 4.5% to 4.1% for a small but statistically significant reduction in hypoglycemia. Seven of nine sites showed improvement. Conclusion Multi-hospital improvements in ICU glycemic control, severe hyperglycemia, and hypoglycemia are feasible. Balanced goals for glycemic control and hypoglycemia in the ICU using SHM benchmarks and metrics enhanced successful improvement efforts with good staff acceptance and sustainability.

  2. Glycemic index, glycemic load, wellness and beauty: the state of the art.

    PubMed

    Berra, Bruno; Rizzo, Angela Maria

    2009-01-01

    The glycemic index (GI) is a ranking system for carbohydrates' effect on blood glucose levels. It compares available carbohydrates gram for gram in individual foods, providing a numerical, evidence-based index of postprandial glycemia. The glycemic load (GL) is a ranking system for carbohydrate content in food portions based on their GI and the portion size. These two markers increasingly are being used to prevent typical diseases of the Western world, including type 2 diabetes mellitus, cardiovascular disease, obesity, metabolic syndrome, and acne. Data on the efficacy of GI and GL in the treatment of Western population diseases are discussed and critically evaluated, with a particular focus on acne and other skin disorders.

  3. Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes

    PubMed Central

    Kizirian, Nathalie V; Goletzke, Janina; Brodie, Shannon; Atkinson, Fiona S; Markovic, Tania P; Ross, Glynis P; Buyken, Anette; Brand-Miller, Jennie P

    2017-01-01

    Objective Maternal glycemia plays a key role in fetal growth. We hypothesized that lower glycemic load (GL) meals (lower glycemic index, modestly lower carbohydrate) would substantially reduce day-long glucose variability in women at risk of gestational diabetes mellitus (GDM). Research design and methods A crossover study of 17 women (mean±SD age 34.8±4 years; gestational weeks 29.3±1.3; body mass index 23.8±4.7 kg/m2) who consumed a low GL or a high GL diet in random order, 1-day each, over 2 consecutive days. Diets were energy-matched and fiber-matched with 5 meals per 24 hours. All food was provided. Continuous glucose monitoring was used to assess diurnal glycemia. Results Maternal glucose levels were 51% lower on the low GL day with lower incremental area under the curve (iAUC±SEM 549±109 vs 1120±198 mmol/L min, p=0.015). Glycemic variability was significantly lower on the low GL day, as demonstrated by a lower average SD (0.7±0.1 vs 0.9±0.1, p<0.001) and lower mean amplitude of glycemic excursions (2.1±0.2 vs 2.7±0.2 mmol/L, p<0.001). Conclusions A lower GL meal plan in pregnancy acutely halves day-long maternal glucose levels and reduces glucose variability, providing further evidence to support the utility of a low GL diet in pregnancy.

  4. Glycemic index, glycemic load and mammographic breast density: the EPIC Florence longitudinal study.

    PubMed

    Masala, Giovanna; Assedi, Melania; Bendinelli, Benedetta; Ermini, Ilaria; Occhini, Daniela; Sieri, Sabina; Brighenti, Furio; Del Turco, Marco Rosselli; Ambrogetti, Daniela; Palli, Domenico

    2013-01-01

    A few studies have evaluated the association between diet and mammographic breast density (MBD) and results are inconsistent. MBD, a well-recognized risk factor for breast cancer, has been proposed as a marker of cumulative exposure to hormones and growth factors. Diets with a high glycemic index (GI) or glycemic load (GL) may increase breast cancer risk, via an effect on the insulin-like growth factor axis. We have investigated the association between carbohydrate intake, GI, GL and MBD in a prospective study. We identified a large series of women, in the frame of the EPIC-Florence cohort, with a mammogram taken five years after enrolment, when detailed information on dietary and lifestyle habits and anthropometric measurements had been collected. Mammograms have been retrieved (1,668, 83%) and MBD assessed according to Wolfe's classification. We compared women with high MBD (P2+DY Wolfe's categories) with those with low MBD (N1+P1) through logistic models adjusted for age, education, body mass index, menopause, number of children, breast feeding, physical activity, non-alcohol energy, fibers, saturated fat and alcohol. A direct association between GL and high MBD emerged in the highest quintile of intake in comparison with the lowest quintile (OR = 1.73, 95%CI 1.13-2.67, p for trend = 0.048) while no association with glycemic index was evident. These results were confirmed after exclusion of women reporting to be on a diet or affected with diabetes, and when Hormone Replacement Therapy at the date of mammographic examination used to assess MBD was considered. The effect was particularly evident among leaner women, although no interaction was found. A positive association was suggested for increasing simple sugar and total carbohydrates intakes limited to the highest quintiles. In this Italian population we observed an association between glycemic load, total and rapidly absorbed carbohydrates and high MBD. These novel results warrant further investigations.

  5. Hyperglycemia, hypoglycemia and glycemic variability in the elderly: a fatal triad?

    PubMed

    Monami, Matteo; Aleffi, Sara

    2016-06-22

    Diabetes mellitus is one of the most important causes of cardiovascular morbidity and mortality; the incidence of chronic complications of diabetes appears to be closely related to the degree of hyperglycaemia. However, results of clinical trials showed that intensive treatment of hyperglycaemia prevents microvascular complications, but has little or no effect on the incidence of cardiovascular events. Different hypoglycaemic drugs show different effects on cardiovascular risk. However, those trials have shown a neutral effect on cardiovascular mortality. This paradoxical result could be explained with the frequent use, in the past, of glucose-lowering agents capable of increasing the risk of hypoglicemia, glycemic variability and weight gain. In conclusion, an adequate glycemic control, in particular in elderly patients, should be achieved, whenever possible, using agents not inducing hypogycemia, glucose fluctuations, and weight gain. In fact, hypoglycaemia and glucose variability should be considered as independent cardiovascular risk factors to a similar extent to hyperglycemia. In this article, the author will review literature supporting the hypothesis that hyperglycemia, hypoglycaemia and glycemic variability are a fatal triad capable of increasing morbidity and mortality in patients with diabetes mellitus.

  6. The effects of hormonal contraceptives on glycemic regulation

    PubMed Central

    Cortés, Manuel E.; Alfaro, Andrea A.

    2014-01-01

    A number of side effects have been linked to the use of hormonal contraceptives, among others, alterations in glucose levels. Hence, the objective of this mini-review is to show the main effects of hormonal contraceptive intake on glycemic regulation. First, the most relevant studies on this topic are described, then the mechanisms that might be accountable for this glycemic regulation impairment as exerted by hormonal contraceptives are discussed. Finally, we briefly discuss the ethical responsibility of health professionals to inform about the potential risks on glycemic homeostasis regarding hormonal contraceptive intake. PMID:25249703

  7. Improved glycemic control in mice lacking Sglt1 and Sglt2.

    PubMed

    Powell, David R; DaCosta, Christopher M; Gay, Jason; Ding, Zhi-Ming; Smith, Melinda; Greer, Jennifer; Doree, Deon; Jeter-Jones, Sabrina; Mseeh, Faika; Rodriguez, Lawrence A; Harris, Angela; Buhring, Lindsey; Platt, Kenneth A; Vogel, Peter; Brommage, Robert; Shadoan, Melanie K; Sands, Arthur T; Zambrowicz, Brian

    2013-01-15

    Sodium-glucose cotransporter 2 (SGLT2) is the major, and SGLT1 the minor, transporter responsible for renal glucose reabsorption. Increasing urinary glucose excretion (UGE) by selectively inhibiting SGLT2 improves glycemic control in diabetic patients. We generated Sglt1 and Sglt2 knockout (KO) mice, Sglt1/Sglt2 double-KO (DKO) mice, and wild-type (WT) littermates to study their relative glycemic control and to determine contributions of SGLT1 and SGLT2 to UGE. Relative to WTs, Sglt2 KOs had improved oral glucose tolerance and were resistant to streptozotocin-induced diabetes. Sglt1 KOs fed glucose-free high-fat diet (G-free HFD) had improved oral glucose tolerance accompanied by delayed intestinal glucose absorption and increased circulating glucagon-like peptide-1 (GLP-1), but had normal intraperitoneal glucose tolerance. On G-free HFD, Sglt2 KOs had 30%, Sglt1 KOs 2%, and WTs <1% of the UGE of DKOs. Consistent with their increased UGE, DKOs had lower fasting blood glucose and improved intraperitoneal glucose tolerance than Sglt2 KOs. In conclusion, 1) Sglt2 is the major renal glucose transporter, but Sglt1 reabsorbs 70% of filtered glucose if Sglt2 is absent; 2) mice lacking Sglt2 display improved glucose tolerance despite UGE that is 30% of maximum; 3) Sglt1 KO mice respond to oral glucose with increased circulating GLP-1; and 4) DKO mice have improved glycemic control over mice lacking Sglt2 alone. These data suggest that, in patients with type 2 diabetes, combining pharmacological SGLT2 inhibition with complete renal and/or partial intestinal SGLT1 inhibition may improve glycemic control over that achieved by SGLT2 inhibition alone.

  8. Effect of macronutrients and fiber on postprandial glycemic responses and meal glycemic index and glycemic load value determinations.

    PubMed

    Meng, Huicui; Matthan, Nirupa R; Ausman, Lynne M; Lichtenstein, Alice H

    2017-02-15

    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/m(2)): 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

  9. Consumption of a high glycemic load but not a high glycemic index diet is marginally associated with oxidative stress in young women.

    PubMed

    Arikawa, Andrea Y; Jakits, Holly E; Flood, Andrew; Thomas, William; Gross, Myron; Schmitz, Kathryn H; Kurzer, Mindy S

    2015-01-01

    Research studies have suggested that chronic consumption of high glycemic index foods may lead to chronically high oxidative stress. This is important because oxidative stress is suspected to be an early event in the etiology of many disease processes. We hypothesized that dietary glycemic index and glycemic load were positively associated with oxidative stress assessed by plasma F2-isoprostanes in healthy, premenopausal women (body mass index [BMI] = 24.7 ± 4.8 kg/m(2) and age 25.3 ± 3.5 years, mean ± SD). We measured plasma F2-isoprostanes in 306 healthy premenopausal women at the baseline visit for the Women In Steady Exercise Research study, using gas chromatography-mass spectrometry. Dietary glycemic index and load were calculated from the National Cancer Institute Diet History Questionnaire, and participants were divided into quartiles of dietary glycemic index and of glycemic load. Plasma F2-isoprostanes were compared across quartile groups of dietary glycemic index and glycemic load using linear regression models. Plasma F2-isoprostanes (pg/mL) increased with quartile of glycemic load (test for linear trend, P = .033), and also increased with quartile of glycemic index in participants with BMI ≥ 25 (P = .035) but not in those with BMI <25 (P = .924). After adjustment for BMI, alcohol consumption and total energy intake, both these positive trends remained marginally significant (P = .123 for quartiles of glycemic index and P = .065 for quartiles of glycemic load).

  10. Glycemic management in ESRD and earlier stages of CKD.

    PubMed

    Williams, Mark E; Garg, Rajesh

    2014-02-01

    The management of hyperglycemia in patients with kidney failure is complex, and the goals and methods regarding glycemic control in chronic kidney disease (CKD) are not clearly defined. Although aggressive glycemic control seems to be advantageous in early diabetic nephropathy, outcome data supporting tight glycemic control in patients with advanced CKD (including end-stage renal disease [ESRD]) are lacking. Challenges in the management of such patients include therapeutic inertia, monitoring difficulties, and the complexity of available treatments. In this article, we review the alterations in glucose homeostasis that occur in kidney failure, current views on the value of glycemic control and issues with its determination, and more recent approaches to monitor or measure glycemic control. Hypoglycemia and treatment options for patients with diabetes and ESRD or earlier stages of CKD also are addressed, discussing the insulin and noninsulin agents that currently are available, along with their indications and contraindications. The article provides information to help clinicians in decision making in order to provide individualized glycemic goals and appropriate therapy for patients with ESRD or earlier stages of CKD.

  11. The Glycemic Indices in Dialysis Evaluation (GIDE) study: Comparative measures of glycemic control in diabetic dialysis patients.

    PubMed

    Williams, Mark E; Mittman, Neal; Ma, Lin; Brennan, Julia I; Mooney, Ann; Johnson, Curtis D; Jani, Chinu M; Maddux, Franklin W; Lacson, Eduardo

    2015-10-01

    The validity of hemoglobin A1c (HgbA1c) is undergoing increasing scrutiny in the advanced CKD/ESRD (chronic kidney disease/end-stage renal disease) population, where it appears to be discordant from other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (GIDE) Study, we sought to assess correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the United States, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013. The distributions of HgbA1c and the other glycemic indices were analyzed. Intra-patient coefficients of variation and correlations among the four glycemic indices were determined. Patients with low HgbA1c values were both on higher erythropoietin (ESA) doses and more anemic. Serum glucose exhibited the highest intra-patient variability over a 3-month period; variability was modest among the other glycemic indices, and least with HgbA1c. Statistical analyses inclusive of all glycemic markers indicated modest to strong correlations. HgbA1c was more likely to be in the target range than glycated albumin or serum fructosamine, suggesting factors which may or may not be directly related to glycemic control, including anemia, ESA management, and iron administration, in interpreting HgbA1c values. These initial results from the GIDE Study clarify laboratory correlations among glycemic indices and add to concerns about reliance on HgbA1c in patients with diabetes and advanced kidney disease.

  12. Tight Glycemic Control in Critically Ill Children.

    PubMed

    Agus, Michael S D; Wypij, David; Hirshberg, Eliotte L; Srinivasan, Vijay; Faustino, E Vincent; Luckett, Peter M; Alexander, Jamin L; Asaro, Lisa A; Curley, Martha A Q; Steil, Garry M; Nadkarni, Vinay M

    2017-02-23

    Background In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking. Methods In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4.4 to 6.1 mmol per liter; lower-target group) or 150 to 180 mg per deciliter (8.3 to 10.0 mmol per liter; higher-target group). Clinicians were guided by continuous glucose monitoring and explicit methods for insulin adjustment. The primary outcome was the number of intensive care unit (ICU)-free days to day 28. Results The trial was stopped early, on the recommendation of the data and safety monitoring board, owing to a low likelihood of benefit and evidence of the possibility of harm. Of 713 patients, 360 were randomly assigned to the lower-target group and 353 to the higher-target group. In the intention-to-treat analysis, the median number of ICU-free days did not differ significantly between the lower-target group and the higher-target group (19.4 days [interquartile range {IQR}, 0 to 24.2] and 19.4 days [IQR, 6.7 to 23.9], respectively; P=0.58). In per-protocol analyses, the median time-weighted average glucose level was significantly lower in the lower-target group (109 mg per deciliter [IQR, 102 to 118]; 6.1 mmol per liter [IQR, 5.7 to 6.6]) than in the higher-target group (123 mg per deciliter [IQR, 108 to 142]; 6.8 mmol per liter [IQR, 6.0 to 7.9]; P<0.001). Patients in the lower-target group also had higher rates of health care-associated infections than those in the higher-target group (12 of 349 patients [3.4%] vs. 4 of 349 [1.1%], P=0.04), as well as higher rates of severe hypoglycemia, defined as a blood glucose level below 40 mg per

  13. Good Schools.

    ERIC Educational Resources Information Center

    Schoenheimer, Henry P.

    This book contains seventeen thumb-nail sketches of schools in Europe, the United States, Asia, Britain, and Australia, as they appeared in the eye of the author as a professional educator and a journalist while travelling around the world. The author considers the schools described to be good schools, and not necessarily the 17 best schools in…

  14. Self-efficacy, self-care behaviors and glycemic control among type-2 diabetes patients attending two private clinics in Yangon, Myanmar.

    PubMed

    Wynn Nyunt, Sandhi; Howteerakul, Nopporn; Suwannapong, Nawarat; Rajatanun, Thitipat

    2010-07-01

    This cross-sectional study aimed to estimate the prevalence of glycemic control and its associated factors among type-2 diabetes patients attending two private clinics in Yangon, Myanmar. Two hundred sixty-six diabetes patients attending two private diabetes clinics in Yangon during February and March, 2009 were included in the study. The participants completed a structured questionnaire. HbA(1c) was used as the index for glycemic control. The prevalence of successful glycemic control (HbA(1c) < or =7%) was 27.1%. The median HbA(1c) value was 7.8%. About 62.0% of patients had high self-efficacy levels, and 30.8% had good self-care behavior. Multiple logistic regression analysis revealed four variables associated with glycemic control: age > or =60 years (OR 2.46, 95% CI 1.17-5.21), taking one oral hypoglycemic agent (OHA) (OR 2.56, 95% CI 1.26-5.19), being overweight (OR 2.01, 95% CI 1.02-3.95) and having a high self-efficacy level (OR 5.29, 95% CI 2.20-12.75). Interventions to increase diabetic patient self-efficacy levels and self-care behavior, especially related to diet and exercise, are needed to reduce poor glycemic control.

  15. Use of focus group interviews with public health nurses to identify the efforts of and challenges faced by branches of the Japan Health Insurance Association to achieve good performance of the Specific Health Guidance initiatives.

    PubMed

    Hayashi, Fumi; Ozawa, Keiko; Kawabata, Teruko; Takemi, Yukari

    2016-01-01

    Objectives Aiming at improvement of the Japan Health Insurance Association's Specific Health Guidance initiatives and human resource development, we conducted a qualitative study to clarify the features necessary for and the challenges hindering the achievement of good performance of the initiatives.Methods From November 2014 to January 2015, we conducted 10 focus group interviews, each 90 minutes long, with 64 public health nurses from 10 Japan Health Insurance Association branches. In addition, self-administered questionnaires were administered to obtain the participants' basic characteristics. After we excluded one group for failing to meet our performance targets, we divided the remaining nine focus groups according to two patterns: Maintenance and Progress. The four focus groups fitting the Maintenance pattern had a well-established track record, and the five focus groups fitting the Progress pattern had a track record of good growth. Using open coding of the interview transcripts, we extracted efforts or needs in two domains, individual and branch, Then, we placed codes in eight main categories: [quality], [general practice], [dietary guidance practice], [success factor], [branch system], [training and skill development], [approach to the member office], and [past efforts]. We further extracted important subcategories based on their rates of appearance within branches.Results Data from 56 female public health nurses working at nine branches were included in the analysis. With respect to the individual domain, subcategories such as "building rapport," "creating the physical environment," and "taking the initiative in evaluating one's own lifestyle" in the 〈high emphasis〉 segment of the [general practice] category were common to both patterns. In addition, "increasing opportunities for training" and "enhancement of training program content" were found for both patterns in relation to the 〈demand〉 segment of the [training and skill development

  16. Adherence to Glycemic Monitoring in Diabetes

    PubMed Central

    Patton, Susana R.

    2015-01-01

    Glucose monitoring either by self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM) plays an important role in diabetes management and in reducing risk for diabetes-related complications. However, despite evidence supporting the role of glucose monitoring in better patient health outcomes, studies also reveal relatively poor adherence rates to SMBG and CGM use and numerous patient-reported barriers. Fortunately, some promising intervention strategies have been identified that promote at least short-term improvements in patients’ adherence to SMBG. These include education, problem solving, contingency management, goal setting, cognitive behavioral therapy, and motivational interviewing. Specific to CGM, interventions to promote greater use among patients are currently under way, yet one pilot study provides data suggesting better maintenance of CGM use in patients showing greater readiness for behavior change. The purpose of this review is to summarize the literature specific to glucose monitoring in patients with diabetes focusing specifically on current adherence rates, barriers to monitoring, and promising intervention strategies that may be ready to deploy now in the clinic setting to promote greater patient adherence to glucose monitoring. Yet, to continue to help patients with diabetes adhere to glucose monitoring, future research is needed to identify the treatment strategies and the intervention schedules that most likely lead to long-term maintenance of optimal glycemic monitoring levels. PMID:25591853

  17. Factors associated with glycemic control in adult type 1 diabetes patients treated with insulin pump therapy.

    PubMed

    Matejko, Bartłomiej; Skupien, Jan; Mrozińska, Sandra; Grzanka, Małgorzata; Cyganek, Katarzyna; Kiec-Wilk, Beata; Malecki, Maciej T; Klupa, Tomasz

    2015-02-01

    Continuous subcutaneous insulin infusion (CSII) by insulin pump seems to improve glycemia and quality of life as compared to conventional insulin therapy in type 1 diabetes (T1DM). However, while many T1DM subjects achieve excellent glycemic control, some others cannot reach recommended goals. In a retrospective analysis, we searched for factors associated with glycemic control in T1DM patients treated with insulin pump therapy. Data from 192 patients (133 women and 59 men) treated with personal insulin pumps at the Department of Metabolic Diseases, University Hospital, Krakow, Poland were analyzed. Sources of information included medical records, memory read-outs from insulin pumps and data from glucose meters. Univariate, multivariate linear and logistic regression analysis for the association with hemoglobin A1c (HbA1c) level were performed. The mean age of the subjects was 28.9 (±11.2) years, the mean duration of T1DM-14.6 (±7.6) years, mean body mass index-23.5 (±3.1) kg/m2. The mean HbA1c level in the entire study group was 7.4% (57 mmol/mol). In the multivariate linear regression analysis, HbA1c correlated with the mean number of daily blood glucose measurements, number of hypoglycemic episodes per 100 blood glucose measurements, age at the examination, and continuous glucose monitoring system use. Multivariate logistic regression analysis for reaching the therapeutic target of HbA1c<7.0% (53 mmol/mol) showed that the independent predictors of achieving this goal included the same four variables. In a large clinical observation, we identified that patient-related and technological factors associated with glycemic control in adult pump-treated T1DM subjects.

  18. Dietary glycemic index and glycemic load and their relationship to cardiovascular risk factors in Chinese children.

    PubMed

    Zhang, Xinyu; Zhu, Yanna; Cai, Li; Ma, Lu; Jing, Jin; Guo, Li; Jin, Yu; Ma, Yinghua; Chen, Yajun

    2016-04-01

    The purpose of this study was to examine the cross-sectional associations between dietary glycemic index (GI) and glycemic load (GL) and cardiovascular disease (CVD) risk factors in Chinese children. A total of 234 Chinese schoolchildren aged 8-11 years in Guangdong participated in the study. Dietary intake was assessed via a 3-day dietary record. Seven established cardiovascular indicators were analyzed in this study: fasting plasma glucose (FPG), fasting triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, and diastolic blood pressure. Higher dietary GI was significantly associated with higher TG levels (P = 0.037) and lower HDL-C levels (P = 0.005) after adjusting for age, sex, nutritional intake, physical activity, and body mass index z score. LDL-C was found to differ across tertiles of dietary GL. The middle tertile tended to show the highest level of LDL-C. TC, FPG, and blood pressure were independent of both dietary GI and GL. Our findings suggest that higher dietary GI is differentially associated with some CVD risk factors, including lower HDL-C and higher TG, in school-aged children from south China.

  19. [Glycemic, insulinemic index, glycemic load of soy beverage with low and high content of carbohydrates].

    PubMed

    Torres y Torres, Nimbe; Palacios-González, Berenice; Noriega-López, Lilia; Tovar-Palacio, Armando R

    2006-01-01

    Consumption of soy has increased in Western countries due to the benefits on health and the attitude of the people to consume natural products as alternative to the use of pharmacological therapies. However, there is no evidence whether the consumption of 25 g of soy protein as recommended by the Food and Drug Administration has some effect on glucose absorption and consequently on insulin secretion. The aim of the present study was to determine glycemic index (GI), insulinemic index (InIn), and glycemic load (GL) of several soy beverages containing low or high concentration of carbohydrates, and compare them with other foods such as peanuts, whole milk, soluble fiber and a mixed meal on GI and InIn. The results showed that soy beverages had low or moderate GI, depending of the presence of other compounds like carbohydrates and fiber. Consumption of soy beverages with low concentration of carbohydrates produced the lowest insulin secretion. Therefore, these products can be recommended in obese and diabetic patients. Finally soy beverages should contain low maltodextrins concentration and be added of soluble fiber.

  20. Carbohydrate Intake, Glycemic Index, Glycemic Load, and Stroke: A Meta-analysis of Prospective Cohort Studies.

    PubMed

    Cai, Xianlei; Wang, Chen; Wang, Shan; Cao, Gaoyang; Jin, Chao; Yu, Jiawei; Li, Xiuyang; Yan, Jing; Wang, Fudi; Yu, Wei; Ding, Fang

    2015-07-01

    The objective of this study was to investigate associations between carbohydrate intake/glycemic index (GI)/glycemic load (GL) and stroke risk. A literature search of MEDLINE, Embase, Web of Science, and CBM databases was performed to retrieve eligible studies published up to March 2014. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were used to evaluate the strength of this association. Publication bias was assessed by the Egger's regression asymmetry test and Begg's rank correlation test with Begg's funnel plot. All analyses were conducted using software STATA 12.0 (StataCorp LP, College Station, TX) and SAS version 9.1 (SAS Institute Inc, Cary, NC). We identified 7 prospective studies that met the inclusion criteria and processed data from cohort studies to update available evidence. There were 25 independent estimates and 225 000 participants free of diabetes from 6 different countries; 3046 stroke events were included; and the follow-up range was 5 to 18 years. High GI was not associated with risk of stroke events (pooled RR = 1.10; 95% CI: 0.99-1.21); GL was a risk factor for stroke (pooled RR = 1.19; 95% CI: 1.05-1.36). There was no significant association between high carbohydrate intake and stroke risk (RR = 1.12; 95% CI: 0.93-1.35). A daily high GL diet is the risk factor of stroke event, and further researches need to verify the meta-analyses results and study associated mechanisms.

  1. Dietary Glycemic Index, Dietary Glycemic Load, Blood Lipids, and Coronary Heart Disease

    PubMed Central

    Denova-Gutiérrez, Edgar; Huitrón-Bravo, Gerardo; Talavera, Juan O.; Castañón, Susana; Gallegos-Carrillo, Katia; Flores, Yvonne; Salmerón, Jorge

    2010-01-01

    Objective. To examine the associations of dietary glycemic index (GI) and dietary glycemic load (GL) with blood lipid concentrations and coronary heart disease (CHD) in nondiabetic participants in the Health Worker Cohort Study (HWCS). Materials and Methods. A cross-sectional analysis was performed, using data from adults who participated in the HWCS baseline assessment. We collected information on participants' socio-demographic conditions, dietary patterns and physical activity via self-administered questionnaires. Dietary GI and dietary GL were measured using a validated food frequency questionnaire. Anthropometric and clinical measurements were assessed with standardized procedures. CHD risk was estimated according to the sex-specific Framingham prediction algorithms. Results. IIn the 5,830 individuals aged 20 to 70 who were evaluated, dietary GI and GL were significantly associated with HDL-C, LDL-C, LDL-C/HDL-C ratio, and triglycerides serum levels. Subjects with high dietary GI have a relative risk of 1.56 (CI 95%; 1.13–2.14), and those with high dietary GL have a relative risk of 2.64 (CI 95%; 1.15–6.58) of having an elevated CHD risk than those who had low dietary GI and GL. Conclusions. Our results suggest that high dietary GI and dietary GL could have an unfavorable effect on serum lipid levels, which are in turn associated with a higher CHD risk. PMID:20700407

  2. [The glycemic index of some foods common in Mexico].

    PubMed

    Frati-Munari, A C; Roca-Vides, R A; López-Pérez, R J; de Vivero, I; Ruiz-Velazco, M

    1991-01-01

    To investigate the increase of glycemia due to the ingestion of usual food in Mexico, portions with 50 g of carbohydrate form white corn tortilla, yellow corn tortilla, spaghetti, rice, potatoes, beans brown and black, nopal (prickle pear cactus) and peanuts, compared with white bread, were given to 21 healthy and 27 non-insulin-dependent diabetic subjects. Serum glucose and insulin were measured every 30 min for 180 min long. Glycemic index was obtained as: (area under curve of glucose with test food/area under curve of glucose with white bread) X 100. A corrected index was calculated subtracting the area corresponding to initial values. Insulin index was obtained similarly. Each sample was studied 14-18 times. Glycemic and insulin indexes of white and yellow corn tortilla, spaghetti, rice and potatoes were not different from bread (P greater than 0.05). Corrected glycemic indexes of brown beans (54 +/- 15, +/- SE) and black beans (43 +/- 17) were low (p less than 0.05), as well as corrected insulin indexes (69 +/- 11 and 64 +/- 10 respectively, (P less than 0.02). Peanuts had low glycemic (33 +/- 17, P less than 0.01), but normal insulin index. Nopal had very low glycemic and insulin indexes (10 +/- 17 and 10 +/- 16, P less than 0.0001). These data might be useful in prescribing diets for diabetic subjects.

  3. Pollution by metals: Is there a relationship in glycemic control?

    PubMed

    González-Villalva, Adriana; Colín-Barenque, Laura; Bizarro-Nevares, Patricia; Rojas-Lemus, Marcela; Rodríguez-Lara, Vianey; García-Pelaez, Isabel; Ustarroz-Cano, Martha; López-Valdez, Nelly; Albarrán-Alonso, Juan Carlos; Fortoul, Teresa I

    2016-09-01

    There are evidences of environmental pollution and health effects. Metals are pollutants implicated in systemic toxicity. One of the least studied effects, but which is currently becoming more important, is the effect of metals on glycemic control. Metals have been implicated as causes of chronic inflammation and oxidative stress and are associated to obesity, hyperglycemia and even diabetes. Arsenic, iron, mercury, lead, cadmium and nickel have been studied as a risk factor for hyperglycemia and diabetes. There is another group of metals that causes hypoglycemia such as vanadium, chromium, zinc and magnesium by different mechanisms. Zinc, magnesium and chromium deficiency is associated with increased risk of diabetes. This review summarizes some metals involved in glycemic control and pretends to alert health professionals about considering environmental metals as an important factor that could explain the poor glycemic control in patients. Further studies are needed to understand this poorly assessed problem.

  4. Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes: Results From a Nationwide Prospective Cohort in Korea.

    PubMed

    Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-03-01

    Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interaction = 0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.47-0.90, P = 0.01; patients with available HbA1c [n = 773], HR = 0.64, 95% CI = 0.46-0.91, P = 0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HR = 0.59, 95% CI = 0.37-0.94, P = 0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c ≥8.0%, HR = 1.21, 95% CI = 0.46-2.76, P = 0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes.

  5. Type 2 diabetes mellitus, glycemic control, and cancer risk.

    PubMed

    Onitilo, Adedayo A; Stankowski, Rachel V; Berg, Richard L; Engel, Jessica M; Glurich, Ingrid; Williams, Gail M; Doi, Suhail A

    2014-03-01

    Type 2 diabetes mellitus is characterized by prolonged hyperinsulinemia, insulin resistance, and progressive hyperglycemia. Disease management relies on glycemic control through diet, exercise, and pharmacological intervention. The goal of the present study was to examine the effects of glycemic control and the use of glucose-lowering medication on the risk of breast, prostate, and colon cancer. Patients diagnosed with type 2 diabetes mellitus (N=9486) between 1 January 1995 and 31 December 2009 were identified and data on glycemic control (hemoglobin A1c, glucose), glucose-lowering medication use (insulin, metformin, sulfonylurea), age, BMI, date of diabetes diagnosis, insurance status, comorbidities, smoking history, location of residence, and cancer diagnoses were electronically abstracted. Cox proportional hazards regression modeling was used to examine the relationship between glycemic control, including medication use, and cancer risk. The results varied by cancer type and medication exposure. There was no association between glycemic control and breast or colon cancer; however, prostate cancer risk was significantly higher with better glycemic control (hemoglobin A1c ≤ 7.0%). Insulin use was associated with increased colon cancer incidence in women, but not with colon cancer in men or breast or prostate cancer risk. Metformin exposure was associated with reduced breast and prostate cancer incidence, but had no association with colon cancer risk. Sulfonylurea exposure was not associated with risk of any type of cancer. The data reported here support hyperinsulinemia, rather than hyperglycemia, as a major diabetes-related factor associated with increased risk of breast and colon cancer. In contrast, hyperglycemia appears to be protective in the case of prostate cancer.

  6. Top 10 Facts to Know About Inpatient Glycemic Control.

    PubMed

    Horton, William B; Subauste, Jose S

    2016-02-01

    Uncontrolled hyperglycemia in hospitalized patients with or without a previous diagnosis of diabetes is associated with adverse outcomes and longer lengths of hospital stay. It is estimated that one-third of hospitalized patients will experience significant hyperglycemia, and the cost associated with hospitalization for patients with diabetes accounts for half of all health care expenditures for this disease. Optimizing glycemic control should be a priority for all health care providers in the inpatient setting. Appropriate management strategies should include identification of appropriate glycemic targets, prevention of hypoglycemia, initiation of appropriate basal-plus-bolus insulin regimens, and planning for the transition from inpatient to outpatient therapy before hospital discharge.

  7. Glycemic index, glycemic load and invasive breast cancer incidence in postmenopausal women: The PREDIMED study.

    PubMed

    Castro-Quezada, Itandehui; Sánchez-Villegas, Almudena; Martínez-González, Miguel Á; Salas-Salvadó, Jordi; Corella, Dolores; Estruch, Ramón; Schröder, Helmut; Álvarez-Pérez, Jacqueline; Ruiz-López, María D; Artacho, Reyes; Ros, Emilio; Bulló, Mónica; Sorli, Jose V; Fitó, Montserrat; Ruiz-Gutiérrez, Valentina; Toledo, Estefanía; Buil-Cosiales, Pilar; García Rodríguez, Antonio; Lapetra, José; Pintó, Xavier; Salaverría, Itziar; Tur, Josep A; Romaguera, Dora; Tresserra-Rimbau, Anna; Serra-Majem, Lluís

    2016-11-01

    The objective of this study was to evaluate the prospective associations between dietary glycemic index (GI) and glycemic load (GL) and the risk for invasive breast cancer incidence in postmenopausal women at high cardiovascular disease (CVD) risk. This study was conducted within the framework of the PREvención con DIeta MEDiterránea (PREDIMED) study, a nutritional intervention trial for primary cardiovascular prevention. We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease. Dietary information was collected using a validated 137-item food frequency questionnaire. We assigned GI values using the International Tables of GI and GL values. Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index. Only cases confirmed by results from cytology tests or histological evaluation were included. We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models. We repeated our analyses using yearly repeated measures of GI/GL intakes. No associations were found between baseline dietary GI/GL and invasive breast cancer incidence. The multivariable hazard ratio and 95% confidence interval (CI) for the top tertile of dietary GI was 1.02 (95% CI: 0.42-2.46) and for dietary GL was 1.00 (95% CI: 0.44-2.30) when compared with the bottom tertile. Repeated-measures analyses yielded similar results. In sensitivity analyses, no significant associations were observed for women with obesity or diabetes. Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk.

  8. Actions of insulin beyond glycemic control: a perspective on insulin detemir.

    PubMed

    Tibaldi, Joseph

    2007-01-01

    The physiologic effects of insulin on carbohydrate metabolism in health in general and in diabetes are well known. Less understood, but far more intriguing, are the extrapancreatic effects of insulin that go beyond glycemic control to help sense, integrate, and maintain energy balance. Virtually every organ, including the brain, is a target for insulin action. When exogenous insulin is administered directly into the brains of experimental animals, the net effect is anorectic; however, patients with type 2 diabetes who transition to insulin therapy often gain weight--a tendency that opposes good glycemic control and overall therapeutic goals. After the brief review of extrapancreatic insulin--signaling pathways presented here, the physiologic impact of developing insulin resistance in relation to body weight is considered. Attention is then focused on insulin detemir, a longacting insulin analog that has consistently been associated with less weight gain than conventional formulations such as neutral protamine Hagedorn insulin. Mechanisms offered to explain this effect include the lower incidence of hypoglycemia and less within-patient variability associated with insulin detemir; however, recent observations and considerations of insulin-signaling pathways have shed light on other important properties of insulin detemir that may impart these weight-neutral effects. Namely, albumin binding, faster transport across the bloodbrain barrier, and preferential activity in brain and liver are characteristics of insulin detemir that potentially explain the observed weight benefit seen in clinical trials, as well as in the real-world practice setting.

  9. Physical activity, glycemic control, and diabetic peripheral neuropathy: a national sample.

    PubMed

    Loprinzi, Paul D; Hager, Kathy K; Ramulu, Pradeep Y

    2014-01-01

    To determine if physical activity and/or blood glycohemoglobin (HbA1c) are associated with the prevalence of peripheral neuropathy (PN) in a representative population of diabetics. Three hundred thirty-nine diabetic participants (40-85 yrs) taking part in 2003-2004 National Health and Nutrition Examination Survey were studied. Participants were defined as having peripheral neuropathy if examination determined ≥1 insensate area in either foot. Moderate-to-vigorous physical activity (MVPA) was objectively-measured using accelerometry. After adjustments, MVPA was not significantly associated with PN (OR=1.16; 95% CI: 0.48-2.78), nor was HbA1c (OR=0.55; 95% CI: 0.28-1.04). However, there was evidence of statistical interaction (OR=0.24; 95% CI: 0.06-0.87) between MVPA and HbA1c status, showing that diabetics engaging in higher levels of MVPA and having normal HgbA1c levels were less likely to have PN than what would be expected based on the individual effects of MVPA and HbA1c alone. Although MVPA was not directly associated with PN, these findings suggest that proper physical activity, coupled with good glycemic control, is associated with less neuropathy. Future longitudinal studies are required to evaluate whether physical activity and improved glycemic control may help prevent or slow the progression of diabetic end-organ damage, particularly diabetic neuropathy.

  10. The Risks and Benefits of Implementing Glycemic Control Guidelines in Frail Elders with Diabetes

    PubMed Central

    Lee, Sei J.; Boscardin, W. John; Cenzer, Irena Stijacic; Huang, Elbert S.; Rice-Trumble, Kathy; Eng, Catherine

    2013-01-01

    BACKGROUND/OBJECTIVES To determine the hypo- and hyper-glycemic outcomes associated with implementing the American Geriatrics Society (AGS) guideline for Hemoglobin A1c (HbA1c)<8% in frail older patients with diabets. DESIGN/SETTING Guideline Implementation in PACE (Program of All-Inclusive Care for the Elderly) PARTICIPANTS All patients in the Before (10/02–12/04, n=338), Early (1/05–6/06, n=289) and Late phases of guideline implementation (7/06–12/08, n=385) with a diagnosis of diabetes mellitus and at least one HbA1c measurement. INTERVENTION Clinician education in 2005 with annual monitoring of the proportion of each clinician’s patients with diabetes with HbA1c<8%. MEASUREMENTS Hypoglycemia (Blood sugar or BS<50), hyperglycemia (BS>400) and severe hypoglycemia (Emergency room or ER visit for hypoglycemia) RESULTS Before, Early and Late groups were similar in mean age, race/ethnicity, comorbidity and functional dependency. Antihyperglycemic medication use increased with more patients using metformin (28% Before versus 42% Late, p<0.001) and insulin (23% Before versus 34% Late, p<0.001), with more patients achieving the AGS glycemic target of HbA1c<8% (74% Before versus 84% Late, p<0.001). Episodes of hyperglycemia (per 100 person-years) decreased dramatically (159 Before versus 46 Late, p<0.001) and episodes of hypoglycemia were unchanged (10.1 versus 9.3, p=0.50). Episodes of severe hypoglycemia were increased in the Early period (1.1 Before versus 2.9 Early, p=0.03). CONCLUSION Implementing the AGS glycemic control guideline for frail elders led to fewer hyperglycemic episodes, but more severe hypoglycemic episodes requiring ER visits in the Early implementation period. Future glycemic control guideline implementation efforts should be coupled with close monitoring for severe hypoglycemia in the early implementation period. PMID:21480838

  11. Glycemic control in diabetic patients served by community health centers.

    PubMed

    Maizlish, Neil A; Shaw, Beryl; Hendry, Khati

    2004-01-01

    The Community Health Center Network measured the prevalence of glycemic control in diabetic patients at 7 community health centers as part of its clinical quality improvement program. A cross-sectional survey was carried out in a random sample of 1817 diabetic patients having 1 or more encounters from October 1, 2000 to September 30, 2001. Computerized laboratory results for hemoglobin A1c (HbA1c) tests were available for half the sample. Manual review of medical charts was carried out for the rest. The proportion of diabetic patients with 1 or more HbA1c tests in the measurement year was 91% (CI95%: 90-93%) and poor glycemic control (HbA1c > 9%) occurred in 27% (CIM%: 25-30%). The mean of the most recent test was 7.8%. The frequency of testing varied significantly by clinic from 79% to 94% and increased with the number of encounters. Poor glycemic control also varied significantly by clinic (17-48%) and was significantly better in females and older patients. Measures of glycemic control were not associated with ethnicity or insurance status in multivariate analyses. A high proportion of diabetic patients received appropriate care, and this care was not associated with ethnicity or insurance status. The data warehouse was an essential tool for the clinical quality improvement program.

  12. Boost glycemic control in teen diabetics through 'family focused teamwork'.

    PubMed

    2003-09-01

    While family conflict during the teenaged years is typical, it can have long-term health consequences when it involves an adolescent with diabetes. However, researchers at Joslin Diabetes Center in Boston have developed a low-cost intervention that aims to remove conflict from disease management responsibilities--and a new study shows that it can boost glycemic control as well.

  13. The intriguing effects of time to glycemic goal in newly diagnosed type 2 diabetes after short-term intensive insulin therapy.

    PubMed

    Cheng, Lin; Xu, Mingtong; Lin, Xiuhong; Tang, Juying; Qi, Yiqin; Wan, Yan; Pan, Xiaofang; Chen, Xiaoyun; Ren, Meng; Yan, Li

    2016-08-31

    Short-term intensive insulin therapy is effective for type 2 diabetes because it offers the potential to achieve excellent glycemic control and improve β-cell function. We observed that the time to glycemic goal (TGG) was adjustable. Original data of 138 newly diagnosed type 2 diabetic patients received intensive insulin therapy by continuous subcutaneous insulin infusion for 2-3 weeks were retrospectively collected. Subjects underwent an intravenous glucose tolerance test (IVGTT) and an oral glucose tolerance test (OGTT) pre and post treatment. The glycemic goal was achieved within 6 (4-8) days. Patients were divided into two groups by TGG above (TGG-slow) and below (TGG-fast) the median value. Patients in both groups had significantly better glycemic control. Compared with TGG-fast, TGG-slow required a few more total insulin and performed more improvement of HOMA-β and IVGTT-AUCIns, but less improvement of HOMA-IR and QUICKI. Multiple linear regression analysis revealed that TGG was always an explanatory variable for the changes (HOMA-β, IVGTT-AUCIns, HOMA-IR and QUICKI). The hypoglycemia prevalence was lower in TGG-slow (1.48% vs. 3.40%, P<0.01). Multivariate logistic regression analysis indicated that individuals in TGG-slow had a lower risk of hypoglycemia (adjusted OR, 0.700; 95% CI, 0.567-0.864; P<0.05). Multiple linear regression analysis confirmed that the ratio of the incremental insulin to glucose responses over the first 30 min during OGTT (ΔIns30/ΔG30), average insulin dose before achieving targets, initial insulin dose and LDL-c were independent predictors for TGG. It is intriguing to hypothesize that patients with fast time to glycemic goal benefit more in improving insulin sensitivity, but patients with slow time benefit more in improving β-cell function and reducing the risk of hypoglycemia.

  14. Current topics in glycemic control by wearable artificial pancreas or bedside artificial pancreas with closed-loop system.

    PubMed

    Hanazaki, Kazuhiro; Munekage, Masaya; Kitagawa, Hiroyuki; Yatabe, Tomoaki; Munekage, Eri; Shiga, Mai; Maeda, Hiromichi; Namikawa, Tsutomu

    2016-09-01

    The incidence of diabetes is increasing at an unprecedented pace and has become a serious health concern worldwide during the last two decades. Despite this, adequate glycemic control using an artificial pancreas has not been established, although the 21st century has seen rapid developments in this area. Herein, we review current topics in glycemic control for both the wearable artificial pancreas for type 1 and type 2 diabetic patients and the bedside artificial pancreas for surgical diabetic patients. In type 1 diabetic patients, nocturnal hypoglycemia associated with insulin therapy remains a serious problem that could be addressed by the recent development of a wearable artificial pancreas. This smart phone-like device, comprising a real-time, continuous glucose monitoring system and insulin pump system, could potentially significantly reduce nocturnal hypoglycemia compared with conventional glycemic control. Of particular interest in this space are the recent inventions of a low-glucose suspend feature in the portable systems that automatically stops insulin delivery 2 h following a glucose sensor value <70 mg/dL and a bio-hormonal pump system consisting of insulin and glucagon pumps. Perioperative tight glycemic control using a bedside artificial pancreas with the closed-loop system has also proved safe and effective for not only avoiding hypoglycemia, but also for reducing blood glucose level variability resulting in good surgical outcomes. We hope that a more sophisticated artificial pancreas with closed-loop system will now be taken up for routine use worldwide, providing enormous relief for patients suffering from uncontrolled hyperglycemia, hypoglycemia, and/or variability in blood glucose concentrations.

  15. Vitamin D Daily short-term Supplementation does not Affect Glycemic Outcomes of Patients with Type 2 Diabetes.

    PubMed

    Chrysostomou, Stavri

    2017-01-27

    There is currently insufficient evidence of a beneficial effect to recommend vitamin D supplementation for optimizing glycemic status in patients with type 2 diabetes mellitus (T2DM). Taking into consideration the significant extra-skeletal effect of vitamin D on pancreatic β-cell function and insulin secretion and the large number of scientific evidence supporting the inverse association between vitamin D status and hyperglycemia, this review article aims to examine whether vitamin D supplementation therapies are beneficial to patients with T2DM considering specific factors through randomized controlled trials (RCTs). EBSCOhost and Medline databases were searched from the beginning of 2009 until the end of 2014 for RCTs in patients with T2DM. Parameters, such as baseline vitamin D levels, frequency/dosage of supplementation, length of the study and type of supplementation, were independently assessed, based on their effect on glycemic status. Although all different types of supplementation were safe and effective in the achievement of vitamin D sufficiency in a dose-dependent way, the impact on glycemic status was different. 14 RCTs were included with daily supplementations ranging from 400-11.200 IU/daily, 40.000-50.000 IU/weekly and 100.000-300.000 IU/intramuscularly or once given, for a period from 8 to 24 weeks. Daily supplementation of vitamin D (up to 11.200 IU) showed no effect, whereas combined supplementation, with calcium (≥300 mg), and with vitamin D doses similar to the RDA, showed positive effects. Additionally, high weekly doses of vitamin D (40.000-50.000 IU) were effective on glycemic outcomes but available data are limited.

  16. Characterization of Factors Affecting Attainment of Glycemic Control in Asian Americans With Diabetes in a Culturally Specific Program

    PubMed Central

    Le, Hung; Wong, Sophia; Iftikar, Tracy; Keenan, Hillary; King, George L.; Hsu, William C.

    2014-01-01

    Purpose The purpose of this study is to examine the effectiveness of a culturally specific pilot clinic for Asian Americans (AA) in reaching glycemic target and to characterize factors affecting the attainment of glycemic control in comparison with white counterparts. Methods This electronic health record review included all new AA patients with type 2 diabetes (n = 109) in a culturally specific program and a randomly selected sample of new white patients with type 2 diabetes (n = 218) in the adult clinic within the same time period and diabetes center. Results AA and whites had a comparable proportion of patients with A1C ≤7% (32.1%, 34.9%; P = .621) at baseline and after 12 months of care (48.6%, 56.0%; P = .210), with a similar A1C decline (−0.9% ± 1.6%, −0.8% ± 1.7%, P = .710) by 12 months. Factors associated with the lack of success in reaching target in AA but not in whites included older age, lower educational attainment, less likelihood of having health insurance, and a need for more educational visits. The percentage of AA reaching A1C ≤7%, as compared to whites, worsened among those with highest initial A1C when stratified by ascending quartiles (96.7% vs 85.2%, P = .101; 61.9% vs 58.9%, P = .813; 24.0% vs 37.7%, P = .230; 15.2% vs 35.4%, P = .044). Conclusion While a culturally specific diabetes program in a specialty setting achieved a similar glycemic outcome for AA compared with whites, reasons for not reaching glycemic target differed. The findings suggest that the elimination of diabetes disparities requires not only culturally and linguistically specific programs, but must also identify and address the socio-environmental differences unique to each population. PMID:23771841

  17. Sodium–glucose cotransporter-2 inhibitor combination therapy to optimize glycemic control and tolerability in patients with type 2 diabetes: focus on dapagliflozin–metformin

    PubMed Central

    Schwartz, Stanley S; Katz, Arie

    2016-01-01

    In type 2 diabetes (T2D), early combination therapy using agents that target a number of the underlying pathophysiologic defects contributing to hyperglycemia may improve patient outcomes. For many patients, the combination of metformin with a sodium–glucose cotransporter-2 (SGLT-2) inhibitor may be a good option because these agents have complementary mechanisms of action, neutral-to-positive effects on body weight, and a low risk of hypoglycemia. This review focuses on the combination of metformin with dapagliflozin, a member of the SGLT-2 inhibitor class of antidiabetes agents. In clinical trials, the combination of dapagliflozin with metformin produced significant and sustained reductions in glycated hemoglobin and body weight in a broad range of adult patients with T2D, including those initiating pharmacotherapy and those with more advanced disease. These reductions were accompanied by modest decreases in blood pressure. Dapagliflozin as add-on therapy to metformin was well tolerated and associated with low rates of hypoglycemia. Genital infections and, in some studies, urinary tract infections were more frequent with dapagliflozin than with placebo. Early combination therapy with dapagliflozin and metformin may be a safe and appropriate treatment option that enables patients with T2D to achieve individualized glycemic goals as either initial combination therapy in treatment-naïve patients or as dapagliflozin add-on in patients inadequately controlled with metformin therapy. PMID:27042132

  18. In vitro starch digestibility and expected glycemic index of pound cakes baked in two-cycle microwave-toaster and conventional oven.

    PubMed

    García-zaragoza, Francisco J; Sánchez-Pardo, María E; Ortiz-Moreno, Alicia; Bello-Pérez, Luis A

    2010-11-01

    Bread baking technology has an important effect on starch digestibility measured as its predicted glycemic index tested in vitro. The aim of this work was to evaluate the changes in predicted glycemic index of pound cake baked in a two-cycle microwave toaster and a conventional oven. The glycemic index was calculated from hydrolysis index values by the Granfeldt method. Non-significant differences (P > 0.05) were found in hydrolysis index (60.67 ± 3.96 for the product baked in microwave oven and 65.94 ± 4.09 for the product baked in conventional oven) and predicted glycemic index content (60.5 for product baked in microwave oven and 65 for the product baked in conventional oven) in freshly-baked samples. Results clearly demonstrate that the baking pound cake conventional process could be replicated using a two-cycle multifunction microwave oven, reducing the traditional baking time. Further research is required in order to achieve pound cake crumb uniformity.

  19. Properties of starch from potatoes differing in glycemic index.

    PubMed

    Lin Ek, Kai; Wang, Shujun; Brand-Miller, Jennie; Copeland, Les

    2014-10-01

    Potatoes are a popular source of dietary carbohydrate worldwide and are generally considered to be a high glycemic index (GI) food. Potato starch characteristics play a key role in determining their rate of digestion and resulting glycemic response. Starches isolated from seven potato cultivars with different GI values, including a low GI cultivar (Carisma), were examined for relative crystallinity, granule size distribution, amylopectin chain length, and thermal and pasting properties. Starch from the Carisma cultivar was more thermally stable and more resistant to gelatinization, with significantly higher (p < 0.05) pasting temperature and differential scanning calorimetry (DSC) gelatinization onset, peak and conclusion temperatures, compared to the other cultivars. Differences between the potatoes in the other properties measured did not align with the GI ranking. Thermal analysis and starch pasting properties may be useful indicators for preliminary identification of potato cultivars that are digested slowly and have a lower GI.

  20. Effects of glycemic control on refraction in diabetic patients

    PubMed Central

    Li, Hai-Yan; Luo, Guo-Chun; Guo, Jiang; Liang, Zhen

    2010-01-01

    AIM To evaluate the effects of glycemic control on refraction in diabetic patients. METHODS Twenty newly diagnosed diabetic patients were included in this study. The random blood glucose, HbA1c levels, fasting C-peptide and postprandial 2h C-peptide were measured before treatment. The patients with random blood glucose higher than 12.0mmol/L and HbA1c level higher than 10.0% were selected. Refraction, intraocular pressure, radius of the anterior corneal curvature, depth of the anterior chamber, lens thickness, vitreous length, and axial length were measured on admission and at the end of week 1, 2, 3 and 4 during glycemic control. RESULTS A transient hyperopic change occurred in all the patients receiving glycemic control. The maximum hyperopic change was 1.60D (range 0.50±3.20D). Recovery of the previous refraction occurred between two and four weeks after insulin treatment. There was a positive correlation between the maximum hyperopic changes and the HbA1c levels on admission (r=0.84, P<0.05). There was a positive correlation between the maximum hyperopic changes and the daily rate of blood glucose reduction over the first 7 days of the treatment (r=0.53, P<0.05). During transient hyperopia, no significant changes were observed in the intraocular pressure, radius of the anterior corneal curvature, depth of the anterior chamber, lens thickness, vitreous length and axial length. CONCLUSION Transient hyperopic changes occur after glycemic control in diabetic patients with severe hyperglycemia. The degrees of transient hyperopia are highly dependent on HbA1c levels before treatment and the rate of reduction of the blood glucose level. PMID:22553542

  1. Effects of Glycemic Regulation on Chronic Postischemia Pain

    PubMed Central

    Ross-Huot, Marie-Christine; Laferrière, André; Gi, Cho Min; Khorashadi, Mina; Schricker, Thomas; Coderre, Terence J.

    2015-01-01

    Background Ischemia-reperfusion (I/R) injuries consist of enhanced oxidative and inflammatory responses along with microvascular dysfunction following prolonged ischemia and reperfusion. Since I/R injuries induce chronic postischemia pain (CPIP) in laboratory animals, it is possible that surgical procedures utilizing prolonged ischemia may result in chronic postoperative pain. Glycemic modulation during ischemia and reperfusion could impact pain following I/R injury, as glucose triggers oxidative, inflammatory and thrombotic reactions, whereas insulin has anti-oxidative, anti-inflammatory and vasodilatory properties. Methods 110 rats underwent a 3-h period of ischemia followed by reperfusion to produce CPIP. CPIP rats had previously been divided into 6 groups with differing glycemic-modulation paradigms: 1) normal feeding; 2) fasting; 3) fasting with normal saline administration; 4) fasting with dextrose administration; 5) normal feeding with insulin administration; and 6) normal feeding with dextrose and insulin administration. Blood glucose levels were assessed during ischemia and reperfusion in these separate groups of rats, and they were tested for mechanical and cold allodynia over the following 21 days (on days 2, 5, 7, 9, 12 and 21 post-I/R injury). Results I/R injury in rats with normoglycemia or relative hyperglycemia (groups 1, 4) led to significant mechanical and cold allodynia; conversely, relative hypoglycemia associated with insulin treatment or fasting (groups 2, 3, and 5) reduced allodynia induced by I/R injury. Importantly, insulin treatment did not reduce allodynia when administered to fed rats given dextrose (group 6). Conclusion Our results suggest that glycemic levels at the time of I/R injury significantly modulate postinjury pain thresholds in CPIP rats. Strict glycemic control during I/R injury significantly reduces CPIP pain and, and conversely, hyperglycemia significantly enhances it, which could have potential clinical applications

  2. Glycemic response of mashed potato containing high-viscocity hydroxypropylmethylcellulose.

    PubMed

    Lightowler, Helen J; Henry, C Jeya K

    2009-08-01

    Potatoes generally have one of the highest glycemic index values of any food. Relatively small differences in the glycemic response (GR) of regularly consumed starch foods have shown beneficial effects on health. Lowering the GR of a potato-based meal has potentially wide-reaching health benefits. High-viscosity hydroxypropylmethylcellulose (HV-HPMC) is a modified cellulose dietary fiber extensively used in the food industry. We hypothesized that the GR of a high-glycemic index product such as mashed potato would be lower with the addition of HV-HPMC. In a nonblind, randomized, repeat-measure, crossover controlled trial, 15 healthy adults consumed portions of mashed potato with different doses (0%, 1%, 2%, and 4%) of a specially selected and optimized HV-HPMC and a reference food (glucose) on separate occasions. Five subjects were excluded from the final analysis due to noncompliance with study procedures. Capillary blood glucose was measured in fasted subjects and at 15, 30, 45, 60, 90, and 120 minutes after starting to eat. For each sample, the incremental area under the blood glucose response curve was calculated and the GR determined. There was a significant lowering effect of HV-HPMC on GR (P < .001) of mashed potato. Glycemic responses for all mashed potato samples with the HV-HPMC were significantly lower than the standard mashed potato: 1% level (P < .05), 2% level (P < .05), and 4% level (P < .05). However, there was no significant effect of the HV-HPMC dose on GR. We conclude that addition of select HV-HPMC to mashed potato blunts GR.

  3. Identifying older diabetic patients at risk of poor glycemic control

    PubMed Central

    Incalzi, Raffaele Antonelli; Corsonello, Andrea; Pedone, Claudio; Corica, Francesco; Carosella, Luciana; Mazzei, Bruno; Perticone, Francesco; Carbonin, PierUgo

    2002-01-01

    Background Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. Methods A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia ≥ 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia ≥ 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population. Results Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143–218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia ≥ 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia ≥ 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population. Conclusion A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control. PMID:12194701

  4. Non-High-Density Lipoprotein Cholesterol in Children with Diabetes: Proposed Treatment Recommendations Based on Glycemic Control, Body Mass Index, Age, Sex, and Generally Accepted Cut Points.

    PubMed

    Schwab, K Otfried; Doerfer, Jürgen; Hungele, Andreas; Scheuing, Nicole; Krebs, Andreas; Dost, Axel; Rohrer, Tilman R; Hofer, Sabine; Holl, Reinhard W

    2015-12-01

    Percentile-based non-high-density lipoprotein cholesterol levels were analyzed by glycemic control, weight, age, and sex of children with type 1 diabetes (n = 26,358). Ten percent of all children and 25% of overweight adolescent girls require both immediate lipid-lowering medication and lifestyle changes to achieve non-high-density lipoprotein cholesterol levels <120 mg/dL and cardiovascular risk reduction.

  5. Relationships among different glycemic variability indices obtained by continuous glucose monitoring.

    PubMed

    Saisho, Yoshifumi; Tanaka, Chihiro; Tanaka, Kumiko; Roberts, Rachel; Abe, Takayuki; Tanaka, Masami; Meguro, Shu; Irie, Junichiro; Kawai, Toshihide; Itoh, Hiroshi

    2015-08-01

    The aim of this study was to assess the relationships among indices of glycemic variability obtained by continuous glucose monitoring (CGM). CGM was performed in 88 patients with diabetes (20 type 1 and 68 type 2 diabetes, age 59 ± 15 years) admitted to our hospital (Keio University Hospital, Tokyo, Japan) between 2010 and 2012. Mean glucose, glucose standard deviation (SDglu) and other glycemic indices such as index of glycemic control (ICG), J-index, mean of daily differences (MODD), continuous overlapping net glycemic action 1 (CONGA1), mean amplitude of glycemic excursions (MAGE) and M value were calculated from CGM data, and the correlations among these indices were assessed. There were strong correlations between SDglu and the indices MAGE, CONGA1, MODD and M value (all r > 0.8, P < 0.05). On the other hand, mean glucose was strongly correlated with J index and M value (both r > 0.8, P < 0.05). SDglu and other glycemic variability indices were more strongly correlated with hypoglycemia than was mean glucose, and the combination of mean glucose and SDglu was useful for predicting hypoglycemia in patients with diabetes. In this study, we demonstrated the characteristics of various glycemic variability indices in relation to mean glucose and SDglu. This information will help physicians to understand the characteristics of various glycemic variability indices and to select an appropriate index for their purpose. Our results also underpin the importance of glycemic variability in relation to risk of hypoglycemia in patients with diabetes.

  6. Glibenclamide or metformin combined with honey improves glycemic control in streptozotocin-induced diabetic rats.

    PubMed

    Erejuwa, Omotayo Owomofoyon; Sulaiman, Siti Amrah; Wahab, Mohd Suhaimi Ab; Sirajudeen, Kuttulebbai Nainamohammed Salam; Salleh, Md Salzihan Md; Gurtu, Sunil

    2011-03-14

    Diabetes mellitus is associated with deterioration of glycemic control and progressive metabolic derangements. This study investigated the effect of honey as an adjunct to glibenclamide or metformin on glycemic control in streptozotocin-induced diabetic rats. Diabetes was induced in rats by streptozotocin. The diabetic rats were randomized into six groups and administered distilled water, honey, glibenclamide, glibenclamide and honey, metformin or metformin and honey. The animals were treated orally once daily for four weeks. The diabetic control rats showed hypoinsulinemia (0.27 ± 0.01 ng/ml), hyperglycemia (22.4 ± 1.0 mmol/L) and increased fructosamine (360.0 ± 15.6 µmol/L). Honey significantly increased insulin (0.41 ± 0.06 ng/ml), decreased hyperglycemia (12.3 ± 3.1 mmol/L) and fructosamine (304.5 ± 10.1 µmol/L). Although glibenclamide or metformin alone significantly (p < 0.05) reduced hyperglycemia, glibenclamide or metformin combined with honey produced significantly much lower blood glucose (8.8 ± 2.9 or 9.9 ± 3.3 mmol/L, respectively) compared to glibenclamide or metformin alone (13.9 ± 3.4 or 13.2 ± 2.9 mmol/L, respectively). Similarly, glibenclamide or metformin combined with honey produced significantly (p < 0.05) lower fructosamine levels (301.3 ± 19.5 or 285.8 ± 22.6 µmol/L, respectively) whereas glibenclamide or metformin alone did not decrease fructosamine (330.0 ± 29.9 or 314.6 ± 17.9 µmol/L, respectively). Besides, these drugs or their combination with honey increased insulin levels. Glibenclamide or metformin combined with honey also significantly reduced the elevated levels of creatinine, bilirubin, triglycerides, and VLDL cholesterol. These results indicate that combination of glibenclamide or metformin with honey improves glycemic control, and provides additional metabolic benefits, not achieved with either glibenclamide or metformin alone.

  7. Improvement of Glycemic Control in Insulin-Dependent Diabetics with Depression by Concomitant Treatment with Antidepressants

    PubMed Central

    Radojkovic, Jana; Sikanic, Natasa; Bukumiric, Zoran; Tadic, Marijana; Kostic, Nada; Babic, Rade

    2016-01-01

    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/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. PMID:27329213

  8. Vasculogenesis and Diabetic Erectile Dysfunction: How Relevant Is Glycemic Control?

    PubMed

    Castela, Angela; Gomes, Pedro; Silvestre, Ricardo; Guardão, Luísa; Leite, Liliana; Chilro, Rui; Rodrigues, Ilda; Vendeira, Pedro; Virag, Ronald; Costa, Carla

    2017-01-01

    Erectile dysfunction (ED) is a complication of diabetes, condition responsible for causing endothelial dysfunction (EDys) and hampering repair mechanisms. However, scarce information is available linking vasculogenesis mediated by Endothelial Progenitor Cells (EPCs) and diabetes-associated ED. Furthermore, it remains to be elucidated if glycemic control plays a role on EPCs functions, EPCs modulators, and penile vascular health. We evaluated the effects of diabetes and insulin therapy on bone marrow (BM) and circulating EPCs, testosterone, and systemic/penile Stromal Derived Factor-1 alpha (SDF-1α) expression. Male Wistar rats were divided into groups: age-matched controls, 8-weeks streptozotocin-induced type 1 diabetics, and insulin-treated 8-weeks diabetics. EPCs were identified by flow cytometry for CD34/CD133/VEGFR2/CXCR4 antigens. Systemic SDF-1α and testosterone levels were evaluated by ELISA. Penile SDF-1α protein expression was assessed, in experimental and human diabetic cavernosal samples, by immunohistochemical techniques. Diabetic animals presented a reduction of BM-derived EPCs and an increase in putative circulating endothelial cells (CECs) sloughed from vessels wall. These alterations were rescued by insulin therapy. In addition, glycemic control promoted an increase in systemic testosterone and SDF-1α levels, which were significantly decreased in animals with diabetes. SDF-1α protein expression was reduced in experimental and human cavernosal diabetic samples, an effect prevented by insulin in treated animals. Insulin administration rescued the effects of diabetes on BM function, CECs levels, testosterone, and plasmatic/penile SDF-1α protein expression. This emphasizes the importance of glycemic control in the prevention of diabetes-induced systemic and penile EDys, by the amelioration of endothelial damage, and increase in protective pathways. J. Cell. Biochem. 118: 82-91, 2017. © 2016 Wiley Periodicals, Inc.

  9. Glycemic Control and Urinary Incontinence in Women with Diabetes Mellitus

    PubMed Central

    Karter, Andrew J.; Thai, Julie N.; Van Den Eeden, Stephen K.; Huang, Elbert S.

    2013-01-01

    Abstract Background Although many studies have shown that diabetes increases the risk for urinary incontinence, it is unclear whether poor glycemic control in women with diabetes is associated with incontinence. This study aims to determine the relationship between the hemoglobin A1c (HbA1c) level and urinary incontinence in a large, diverse cohort of older women. Methods We examined 6026 older women who responded to a survey (62% response rate) and were enrolled in the Diabetes and Aging Study, an ethnically stratified random sample of patients with diabetes enrolled in Kaiser Permanente Northern California. Our primary independent variable was the mean of all HbA1c measurements in the year preceding the survey. Outcomes included the presence/absence of incontinence and limitations in daily activities due to incontinence. We used modified Poisson regression and ordinal logistic regression models to account for age, race, body mass index, parity, diabetes treatment, duration of diabetes, and comorbidity. Results Sixty-five percent of women reported incontinence (mean age 59±10 years). After adjustment, HbA1c levels were not associated with the presence or absence of incontinence. However, among women reporting incontinence, HbA1c ≥9% was associated with more limitations due to incontinence than HbA1c <6% (adjusted odds ratio 1.67, 95% confidence interval: 1.09–2.57). Conclusion In this cross-sectional analysis, HbA1c level is not associated with the presence or absence of incontinence. However, for women with incontinence, poor glycemic control (HbA1c ≥9%) is associated with more limitations in daily activities due to incontinence. Longitudinal studies are needed to determine whether improving glycemic control to HbA1c <9% leads to fewer limitations in daily activities due to incontinence. PMID:24032999

  10. Effect of Fructose on Glycemic Control in Diabetes

    PubMed Central

    Cozma, Adrian I.; Sievenpiper, John L.; de Souza, Russell J.; Chiavaroli, Laura; Ha, Vanessa; Wang, D. David; Mirrahimi, Arash; Yu, Matt E.; Carleton, Amanda J.; Di Buono, Marco; Jenkins, Alexandra L.; Leiter, Lawrence A.; Wolever, Thomas M.S.; Beyene, Joseph; Kendall, Cyril W.C.; Jenkins, David J.A.

    2012-01-01

    OBJECTIVE The effect of fructose on cardiometabolic risk in humans is controversial. We conducted a systematic review and meta-analysis of controlled feeding trials to clarify the effect of fructose on glycemic control in individuals with diabetes. RESEARCH DESIGN AND METHODS We searched MEDLINE, EMBASE, and the Cochrane Library (through 22 March 2012) for relevant trials lasting ≥7 days. Data were aggregated by the generic inverse variance method (random-effects models) and expressed as mean difference (MD) for fasting glucose and insulin and standardized MD (SMD) with 95% CI for glycated hemoglobin (HbA1c) and glycated albumin. Heterogeneity was assessed by the Cochran Q statistic and quantified by the I2 statistic. Trial quality was assessed by the Heyland methodological quality score (MQS). RESULTS Eighteen trials (n = 209) met the eligibility criteria. Isocaloric exchange of fructose for carbohydrate reduced glycated blood proteins (SMD −0.25 [95% CI −0.46 to −0.04]; P = 0.02) with significant intertrial heterogeneity (I2 = 63%; P = 0.001). This reduction is equivalent to a ∼0.53% reduction in HbA1c. Fructose consumption did not significantly affect fasting glucose or insulin. A priori subgroup analyses showed no evidence of effect modification on any end point. CONCLUSIONS Isocaloric exchange of fructose for other carbohydrate improves long-term glycemic control, as assessed by glycated blood proteins, without affecting insulin in people with diabetes. Generalizability may be limited because most of the trials were <12 weeks and had relatively low MQS (<8). To confirm these findings, larger and longer fructose feeding trials assessing both possible glycemic benefit and adverse metabolic effects are required. PMID:22723585

  11. Patient Age, Ethnicity, Medical History, and Risk Factor Profile, but Not Drug Insurance Coverage, Predict Successful Attainment of Glycemic Targets

    PubMed Central

    Teoh, Hwee; Braga, Manoela F.B.; Casanova, Amparo; Drouin, Denis; Goodman, Shaun G.; Harris, Stewart B.; Langer, Anatoly; Tan, Mary K.; Ur, Ehud; Yan, Andrew T.; Zinman, Bernard; Leiter, Lawrence A.

    2010-01-01

    OBJECTIVE To identify factors in patients with type 2 diabetes and A1C >7.0% associated with attainment of A1C ≤7.0%. RESEARCH DESIGN AND METHODS We used a prospective registry of 5,280 Canadian patients in primary care settings enrolled in a 12-month glycemic pharmacotherapy optimization strategy based on national guidelines. RESULTS At close out, median A1C was 7.1% (vs. 7.8% at baseline) with 48% of subjects achieving A1C ≤7.0% (P < 0.0001). Older patients of Asian or black origin, those with longer diabetes duration, those with lower baseline A1C, BMI, LDL cholesterol, and blood pressure, and those on angiotensin receptor blockers and a lower number of antihyperglycemic agents, were more likely to achieve A1C ≤7.0% at some point during the study (all P < 0.0235). Access to private versus public drug coverage did not impact glycemic target realization. CONCLUSIONS Patient demography, cardiometabolic health, and ongoing pharmacotherapy, but not access to private drug insurance coverage, contribute to the care gap in type 2 diabetes. PMID:20823344

  12. GLYCEMIC INDEX, CHOLECYSTOKININ, SATIETY AND DISINHIBITION: IS THERE AN UNAPPRECIATED PARADOX FOR OVERWEIGHT WOMEN?

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The clinical utility of a low glycemic index (GI) diet for appetite and food intake control is controversial. Complicating the issue is psychological and behavioral influences related to eating. The aim of the present study was to investigate the satiety and glycemic response to high and low GI meal...

  13. The Potential of an in Vitro Digestion Method for Predicting Glycemic Response of Foods and Meals

    PubMed Central

    Argyri, Konstantina; Athanasatou, Adelais; Bouga, Maria; Kapsokefalou, Maria

    2016-01-01

    Increased interest in glycemic response derives from its linkage with chronic diseases, including obesity and type 2 diabetes. Our objective was to develop an in vitro method that predicts glycemic response. We proposed a simulated gastrointestinal digestion protocol that uses the concentration of dialyzable glucose (glucose in the soluble low molecular weight fraction of digests) as an index for the prediction of glycemic response. For protocol evaluation, dialyzable glucose from 30 foods or meals digested in vitro were compared with published values for their glycemic index (GI) (nine foods), glycemic load (GL) (16 foods) and glycemic response (14 meals). The correlations were significant when comparing dialyzable glucose with GL (Spearman’s rho = 0.953, p < 0.001), GI (Spearman’s rho = 0.800, p = 0.010) and glycemic response (Spearman’s rho = 0.736, p = 0.003). These results demonstrate that despite limitations associated with in vitro approaches, the proposed protocol may be a useful tool for predicting glycemic response of foods or meals.

  14. Glycemic carbohydrate and health: background and synopsis of the symposium.

    PubMed

    Kimura, Shuichi

    2003-05-01

    Carbohydrates are global foodstuffs and important energy sources. They also influence many physiologic functions, including brain function and physical performance and are ultimately related to human health. In 1998, ILSI Japan formed a team to conduct research on "The Medical and Nutritional Aspects of Sugars." The research included studies of several new aspects of the metabolic characteristics and physiologic effects of sugars. This paper presents some highlights of our research, including the background of the project, the metabolic characteristics of sugars, and the effect of sugars on glycemic response, memory, and appetite and food intake in humans, etc.

  15. Children's glycemic control: mother's knowledge and socioeconomic status.

    PubMed

    Al-Odayani, Abdulrahman Nasser; Alsharqi, Omar Zayyan; Ahmad, Alaeddin Mohammad Khalaf; Khalaf Ahmad, Ala'eddin Mohammad; Al-Borie, Hussein Mohammad; Qattan, Ameerah M N

    2013-10-29

    The present study was designed to examine the role of socioeconomic status (SES) of the mother's knowledge about different aspects of diabetes and the glycemic control of type 1 children with diabetes. Samples were taken from successive admissions to the outpatient diabetes clinics in Prince Sultan Medical Military City (PSMMC), Riyadh, Saudi Arabia. A well designed questionnaire covering different aspects including demographic data, educational background, and socioeconomic status of the care providers was used to collect information from mothers of type 1 diabetes mellitus (T1DM) children. The questionnaire was designed on the basis of the Michigan diabetes knowledge scale and also on the basis of food habits of Saudi Arabia and it was validated. The questionnaire was completed after interviewing the mothers during visits to the PSMMC hospital. Every mother was asked with those particular questions. Glycemic control was assessed by glycosylated haemoglobin (HbA1c). The socio-demographic data of mothers was recorded by self-report. It was found that, there was significant variation in the knowledge of diabetes among mothers with different ages (P 0.05). No significant results were observed between family income and diabetes knowledge (p>0.05).However, a positive relationship was observed with higher income and higher knowledge. There was a significant association between mothers knowledge of diabetes and HbA1C level (r = -0.1739, p.<0.05) indicating that, higher knowledge ultimately leads to greater control of HbA1c level. A significant association was also observed between education and HbA1c level (r=-02538, p<0.05) with children of mothers with higher level of education showing a better control of glycated haemoglobin levels. However, no significant association was found between monthly family income and HbA1C level. In conclusion, the current study illustrated that, mothers with more knowledge of diabetes and with better education were maintaining a better

  16. Endoplasmic reticulum stress and Nrf2 repression in circulating cells of type 2 diabetic patients without the recommended glycemic goals.

    PubMed

    Mozzini, C; Garbin, U; Stranieri, C; Pasini, A; Solani, E; Tinelli, I A; Cominacini, L; Fratta Pasini, A M

    2015-03-01

    Endoplasmic reticulum (ER) stress plays a role in the pathogenesis of type 2 diabetes mellitus (T2DM), with activation of the unfolded protein response (UPR) and ER apoptosis in β-cells. The aim of the study is investigating the role of the prolonged glycemic, inflammatory, and oxidative impairment as possible UPR and ER apoptosis inductors in triggering the ER stress response and the protective nuclear erythroid-related factor 2 (Nrf2)/antioxidant-related element (ARE) activation in peripheral blood mononuclear cells (PBMC) of T2DM patients without glycemic target. Oxidative stress markers (oxidation product of phospholipid 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine [oxPAPC], and malondialdehyde [MDA]), the UPR and ER apoptosis, the activation of the pro-inflammatory nuclear factor-kappa B (NF-kB) with its inhibitory protein inhibitor-kBα, and the expression of the protective Nrf2 and heme oxygenase-1 (HO-1) were evaluated in PBMC of 15 T2DM patients and 15 healthy controls (C). OxPAPC concentrations (in PBMC and plasma), MDA levels (in plasma), the expressions of the glucose-regulated protein 78 kDa (or BiP) as representative of UPR, and of the CCAAT/enhancer-binding protein homologous protein as representative of ER apoptosis were significantly higher (p < 0.01) in T2DM with respect to C. IkBα expression was significantly lower (p < 0.01) in T2DM as well as Nrf2 and HO-1. In vitro experiments demonstrated that hyperglycemic conditions, if prolonged, were NF-kB inductors, without a corresponding Nrf2/ARE response. In PBMC of T2DM without glycemic target achievement, there is an activation of the UPR and of the ER apoptosis, which may be related to the chronic exposure to hyperglycemia, to the augmented inflammation, and to the augmented oxidative stress, without a corresponding Nrf2/ARE defense activation.

  17. Differences in glycemic control across world regions: a post-hoc analysis in patients with type 2 diabetes mellitus on dual antidiabetes drug therapy

    PubMed Central

    Brath, H; Paldánius, P M; Bader, G; Kolaczynski, W M; Nilsson, P M

    2016-01-01

    Objective: This post-hoc analysis of the EDGE (Effectiveness of Diabetes control with vildaGliptin and vildagliptin/mEtformin) study assessed inter-regional differences in baseline characteristics and response to treatment intensification with dual oral antidiabetes drugs (OADs) in patients with type 2 diabetes mellitus (T2DM). Methods: Patients with T2DM inadequately controlled with first-line monotherapy were assigned to receive a dipeptidyl peptidase-4 (DPP-4) inhibitor, vildagliptin, or comparator OADs as add-on dual therapy. The primary effectiveness end point (PEP) was achieving glycated hemoglobin (HbA1c) reduction >0.3% without hypoglycemia, peripheral edema, discontinuation owing to gastrointestinal events or weight gain ⩾5% at 12 months. The secondary effectiveness end point (SEP) was achieving HbA1c of <7% without hypoglycemia or weight gain ⩾3% at 12 months. Results: Baseline characteristics of patients (N=43 791), including mean HbA1c (8.2%), varied across regions. Baseline age (62.3 years) and T2DM duration (6.3 years) were greater in patients from Europe than those from India and the Middle East (age: 51.8 and 52.1 years; T2DM duration: 4.3 and 4.2 years, respectively). The probability of achieving PEP with dual therapy was higher in India (odds ratio (OR): 1.5), Latin America (OR: 1.2) and Middle East (OR: 2.0) than in Europe (OR: 0.8) and East Asia (OR: 0.3). Achievement of SEP in patients receiving dual therapy was greater in Latin America (OR: 1.7) and Middle East (OR: 1.7). Vildagliptin add-on therapy allowed more patients to achieve SEP across regions. Women aged ⩾45 years less often attained glycemic target (HbA1c<7%) without significant weight gain ⩾5% compared with women aged <45 years (OR: 0.876, 95% confidence interval: 0.774, 0.992; P=0.037). Conclusions: Baseline HbA1c and T2DM duration differed considerably across all regions. Treatment intensification with second OAD, particularly with a DPP-4 inhibitor vildagliptin, resulted

  18. Gluten-free snacks using plantain-chickpea and maize blend: chemical composition, starch digestibility, and predicted glycemic index.

    PubMed

    Flores-Silva, Pamela C; Rodriguez-Ambriz, Sandra L; Bello-Pérez, Luis A

    2015-05-01

    An increase in celiac consumers has caused an increasing interest to develop good quality gluten-free food products with high nutritional value. Snack foods are consumed worldwide and have become a normal part of the eating habits of the celiac population making them a target to improve their nutritive value. Extrusion and deep-frying of unripe plantain, chickpea, and maize flours blends produced gluten-free snacks with high dietary fiber contents (13.7-18.2 g/100 g) and low predicted glycemic index (28 to 35). The gluten-free snacks presented lower fat content (12.7 to 13.6 g/100 g) than those reported in similar commercial snacks. The snack with the highest unripe plantain flour showed higher slowly digestible starch (11.6 and 13.4 g/100 g) than its counterpart with the highest chickpea flour level (6 g/100 g). The overall acceptability of the gluten-free snacks was similar to that chili-flavored commercial snack. It was possible to develop gluten-free snacks with high dietary fiber content and low predicted glycemic index with the blend of the 3 flours, and these gluten-free snacks may also be useful as an alternative to reduce excess weight and obesity problems in the general population and celiac community.

  19. Plasma Proteins Modified by Advanced Glycation End Products (AGEs) Reveal Site-specific Susceptibilities to Glycemic Control in Patients with Type 2 Diabetes.

    PubMed

    Greifenhagen, Uta; Frolov, Andrej; Blüher, Matthias; Hoffmann, Ralf

    2016-04-29

    Protein glycation refers to the reversible reaction between aldoses (or ketoses) and amino groups yielding relatively stable Amadori (or Heyns) products. Consecutive oxidative cleavage reactions of these products or the reaction of amino groups with other reactive substances (e.g. α-dicarbonyls) yield advanced glycation end products (AGEs) that can alter the structures and functions of proteins. AGEs have been identified in all organisms, and their contents appear to rise with some diseases, such as diabetes and obesity. Here, we report a pilot study using highly sensitive and specific proteomics approach to identify and quantify AGE modification sites in plasma proteins by reversed phase HPLC mass spectrometry in tryptic plasma digests. In total, 19 AGE modification sites corresponding to 11 proteins were identified in patients with type 2 diabetes mellitus under poor glycemic control. The modification degrees of 15 modification sites did not differ among cohorts of normoglycemic lean or obese and type 2 diabetes mellitus patients under good and poor glycemic control. The contents of two amide-AGEs in human serum albumin and apolipoprotein A-II were significantly higher in patients with poor glycemic control, although the plasma levels of both proteins were similar among all plasma samples. These two modification sites might be useful to predict long term, AGE-related complications in diabetic patients, such as impaired vision, increased arterial stiffness, or decreased kidney function.

  20. Effects of Carbohydrate and Dietary Fiber Intake, Glycemic Index and Glycemic Load on HDL Metabolism in Asian Populations.

    PubMed

    Yanai, Hidekatsu; Katsuyama, Hisayuki; Hamasaki, Hidetaka; Abe, Shinichi; Tada, Norio; Sako, Akahito

    2014-10-01

    High-density lipoprotein (HDL) is a lipoprotein which has anti-atherogenic property by reverse cholesterol transport from the peripheral tissues to liver. Low HDL-cholesterol (HDL-C) levels are associated with the development of coronary artery diseases (CADs). Various epidemiological studies have suggested that the development of CAD increase in individuals with less than 40 mg/dL of HDL-C. In spite of accumulation of evidences which suggest a significant association between low HDL-C and cardiovascular diseases, effects of dietary factors on HDL metabolism remained largely unknown. There may be interracial differences in effects of dietary factors on HDL metabolism. Here we reviewed published articles about effects of carbohydrate and dietary fiber intake, glycemic index (GI) and glycemic load (GL), on HDL-C metabolism, regarding meta-analyses and clinical studies performed in Asian population as important articles. Low carbohydrate intake, GI and GL may be beneficially associated with HDL metabolism. Dietary fiber intake may be favorably associated with HDL metabolism in Asian populations.

  1. Trace elements, oxidative stress and glycemic control in young people with type 1 diabetes mellitus.

    PubMed

    Lin, Ching-Chiang; Huang, Hsiu-Hua; Hu, Chiung-Wen; Chen, Bai-Hsiun; Chong, Inn-Wen; Chao, Yu-Ying; Huang, Yeou-Lih

    2014-01-01

    Trace elements and oxidative stress are associated with glycemic control and diabetic complications in type 1 diabetes mellitus. In this study, we analyzed the levels of serum copper, zinc, superoxide dismutase (SOD) activity, and malondialdehyde (MDA) and urinary MDA and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in 33 type 1 diabetic patients with optimal and suboptimal glycemic control (HbA1C<9.0%) and 40 patients with poor glycemic control (HbA1C≥9%) and 27 age- and sex-matched non-diabetic controls to evaluate the differences between these markers in different glycemic control states. Diabetic patients, especially poor-glycemic-control subjects (HbA1C≥9%), exhibited significantly lower levels of serum zinc and increased levels of serum copper (and, therefore, increased serum copper-to-zinc ratios), serum SOD, blood MDA, and urinary MDA and 8-OHdG, relative to non-diabetic subjects. Furthermore, significant correlations existed in these patients between the serum copper, serum copper-to-zinc ratio, and urinary MDA (all p<0.001) and the levels of urinary 8-OHdG (p=0.007) and HbA1C. Our results suggest that high serum copper levels and oxidative stress correlate with glycemic control. Therefore, strict glycemic control, decreased oxidative stress, and a lower copper concentration might prevent diabetic complications in patients with type 1 diabetes mellitus.

  2. Correlation Between Glycemic Control and the Incidence of Peritoneal and Catheter Tunnel and Exit-Site Infections in Diabetic Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Rodríguez-Carmona, Ana; Pérez-Fontán, Miguel; López-Muñiz, Andrés; Ferreiro-Hermida, Tamara; García-Falcón, Teresa

    2014-01-01

    ♦ Background: Diabetes mellitus, especially if complicated by poor glycemic control, portends an increased risk of infection. The significance of this association in the case of diabetic patients undergoing peritoneal dialysis (PD) has not been assessed. ♦ Methods: Using a retrospective observational design, we analyzed the association between glycemic control at the start of PD (estimated from glycosylated hemoglobin levels) and the risk of peritoneal and catheter tunnel and exit-site infections during follow-up in 183 incident patients on PD. We used the median value of glycosylated hemoglobin to classify patients into good (group A) or poor (group B) glycemic control groups. We applied multivariate strategies of analysis to control for other potential predictors of PD-related infection. ♦ Results: Groups A and B differed significantly in age, dialysis vintage, use of insulin, and rate of Staphylococcus aureus carriage. Neither the incidence (0.60 episodes in group A vs 0.56 episodes in group B per patient-year) nor the time to a first peritoneal infection (median: 42 months vs 38 months) differed significantly between the study groups. In contrast, group B had a significantly higher incidence of catheter tunnel and exit-site infections (0.23 episodes vs 0.12 episodes per patient-year) and shorter time to a first infection episode (64 months vs 76 months, p = 0.004). The difference persisted in multivariate analysis (adjusted hazard ratio: 2.65; 95% confidence interval: 1.13 to 6.05; p = 0.013). We observed no differences between the study groups in the spectrum of causative organisms or in the outcomes of PD-related infections. ♦ Conclusions: Poor glycemic control is a consistent predictor of subsequent risk of catheter tunnel and exit-site infection, but not of peritoneal infection, among diabetic patients starting PD therapy. PMID:23818005

  3. Intensive glycemic control after heart transplantation is safe and effective for diabetic and non-diabetic patients.

    PubMed

    Garcia, Cristina; Wallia, Amisha; Gupta, Suruchi; Schmidt, Kathleen; Malekar-Raikar, Shilpa; Johnson Oakes, Diana; Aleppo, Grazia; Grady, Kathleen; McGee, Edwin; Cotts, William; Andrei, Adin-Cristian; Molitch, Mark E

    2013-01-01

    Some studies have shown increased mortality, infection, and rejection rates among diabetic (DM) compared to non-diabetic (non-DM) patients undergoing heart transplant (HT). This is a retrospective chart review of adult patients (DM, n = 26; non-DM, n = 66) undergoing HT between June 1, 2005, and July 31, 2009. Glycemic control used intravenous (IV) and subcutaneous (SQ) insulin protocols with a glucose target of 80-110 mg/dL. There were no significant differences between DM and non-DM patients in mean glucose levels on the IV and SQ insulin protocols. Severe hypoglycemia (glucose <40 mg/dL) did not occur on the IV protocol and was experienced by only 3 non-DM patients on the SQ protocol. Moderate hypoglycemia (glucose >40 and <60 mg/dL) occurred in 17 (19%) patients on the IV protocol and 24 (27%) on the SQ protocol. There were no significant differences between DM and non-DM patients within 30 d of surgery in all-cause mortality, treated HT rejection episodes, reoperation, prolonged ventilation, 30-d readmissions, ICU readmission, number of ICU hours, hospitalization days after HT, or infections. This study demonstrates that DM and non-DM patients can achieve excellent glycemic control post-HT with IV and SQ insulin protocols with similar surgical outcomes and low hypoglycemia rates.

  4. The effect of three snack bars on glycemic response in healthy adults.

    PubMed

    Miller, Carla K; Gabbay, Robert A; Dillon, Judith; Apgar, Joan; Miller, Debra

    2006-05-01

    Many consumers prefer convenient, portable, and preportioned snack foods. Foods with a lower glycemic response are associated with reduced risk for chronic disease. The glycemic index and glycemic load of three nationally available snack bars were determined. Ten subjects, with mean age (+/-standard deviation) of 29+/-7 years and mean body mass index (+/-standard deviation) of 25.3+/-3.2, were tested on four occasions on nonconsecutive days. After an overnight fast, subjects consumed 50 g of available carbohydrate as a glucose beverage or as a portion of one of three bars: SmartZone nutrition bar (The Hershey Co, Hershey, PA), ZonePerfect nutrition bar (Abbott Laboratories, Abbott Park, IL), or SlimFast meal bar (SlimFast Foods Co, West Palm Beach, FL). Blood glucose was tested at 0, 15, 30, 45, 60, 90, and 120 minutes after consumption. Incremental area under the glucose response curve was calculated for each test bar and compared with that of the glucose beverage to determine glycemic index. The glycemic index (+/-standard error of the mean) for SmartZone was 10.9+/-3.9 and was significantly less (P<0.05) than that of ZonePerfect (43.7+/-7.3) or SlimFast (63.8+/-13.0). The glycemic loads (+/-standard error of the mean) for the SmartZone (2.0+/-0.7) and ZonePerfect (8.3+/-1.4) bars were significantly less (P<0.05) than the glycemic load of the SlimFast bar (21.1+/-4.3). Although the long-term impact of snack foods with a lower glycemic load requires further research, the SmartZone and ZonePerfect bars provide a lower glycemic response for consumers.

  5. Periprocedural glycemic control in patients with diabetes mellitus undergoing coronary angiography with possible percutaneous coronary intervention.

    PubMed

    Shah, Binita; Berger, Jeffrey S; Amoroso, Nicholas S; Mai, Xingchen; Lorin, Jeffrey D; Danoff, Ann; Schwartzbard, Arthur Z; Lobach, Iryna; Guo, Yu; Feit, Frederick; Slater, James; Attubato, Michael J; Sedlis, Steven P

    2014-05-01

    Periprocedural hyperglycemia is an independent predictor of mortality in patients who underwent percutaneous coronary intervention (PCI). However, periprocedural management of blood glucose is not standardized. The effects of routinely continuing long-acting glucose-lowering medications before coronary angiography with possible PCI on periprocedural glycemic control have not been investigated. Patients with diabetes mellitus (DM; n = 172) were randomized to continue (Continue group; n = 86) or hold (Hold group; n = 86) their clinically prescribed long-acting glucose-lowering medications before the procedure. The primary end point was glucose level on procedural access. In a subset of patients (no DM group: n = 25; Continue group: n = 25; and Hold group: n = 25), selected measures of platelet activity that change acutely were assessed. Patients with DM randomized to the Continue group had lower blood glucose levels on procedural access compared with those randomized to the Hold group (117 [97 to 151] vs 134 [117 to 172] mg/dl, p = 0.002). There were two hypoglycemic events in the Continue group and none in the Hold group, and no adverse events in either group. Selected markers of platelet activity differed across the no DM, Continue, and Hold groups (leukocyte platelet aggregates: 8.1% [7.2 to 10.4], 8.7% [6.9 to 11.4], 10.9% [8.6 to 14.7], p = 0.007; monocyte platelet aggregates: 14.0% [10.3 to 16.3], 20.8% [16.2 to 27.0], 22.5% [15.2 to 35.4], p <0.001; soluble p-selectin: 51.9 ng/ml [39.7 to 74.0], 59.1 ng/ml [46.8 to 73.2], 72.2 ng/ml [58.4 to 77.4], p = 0.014). In conclusion, routinely continuing clinically prescribed long-acting glucose-lowering medications before coronary angiography with possible PCI help achieve periprocedural euglycemia, appear safe, and should be considered as a strategy for achieving periprocedural glycemic control.

  6. The Benefits of Good Teaching Extend beyond Course Achievement

    ERIC Educational Resources Information Center

    Loes, Chad N.; Pascarella, Ernest T.

    2015-01-01

    This paper synthesizes research from the Wabash National Study on Liberal Arts Education, the National Study on Student Learning, and the Research on Iowa Student Experiences study that estimates the influence of certain effective instructional practices on a range of student outcomes. Student perceptions of two specific teacher…

  7. Glycemic Variation in Tumor Patients with Total Parenteral Nutrition

    PubMed Central

    Yang, Jin-Cheng; Dai, Yuan-Yuan; Wang, Li-Ming; Xie, Yi-Bin; Zhou, Hai-Yan; Li, Guo-Hui

    2015-01-01

    Background: Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients. Methods: This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG. Results: The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time. Conclusions: When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The

  8. Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus

    PubMed Central

    Gonzalez-Zacarias, Alicia A.; Mavarez-Martinez, Ana; Arias-Morales, Carlos E.; Stoicea, Nicoleta; Rogers, Barbara

    2016-01-01

    Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications. PMID:27672634

  9. Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus.

    PubMed

    Gonzalez-Zacarias, Alicia A; Mavarez-Martinez, Ana; Arias-Morales, Carlos E; Stoicea, Nicoleta; Rogers, Barbara

    2016-01-01

    Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications.

  10. Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Almond consumption is associated with ameliorations in obesity, hyperlipidemia, hypertension, and hyperglycemia. The hypothesis of this 12-wk randomized crossover clinical trial was that almond consumption would improve glycemic control and decrease risk to cardiovascular disease in 20 Chinese type ...

  11. Veganism Is a Viable Alternative to Conventional Diet Therapy for Improving Blood Lipids and Glycemic Control.

    PubMed

    Trepanowski, John F; Varady, Krista A

    2015-01-01

    The American Diabetes Association (ADA) and the National Cholesterol Education Program (NCEP) have each outlined a set of dietary recommendations aimed at improving glycemic control and blood lipids, respectively. However, traditional vegan diets (low-fat diets that proscribe animal product consumption) are also effective at improving glycemic control, and dietary portfolios (vegan diets that contain prescribed amounts of plant sterols, viscous fibers, soy protein, and nuts) are also effective at improving blood lipids. The purpose of this review was to compare the effects of traditional vegan diets and dietary portfolios with ADA and NCEP diets on body weight, blood lipids, blood pressure, and glycemic control. The main findings are that traditional vegan diets appear to improve glycemic control better than ADA diets in individuals with type 2 diabetes mellitus (T2DM), while dietary portfolios have been consistently shown to improve blood lipids better than NCEP diets in hypercholesterolemic individuals.

  12. Dietary glycemic index and glycemic load and risk of colorectal cancer: results from the EPIC-Italy study.

    PubMed

    Sieri, S; Krogh, V; Agnoli, C; Ricceri, F; Palli, D; Masala, G; Panico, S; Mattiello, A; Tumino, R; Giurdanella, M C; Brighenti, F; Scazzina, F; Vineis, P; Sacerdote, C

    2015-06-15

    A carbohydrate-rich diet, resulting in high blood glucose and insulin, has been hypothesized as involved in colorectal cancer etiology. We investigated dietary glycemic index (GI) and glycemic load (GL), in relation to colorectal cancer, in the prospectively recruited EPIC-Italy cohort. After a median 11.7 years, 421 colorectal cancers were diagnosed among 47,749 recruited adults. GI and GL were estimated from validated food frequency questionnaires. Multivariable Cox modeling estimated hazard ratios (HRs) for associations between colorectal cancer and intakes of total, high GI and low GI carbohydrate and GI and GL. The adjusted HR of colorectal cancer for highest versus lowest GI quartile was 1.35; 95% confidence interval (CI) 1.03-1.78; p trend 0.031. Increasing high GI carbohydrate intake was also significantly associated with increasing colorectal cancer risk (HR 1.45; 95% CI 1.04-2.03; p trend 0.034), whereas increasing low GI carbohydrate was associated with reducing risk (HR 0.73; 95% CI 0.54-0.98; p trend 0.033). High dietary GI and high GI carbohydrate were associated with increased risks of cancer at all colon sites (HR 1.37; 95% CI 1.00-1.88, HR 1.80; 95% CI 1.22-2.65, respectively), whereas high GI carbohydrate and high GL were associated with increased risk of proximal colon cancer (HR 1.94; 95% CI 1.18-3.16, HR 2.01; 95% CI 1.08-3.74, respectively). After stratification for waist-to-hip ratio (WHR), cancer was significantly associated with GI, and high GI carbohydrate, in those with high WHR. These findings suggest that high dietary GI and high carbohydrate intake from high GI foods are associated with increased risk of colorectal cancer.

  13. The effect of the glycemic index of an evening meal on the metabolic responses to a standard high glycemic index breakfast and subsequent exercise in men.

    PubMed

    Stevenson, Emma; Williams, Clyde; Nute, Maria; Swaile, Peter; Tsui, Monica

    2005-06-01

    The present study investigated the effect of the glycemic index of an evening meal on responses to a standard high glycemic index (HGI) breakfast the following morning. The metabolic responses to exercise 3 h after breakfast were also investigated. Seven active males completed 2 trials. In each trial, participants were provided with an evening meal on day 1, which was composed of either HGI or LGI (high or low glycemic index) carbohydrates. On day 2, participants were provided with a standard HGI breakfast and then performed a 60 min run at 65% VO(2max) 3 h later. Plasma glucose and serum insulin concentrations following breakfast were higher in the HGI trial compared to the LGI trial (P < 0.05). During exercise, there were no differences in substrate utilization. The results suggest that consuming a single LGI evening meal can improve glucose tolerance at breakfast but the metabolic responses to subsequent exercise were not affected.

  14. Effect of hypolipidemic treatment on glycemic profile in patients with mixed dyslipidemia

    PubMed Central

    Kei, Anastazia; Liberopoulos, Evangelos; Elisaf, Moses

    2013-01-01

    AIM: To assess the effect of different hypolipidemic treatment strategies on glycemic profile in mixed dyslipidemia patients. METHODS: This is a prespecified analysis of a prospective, randomized, open-label, blinded end point (PROBE) study (ClinicalTrials.gov identifier: NCT01010516). Patients (n = 100) with mixed dyslipidemia on a standard statin dose who had not achieved lipid targets were randomized to switch to the highest dose of rosuvastatin (40 mg/d) or to add-on-statin extended release nicotinic acid (ER-NA)/laropiprant (LRPT) or to add-on-statin micronised fenofibrate for a total of 3 mo. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR) index and lipid profile were evaluated at baseline and 3 mo after treatment intervention. RESULTS: FPG increased in add-on ER-NA/LRPT and rosuvastatin monotherapy groups by 9.7% and 4.4%, respectively (P < 0.01 between the 2 groups and compared with baseline), while it did not significantly change in the add-on fenofibrate group. Similarly, HbA1c increased by 0.3% in add-on ER-NA/LRPT group and by 0.2% in the rosuvastatin monotherapy group (P < 0.01 for all comparisons vs baseline and for the comparison between the 2 groups), while no significant change was reported in the add-on fenofibrate group. HOMA-IR increased by 65% in add-on ER-NA/LRPT and by 14% in rosuvastatin monotherapy group, while it decreased by 6% in the add-on fenofibrate group (P < 0.01 vs baseline and for all comparisons among the groups). Non-HDL-C decreased in all groups (by 23.7%, 24.7% and 7% in the rosuvastatin, ER-NA/LRPT and fenofibrate group, respectively, P < 0.01 for all vs baseline and P < 0.01 for all vs with fenofibrate group). CONCLUSION: Both addition of ER-NA/LRPT and switch to the highest dose of rosuvastatin deteriorated glycemic profile in patients with mixed dyslipidemia, while add-on fenofibrate seems to increase insulin sensitivity. PMID:24379928

  15. Frequency and predictors of suboptimal glycemic control in an African diabetic population

    PubMed Central

    Kibirige, Davis; Akabwai, George Patrick; Kampiire, Leaticia; Kiggundu, Daniel Ssekikubo; Lumu, William

    2017-01-01

    Background Persistent suboptimal glycemic control is invariably associated with onset and progression of acute and chronic diabetic complications in diabetic patients. In Uganda, studies documenting the magnitude and predictors of suboptimal glycemic control in adult ambulatory diabetic patients are limited. This study aimed at determining the frequency and predictors of suboptimal glycemic control in adult diabetic patients attending three urban outpatient diabetic clinics in Uganda. Methods In this hospital-based cross-sectional study, eligible ambulatory adult diabetic patients attending outpatient diabetic clinics of three urban hospitals were consecutively enrolled over 11 months. Suboptimal glycemic control was defined as glycated hemoglobin (HbA1c) level ≥7%. Multivariable analysis was applied to determine the predictors. Results The mean age of the study participants was 52.2±14.4 years, and the majority of them were females (283, 66.9%). The median (interquartile range) HbA1c level was 9% (6.8%–12.4%). Suboptimal glycemic control was noted in 311 study participants, accounting for 73.52% of the participants. HbA1c levels of 7%–8%, 8.1%–9.9%, and ≥10% were noted in 56 (13.24%), 76 (17.97%), and 179 (42.32%) study participants, respectively. The documented predictors of suboptimal glycemic control were metformin monotherapy (odds ratio: 0.36, 95% confidence interval: 0.21–0.63, p<0.005) and insulin therapy (odds ratio: 2.41, 95% confidence interval: 1.41–4.12, p=0.001). Conclusion Suboptimal glycemic control was highly prevalent in this study population with an association to metformin monotherapy and insulin therapy. Strategies aimed at improving glycemic control in diabetes care in Uganda should be enhanced. PMID:28260942

  16. Effect of glycemic index meals on recovery and subsequent endurance capacity.

    PubMed

    Wong, S H; Chen, Y J; Fung, W M; Morris, J G

    2009-12-01

    This study examined the effect of ingesting a high or low glycemic index (GI) meal during a short-term recovery period on endurance running capacity. On two occasions, seven men (age 30.0+/-2.6 yr, body mass 60.7+/-1.4 kg, VO (2max) 62.1+/-2.2 ml.kg (-1).min (-1)) ran at 70% VO (2max) on a level treadmill for 90 min (R1), followed by a 4 h recovery (REC) and a further exhaustive run at the same speed (R2). Twenty minutes after R1, each subject consumed an isoenergetic meal containing either high GI (HGI, GI=77) or low GI (LGI, GI=37) carbohydrate providing 1.5 g CHO.kg (-1) BM. During REC, subjects also ingested a prescribed volume of water equal to 150% of their BM loss during R1. The duration of R2 in the HGI trial was 15% longer than in the LGI trial (HGI: 86.6+/-10.7 min vs. LGI: 75.2+/-8.1 min, p<0.05). The subjects also achieved complete rehydration after REC on both occasions. In conclusion, the consumption of a HGI meal during a 4 h recovery improved endurance capacity in a subsequent run; however, the precise mechanism(s) by which this takes place is yet to be clarified.

  17. Effect of glycemic load on eating behavior self-efficacy during weight loss.

    PubMed

    Karl, J Philip; Cheatham, Rachel A; Das, Sai Krupa; Hyatt, Raymond R; Gilhooly, Cheryl H; Pittas, Anastassios G; Lieberman, Harris R; Lerner, Debra; Roberts, Susan B; Saltzman, Edward

    2014-09-01

    High eating behavior self-efficacy may contribute to successful weight loss. Diet interventions that maximize eating behavior self-efficacy may therefore improve weight loss outcomes. However, data on the effect of diet composition on eating behavior self-efficacy are sparse. To determine the effects of dietary glycemic load (GL) on eating behavior self-efficacy during weight loss, body weight and eating behavior self-efficacy were measured every six months in overweight adults participating in a 12-mo randomized trial testing energy-restricted diets differing in GL. All food was provided during the first six months and self-selected thereafter. Total mean weight loss did not differ between groups, and GL-level had no significant effect on eating behavior self-efficacy. In the combined cohort, individuals losing the most weight reported improvements in eating behavior self-efficacy, whereas those achieving less weight loss reported decrements in eating behavior self-efficacy. Decrements in eating behavior self-efficacy were associated with subsequent weight regain when diets were self-selected. While GL does not appear to influence eating behavior self-efficacy, lesser amounts of weight loss on provided-food energy restricted diets may deter successful maintenance of weight loss by attenuating improvements in eating behavior self-efficacy.

  18. Good and not so good medical ethics.

    PubMed

    Rhodes, Rosamond

    2015-01-01

    In this paper, I provide a brief sketch of the purposes that medical ethics serves and what makes for good medical ethics. Medical ethics can guide clinical practice and biomedical research, contribute to the education of clinicians, advance thinking in the field, and direct healthcare policy. Although these are distinct activities, they are alike in several critical respects. Good medical ethics is coherent, illuminating, accurate, reasonable, consistent, informed, and measured. After this overview, I provide specific examples to illustrate some of the ways in which medical ethics could go wrong as a caution and a reminder that taking on the role of an ethicist involves serious responsibilities that must be exercised with care.

  19. An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

    PubMed Central

    Liao, Wen-I; Lin, Chin-Sheng; Lee, Chien-Hsing; Wu, Ya-Chieh; Chang, Wei-Chou; Hsu, Chin-Wang; Wang, Jen-Chun; Tsai, Shih-Hung

    2016-01-01

    Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients’ medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies. PMID:27291987

  20. Effect of carbohydrate counting using bolus calculators on glycemic control in type 1 diabetes patients during continuous subcutaneous insulin infusion.

    PubMed

    Yamada, Eijiro; Okada, Shuichi; Nakajima, Yasuyo; Bastie, Claire C; Tagaya, Yuko; Osaki, Aya; Shimoda, Yoko; Shibusawa, Ryo; Saito, Tsugumichi; Ozawa, Atsushi; Yamada, Masanobu

    2016-11-29

    The present study examined the long-term efficacy of insulin pump therapy for type 1 diabetes patients when carried out using carbohydrate counting with bolus calculators for 1 year. A total of 22 type 1 diabetes patients who had just started continuous subcutaneous insulin infusion were examined and divided into two groups: one that was educated about carbohydrate counting using bolus calculators (n = 14); and another that did not use bolus calculators (n = 8). After 1 year, the hemoglobin A1c levels of the patient group that used bolus calculators decreased persistently and significantly (P = 0.0297), whereas those of the other group did not. The bodyweight, total daily dose of insulin and bolus percentage of both groups did not change. Carbohydrate counting using bolus calculators is necessary to achieve optimal and persistent glycemic control in patients undergoing continuous subcutaneous insulin infusion.

  1. Good Concrete Activity Is Good Mental Activity

    ERIC Educational Resources Information Center

    McDonough, Andrea

    2016-01-01

    Early years mathematics classrooms can be colourful, exciting, and challenging places of learning. Andrea McDonough and fellow teachers have noticed that some students make good decisions about using materials to assist their problem solving, but this is not always the case. These experiences lead her to ask the following questions: (1) Are…

  2. What Makes Teachers Good?

    ERIC Educational Resources Information Center

    Cruickshank, Donald R.

    2000-01-01

    Over time, variations in describing what constitutes good teaching have included ideal, analytic, effective, dutiful, competent, expert, reflective, satisfying, diversity-responsive, and respected. If good teaching could be observed and measured, the results would not indicate a one-size-fits-all model, but rather demonstrate that good teaching is…

  3. Do Cinnamon Supplements Have a Role in Glycemic Control in Type 2 Diabetes? A Narrative Review.

    PubMed

    Costello, Rebecca B; Dwyer, Johanna T; Saldanha, Leila; Bailey, Regan L; Merkel, Joyce; Wambogo, Edwina

    2016-11-01

    Cinnamon (Cinnamomum sp) has been suggested to help patients with type 2 diabetes mellitus (T2DM) achieve better glycemic control, although conclusions from meta-analyses are mixed. To evaluate whether the use of cinnamon dietary supplements by adults with T2DM had clinically meaningful effects on glycemic control, as measured by changes in fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c), a comprehensive PubMed literature search was performed. Eleven randomized controlled trials were identified that met our inclusion criteria that enrolled 694 adults with T2DM receiving hypoglycemic medications or not. In 10 of the studies, participants continued to take their hypoglycemic medications during the cinnamon intervention period. Studies ranged from 4 to 16 weeks in duration; seven studies were double-blind. Cinnamon doses ranged from 120 to 6,000 mg/day. The species of cinnamon used varied: seven used Cinnamomum cassia or Cinnamomum aromaticum, one used Cinnamomum zeylanicum, and three did not disclose the species. Because of the heterogeneity of the studies, a meta-analysis was not conducted. All 11 of the studies reported some reductions in FPG during the cinnamon intervention, and of the studies measuring HbA1c very modest decreases were also apparent with cinnamon, whereas changes in the placebo groups were minimal. However, only four studies achieved the American Diabetes Association treatment goals (FPG <7.2 mmol/L [130 mg/dL] and/or HbAlc <7.0). We conclude that cinnamon supplements added to standard hypoglycemic medications and other lifestyle therapies had modest effects on FPG and HbA1c. Until larger and more rigorous studies are available, registered dietitian nutritionists and other health care professionals should recommend that patients continue to follow existing recommendations of authoritative bodies for diet, lifestyle changes, and hypoglycemic drugs.

  4. Depreciation of public goods in spatial public goods games

    NASA Astrophysics Data System (ADS)

    Shi, Dong-Mei; Zhuang, Yong; Li, Yu-Jian; Wang, Bing-Hong

    2011-10-01

    In real situations, the value of public goods will be reduced or even lost because of external factors or for intrinsic reasons. In this work, we investigate the evolution of cooperation by considering the effect of depreciation of public goods in spatial public goods games on a square lattice. It is assumed that each individual gains full advantage if the number of the cooperators nc within a group centered on that individual equals or exceeds the critical mass (CM). Otherwise, there is depreciation of the public goods, which is realized by rescaling the multiplication factor r to (nc/CM)r. It is shown that the emergence of cooperation is remarkably promoted for CM > 1 even at small values of r, and a global cooperative level is achieved at an intermediate value of CM = 4 at a small r. We further study the effect of depreciation of public goods on different topologies of a regular lattice, and find that the system always reaches global cooperation at a moderate value of CM = G - 1 regardless of whether or not there exist overlapping triangle structures on the regular lattice, where G is the group size of the associated regular lattice.

  5. Assessing inpatient glycemic control: what are the next steps?

    PubMed

    Cook, Curtiss B; Wellik, Kay E; Kongable, Gail L; Shu, Jianfen

    2012-03-01

    Despite the emergence of glucometrics (i.e., systematic analysis of data on blood glucose levels of inpatients) as a subject of high interest, there remains a lack of standardization on how glucose parameters are measured and reported. This dilemma must be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines and that can also be supported by quality care organizations. In this article, we review some of the questions that need to be resolved through consensus and review of the evidence, and discuss some of the limitations in analyzing and reporting inpatient glucose data that must be addressed (or at least accepted as limitations) before hospitals can commit resources to gathering, compiling, and presenting inpatient glucose statistics as a health care quality measure. Standards must include consensus on which measures to report, the unit of analysis, definitions of targets for hyperglycemia treatment, a definition of hypoglycemia, determination of how data should be gathered (from chart review or from laboratory information systems), and which type of sample (blood or point of care) should be used for analysis of glycemic control. Hospitals and/or their representatives should be included in the discussion. For inpatient glucose control to remain a focus of interest, further dialogue and consensus on the topic are needed.

  6. Variable classifications of glycemic index determined by glucose meters.

    PubMed

    Lin, Meng-Hsueh Amanda; Wu, Ming-Chang; Lin, Jenshinn

    2010-07-01

    THE STUDY EVALUATED AND COMPARED THE DIFFERENCES OF GLUCOSE RESPONSES, INCREMENTAL AREA UNDER CURVE (IAUC), GLYCEMIC INDEX (GI) AND THE CLASSIFICATION OF GI VALUES BETWEEN MEASURED BY BIOCHEMICAL ANALYZER (FUJI AUTOMATIC BIOCHEMISTRY ANALYZER (FAA)) AND THREE GLUCOSE METERS: Accue Chek Advantage (AGM), BREEZE 2 (BGM), and Optimum Xceed (OGM). Ten healthy subjects were recruited for the study. The results showed OGM yield highest postprandial glucose responses of 119.6 +/- 1.5, followed by FAA, 118.4 +/- 1.2, BGM, 117.4 +/- 1.4 and AGM, 112.6 +/- 1.3 mg/dl respectively. FAA reached highest mean IAUC of 4156 +/- 208 mg x min/dl, followed by OGM (3835 +/- 270 mg x min/dl), BGM (3730 +/- 241 mg x min/dl) and AGM (3394 +/- 253 mg x min/dl). Among four methods, OGM produced highest mean GI value than FAA (87 +/- 5) than FAA, followed by BGM and AGM (77 +/- 1, 68 +/- 4 and 63 +/- 5, p<0.05). The results suggested that the AGM, BGM and OGM are more variable methods to determine IAUC, GI and rank GI value of food than FAA. The present result does not necessarily apply to other glucose meters. The performance of glucose meter to determine GI value of food should be evaluated and calibrated before use.

  7. Rice: a high or low glycemic index food?

    PubMed

    Miller, J B; Pang, E; Bramall, L

    1992-12-01

    We determined the glycemic (GI) and insulin-index (II) values for 12 rice products, using eight healthy subjects. The products were brown and white versions of three commercial varieties of rice [two varieties with normal amylose content (20%) and the other with 28% amylose], a waxy rice (0-2% amylose), a converted rice, a quick-cooking brown rice, puffed rice cakes, rice pasta, and rice bran. The GI of the rices ranged from 64 +/- 9 to 93 +/- 11, where glucose = 100. The high amylose rice gave a lower GI and II (P < 0.01) than did the normal-amylose and waxy-rice varieties. The converted rice and most other rice products gave a high GI. Insulin indices correlated positively with GI (r = 0.75, P < 0.05), although they were lower than expected. These results indicate that many varieties of rice, whether white, brown, or parboiled, should be classified as high GI foods. Only high-amylose varieties are potentially useful in low-GI diets.

  8. Glycemic index of local foods and diets: the Mediterranean experience.

    PubMed

    Riccardi, Gabriele; Clemente, Gennaro; Giacco, Rosalba

    2003-05-01

    The Mediterranean diet is a healthful eating pattern associated with the prevention of coronary heart disease (CHD). Its main features are moderate intake of total fat (predominantly monounsaturated fat), low consumption of saturated fat and cholesterol-rich foods, and high intake of starch. Although this type of diet has beneficial effects on lipid metabolism, its high carbohydrate content might not be ideal for patients with diabetes or other conditions associated with insulin resistance (e.g., metabolic syndrome), who are known to be at particular risk of CHD. We therefore evaluated the glycemic response to starchy foods based on wheat (typical of the Italian diet) in patients with type 2 diabetes and identified certain characteristics of foods explaining their effects on postprandial glucose response. We found that spaghetti and potato dumplings, because of their low blood glucose response, represent a valid alternative to other starchy foods typical of the Mediterranean diet. Food structure plays an important role in determining the accessibility of starch to digestion, thus influencing the postprandial blood glucose response, which modulates plasma insulin and lipid levels.

  9. Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control.

    PubMed

    Perichart-Perera, Otilia; Balas-Nakash, Margie; Rodríguez-Cano, Ameyalli; Legorreta-Legorreta, Jennifer; Parra-Covarrubias, Adalberto; Vadillo-Ortega, Felipe

    2012-01-01

    Background. Due to the higher prevalence of obesity and diabetes mellitus (DM), more pregnant women complicated with diabetes are in need of clinical care. Purpose. Compare the effect of including only low glycemic index (GI) carbohydrates (CHO) against all types of CHO on maternal glycemic control and on the maternal and newborn's nutritional status of women with type 2 DM and gestational diabetes mellitus (GDM). Methods. Women (n = 107, ≤29 weeks of gestation) were randomly assigned to one of two nutrition intervention groups: moderate energy and CHO restriction (Group 1: all types of CHO, Group 2: low GI foods). Results. No baseline differences in clinical data were observed. Capillary glucose concentrations throughout pregnancy were similar between groups. Fewer women in Group 2 exceeded weight gain recommendations. Higher risk of prematurity was observed in women in Group 2. No differences in glycemic control were observed between women with type 2 DM and those with GDM. Conclusions. Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO. This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity.

  10. Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control

    PubMed Central

    Perichart-Perera, Otilia; Balas-Nakash, Margie; Rodríguez-Cano, Ameyalli; Legorreta-Legorreta, Jennifer; Parra-Covarrubias, Adalberto; Vadillo-Ortega, Felipe

    2012-01-01

    Background. Due to the higher prevalence of obesity and diabetes mellitus (DM), more pregnant women complicated with diabetes are in need of clinical care. Purpose. Compare the effect of including only low glycemic index (GI) carbohydrates (CHO) against all types of CHO on maternal glycemic control and on the maternal and newborn's nutritional status of women with type 2 DM and gestational diabetes mellitus (GDM). Methods. Women (n = 107, ≤29 weeks of gestation) were randomly assigned to one of two nutrition intervention groups: moderate energy and CHO restriction (Group 1: all types of CHO, Group 2: low GI foods). Results. No baseline differences in clinical data were observed. Capillary glucose concentrations throughout pregnancy were similar between groups. Fewer women in Group 2 exceeded weight gain recommendations. Higher risk of prematurity was observed in women in Group 2. No differences in glycemic control were observed between women with type 2 DM and those with GDM. Conclusions. Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO. This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity. PMID:23251152

  11. Effects of diets differing in glycemic index and glycemic load on cardiovascular risk factors: review of randomized controlled-feeing trials

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Despite a considerable amount of data available on the relationship between dietary glycemic index (GI) or load (GL) and cardiovascular disease (CVD) risk factors, in aggregate, the area remains unsettled. The aim of the present review was to summarize the effect of diets differing in GI/GL on CVD r...

  12. Effect of green tea catechins on the postprandial glycemic response to starches differing in amylose content.

    PubMed

    Liu, Jie; Wang, Mingzhu; Peng, Shanli; Zhang, Genyi

    2011-05-11

    The effect of tea polyphenols (TPLs), specifically tea catechins, on the postprandial glycemic response to cooked starches differing in amylose contents was investigated. The in vivo test using a mouse model showed a moderate reduction of the postprandial glycemic response to co-cooked normal (containing 27.8% amylose) or waxy corn starch with 10% TPLs (dry weight of starch), while an augmented glycemic response with a delayed blood glucose peak was observed when high amylose corn starch (HAC, containing 79.4% amylose) was used as the starch component. Enzyme kinetics results demonstrated that TPLs noncompetitively inhibit the digestion of waxy or normal corn starch, while the digestion rate of HAC starch was increased in the presence of TPLs, which supports the observed postprandial glycemic responses. Further studies using X-ray powder diffraction showed that the diffraction intensity (area under the diffraction curves) of normal and HAC starch was increased by 45% and 74%, respectively, whereas no change was observed for waxy corn starch. Consistently, dynamic laser light scattering studies using a solution of pure amylose showed an increased hydrodynamic radius of amylose molecules from ∼54 nm to ∼112 nm in the presence of TPLs. These experimental results indicate that there might exist an interaction between TPLs and amylose, which facilitates the association of amylose molecules to form a special nonordered structure that can produce a high and sustained postprandial glycemic response. Thus, a combination of tea polyphenols and specific starches could be used to manipulate postprandial glycemic response for glycemic control and optimal health.

  13. Good Science, Good Sense and Good Sensibilities: The Three Ss of Carol Newton.

    PubMed

    Smith, Adrian J; Hawkins, Penny

    2016-11-11

    The Three Rs principle of Replacement, Reduction and Refinement developed by William M. S. Russell and Rex L. Burch in the 1950s has achieved worldwide recognition as a means of reducing the impact of science on animals and improving their welfare. However, application of the Three Rs is still far from universal, and evidence-based methods to implement the Three Rs are still lacking in many areas of laboratory animal science. The purpose of this paper is to create interest in a less well-known but equally useful principle that complements the Three Rs, which was proposed by the American biomathematician Carol M. Newton in the 1970s: the Three Ss-Good Science, Good Sense and Good Sensibilities.

  14. Developing Good Practices

    ERIC Educational Resources Information Center

    Fox, Sharon E.

    1972-01-01

    Discusses some good oral reading concepts that teachers should consider when developing new classroom practices, including: round robin reading, silent reading before oral reading, shared reading, etc. (NL)

  15. Raising Boys' Achievement in Schools.

    ERIC Educational Resources Information Center

    Bleach, Kevan, Ed.

    This book offers insights into the range of strategies and good practice being used to raise the achievement of boys. Case studies by school-based practitioners suggest ideas and measures to address the issue of achievement by boys. The contributions are: (1) "Why the Likely Lads Lag Behind" (Kevan Bleach); (2) "Helping Boys Do…

  16. Anxiety Symptoms in Adolescents with Type 1 Diabetes: Association with Blood Glucose Monitoring and Glycemic Control

    PubMed Central

    Herzer, Michele

    2010-01-01

    Objective To examine the prevalence of anxiety symptoms and their association with blood glucose monitoring (BGM) and glycemic control in adolescents with type 1 diabetes. Methods 276 adolescents and their caregivers completed measures of anxiety symptoms. Adolescents completed a measure of depressive symptoms. Demographic and family characteristics were obtained from caregiver report. Diabetes duration, regimen type, BGM frequency, and glycemic control were also collected. Results Trait anxiety symptoms that suggest further clinical assessment is needed were present in 17% of adolescents; the rate was 13% for state anxiety symptoms. Higher levels of state anxiety symptoms were associated with less frequent BGM F(14, 261) = 6.35, p < .0001, R2 = .25, and suboptimal glycemic control, F(15, 260) = 7.97, p < .0001, R2 = .32. State anxiety symptoms were correlates of BGM frequency and glycemic control independent of depressive symptoms. Conclusions State anxiety symptoms are associated with less frequent BGM and suboptimal glycemic control in adolescents with type 1 diabetes. PMID:19684117

  17. Family system dynamics and type 1 diabetic glycemic variability: a vector-auto-regressive model.

    PubMed

    Günther, Moritz Philipp; Winker, Peter; Böttcher, Claudia; Brosig, Burkhard

    2013-06-01

    Statistical approaches rooted in econometric methodology, so far foreign to the psychiatric and psychological realms have provided exciting and substantial new insights into complex mind-body interactions over time and individuals. Over 120 days, this structured diary study explored the mutual interactions of emotions within a classic 3-person family system with its Type 1 diabetic adolescent's daily blood glucose variability. Glycemic variability was measured through daily standard deviations of blood glucose determinations (at least 3 per day). Emotions were captured individually utilizing the self-assessment manikin on affective valence (negative-positive), activation (calm-excited), and control (dominated-dominant). Auto- and cross-correlating the stationary absolute (level) values of the mutually interacting parallel time series data sets through vector autoregression (VAR, grounded in econometric theory) allowed for the formulation of 2 concordant models. Applying Cholesky Impulse Response Analysis at a 95% confidence interval, we provided evidence for an adolescent being happy, calm, and in control to exhibit less glycemic variability and hence diabetic derailment. A nondominating mother and a happy father seemed to also reduce glycemic variability. Random shocks increasing glycemic variability affected only the adolescent and her father: In 1 model, the male parent felt in charge; in the other, he calmed down while his daughter turned sad. All reactions to external shocks lasted for less than 4 full days. Extant literature on affect and glycemic variability in Type 1 diabetic adolescents as well as challenges arising from introducing econometric theory to the field were discussed.

  18. Cape of Good Hope

    Atmospheric Science Data Center

    2013-04-16

    article title:  Aerosol retrieval over Cape of Good Hope   ... Da image in the southern part of South Africa - the aerosol retrieval picks it up, and also the slightly clearer area in the middle. Also, ... MISR Science Teams Aug 23, 2000 - Aerosol retrieval over Cape of Good Hope. project:  MISR ...

  19. Cape of Good Hope

    Atmospheric Science Data Center

    2016-08-24

    article title:  Aerosol retrieval over Cape of Good Hope (Enlargement)     ... (MISR) image is an enlargement of the  aerosol retrieval over Cape of Good Hope, August 23, 2000 , showing a more detailed ... energy, so MISR's contribution is not only the aerosol retrieval necessary to do the correction, but the multi-angular integration. ...

  20. How Good Writers Punctuate.

    ERIC Educational Resources Information Center

    Dawkins, John

    The punctuation system presented in this paper has explanatory power insofar as it explains how good writers punctuate. The paper notes that good writers have learned, through reading, the differences among a hierarchy of marks and acquired a sense of independent clauses that allows them to use the hierarchy, along with a reader-sensitive notion…

  1. The Good Work.

    ERIC Educational Resources Information Center

    Csikszentmihalyi, Mihaly

    2003-01-01

    Examines the working lives of geneticists and journalists to place into perspective what lies behind personal ethics and success. Defines "good work" as productive activity that is valued socially and loved by people engaged in it. Asserts that certain cultural values, social controls, and personal standards are necessary to maintain good work and…

  2. Advice on Good Grooming.

    ERIC Educational Resources Information Center

    Tingey, Carol

    1987-01-01

    Suggestions are presented from parents on how to help children with disabilities (with particular focus on Downs Syndrome) learn good grooming habits in such areas as good health, exercise, cleanliness, teeth and hair care, skin care, glasses and other devices, and social behavior. (CB)

  3. What Are Good Universities?

    ERIC Educational Resources Information Center

    Connell, Raewyn

    2016-01-01

    This paper considers how we can arrive at a concept of the good university. It begins with ideas expressed by Australian Vice-Chancellors and in the "league tables" for universities, which essentially reproduce existing privilege. It then considers definitions of the good university via wish lists, classic texts, horror lists, structural…

  4. Productivity and Capital Goods.

    ERIC Educational Resources Information Center

    Zicht, Barbara, Ed.; And Others

    1981-01-01

    Providing teacher background on the concepts of productivity and capital goods, this document presents 3 teaching units about these ideas for different grade levels. The grade K-2 unit, "How Do They Do It?," is designed to provide students with an understanding of how physical capital goods add to productivity. Activities include a field trip to…

  5. Interaction between amylose and tea polyphenols modulates the postprandial glycemic response to high-amylose maize starch.

    PubMed

    Chai, Yanwei; Wang, Mingzhu; Zhang, Genyi

    2013-09-11

    High-amylose maize starch (HAM) is a common source material to make resistant starch with its high content of amylose (>70%). In the current investigation, the self-assembly of amylose in the presence of bioactive tea polyphenols (TPLs) and resulting slow digestion property of starch were explored. The experimental results using a mouse model showed a slow digestion property can be achieved with an extended and moderate glycemic response to HAM starch cocooked with TPLs. Further studies using a dilute aqueous amylose solution (0.1%, w/v) revealed an increased hydrodynamic radius of amylose molecules, indicating that TPLs could bridge them together, leading to increased molecular sizes. On the other hand, the bound TPLs interrupted the normal process of amylose recrystallizaiton evidenced by a decreased viscosity and storage modulus (G') of HAM (5%) gel, a rough surface of the cross-section of HAM film, and decreased short-range orders examined by Fourier transform infrared spectral analysis. Single-step degradation curves in the thermal gravimetric profile demonstrated the existence of a self-assembled amylose-TPL complex, which is mainly formed through hydrogen bonding interaction according to the results of iodine binding and X-ray powder diffraction analysis. Collectively, the amylose-TPL complexation influences the normal self-assembling process of amylose, leading to a low-ordered crystalline structure, which is the basis for TPLs' function in modulating the digestion property of HAM starch to produce a slowly digestible starch material that is beneficial to postprandial glycemic control and related health effects.

  6. When headaches are good.

    PubMed

    Packard, R C; Andrasik, F; Weaver, R

    1989-02-01

    Occasionally patients with headache present with the complaint of "a really good one." This paper examines three cases of patients with migraine who often referred to their headaches as "good." When the patients were asked what made the headaches good, they immediately tried to clarify their terminology as "just a figure of speech" that really meant bad. Further exploration usually revealed the headache symptoms had indeed been "good" in a relative sense, in that it had somehow served to help the patient avoid a more unpleasant emotional situation. The headache may have allowed a "time out" or a forced period of rest in a hectic schedule, resolved a conflict for the patient in an acceptable way by becoming sick, or represented a suppressed or repressed affect, usually anger. When headaches are described as good, there may very well be something in the patient's life that is worse.

  7. Carbohydrate intake, glycemic index and prostate cancer risk

    PubMed Central

    Vidal, Adriana C.; Williams, Christina D.; Allott, Emma H.; Howard, Lauren E.; Grant, Delores J.; McPhail, Megan; Sourbeer, Katharine N.; Pao-Hwa, Lin; Boffetta, Paolo; Hoyo, Cathrine; Freedland, Stephen J.

    2014-01-01

    BACKGROUND Reported associations between dietary carbohydrate and prostate cancer (PC) risk are poorly characterized by race. METHODS We analyzed the association between carbohydrate intake, glycemic index (GI), and PC risk in a study of white (N=262) and black (N=168) veterans at the Durham VA Hospital. Cases were 156 men with biopsy-confirmed PC and controls (N=274) had a PSA test but were not recommended for biopsy. Diet was assessed before biopsy with a self-administered food frequency questionnaire. Logistic regression models were used to estimate PC risk. RESULTS In multivariable analyses, higher carbohydrate intake, measured as percent of energy from carbohydrates, was associated with reduced PC risk (3rd vs. 1st tertile, OR=0.41, 95%CI 0.21–0.81, p=0.010), though this only reached significance in white men (p-trend=0.029). GI was unrelated to PC risk among all men, but suggestively linked with reduced PC risk in white men (p-trend=0.066) and increased PC risk in black men (p-trend=0.172), however the associations were not significant. Fiber intake was not associated with PC risk (all p-trends >0.55). Higher carbohydrate intake was associated with reduced risk of high-grade (p-trend=0.016), but not low-grade PC (p-trend=0.593). CONCLUSIONS Higher carbohydrate intake may be associated with reduced risk of overall and high-grade PC. Future larger studies are needed to confirm these findings. PMID:25417840

  8. Barley cultivar, kernel composition, and processing affect the glycemic index.

    PubMed

    Aldughpassi, Ahmed; Abdel-Aal, El-Sayed M; Wolever, Thomas M S

    2012-09-01

    Barley has a low glycemic index (GI), but it is unknown whether its GI is affected by variation in carbohydrate composition in different cultivars and by food processing and food form. To examine the effect of these factors on GI, 9 barley cultivars varying in amylose and β-glucan content were studied in 3 experiments in separate groups of 10 healthy participants. In Expt. 1, 3 barley cultivars underwent 2 levels of processing: hull removal [whole-grain (WG)] and bran, germ, and crease removal [white pearled (WP)]. GI varied by cultivar (CDC Fibar vs. AC Parkhill, [mean ± SEM]: 26 ± 3 vs. 53 ± 4, respectively; P < 0.05) and pearling (WG vs. WP: 26 ± 4 vs. 35 ± 3, respectively; P < 0.05) with no cultivar × pearling interaction. In Expt. 2, the GI of 7 WG cultivars ranged from 21 ± 4 to 36 ± 8 (P = 0.09). In Expt. 3, WG and WP AC Parkhill and Celebrity cultivars were ground and made into wet pasta. The GI of AC Parkhill pasta (69 ± 3) was similar to that of Celebrity pasta (64 ± 4) but, unlike in Expt. 1, the GI of WP pasta (61 ± 3) was less than that of WG pasta (72 ± 4) (P < 0.05). Pooled data from Expts. 1 and 2 showed that GI was correlated with total fiber (r = -0.75, P = 0.002) but not with measures of starch characteristics. We conclude that the GI of barley is influenced by cultivar, processing, and food form but is not predicted by its content of amylose or other starch characteristics.

  9. Reconsidering the "Good Divorce"

    PubMed

    Amato, Paul R; Kane, Jennifer B; James, Spencer

    2011-12-01

    This study attempted to assess the notion that a "good divorce" protects children from the potential negative consequences of marital dissolution. A cluster analysis of data on postdivorce parenting from 944 families resulted in three groups: cooperative coparenting, parallel parenting, and single parenting. Children in the cooperative coparenting (good divorce) cluster had the smallest number of behavior problems and the closest ties to their fathers. Nevertheless, children in this cluster did not score significantly better than other children on 10 additional outcomes. These findings provide only modest support for the good divorce hypothesis.

  10. Long–Term Effects of Energy-Restricted Diets Differing in Glycemic Load on Metabolic Adaptation and Body Composition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A randomized controlled trial of high glycemic load (HG) and low glycemic load (LG) diets with food provided for 6 months and self-administered for 6 additional months at 30% caloric restriction (CR) was performed in 29 overweight adults (mean+/-SD, age 35+/-5y; BMI 27.5+/-1.5 kg/m2). Total energy e...

  11. Effects of a Psychoeducational Group on Mood and Glycemic Control in Adults with Diabetes and Visual Impairments.

    ERIC Educational Resources Information Center

    Trozzolino, Linda; Thompson, Pamela S.; Tansman, Mara S.; Azen, Stanley P.

    2003-01-01

    This study evaluated the effectiveness of a 12-week psychoeducational group therapy program in improving mood and glycemic control in 48 adults with diabetes and visual impairments. Participants made statistically significant gains in glycemic control. There was a significant positive relationship between control and improvement in depression, but…

  12. Epigenetic Changes in Endothelial Progenitors as a Possible Cellular Basis for Glycemic Memory in Diabetic Vascular Complications.

    PubMed

    Rajasekar, Poojitha; O'Neill, Christina L; Eeles, Lydia; Stitt, Alan W; Medina, Reinhold J

    2015-01-01

    The vascular complications of diabetes significantly impact the quality of life and mortality in diabetic patients. Extensive evidence from various human clinical trials has clearly established that a period of poor glycemic control early in the disease process carries negative consequences, such as an increase in the development and progression of vascular complications that becomes evident many years later. Importantly, intensive glycemic control established later in the disease process cannot reverse or slow down the onset or progression of diabetic vasculopathy. This has been named the glycemic memory phenomenon. Scientists have successfully modelled glycemic memory using various in vitro and in vivo systems. This review emphasizes that oxidative stress and accumulation of advanced glycation end products are key factors driving glycemic memory in endothelial cells. Furthermore, various epigenetic marks have been proposed to closely associate with vascular glycemic memory. In addition, we comment on the importance of endothelial progenitors and their role as endogenous vasoreparative cells that are negatively impacted by the diabetic milieu and may constitute a "carrier" of glycemic memory. Considering the potential of endothelial progenitor-based cytotherapies, future studies on their glycemic memory are warranted to develop epigenetics-based therapeutics targeting diabetic vascular complications.

  13. The Importance of Social Support on Glycemic Control in Low-Income Latinos with Type 2 Diabetes

    ERIC Educational Resources Information Center

    Rotberg, Britt; Junqueira, Yasmine; Gosdin, Lucas; Mejia, Roberto; Umpierrez, Guillermo E.

    2016-01-01

    Background: The U.S. Latino population exhibits poorer glycemic control than the white population, leading to more frequent health complications and greater disease severity. Social support has been shown a significant factor in health and well-being. Purpose: To determine the association between glycemic control and social support in patients…

  14. Epigenetic Changes in Endothelial Progenitors as a Possible Cellular Basis for Glycemic Memory in Diabetic Vascular Complications

    PubMed Central

    Rajasekar, Poojitha; O'Neill, Christina L.; Eeles, Lydia; Stitt, Alan W.; Medina, Reinhold J.

    2015-01-01

    The vascular complications of diabetes significantly impact the quality of life and mortality in diabetic patients. Extensive evidence from various human clinical trials has clearly established that a period of poor glycemic control early in the disease process carries negative consequences, such as an increase in the development and progression of vascular complications that becomes evident many years later. Importantly, intensive glycemic control established later in the disease process cannot reverse or slow down the onset or progression of diabetic vasculopathy. This has been named the glycemic memory phenomenon. Scientists have successfully modelled glycemic memory using various in vitro and in vivo systems. This review emphasizes that oxidative stress and accumulation of advanced glycation end products are key factors driving glycemic memory in endothelial cells. Furthermore, various epigenetic marks have been proposed to closely associate with vascular glycemic memory. In addition, we comment on the importance of endothelial progenitors and their role as endogenous vasoreparative cells that are negatively impacted by the diabetic milieu and may constitute a “carrier” of glycemic memory. Considering the potential of endothelial progenitor-based cytotherapies, future studies on their glycemic memory are warranted to develop epigenetics-based therapeutics targeting diabetic vascular complications. PMID:26106624

  15. Interactions between Starch, Lipids, and Proteins in Foods: Microstructure Control for Glycemic Response Modulation.

    PubMed

    Parada, Javier; Santos, Jose L

    2016-10-25

    In real food, starch is usually forming part of a matrix with lipids and proteins. However, research on this ternary system and interactions between such food components has been scarce so far. The control of food microstructure is crucial to determine the product properties, including sensorial and nutritionals ones. This paper reviews the microstructural principles of interactions between starch, lipids, and proteins in foods as well as their effect on postprandial glycemic response, considering human intrinsic differences on postprandial glycemic responses. Several lines of research support the hypothesis that foods without rapidly digestible starch will not mandatorily generate the lowest postprandial glycemic response, highlighting that the full understanding of food microstructure, which modulates starch digestion, plays a key role on food design from a nutritional viewpoint.

  16. Diabetes and cardiovascular disease: changing the focus from glycemic control to improving long-term survival.

    PubMed

    Wang, Cecilia C Low; Reusch, Jane E B

    2012-11-06

    Diabetes mellitus (DM) is the fifth-leading cause of death worldwide and contributes to leading causes of death, cancer and cardiovascular disease, including CAD, stroke, peripheral vascular disease, and other vascular disease. While glycemic management remains a cornerstone of DM care, the co-management of hypertension, atherosclerosis, cardiovascular risk reduction, and prevention of long-term consequences associated with DM are now well recognized as essential to improve long-term survival. Clinical trial evidence substantiates the importance of glycemic control, low-density cholesterol-lowering therapy, blood pressure lowering, control of albuminuria, and comprehensive approaches targeting multiple risk factors to reduce cardiovascular risk. This article presents a review of the role of DM in the pathogenesis of atherosclerosis and cardiac dysfunction, recent evidence on the degree of glycemic control and mortality, and available evidence for a multifaceted approach to improve long-term outcomes for patients.

  17. The Glycemic Index of Rice and Rice Products: A Review, and Table of GI Values.

    PubMed

    Kaur, Bhupinder; Ranawana, Viren; Henry, Jeyakumar

    2016-01-01

    Rice is the principle staple and energy source for nearly half the world's population and therefore has significant nutrition and health implications. Rice is generally considered a high glycemic index (GI) food, however, this depends on varietal, compositional, processing, and accompaniment factors. Being a major contributor to the glycemic load in rice eating populations, there is increasing concern that the rising prevalence of insulin resistance is as a result of the consumption of large amounts of rice. Devising ways and means of reducing the glycemic impact of rice is therefore imperative. This review gathers studies examining the GI of rice and rice products and provides a critical overview of the current state of the art. A table collating published GI values for rice and rice products is also included.

  18. Improved Glycemic Control in Intensively Treated Adult Subjects with Type 1 Diabetes Using Insulin Guidance Software

    PubMed Central

    Bookout, Tevin R.; McFann, Kim K.; Kelly, William C.; Beatson, Christie; Ellis, Samuel L.; Gutin, Raymond S.; Gottlieb, Peter A.

    2008-01-01

    Abstract Background Management of type 1 diabetes could be significantly improved with the availability of computerized insulin algorithms for home use. Methods This was a 1-year open label randomized control trial involving 123 adult subjects with type 1 diabetes (hemoglobin A1c values 7.5–11%) assigned to either the insulin guidance software (ACCU-CHEK® [Roche, Indianapolis, IN] Advisor) for personal data assistant (experimental group) or the control group. The primary aim of the study was to see if subjects using insulin dosing advisor software will improve glucose control over 1 year. The principal end point was an improvement in A1c at 6 and 12 months by ≥0.4%. Results Baseline demographics were similar in the two groups. Mean A1c was 8.54 ± 0.11% in the control group and 8.42 ± 0.11% (P = 0.4265) in the experimental group. The mean A1c was significantly lower from 3 to 12 months in the experimental group (P < 0.02). A1c reduction of ≥0.6% was maintained at 12 months in the experimental group. Also, a significantly higher number of subjects achieved A1c <7.5% in the experimental group from 3 to 9 months. Within target range glycemia (70–150 mg/dL) was higher in the experimental group at 3–9 months without any change in insulin dose or weight. Above target range glycemia was lower in the experimental group throughout the study. Frequency of testing per day was higher in the experimental group. Nocturnal hypoglycemia was not different between groups; however, the experimental group experienced more severe hypoglycemic events. Conclusions This is the first report that shows improved glycemic control can be maintained over 12 months in patients with type 1 diabetes by using Advisor with no change in insulin dose and weight. PMID:18715213

  19. A High Legume Low Glycemic Index Diet Improves Serum Lipid Profiles in Men

    PubMed Central

    Zhang, Zhiying; Lanza, Elaine; Kris-Etherton, Penny M.; Colburn, Nancy H.; Bagshaw, Deborah; Rovine, Michael J.; Ulbrecht, Jan S.; Bobe, Gerd; Chapkin, Robert S.; Hartman, Terryl J.

    2012-01-01

    Clinical studies have shown that fiber consumption facilitates weight loss and improves lipid profiles; however, the beneficial effects of high fermentable fiber low glycemic index (GI) diets under conditions of weight maintenance are unclear. In the Legume Inflammation Feeding Experiment, a randomized controlled cross-over feeding study, 64 middle-aged men who had undergone colonoscopies within the previous 2 years received both a healthy American (HA) diet (no legume consumption, fiber consumption = 9 g/1,000 kcal, and GI = 69) and a legume enriched (1.5 servings/1,000 kcal), high fiber (21 g/1,000 kcal), low GI (GI = 38) diet (LG) in random order. Diets were isocaloric and controlled for macronutrients including saturated fat; they were consumed each for 4 weeks with a 2–4 week break separating dietary treatments. Compared to the HA diet, the LG diet led to greater declines in both fasting serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) (P <0.001 and P <0.01, respectively). Insulin-resistant (IR) subjects had greater reductions in high density lipoprotein cholesterol (HDL-C; P <0.01), and triglycerides (TAG)/HDL-C (P = 0.02) after the LG diet, compared to the HA diet. Insulin-sensitive (IS) subjects had greater reductions in TC (P <0.001), LDL-C (P <0.01), TC/HDL-C (P <0.01), and LDL-C/HDL-C (P = 0.02) after the LG diet, compared to the HA diet. In conclusion, a high legume, high fiber, low GI diet improves serum lipid profiles in men, compared to a healthy American diet. However, IR individuals do not achieve the full benefits of the same diet on cardiovascular disease (CVD) lipid risk factors. PMID:20734238

  20. Effect of the carbohydrate counting method on glycemic control in patients with type 1 diabetes

    PubMed Central

    2010-01-01

    Background The importance of achieving and maintaining an appropriate metabolic control in patients with type 1 diabetes mellitus (DM1) has been established in many studies aiming to prevent the development of chronic complications. The carbohydrate counting method can be recommended as an additional tool in the nutritional treatment of diabetes, allowing patients with DM1 to have more flexible food choices. This study aimed to evaluate the influence of nutrition intervention and the use of multiple short-acting insulin according to the carbohydrate counting method on clinical and metabolic control in patients with DM1. Methods Our sample consisted of 51 patients with DM1, 32 females, aged 25.3 ± 1.55 years. A protocol of nutritional status evaluation was applied and laboratory analysis was performed at baseline and after a three-month intervention. After the analysis of the food records, a balanced diet was prescribed using the carbohydrate counting method, and short-acting insulin was prescribed based on the total amount of carbohydrate per meal (1 unit per 15 g of carbohydrate). Results A significant decrease in A1c levels was observed from baseline to the three-month evaluation after the intervention (10.40 ± 0.33% and 9.52 ± 0.32%, respectively, p = 0.000). It was observed an increase in daily insulin dose after the intervention (0.99 ± 0.65 IU/Kg and 1.05 ± 0.05 IU/Kg, respectively, p = 0.003). No significant differences were found regarding anthropometric evaluation (BMI, waist, hip or abdominal circumferences and waist to hip ratio) after the intervention period. Conclusions The use of short-acting insulin based on the carbohydrate counting method after a short period of time resulted in a significant improvement of the glycemic control in patients with DM1 with no changes in body weight despite increases in the total daily insulin doses. PMID:20716374

  1. Ethnic Disparities in Glycemic Control Among Rural Older Adults with Type 2 Diabetes

    PubMed Central

    Quandt, Sara A.; Bell, Ronny A.; Snively, Beverly M.; Smith, Shannon L.; Stafford, Jeanette M.; Wetmore, Lindsay K.; Arcury, Thomas A.

    2006-01-01

    Glycemic control is a predictor of diabetes-related morbidity and mortality. However, little is known about how well older adults in rural communities, with limited access to self-care resources and specialty care practitioners, control their diabetes. Even less is known about whether minority, older, rural adults are at increased risk for poor glycemic control. We analyzed data from a cross-sectional survey of randomly selected older (≥65 years) adults with type 2 diabetes in rural North Carolina. Participants (N=693) were men and women from three ethnic groups: African American, Native American, and White. Capillary blood samples were collected for HbA1C analysis. HbA1C levels (<7%, 7%–<8%, and ≥8%) were compared across ethnic and gender groups. Two multiple logistic regression models (model 1: personal characteristics; model 2: personal and health characteristics) were used to evaluate potential predictors of HbA1C ≥7%. Overall, 36.4% had HbA1C ≥7%. Native Americans and African-American men had the highest proportion at levels of poor glycemic control (≥7%), and African-American women and White men had the lowest. In bivariate analysis, ethnicity, living arrangements, use of medications for diabetes, having a diabetes-related healthcare visit in the past year, and duration of diabetes were significantly associated with glycemic control. In multivariate analysis (model 1), being Native American, having low income without Medicaid, and being married were associated with poor glycemic control. Adding health characteristics (model 2), longer diabetes duration and diabetes medication therapy were significant predictors. These data indicate that older ethnic minorities in rural communities are at increased risk for diabetes complications and need diabetes management strategies to improve glycemic control. PMID:16259490

  2. The effects of glycemic control on seizures and seizure-induced excitotoxic cell death

    PubMed Central

    2012-01-01

    Background Epilepsy is the most common neurological disorder after stroke, affecting more than 50 million persons worldwide. Metabolic disturbances are often associated with epileptic seizures, but the pathogenesis of this relationship is poorly understood. It is known that seizures result in altered glucose metabolism, the reduction of intracellular energy metabolites such as ATP, ADP and phosphocreatine and the accumulation of metabolic intermediates, such as lactate and adenosine. In particular, it has been suggested that the duration and extent of glucose dysregulation may be a predictor of the pathological outcome of status. However, little is known about neither the effects of glycemic control on brain metabolism nor the effects of managing systemic glucose concentrations in epilepsy. Results In this study, we examined glycemic modulation of kainate-induced seizure sensitivity and its neuropathological consequences. To investigate the relationship between glycemic modulation, seizure susceptibility and its neuropathological consequences, C57BL/6 mice (excitotoxin cell death resistant) were subjected to hypoglycemia or hyperglycemia, followed by systemic administration of kainic acid to induce seizures. Glycemic modulation resulted in minimal consequences with regard to seizure severity but increased hippocampal pathology, irrespective of whether mice were hypoglycemic or hyperglycemic prior to kainate administration. Moreover, we found that exogenous administration of glucose following kainic acid seizures significantly reduced the extent of hippocampal pathology in FVB/N mice (excitotoxin cell death susceptible) following systemic administration of kainic acid. Conclusion These findings demonstrate that modulation of the glycemic index can modify the outcome of brain injury in the kainate model of seizure induction. Moreover, modulation of the glycemic index through glucose rescue greatly diminishes the extent of seizure-induced cell death following kainate

  3. Good vs. Bad Cholesterol

    MedlinePlus

    ... Venous Thromboembolism Aortic Aneurysm More Good vs. Bad Cholesterol Updated:Apr 3,2017 Cholesterol can't dissolve ... test . View an animation of cholesterol . LDL (Bad) Cholesterol LDL cholesterol is considered the “bad” cholesterol because ...

  4. Long–Term Effects of High-and Low-Glycemic Load Energy-Restricted Diets on Metabolic Adaptation and the Composition of Weight Loss

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effects of high glycemic load (HG) and low glycemic load (LG) diets on resting metabolic rate (RMR) and body composition changes in response to caloric restriction (CR) remains controversial. Objective To examine the effects of two CR diets differing primarily in glycemic load on RMR and the % o...

  5. A good death.

    PubMed

    2011-10-26

    Definitions of a good death often include being at home. Dying at home may be optimal for the patient but could place a significant burden on families and leave them with traumatic memories. Death in hospital should not mean that it is a 'bad death'. How someone dies is more important than where they die and nurses should be taught to provide good end of life care in all settings.

  6. The individual and combined effects of glycemic index and protein on glycemic response, hunger, and energy intake.

    PubMed

    Makris, Angela P; Borradaile, Kelley E; Oliver, Tracy L; Cassim, Nida G; Rosenbaum, Diane L; Boden, Guenther H; Homko, Carol J; Foster, Gary D

    2011-12-01

    Although high protein and low glycemic index (GI) foods are thought to promote satiety, little is known about the effects of GI, protein, and their interaction on hunger and energy intake several hours following a mixed meal. This study investigated the long term effects of GI, protein, and their combined effects on glucose, insulin, hunger, and energy intake in healthy, sedentary, overweight, and obese adults (BMI of 30.9 ± 3.7 kg/m(2)). Sixteen individuals participated separately in four testing sessions after an overnight fast. The majority (75%) were non-Hispanic Blacks. Each consumed one of four breakfast meals (high GI/low protein, high GI/high protein, low GI/low protein, low GI/high protein) in random order. Visual analog scales (VAS) and blood samples were taken at baseline, 15 min, and at 30 min intervals over 4 h following the meal. After 4 h, participants were given the opportunity to consume food ad libitum from a buffet style lunch. Meals containing low GI foods produced a smaller glucose (P < 0.002) and insulin (P = 0.0001) response than meals containing high GI foods. No main effects for protein or interactions between GI and protein were observed in glucose or insulin responses, respectively. The four meals had no differential effect on observed energy intake or self-reported hunger, satiety, and prospective energy intake. Low GI meals produced the smallest postprandial increases in glucose and insulin. There were no effects for GI, protein, or their interaction on appetite or energy intake 4 h after breakfast.

  7. Good Science, Good Sense and Good Sensibilities: The Three Ss of Carol Newton

    PubMed Central

    Smith, Adrian J.; Hawkins, Penny

    2016-01-01

    Simple Summary The use of animals in research is controversial and there are ongoing efforts to refine and limit their use to an absolute minimum. The Three Rs principle developed by William M. S. Russell and Rex L. Burch in the UK in the 1950s is widely used for this purpose: Replacement, Reduction and Refinement. Another useful principle which complements the Three Rs was proposed by Carol Newton in the 1970s. This principle is the Three Ss: Good Science, Good Sense and Good Sensibilities. Unlike the Three Rs, the Three Ss have not been described in detail in the literature. The purpose of this paper is to increase awareness of the Three Ss, which are a useful supplement to the Three Rs, improving animal welfare and leading to better science. Abstract The Three Rs principle of Replacement, Reduction and Refinement developed by William M. S. Russell and Rex L. Burch in the 1950s has achieved worldwide recognition as a means of reducing the impact of science on animals and improving their welfare. However, application of the Three Rs is still far from universal, and evidence-based methods to implement the Three Rs are still lacking in many areas of laboratory animal science. The purpose of this paper is to create interest in a less well-known but equally useful principle that complements the Three Rs, which was proposed by the American biomathematician Carol M. Newton in the 1970s: the Three Ss—Good Science, Good Sense and Good Sensibilities. PMID:27845707

  8. Utility of different glycemic control metrics for optimizing management of diabetes

    PubMed Central

    Kohnert, Klaus-Dieter; Heinke, Peter; Vogt, Lutz; Salzsieder, Eckhard

    2015-01-01

    The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin (HbA1c). Despite its importance as an indicator for the development of diabetic complications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between HbA1c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to HbA1c in routine diabetes care is self-monitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize

  9. Hope matters to the glycemic control of adolescents and young adults with type 1 diabetes.

    PubMed

    Santos, Fábio R M; Sigulem, Daniel; Areco, Kelsy C N; Gabbay, Monica A L; Dib, Sergio A; Bernardo, Viviane

    2015-05-01

    This study investigated the association of hope and its factors with depression and glycemic control in adolescents and young adults with type 1 diabetes. A total of 113 patients were invited to participate. Significant negative correlations were found between hope and HbA1c and also between hope and depression. Hope showed a significant association with HbA1c and depression in the stepwise regression model. Among the hope factors, "inner positive expectancy" was significantly associated with HbA1c and depression. This study supports that hope matters to glycemic control and depression. Intervention strategies focusing on hope should be further explored.

  10. Low-glycemic load decreases postprandial insulin and glucose and increases postprandial ghrelin in white but not black women.

    PubMed

    Brownley, Kimberly A; Heymen, Steve; Hinderliter, Alan L; Galanko, Joseph; Macintosh, Beth

    2012-07-01

    Alterations in appetite hormones favoring increased postprandial satiety have been implicated in both the glycemic control and potential weight-loss benefits of a low-glycemic diet. Racial differences exist in dietary glycemic load and appetite hormone concentrations. This study examined the impact of glycemic load on appetite hormones in 20 black women [10 normal weight, BMI = 22.8 ± 1.42 (mean ± SD); 10 obese, BMI = 35.1 ± 2.77] and 20 white women (10 normal weight, BMI = 22.9 ± 1.45; 10 obese, BMI = 34.3 ± 2.77). Each woman completed two 4.5-d weight-maintenance, mixed-macronutrient, high-glycemic vs. low-glycemic load diets that concluded with a test meal of identical composition. Blood samples collected before and serially for 3 h after each test meal were assayed for plasma ghrelin and serum insulin and glucose concentrations. Compared with the high-glycemic load meal, the low-glycemic load meal was associated with lower insulin(AUC) (P = 0.02), glucose(AUC) (P = 0.01), and urge to eat ratings (P = 0.05) but with higher ghrelin(AUC) (P = 0.008). These results suggest the satiating effect of a low-glycemic load meal is not directly linked to enhanced postprandial suppression of ghrelin. Notably, these effects were significant among white but not black women, suggesting that black women may be less sensitive than white women to the glucoregulatory effects of a low-glycemic load. These findings add to a growing literature demonstrating racial differences in postprandial appetite hormone responses. If reproducible, these findings have implications for individualized diet prescription for the purposes of glucose or weight control in women.

  11. In vitro starch digestibility, estimated glycemic index and antioxidant potential of taro (Colocasia esculenta L. Schott) corm.

    PubMed

    Simsek, Sebnem; Nehir El, Sedef

    2015-02-01

    The purpose of this study was to determine some functional properties of taro (Colocasia esculenta L. Schott) corm, which can be a good alternative to the other dietary carbohydrate sources with its high starch content. The total phenolic and flavonoid content of taro corm was found as 205±53mgCAE/100g and 61±9mgCAE/100g, respectively. The antioxidant capacity of corm was determined as 452±72mMTEAC/100g and 244±73mMTEAC/100g, by the scavenging activity against ABTS and DPPH radicals, respectively. The free glucose content of corms was less than 1%, whereas the 60% of dry matter was composed of starch. According to the results, the taro corms' starch was highly digestible and higher than the 50% of the starch was composed of rapidly digestible starch (RDS) fractions. The estimated glycemic index (eGI) of taro corm was 63.1±2.5, indicating taro corm as a medium GI food and a good dietary carbohydrate alternative especially for diabetic people.

  12. Effects of Low Glycemic Index Diets on Gestational Diabetes Mellitus

    PubMed Central

    Wei, Jinhua; Heng, Weijun; Gao, Jianbo

    2016-01-01

    Abstract Studies of the effects of low glycemic index (LGI) diets on gestational diabetes mellitus (GDM) have reported conflicting findings. The aim of the study was to evaluate the results of randomized controlled trials (RCTs) that investigated the effects of LGI diets with and without added dietary fiber (DF) on maternal and neonatal outcomes in GDM patients. We searched the MEDLINE, EMBASE, EBSCO, Springer, Ovid, and Cochrane Library databases for studies of the effects of LGI diets in GDM patients. We performed a meta-analysis of the effects of the LGI diets with and without added dietary fiber (DF) on GDM outcomes. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated using random- and fixed-effects models. Five RCTs involving 302 participants were included in our meta-analysis. No statistically significant differences in the risks of cesarean section delivery, large for gestational age, and small for gestational age were observed. The risk of macrosomia in the LGI groups was significantly lower (RR = 0.27; 95% CI: 0.10–0.71; P = 0.008) than that in the control groups. Our subgroup analysis of the effects of DF showed that LGI diets with an increased level of DF, relative to the control diet, reduced the risk of macrosomia beyond that of the LGI diets alone (RR: 0.17 vs 0.47, respectively). The subgroup analysis also showed that LGI diets in which the level of DF was approximately equivalent to that in the control diets significantly reduced the risk of insulin usage (RR = 0.69; 95% CI: 0.52–0.92; P = 0.01). The LGI diets reduced the risk of macrosomia in GDM patients, and LGI diets with added DF reduced the risk of macrosomia further. The LGI diets with levels of DF approximately equivalent to that in the control diets reduced the risk of insulin usage in GDM patients. PMID:27258511

  13. Taking a low glycemic index multi-nutrient supplement as breakfast improves glycemic control in patients with type 2 diabetes mellitus: a randomized controlled trial.

    PubMed

    Li, Di; Zhang, Peiwen; Guo, Honghui; Ling, Wenhua

    2014-12-10

    Dietary therapy is the mainstay of treatment for diabetes. This study examined the effect of a low glycemic index (GI) multi-nutrient supplement, consumed in place of breakfast, on glycemic control in patients with type 2 diabetes mellitus (T2DM). A total of 71 participants were randomized at a 2:1 ratio into either a breakfast replacement group or a normal breakfast group for a 12-week interventional study. The primary outcome measure was change in hemoglobin A1c (HbA1c). Nutrition status and somatometry were studied as secondary outcomes. The breakfast replacement group displayed a -0.2% absolute reduction in HbA1c (95% CI (confidence interval), -0.38% to -0.07%, p = 0.004), while the HbA1c of the control group increased 0.3% (95% CI, 0.1% to 0.5%, p = 0.005). The baseline Mini Nutritional Assessment score for both groups was 26.0 and no significant changes occurred following intervention. However, there was a statistically significant difference in body mass index between the treatment and control groups (p = 0.032) due to the weight gain in the control group (increased 0.5 kg, 95% CI was 0.2 to 0.9, p = 0.007). These data suggest that breakfast replacement with a low GI multi-nutrient supplement can improve glycemic and weight control in T2DM.

  14. Taking a Low Glycemic Index Multi-Nutrient Supplement as Breakfast Improves Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

    PubMed Central

    Li, Di; Zhang, Peiwen; Guo, Honghui; Ling, Wenhua

    2014-01-01

    Dietary therapy is the mainstay of treatment for diabetes. This study examined the effect of a low glycemic index (GI) multi-nutrient supplement, consumed in place of breakfast, on glycemic control in patients with type 2 diabetes mellitus (T2DM). A total of 71 participants were randomized at a 2:1 ratio into either a breakfast replacement group or a normal breakfast group for a 12-week interventional study. The primary outcome measure was change in hemoglobin A1c (HbA1c). Nutrition status and somatometry were studied as secondary outcomes. The breakfast replacement group displayed a −0.2% absolute reduction in HbA1c (95% CI (confidence interval), −0.38% to −0.07%, p = 0.004), while the HbA1c of the control group increased 0.3% (95% CI, 0.1% to 0.5%, p = 0.005). The baseline Mini Nutritional Assessment score for both groups was 26.0 and no significant changes occurred following intervention. However, there was a statistically significant difference in body mass index between the treatment and control groups (p = 0.032) due to the weight gain in the control group (increased 0.5 kg, 95% CI was 0.2 to 0.9, p = 0.007). These data suggest that breakfast replacement with a low GI multi-nutrient supplement can improve glycemic and weight control in T2DM. PMID:25514391

  15. Good Teachers: Who They Are and How We Fail Them

    ERIC Educational Resources Information Center

    Bunting, Carolyn

    2006-01-01

    In this article, the author describes what it takes to become a good teacher and what the system could do to develop good teachers. The author explains that good teachers chronicle their years by the number of flawed programs survived. The author notes that good teachers need to learn self-reliance. To achieve this, they need breathing room, and…

  16. Ecology and the Good

    ERIC Educational Resources Information Center

    Gustafson, James W.

    1971-01-01

    Our value system relating to the natural sciences is examined for its acceptability and worthiness. Scrutinized are the cognitive meanings about values, validity of values, subjective and cultural relativism, the good of objective realities, and cooperation with natural forces and God. (BL)

  17. Crafting Good Citizens

    ERIC Educational Resources Information Center

    Macedo, Stephen

    2004-01-01

    Americans are rightly concerned that schools are not providing students with the knowledge and habits necessary to be good citizens. With the notable exception of volunteer activity, every form of civic engagement among the young has declined. As a response, increasing attention is being paid to civic education in the schools. But strangely, at a…

  18. Restructuring for Good Governance

    ERIC Educational Resources Information Center

    Robert, Stephen; Carey, Russell C.

    2006-01-01

    American higher education has never been more in need of good governance than it is right now. Yet much of the structure many boards have inherited or created tends to stall or impede timely, well-informed, and broadly supported decision making. At many institutions (ours included), layers of governance have been added with each passing year,…

  19. Reconsidering the "Good Divorce"

    ERIC Educational Resources Information Center

    Amato, Paul R.; Kane, Jennifer B.; James, Spencer

    2011-01-01

    This study attempted to assess the notion that a "good divorce" protects children from the potential negative consequences of marital dissolution. A cluster analysis of data on postdivorce parenting from 944 families resulted in three groups: cooperative coparenting, parallel parenting, and single parenting. Children in the cooperative coparenting…

  20. Exploration of Low-Glycemic-Impact Sugars and Polyols, using SRC, DSC, and RVA

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The anti-plasticizing action of the high sucrose concentration in a cookie formula inhibits both gluten development during dough mixing and starch gelatinization/pasting during baking. If alternative sugars and polyols with lower glycemic impact are used to replace sucrose, the resulting absence of ...

  1. Association between Social Relationship and Glycemic Control among Older Japanese: JAGES Cross-Sectional Study

    PubMed Central

    Kawachi, Ichiro; Kondo, Katsunori; Kondo, Naoki; Nagamine, Yuiko; Tani, Yukako; Shirai, Kokoro; Tazuma, Susumu

    2017-01-01

    Aim The present study examined whether social support, informal socializing and social participation are associated with glycemic control in older people. Methods Data for this population-based cross-sectional study was obtained from the Japan Gerontological Evaluation Study (JAGES) 2010 linked to the annual health check-up data in Japan. We analyzed 9,554 individuals aged ≥65 years without the certification of needed long-term care. Multivariate logistic regression models were used to assess the effect of social support, informal socializing and social participations on glycemic control. The outcome measure was HbA1c ≥8.4%. Results 1.3% of the participants had a level of HbA1c over 8.4%. Better glycemic control was significantly associated with meeting with friends one to four times per month (odds ratio [OR] 0.51, 95% confidence interval [CI]0.30–0.89, compared to meeting with friends a few times per year or less) and participation in sports groups (OR 0.50, 95% CI 0.26–0.97) even after adjusting for other variables. Meeting with friends more than twice per week, receiving social support, and being married were not associated with better control of diabetes. Conclusions Meeting with friends occasionally is associated with better glycemic control among older people. PMID:28060887

  2. Progressive zinc-induced changes in glycemic responses in lean and obese LAIN-cp rats

    SciTech Connect

    Zwick, D.; Frimpong, N.A.; Tulp, O.L. )

    1991-03-15

    The effect of diet and phenotype on glycemic status was studied in 9-17 week (wk) old female LAIN-cp rats fed isoenergetic diets containing 0, 20 (control), or 100 ppm Zn. At 9, 13 and 17 wks of age, fasting glucose (FG) of obese > lean. At age 13 wks, Fg of obese + 0 ppm Zn < control obese, and by 17 weeks, lean + 0 ppm Zn < controls, consistent with both diet and phenotype effects on FG. Four point glucose tolerance tests were determined via both intraperitoneal (ipGTT) and oral (OGT) routes at periodic intervals. ipGTT glycemic responses of control obese > lean at all ages, and at both 13 and 17 weeks, obese rats fed both 0 ppm and 100 ppm Zn diets had greater glycemic excursions at +30, +60, and +120 minutes than obese controls, and the glycemic excursions became progressively more impaired as the dietary regimens progressed. In contrast, the corresponding plasma glucoses following ipGTT in lean rats fed 0 or 100 ppm Zn diets and the OGT responses of all rats of both phenotypes remained similar to lean controls at those point. Plasma insulin concentrations of obese 0 ppm Zn < controls following ipGTT, and became progressively more impaired in obese rats fed 0 ppm Zn diet as the duration of treatment continued. These observations suggest that the progressive deterioration of glucose homeostasis when fed diets deficient or excessive in Zn content may be due to impaired pancreatic secretion and/or release of insulin.

  3. Determination of Factors Effected Dietary Glycemic Index in Turkish University Students

    ERIC Educational Resources Information Center

    Gumus, Huseyin; Akdevelioglu, Yasemin; Bulduk, Sidika

    2014-01-01

    We aimed to determine how factors such as smoking, regular activity, etc. affected dietary glycemic index in university students. Methods: This study was carried out at Gazi University, Ankara, Turkey. The participants were 577 randomly selected Turkish healthy female university students aged 17-32 years. The survey included a questionnaire that…

  4. Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The purpose of this study was to investigate insulin sensitivity and secretion indices and determinants of glycemic control in youth with recent-onset type 2 diabetes (T2DM) at randomization in the TODAY study, the largest study of youth with T2DM to date. We examined estimates of insulin sensitivit...

  5. Effect of cooling of cooked white rice on resistant starch content and glycemic response.

    PubMed

    Sonia, Steffi; Witjaksono, Fiastuti; Ridwan, Rahmawati

    2015-01-01

    Cooling of cooked starch is known to cause starch retrogradation which increases resistant starch content. This study aimed to determine the effect of cooling of cooked white rice on resistant starch content and glycemic response in healthy subjects. Resistant starch contents were analyzed on freshly cooked white rice (control rice), cooked white rice cooled for 10 hours at room temperature (test rice I), and cooked white rice cooled for 24 hours at 4°C then reheated (test rice II). The results showed that resistant starch contents in control rice, test rice I, and test rice II were 0.64 g/100 g, 1.30 g/100 g, and 1.65 g/100 g, respectively. Test rice II had higher resistant starch content than test rice I, hence used in the clinical study along with control rice to characterize glycemic response in 15 healthy adults. The clinical study was a randomized, single-blind crossover study. In the clinical study, test rice II significantly lowered glycemic response compared with control rice (125±50.1 vs 152±48.3 mmol.min/L, respectively; p=0.047). In conclusion, cooling of cooked white rice increased resistant starch content. Cooked white rice cooled for 24 hours at 4°C then reheated lowered glycemic response compared with freshly cooked white rice.

  6. Impact of food processing on the glycemic index (GI) of potato products

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Potatoes are one of the most popular carbohydrate foods in industrialized and some developing countries. However, contradicting arguments and misconceptions on potatoes as a high glycemic index (GI) food is directly affecting potato consumption during the past years. Potato varieties, maturity level...

  7. Estimated glycemic index and dietary fiber content of cookies elaborated with extruded wheat bran.

    PubMed

    Reyes-Pérez, Faviola; Salazar-García, María Guadalupe; Romero-Baranzini, Ana Lourdes; Islas-Rubio, Alma Rosa; Ramírez-Wong, Benjamín

    2013-03-01

    The increasing demand for high-fiber products has favored the design of numerous bakery products rich in fiber such as bread, cookies, and cakes. The objective of this study was to evaluate the dietary fiber and estimated glycemic index of cookies containing extruded wheat bran. Wheat bran was subjected to extrusion process under three temperature profiles: TP1;(60, 75, 85 and 100 °C), TP2;(60, 80, 100 and 120 °C), and TP3;(60, 80, 110 and 140 °C) and three moisture contents: (15, 23, and 31 %). Cookies were elaborated using extruded wheat bran (30 %), separated into two fractions (coarse and fine). The dietary fiber content of cookies elaborated with extruded wheat bran was higher than the controls; C0 (100 % wheat flour) and C1 (30 % of no extruded bran coarse fraction) and C2 (30 % of no extruded bran fine fraction). The higher values of dietary fiber were observed on cookies from treatments 5 (TP1, 31 % moisture content and coarse fraction) and 11 (TP2, 31 % moisture content and coarse fraction). The estimated glycemic index of cookies ranged from 68.54 to 80.16. The dietary fiber content of cookies was increased and the lowest glycemic index corresponded to the cookies elaborated with extruded wheat bran. Cookie made with the treatment 11 had a better dietary fiber content and lower estimated glycemic index.

  8. Association of Exercise Stages of Change with Glycemic Control in Individuals with Type 2 Diabetes.

    ERIC Educational Resources Information Center

    Natarajan, Sundar; Clyburn, Ernest B.; Brown, Ronald T.

    2002-01-01

    Investigated the distribution of diabetic patients' stages of change to follow an exercise regimen, examining whether later stages of change were associated with better glycemic control. Data on participants from a primary care clinic (who were predominantly black, female, and indigent) indicated that over half of were in pre-contemplation,…

  9. Dietary hyperglycemia, glycemic index and age-related metabolic retinal diseases

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The glycemic index (GI) indicates how fast blood glucose is raised after consuming a carbohydrate-containing food. Human metabolic studies indicate that GI is related to patho-physiological responses after meals. Compared with a low-GI meal, a high-GI meal is characterized with hyperglycemia during ...

  10. Glycemic index treatment using Japanese foods in a girl with Lennox-Gastaut syndrome.

    PubMed

    Kumada, Tomohiro; Hiejima, Ikuko; Nozaki, Fumihito; Hayashi, Anri; Fujii, Tatsuya

    2013-05-01

    We introduced a low glycemic index treatment using Japanese ethnic foods to a 13-year-old girl with Lennox-Gastaut syndrome caused by tuberous sclerosis complex. She had previously refused the modified Atkins diet within 2 weeks of diet treatment because of its restrictiveness. The low glycemic index treatment was implemented by limiting the daily carbohydrate intake to 50 g of foods with a glycemic index of less than 50 relative to that of glucose, which included udon, soba, and unpolished Japonica rice with natto. One month after the initiation of the diet therapy, the clusters of tonic seizures for 30 to 60 minutes during sleep were reduced from two or three times per week to once or twice per month, and the frequent myoclonic seizures in the awake state disappeared. She has been on the diet therapy for more than 1 year, and the efficacy of the diet has been sustained. Low glycemic index treatment should be considered for patients with medication-resistant epilepsy who cannot tolerate restrictive diet therapies. Japanese ethnic foods can be used for this diet therapy.

  11. Postprandial lipid responses to standard carbohydrate challenges used to determine glycemic index values

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Prior studies assessing metabolic effects of different types of carbohydrate have focused on their glycemic response. Not considered has been the response of postprandial cardiometabolic risk indicators. This study assessed the postprandial lipid responses to two forms of carbohydrates used as ref...

  12. Acute effects of dietary glycemic index on antioxidant capacity in nutrient-controlled feeding study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Oxidative stress, caused by an imbalance between antioxidant capacity and reactive oxygen species, may be an early event in a metabolic cascade elicited by a high glycemic index (GI) diet, ultimately increasing the risk for cardiovascular disease and diabetes. We conducted a feeding study to evalua...

  13. Estimating the reliability of glycemic index values and potential sources of methodological and biological variability

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: The utility of glycemic index (GI) values for chronic disease risk management remains controversial. While absolute GI value determinations for individual foods have been shown to vary significantly in individuals with diabetes, there is a dearth of data on the reliability of GI value de...

  14. Glycemic Control in a Clinic-Based Sample of Diabetics in M'Bour Senegal

    ERIC Educational Resources Information Center

    BeLue, Rhonda; Ndiaye, Khadidiatou; NDao, Fatou; Ba, Fatou Niass Niang; Diaw, Mor

    2016-01-01

    Background: Sub-Saharan Africa (SSA) including Senegal is faced with a significant and increasing burden of type 2 diabetes. However, little information is available about diabetes management among Senegalese diabetics. Purpose: The current study aims to describe the level of glycemic control among a convenience sample of diabetics who receive…

  15. Hindbrain DPP-IV inhibition improves glycemic control and promotes negative energy balance.

    PubMed

    Mietlicki-Baase, Elizabeth G; McGrath, Lauren E; Koch-Laskowski, Kieran; Krawczyk, Joanna; Pham, Tram; Lhamo, Rinzin; Reiner, David J; Hayes, Matthew R

    2017-05-01

    The beneficial glycemic and food intake-suppressive effects of glucagon-like peptide-1 (GLP-1) have made this neuroendocrine system a leading target for pharmacological approaches to the treatment of diabetes and obesity. One strategy to increase the activity of endogenous GLP-1 is to prevent the rapid degradation of the hormone by the enzyme dipeptidyl peptidase-IV (DPP-IV). However, despite the expression of both DPP-IV and GLP-1 in the brain, and the clear importance of central GLP-1 receptor (GLP-1R) signaling for glycemic and energy balance control, the metabolic effects of central inhibition of DPP-IV activity are unclear. To test whether hindbrain DPP-IV inhibition suppresses blood glucose, feeding, and body weight gain, the effects of 4th intracerebroventricular (ICV) administration of the FDA-approved DPP-IV inhibitor sitagliptin were evaluated. Results indicate that hindbrain delivery of sitagliptin improves glycemic control in a GLP-1R-dependent manner, suggesting that this effect is due at least in part to increased endogenous brainstem GLP-1 activity after sitagliptin administration. Furthermore, 4th ICV injection of sitagliptin reduced 24h body weight gain and energy intake, with a selective suppression of high-fat diet, but not chow, intake. These data reveal a novel role for hindbrain GLP-1R activation in glycemic control and also demonstrate that DPP-IV inhibition in the caudal brainstem promotes negative energy balance.

  16. Revisiting tight glycemic control in perioperative and critically ill patients: when one size may not fit all.

    PubMed

    Abdelmalak, Basem B; Lansang, M Cecilia

    2013-09-01

    Glycemic control has received intense scrutiny in the last decade as an important aspect of patient care. Earlier studies suggested that tight glycemic control (target level of 80 - 110 mg/dL) improved outcomes in intensive care unit (ICU) patients. Subsequent trials did not confirm the same benefit. Moreover, increased mortality was found in association with such tight control compared with a less strict target. As a result, tight glucose control has become less popular. The interaction between diabetic status and outcomes in relation to glucose control strategies and/or chronic glycemic state in perioperative and critically ill patients was examined. Tight glucose control appears to be more beneficial in patients without diabetes than in those with known diabetes. It also may be more beneficial in improving outcomes in surgical rather than nonsurgical ICU patients, and in decreasing sepsis rather than mortality. Tight glycemic control was associated with a high incidence of hypoglycemia, which may offset some of its potential benefits. Tight glycemic control in the perioperative and intensive care settings should not be totally abandoned either as a clinical practice or as a subject of future research. Beneficial effects of tight glycemic control may be demonstrated when the appropriate glycemic targets are matched to the appropriate population.

  17. Glycemic response to carob (ceratonia siliqua L) in healthy subjects and with the in vitro hydrolysis index.

    PubMed

    Milek Dos Santos, Luciana; Tomzack Tulio, Lindamir; Fuganti Campos, Leticia; Ramos Dorneles, Marcelo; Carneiro Hecke Krüger, Claudia

    2014-09-12

    The purpose of this study was to determine the in vivo glycemic index of carob tablets with healthy subjects and to determine the in vitro glycemic index of carob tablets and carob flour by the hydrolysis index. Seven healthy volunteers consumed portions of carob tablets containing 26g of available carbohydrate. Their capillary blood was taken at intervals after carob or glucose consumption. The glycemic hydrolysis index by an in vitro technique was based in the release of glucose after enzymatic treatment of carob tablets and carob flour. The determination of the fiber content was performed using the enzymatic- gravimetric method. By the in vivo determination, the estimated glycemic index of carob tablets could be considered low (≤ 55). By the in vitro determination, the estimated glycemic index ranged from 40.1+0.02 of carob tablets to 40.6+0.05 of carob flour. The total fiber values obtained for carob flour samples were from 42.6% ± 0.49 to 42.9% ± 0.68 with no statistical significant differences between samples. Carob tablets and carob flour could be classified as low glycemic index food and low glycemic load food. Carob flour is a high fiber food, containing mainly high levels of insoluble fiber.

  18. Peri-procedural Glycemic Control in Patients with Diabetes Mellitus Undergoing Coronary Angiography with Possible Percutaneous Coronary Intervention

    PubMed Central

    Shah, Binita; Berger, Jeffrey S.; Amoroso, Nicholas S.; Mai, Xingchen; Lorin, Jeffrey D.; Danoff, Ann; Schwartzbard, Arthur Z.; Lobach, Iryna; Guo, Yu; Feit, Frederick; Slater, James; Attubato, Michael J.; Sedlis, Steven P.

    2014-01-01

    Peri-procedural hyperglycemia is an independent predictor of mortality in patients undergoing percutaneous coronary intervention (PCI). However, peri-procedural management of blood glucose is not standardized. The effects of routinely continuing long-acting glucose-lowering medications prior to coronary angiography with possible PCI on peri-procedural glycemic control have not been investigated. Patients with diabetes mellitus (DM) (n=172) were randomized to continue (Continue group; n=86) or hold (Hold group; n=86) their clinically prescribed long-acting glucose-lowering medications prior to procedure. The primary endpoint was glucose level on procedural access. In a subset of patients (no DM group, n=25, Continue group, n=25, and Hold group, n=25), selected measures of platelet activity that change acutely were assessed. Patients with DM randomized to the Continue group had lower blood glucose levels on procedural access compared with those randomized to the Hold group (117 [97–151] vs 134 [117–172] mg/dL, p=0.002). There were 2 hypoglycemic events in the Continue group and none in the Hold group, and no adverse events in either group. Selected markers of platelet activity differed across the no DM, Continue, and Hold groups (leukocyte platelet aggregates: 8.1% [7.2–10.4], 8.7% [6.9–11.4], 10.9% [8.6–14.7], p=0.007; monocyte platelet aggregates: 14.0% [10.3–16.3], 20.8% [16.2–27.0], 22.5% [15.2–35.4], p<0.001; soluble p-selectin: 51.9ng/mL [39.7–74.0], 59.1ng/mL [46.8–73.2], 72.2ng/mL [58.4–77.4], p=0.014). In conclusion, routinely continuing clinically prescribed long-acting glucose-lowering medications prior to coronary angiography with possible PCI helps achieve peri-procedural euglycemia, appears safe, and should be considered as a strategy for achieving peri-procedural glycemic control. PMID:24630791

  19. Plasma adiponectin concentrations are associated with dietary glycemic index in Malaysian patients with type 2 diabetes.

    PubMed

    Loh, Beng-In; Sathyasuryan, Daniel Robert; Mohamed, Hamid Jan Jan

    2013-01-01

    Adiponectin, an adipocyte-derived hormone has been implicated in the control of blood glucose and chronic inflammation in type 2 diabetes. However, limited studies have evaluated dietary factors on plasma adiponectin levels, especially among type 2 diabetic patients in Malaysia. The aim of this study was to investigate the influence of dietary glycemic index on plasma adiponectin concentrations in patients with type 2 diabetes. A cross-sectional study was conducted in 305 type 2 diabetic patients aged 19-75 years from the Penang General Hospital, Malaysia. Socio-demographic information was collected using a standard questionnaire while dietary details were determined by using a pre-validated semi-quantitative food frequency questionnaire. Anthropometry measurement included weight, height, BMI and waist circumference. Plasma adiponectin concentrations were measured using a commercial ELISA kit. Data were analyzed using multiple linear regression. After multivariate adjustment, dietary glycemic index was inversely associated with plasma adiponectin concentrations (β =-0.272, 95% CI -0.262, - 0.094; p<0.001). It was found that in individuals who consumed 1 unit of foods containing high dietary glycemic index that plasma adiponectin level reduced by 0.3 μg/mL. Thirty two percent (31.9%) of the variation in adiponectin concentrations was explained by age, sex, race, smoking status, BMI, waist circumference, HDL-C, triglycerides, magnesium, fiber and dietary glycemic index according to the multiple linear regression model (R2=0.319). These results support the hypothesis that dietary glycemic index influences plasma adiponectin concentrations in patients with type 2 diabetes. Controlled clinical trials are required to confirm our findings and to elucidate the underlying mechanism.

  20. Glucose sensor evaluation of glycemic instability in pediatric type 1 diabetes mellitus.

    PubMed

    Alemzadeh, Ramin; Loppnow, Cindy; Parton, Elaine; Kirby, Midge

    2003-01-01

    Maintaining blood glucose (BG) levels within the target range can be an elusive goal in children with type 1 diabetes mellitus (DM). To identify factor(s) that may contribute to glycemic instability, we analyzed the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 DM and a history of frequent BG fluctuations and hypoglycemia. A total of 30 (17 girls, 13 boys) pediatric patients with a history of frequent BG fluctuations and hypoglycemia (mean age, 10.5 +/- 0.7 years; duration, 5.0 +/- 0.6 years), on three to four injections of insulin daily or insulin pump therapy, were evaluated by the CGMS. The mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated in each patient. There was a significant correlation between MBG and glycosylated hemoglobin (HbA1c) (r(2) = 0.22, p < 0.009). There was also a significant correlation between severity of lipohypertrophy and glycemic control (HbA1c) (r(2) = 0.20, p < 0.01). The MODD values had a positive correlation with the severity of injection site lipohypertrophy (r(2) = 0.37, p < 0.0003). The MAGE values had a positive correlation with bolus:basal insulin ratio (r(2) = 0.22, p < 0.009) and number of hypoglycemic events (r(2) = 0.21, p < 0.008), independent of age, MBG, and glycemic control. The 48-h CGMS profile can help characterize day-to-day and within-day BG variability and identify factors influencing glycemic instability in pediatric type 1 DM.

  1. Glycemic index of starch affects nitrogen retention in grower pigs.

    PubMed

    Drew, M D; Schafer, T C; Zijlstra, R T

    2012-04-01

    Three studies were performed to examine the effect of starch and protein digestion rates on N retention in grower pigs. In Exp. 1, the glycemic index (GI) of corn, a malting barley, and a slow-rumen-degradable barley (SRD-barley) were measured using 6 barrows (BW = 18.0 ± 0.5 kg). The GI of malting barley was greater (P < 0.05) than that of SRD-barley (71.1 vs. 49.4), and the GI of both barley cultivars was less (P < 0.05) than that of corn (104.8). In Exp. 2, the standardized ileal digestibility of AA and DE content of the 3 ingredients were determined using 5 ileal-cannulated barrows (BW = 20.7 ± 2.3). The apparent total-tract energy digestibility values of corn (86.1%) and malting barley (85.7%) were greater (P < 0.05) than that of SRD-barley (82.3%). The standardized ileal digestibility of Lys was 94.0, 92.6, and 92.4% for corn, malting barley, and SRD-barley, respectively, and did not differ among grains. In Exp. 3, 6 diets were formulated to equal DE (3.40 Mcal/kg), standardized ileal digestibility of Lys (8.6 g/kg), starch (424.9 g/kg), and digestible CP (180.0 g/kg) using the values obtained in Exp. 2. Three GI [high (corn), medium (malting barley), and low (SRD-barley)] and 2 rates of protein digestion [rapid (soy protein hydrolysate) and slow (soy protein isolate)] were tested in a 3 × 2 factorial arrangement with 36 barrows (BW = 32.2 ± 2.5 kg). Pigs were fed 3.0 times the maintenance energy requirement daily in 2 meals for 2 wk and were housed in metabolic crates to collect feces and urine separately. At the end of the study, intestinal contents were collected from 4 equal-length segments of the small intestine. The percentage of unabsorbed CP in segment 1 relative to dietary CP was greater (P < 0.05) for the soy protein isolate diet than for the soy protein hydrolysate diet (170.3 vs. 116.5%). The percentages of unabsorbed starch in segments 1 and 2 were greater (P < 0.05) for the SRD-barley diet than for the malting barley or corn diet. Nitrogen

  2. DIETARY HYPERGLYCEMIA, GLYCEMIC INDEX AND METABOLIC RETINAL DISEASES

    PubMed Central

    Chiu, Chung-Jung; Taylor, Allen

    2014-01-01

    The glycemic index (GI) indicates how fast blood glucose is raised after consuming a carbohydrate-containing food. Human metabolic studies indicate that GI is related to patho-physiological responses after meals. Compared with a low-GI meal, a high-GI meal is characterized with hyperglycemia during the early postprandial stage (0~2 h) and a compensatory hyperlipidemia associated with counter-regulatory hormone responses during late postprandial stage (4~6 h). Over the past three decades, several human health disorders have been related to GI. The strongest relationship suggests that consuming low-GI foods prevents diabetic complications. Diabetic retinopathy (DR) is a complication of diabetes. In this aspect, GI appears to be useful as a practical guideline to help diabetic people choose foods. Abundant epidemiological evidence also indicates positive associations between GI and risk for type 2 diabetes, cardiovascular disease, and more recently, age-related macular degeneration (AMD) in people without diabetes. Although data from randomized controlled intervention trials are scanty, these observations are strongly supported by evolving molecular mechanisms which explain the pathogenesis of hyperglycemia. This wide range of evidence implies that dietary hyperglycemia is etiologically related to human aging and diseases, including DR and AMD. In this context, these diseases can be considered metabolic retinal diseases. Molecular theories that explain hyperglycemic pathogenesis involve a mitochondria-associated pathway and four glycolysis-associated pathways, including advanced glycation end products formation, protein kinase C activation, polyol pathway, and hexosamine pathway. While the four glycolysis-associated pathways appear to be universal for both normoxic and hypoxic conditions, the mitochondria-associated mechanism appears to be most relevant to the hyperglycemic, normoxic pathogenesis. For diseases that affect tissues with highly active metabolism and that

  3. Multi-Scale Glycemic Variability: A Link to Gray Matter Atrophy and Cognitive Decline in Type 2 Diabetes

    PubMed Central

    Cui, Xingran; Abduljalil, Amir; Manor, Brad D.; Peng, Chung-Kang; Novak, Vera

    2014-01-01

    Objective Type 2 diabetes mellitus (DM) accelerates brain aging and cognitive decline. Complex interactions between hyperglycemia, glycemic variability and brain aging remain unresolved. This study investigated the relationship between glycemic variability at multiple time scales, brain volumes and cognition in type 2 DM. Research Design and Methods Forty-three older adults with and 26 without type 2 DM completed 72-hour continuous glucose monitoring, cognitive tests and anatomical MRI. We described a new analysis of continuous glucose monitoring, termed Multi-Scale glycemic variability (Multi-Scale GV), to examine glycemic variability at multiple time scales. Specifically, Ensemble Empirical Mode Decomposition was used to identify five unique ultradian glycemic variability cycles (GVC1–5) that modulate serum glucose with periods ranging from 0.5–12 hrs. Results Type 2 DM subjects demonstrated greater variability in GVC3–5 (period 2.0–12 hrs) than controls (P<0.0001), during the day as well as during the night. Multi-Scale GV was related to conventional markers of glycemic variability (e.g. standard deviation and mean glycemic excursions), but demonstrated greater sensitivity and specificity to conventional markers, and was associated with worse long-term glycemic control (e.g. fasting glucose and HbA1c). Across all subjects, those with greater glycemic variability within higher frequency cycles (GVC1–3; 0.5–2.0 hrs) had less gray matter within the limbic system and temporo-parietal lobes (e.g. cingulum, insular, hippocampus), and exhibited worse cognitive performance. Specifically within those with type 2 DM, greater glycemic variability in GVC2–3 was associated with worse learning and memory scores. Greater variability in GVC5 was associated with longer DM duration and more depression. These relationships were independent of HbA1c and hypoglycemic episodes. Conclusions Type 2 DM is associated with dysregulation of glycemic variability over multiple

  4. The Goods Upstairs Car Innovative Design

    NASA Astrophysics Data System (ADS)

    Wang, Feng-Lan; Zhang, Bo; Gao, Bo; Liu, Yan-Xin; Gao, Bo

    2016-05-01

    The design is a new kind of cars used for loading goods when you upstairs. The cars -- ones are very safe and convenient --consist of body, chassis, bottom, round, object, stage, upstairs, train wheels, handles, storage tank, security fence etc. The design, composed of combination of each structure, achieves the purpose of loading goods and even some large potted plants when you go upstairs or downstairs very flatly.

  5. Good clinical sense in diabetology.

    PubMed

    Kalra, Sanjay; Gupta, Yashdeep

    2015-08-01

    This article defines and explains the concept of good clinical sense. It defines good clinical sense as "the presence of sensory faculties, their usage and interpretation, by which one is able to practice good clinical medicine". Good clinical sense differs from good clinical practice (GCP) and good clinical acumen. It encompasses all steps of the clinical, diagnostic and therapeutic process, and encourages diligent practice of clinical medicine. Good clinical sense is integral to the practice of diabetology.

  6. One of the Good Guys

    SciTech Connect

    Wiley, H. S.

    2010-10-01

    I was talking with some younger colleagues at a meeting last month when the subject of career goals came up. These colleagues were successful in that they had recently received tenure at top research universities and had some grants and good students. Thus, the early career pressure to simply survive was gone. So now what motivated them? Solving challenging and significant scientific problems was at the top of their lists. Interestingly, they were also motivated by a desire to become one of the “good guys” in science. The fact that being an important contributor to the scientific community can be fulfilling should not come as a surprise to anyone. However, what I do consider surprising is how rarely this seems to be discussed with students and postdocs. What we do discuss are either those issues that are fundamental aspects of the job (get a grant, get tenure, do research in an important field) or those that are important to our institutions. Knowing how to do our jobs well is indeed essential for any kind of professional success. However, achieving the right balance in our ambitions is also important for our happiness.

  7. A systematic review on the effect of sweeteners on glycemic response and clinically relevant outcomes

    PubMed Central

    2011-01-01

    Background The major metabolic complications of obesity and type 2 diabetes may be prevented and managed with dietary modification. The use of sweeteners that provide little or no calories may help to achieve this objective. Methods We did a systematic review and network meta-analysis of the comparative effectiveness of sweetener additives using Bayesian techniques. MEDLINE, EMBASE, CENTRAL and CAB Global were searched to January 2011. Randomized trials comparing sweeteners in obese, diabetic, and healthy populations were selected. Outcomes of interest included weight change, energy intake, lipids, glycated hemoglobin, markers of insulin resistance and glycemic response. Evidence-based items potentially indicating risk of bias were assessed. Results Of 3,666 citations, we identified 53 eligible randomized controlled trials with 1,126 participants. In diabetic participants, fructose reduced 2-hour blood glucose concentrations by 4.81 mmol/L (95% CI 3.29, 6.34) compared to glucose. Two-hour blood glucose concentration data comparing hypocaloric sweeteners to sucrose or high fructose corn syrup were inconclusive. Based on two ≤10-week trials, we found that non-caloric sweeteners reduced energy intake compared to the sucrose groups by approximately 250-500 kcal/day (95% CI 153, 806). One trial found that participants in the non-caloric sweetener group had a decrease in body mass index compared to an increase in body mass index in the sucrose group (-0.40 vs 0.50 kg/m2, and -1.00 vs 1.60 kg/m2, respectively). No randomized controlled trials showed that high fructose corn syrup or fructose increased levels of cholesterol relative to other sweeteners. Conclusions Considering the public health importance of obesity and its consequences; the clearly relevant role of diet in the pathogenesis and maintenance of obesity; and the billions of dollars spent on non-caloric sweeteners, little high-quality clinical research has been done. Studies are needed to determine the role

  8. A Good Death.

    PubMed

    Powell, Tia; Hulkower, Adira

    2017-01-01

    A good death is hard to find. Family members tell us that loved ones die in the wrong place-the hospital-and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively new and still vulnerable aspect of medical care. For thousands of years, patients and surrogates had no say in medical decision-making. Today, standards support shared decision-making, but these articles both carve out exceptions to those standards, limiting the rights of patients and families in decisions about specific end-of-life treatments. As bioethics consultants in an acute care setting, we frequently confront conflicts similar to those described by Jeffrey Berger and by Ellen Robinson and colleagues. In such cases, our service emphasizes redoubled efforts at communication and mediation. Focusing on goals and values, rather than interventions, produces the best possible collaboration in health care decision-making. Cases in which we would overturn a surrogate's recommendations regarding palliative sedation or do-not-resuscitate orders are rare and require careful processes and clear evidence that the surrogate's choice is contrary to patient values.

  9. The Good Investment.

    PubMed

    Prescott, John E; Fresne, Julie A; Youngclaus, James A

    2017-01-24

    The authors reflect on the article in this issue entitled "Borrow or Serve? An Economic Analysis of Options for Financing a Medical School Education" by Marcu and colleagues, which makes a compelling case that a medical school education is a good investment, no matter what financing option students use, from federal service programs to federal loans. The lead author of this Commentary shares lessons learned from his own medical school education, which was funded by an Armed Forces Health Professions Scholarship, and from his current position interacting with medical students across the United States.Regardless of the financing path they choose, all students should understand basic financial concepts and the details of the various pathways that are available to pay for their medical school education, as well as how each could potentially impact their own future and that of their families. One underappreciated aspect of financing a medical school education is that federal repayment scenarios can link loan payments to income, rather than debt levels, which means that all physicians are able to afford their loan payments no matter what specialty they practice, what they are paid, or where they live.Medical education, while expensive, remains the good investment. An MD degree can lead to a lifetime of personal fulfillment and societal contributions. Everyone, with rare exceptions, accepted to a U.S. medical school will be able to finance their medical education via a path that aligns with their personal values and priorities.

  10. The effect of apparent amylose content and dietary fibre on the glycemic response of different varieties of cooked milled and brown rice.

    PubMed

    Trinidad, Trinidad P; Mallillin, Aida C; Encabo, Rosario R; Sagum, Rosario S; Felix, Angelina D R; Juliano, Bienvenido O

    2013-02-01

    Brown rice is a good source of dietary fibre (DF) and contains higher vitamins/minerals than milled rice. The study determined the effect of amylose content (AC) and DF on glucose response (GR) from different varieties of milled and brown rice. Milled and brown rice were used as test foods. They were fed to 9-10 human volunteers containing 50 g available carbohydrate after an overnight fast. GR and the glycemic index (GI) were determined. Results found that Sinandomeng with the lowest AC had a high GI = 75, while PSBRc10 with the highest AC had a low GI = 50. Sinandomeng with a low DF had GI = 75, while its brown rice had GI = 55. Brown rice (IR64) with 23% AC and DF of 2.5 g/100 g had low GI = 51. In conclusion, the GR and GI of the different varieties of cooked milled and brown rice varied depending on its AC and DF contents.

  11. Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

    PubMed Central

    Shi, Hao-Jun; Jin, Chen; Fu, De-Liang

    2017-01-01

    AIM To evaluate the impact of glycemic control and nutritional status after total pancreatectomy (TP) on complications, tumor recurrence and overall survival. METHODS Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified. RESULTS High early postoperative fasting blood glucose (FBG) levels (OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels (OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative HbA1c levels over 7% (HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus (HR = 15.019, 95%CI: 1.278-176.211, P = 0.031) and alcohol history (B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively. CONCLUSION At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival. PMID:28127200

  12. Extended Prandial Glycemic Profiles of Foods as Assessed Using Continuous Glucose Monitoring Enhance the Power of the 120-Minute Glycemic Index

    PubMed Central

    Chlup, Rudolf; Peterson, Karolina; Zapletalová, Jana; Kudlová, Pavla; Sečkař, Pavel

    2010-01-01

    Background The glycemic index (GI) is routinely measured 120 minutes after food intake (GI120). The purpose of this prospective open label study was to assess (1) the dynamics of glycemia over the 210 minutes following food consumption and (2) the evolution of GIs based on 120-, 150-, 180-, and 210-minute glycemic profiles. Method Twenty healthy subjects (mean ± SE; 21.9 ± 1.39 years of age; body mass index 23.6 ± 0.63 kg/m2; 7 men and 13 women) completed the study. Each subject consumed 10 different foods with known GI120 on three separate occasions at four different times of day according to a defined meal plan over a 9-day period; 32 meals were evaluated. The GIs for intervals of 120, 150, 180 and 210 minutes after food consumption were determined using a continuous glucose monitoring system (CGMS) to measure glycemia. The Wilcoxon signed-rank test was applied to compare the GIs. Results Glycemia returned to baseline within 120 minutes for honey and tomato soup; within 210 minutes for white bread, choco-rice cookies, fish and potatoes, wafers, and meat ravioli with cheese; and later for dark chocolate, apricot dumplings, and choco-wheat cookies. The extended GIs were higher than the respective GI120s in eight of the foods. Conclusions The 120-minute glycemic index fails to fully account for changes in glycemia after ingestion of a mixed meal because glycemia remains above baseline for a longer period. The CGMS is a convenient method to determine the glucose response/GIs over intervals extended up to 210 minutes, which is adequate time for the absorption of most foods. PMID:20513328

  13. First pilot trial of the STAR-Liege protocol for tight glycemic control in critically ill patients.

    PubMed

    Penning, Sophie; Le Compte, Aaron J; Moorhead, Katherine T; Desaive, Thomas; Massion, Paul; Preiser, Jean-Charles; Shaw, Geoffrey M; Chase, J Geoffrey

    2012-11-01

    Tight glycemic control (TGC) has shown benefits in ICU patients, but been difficult to achieve consistently due to inter- and intra- patient variability that requires more adaptive, patient-specific solutions. STAR (Stochastic TARgeted) is a flexible model-based TGC framework accounting for patient variability with a stochastically derived maximum 5% risk of blood glucose (BG) below 72 mg/dL. This research describes the first clinical pilot trial of the STAR approach and the post-trial analysis of the models and methods that underpin the protocol. The STAR framework works with clinically specified targets and intervention guidelines. The clinically specified glycemic target was 125 mg/dL. Each trial was 24 h with BG measured 1-2 hourly. Two-hourly measurement was used when BG was between 110-135 mg/dL for 3 h. In the STAR approach, each intervention leads to a predicted BG level and outcome range (5-95th percentile) based on a stochastic model of metabolic patient variability. Carbohydrate intake (all sources) was monitored, but not changed from clinical settings except to prevent BG<100 mg/dL when no insulin was given. Insulin infusion rates were limited (6 U/h maximum), with limited increases based on current infusion rate (0.5-2.0 U/h), making this use of the STAR framework an insulin-only TGC approach. Approval was granted by the Ethics Committee of the Medical Faculty of the University of Liege (Liege, Belgium). Nine patient trials were undertaken after obtaining informed consent. There were 205 measurements over all 9 trials. Median [IQR] per-patient results were: BG: 138.5 [130.6-146.0]mg/dL; carbohydrate administered: 2-11 g/h; median insulin:1.3 [0.9-2.4]U/h with a maximum of 6.0 [4.7-6.0]U/h. Median [IQR] time in the desired 110-140 mg/dL band was: 50.0 [31.2-54.2]%. Median model prediction errors ranged: 10-18%, with larger errors due to small meals and other clinical events. The minimum BG was 63 mg/dL and no other measurement was below 72 mg/dL, so

  14. α-2-Macroglobulin in Saliva Is Associated with Glycemic Control in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Aitken, Juan Pablo; Ortiz, Carolina; Morales-Bozo, Irene; Rojas-Alcayaga, Gonzalo; Baeza, Mauricio; Beltran, Caroll

    2015-01-01

    Background. Subjects with type 2 diabetes mellitus (DM2) require an adequate glycemic control to avoid diabetic complications. Currently, saliva biomarkers are used as a diagnostic tool and can be indicative of the degree of progression and control of various diseases. Several studies indicate that α-2-macroglobulin levels are elevated in diabetic patients. Methods. 120 subjects with DM2 were enrolled and classified into two groups according to their glycemic control (percentage of glycated hemoglobin-A1c (HbA1c), <7% adequate glycemic control group; >7% inadequate glycemic control group). The relationship between α-2-macroglobulin levels from saliva samples and HbA1c was subsequently evaluated. Results. We found a positive correlation between α-2-macroglobulin and HbA1c (r = 0.778 and P < 0.0001). Area under the receivers operating characteristic (ROC) curve of α-2-macroglobulin indicated a positive discrimination threshold of α-2-macroglobulin (AUC = 0.903, CI 95%: 0.847–0.959, P < 0.0001) to diagnose glycemic control. Conclusions. Our data strongly suggest that the level of saliva α-2-macroglobulin is an indicator for the degree of glycemic control in diabetic patients and represents a promising alternative method to evaluate this parameter. PMID:25821337

  15. Longitudinal relationships between glycemic status and body mass index in a multiethnic study: evidence from observational and genetic epidemiology.

    PubMed

    Ishola, Adeola F; Gerstein, Hertzel C; Engert, James C; Mohan, Viswanathan; Diaz, Rafael; Anand, Sonia S; Meyre, David

    2016-08-02

    We investigated the relationship between glycemic status and BMI and its interaction with obesity single-nucleotide polymorphisms (SNPs) in a multi-ethnic longitudinal cohort at high-risk for dysglycemia. We studied 17 394 participants from six ethnicities followed-up for 3.3 years. Twenty-three obesity SNPs were genotyped and an unweighted genotype risk score (GRS) was calculated. Glycemic status was defined using an oral glucose tolerance test. Linear regression models were adjusted for age, sex and population stratification. Normal glucose tolerance (NGT) to dysglycemia transition was associated with baseline BMI and BMI change. Impaired fasting glucose/impaired glucose tolerance to type 2 diabetes transition was associated with baseline BMI but not BMI change. No simultaneous significant main genetic effects and interactions between SNPs/GRS and glycemic status or transition on BMI level and BMI change were observed. Our data suggests that the interplay between glycemic status and BMI trajectory may be independent of the effects of obesity genes. This implies that individuals with different glycemic statuses may be combined together in genetic association studies on obesity traits, if appropriate adjustments for glycemic status are performed. Implementation of population-wide weight management programs may be more beneficial towards individuals with NGT than those at a later disease stage.

  16. Graded Achievement, Tested Achievement, and Validity

    ERIC Educational Resources Information Center

    Brookhart, Susan M.

    2015-01-01

    Twenty-eight studies of grades, over a century, were reviewed using the argument-based approach to validity suggested by Kane as a theoretical framework. The review draws conclusions about the meaning of graded achievement, its relation to tested achievement, and changes in the construct of graded achievement over time. "Graded…

  17. Glycemic Response to Corn Starch Modified with Cyclodextrin Glycosyltransferase and its Relationship to Physical Properties.

    PubMed

    Dura, A; Yokoyama, W; Rosell, C M

    2016-09-01

    Corn starch was modified with cyclodextrin glycosyltransferase (CGTase) below the gelatinization temperature. The porous granules with or without CGTase hydrolysis products may be used as an alternative to modified corn starches in foods applications. The amount and type of hydrolysis products were determined, containing mainly β-cyclodextrin (CD), which will influence pasting behavior and glycemic response in mice. Irregular surface and small holes were observed by microscopic analysis and differences in pasting properties were observed in the presence of hydrolysis products. Postprandial blood glucose in mice fed gelatinized enzymatically modified starch peaked earlier than their ungelatinized counterparts. However, in ungelatinized enzymatically modified starches, the presence of β- CD may inhibit the orientation of amylases slowing hydrolysis, which may help to maintain lower blood glucose levels. Significant correlations were found between glycemic curves and viscosity pattern of starches.

  18. Metabolic and Glycemic Sequelae of Sleep Disturbances in Children and Adults

    PubMed Central

    Koren, Dorit; O'Sullivan, Katie L.; Mokhlesi, Babak

    2015-01-01

    The prevalence of obesity in adults and children has increased greatly in the past three decades, as have metabolic sequelae, such as insulin resistance and type 2 diabetes mellitus (T2DM). Sleep disturbances are increasingly recognized as contributors to this widespread epidemic in adults, and data are emerging in children as well. The categories of sleep disturbances that contribute to obesity and its glycemic co-morbidities include the following: (1) alterations of sleep duration, chronic sleep restriction and excessive sleep; (2) alterations in sleep architecture; (3) sleep fragmentation; (4) circadian rhythm disorders and disruption (i.e., shift work); and (5) obstructive sleep apnea. This article reviews current evidence supporting the contributions that these sleep disorders play in the development of obesity, insulin resistance, and T2DM as well as possibly influences on glycemic control in type 1 diabetes, with a special focus on data in pediatric populations. PMID:25398202

  19. Metabolic and glycemic sequelae of sleep disturbances in children and adults.

    PubMed

    Koren, Dorit; O'Sullivan, Katie L; Mokhlesi, Babak

    2015-01-01

    The prevalence of obesity in adults and children has increased greatly in the past three decades, as have metabolic sequelae, such as insulin resistance and type 2 diabetes mellitus (T2DM). Sleep disturbances are increasingly recognized as contributors to this widespread epidemic in adults, and data are emerging in children as well. The categories of sleep disturbances that contribute to obesity and its glycemic co-morbidities include the following: (1) alterations of sleep duration, chronic sleep restriction and excessive sleep; (2) alterations in sleep architecture; (3) sleep fragmentation; (4) circadian rhythm disorders and disruption (i.e., shift work); and (5) obstructive sleep apnea. This article reviews current evidence supporting the contributions that these sleep disorders play in the development of obesity, insulin resistance, and T2DM as well as possibly influences on glycemic control in type 1 diabetes, with a special focus on data in pediatric populations.

  20. Role of glycemic elements of Cynodon dactylon and Musa paradisiaca in diabetes management.

    PubMed

    Rai, Prashant Kumar; Jaiswal, Dolly; Rai, Nilesh K; Pandhija, Shiwani; Rai, A K; Watal, Geeta

    2009-09-01

    The study defined the scientific evaluation of glycemic elements of extracts of Cynodon dactylon and Musa paradisiaca. A dose of 500 mg/kg body weight (bw) of C. dactylon produced maximum falls of 23.2% and 22.8% in blood glucose levels of normoglycemic rats during studies of fasting blood glucose and glucose tolerance, respectively, whereas the same dose of M. paradisiaca produced a rise of 34.9% and 18.4%. In diabetic rats during glucose tolerance tests, a fall of 27.8% and a rise of 17.5% were observed with the same dose of C. dactylon and M. paradisiaca, respectively. Laser-induced breakdown spectroscopy used for detection of glycemic elements present in both the extracts indicated that C. dactylon was rich in magnesium (Mg), whereas M. paradisiaca was rich in potassium (K) and sodium (Na), comparatively, suggesting thereby the defined roles of these elements in diabetes management.

  1. Glycemic index of American-grown jasmine rice classified as high.

    PubMed

    Truong, Teresa H; Yuet, Wei Cheng; Hall, Micki D

    2014-06-01

    The primary objective was to determine the glycemic index (GI) of jasmine rice grown in the United States (US). Secondary objective was to compare the GI of US grown jasmine rice to those grown in Thailand. Twelve healthy subjects were served all four brands of jasmine rice and a reference food (glucose), each containing 50 g of available carbohydrate. Fingerstick blood glucose was measured at 0, 15, 30, 45, 60, 90, and 120 min after consumption following a fasting state. The GI was calculated using the standard equation. The GI values for test foods ranged from 96 to 116 and were all classified as high GI foods. No difference in GI was found between American-grown and Thailand-grown jasmine rice. Although not statistically significant, observations show glycemic response among Asian American participants may be different. GI should be considered when planning meals with jasmine rice as the main source carbohydrate.

  2. Glycemic index of grain amaranth, wheat and rice in NIDDM subjects.

    PubMed

    Chaturvedi, A; Sarojini, G; Nirmala, G; Nirmalamma, N; Satyanarayana, D

    1997-01-01

    Glycemic index of grain amaranth, wheat and rice preparations was studied in non-insulin dependent diabetic subjects. Diets containing 50 g carbohydrate equivalent were given and post-prandial blood glucose estimated at different intervals. Glycemic index calculated for different experimental diets showed that GI of amaranth-wheat composite flour diet (25:75) was the least (65.6%) followed by wheat diet (65.7%), rice diet (69.2%), amaranth-wheat flour 50:50 (75.5%), and popped amaranth in milk (97.3%). Therefore 25:75 combination of amaranth and wheat, wheat and rice can be considered low GI food, 50:50 grain amaranth and wheat medium GI food and popped amaranth and milk combination high GI food.

  3. Community Interventions to Improve Glycemic Control in African Americans With Type 2 Diabetes: A Systemic Review

    PubMed Central

    Smalls, Brittany L.; Walker, Rebekah J.; Bonilha, Heather S.; Campbell, Jennifer A.; Egede, Leonard E.

    2015-01-01

    Purpose: The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. Methods: Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. Results: Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. Conclusion: In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches. PMID:26156923

  4. Dietary energy density but not glycemic load is associated with gestational weight gain

    PubMed Central

    Deierlein, Andrea L.; Siega-Riz, Anna Maria; Herring, Amy

    2009-01-01

    Background The majority of pregnant women are gaining outside of the recommended weight gain ranges. Excessive weight gains have been linked to pregnancy complications and long term maternal and child health outcomes. Objective To examine the impact of dietary glycemic load and energy density on total gestational weight gain and weight gain ratio (observed weight gain/expected weight gain). Design Data are from 1231 women with singleton pregnancies who participated in the Pregnancy, Infection, and Nutrition Cohort Study. Dietary information was collected at 26–29 weeks gestation using a semi-quantified food frequency questionnaire. Linear regression models were used to estimate the associations between glycemic load (in quartiles) and energy density (in quartiles) with total gestational weight gain and weight gain ratio. Results Dietary patterns of pregnant women significantly differed across many sociodemographic and behavioral characteristics, with the greatest contrasts seen for glycemic load. After adjustment for covariates, in comparison to women in the first quartile, consuming a mean dietary energy density of 0.77 kcal/g (reference), women in the second quartile, consuming a mean energy density of 0.95 kcal/g, gained an excess of 0.91 kg (95% CI: 0.02–1.79) and women in the third quartile, consuming a mean energy density of 1.09 kcal/g, gained an excess of 1.47 kg (95% CI: 0.58–2.36). All other comparisons of energy intakes were not statistically significant. Glycemic load was not associated with total gestational weight gain or weight gain ratio. Conclusions Dietary energy density is a modifiable factor that may assist pregnant women in managing gestational weight gains. PMID:18779285

  5. Evaluation of a novel artificial pancreas: closed loop glycemic control system with continuous blood glucose monitoring.

    PubMed

    Tsukamoto, Yuuki; Kinoshita, Yoshihiko; Kitagawa, Hiroyuki; Munekage, Masaya; Munekage, Eri; Takezaki, Yuka; Yatabe, Tomoaki; Yamashita, Koichi; Yamazaki, Rie; Okabayashi, Takehiro; Tarumi, Masatoshi; Kobayashi, Masaki; Mishina, Suguru; Hanazaki, Kazuhiro

    2013-04-01

    A closed-loop glycemic control system using an artificial pancreas has been applied with many clinical benefits in Japan since 1987. To update this system incorporating user-friendly features, we developed a novel artificial pancreas (STG-55). The purpose of this study was to evaluate STG-55 for device usability, performance of blood glucose measurement, glycemic control characteristics in vivo in animal experiments, and evaluate its clinical feasibility. There are several features for usability improvement based on the design concepts, such as compactness, display monitor, batteries, guidance function, and reduction of the preparation time. All animal study data were compared with a clinically available artificial pancreas system in Japan (control device: STG-22). We examined correlations of both blood glucose levels between two groups (STG-55 vs. control) using Clarke's error grid analysis, and also compared mean glucose infusion rate (GIR) during glucose clamp. The results showed strong correlation in blood glucose concentrations (Pearson's product-moment correlation coefficient: 0.97; n = 1636). Clarke's error grid analysis showed that 98.4% of the data fell in Zones A and B, which represent clinically accurate or benign errors, respectively. The difference in mean GIRs was less than 0.2 mg/kg/min, which was considered not significant. Clinical feasibility study demonstrated sufficient glycemic control maintaining target glucose range between 80 and 110 (mg/dL), and between 140 and 160 without any hypoglycemia. In conclusion, STG-55 was a clinically acceptable artificial pancreas with improved interface and usability. A closed-loop glycemic control system with STG-55 would be a useful tool for surgical and critical patients in intensive care units, as well as diabetic patients.

  6. Diabetes management at the end of life: transitioning from tight glycemic control to comfort.

    PubMed

    Tice, Martha A

    2006-05-01

    Tight glycemic control has become the standard of care for prevention of the long-term side effects of diabetes mellitus. When individuals with diabetes approach the end of life from advanced cancer or another chronic illness, they often become anorexic. The result is an increased risk for hypoglycemic episodes. It is appropriate to shift the goal of therapy from tight control of blood sugar to maintaining comfort and enhancing quality of life.

  7. Eggs: good or bad?

    PubMed

    Griffin, Bruce A

    2016-08-01

    Eggs have one of the lowest energy to nutrient density ratios of any food, and contain a quality of protein that is superior to beef steak and similar to dairy. From a nutritional perspective, this must qualify eggs as 'good'. The greater burden of proof has been to establish that eggs are not 'bad', by increasing awareness of the difference between dietary and blood cholesterol, and accumulating sufficient evidence to exonerate eggs from their associations with CVD and diabetes. After 60 years of research, a general consensus has now been reached that dietary cholesterol, chiefly from eggs, exerts a relatively small effect on serum LDL-cholesterol and CVD risk, in comparison with other diet and lifestyle factors. While dietary guidelines have been revised worldwide to reflect this view, associations between egg intake and the incidence of diabetes, and increased CVD risk in diabetes, prevail. These associations may be explained, in part, by residual confounding produced by other dietary components. The strength of evidence that links egg intake to increased CVD risk in diabetes is also complicated by variation in the response of serum LDL-cholesterol to eggs and dietary cholesterol in types 1 and 2 diabetes. On balance, the answer to the question as to whether eggs are 'bad', is probably 'no', but we do need to gain a better understanding of the effects of dietary cholesterol and its association with CVD risk in diabetes.

  8. Good Clinical Practice Training

    PubMed Central

    Arango, Jaime; Chuck, Tina; Ellenberg, Susan S.; Foltz, Bridget; Gorman, Colleen; Hinrichs, Heidi; McHale, Susan; Merchant, Kunal; Shapley, Stephanie; Wild, Gretchen

    2016-01-01

    Good Clinical Practice (GCP) is an international standard for the design, conduct, performance, monitoring, auditing, recording, analyses, and reporting of clinical trials. The goal of GCP is to ensure the protection of the rights, integrity, and confidentiality of clinical trial participants and to ensure the credibility and accuracy of data and reported results. In the United States, trial sponsors generally require investigators to complete GCP training prior to participating in each clinical trial to foster GCP and as a method to meet regulatory expectations (ie, sponsor’s responsibility to select qualified investigators per 21 CFR 312.50 and 312.53(a) for drugs and biologics and 21 CFR 812.40 and 812.43(a) for medical devices). This training requirement is often extended to investigative site staff, as deemed relevant by the sponsor, institution, or investigator. Those who participate in multiple clinical trials are often required by sponsors to complete repeated GCP training, which is unnecessarily burdensome. The Clinical Trials Transformation Initiative convened a multidisciplinary project team involving partners from academia, industry, other researchers and research staff, and government to develop recommendations for streamlining current GCP training practices. Recommendations drafted by the project team, including the minimum key training elements, frequency, format, and evidence of training completion, were presented to a broad group of experts to foster discussion of the current issues and to seek consensus on proposed solutions. PMID:27390628

  9. Higher glycemic index and glycemic load diet is associated with increased risk of esophageal squamous cell carcinoma: a case-control study.

    PubMed

    Eslamian, Ghazaleh; Jessri, Mahsa; Hajizadeh, Bahareh; Ibiebele, Torukiri I; Rashidkhani, Bahram

    2013-09-01

    Several studies have indicated the association between intake of foods high in dietary glycemic index (GI) and glycemic load (GL) with an increased risk of digestive tract cancers. We hypothesized that GI and GL may be associated with risk of esophageal squamous cell carcinoma (ESCC) in a high-risk population in Iran. In total, we interviewed 47 cases with incident of ESCC and 96 frequency-matched hospital controls, then calculated the average dietary GI and GL via a validated food frequency questionnaire. Dietary GL was calculated as a function of GI, carbohydrate content, and frequency of intake of certain foods. Dietary GI and GL levels were significantly higher among the ESCC cases compared with the controls (P < .05). After adjustment for potential confounders, those in the highest tertile of dietary GI had 2.95 times higher risk of ESCC compared with those in the lowest (95% confidence interval, 1.68-3.35; P for trend = .002). In addition, being in the highest tertile of dietary GL was positively associated with an ESCC risk (odds ratio, 3.49; 95% confidence interval, 2.98-4.41; P for trend = .001). Findings of the present study indicate that diets with high GI and GL might have potentially unfavorable effects on ESCC risk and suggest a possible role for excess circulating insulin and related insulin-like growth factor 1 in esophageal cancer development.

  10. The association between dietary glycemic index, glycemic load and diet quality indices in Iranian adults: results from Isfahan Healthy Heart Program.

    PubMed

    Azadbakht, Leila; Mohammadifard, Noushin; Akhavanzanjani, Mohsen; Taheri, Marzieh; Golshahi, Jafar; Haghighatdoost, Fahimeh

    2016-01-01

    To assess the association between dietary glycemic index (GI), glycemic load (GL) and dietary quality indices in Iranian adults. This cross section was conducted among 1571 Iranian adults aged  ≥19 years. GI, GL and diet quality indices were estimated by 24-h recall and DDS was calculated using a validated 48-item food frequency questionnaire. Participants who were in the top tertile of GI had lower healthy eating index (HEI) (57.2 ± 7.8 versus 55.6 ± 8.7; p < 0.001), dietary diversity score (DDS) (3.6 ± 0.9 versus 3.3 ± 1.1; p < 0.001) and nutrient adequacy ratios (NARs) for Zn, Ca, vitamin C and B2. Individuals in the lowest tertile of GL had lower HEI, MAR and NARs for Zn, vitamin B2, B3, B6, B12, vitamin D. Both GI and GL were positively related to dietary diversity score (DED) (p < 0.001). The inverse associations for GI and GL with diet quality indices may suggest the relevance of carbohydrate source in determining the diet quality indices.

  11. The association between glycemic control and microalbuminuria in Type 2 diabetes.

    PubMed

    Showail, Anwar Ali; Ghoraba, Medhat

    2016-05-01

    Microalbuminuria is an independent risk factor for cardiovascular and renal out- come in a patient with Type 2 diabetes. The evidence that intensive glycemic control reduces the microvascular complications of diabetes is based almost exclusively on prevention of micro- albuminuria. To evaluate the association between microalbuminuria and glycemic control and other factors in Type 2 diabetes, we studied retrospectively 551 patients with Type 2 diabetes. The patients were divided into two groups: 175 patients with microalbuminuria in the case group and 376 with normal urine albumin-creatinine ratio in the control group. Our data indicated that there was a significant association between the uncontrolled glycemia and development of microalbuminuria and that was more obvious if HbA1c level was >11%. Our data also indicate that there was a statistical significant association between male gender, age, the systolic and diastolic blood pressure (DBP) levels, and the microalbuminuria in crude odds ratios (ORs). We conclude that there was a clear association between the glycemic control and microalbuminuria, and microalbuminuria was associated with older age, male gender, and systolic and DBP in crude ORs.

  12. Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis

    PubMed Central

    Houle, Janie; Lauzier-Jobin, François; Beaulieu, Marie-Dominique; Meunier, Sophie; Coulombe, Simon; Côté, José; Lespérance, François; Chiasson, Jean-Louis; Bherer, Louis; Lambert, Jean

    2016-01-01

    Objective The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control. Methods A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES. Results Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c. Conclusions To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet. PMID:27239316

  13. Pathogenesis and glycemic management of type 2 diabetes mellitus: a physiological approach.

    PubMed

    Ismail-Beigi, Faramarz

    2012-04-01

    Type 2 diabetes (T2DM) is an incompletely understood chronic, progressive multifactorial disease with insulin resistance and decreased β-cell function playing dominant roles in its genesis.  The worldwide incidence of the disease is rapidly increasing to pandemic proportions.  The increase in incidence of T2DM is attributable to changes in lifestyle, diet and obesity, but other causes remain to be defined.  The disease is a major cause of early mortality due to atherosclerosis and cardiovascular disease (CVD), and is the leading cause of blindness, leg amputations, and chronic renal disease.  Hyperglycemia inT2DM becomes manifest once insulin secretion is no longer adequate for the metabolic demands of the individual. The approach to glycemic management of the disease is increasingly based on understanding the underlying pathophysiology.  Efforts to maintain and preserve β-cell function during the earlier phases of the disease may have important implications in prevention of subsequent complications of T2DM.  Finally, the approach to glycemic management of the disease should be individualized by considering the psycho-socio-economic condition of each patient, and glycemic targets should reflect presence of comorbid conditions, age of the patient, the stage of their disease in terms of duration, presence of macro- and micro-vascular complications, and propensity for severe hypoglycemia.

  14. Association between Responsible Pet Ownership and Glycemic Control in Youths with Type 1 Diabetes

    PubMed Central

    2016-01-01

    Type 1 diabetes mellitus (T1DM) a chronic characterized by an absolute insulin deficiency requires conscientious patient self-management to maintain glucose control within a normal range. Family cohesion and adaptability, positive coping strategies, social support and adequate self-regulatory behavior are found to favorably influence glycemic control. Our hypothesis was that the responsible care of a companion animal is associated with these positive attributes and correlated with the successful management of a chronic illness such as type 1 diabetes. We recruited 223 youths between 9 and 19 years of age from the Pediatric Diabetes clinic at the University of Massachusetts Medical School, reviewed the status of their glycemic control (using three consecutive A1c values) and asked them questions about the presence of a pet at home, and their level of involvement with its care. Multivariate analyses show that children who care actively for one or more pets at home are 2.5 times more likely to have control over their glycemic levels than children who do not care for a pet, adjusting for duration of disease, socio-economic status, age and self-management [1.1 to 5.8], pWald = 0.032. A separate model involving the care of a petdog only yielded comparable results (ORa = 2.6 [1.1 to 5.9], pWald = 0.023). PMID:27104736

  15. Association between Responsible Pet Ownership and Glycemic Control in Youths with Type 1 Diabetes.

    PubMed

    Maranda, Louise; Gupta, Olga T

    2016-01-01

    Type 1 diabetes mellitus (T1DM) a chronic characterized by an absolute insulin deficiency requires conscientious patient self-management to maintain glucose control within a normal range. Family cohesion and adaptability, positive coping strategies, social support and adequate self-regulatory behavior are found to favorably influence glycemic control. Our hypothesis was that the responsible care of a companion animal is associated with these positive attributes and correlated with the successful management of a chronic illness such as type 1 diabetes. We recruited 223 youths between 9 and 19 years of age from the Pediatric Diabetes clinic at the University of Massachusetts Medical School, reviewed the status of their glycemic control (using three consecutive A1c values) and asked them questions about the presence of a pet at home, and their level of involvement with its care. Multivariate analyses show that children who care actively for one or more pets at home are 2.5 times more likely to have control over their glycemic levels than children who do not care for a pet, adjusting for duration of disease, socio-economic status, age and self-management [1.1 to 5.8], pWald = 0.032. A separate model involving the care of a petdog only yielded comparable results (ORa = 2.6 [1.1 to 5.9], pWald = 0.023).

  16. Higher glycemic load diet is associated with poorer nutrient intake in women with gestational diabetes mellitus.

    PubMed

    Louie, Jimmy Chun Yu; Markovic, Tania P; Ross, Glynis P; Foote, Deborah; Brand-Miller, Jennie C

    2013-04-01

    Changes in the quality and quantity of carbohydrate foods may compromise nutrient intake in women with gestational diabetes mellitus (GDM). We hypothesized that glycemic index, glycemic load (GL), carbohydrate intake, grains, and cereal product consumption would be associated with nutrient adequacy. Eighty-two women with GDM (61% of Asian background, 34% whites) completed a 3-day food record following their routine group nutrition education session. Nutrient intakes were compared to Nutrient Reference Values (NRV) for Australia and New Zealand. Nutrient intake across energy-adjusted tertiles of glycemic index, GL, carbohydrate intake, and intake of grains and cereal products were assessed. The majority of women (66%-99%) did not meet the NRV for fiber, folate, vitamin D, iodine, and iron, and exceeded NRV for saturated fat and sodium. Higher dietary GL was associated with lower intakes of total, monounsaturated, and polyunsaturated fat; vitamin E; and potassium (all P < .001). Higher grain intake was not significantly associated with intake of any micronutrients. In Australian women with GDM, high dietary GL predicts greater risk of poor nutrition.

  17. 24-Hour Glucose Profiles on Diets Varying in Protein Content and Glycemic Index

    PubMed Central

    van Baak, Marleen A.

    2014-01-01

    Evidence is increasing that the postprandial state is an important factor contributing to the risk of chronic diseases. Not only mean glycemia, but also glycemic variability has been implicated in this effect. In this exploratory study, we measured 24-h glucose profiles in 25 overweight participants in a long-term diet intervention study (DIOGENES study on Diet, Obesity and Genes), which had been randomized to four different diet groups consuming diets varying in protein content and glycemic index. In addition, we compared 24-h glucose profiles in a more controlled fashion, where nine other subjects followed in random order the same four diets differing in carbohydrate content by 10 energy% and glycemic index by 20 units during three days. Meals were provided in the lab and had to be eaten at fixed times during the day. No differences in mean glucose concentration or glucose variability (SD) were found between diet groups in the DIOGENES study. In the more controlled lab study, mean 24-h glucose concentrations were also not different. Glucose variability (SD and CONGA1), however, was lower on the diet combining a lower carbohydrate content and GI compared to the diet combining a higher carbohydrate content and GI. These data suggest that diets with moderate differences in carbohydrate content and GI do not affect mean 24-h or daytime glucose concentrations, but may result in differences in the variability of the glucose level in healthy normal weight and overweight individuals. PMID:25093276

  18. The effect of dietary glycemic index on weight maintenance in overweight subjects: a pilot study.

    PubMed

    Philippou, Elena; Neary, Nicola M; Chaudhri, Owais; Brynes, Audrey E; Dornhorst, Anne; Leeds, Anthony R; Hickson, Mary; Frost, Gary S

    2009-02-01

    Evidence suggests that a low-glycemic index (LGI) diet has a satiating effect and thus may enhance weight maintenance following weight loss. This study was conducted at Hammersmith Hospital, London, UK, and assessed the effect of altering diet GI on weight-loss maintenance. It consisted of a weight-loss phase and a 4-month randomized weight maintenance phase. Subjects were seen monthly to assess dietary compliance and anthropometrics. Appetite was assessed bimonthly by visual analogue scales while meal challenge postprandial insulin and glucose concentrations were assessed before and after the intervention. Following a median weight loss of 6.1 (interquartile range: 5.2-7.1) % body weight, subjects were randomized to a high-glycemic index (HGI) (n = 19) or LGI (n = 23) diet. Dietary composition differed only in GI (HGI group: 63.7 +/- 9.4; LGI group: 49.7 +/- 5.7, P < 0.001) and glycemic load (HGI group: 136.8 +/- 56.3; LGI group: 89.7 +/- 27.5, P < 0.001). Groups did not differ in body weight (weight change over 4 months, HGI group: 0.3 +/- 1.9 kg; LGI group: -0.7 +/- 2.9 kg, P = 0.3) or other anthropometric measurements. This pilot study suggests that in the setting of healthy eating, changing the diet GI does not appear to significantly affect weight maintenance.

  19. [Glycemic response to consumption of a cereals and legume (Phaseolus vulgaris) bar on healthy individuals].

    PubMed

    Zambrano, Rosaura; Granito, Marisela; Valero, Yolmar

    2013-06-01

    The objective of this work was to formulate a cereals and legume (Phaseolus vulgaris) bar and assess its impact on the glycemic response of healthy individuals, in order to contribute to the healthy food supply beneficial to consumers. A mixture of cereals (corn and oats) and different percentages (20 and 30%) of Phaseolus vulgaris was used to formulate the bar. Additionally, a legume cereal bar without legumes (bar control) was prepared. The bar with 30% of Phaseolus vulgaris was selected through sensory evaluation, being scored with better flavor and texture. This combination of cereals and legumes aminoacid improves complementation and reaches the formulation criteria previously established. Chemical characterization indicated a higher protein content in the bar with 30% of Phaseolus vulgaris (13.55%) relative to the bar control (8.5%). The contents of fat, ash and dietary fiber did not differ between the two bars evaluated. However, the soluble fiber and resistant starch of the selected bar was a 32.05% and 18.67%, respectively, than in the control bar; this may contribute to decreasing the rate of glucose uptake. The selected bar presented a low glycemic index (49) and intermediate glycemic load (12.0) in healthy volunteers, which could lead to a possible reduction in the rate of absorption of glucose into the bloodstream, associated with a carbohydrate content of slow absorption. This bar represents a proposal of a healthy snack for the consumer.

  20. Impact of Type 2 Diabetes Susceptibility Variants on Quantitative Glycemic Traits Reveals Mechanistic Heterogeneity

    PubMed Central

    Dimas, Antigone S.; Lagou, Vasiliki; Barker, Adam; Knowles, Joshua W.; Mägi, Reedik; Hivert, Marie-France; Benazzo, Andrea; Rybin, Denis; Jackson, Anne U.; Stringham, Heather M.; Song, Ci; Fischer-Rosinsky, Antje; Boesgaard, Trine Welløv; Grarup, Niels; Abbasi, Fahim A.; Assimes, Themistocles L.; Hao, Ke; Yang, Xia; Lecoeur, Cécile; Barroso, Inês; Bonnycastle, Lori L.; Böttcher, Yvonne; Bumpstead, Suzannah; Chines, Peter S.; Erdos, Michael R.; Graessler, Jurgen; Kovacs, Peter; Morken, Mario A.; Narisu, Narisu; Payne, Felicity; Stancakova, Alena; Swift, Amy J.; Tönjes, Anke; Bornstein, Stefan R.; Cauchi, Stéphane; Froguel, Philippe; Meyre, David; Schwarz, Peter E.H.; Häring, Hans-Ulrich; Smith, Ulf; Boehnke, Michael; Bergman, Richard N.; Collins, Francis S.; Mohlke, Karen L.; Tuomilehto, Jaakko; Quertemous, Thomas; Lind, Lars; Hansen, Torben; Pedersen, Oluf; Walker, Mark; Pfeiffer, Andreas F.H.; Spranger, Joachim; Stumvoll, Michael; Meigs, James B.; Wareham, Nicholas J.; Kuusisto, Johanna; Laakso, Markku; Langenberg, Claudia; Dupuis, Josée; Watanabe, Richard M.; Florez, Jose C.; Ingelsson, Erik; McCarthy, Mark I.; Prokopenko, Inga

    2014-01-01

    Patients with established type 2 diabetes display both β-cell dysfunction and insulin resistance. To define fundamental processes leading to the diabetic state, we examined the relationship between type 2 diabetes risk variants at 37 established susceptibility loci, and indices of proinsulin processing, insulin secretion, and insulin sensitivity. We included data from up to 58,614 nondiabetic subjects with basal measures and 17,327 with dynamic measures. We used additive genetic models with adjustment for sex, age, and BMI, followed by fixed-effects, inverse-variance meta-analyses. Cluster analyses grouped risk loci into five major categories based on their relationship to these continuous glycemic phenotypes. The first cluster (PPARG, KLF14, IRS1, GCKR) was characterized by primary effects on insulin sensitivity. The second cluster (MTNR1B, GCK) featured risk alleles associated with reduced insulin secretion and fasting hyperglycemia. ARAP1 constituted a third cluster characterized by defects in insulin processing. A fourth cluster (TCF7L2, SLC30A8, HHEX/IDE, CDKAL1, CDKN2A/2B) was defined by loci influencing insulin processing and secretion without a detectable change in fasting glucose levels. The final group contained 20 risk loci with no clear-cut associations to continuous glycemic traits. By assembling extensive data on continuous glycemic traits, we have exposed the diverse mechanisms whereby type 2 diabetes risk variants impact disease predisposition. PMID:24296717

  1. In vitro colonic fermentation and glycemic response of different kinds of unripe banana flour.

    PubMed

    Menezes, Elizabete Wenzel; Dan, Milana C T; Cardenette, Giselli H L; Goñi, Isabel; Bello-Pérez, Luis Arturo; Lajolo, Franco M

    2010-12-01

    This work aimed to study the in vitro colonic fermentation profile of unavailable carbohydrates of two different kinds of unripe banana flour and to evaluate their postprandial glycemic responses. The unripe banana mass (UBM), obtained from the cooked pulp of unripe bananas (Musa acuminata, Nanicão variety), and the unripe banana starch (UBS), obtained from isolated starch of unripe banana, plantain type (Musa paradisiaca) in natura, were studied. The fermentability of the flours was evaluated by different parameters, using rat inoculum, as well as the glycemic response produced after the ingestion by healthy volunteers. The flours presented high concentration of unavailable carbohydrates, which varied in the content of resistant starch, dietary fiber and indigestible fraction (IF). The in vitro colonic fermentation of the flours was high, 98% for the UBS and 75% for the UBM when expressed by the total amount of SCFA such as acetate, butyrate and propionate in relation to lactulose. The increase in the area under the glycemic curve after ingestion of the flours was 90% lower for the UBS and 40% lower for the UBM than the increase produced after bread intake. These characteristics highlight the potential of UBM and UBS as functional ingredients. However, in vivo studies are necessary in order to evaluate the possible benefit effects of the fermentation on intestinal health.

  2. Effect of Added Carbohydrates on Glycemic and Insulin Responses to Children’s Milk Products

    PubMed Central

    Brand-Miller, Jennie; Atkinson, Fiona; Rowan, Angela

    2013-01-01

    Powdered milk products for children (Growing Up Milk Powders or GUMPs) containing added carbohydrates such as glucose and sucrose are now well established in parts of Asia. We surveyed GUMPs in Malaysia and Indonesia to determine the content of added carbohydrates. The ingredient lists and nutrition information panels were used to calculate the percentage of declared carbohydrates contributed by added carbohydrates and a subset of seven products was tested for their glycemic index (GI) and insulin responses in healthy adults. The glycemic load for each product was calculated. In total, 58 products (n = 24 in Malaysia and n = 34 in Indonesia) were surveyed. Added carbohydrate content (excluding fibre) ranged from 0 to 21.5 g per serve. Milk powders without added sources of carbohydrate had similar GI values to standard liquid whole milk. Products containing maltodextrins, corn or glucose syrups increased the GI by more than 2-fold, and glycemic load (GL) by 7-fold compared to milk powders with no added carbohydrates. Insulin responses were significantly but not strongly correlated with glucose responses (r = 0.32, p < 0.006). Children’s milk powders containing higher levels of added carbohydrate ingredients elicit higher glucose and insulin responses than liquid or powdered whole milk. PMID:23306187

  3. Glycemic responses to sweetened dried and raw cranberries in humans with type 2 diabetes.

    PubMed

    Wilson, Ted; Luebke, Justin L; Morcomb, Erin F; Carrell, Emily J; Leveranz, Megan C; Kobs, Lisa; Schmidt, Travis P; Limburg, Paul J; Vorsa, Nicholi; Singh, Ajay P

    2010-10-01

    This study assessed the metabolic response to sweetened dried cranberries (SDC), raw cranberries (RC), and white bread (WB) in humans with type 2 diabetes. Development of palatable cranberry preparations associated with lower glycemic responses may be useful for improving fruit consumption and glycemic control among those with diabetes. In this trial, type 2 diabetics (n= 13) received WB (57 g, 160 cal, 1 g fiber), RC (55 g, 21 cal, 1 g fiber), SDC (40 g, 138 cal, 2.1 g fiber), and SDC containing less sugar (SDC-LS, 40 g, 113 cal, 1.8 g fiber + 10 g polydextrose). Plasma glucose (mmol/L) peaked significantly at 60 min for WB, and at 30 min for RC, SDC, and SDC-LS at 9.6 ± 0.4, 7.0 ± 0.4, 9.6 ± 0.5, and 8.7 ± 0.5, respectively, WB remained significantly elevated from the other treatments at 120 min. Plasma insulin (pmol/mL) peaked at 60 min for WB and SDC and at 30 min for RC and SDC-LS at 157 ± 15, 142 ± 27, 61 ± 8, and 97 ± 11, respectively. Plasma insulin for SDC-LS was significantly lower at 60 min than either WB or SDC. Insulin area under the curve (AUC) values for RC and SDC-LS were both significantly lower than WB or SDC. Phenolic content of SDC and SDC-LS was determined following extraction with 80% acetone prior to high-performance liquid chromatography (HPLC) and electronspray ionization-mass spectrometry (ESI-MS) and found to be rich in 5-caffeoylquinic cid, quercetin-3-galactoside, and quercetin-3-galactoside, and the proanthocyanidin dimer epicatechin. In conclusion, SDC-LS was associated with a favorable glycemic and insulinemic response in type 2 diabetics. Practical Application: This study compares phenolic content and glycemic responses among different cranberry products. The study seeks to expand the palatable and portable healthy food choices for persons with type 2 diabetes. The novel use of polydextrose as a bulking agent making possible a reduction in caloric content and potential glycemic response is also characterized in this study.

  4. Competition in Healthcare: Good, Bad or Ugly?

    PubMed

    Goddard, Maria

    2015-08-01

    The role of competition in healthcare is much debated. Despite a wealth of international experience in relation to competition, evidence is mixed and contested and the debate about the potential role for competition is often polarised. This paper considers briefly some of the reasons for this, focusing on what is meant by "competition in healthcare" and why it is more valuable to think about the circumstances in which competition is more and less likely to be a good tool to achieve benefits, rather than whether or not it is "good" or "bad," per se.

  5. Methodological challenges in the application of the glycemic index in epidemiological studies using data from the European Prospective Investigation into Cancer and Nutrition.

    PubMed

    van Bakel, Marit M E; Slimani, Nadia; Feskens, Edith J M; Du, Huaidong; Beulens, Joline W J; van der Schouw, Yvonne T; Brighenti, Furio; Halkjaer, Jytte; Cust, Anne E; Ferrari, Pietro; Brand-Miller, Jennie; Bueno-de-Mesquita, H Bas; Peeters, Petra; Ardanaz, Eva; Dorronsoro, Miren; Crowe, Francesca L; Bingham, Sheila; Rohrmann, Sabine; Boeing, Heiner; Johansson, Ingegerd; Manjer, Jonas; Tjonneland, Anne; Overvad, Kim; Lund, Eiliv; Skeie, Guri; Mattiello, Amalia; Salvini, Simonetta; Clavel-Chapelon, Françoise; Kaaks, Rudolf

    2009-03-01

    Associations between the glycemic index (GI) or glycemic load (GL) and diseases are heterogeneous in epidemiological studies. Differences in assigning GI values to food items may contribute to this inconsistency. Our objective was to address methodological issues related to the use of current GI and GL values in epidemiological studies. We performed ecological comparison and correlation studies by calculating dietary GI and GL from country-specific dietary questionnaires (DQ) from 422,837 participants from 9 countries participating in the European Prospective Investigation into Cancer and Nutrition study and single standardized 24-h dietary recalls (24-HDR) obtained from a representative sample (n = 33,404) using mainly Foster Powell's international table as a reference source. Further, 2 inter-rater and 1 inter-method comparison were conducted, comparing DQ GI values assigned by independent groups with values linked by us. The ecological correlation between DQ and 24-HDR was good for GL (overall r = 0.76; P < 0.005) and moderate for GI (r = 0.57; P < 0.05). Mean GI/GL differences between DQ and 24-HDR were significant for most centers. GL but not GI from DQ was highly correlated with total carbohydrate (r = 0.98 and 0.15, respectively; P < 0.0001) and this was higher for starch (r = 0.72; P < 0.0001) than for sugars (r = 0.36; P < 0.0001). The inter-rater and inter-method variations were considerable for GI (weighted kappa coefficients of 0.49 and 0.65 for inter-rater and 0.25 for inter-method variation, respectively) but only mild for GL (weighted kappa coefficients > 0.80). A more consistent methodology to attribute GI values to foods and validated DQ is needed to derive meaningful GI/GL estimates for nutritional epidemiology.

  6. Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity

    PubMed Central

    Sacks, Frank M.; Carey, Vincent J.; Anderson, Cheryl A. M.; Miller, Edgar R.; Copeland, Trisha; Charleston, Jeanne; Harshfield, Benjamin J.; Laranjo, Nancy; McCarron, Phyllis; Swain, Janis; White, Karen; Yee, Karen; Appel, Lawrence J.

    2015-01-01

    IMPORTANCE Foods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood. OBJECTIVE To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes. DESIGN, SETTING, AND PARTICIPANTS Randomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120–159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure. INTERVENTIONS (1) A high–glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low–glycemic index (40%), high-carbohydrate diet; (3) a high–glycemic index, low-carbohydrate diet (40% energy); and (4) a low–glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet. MAIN OUTCOMES AND MEASURES The 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure. RESULTS At high dietary carbohydrate content, the low– compared with high–glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (−20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the

  7. The role of parent-adolescent attachment in the glycemic control of adolescents with Type 1 diabetes: a pilot study.

    PubMed

    Rosenberg, Tziporah; Shields, Cleveland G

    2009-09-01

    This pilot study explored the associations between parent and adolescent reports of adolescent attachment and glycemic control in adolescents with Type 1 diabetes. We hypothesized that more secure attachment would correlate with more optimal diabetes control. Thirty-one families completed written self-report questionnaires about adolescent attachment, demographic data, and diabetes control. Adolescents and parents reported on their perceptions of adolescents' attachment to mothers and fathers. Mean HbA1c for the sample was 7.6% (SD = 1.14). Mothers' perceptions of adolescents' attachment were significantly correlated with adolescents' hemoglobin A1c (r = -.42, p = .022), indicating that maternal perceptions of more secure attachment was associated with better glycemic control. Neither fathers' perceptions nor adolescents' reports of attachment was significantly correlated with glycemic control. Attachment appears to be associated with glycemic control in this population though the mechanisms are unclear. Mothers' perceptions of attachment had the strongest associations with control, not adolescent reports. Further research is needed to understand the mechanisms through which parent reports of adolescent attachment are associated with glycemic control.

  8. Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans

    PubMed Central

    Fedirko, V.; Lukanova, A.; Bamia, C.; Trichopolou, A.; Trepo, E.; Nöthlings, U.; Schlesinger, S.; Aleksandrova, K.; Boffetta, P.; Tjønneland, A.; Johnsen, N. F.; Overvad, K.; Fagherazzi, G.; Racine, A.; Boutron-Ruault, M. C.; Grote, V.; Kaaks, R.; Boeing, H.; Naska, A.; Adarakis, G.; Valanou, E.; Palli, D.; Sieri, S.; Tumino, R.; Vineis, P.; Panico, S.; Bueno-de-Mesquita, H. B(as).; Siersema, P. D.; Peeters, P. H.; Weiderpass, E.; Skeie, G.; Engeset, D.; Quirós, J. R.; Zamora-Ros, R.; Sánchez, M. J.; Amiano, P.; Huerta, J. M.; Barricarte, A.; Johansen, D.; Lindkvist, B.; Sund, M.; Werner, M.; Crowe, F.; Khaw, K. T.; Ferrari, P.; Romieu, I.; Chuang, S. C.; Riboli, E.; Jenab, M.

    2013-01-01

    Background The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. Patients and methods The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case–control subset. Results Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17–1.74) per 50 g/day, total starch = 0.70 (0.55–0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52–0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23–1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37–0.99) per 10 g/day], but not biliary tract cancer. Conclusions Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk. PMID:23123507

  9. Dietary glycemic index, but not glycemic load, is positively associated with serum homocysteine concentration in free-living young Japanese women.

    PubMed

    Murakami, Kentaro; Sasaki, Satoshi; Uenishi, Kazuhiro

    2014-01-01

    It has been suggested that diets which enhance diurnal insulin secretion, such as a high glycemic index (GI) and glycemic load (GL) diet, can be expected to increase homocysteine levels. We investigated the hypothesis that dietary GI and GL are positively associated with serum homocysteine concentration in a group of free-living young Japanese women. This preliminary cross-sectional study included 1050 female Japanese dietetic students aged 18 to 22 years. Dietary intake was assessed using a validated, self-administered, comprehensive diet history questionnaire. Fasting blood samples were collected and serum homocysteine concentrations were measured. Adjustment was made for survey year, region, municipality level, current smoking, current alcohol consumption, dietary supplement use, physical activity, body mass index, energy intake, and intakes of B vitamins (folate, vitamin B6, vitamin B12, and riboflavin). After adjustment for nondietary confounding factors, both dietary GI and GL were positively associated with homocysteine concentration (both P for trend=.001). The positive association between dietary GI and homocysteine concentration remained after further adjustment for intakes of B vitamins. Mean (95% confidence interval) values of serum homocysteine concentration for each quintile of dietary GI were 6.9 (6.7-7.2), 7.1 (6.8-7.3), 7.0 (6.7-7.2), 7.4 (7.2-7.7), and 7.3 (7.0-7.6) μmol/L, respectively (P for trend = .04). Conversely, there was no association between dietary GL and homocysteine concentration after further adjustment for intakes of B vitamins (P for trend = .40). To conclude, in a group of free-living young Japanese women, dietary GI, but not GL, was independently and positively associated with serum homocysteine concentration.

  10. Is fructose the optimal low glycemic index sweetener?

    PubMed

    Bantle, John P

    2006-01-01

    Fructose is a monosaccharide which is abundant in nature. It is the sweetest naturally occurring carbohydrate. The availability of fructose increased substantially when it became possible in the 1960s to economically produce high fructose syrups from corn starch and other starches. Such high fructose syrups are now used to sweeten soft drinks, fruit drinks, baked goods, jams, syrups and candies. The most recent data available suggest that fructose consumption is increasing worldwide. Fructose presently accounts for about 10% of average total energy intake in the United States. Studies in both healthy and diabetic subjects demonstrated that fructose produced a smaller postprandial rise in plasma glucose and serum insulin than other common carbohydrates. Substitution of dietary fructose for other carbohydrates produced a 13% reduction in mean plasma glucose in a study of type-1 and type-2 diabetic subjects. However, there is concern that fructose may aggravate lipemia, particularly in men. In one study, daylong plasma triglycerides (estimated by determining the area under response curves) in healthy men was 32% greater during a high fructose diet than during a high glucose diet. There is also concern that fructose may be a factor contributing to the growing worldwide prevalence of obesity. Increasing fructose consumption is temporally associated with the increase in obesity. Moreover, on theoretical grounds, dietary fructose might increase energy intake. Fructose stimulates insulin secretion less than does glucose and glucose-containing carbohydrates. Since insulin increases leptin release, lower circulating insulin and leptin after fructose ingestion might inhibit appetite less than consumption of other carbohydrates and lead to increased energy intake. However, there is not yet any convincing experimental evidence that dietary fructose does increase energy intake. Although evidence that fructose has adverse effects is limited, adding fructose in large amounts to

  11. Effects of soy vs. casein protein on body weight and glycemic control in female monkeys and their offspring.

    PubMed

    Wagner, Janice D; Jorgensen, Matthew J; Cline, J Mark; Lees, Cynthia J; Franke, Adrian A; Zhang, Li; Ayers, Melissa R; Schultz, Carrie; Kaplan, Jay R

    2009-09-01

    Nutritional interventions are important for reducing obesity and related conditions. Soy is a good source of protein and also contains isoflavones that may affect plasma lipids, body weight, and insulin action. Described here are data from a monkey breeding colony in which monkeys were initially fed a standard chow diet that is low fat with protein derived from soy. Monkeys were then randomized to a defined diet with a fat content similar to the typical American diet (TAD) containing either protein derived from soy (TAD soy) or casein-lactalbumin (TAD casein). The colony was followed for over two years to assess body weight, and carbohydrate and lipid measures in adult females (n=19) and their offspring (n=25). Serum isoflavone concentrations were higher with TAD soy than TAD casein, but not as high as when monkey chow was fed. Offspring consuming TAD soy had higher serum isoflavone concentrations than adults consuming TAD soy. Female monkeys consuming TAD soy had better glycemic control, as determined by fructosamine concentrations, but no differences in lipids or body weight compared with those consuming diets with TAD casein. Offspring born to dams consuming TAD soy had similar body weights at birth but over a two-year period weighed significantly less, had significantly lower triglyceride concentrations, and like adult females, had significantly lower fructosamine concentrations compared to TAD casein. Glucose tolerance tests in adult females were not significantly different with diet, but offspring eating TAD soy had increased glucose disappearance with overall lower glucose and insulin responses to the glucose challenge compared with TAD casein. Potential reasons for the additional benefits of TAD soy observed in offspring but not in adults may be related to higher serum isoflavone concentrations in offspring, presence of the diet differences throughout more of their lifespan (including gestation), or different tissue susceptibilities in younger animals.

  12. The polyphenol-rich baobab fruit (Adansonia digitata L.) reduces starch digestion and glycemic response in humans.

    PubMed

    Coe, Shelly A; Clegg, Miriam; Armengol, Mar; Ryan, Lisa

    2013-11-01

    The baobab fruit (Adansonia digitata L.) is found throughout regions of Africa and is becoming increasingly recognized for its high nutrient and polyphenol content. Polyphenols have been beneficial for their effects on reducing the glycemic response (GR) and for improving various other metabolic parameters. Based on previous research, it was hypothesized that the baobab fruit extract would reduce starch digestion in vitro and would show potential for reducing the GR and for increasing satiety and diet-induced thermogenesis in humans. Six extracts of baobab from 6 different locations in Africa were measured for their antioxidant and polyphenol content using the ferric ion-reducing antioxidant power and the Folin-Ciocalteu methods, respectively. Baobab extract was baked into white bread at different doses to determine the optimal dose for reducing starch breakdown and sugar release from white bread after an in vitro digestion procedure. In vivo, baobab extract was consumed in solution at both a low-dose (18.5 g) and a high-dose (37 g) aqueous drink in 250 mL of water along with white bread, and resulting GR, satiety, and postprandial energy expenditure were measured. All extracts in this study were shown to be good sources of polyphenols. Baobab fruit extract added to white bread at 1.88 % significantly (P < .05) reduced rapidly digestible starch from white bread samples. In vivo, the baobab fruit extract at both low and high doses significantly (P < .05) reduced GR, although there was no significant effect on satiety or on energy expenditure.

  13. Defining the Good Reading Teacher.

    ERIC Educational Resources Information Center

    Kupersmith, Judy; And Others

    In the quest for a definition of the good reading teacher, a review of the literature shows that new or copious materials, one specific teaching method, and static teaching behaviors are not responsible for effective teaching. However, observations of five reading teachers, with good references and good reputations but with widely divergent…

  14. Leader as achiever.

    PubMed

    Dienemann, Jacqueline

    2002-01-01

    This article examines one outcome of leadership: productive achievement. Without achievement one is judged to not truly be a leader. Thus, the ideal leader must be a visionary, a critical thinker, an expert, a communicator, a mentor, and an achiever of organizational goals. This article explores the organizational context that supports achievement, measures of quality nursing care, fiscal accountability, leadership development, rewards and punishments, and the educational content and teaching strategies to prepare graduates to be achievers.

  15. Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study

    PubMed Central

    Buhary, Badurudeen Mahmood; Almohareb, Ohoud; Aljohani, Naji; Alzahrani, Saad H.; Elkaissi, Samer; Sherbeeni, Suphia; Almaghamsi, Abdulrahman; Almalki, Mussa

    2016-01-01

    Context: Diabetes in pregnancy (DIP) is either pregestational or gestational. Aims: To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. Settings and Design: In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. Subjects and Methods: The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes. Statistical Analysis Used: Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression. Results: Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia. Conclusions: Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception. PMID:27366714

  16. Glycemic Effects of Rebaudioside A and Erythritol in People with Glucose Intolerance

    PubMed Central

    Shin, Dong Hee; Lee, Ji Hye; Kang, Myung Shin; Kim, Tae Hoon; Jeong, Su Jin; Kim, Sang Soo

    2016-01-01

    Background Rebaudioside A and erythritol are nonnutritive sweeteners. There have been several studies of their glycemic effects, but the outcomes remain controversial. The purpose of this study was to evaluate the glycemic effects of rebaudioside A and erythritol as a sweetener in people with glucose intolerance. Methods This trial evaluated the glycemic effect after 2 weeks of consumption of rebaudioside A and erythritol as sweeteners in a pre-diabetic population. The patients were evaluated for fructosamine, fasting plasma glucose, C-peptide, insulin, and 2-hour plasma glucose before and after consumption of sweetener. The primary outcome was a change in fructosamine levels from the baseline to the end of treatment. Secondary outcomes were the changes in levels of fasting plasma glucose and 2-hour plasma glucose. Results From the baseline to the end of experiment, the changes in fructosamine levels after consumption of rebaudioside A and erythritol, did not differ significantly (244.00±19.57 vs. 241.68±23.39 µmol/L, P=0.366). The change in levels from the baseline to end of the study for rebaudioside A and erythritol were fasting plasma glucose (102.56±10.72 vs. 101.32±9.20 mg/dL), 2-hour plasma glucose (154.92±54.53 vs. 141.92±42.22 mg/dL), insulin (7.56±4.29 vs. 7.20±5.12 IU/mL), and C-peptide (2.92±1.61 vs. 2.73±1.31 ng/mL), respectively, and also did not differ significantly (P>0.05 for all). Conclusion Our study suggests that consumption of rebaudioside A and erythritol does not alter the glucose homeostasis in people with glucose intolerance. PMID:27352150

  17. Effect of glycemic state on hospital mortality in critically ill surgical patients.

    PubMed

    Chi, Albert; Lissauer, Matthew E; Kirchoffner, Jill; Scalea, Thomas M; Johnson, Steven B

    2011-11-01

    Intensive insulin therapy can reduce mortality. Hypoglycemia related to intensive therapy may worsen outcomes. This study compared risk adjusted mortality for different glycemic states. A retrospective review of patients admitted to a surgical intensive care unit over 4 years was performed. Patients were divided into glycemic groups: HYPER (≥1 episode > 180 mg/dL, any <60), HYPO (≥1 episode < 60 mg/dL, any >180), BOTH (≥1 episode < 60 and ≥1 episode > 180 mg/dL), NORMO (all episodes 60-180 mg/dL), HYPER-Only (≥1 episode > 180, none <60 mg/dL), and HYPO-Only (≥1 episode < 60, none >180 mg/dL). Observed to expected Acute Physiology and Chronic Health Evaluation (APACHE) III mortality ratios (O/E) were studied. Number of adverse glycemic events was compared with mortality. Hypoglycemia and hyperglycemia occurred in 18 per cent and 50 per cent of patients. Mortality was 12.4 per cent (O/E = 0.88). BOTH had the highest O/E ratio (1.43) with HYPO the second highest (1.30). Groups excluding hypoglycemia (NORMO and HYPER-only) had the lowest O/E ratios: 0.56 and 0.88. Increasing number of hypoglycemic events were associated with increasing O/E ratio: 0.69 O/E for no events, 1.19 for 1-3 events, 1.35 for 4-6 events, 1.9 for 7-9 events, and 3.13 for ≥ 10 events. Ten or more hyperglycemic events were needed to significantly associate with worse mortality (O/E 1.53). Hyper- and hypoglycemia increase mortality compared with APACHE III expected mortality, with highest mortality risk if both are present. Hypoglycemia is associated with worse risk. Glucose control may need to be loosened to prevent hypoglycemia and reduce glucose variability.

  18. Body mass index and glycemic control influences lipoproteins in children with type 1 diabetes

    PubMed Central

    Vaid, Shalini; Hanks, Lynae; Griffin, Russell; Ashraf, Ambika P.

    2017-01-01

    Background Patients with Type 1 Diabetes Mellitus (T1DM) have an extremely high risk of cardiovascular disease (CVD) morbidity and mortality. It is well-known that dyslipidemia is a subclinical manifestation of atherosclerosis. Objective To analyze presence and predicting factors of lipoprotein abnormalities prevalent in children with T1DM and whether race specific differences exists between non-Hispanic White (NHW) and non-Hispanic Black (NHB) in the lipoprotein characteristics. Methods A retrospective electronic chart review including 600 (123 NHB and 477 NHW ) T1DM patients, ages 7.85 ± 3.75 years who underwent lipoprotein analysis. Results Relative to NHW counterparts, NHB T1DM subjects had a higher HbA1c, total cholesterol (TC), low density lipoprotein cholesterol (LDL), apoB 100, lipoprotein (a), and high density lipoprotein cholesterol (HDL), HDL-2 and -3. Body mass index (BMI) was positively associated with TC, LDL, apoB 100, and non-HDL and inversely associated with HDL, HDL-2, and HDL-3. HbA1c was positively associated with TC, LDL, apoB100, non-HDL, and HDL-3. Multilinear regression analysis demonstrated that HbA1c was positively associated with apoB 100 in both NHB and NHW, and BMI was a positive determinant of apoB 100 in NHW only. Conclusion Poor glycemic control and high BMI may contribute to abnormal lipoprotein profiles. Glycemic control (in NHB and NHW) and weight management (in NHW) may have significant implications in T1DM. ApoB100 concentrations in subjects with T1DM were determined by modifiable risk factors, BMI, HbA1C, and blood pressure, indicating the importance of adequate weight-, glycemic-, and blood pressure control for better diabetes care, and likely lower CVD risk. PMID:27678442

  19. Effect of proton pump inhibitors on glycemic control in patients with diabetes

    PubMed Central

    Takebayashi, Kohzo; Inukai, Toshihiko

    2015-01-01

    Gastrin is a linear peptide hormone which is secreted mostly in the stomach pyloric antrum G cells. Although the main role of this hormone is the promotion of the secretion of gastric acid from the stomach parietal cells, gastrin can also behave as a growth factor and stimulate gastric cell proliferation. It is also reported that gastrin promotes β cell neogenesis in the pancreatic ductal complex, modest pancreatic β cell replication, and improvement of glucose tolerance in animal models, in which the remodeling of pancreatic tissues is promoted. These findings suggest the possibility that gastrin has the potential to promote an increase of β cell mass in pancreas, and therefore that gastrin may improve glucose tolerance. Proton pump inhibitors (PPIs) are wildly used clinically for the therapy of gastro-esophageal reflex disease, gastritis due to excess stomach acid, and gastric ulcers. PPIs indirectly elevate serum gastrin levels via a negative feedback effect. Recent evidence has revealed the beneficial effect of PPIs on glycemic control especially in patients with type 2 diabetes mellitus (T2DM), probably via the elevation of the levels of serum gastrin, although the detailed mechanism remains unclear. In addition, the beneficial effects of a combination therapy of gastrin or a PPI with a glucagon-like peptide-1 receptor agonist on glycemic control in animal models have been demonstrated. Although PPIs may be possible candidates for a new approach in the therapy of diabetes, a prospective, long-term, randomized, double-blind, placebo-controlled study is needed to establish the effect of PPIs on glycemic control in a large number of patients with T2DM. PMID:26322158

  20. Oral salmon calcitonin improves fasting and postprandial glycemic control in lean healthy rats.

    PubMed

    Feigh, M; Nielsen, R H; Hansen, C; Henriksen, K; Christiansen, C; Karsdal, M A

    2012-02-01

    A novel oral form of salmon calcitonin (sCT) was recently demonstrated to improve both fasting and postprandial glycemic control and induce weight loss in diet-induced obese and insulin-resistant rats. To further explore the glucoregulatory efficacy of oral sCT, irrespective of obesity and metabolic dysfunction, the present study investigated the effect of chronic oral sCT treatment on fasting and postprandial glycemic control in male lean healthy rats. 20 male rats were divided equally into a control group receiving oral vehicle or an oral sCT (2 mg/kg) group. All rats were treated twice daily for 5 weeks. Body weight and food intake were monitored during the study period and fasting blood glucose, plasma insulin and insulin sensitivity were determined and an oral glucose tolerance test (OGTT) performed at study end. Compared with the vehicle group, rats receiving oral sCT had improved fasting glucose homeostasis and insulin resistance, as measured by homeostatic model assessment of insulin resistance index (HOMA-IR), with no change in body weight or fasting plasma insulin. In addition, the rats receiving oral sCT had markedly reduced glycemia and insulinemia during OGTT. This is the first report showing that chronic oral sCT treatment exerts a glucoregulatory action in lean healthy rats, irrespective of influencing body weight. Importantly, oral sCT seems to exert a dual treatment effect by improving fasting and postprandial glycemic control and insulin sensitivity. This and previous studies suggest oral sCT is a promising agent for the treatment of obesity-related insulin resistance and type 2 diabetes.

  1. Effect of Selenium Supplementation on Glycemic Control and Lipid Profiles in Patients with Diabetic Nephropathy.

    PubMed

    Bahmani, Fereshteh; Kia, Mahsa; Soleimani, Alireza; Asemi, Zatollah; Esmaillzadeh, Ahmad

    2016-08-01

    To our knowledge, data on the effects of selenium supplementation on glycemic control and lipid concentrations in patients with diabetic nephropathy (DN) are scarce. The current study was done to determine the effects of selenium supplementation on glycemic control and lipid concentrations in patients with DN. This was a randomized double-blind placebo-controlled clinical trial in which 60 patients with DN were randomly allocated into two groups to receive either 200 μg of selenium supplements (n = 30) or placebo (n = 30) daily for 12 weeks. Blood sampling was performed for the quantification of glycemic indicators and lipid profiles at the onset of the study and after 12 weeks of intervention. Selenium supplementation for 12 weeks resulted in a significant decrease in serum insulin levels (P = 0.01), homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (P = 0.02), homeostasis model of assessment-estimated B cell function (HOMA-B) (P = 0.009) and a significant rise in plasma glutathione peroxidase (GPx) (P = 0.001) compared with the placebo. Taking selenium supplements had no significant effects on fasting plasma glucose (FPG), quantitative insulin sensitivity check index (QUICKI) and lipid profiles compared with the placebo. Overall, our study demonstrated that selenium supplementation for 12 weeks among patients with DN had beneficial effects on plasma GPx, serum insulin levels, HOMA-IR, and HOMA-B, while it did not affect FPG, QUICKI, and lipid profiles.

  2. Vertical Sextants give Good Sights

    NASA Astrophysics Data System (ADS)

    Dixon, Mark

    Many texts stress the need for marine sextants to be held precisely vertical at the instant that the altitude of a heavenly body is measured. Several authors lay particular emphasis on the technique of the instrument in a small arc about the horizontal axis to obtain a good sight. Nobody, to the author's knowledge, however, has attempted to quantify the errors involved, so as to compare them with other errors inherent in determining celestial position lines. This paper sets out to address these issues and to pose the question: what level of accuracy of vertical alignment can reasonably be expected during marine sextant work at sea ?When a heavenly body is brought to tangency with the visible horizon it is particularly important to ensure that the sextant is held in a truly vertical position. To this end the instrument is rocked gently about the horizontal so that the image of the body describes a small arc in the observer's field of vision. As Bruce Bauer points out, tangency with the horizon must be achieved during the process of rocking and not a second or so after rocking has been discontinued. The altitude is recorded for the instant that the body kisses the visible horizon at the lowest point of the rocking arc, as in Fig. 2. The only other visual clue as to whether the sextant is vertical is provided by the right angle made by the vertical edge of the horizon glass mirror with the horizon. There may also be some input from the observer's sense of balance and his hand orientation.

  3. There's No Romance without Finance: "Good Management Begins with Good People"

    ERIC Educational Resources Information Center

    Vicars, Dennis

    2008-01-01

    Centers and schools go out of business not for lack of program or good intentions. They failed because they lacked the ability to plan, budget, and utilize resources appropriately. A center or school can achieve almost any goal it desires, as long as a well-conceived plan is created and followed to the end. Yes, sometimes variables occur which…

  4. The effect of caloric restriction and glycemic load on measures of oxidative stress and antioxidants in humans: results from the calerie trial of human caloric restriction

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Reducing oxidative stress and increasing antioxidant defense is suggested as one mechanism by which caloric restriction (CR) increases longevity in animals. A total of 46 moderately overweight volunteers (BMI: 25-30 kg/m2), ages 20-42 yr were randomized to either high glycemic (HG) or low glycemic ...

  5. Lifestyle and glycemic control in Japanese adults receiving diabetes treatment: an analysis of the 2009 Japan Society of Ningen Dock database.

    PubMed

    Takahashi, Eiko; Moriyama, Kengo; Yamakado, Minoru

    2014-05-01

    We investigated the level of glycemic control in 7020 patients treated with diabetes medications. We found that the overall mean HbA1c was 7.3% (56 mmol/mol). Over half had HbA1c levels ≥7.0% (53 mmol/mol) and poorer glycemic control was associated with unhealthy lifestyle habits.

  6. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management.

    PubMed

    Williams, Geoffrey C; McGregor, Holly A; Zeldman, Allan; Freedman, Zachary R; Deci, Edward L

    2004-01-01

    A longitudinal study tested the self-determination theory (SDT) process model of health behavior change for glycemic control within a randomized trial of patient activation versus passive education. Glycosylated hemoglobin for patients with Type 2 diabetes (n=159) was assessed at baseline, 6 months, and 12 months. Autonomous motivation and perceived competence were assessed at baseline and 6 months, and the autonomy supportiveness of clinical practitioners was assessed at 3 months. Perceptions of autonomy and competence were promoted by perceived autonomy support, and changes in perceptions of autonomy and competence, in turn, predicted change in glycemic control. Self-management behaviors mediated the relation between change in perceived competence and change in glycemic control. The self-determination process model fit the data well.

  7. Vitamin D Deficiency and Glycemic Status in Children and Adolescents with Type 1 Diabetes Mellitus

    PubMed Central

    Savastio, Silvia; Cadario, Francesco; Genoni, Giulia; Bellomo, Giorgio; Bagnati, Marco; Secco, Gioel; Picchi, Raffaella; Giglione, Enza; Bona, Gianni

    2016-01-01

    Background Vitamin D (25OHD) effects on glycemic control are unclear in children and adolescents with type 1 diabetes. Aims of this study were to investigate 25OHD status among children with T1DM and its relationship with insulin sensitivity and glycemic status. Subjects and Methods A cross sectional study was carried out between 2008–2014. A total of 141 patients had a T1DM >12 months diagnosis and were enrolled in the present study. Of these 35 (24.8%) were migrants and 106 (75.2%) Italians (T2). We retrospectively analyzed data at the onset of the disease (T0)(64 subjects) and 12–24 months before the last visit (T1,124 subjects). Fasting glucose, glycated hemoglobin (HbA1c), 25OHD levels and daily insulin requirement were evaluated and Cholecalciferol 1000 IU/day supplementation for the management of vitamin D insufficiency (<75 nmol/L) was systematically added. Results A generalized 25OHD insufficiency was found at each study time, particularly in migrants. At T0, the 25OHD levels were inversely related to diabetic keto-acidosis (DKA) severity (p<0.05). At T1 and T2, subjects with 25OHD ≤25nmol/L (10 ng/mL) showed higher daily insulin requirement (p<0.05) and HbA1c values (p<0.01) than others vitamin D status. The 25OHD levels were negatively related with HbA1c (p<0.001) and daily insulin dose (p<0.05) during follow up. There was a significant difference in 25OHD (p<0.01) between subjects with different metabolic control (HbA1c <7.5%,7.5–8%,>8%), both at T1 and T2. In supplemented subjects, we found a significant increase in 25OHD levels (p<0.0001) and decrease of HbA1c (p<0.001) between T1 and T2, but this was not significant in the migrants subgroup. Multivariate regression analysis showed a link between HbA1c and 25OHD levels (p<0.001). Conclusions Children with T1DM show a generalized 25OHD deficiency that impact on metabolic status and glycemic homeostasis. Vitamin D supplementation improves glycemic control and should be considered as an

  8. Outpatient Glycemic Control with a Bionic Pancreas in Type 1 Diabetes

    PubMed Central

    Sinha, Manasi; Magyar, Kendra L.; McKeon, Katherine; Goergen, Laura G.; Balliro, Courtney; Hillard, Mallory A.; Nathan, David M.; Damiano, Edward R.

    2014-01-01

    BACKGROUND The safety and effectiveness of automated glycemic management have not been tested in multiday studies under unrestricted outpatient conditions. METHODS In two random-order, crossover studies with similar but distinct designs, we compared glycemic control with a wearable, bihormonal, automated, “bionic” pancreas (bionic-pancreas period) with glycemic control with an insulin pump (control period) for 5 days in 20 adults and 32 adolescents with type 1 diabetes mellitus. The automatically adaptive algorithm of the bionic pancreas received data from a continuous glucose monitor to control subcutaneous delivery of insulin and glucagon. RESULTS Among the adults, the mean plasma glucose level over the 5-day bionic-pancreas period was 138 mg per deciliter (7.7 mmol per liter), and the mean percentage of time with a low glucose level (<70 mg per deciliter [3.9 mmol per liter]) was 4.8%. After 1 day of automatic adaptation by the bionic pancreas, the mean (±SD) glucose level on continuous monitoring was lower than the mean level during the control period (133±13 vs. 159±30 mg per deciliter [7.4±0.7 vs. 8.8±1.7 mmol per liter], P<0.001) and the percentage of time with a low glucose reading was lower (4.1% vs. 7.3%, P = 0.01). Among the adolescents, the mean plasma glucose level was also lower during the bionic-pancreas period than during the control period (138±18 vs. 157±27 mg per deciliter [7.7±1.0 vs. 8.7±1.5 mmol per liter], P = 0.004), but the percentage of time with a low plasma glucose reading was similar during the two periods (6.1% and 7.6%, respectively; P = 0.23). The mean frequency of interventions for hypoglycemia among the adolescents was lower during the bionic-pancreas period than during the control period (one per 1.6 days vs. one per 0.8 days, P<0.001). CONCLUSIONS As compared with an insulin pump, a wearable, automated, bihormonal, bionic pancreas improved mean glycemic levels, with less frequent hypoglycemic episodes, among both

  9. Effect of low glycemic load diet on glycated hemoglobin (HbA1c) in poorly-controlled diabetes patients.

    PubMed

    Ziaee, Amir; Afaghi, Ahmad; Sarreshtehdari, Majied

    2011-12-29

    Different carbohydrate diets have been administrated to diabetic patients to evaluate the glycemic response, while Poor-controlled diabetes is increasing world wide. To investigate the role of an alternative carbohydrate diet on glycemic control, we explored the effect of a low glycemic load (Low GL)-high fat diet on glycemic response and also glycated hemoglobin (HbA1c) of poor-controlled diabetes patients. Hundred poorly-controlled diabetes patients, HbA1c > 8, age 52.8 ± 4.5 y, were administrated a low GL diet , GL = 67 (Energy 1800 kcal; total fat 36%; fat derived from olive oil and nuts 15%; carbohydrate 42%; protein 22%) for 10 weeks. Patients did their routine life style program during intervention. Fasting blood glucose and HbA1c before and after intervention with significant reduction were: 169 ± 17, 141 ± 12; 8.85% (73 mmol/mol) ± 0.22%, and 7.81% (62 mmol/mol) ± 0.27%; respectively (P < 0.001). Mean fasting blood glucose reduced by 28.1 ± 12.5 and HbA1c by 1.1% (11 mmol/mol) ± 0.3% (P=0.001). There was positive moderate correlation between HbA1c concentration before intervention and FBS reduction after intervention (P < 0.001, at 0.01 level, R =0.52), and strong positive correlation between FBS before intervention and FBS reduction (P < 0.001, at 0.01 level, R = 0.70). This study demonstrated that our alternative low glycemic load diet can be effective in glycemic control.

  10. THE CONTENT OF MICROELEMENTS IN BLOOD SERUM AND ERYTHROCYTES IN CHILDREN WITH DIABETES MELLITUS TYPE I DEPENDING ON LEVEL OF GLYCEMIC CONTROL.

    PubMed

    Gluschenko, N; Vasylyshyn, Kh; Roschupkin, A; Lekishvili, S; Gladchenko, O

    2016-01-01

    The aim of this paper is to investigate the content of chromium, cobalt and nickel in serum and erythrocytes in children with type 1 diabetes mellitus, depending on the level of glycemic control. The study was conducted on 68 children with type 1 diabetes mellitus. The patients were divided into four groups based on glycemic control. Group I was composed of 9 children with optimal level of glycemic control. Group II - 25 children with suboptimal level of glycemic control. Group III - 34 children with a high risk to life level of glycemic control. Group IV (control group) consisted of 30 healthy children. Compensation state of type 1 diabetes was evaluated according to ISPAD (Consensus for the Management of Type 1 Diabetes Mellitus in Children and Adolescens 2000). The content of trace elements in biological agents was determined by atomic absorbtion spectrophotometry method with C-115M1 mass-spectrophotometer, manufactured by «Selmi» enterprise (Ukraine). It is found that there is a decrease in serum concentrations of chromium and erythrocyte content of cobalt in patients with optimal level of glycemic control. The deficiency of chromium is accompanied by the deficiency of cobalt in patients with suboptimal level of glycemic control. The lower levels of cobalt and nickel are recorded simultaneously, but there is theexcess of chromium in the erythrocytes of these patients. Patients, who suffer from 1 type diabetes mellitus and high risk for life level of glycemic control have considerable polideficiency of cobalt, nickel and chromium in serum.The increasing level of chromium was recorded only in the erythrocytes. The level of glycemic control and the duration of 1 type diabetes mellitus are important in the forecasting of the development of chronic diabetic complications. It is found that the duration of 1 type diabetes mellitus influences the levels of cobalt and nickel in serum mostly, while the level of glycemic control influences the chromium content.

  11. Comparing Science Achievement Constructs: Targeted and Achieved

    ERIC Educational Resources Information Center

    Ferrara, Steve; Duncan, Teresa

    2011-01-01

    This article illustrates how test specifications based solely on academic content standards, without attention to other cognitive skills and item response demands, can fall short of their targeted constructs. First, the authors inductively describe the science achievement construct represented by a statewide sixth-grade science proficiency test.…

  12. Glycemic control in hospitalized patients not in intensive care: beyond sliding-scale insulin.

    PubMed

    Nau, Konrad C; Lorenzetti, Rosemarie C; Cucuzzella, Mark; Devine, Timothy; Kline, Jonathan

    2010-05-01

    Glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. Despite persistent expert recommendations urging its abandonment, the use of sliding-scale insulin remains pervasive in U.S. hospitals. Evidence for the effectiveness of sliding-scale insulin is lacking after more than 40 years of use. New physiologic subcutaneous insulin protocols use basal, nutritional, and correctional insulin. The initial total daily dose of subcutaneous insulin is calculated using a factor of 0.3 to 0.6 units per kg body weight, with one half given as long-acting insulin (the basal insulin dose), and the other one half divided daily over three meals as short-acting insulin doses (nutritional insulin doses). A correctional insulin dose provides a final insulin adjustment based on the preprandial glucose value. This correctional dose resembles a sliding scale, but is only a small fine-tuning of therapy, as opposed to traditional sliding-scale insulin alone. Insulin sensitivity, nutritional intake, and total daily dosing review can alter the physiologic insulin-dosing schedule. Prospective trials have demonstrated reductions in hyperglycemic measurements, hypoglycemia, and adjusted hospital length of stay when physiologic subcutaneous insulin protocols are used. Transitions in care require special considerations and attention to glycemic control medications. Changing the sliding-scale insulin culture requires a multidisciplinary effort to improve patient safety and outcomes.

  13. Vascularized tissue-engineered chambers promote survival and function of transplanted islets and improve glycemic control.

    PubMed

    Knight, K R; Uda, Y; Findlay, M W; Brown, D L; Cronin, K J; Jamieson, E; Tai, T; Keramidaris, E; Penington, A J; Rophael, J; Harrison, L C; Morrison, W A

    2006-03-01

    We have developed a chamber model of islet engraftment that optimizes islet survival by rapidly restoring islet-extracellular matrix relationships and vascularization. Our aim was to assess the ability of syngeneic adult islets seeded into blood vessel-containing chambers to correct streptozotocin-induced diabetes in mice. Approximately 350 syngeneic islets suspended in Matrigel extracellular matrix were inserted into chambers based on either the splenic or groin (epigastric) vascular beds, or, in the standard approach, injected under the renal capsule. Blood glucose was monitored weekly for 7 weeks, and an intraperitoneal glucose tolerance test performed at 6 weeks in the presence of the islet grafts. Relative to untreated diabetic animals, glycemic control significantly improved in all islet transplant groups, strongly correlating with islet counts in the graft (P<0.01), and with best results in the splenic chamber group. Glycemic control deteriorated after chambers were surgically removed at week 8. Immunohistochemistry revealed islets with abundant insulin content in grafts from all groups, but with significantly more islets in splenic chamber grafts than the other treatment groups (P<0.05). It is concluded that hyperglycemia in experimental type 1 diabetes can be effectively treated by islets seeded into a vascularized chamber functioning as a "pancreatic organoid."

  14. Lowering the glycemic index of white bread using a white bean extract

    PubMed Central

    Udani, Jay K; Singh, Betsy B; Barrett, Marilyn L; Preuss, Harry G

    2009-01-01

    Background Phase 2® is a dietary supplement derived from the common white kidney bean (Phaseolus vulgaris). Phase 2 has been shown to inhibit alpha-amylase, the complex carbohydrate digesting enzyme, in vitro. The inhibition of alpha-amylase may result in the lowering of the effective Glycemic Index (GI) of certain foods. The objective of this study was to determine whether the addition of Phase 2 would lower the GI of a commercially available high glycemic food (white bread). Methods An open-label 6-arm crossover study was conducted with 13 randomized subjects. Standardized GI testing was performed on white bread with and without the addition of Phase 2 in capsule and powder form, each in dosages of 1500 mg, 2000 mg, and 3000 mg. Statistical analysis was performed by one-way ANOVA of all seven treatment groups using unadjusted multiple comparisons (t tests) to the white bread control. Results For the capsule formulation, the 1500 mg dose had no effect on the GI and the 2000 mg and 3000 mg capsule doses caused insignificant reductions in GI. For the powder, the 1500 mg and 2000 mg doses caused insignificant reductions in the GI, and the 3000 mg dose had a significant effect (-20.23 or 34.11%, p = 0.023) Conclusion Phase 2 white bean extract appears to be a novel and potentially effective method for reducing the GI of existing foods without modifying their ingredient profile. Trial Registration Trial Registration: ISRCTN50347345 PMID:19860922

  15. Glycemic index and quality evaluation of little millet (Panicum miliare) flakes with enhanced shelf life.

    PubMed

    Patil, Kavita B; Chimmad, Bharati V; Itagi, Sunanda

    2015-09-01

    Little millet is a minor cereal crop contains several nutraceutical components. Ready To Cook (RTC) flakes of the millet exhibited higher total dietary fiber content (22.40 %) compared to dehulled grain (15.80 %). One serving (30 g) of RTC flakes provided 2.25 g of protein, 0.13 g of fat, 0.13 g of total minerals, 9.67 mg of iron and zero trans fats. The flakes possessed a medium Glycemic Index (GI) of 52.11 ranging from 41.57 to 61.80 among normal volunteers. Glycemic Load (GL) of the flakes was a low of 9.24. The RTC flakes exhibited an acceptability index of 81.11. The flakes possessed a shelf life of more than 6 months with an acceptability index of 67.55, moisture content of 11.82 per cent and Free fatty acid content of 18.02 per cent at the end of sixth month of storage period.

  16. Characterisation, in vitro digestibility and expected glycemic index of commercial starches as uncooked ingredients.

    PubMed

    Romano, Annalisa; Mackie, Alan; Farina, Federica; Aponte, Maria; Sarghini, Fabrizio; Masi, Paolo

    2016-12-01

    In this study native starches as ingredients (corn, rice, wheat, tapioca and potato) were characterized for microstructure, physicochemical, functional and thermal properties, in vitro digestibility and glycemic index. There was a significant variation in the granule shape and size distribution of the starches. Particle size monomodal (corn, tapioca, potato) and bimodal (rice, wheat) distribution was observed amongst the starches. The potato starch showed the biggest size granules while the rice showed the smallest. The examined properties and nutritional characteristics of starches were significantly different. Thermal properties were studied using Differential Scanning Calorimeter (DSC). DSC results showed that the transition temperatures (58.8-78.7 °C) and enthalpies of gelatinization (2.3-8.2 J/g) of the starches appeared to be greatly influenced by microstructure and chemical composition (e.g. resistant starch). Nutritional properties such as slowly digestible starch and expected glycemic index values followed the order: rice > wheat > tapioca > corn > potato. In particular, the highest resistant starch was recorded for potato starch.

  17. Antioxidant alpha-tocopherol ameliorates glycemic control of GK rats, a model of type 2 diabetes.

    PubMed

    Ihara, Y; Yamada, Y; Toyokuni, S; Miyawaki, K; Ban, N; Adachi, T; Kuroe, A; Iwakura, T; Kubota, A; Hiai, H; Seino, Y

    2000-05-04

    We have shown recently that oxidative stress by chronic hyperglycemia damages the pancreatic beta-cells of GK rats, a model of non-obese type 2 diabetes, which may worsen diabetic condition and suggested the administration of antioxidants as a supportive therapy. To determine if natural antioxidant alpha-tocopherol (vitamin E) has beneficial effects on the glycemic control of type 2 diabetes, GK rats were fed a diet containing 0, 20 or 500 mg/kg diet alpha-tocopherol. Intraperitoneal glucose tolerance test revealed a significant increment of insulin secretion at 30 min and a significant decrement of blood glucose levels at 30 and 120 min after glucose loading in the GK rats fed with high alpha-tocopherol diet. The levels of glycated hemoglobin A1c, an indicator of glycemic control, were also reduced. Vitamin E supplementation clearly ameliorated diabetic control of GK rats, suggesting the importance of not only dietary supplementation of natural antioxidants but also other antioxidative intervention as a supportive therapy of type 2 diabetic patients.

  18. Effect of preexercise meals with different glycemic indices and loads on metabolic responses and endurance running.

    PubMed

    Chen, Ya Jun; Wong, Stephen H; Wong, Chun Kwok; Lam, Ching Wan; Huang, Ya Jun; Siu, Parco M

    2008-06-01

    This study examined the effect of ingesting 3 isocaloric meals with different glycemic indices (GI) and glycemic loads (GL) 2 hr before exercise on metabolic responses and endurance running performance. Eight male runners completed 3 trials in a randomized order, separated by at least 7 days. Carbohydrate (CHO) content (%), GI, and GL were, respectively, 65%, 79, and 82 for the high-GI/high-GL meal (H-H); 65%, 40, and 42 for the low-GI/low-GL meal (L-L); and 36%, 78, and 44 for the high-GI/low-GL meal (H-L). Each trial consisted of a 1-hr run at 70% VO2max, followed by a 10-km performance run. Low-GL diets (H-L and L-L) were found to induce smaller metabolic changes during the postprandial period and during exercise, which were characterized by a lower CHO oxidation in the 2 trials (p < .05) and a concomitant, higher glycerol and free-fatty-acid concentration in the H-L trial (p < .05). There was no difference, however, in time to complete the preloaded 10-km performance run between trials. This suggests that the GL of the preexercise meal has an important role in determining subsequent metabolic responses.

  19. Preexercise carbohydrate ingestion, glucose kinetics, and muscle glycogen use: effect of the glycemic index.

    PubMed

    Febbraio, M A; Keenan, J; Angus, D J; Campbell, S E; Garnham, A P

    2000-11-01

    Eight trained men cycled at 70% peak oxygen uptake for 120 min followed by a 30-min performance cycle after ingesting either a high-glycemic index (HGI), low-glycemic index (LGI), or placebo (Con) meal 30 min before exercise. Ingestion of HGI resulted in an elevated (P<0.01) blood glucose concentration compared with LGI and Con. At the onset of exercise, blood glucose fell (P<0.05) such that it was lower (P<0.05) in HGI compared with LGI and Con at 15 and 30 min during exercise. Plasma insulin concentration was higher (P<0.01) throughout the rest period after ingestion of HGI compared with LGI and Con. Plasma free fatty acid concentrations were lower (P<0.05) throughout exercise in HGI compared with LGI and Con. The rates of [6,6-(2)H]glucose appearance and disappearance were higher (P<0.05) at rest after ingestion and throughout exercise in HGI compared with LGI and Con. Carbohydrate oxidation was higher (P<0.05) throughout exercise, whereas glycogen use tended (P = 0.07) to be higher in HGI compared with LGI and Con. No differences were observed in work output during the performance cycle when comparing the three trials. These results demonstrate that preexercise carbohydrate feeding with a HGI, but not a LGI, meal augments carbohydrate utilization during exercise but does not effect exercise performance.

  20. Improving Glycemic Control and Insulin Ordering Efficiency for Hospitalized Patients With Diabetes Through Carbohydrate Counting.

    PubMed

    Pearson, Kristina K; Reiland, Sarah A; Meara, John G O; Brown, Julie K; Fedraw, Leslie A; Mapes, David L

    2016-01-01

    Glycemic control in hospitalized patients is challenging but important for optimal outcomes. Insulin dosing through carbohydrate counting may address patient, provider, and institutional factors that complicate hospital glycemic management. On two surgical units at a tertiary care teaching hospital, we pilot tested postmeal insulin dosing based on carbohydrate counting (plus basal insulin) rather than the current process of ordering scheduled premeal insulin without knowledge of the patient's consumption. Analysis assessed hyperglycemia, hypoglycemia, insulin orders, and nurse and provider satisfaction and confidence. On general surgery, mean glucose level improved from 188 to 137 mg/dl (p < .001). On cardiovascular surgery, mean glucose improved only mildly from 177 to 175 mg/dl (p < .28). No hypoglycemia was reported. Efficiency of mealtime insulin dosing improved through reduced average number of insulin orders per meal from 1.1 to 0.09. Process satisfaction improved for providers (preintervention, 60%; postintervention, 100%), general surgery nurses (preintervention, 72%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 69%; postintervention, 84%). Confidence in insulin dose accuracy improved for providers (preintervention, 50%; postintervention, 100%), general surgery nurses (preintervention, 59%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 48%; postintervention, 84%). Carbohydrate counting is effective and efficient and improved staff satisfaction and confidence in hospital mealtime insulin dosing.

  1. Eating disinhibition and vagal tone moderate the postprandial response to glycemic load: a randomised controlled trial

    PubMed Central

    Young, Hayley A.; Watkins, Heather

    2016-01-01

    Reducing the glycemic load (GL) of the diet may benefit appetite control but its utility is complicated by psychological influences on eating. Disinhibited behaviour, a risk factor for overconsumption, is characterized by reduced prefrontal cortex activity, which in turn modulates vagal tone; a phenomenon associated with glucoregulation. This double blind randomised controlled trial explored for the first time the influence of disinhibited eating and vagal tone (heart rate variability (HRV)) on hunger and the postprandial response to GL. Blood glucose (BG) and hunger were measured 30 and 150 min after consumption of water, glucose or isomaltulose (low glycemic sugar). After consuming glucose, independently of BMI or habitual diet, those with the highest levels of disinhibition had higher BG levels after thirty minutes (B = 0.192, 95% CI LL. 086, UL 0.297), and lower BG after one hundred and fifty minutes (B = −0.240, 95% CI LL −0.348, UL −0.131). BG was related to hunger but only in low disinhibited eaters. Disinhibited eaters were characterised by a reduced HRV which was related to greater BG excursions (B = 0.407, 95% CI LL 0.044, UL 1.134). These findings highlight novel mechanisms by which disinhibited eating leads to obesity and insulin resistance. This trial was registered at clinicaltrials.gov NCT02827318. PMID:27761024

  2. The Consumption of Bicarbonate-Rich Mineral Water Improves Glycemic Control

    PubMed Central

    Murakami, Shinnosuke; Goto, Yasuaki; Ito, Kyo; Hayasaka, Shinya; Kurihara, Shigeo; Soga, Tomoyoshi; Tomita, Masaru; Fukuda, Shinji

    2015-01-01

    Hot spring water and natural mineral water have been therapeutically used to prevent or improve various diseases. Specifically, consumption of bicarbonate-rich mineral water (BMW) has been reported to prevent or improve type 2 diabetes (T2D) in humans. However, the molecular mechanisms of the beneficial effects behind mineral water consumption remain unclear. To elucidate the molecular level effects of BMW consumption on glycemic control, blood metabolome analysis and fecal microbiome analysis were applied to the BMW consumption test. During the study, 19 healthy volunteers drank 500 mL of commercially available tap water (TW) or BMW daily. TW consumption periods and BMW consumption periods lasted for a week each and this cycle was repeated twice. Biochemical tests indicated that serum glycoalbumin levels, one of the indexes of glycemic controls, decreased significantly after BMW consumption. Metabolome analysis of blood samples revealed that 19 metabolites including glycolysis-related metabolites and 3 amino acids were significantly different between TW and BMW consumption periods. Additionally, microbiome analysis demonstrated that composition of lean-inducible bacteria was increased after BMW consumption. Our results suggested that consumption of BMW has the possible potential to prevent and/or improve T2D through the alterations of host metabolism and gut microbiota composition. PMID:26798400

  3. The Consumption of Bicarbonate-Rich Mineral Water Improves Glycemic Control.

    PubMed

    Murakami, Shinnosuke; Goto, Yasuaki; Ito, Kyo; Hayasaka, Shinya; Kurihara, Shigeo; Soga, Tomoyoshi; Tomita, Masaru; Fukuda, Shinji

    2015-01-01

    Hot spring water and natural mineral water have been therapeutically used to prevent or improve various diseases. Specifically, consumption of bicarbonate-rich mineral water (BMW) has been reported to prevent or improve type 2 diabetes (T2D) in humans. However, the molecular mechanisms of the beneficial effects behind mineral water consumption remain unclear. To elucidate the molecular level effects of BMW consumption on glycemic control, blood metabolome analysis and fecal microbiome analysis were applied to the BMW consumption test. During the study, 19 healthy volunteers drank 500 mL of commercially available tap water (TW) or BMW daily. TW consumption periods and BMW consumption periods lasted for a week each and this cycle was repeated twice. Biochemical tests indicated that serum glycoalbumin levels, one of the indexes of glycemic controls, decreased significantly after BMW consumption. Metabolome analysis of blood samples revealed that 19 metabolites including glycolysis-related metabolites and 3 amino acids were significantly different between TW and BMW consumption periods. Additionally, microbiome analysis demonstrated that composition of lean-inducible bacteria was increased after BMW consumption. Our results suggested that consumption of BMW has the possible potential to prevent and/or improve T2D through the alterations of host metabolism and gut microbiota composition.

  4. [Glycemic index of two varieties of pasta and two varieties of rice].

    PubMed

    Ridner, Edgardo; Di Sibio, Antonio

    2015-06-01

    The IG has been extensively studied as an indicator of the physiological effects of a carbohydrate meal with applications in the management and prevention of diabetes, dyslipidemia and obesity. A standard assay was performed to measure the glycemic index (GI) of two significant sources of carbohydrates following the World Health Organization (WHO) recommended methodology, determining the incremental area under the blood glucose response curve of a 50g carbohydrate portion of the test food compared to the same amount of carbohydrate from a glucose solution by the same subject measured in capillary whole blood before and 15, 30, 45, 60, 90 and 120 minutes after ingestion in a total of 9 subjects. The following results were obtained: Parboil rice: 73, Long Grain White Rice: 59; Pasta of durum wheat (Triticum durum): 71, Pasta of regular flour (Triticum aestivium): 38. This test confirms the low glycemic index of pasta made from durum wheat, and is the first measurement for pasta of common wheat flour properly characterized. It also indicates the values of the prevailing presentations of rice in the region, adding a reference for professionals and authorities.

  5. The Potential for Glycemic Control Monitoring and Screening for Diabetes at Dental Visits Using Oral Blood

    PubMed Central

    Rosedale, Mary T.; Pesce, Michael A.; Rindskopf, David M.; Kaur, Navjot; Juterbock, Caroline M.; Wolff, Mark S.; Malaspina, Dolores; Danoff, Ann

    2015-01-01

    Objectives. We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes. Methods. In 2013 and 2014, we performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired “gold-standard” HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients. Results. About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits. Conclusions. Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients. PMID:25713975

  6. Chromium supplements for glycemic control in type 2 diabetes: limited evidence of effectiveness.

    PubMed

    Costello, Rebecca B; Dwyer, Johanna T; Bailey, Regan L

    2016-07-01

    Some adults with type 2 diabetes mellitus (T2DM) believe that chromium-containing supplements will help control their disease, but the evidence is mixed. This narrative review examines the efficacy of chromium supplements for improving glycemic control as measured by decreases in fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c). Using systematic search criteria, 20 randomized controlled trials of chromium supplementation in T2DM patients were identified. Clinically meaningful treatment goals were defined as an FPG of ≤7.2 mmol/dL, a decline in HbA1c to ≤7%, or a decrease of ≥0.5% in HbA1c. In only a few randomized controlled trials did FPG (5 of 20), HbA1c (3 of 14), or both (1 of 14) reach the treatment goals with chromium supplementation. HbA1c declined by ≥0.5% in 5 of 14 studies. On the basis of the low strength of existing evidence, chromium supplements have limited effectiveness, and there is little rationale to recommend their use for glycemic control in patients with existing T2DM. Future meta-analyses should include only high-quality studies with similar forms of chromium and comparable inclusion/exclusion criteria to provide scientifically sound recommendations for clinicians.

  7. Which Achievement Gap?

    ERIC Educational Resources Information Center

    Anderson, Sharon; Medrich, Elliott; Fowler, Donna

    2007-01-01

    From the halls of Congress to the local elementary school, conversations on education reform have tossed around the term "achievement gap" as though people all know precisely what that means. As it's commonly used, "achievement gap" refers to the differences in scores on state or national achievement tests between various…

  8. Educating for Good Work: From Research to Practice

    ERIC Educational Resources Information Center

    Mucinskas, Daniel; Gardner, Howard

    2013-01-01

    Launched in 1995, the GoodWork Project is a long-term, multi-site effort to understand the nature of good work across the professional landscape and to promote its achievement by relevant groups of students and professionals. In this essay, the authors review the goals and methods of the initial research project and its most salient findings. They…

  9. What Are Good Child Outcomes?

    ERIC Educational Resources Information Center

    Moore, Kristin Anderson; Evans, V. Jeffery; Brooks-Gunn, Jeanne; Roth, Jodie

    This paper considers the question "What are good child outcomes?" from the perspectives of developmental psychology, economics, and sociology. Section 1 of the paper examines good child outcomes as characteristics of stage-salient tasks of development. Section 2 emphasizes the acquisition of "human capital," the development of productive traits…

  10. Enjoyment and the Good Life.

    ERIC Educational Resources Information Center

    Estes, Cheryl; Henderson, Karla

    2003-01-01

    Presents information to update parks and recreation professionals about what recent research says in regard to enjoyment and the good life, noting what applications this research has for practitioners. The article focuses on: the good life and leisure services; happiness, subjective well-being, and intrinsic motivation; leisure, happiness, and…

  11. What 'makes' a good doctor?

    PubMed

    Huxham, G J; Lipton, A; Hamilton, D; Chant, D

    1989-01-01

    The relation between gender, personality, school scores, grades at medical school and eventual achievement as a medical practitioner 8 years after qualifying has been explored by path analysis in a cohort of medical students. Factor analysis of data derived from a questionnaire identified a significant factor accounting for 75% of the common variance of the professional achievement scores. Standardized path coefficients were computed to indicate the relative importance of the causal factors to postgraduate achievement. Gender played an important role at many levels. For example it was apparent that many of our women graduates were seriously disadvantaged in their professional careers. Of the school subjects, chemistry was a surprising long-term predictor of postgraduate achievement. Academic achievement during medical school training, particularly in the final year, was a significant predictor, while personality attributes made their contribution to one or other aspect of achievement at earlier stages in training but made little additional direct contribution to postgraduate performance.

  12. Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort

    PubMed Central

    Pop-Busui, Rodica; Lu, Jiang; Lopes, Neuza; Jones, Teresa L. Z.

    2009-01-01

    We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass-Angioplasty-Revascularization-Investigation-2-Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing versus insulin-providing treatments for diabetes. 2368 patients with type 2 diabetes and CAD were evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression, adjusted for multiple covariates including age, sex, HbA1c, diabetes duration. 51% BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR1.57, 1.15, 2.13). Patients on sulfonylurea or combination of sulfonylurea/metformin/TZD had marginally higher rates of DPN than the metformin/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN. PMID:19335534

  13. Orange pomace improves postprandial glycemic responses: an acute, randomized, placebo-controlled, double-blind, crossover trial in overweight men

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Orange pomace (OP), a fiber-rich byproduct of juice production, has the potential for being formulated into a variety of food products. We hypothesized that OP would diminish postprandial glycemic responses to a high carbohydrate/fat breakfast and lunch. We conducted an acute, randomized, placebo-co...

  14. Exploration of Functionality of Low-Glycemic-Impact Sugars and Polyols using DSC, RVA, SRC, and Cookie Baking

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Consumers’ growing interest in healthy cookies includes expectations for prebiotic nutritional benefits and low glycemic impact. The anti-plasticizing action of the high sucrose concentration in a cookie formula inhibits gluten development during dough mixing and starch gelatinization/pasting durin...

  15. Cfh genotype interacts with dietary glycemic index to modulate age-related macular degeneration-like features in mice

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Age-related macular degeneration (AMD) is a leading cause of visual impairment worldwide. Genetics and diet contribute to the relative risk for developing AMD, but their interactions are poorly understood. Genetic variations in Complement Factor H (CFH), and dietary glycemic index (GI) are major ris...

  16. Good Law, Good Practice, Good Sense: Using Legal Guidelines for Drafting Educational Policies.

    ERIC Educational Resources Information Center

    Bogotch, Ira E.

    1988-01-01

    Suggests how to use legal guidelines for drafting educational policies. Analyzes the political context in which present policymaking and governance initiatives exist. Two assumptions frame this article. First, good law makes for good administrative practice. Second, administrator policymaking is more important than the content of the policy…

  17. Food Science for the Public Good

    NASA Astrophysics Data System (ADS)

    Miller, Cassandra

    If you are interested in food science, looking for a meaningful career path, and are motivated by the desire to make a difference, you may find that a career working for the public good can be very rewarding. Often, such opportunities address issues of social responsibility, sustainability, public health, and/or economic development. Food scientists who choose this path typically have an interest in social and public health issues, and are usually driven by the achievement of some sort of social, health, or societal gain. As food science in itself is a very broad discipline, applying this knowledge for the public good can also take a variety of paths. Whether you're interested in manufacturing, food safety, nutrition, food policy, product development, quality control, marketing and sales, or any other discipline that makes up the diverse field of food science, various opportunities exist to make a difference to society.

  18. Mobile bag starch prececal disappearance and postprandial glycemic response of four forms of barley in horses.

    PubMed

    Philippeau, C; Varloud, M; Julliand, V

    2014-05-01

    To determine prececal starch digestibili-ty and estimate glucose uptake from the digestion of 4 forms of barley in the small intestine, 4 mature cecally fistulated geldings (449 ± 41 kg BW) fed a 62:38 (wt/wt) meadow hay:concentrate diet at 1.7 kg DM/100 kg BW were included in a 4 × 4 Latin square design experiment. During each period, horses received 80% DM of their concentrate as 1 of the 4 forms of a same batch of barley, whole grain, 2.5 mm ground, steam flaked, and pelleted. Hay was offered in 2 equal meals and concentrate in 2 unequal meals. The starch supply in the morning meal amounted 2.7 g starch/kg BW. At each period, mobile bag DM and starch disappearance was determined. Except for ground barley, each form of barley was 4 mm ground before being introduced in the bag. Nylon bags containing each substrate were intubated in the horse receiving the pelleted barley. Bags were collected in the cecum for 10 h postintubation. At each period, postprandial glycemia was measured on blood samples collected on the 4 horses via an indwelling jugular catheter just before the concentrate morning meal and for 8 h. No hay in the morning meal was given the day of the measurements. Whole blood glucose was analyzed with a portable blood glucose meter. Mobile bag prececal DM disappearance and starch disappearance depended (P < 0.01) on barley form. Prececal starch disappearance of whole barley was the lowest but no difference (P > 0.05) was detected among the 3 processed grains. No significant effect of barley form was found whatever the glycemic parameters. No significant correlation was reported between glycemic parameters and the amount of prececal mobile bag disappeared starch calculated as the starch intake in the morning meal by the mobile bag starch disappearance. To conclude, the whole form of barley exhibited the lowest prececal mobile bag starch disappearance whereas, in relationship with large individual variations, no significant variation has been shown in

  19. A High Dietary Glycemic Index Increases Total Mortality in a Mediterranean Population at High Cardiovascular Risk

    PubMed Central

    Castro-Quezada, Itandehui; Sánchez-Villegas, Almudena; Estruch, Ramón; Salas-Salvadó, Jordi; Corella, Dolores; Schröder, Helmut; Álvarez-Pérez, Jacqueline; Ruiz-López, María Dolores; Artacho, Reyes; Ros, Emilio; Bulló, Mónica; Covas, María-Isabel; Ruiz-Gutiérrez, Valentina; Ruiz-Canela, Miguel; Buil-Cosiales, Pilar; Gómez-Gracia, Enrique; Lapetra, José; Pintó, Xavier; Arós, Fernando; Fiol, Miquel; Lamuela-Raventós, Rosa María; Martínez-González, Miguel Ángel; Serra-Majem, Lluís

    2014-01-01

    Objective Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI) and glycemic load (GL) are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study. Material and Methods The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ). We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures. Results We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths). As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15–4.04); P for trend  = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-cause mortality only when subjects were younger than 75 years. Conclusions High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk. PMID:25250626

  20. Safety and efficacy of saxagliptin for glycemic control in non-critically ill hospitalized patients

    PubMed Central

    Garg, Rajesh; Schuman, Brooke; Hurwitz, Shelley; Metzger, Cheyenne; Bhandari, Shreya

    2017-01-01

    Objective To evaluate whether saxagliptin is non-inferior to basal-bolus insulin therapy for glycemic control in patients with controlled type 2 diabetes mellitus (T2DM) admitted to hospital with non-critical illnesses. Research design and methods This was an open-label, randomized controlled clinical trial. Patients received either saxagliptin or basal-bolus insulin, both with correctional insulin doses. The main study outcome was the mean daily blood glucose (BG) after the first day of randomization. Results Of 66 patients completing the study, 33 (age 69±10 years, 40% men) were randomized to saxagliptin and 33 (age 67±10 years, 52% men) to basal-bolus insulin therapy. The mean daily BG was 149.8±22.0 mg/dL in the saxagliptin group and 146.9±30.5 mg/dL in the insulin group (p=0.59). With an observed group difference of 2.9 mg/dL and an a priori margin of 20 mg/dL, inferiority of saxagliptin was rejected in favor of non-inferiority (p=0.007). There was no significant difference in the percentage of high or low BG values. The insulin group received a higher number of insulin injections (2.3±1.7/day vs 1.2±1.9/day; p<0.001) as well as a higher daily insulin dose (13.3±12.9 units/day vs 2.4±3.3 units/day; p<0.001) than did the saxagliptin group. Continuous BG monitoring showed that glycemic variability was lower in the saxagliptin group as compared to the insulin group. Patient satisfaction scores were similar in the two groups. Conclusions We conclude that saxagliptin use is non-inferior to basal-bolus insulin in non-critically ill hospitalized patients with T2DM controlled on 0–2 oral agents without insulin. Saxagliptin use may decrease glycemic variability in these patients. Trial registration number NCT02182895.

  1. Is glycemic index of food a feasible predictor of appetite, hunger, and satiety?

    PubMed

    Niwano, Yoshimi; Adachi, Takashi; Kashimura, Jun; Sakata, Takashi; Sasaki, Hajime; Sekine, Kazunori; Yamamoto, Satoshi; Yonekubo, Akie; Kimura, Shuichi

    2009-06-01

    This review assesses the feasibility of using glycemic index (GI) as a predictor of appetite, hunger and satiety by surveying published human intervention studies. We also discuss the relationship between GI and two appetite/satiety control hormones, leptin and ghrelin. Ingestion of high-GI food increased hunger and lowered satiety in short-term human intervention studies. This effect may be attributed to the rapid decline in blood glucose level following a hyperinsulinemic response caused by a sharp and transient increase in blood glucose level that occurs after the ingestion of high-GI food, which is defined as the glucostatic theory. However, appetite, hunger and satiety after the ingestion of foods with varying GI were inconsistent among long-term human intervention studies. From the few relevant long-term studies available, we selected two recent well-designed examples for analysis, but they failed to elicit clear differences in glycemic and insulinemic responses between high- and low-GI meals (consisting of a combination of different foods or key carbohydrate-rich foods incorporated into habitual diets). One of the reasons that these studies could not predict glycemic response to mixed meals is presumably that the GI of each particular food was not reflected in that of the mixed meals as a whole. Thus, it is difficult to conclude that the GI values of foods or mixed meals are a valid long-term predictor for appetite, hunger and satiety. Both insulin and insulin-mediated glucose uptake and metabolism in adipose tissue affect blood leptin concentration and its diurnal pattern. Circulating ghrelin level is suppressed by carbohydrate-rich meals, presumably via glycemia and insulinemia. Accordingly, low-GI foods may not necessarily increase satiety or suppress appetite and/or hunger because of the lack of insulin-mediated leptin stimulation and ghrelin suppression. However, insulin-mediated leptin stimulation and ghrelin suppression per se is not consistent among

  2. Good Show by Today's Students

    ERIC Educational Resources Information Center

    Lowry, W. Kenneth

    1977-01-01

    Investigates whether today's students would score as well as students of the 1930-1950 era on achievement tests. Uses the Progressive Achievement Test, a test widely used in the 1930-1950 era as a barometer of student ability. (RK)

  3. Measurement Error. For Good Measure....

    ERIC Educational Resources Information Center

    Johnson, Stephen; Dulaney, Chuck; Banks, Karen

    No test, however well designed, can measure a student's true achievement because numerous factors interfere with the ability to measure achievement. These factors are sources of measurement error, and the goal in creating tests is to have as little measurement error as possible. Error can result from the test design, factors related to individual…

  4. Good News About Childhood Cancer

    MedlinePlus

    ... Home Current Issue Past Issues Good News About Childhood Cancer Past Issues / Spring 2008 Table of Contents ... 85 percent for the most common form of childhood cancer (acute lymphoblastic leukemia or ALL). During the ...

  5. The ABCs of Good Zzzzzs

    MedlinePlus

    ... for you in a new report. The key indicators include: sleeping at least 85 percent of the ... outlined research needed to identify and describe more indicators of good sleep quality among people of all ...

  6. Diet and good health (image)

    MedlinePlus

    ... age. A healthy diet is especially important for children since a variety of food is needed for proper development. Other elements of good health include exercise, rest and avoidance of stimulants such as sugar and caffeine.

  7. Metabolic and inflammatory responses to the common sweetener stevioside and a glycemic challenge in horses with equine metabolic syndrome.

    PubMed

    Elzinga, S E; Rohleder, B; Schanbacher, B; McQuerry, K; Barker, V D; Adams, A A

    2017-02-04

    Extracts derived from the leaves of the stevia plant (stevioside) are commonly used as sweeteners for humans and horses. Stevioside appears to be safe for human consumption, including for individuals with insulin dysregulation. In the horse, the safety or metabolic effects of stevioside on normal animals or on those with metabolic dysfunction are unknown. Furthermore, the inflammatory response to a glycemic challenge or to stevioside in horses is not well defined. Therefore, the objective of this study was to measure the effects of stevioside and a glycemic challenge on insulin, glucose, and inflammatory responses in horses with a common metabolic dysfunction (equine metabolic syndrome or EMS) compared with non-EMS controls. To accomplish this, 15 horses were selected; 8 EMS and 7 age-matched controls. An oral sugar test was performed using Karo corn syrup (karo) or stevioside in a random crossover design. Horses were given 0.15 mL/kg body weight of karo or its equivalent grams of sugar in stevia dissolved in water. Blood samples were collected by jugular venipuncture before administration of either stevia or karo and at 60 and 240 min after administration. Serum was used for glucose and insulin determination and plasma for isolation of peripheral blood mononuclear cells (PBMCs) for inflammatory cytokine analysis via flow cytometry and reverse transcription PCR (RT-PCR). Stevia appeared to stimulate lower glycemic and insulinemic responses when compared to karo, in particular in EMS horses. EMS and control horses had inverse inflammatory responses to administration of either stevia or karo with EMS horses having a proinflammatory response (P ≤ 0.05). These data provide evidence as to why horses with EMS may be predisposed to developing laminitis, potentially as a result of an exaggerated inflammatory response to glycemic and insulinemic responses. Furthermore, the data provide new avenues for exploring mechanisms behind the syndrome, in particular when using a

  8. Effect of traditional Arabic coffee consumption on the glycemic index of Khalas dates tested in healthy and diabetic subjects.

    PubMed

    Alkaabi, Juma; Al-Dabbagh, Bayan; Saadi, Hussein; Gariballa, Salah; Yasin, Javed

    2013-01-01

    The consumption of dates with coffee is common among Arabs and may affect postprandial hyperglycemia ex-cursion. The study aimed to determine the effect of coffee on the glycemic index of a common variety of dates (Khalas) tested in healthy and type 2 diabetes mellitus individuals. Study subjects were thirteen healthy volunteers (mean age: 40.2±6.7 years) and ten diabetic participants with a mean HbA1c of 6.6±(0.7%) and a mean age of 40.8±5.7 years. Each subject participated in five days of tests with 50 g of glucose and 50 g equivalent of available carbohydrates from the dates (with/without coffee). Capillary glucose was measured in the healthy subjects at 0, 15, 30, 45, 60, 90 and 120 min, and for the diabetics at 0, 30, 60, 90, 120, 150 and 180 min. Glycemic indices were determined as ratios of the incremental areas under the response curves for the interventions. Statistical analyses were performed using the independent samples and paired t-tests. Mean±SE glycemic indices of the Khalas dates for the healthy individuals were 55.1±7.7 and 52.7±6.2 without and with coffee consumption, respectively. Similar values were observed for those with diabetes (53.0±6.0 and 41.5±5.4). Differences between glycemic indices of Khalas with or without coffee were not significant (p=0.124). There were no significant differences in glycemic index between the diabetic and healthy subjects (p=0.834 and p=0.202 without and with coffee respectively). In conclusion, at least in the short term, coffee does not adversely affect capillary glucose levels following Khalas dates consumption in healthy and diabetic volunteers.

  9. The glycemic response to fibre rich foods and their relationship with gastric emptying and motor functions: an MRI study.

    PubMed

    Gopirajah, R; Raichurkar, Keshav Prakash; Wadhwa, Rajkumar; Anandharamakrishnan, C

    2016-09-14

    The chief motor functions of human stomach, namely receiving, storing, mixing and emptying, influence the absorption of ingested food and hence determine the glycemic response to the meal. However, among these functions, the gastric emptying pattern of the stomach is essentially regulated by the meal characteristics such as particle size, volume, nutrient composition and viscosity. Understanding the complex relationship between the stomach motor functions and the physicochemical characteristics of meal on glycemic control needs more attention in the formulation of functional foods. Hence, the objective of this study is to employ the magnetic resonance imaging (MRI) technique in ten healthy human volunteers to elucidate the relationship between the motor functions of the stomach and the glycemic response to fibre rich foods. For this, wheat and oat based breakfast meals were selected as fibre rich foods with low (0.042 Pa s) and high (0.266 Pa s) viscosity, respectively. Although wheat meal had a lower viscosity compared to oatmeal, the gastric emptying was found to be delayed for the former due to its high caloric density. This was reflected in the glycemic response as well, with wheat meal having a lower area under the curve (AUC) value than oatmeal. The antral contraction frequency is significantly reduced (P < 0.05) with delayed gastric emptying in the case of high nutrient wheat meal. Overall, the study demonstrated the synergistic effect of gastric emptying, stomach motor functions and physicochemical characteristics of food on the glycemic response to a meal. This information will aid in the development of functional foods with specific end applications.

  10. The impact of measurement frequency on the domains of glycemic control in the critically ill--a Monte Carlo simulation.

    PubMed

    Krinsley, James S; Bruns, David E; Boyd, James C

    2015-03-01

    The role of blood glucose (BG) measurement frequency on the domains of glycemic control is not well defined. This Monte Carlo mathematical simulation of glycemic control in a cohort of critically ill patients modeled sets of 100 patients with simulated BG-measuring devices having 5 levels of measurement imprecision, using 2 published insulin infusion protocols, for 200 hours, with 3 different BG-measurement intervals-15 minutes (Q15'), 1 hour (Q1h), and 2 hours (Q2h)-resulting in 1,100,000 BG measurements for 3000 simulated patients. The model varied insulin sensitivity, initial BG value and rate of gluconeogenesis. The primary outcomes included rates of hyperglycemia (BG > 180 mg/dL), hypoglycemia (BG < 70 and 40 mg/dL), proportion of patients with elevated glucose variability (within-patient coefficient of variation [CV] > 20%), and time in range (BG ranges 80-150 mg/dL and 80-180 mg/dL). Percentages of hyperglycemia, hypoglycemia at both thresholds, and patients with elevated glucose variability as well as time outside glycemic targets were substantially higher in simulations with measurement interval Q2h compared to those with measurement interval Q1h and moderately higher in simulations with Q1h than in those with Q15'. Higher measurement frequency mitigated the deleterious effect of high measurement imprecision, defined as CV ≥ 15%. This Monte Carlo simulation suggests that glycemic control in critically ill patients is more optimal with a BG measurement interval no longer than 1h, with further benefit obtained with use of measurement interval of 15'. These findings have important implications for the development of glycemic control standards.

  11. Technical Excellence: A Requirement for Good Engineering

    NASA Technical Reports Server (NTRS)

    Gill, Paul S.; Vaughan, William W.

    2008-01-01

    Technical excellence is a requirement for good engineering. Technical excellence has many different ways of expressing itself within engineering. NASA has initiatives that address the enhancement of the Agency's technical excellence and thrust to maintain the associated high level of performance by the Agency on current programs/projects and as it moves into the Constellation Program and the return to the Moon with plans to visit Mars. This paper addresses some of the key initiatives associated with NASA's technical excellence thrust. Examples are provided to illustrate some results being achieved and plans to enhance these initiatives.

  12. 'No delays achiever'.

    PubMed

    2007-05-01

    The latest version of the NHS Institute for Innovation and Improvement's 'no delays achiever', a web based tool created to help NHS organisations achieve the 18-week target for GP referrals to first treatment, is available at www.nodelaysachiever.nhs.uk.

  13. Vicarious Achievement Orientation.

    ERIC Educational Resources Information Center

    Leavitt, Harold J.; And Others

    This study tests hypotheses about achievement orientation, particularly vicarious achievement. Undergraduate students (N=437) completed multiple-choice questionnaires, indicating likely responses of one person to the success of another. The sex of succeeder and observer, closeness of relationship, and setting (medical school or graduate school of…

  14. Heritability of Creative Achievement

    ERIC Educational Resources Information Center

    Piffer, Davide; Hur, Yoon-Mi

    2014-01-01

    Although creative achievement is a subject of much attention to lay people, the origin of individual differences in creative accomplishments remain poorly understood. This study examined genetic and environmental influences on creative achievement in an adult sample of 338 twins (mean age = 26.3 years; SD = 6.6 years). Twins completed the Creative…

  15. Confronting the Achievement Gap

    ERIC Educational Resources Information Center

    Gardner, David

    2007-01-01

    This article talks about the large achievement gap between children of color and their white peers. The reasons for the achievement gap are varied. First, many urban minorities come from a background of poverty. One of the detrimental effects of growing up in poverty is receiving inadequate nourishment at a time when bodies and brains are rapidly…

  16. Achievement-Based Resourcing.

    ERIC Educational Resources Information Center

    Fletcher, Mike; And Others

    1992-01-01

    This collection of seven articles examines achievement-based resourcing (ABR), the concept that the funding of educational institutions should be linked to their success in promoting student achievement, with a focus on the application of ABR to postsecondary education in the United Kingdom. The articles include: (1) "Introduction" (Mick…

  17. States Address Achievement Gaps.

    ERIC Educational Resources Information Center

    Christie, Kathy

    2002-01-01

    Summarizes 2 state initiatives to address the achievement gap: North Carolina's report by the Advisory Commission on Raising Achievement and Closing Gaps, containing an 11-point strategy, and Kentucky's legislation putting in place 10 specific processes. The North Carolina report is available at www.dpi.state.nc.us.closingthegap; Kentucky's…

  18. Colonic Fermentation of Unavailable Carbohydrates from Unripe Banana and its Influence over Glycemic Control.

    PubMed

    Dan, Milana C T; Cardenette, Giselli H L; Sardá, Fabiana A H; Giuntini, Eliana Bistriche; Bello-Pérez, Luis Arturo; Carpinelli, Ângelo R; Lajolo, Franco M; Menezes, Elizabete Wenzel

    2015-09-01

    The aim of this study was to evaluate the effect of the colonic fermentation of unavailable carbohydrates from unripe banana (mass - UBM - and starch - UBS) over parameters related to glucose and insulin response in rats. Wistar male rats were fed either a control diet, a UBM diet (5 % resistant starch - RS) or a UBS diet (10 % RS) for 28 days. In vivo (oral glucose tolerance test) and in vitro (cecum fecal fermentation, pancreatic islet insulin secretion) analyses were performed. The consumption of UBM and UBS diets by Wistar rats for 28 days improved insulin/glucose ratio. Also, pancreatic islets isolated from the test groups presented significant lower insulin secretion compared to the control group, when the same in vitro glucose stimulation was done. Total short chain fatty acids produced were higher in both experimental groups in relation to the control group. These findings suggest that UBM and UBS diets promote colonic fermentation and can influence glycemic control, improving insulin sensitivity in rats.

  19. Sorghum flour fractions: correlations among polysaccharides, phenolic compounds, antioxidant activity and glycemic index.

    PubMed

    Moraes, Érica Aguiar; Marineli, Rafaela da Silva; Lenquiste, Sabrina Alves; Steel, Caroline Joy; de Menezes, Cícero Beserra; Queiroz, Valéria Aparecida Vieira; Maróstica Júnior, Mário Roberto

    2015-08-01

    Nutrients composition, phenolic compounds, antioxidant activity and estimated glycemic index (EGI) were evaluated in sorghum bran (SB) and decorticated sorghum flour (DSF), obtained by a rice-polisher, as well as whole sorghum flour (WSF). Correlation between EGI and the studied parameters were determined. SB presented the highest protein, lipid, ash, β-glucan, total and insoluble dietary fiber contents; and the lowest non-resistant and total starch contents. The highest carbohydrate and resistant starch contents were in DSF and WSF, respectively. Phenolic compounds and antioxidant activities were concentrated in SB. The EGI values were: DSF 84.5 ± 0.41; WSF 77.2 ± 0.33; and SB 60.3 ± 0.78. Phenolic compounds, specific flavonoids and antioxidant activities, as well as total, insoluble and soluble dietary fiber and β-glucans of sorghum flour samples were all negatively correlated to EGI. RS content was not correlated to EGI.

  20. Fasts, feasts and festivals in diabetes-1: Glycemic management during Hindu fasts

    PubMed Central

    Kalra, Sanjay; Bajaj, Sarita; Gupta, Yashdeep; Agarwal, Pankaj; Singh, S. K.; Julka, Sandeep; Chawla, Rajeev; Agrawal, Navneet

    2015-01-01

    This communication is the first of a series on South Asian fasts, festivals, and diabetes, designed to spread awareness and stimulate research on this aspect of diabetes and metabolic care. It describes the various fasts observed as part of Hindu religion and offers a classification scheme for them, labeling them as infrequent and frequent. The infrequent fasts are further sub-classified as brief and prolonged, to facilitate a scientific approach to glycemic management during these fasts. Pre-fast counseling, non-pharmacological therapy, pharmacological modification, and post-fast debriefing are discussed in detail. All available drug classes and molecules are covered in this article, which provides guidance about necessary changes in dosage and timing of administration. While in no way exhaustive, the brief review offers a basic framework which diabetes care professionals can use to counsel and manage persons in their care who wish to observe various Hindu fasts. PMID:25729681

  1. Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control

    PubMed Central

    Lipska, Kasia J.; Ross, Joseph S.; Miao, Yinghui; Shah, Nilay D.; Lee, Sei J.; Steinman, Michael A.

    2015-01-01

    IMPORTANCE In older adults with multiple serious comorbidities and functional limitations, the harms of intensive glycemic control likely exceed the benefits. OBJECTIVES To examine glycemic control levels among older adults with diabetes mellitus by health status and to estimate the prevalence of potential overtreatment of diabetes. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of the data on 1288 older adults (≥65 years) with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2010 who had a hemoglobin A1c (HbA1c) measurement. All analyses incorporated complex survey design to produce nationally representative estimates. EXPOSURES Health status categories: very complex/poor, based on difficulty with 2 or more activities of daily living or dialysis dependence; complex/intermediate, based on difficulty with 2 or more instrumental activities of daily living or presence of 3 or more chronic conditions; and relatively healthy if none of these were present. MAIN OUTCOMES AND MEASURES Tight glycemic control (HbA1c level, <7%) and use of diabetes medications likely to result in hypoglycemia (insulin or sulfonylureas). RESULTS Of 1288 older adults with diabetes, 50.7% (95% CI, 46.6%–54.8%), representing 3.1 million (95% CI, 2.7–3.5), were relatively healthy, 28.1% (95% CI, 24.8%–31.5%), representing 1.7 million (95% CI, 1.4–2.0), had complex/intermediate health, and 21.2% (95% CI, 18.3%–24.4%), representing 1.3 million (95% CI, 1.1–1.5), had very complex/poor health. Overall, 61.5% (95% CI, 57.5%–65.3%), representing 3.8 million (95% CI, 3.4–4.2), had an HbA1c level of less than 7%; this proportion did not differ across health status categories (62.8% [95% CI, 56.9%–68.3%]) were relatively healthy, 63.0% (95% CI, 57.0%–68.6%) had complex/intermediate health, and 56.4% (95% CI, 49.7%–62.9%) had very complex/poor health (P = .26). Of the older adults with an HbA1c level of less than 7%, 54.9% (95

  2. Non-nutritive sweeteners: no class effect on the glycemic or appetite responses to ingested glucose

    PubMed Central

    Bryant, Charlotte E.; Wasse, Lucy K.; Astbury, Nerys; Nandra, Gurinder; McLaughlin, John T.

    2014-01-01

    There is considerable interest in whether non-nutritive sweeteners are sensed in the gastrointestinal tract to modulate appetitive or absorptive responses to ingested carbohydrate. We determined the effect of a panel of non-nutritive sweeteners, aspartame, saccharin and acesulfame-K, delivered in doses that would be consumed in normal usage. Each was given in combination with glucose, assessing their effect on glycemic responses and appetite in ten healthy human subjects. There was no additional effect of aspartame or saccharin on the blood glucose response to oral glucose at any time point, although acesulfame-K exerted a small effect. However, none had an effect on perceptions of hunger or fullness. We conclude that there is no consistent evidence that non-nutrient sweeteners, when acutely consumed with glucose in dietetically relevant doses, have a class effect in modulating blood glucose in healthy human subjects. However, acesulfame-K may require further exploration. PMID:24595225

  3. Continuous Glucose Monitoring for Evaluation of Glycemic Excursions after Gastric Bypass

    PubMed Central

    Halperin, Florencia; Patti, Mary Elizabeth; Skow, Megan; Bajwa, Muhammad; Goldfine, Allison B.

    2011-01-01

    Background. Hyperinsulinemic hypoglycemia with neuroglycopenia is a rare complication of Roux-en-Y gastric bypass (RYGB). We hypothesized that continuous glucose monitoring (CGM) would be useful to characterize glycemic variability after RYGB. Methods. CGM and mixed meal tolerance testing (MMTT) were performed on sixteen post-RYGB subjects, ten with a history of neuroglycopenia on medical treatment and six asymptomatic controls. Results. 9 of 10 subjects with neuroglycopenia developed hypoglycemia defined by glucose <70 mg/dL on CGM, and 3 of 9 on MMTT. In asymptomatic subjects, 3 of 6 had asymptomatic hypoglycemia during CGM, and 3 of 5 on MMTT. Therefore, the sensitivity and specificity to detect clinically significant hypoglycemia was 90% and 50% for CGM and 33% and 40% for MMTT. Conclusions. Asymptomatic hypoglycemia after RYGB is more frequent than commonly recognized. For clinicians evaluating patients for postbypass neuroglycopenia, CGM may be a valuable diagnostic tool. PMID:21331295

  4. Biopsychosocial pathways linking subjective socioeconomic disadvantage to glycemic control in youths with type I diabetes.

    PubMed

    Zilioli, Samuele; Ellis, Deborah A; Carré, Justin M; Slatcher, Richard B

    2017-04-01

    Older adolescent and young adults (OAYA) with type 1 diabetes (T1D) living in contexts of socio-economic disadvantage (SED) suffer disproportionately from poor glycemic control and related health complications. Although SED may convey a variety of risks, it may exacerbate diabetes-related stress levels, which in turn may account for observed disparities in health outcomes. The primary goal of the present study was to investigate the relationship between subjective SED, diabetes-related perceived stress, and diurnal cortisol secretion in urban OAYA with T1D. A secondary goal was to determine if cortisol was related to measures of blood glucose (HbA1c and mean blood glucose). Analyses were conducted among OAYA ages 17-20 years (n=61) affected by T1D, who provided daily saliva samples for four days, measures of glycemic control (i.e., HbA1c and mean blood glucose assessed via Continuous Glucose Monitor), and completed psychosocial questionnaires. We found that subjective SED was associated with a flatter diurnal cortisol rhythm via diabetes-related stress. Flattened cortisol rhythm was, in turn, associated with higher levels of HbA1c, but not with mean blood glucose assessed via Continuous Glucose Monitor. These results represent some of the first empirical evidence on how distal social factors (i.e., subjective SED) and proximal psychological processes (diabetes-related perceived stress) are connected to condition-relevant biological mechanisms (i.e., elevated HbA1c), via broad biological pathways implicated in health (i.e., flatter cortisol slope).

  5. In vitro starch digestibility and in vivo glycemic response of foxtail millet and its products.

    PubMed

    Ren, Xin; Chen, Jing; Molla, Mohammad Mainuddin; Wang, Chao; Diao, Xianmin; Shen, Qun

    2016-01-01

    Foxtail millet, as a leading variety in arid and semi-arid areas of Asia and Africa, can provide broad potential benefits to human health. However, its digestion properties have not been reported. So in this study, the in vitro starch digestibilities and in vivo glycemic indices (GI) of foxtail millet and pure millet products were investigated. The results showed that starch digestibility of the foxtail millet flour is obviously lower than that of wheat flour. However, deproteinization and heating significantly increased its rapidly digestible starch and decreased its slowly digestible starch and resistant starch. The GIs of pure millet products were in the following order: millet porridge (93.6 ± 11.3) > millet steamed bread (89.6 ± 8.8) > No. 1 millet pancake (75.0% millet flour and 25.0% extrusion flour, 83.0 ± 9.6) > No. 2 millet pancake (without extrusion flour, 76.2 ± 10.7) > cooked millet (64.4 ± 8.5). They were significantly positively correlated with the rapidly digestible starch (r = 0.959), degree of gelatinization (r = 0.967) and estimated glycemic index (r = 0.988). Both in vitro and in vivo tests suggested that boiling, steaming and extrusion enhanced the formation of digestible starch and subsequently increased the GI values. Additionally, the No. 1 millet pancake and cooked millet had a relatively gentle stimulation on β-cell. Therefore, foxtail millet, especially the cooked millet, may serve as a potential source of nutraceutical and functional food that could delay the development of type 2 diabetes.

  6. Sustainability of Improved Glycemic Control After Diabetes Self-Management Education.

    PubMed

    Nicoll, Katie G; Ramser, Kristie L; Campbell, Jennifer D; Suda, Katie J; Lee, Marilyn D; Wood, G Christopher; Sumter, Robert; Hamann, Gale L

    2014-08-01

    Objective. The purpose of this study was to evaluate glycemic control as measured by A1C during a 2-year period after patients received diabetes self-management education (DSME). Methods. Patients who completed DSME in 2009 and received medical follow-up with A1C measurements for at least 2 years after DSME were included in the evaluation. Primary endpoints were changes in A1C from before to immediately after, 1 year after, and 2 years after DSME. Secondary outcomes included the effects of the following factors on change in A1C: sex, duration of diabetes, uncontrolled diabetes (A1C ≥ 9%), health insurance coverage, and self-reported education level. Results. Forty-three patients were included in the evaluation. Mean A1C before DSME was 10.2 ± 3.7%. Mean A1C after DSME was 7.8 ± 2.2% (P < 0.0001), a 23.5% reduction. Mean A1C at 1 and 2 years after DSME was 7.8 ± 2.1% for each year and remained unchanged from just after DSME to 1 and 2 years after DSME (P > 0.05). Patients with a duration of diabetes of < 1 year had a significantly greater reduction in mean A1C than those with a duration of diabetes ≥ 1 year (28.7 and 20.2%, respectively, P = 0.001). Conclusion. DSME improved glycemic control to a substantial degree, and the effect was sustained for up to 2 years. Although the reduction in A1C was significant for all patients receiving DSME, there was a significantly greater reduction for patients who had a duration of diabetes of < 1 year than for those with a duration of diabetes > 1 year.

  7. Effect of Wheat Flour Noodles with Bombyx mori Powder on Glycemic Response in Healthy Subjects

    PubMed Central

    Suk, Wanhee; Kim, JiEun; Kim, Do-Yeon; Lim, Hyunjung; Choue, Ryowon

    2016-01-01

    Recent trial results suggest that the consumption of a low glycemic index (GI) diet is beneficial in the prevention of high blood glucose levels. Identifying active hypoglycemic substances in ordinary foods could be a significant benefit to the management of blood glucose. It has been hypothesized that noodles with Bombyx mori powder are a low GI food. We evaluated GI and changes in postprandial glucose levels following consumption of those noodles and compared them with those following consumption of plain wheat flour noodles (control) and glucose (reference) in healthy subjects. Thirteen males (age: 34.2±4.5 years, body mass index: 23.2±1.1 kg/m2) consumed 75 g carbohydrate portions of glucose and the 2 kinds of noodle after an overnight fast. Capillary blood was measured at time 0 (fasting), 15, 30, 45, 60, 90, 120, and 180 min from the start of each food intake. The GI values were calculated by taking the ratio of the incremental area under the blood glucose response curve (IAUC) for the noodles and glucose. There was a significant difference in postprandial glucose concentrations at 30 and 45 min between the control noodles and the noodles with Bombyx mori powder: the IAUC and GI for the noodles with Bombyx mori powder were significantly lower than those for glucose and plain wheat flour noodles. The wheat flour noodles with Bombyx mori powder could help prevent an increase in postprandial glucose response and possibly provide an alternative to other carbohydrate staple foods for glycemic management. PMID:27752491

  8. Glycemic and insulinemic response to selected snack bars in trained versus sedentary individuals.

    PubMed

    Trompers, Willeke; Perry, Tracy L; Rose, Meredith C; Rehrer, Nancy J

    2010-02-01

    The purpose of this study was to determine whether glycemic index (GI) is influenced by training state. Participants were tested in a randomized order: twice with a reference solution containing 50 g glucose and once each with 2 commercially available snack bars (Griffin's Fruitli bar and Peak Fuel's Summit bar) containing 50 g available carbohydrate. Eleven of the participants (6 men and 5 women, M + or - SD age 20.8 + or - 2.0 yr) were endurance trained (ET; VO(2max) 57.5 + or - 8.4 ml x kg(-1) x min(-1) ), and 9 participants (2 men and 7 women, M + or - SD age 22.4 + or - 1.8 yr) were sedentary (SE; VO(2max) 43.7 + or - 9.1 ml x kg(-1) x min(-1) ). After an overnight fast, participants consumed either the glucose solution or snack bar, with blood samples taken before eating and at 15, 30, 45, 60, 90, and 120 min after eating began. The mean incremental area under the curve (IAUC) of the glucose reference was 31% lower (95% CI 3-52%, p = .03), and the Fruitli bar 38% lower (95% CI 0-61%, p = .05) in ET than in SE participants. There was a trend for the IAUC for the Summit bar to be 35% lower in ET than in SE participants (95% CI -7% to 61% p = .09). There was no significant interaction between training state and test food. The GIs of the Fruitli and Summit bars was not significantly different between ET and SE participants (p = .65 and .54, respectively). ET participants had a lower glycemic response than SE participants; however, training state did not influence GI.

  9. Association of dietary quality indices with glycemic status in korean patients with type 2 diabetes.

    PubMed

    Kim, Jiyoung; Cho, Youngyun; Park, Youngmi; Sohn, Cheongmin; Rha, Miyong; Lee, Moon-Kyu; Jang, Hak C

    2013-07-01

    The present study was performed to evaluate the relationship between dietary quality indices including the Diet Quality Index-International (DQI-I), Alternate Healthy Eating Index (AHEI), and Healthy Diet Indicator (HDI) and glycemic status in Korean patients with type 2 diabetes. A total of 110 consecutive outpatients with type 2 diabetes who visited 2 university hospitals in Seoul and Seongnam from April 2004 to November 2006 were enrolled as subjects. At the time of enrollment, anthropometric parameters, dietary habits, experience of exercise, and metabolic parameters were obtained. Experienced registered dietitians collected one-day dietary intake using the 24-hour recall method. The mean scores for DQI-I, AHEI, and HDI were 68.9 ± 8.2, 39.4 ± 8.9, and 5.0 ± 1.3, respectively. After adjustment for age, body mass index, and energy intake, DQI-I and HDI were found to have a significant correlation with hemoglobin A1c (HbA1c) (r = -0.21, p < 0.05; r = -0.28, p < 0.05), fasting plasma glucose (r = -0.21, p < 0.05; r = -0.23, p < 0.05), and postprandial 2-h glucose (r = -0.30, p < 0.05; r = -0.26, p < 0.05, respectively). However, AHEI did not have a significant correlation with HbA1c. In conclusion, the DQI-I and HDI may be useful tools in assessing diet quality and adherence to dietary recommendations in Korean patients with type 2 diabetes. Future research is required to determine whether the dietary quality indices have predictive validity for dietary and glycemic changes following diet education in a clinical setting.

  10. Urine Albumin Excretion as a Marker of Acute Glycemic Changes in Isolated Postprandial Hyperglycemia

    PubMed Central

    Shilpasree, Alagilawada S; Patil, Vidya S; Patil, Vijayetha P; Ingleshwar, Deepti G

    2017-01-01

    Introduction: Postprandial hyperglycemia is a major risk factor for the development of cardiovascular diseases (CVDs), and Most of the times it occurs in patients with normal glycemic control diagnosed by fasting blood glucose (FBG) and glycated hemoglobin levels. Urine albumin excretion (UAE) is an independent predictor of CVD risk. Aim: To estimate UAE in isolated postprandial hyperglycemia (IPPHG) patients and to assess the relationship of UAE with FBG and postprandial blood glucose (PPBG) levels. Settings and Design: A cross-sectional study was carried out in 318 patients with Type II diabetes in the age group 30–60 years for 6 months. Materials and Methods: Patients were divided into five groups based on their FBG and PPBG values. UAE and lipid profile were measured in all the groups. Statistical Analysis: UAE and lipid profile in different groups were compared using ANOVA. Regression analysis was used to predict the variation of UAE with FBG, PPBG, and total cholesterol (TC). Results: Patients with IPPHG had significantly higher albumin excretion compared to normoglycemia (NG) group [P < 0.0001]. In impaired glucose tolerance and isolated fasting hyperglycemia groups, it did not differ significantly from NG group [P = 0.206 and P = 0.173]. Lipid profile did not show any significant difference between the groups. On regression analysis, PPBG but not FBG or TC correlated positively with UAE. Conclusion: UAE is easy, less expensive, and Widely available method done on spot urine samples which predicts the acute glycemic changes and increased risk of developing CVDs in patients with IPPHG. PMID:28042215

  11. Serum Magnesium Concentrations in the Canadian Population and Associations with Diabetes, Glycemic Regulation, and Insulin Resistance

    PubMed Central

    Bertinato, Jesse; Wang, Kuan Chiao; Hayward, Stephen

    2017-01-01

    Total serum magnesium (Mg) concentration (SMC) is commonly used to assess Mg status. This study reports current SMCs of Canadians and their associations with demographic factors, diabetes, and measures of glycemic control and insulin resistance using results from the Canadian Health Measures Survey cycle 3 (2012–2013). Associations were examined in adults aged 20–79 years using linear mixed models. Mean SMCs and percentile distributions for 11 sex-age groups between 3 and 79 years (n = 5561) are reported. SMCs were normally distributed and differences (p < 0.05) among sex and age groups were small. Between 9.5% and 16.6% of adult sex-age groups had a SMC below the lower cut-off of a population-based reference interval (0.75–0.955 mmol·L−1) established in the United States population as part of the NHANES I conducted in 1971–1974. Having diabetes was associated with 0.04 to 0.07 mmol·L−1 lower SMC compared to not having diabetes in the various models. Body mass index, glycated hemoglobin, serum glucose and insulin concentrations, and homeostatic model assessment of insulin resistance were negatively associated with SMC. This is the first study to report SMCs in a nationally representative sample of the Canadian population. A substantial proportion of Canadians are hypomagnesaemic in relation to a population-based reference interval, and SMC was negatively associated with diabetes and indices of glycemic control and insulin resistance. PMID:28304338

  12. Reductions in regimen distress are associated with improved management and glycemic control over time.

    PubMed

    Hessler, Danielle; Fisher, Lawrence; Glasgow, Russell E; Strycker, Lisa A; Dickinson, L Miriam; Arean, Patricia A; Masharani, Umesh

    2014-01-01

    OBJECTIVE Cross-sectional and longitudinal associations among regimen distress (RD), self-management, and glycemic control were undertaken to explore mechanisms of operation among these variables. RESEARCH DESIGN AND METHODS In a behavioral randomized control trial (RCT) to reduce RD, 392 adults with type 2 diabetes were assessed for RD, diet, exercise, medication adherence, and HbA1c at baseline and at 4 and 12 months. Associations among RD, self-management, and HbA1c were examined in cross-sectional analyses at baseline, in prospective analyses using baseline values to predict change over time, and in time-varying analyses. RESULTS At baseline, greater RD and poorer medication adherence were independently associated with higher HbA1c (P = 0.05 and P < 0.001, respectively), and greater RD was associated with poorer medication adherence (P = 0.03). No consistent pattern of significant prospective associations was found. Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence (P < 0.01), physical activity (P < 0.001), and HbA1c (P = 0.02) over time following intervention. Changes in self-management were not associated with changes in HbA1c over time. CONCLUSIONS In the context of an RCT to reduce distress, RD, self-management, and HbA1c were interrelated in cross-sectional and time-varying analyses. Decreases in RD were associated with improvements in both self-management and HbA1c over 12 months. Findings point to the complex and likely multifaceted pathways of association among these key constructs, with results indicating significant linkages between RD and both self-management and glycemic control over time.

  13. The Impact of Food Viscosity on Eating Rate, Subjective Appetite, Glycemic Response and Gastric Emptying Rate

    PubMed Central

    Zhu, Yong; Hsu, Walter H.; Hollis, James H.

    2013-01-01

    Understanding the impact of rheological properties of food on postprandial appetite and glycemic response helps to design novel functional products. It has been shown that solid foods have a stronger satiating effect than their liquid equivalent. However, whether a subtle change in viscosity of a semi-solid food would have a similar effect on appetite is unknown. Fifteen healthy males participated in the randomized cross-over study. Each participant consumed a 1690 kJ portion of a standard viscosity (SV) and a high viscosity (HV) semi-solid meal with 1000 mg acetaminophen in two separate sessions. At regular intervals during the three hours following the meal, subjective appetite ratings were measured and blood samples collected. The plasma samples were assayed for insulin, glucose-dependent insulinotropic peptide (GIP), glucose and acetaminophen. After three hours, the participants were provided with an ad libitum pasta meal. Compared with the SV meal, HV was consumed at a slower eating rate (P = 0.020), with postprandial hunger and desire to eat being lower (P = 0.019 and P<0.001 respectively) while fullness was higher (P<0.001). In addition, consuming the HV resulted in lower plasma concentration of GIP (P<0.001), higher plasma concentration of glucose (P<0.001) and delayed gastric emptying as revealed by the acetaminophen absorption test (P<0.001). However, there was no effect of food viscosity on insulin or food intake at the subsequent meal. In conclusion, increasing the viscosity of a semi-solid food modulates glycemic response and suppresses postprandial satiety, although the effect may be short-lived. A slower eating rate and a delayed gastric emptying rate can partly explain for the stronger satiating properties of high viscous semi-solid foods. PMID:23818981

  14. Chemical composition and glycemic index of Brazilian pine (Araucaria angustifolia) seeds.

    PubMed

    Cordenunsi, Beatriz Rosana; De Menezes Wenzel, Elizabete; Genovese, Maria Inés; Colli, Célia; De Souza Gonçalves, Alessandra; Lajolo, Franco Maria

    2004-06-02

    The seeds of Parana pine (Araucaria brasiliensis syn. Araucaria angustifolia), named pinhão, are consumed after cooking and posterior dehulling, or they are used to prepare a flour employed in regional dishes. Native people that live in the South of Brazil usually consume baked pinhão. As a result of cooking, the white seeds become brown on the surface due to the migration of some tinted compounds present in the seed coat. In this work, the proximate composition, minerals, flavonoids, and glycemic index (GI) of cooked and raw pinhão seeds were compared. No differences in moisture, lipids, soluble fiber, and total starch after boiling were found. However, the soluble sugars and P, Cu, and Mg contents decreased, probably as a consequence of leaching in the cooking water. Also, the boiling process modified the profile of the phenolic compounds in the seeds. No flavonols were detected in raw pinhão seeds. The internal seed coat had a quercetin content five times higher than that of the external seed coat; also, quercetin migrated into the seed during cooking. The internal seed coat had a high content of total phenolics, and seeds cooked in normal conditions (with the seed coat) showed a total phenolics content five times higher than that of seeds cooked without the seed coat. Cooking was then extremely favorable to pinhão seeds bioactive compounds content. The carbohydrate availability was evaluated in a short-term assay in humans by the GI. The GI of pinhão seeds cooked with the coat (67%) was similar to that of the seeds cooked without a coat (62%) and lower than bread, showing that cooking does not interfere with starch availability. The low glycemic response can be partly due to its high content of resistant starch (9% of the total starch).

  15. A Pretty Good Paper about Pretty Good Privacy.

    ERIC Educational Resources Information Center

    McCollum, Roy

    With today's growth in the use of electronic information systems for e-mail, data development and research, and the relative ease of access to such resources, protecting one's data and correspondence has become a great concern. "Pretty Good Privacy" (PGP), an encryption program developed by Phil Zimmermann, may be the software tool that…

  16. Answering the Complex Question of "How Good Is Good Enough?"

    ERIC Educational Resources Information Center

    Suskie, Linda

    2007-01-01

    Imagine that a student--let's call him Michael--has earned a score of 55 on an examination. How well did he do? Was his score good enough for him to pass the examination, or pass the course, or be deemed at least minimally competent in whatever the exam was assessing? Michael's score alone, in the absence of any other information, cannot answer…

  17. Achievability for telerobotic systems

    NASA Astrophysics Data System (ADS)

    Kress, Reid L.; Draper, John V.; Hamel, William R.

    2001-02-01

    Methods are needed to improve the capabilities of autonomous robots to perform tasks that are difficult for contemporary robots, and to identify those tasks that robots cannot perform. Additionally, in the realm of remote handling, methods are needed to assess which tasks and/or subtasks are candidates for automation. We are developing a new approach to understanding the capability of autonomous robotic systems. This approach uses formalized methods for determining the achievability of tasks for robots, that is, the likelihood that an autonomous robot or telerobot can successfully complete a particular task. Any autonomous system may be represented in achievability space by the volume describing that system's capabilities within the 3-axis space delineated by perception, cognition, and action. This volume may be thought of as a probability density with achievability decreasing as the distance from the centroid of the volume increases. Similarly, any task may be represented within achievability space. However, as tasks have more finite requirements for perception, cognition, and action, each may be represented as a point (or, more accurately, as a small sphere) within achievability space. Analysis of achievability can serve to identify, a priori, the survivability of robotic systems and the likelihood of mission success; it can be used to plan a mission or portions of a mission; it can be used to modify a mission plan to accommodate unpredicted occurrences; it can also serve to identify needs for modifications to robotic systems or tasks to improve achievability. .

  18. Religiosity as a public good.

    PubMed

    Sherlock, Richard

    2008-09-01

    Public Goods can be seen as one important way in which societies sustain themselves over time. These are part of the puzzle of the development of political order. Public goods like the rule of law are non-substractable and non-excludable . For economists the classic textbook examples are national defense and police protection. In this paper I argue that religiosity can function like police protection, a means of sustaining order through fear of punishment from a transcendent source. As a means of reducing defection from social norms it has a role to play as a public good. But religion cannot at the same time be seen as the source of such norms or dissention will undermine the very order that punishment seems to reinforce.

  19. Walking behaviour and glycemic control in type 2 diabetes: seasonal and gender differences-Study design and methods

    PubMed Central

    Dasgupta, Kaberi; Chan, Cathy; Da Costa, Deborah; Pilote, Louise; De Civita, Mirella; Ross, Nancy; Strachan, Ian; Sigal, Ronald; Joseph, Lawrence

    2007-01-01

    Background The high glucose levels typically occurring among adults with type 2 diabetes contribute to blood vessel injury and complications such as blindness, kidney failure, heart disease, and stroke. Higher physical activity levels are associated with improved glycemic control, as measured by hemoglobin A1C. A 1% absolute increase in A1C is associated with an 18% increased risk for heart disease or stroke. Among Canadians with type 2 diabetes, we postulate that declines in walking associated with colder temperatures and inclement weather may contribute to annual post-winter increases in A1C levels. Methods During this prospective cohort study being conducted in Montreal, Quebec, Canada, 100 men and 100 women with type 2 diabetes will undergo four assessments (once per season) over a one-year period of observation. These assessments include (1) use of a pedometer with a concealed viewing window for a two-week period to measure walking (2) a study centre visit during which venous blood is sampled for A1C, anthropometrics are assessed, and questionnaires are completed for measurement of other factors that may influence walking and/or A1C (e.g. food frequency, depressive symptomology, medications). The relationship between spring-fall A1C difference and winter-summer difference in steps/day will be examined through multivariate linear regression models adjusted for possible confounding. Interpretation of findings by researchers in conjunction with potential knowledge "users" (e.g. health professionals, patient groups) will guide knowledge translation efforts. Discussion Although we cannot alter weather patterns to favour active lifestyles, we can design treatment strategies that take seasonal and weather-related variations into account. For example, demonstration of seasonal variation of A1C levels among Canadian men and women with T2D and greater understanding of its determinants could lead to (1) targeting physical activity levels to remain at or exceed peak

  20. Culture and Achievement Motivation

    ERIC Educational Resources Information Center

    Maehr, Martin L.

    1974-01-01

    A framework is suggested for the cross-cultural study of motivation that stresses the importance of contextual conditions in eliciting achievement motivation and emphasizes cultural relativity in the definition of the concept. (EH)

  1. Achieving Salary Equity

    ERIC Educational Resources Information Center

    Nevill, Dorothy D.

    1975-01-01

    Three techniques are outlined for use by higher education institutions to achieve salary equity: salary prediction (using various statistical procedures), counterparting (comparing salaries of persons of similar rank), and grievance procedures. (JT)

  2. A comparative study on starch digestibility, glycemic index and resistant starch of pigmented ('Njavara' and 'Jyothi') and a non-pigmented ('IR 64') rice varieties.

    PubMed

    Deepa, G; Singh, Vasudeva; Naidu, K Akhilender

    2010-12-01

    In vitro starch digestibility and glycemic indices of three rice varieties- 'Njavara', 'Jyothi' (pigmented rice verities) and 'IR 64' (non-pigmented rice) with similar amylose content were studied. Starch digestibility studies showed differences in glycemic response in three types of rice. The rate of starch hydrolysis was maximum (67.3%) in 'Njavara' rice compared to other two rice varieties. 'Njavara' exhibited the lowest kinetic constant (k) indicating inherent resistance to enzymatic hydrolysis. The glycemic load (GL) and glycemic index (GI) of 'Njavara' were similar to 'Jyothi' and 'IR 64'. Resistant starch content was high in pigmented rice varieties compared to 'IR 64'. The resistant starch content of dehusked and cooked rice increased with the storage time at refrigeration temperature (4°C). 'Njavara' is an easily digestible rice and can be used for baby and geriatric foods.

  3. What Makes a Good Teacher?

    ERIC Educational Resources Information Center

    Ida, Zagyváné Szucs

    2017-01-01

    The introduction of the new Teacher Career Model, the School Inspectorate and the Complex School Assessment imply the basic question "What makes a good teacher?" The scholars have been focusing on the issue for a long period of time. The target of the recent studies is the teachers', school principals' and the teacher students' beliefs.…

  4. Measuring Goodness of Story Narratives

    ERIC Educational Resources Information Center

    Le, Karen; Coelho, Carl; Mozeiko, Jennifer; Grafman, Jordan

    2011-01-01

    Purpose: The purpose of this article was to evaluate a new measure of story narrative performance: story completeness. It was hypothesized that by combining organizational (story grammar) and completeness measures, story "goodness" could be quantified. Method: Discourse samples from 46 typically developing adults were compared with those from 24…

  5. Practicing Good Habits, Grade 2.

    ERIC Educational Resources Information Center

    Nguyen Van Quan; And Others

    This illustrated primer, designed for second grade students in Vietnam, consists of stories depicting rural family life in Vietnam. The book is divided into the following six chapters: (1) Practicing Good Habits (health, play, helpfulness); (2) Duties at Home (grandparents, father and mother, servants, the extended family; (3) Duties in School…

  6. Making the Common Good Common

    ERIC Educational Resources Information Center

    Chase, Barbara

    2011-01-01

    How are independent schools to be useful to the wider world? Beyond their common commitment to educate their students for meaningful lives in service of the greater good, can they educate a broader constituency and, thus, share their resources and skills more broadly? Their answers to this question will be shaped by their independence. Any…

  7. Metrics for Soft Goods Merchandising.

    ERIC Educational Resources Information Center

    Cooper, Gloria S., Ed.; Magisos, Joel H., Ed.

    Designed to meet the job-related metric measurement needs of students interested in soft goods merchandising, this instructional package is one of five for the marketing and distribution cluster, part of a set of 55 packages for metric instruction in different occupations. The package is intended for students who already know the occupational…

  8. Metrics for Hard Goods Merchandising.

    ERIC Educational Resources Information Center

    Cooper, Gloria S., Ed.; Magisos, Joel H., Ed.

    Designed to meet the job-related metric measurement needs of students interested in hard goods merchandising, this instructional package is one of five for the marketing and distribution cluster, part of a set of 55 packages for metric instruction in different occupations. The package is intended for students who already know the occupational…

  9. Gender Play and Good Governance

    ERIC Educational Resources Information Center

    Powell, Mark

    2008-01-01

    Like good government, thoughtful care of children requires those in power, whether teachers or parents, to recognize when it is appropriate for them to step back from day-to-day decision-making while still working behind the scenes to ensure an organizational structure that supports the independence and equitable development of those they serve.…

  10. What Good Are Conferences, Anyway?

    ERIC Educational Resources Information Center

    Pietro, David C.

    1996-01-01

    According to Frederick Herzberg's studies of employee motivation, humans are driven by motivating factors that allow them to grow psychologically and hygiene factors that help them meet physical needs. Good education conferences can enhance both factors by helping principals refocus their energies, exchange ideas with trusted colleagues, and view…

  11. Good and Bad Public Prose.

    ERIC Educational Resources Information Center

    Cockburn, Stewart

    1969-01-01

    The basic requirements of all good prose are clarity, accuracy, brevity, and simplicity. Especially in public prose--in which the meaning is the crux of the article or speech--concise, vigorous English demands a minimum of adjectives, a maximum use of the active voice, nouns carefully chosen, a logical argument with no labored or obscure points,…

  12. Are You a Good Protege?

    ERIC Educational Resources Information Center

    Perlmutter, David D.

    2008-01-01

    Perhaps getting advice seems a clearer-cut task than giving it. But at a time when budding academics seem busier and more distracted than ever, it is all the more important to understand how to learn from a mentor, and that being a good protege has its own strategies, techniques and responsibilities. The mentor relationship is alive and well in…

  13. The global public good concept: a means of promoting good veterinary governance.

    PubMed

    Eloit, M

    2012-08-01

    At the outset, the concept of a 'public good' was associated with economic policies. However, it has now evolved not only from a national to a global concept (global public good), but also from a concept applying solely to the production of goods to one encompassing societal issues (education, environment, etc.) and fundamental rights, including the right to health and food. Through their actions, Veterinary Services, as defined by the Terrestrial Animal Health Code (Terrestrial Code) of the World Organisation for Animal Health (OIE), help to improve animal health and reduce production losses. In this way they contribute directly and indirectly to food security and to safeguarding human health and economic resources. The organisation and operating procedures of Veterinary Services are therefore key to the efficient governance required to achieve these objectives. The OIE is a major player in global cooperation and governance in the fields of animal and public health through the implementation of its strategic standardisation mission and other programmes for the benefit of Veterinary Services and OIE Member Countries. Thus, the actions of Veterinary Services and the OIE deserve to be recognised as a global public good, backed by public investment to ensure that all Veterinary Services are in a position to apply the principles of good governance and to comply with the international standards for the quality of Veterinary Services set out in the OIE Terrestrial Code (Section 3 on Quality of Veterinary Services) and Aquatic Animal Health Code (Section 3 on Quality of Aquatic Animal Health Services).

  14. Impact of Glycemic Control and Metformin Use on the Recurrence and Progression of Non-Muscle Invasive Bladder Cancer in Patients with Diabetes Mellitus

    PubMed Central

    2016-01-01

    The purpose of the present study was to determine the potential relationships of glycemic control and use of metformin with non-muscle invasive bladder cancer characteristics. We reviewed data from 645 patients with non-muscle invasive bladder cancer between January 2004 and May 2015. We analyzed the association of pre and post-operative glycemic control and use of metformin with clinical characteristics of bladder tumors. We also analyzed the association of glycemic control and use of metformin with recurrence-free and progression-free survivals. Diabetes mellitus patients showed decreased recurrence-free survival (hazard ratio 1.42; 95% confidence interval 1.1–1.9; P = 0.021) and progression-free survival (hazard ratio 1.79; 95% confidence interval 1.1–2.8; P = 0.013). Diabetes mellitus patients with a HbA1c ≥ 7.0% demonstrated a higher rate of progression (P = 0.026). Kaplan-Meier analysis showed that progression-free survival rate was associated with poor baseline glycemic control (P = 0.026) and post-operative glycemic control (P = 0.025). However, use of metformin had no impact on the recurrence (P = 1.00) and progression (P = 0.282). In conclusion, poor baseline and post-operative glycemic control was related with shorter progression-free survival of patients with non-muscle invasive bladder cancer. Use of metformin had no impact on the recurrence and progression. Therefore, tight glycemic control and close follow-up for bladder tumor may be beneficial in patients with poor glycemic control. PMID:27510392

  15. Cooperation and the common good

    PubMed Central

    Johnstone, Rufus A.; Rodrigues, António M. M.

    2016-01-01

    In this paper, we draw the attention of biologists to a result from the economic literature, which suggests that when individuals are engaged in a communal activity of benefit to all, selection may favour cooperative sharing of resources even among non-relatives. Provided that group members all invest some resources in the public good, they should refrain from conflict over the division of these resources. The reason is that, given diminishing returns on investment in public and private goods, claiming (or ceding) a greater share of total resources only leads to the actor (or its competitors) investing more in the public good, such that the marginal costs and benefits of investment remain in balance. This cancels out any individual benefits of resource competition. We illustrate how this idea may be applied in the context of biparental care, using a sequential game in which parents first compete with one another over resources, and then choose how to allocate the resources they each obtain to care of their joint young (public good) versus their own survival and future reproductive success (private good). We show that when the two parents both invest in care to some extent, they should refrain from any conflict over the division of resources. The same effect can also support asymmetric outcomes in which one parent competes for resources and invests in care, whereas the other does not invest but refrains from competition. The fact that the caring parent gains higher fitness pay-offs at these equilibria suggests that abandoning a partner is not always to the latter's detriment, when the potential for resource competition is taken into account, but may instead be of benefit to the ‘abandoned’ mate. PMID:26729926

  16. Peer Support Training Improved the Glycemic Control, Insulin Management, and Diabetic Behaviors of Patients with Type 2 Diabetes in Rural Communities of Central China: A Randomized Controlled Trial

    PubMed Central

    Deng, Kaiqin; Ren, Yanlei; Luo, Zhongmei; Du, Kun; Zhang, Xiaoqin; Zhang, Qiong

    2016-01-01

    Background The efficacy of peer support in Chinese diabetes patients is still uncertain. The purpose of this study was to observe the effects of a peer support program on the outcomes of patients with type 2 diabetes who received community-based insulin therapy in rural communities of central China. Material/Methods Two hundred and eight eligible patients with type 2 diabetes were randomly assigned into the traditional training group (control group, n=111) and peer support intervention group (peer group, n=97) between June 2013 and January 2014 in 2 rural communities of Jingzhou area, China. Both groups received 3-month traditional training, followed by another 4-month traditional training or peer support training, respectively. At baseline and 7 months after treatment, the blood glycemic level was evaluated by biochemical detection. Capacities of self-management and knowledge related to insulin usage were assessed by questionnaire survey. Results Ninety-seven and ninety patients completed this study in the control group and peer group, respectively. There was no significant difference in age, gender, diabetes duration, insulin usage time, and complications between the 2 groups at baseline (P>0.05). Compared with the control group, peer group patients achieved a more significant decrease in blood glycosylated hemoglobin levels (P<0.05), increase in knowledge related to insulin usage, and increase of diabetes self-management ability (P<0.05). Conclusions Peer support intervention effectively improves outcomes of patients with type 2 diabetes in rural communities of central China. PMID:26808489

  17. Weighing the evidence of low glycemic index dietary intervention for the management of gestational diabetes mellitus: an Asian perspective.

    PubMed

    Mohd Yusof, Barakatun-Nisak; Firouzi, Somayyeh; Mohd Shariff, Zalilah; Mustafa, Norlaila; Mohamed Ismail, Nor Azlin; Kamaruddin, Nor Azmi

    2014-03-01

    This review aims to evaluate the effectiveness of low glycemic index (GI) dietary intervention for the treatment of gestational diabetes mellitus (GDM), specifically from the Asian perspective. A systematic review of the literature using multiple databases without time restriction was conducted. Three studies were retrieved based upon a priori inclusion criteria. While there was a trend towards improvement, no significant differences were observed in overall glycemic control and pregnancy outcomes in GDM women. However, a tendency for lower birth weight and birth centile if the intervention began earlier was noted. Low GI diets were well accepted and had identical macro-micronutrient compositions as the control diets. However, due to genetic, environment and especially food pattern discrepancies between Western countries and Asians, these results may not be contributed to Asian context. Clearly, there are limited studies focusing on the effect of low GI dietary intervention in women with GDM, particularly in Asia.

  18. Large-scale association analyses identify new loci influencing glycemic traits and provide insight into the underlying biological pathways.

    PubMed

    Scott, Robert A; Lagou, Vasiliki; Welch, Ryan P; Wheeler, Eleanor; Montasser, May E; Luan, Jian'an; Mägi, Reedik; Strawbridge, Rona J; Rehnberg, Emil; Gustafsson, Stefan; Kanoni, Stavroula; Rasmussen-Torvik, Laura J; Yengo, Loïc; Lecoeur, Cecile; Shungin, Dmitry; Sanna, Serena; Sidore, Carlo; Johnson, Paul C D; Jukema, J Wouter; Johnson, Toby; Mahajan, Anubha; Verweij, Niek; Thorleifsson, Gudmar; Hottenga, Jouke-Jan; Shah, Sonia; Smith, Albert V; Sennblad, Bengt; Gieger, Christian; Salo, Perttu; Perola, Markus; Timpson, Nicholas J; Evans, David M; Pourcain, Beate St; Wu, Ying; Andrews, Jeanette S; Hui, Jennie; Bielak, Lawrence F; Zhao, Wei; Horikoshi, Momoko; Navarro, Pau; Isaacs, Aaron; O'Connell, Jeffrey R; Stirrups, Kathleen; Vitart, Veronique; Hayward, Caroline; Esko, Tõnu; Mihailov, Evelin; Fraser, Ross M; Fall, Tove; Voight, Benjamin F; Raychaudhuri, Soumya; Chen, Han; Lindgren, Cecilia M; Morris, Andrew P; Rayner, Nigel W; Robertson, Neil; Rybin, Denis; Liu, Ching-Ti; Beckmann, Jacques S; Willems, Sara M; Chines, Peter S; Jackson, Anne U; Kang, Hyun Min; Stringham, Heather M; Song, Kijoung; Tanaka, Toshiko; Peden, John F; Goel, Anuj; Hicks, Andrew A; An, Ping; Müller-Nurasyid, Martina; Franco-Cereceda, Anders; Folkersen, Lasse; Marullo, Letizia; Jansen, Hanneke; Oldehinkel, Albertine J; Bruinenberg, Marcel; Pankow, James S; North, Kari E; Forouhi, Nita G; Loos, Ruth J F; Edkins, Sarah; Varga, Tibor V; Hallmans, Göran; Oksa, Heikki; Antonella, Mulas; Nagaraja, Ramaiah; Trompet, Stella; Ford, Ian; Bakker, Stephan J L; Kong, Augustine; Kumari, Meena; Gigante, Bruna; Herder, Christian; Munroe, Patricia B; Caulfield, Mark; Antti, Jula; Mangino, Massimo; Small, Kerrin; Miljkovic, Iva; Liu, Yongmei; Atalay, Mustafa; Kiess, Wieland; James, Alan L; Rivadeneira, Fernando; Uitterlinden, Andre G; Palmer, Colin N A; Doney, Alex S F; Willemsen, Gonneke; Smit, Johannes H; Campbell, Susan; Polasek, Ozren; Bonnycastle, Lori L; Hercberg, Serge; Dimitriou, Maria; Bolton, Jennifer L; Fowkes, Gerard R; Kovacs, Peter; Lindström, Jaana; Zemunik, Tatijana; Bandinelli, Stefania; Wild, Sarah H; Basart, Hanneke V; Rathmann, Wolfgang; Grallert, Harald; Maerz, Winfried; Kleber, Marcus E; Boehm, Bernhard O; Peters, Annette; Pramstaller, Peter P; Province, Michael A; Borecki, Ingrid B; Hastie, Nicholas D; Rudan, Igor; Campbell, Harry; Watkins, Hugh; Farrall, Martin; Stumvoll, Michael; Ferrucci, Luigi; Waterworth, Dawn M; Bergman, Richard N; Collins, Francis S; Tuomilehto, Jaakko; Watanabe, Richard M; de Geus, Eco J C; Penninx, Brenda W; Hofman, Albert; Oostra, Ben A; Psaty, Bruce M; Vollenweider, Peter; Wilson, James F; Wright, Alan F; Hovingh, G Kees; Metspalu, Andres; Uusitupa, Matti; Magnusson, Patrik K E; Kyvik, Kirsten O; Kaprio, Jaakko; Price, Jackie F; Dedoussis, George V; Deloukas, Panos; Meneton, Pierre; Lind, Lars; Boehnke, Michael; Shuldiner, Alan R; van Duijn, Cornelia M; Morris, Andrew D; Toenjes, Anke; Peyser, Patricia A; Beilby, John P; Körner, Antje; Kuusisto, Johanna; Laakso, Markku; Bornstein, Stefan R; Schwarz, Peter E H; Lakka, Timo A; Rauramaa, Rainer; Adair, Linda S; Smith, George Davey; Spector, Tim D; Illig, Thomas; de Faire, Ulf; Hamsten, Anders; Gudnason, Vilmundur; Kivimaki, Mika; Hingorani, Aroon; Keinanen-Kiukaanniemi, Sirkka M; Saaristo, Timo E; Boomsma, Dorret I; Stefansson, Kari; van der Harst, Pim; Dupuis, Josée; Pedersen, Nancy L; Sattar, Naveed; Harris, Tamara B; Cucca, Francesco; Ripatti, Samuli; Salomaa, Veikko; Mohlke, Karen L; Balkau, Beverley; Froguel, Philippe; Pouta, Anneli; Jarvelin, Marjo-Riitta; Wareham, Nicholas J; Bouatia-Naji, Nabila; McCarthy, Mark I; Franks, Paul W; Meigs, James B; Teslovich, Tanya M; Florez, Jose C; Langenberg, Claudia; Ingelsson, Erik; Prokopenko, Inga; Barroso, Inês

    2012-09-01

    Through genome-wide association meta-analyses of up to 133,010 individuals of European ancestry without diabetes, including individuals newly genotyped using the Metabochip, we have increased the number of confirmed loci influencing glycemic traits to 53, of which 33 also increase type 2 diabetes risk (q < 0.05). Loci influencing fasting insulin concentration showed association with lipid levels and fat distribution, suggesting impact on insulin resistance. Gene-based analyses identified further biologically plausible loci, suggesting that additional loci beyond those reaching genome-wide significance are likely to represent real associations. This conclusion is supported by an excess of directionally consistent and nominally significant signals between discovery and follow-up studies. Functional analysis of these newly discovered loci will further improve our understanding of glycemic control.

  19. Large-scale association analyses identify new loci influencing glycemic traits and provide insight into the underlying biological pathways

    PubMed Central

    Scott, Robert A; Lagou, Vasiliki; Welch, Ryan P; Wheeler, Eleanor; Montasser, May E; Luan, Jian’an; Mägi, Reedik; Strawbridge, Rona J; Rehnberg, Emil; Gustafsson, Stefan; Kanoni, Stavroula; Rasmussen-Torvik, Laura J; Yengo, Loïc; Lecoeur, Cecile; Shungin, Dmitry; Sanna, Serena; Sidore, Carlo; Johnson, Paul C D; Jukema, J Wouter; Johnson, Toby; Mahajan, Anubha; Verweij, Niek; Thorleifsson, Gudmar; Hottenga, Jouke-Jan; Shah, Sonia; Smith, Albert V; Sennblad, Bengt; Gieger, Christian; Salo, Perttu; Perola, Markus; Timpson, Nicholas J; Evans, David M; Pourcain, Beate St; Wu, Ying; Andrews, Jeanette S; Hui, Jennie; Bielak, Lawrence F; Zhao, Wei; Horikoshi, Momoko; Navarro, Pau; Isaacs, Aaron; O’Connell, Jeffrey R; Stirrups, Kathleen; Vitart, Veronique; Hayward, Caroline; Esko, Tönu; Mihailov, Evelin; Fraser, Ross M; Fall, Tove; Voight, Benjamin F; Raychaudhuri, Soumya; Chen, Han; Lindgren, Cecilia M; Morris, Andrew P; Rayner, Nigel W; Robertson, Neil; Rybin, Denis; Liu, Ching-Ti; Beckmann, Jacques S; Willems, Sara M; Chines, Peter S; Jackson, Anne U; Kang, Hyun Min; Stringham, Heather M; Song, Kijoung; Tanaka, Toshiko; Peden, John F; Goel, Anuj; Hicks, Andrew A; An, Ping; Müller-Nurasyid, Martina; Franco-Cereceda, Anders; Folkersen, Lasse; Marullo, Letizia; Jansen, Hanneke; Oldehinkel, Albertine J; Bruinenberg, Marcel; Pankow, James S; North, Kari E; Forouhi, Nita G; Loos, Ruth J F; Edkins, Sarah; Varga, Tibor V; Hallmans, Göran; Oksa, Heikki; Antonella, Mulas; Nagaraja, Ramaiah; Trompet, Stella; Ford, Ian; Bakker, Stephan J L; Kong, Augustine; Kumari, Meena; Gigante, Bruna; Herder, Christian; Munroe, Patricia B; Caulfield, Mark; Antti, Jula; Mangino, Massimo; Small, Kerrin; Miljkovic, Iva; Liu, Yongmei; Atalay, Mustafa; Kiess, Wieland; James, Alan L; Rivadeneira, Fernando; Uitterlinden, Andre G; Palmer, Colin N A; Doney, Alex S F; Willemsen, Gonneke; Smit, Johannes H; Campbell, Susan; Polasek, Ozren; Bonnycastle, Lori L; Hercberg, Serge; Dimitriou, Maria; Bolton, Jennifer L; Fowkes, Gerard R; Kovacs, Peter; Lindström, Jaana; Zemunik, Tatijana; Bandinelli, Stefania; Wild, Sarah H; Basart, Hanneke V; Rathmann, Wolfgang; Grallert, Harald; Maerz, Winfried; Kleber, Marcus E; Boehm, Bernhard O; Peters, Annette; Pramstaller, Peter P; Province, Michael A; Borecki, Ingrid B; Hastie, Nicholas D; Rudan, Igor; Campbell, Harry; Watkins, Hugh; Farrall, Martin; Stumvoll, Michael; Ferrucci, Luigi; Waterworth, Dawn M; Bergman, Richard N; Collins, Francis S; Tuomilehto, Jaakko; Watanabe, Richard M; de Geus, Eco J C; Penninx, Brenda W; Hofman, Albert; Oostra, Ben A; Psaty, Bruce M; Vollenweider, Peter; Wilson, James F; Wright, Alan F; Hovingh, G Kees; Metspalu, Andres; Uusitupa, Matti; Magnusson, Patrik K E; Kyvik, Kirsten O; Kaprio, Jaakko; Price, Jackie F; Dedoussis, George V; Deloukas, Panos; Meneton, Pierre; Lind, Lars; Boehnke, Michael; Shuldiner, Alan R; van Duijn, Cornelia M; Morris, Andrew D; Toenjes, Anke; Peyser, Patricia A; Beilby, John P; Körner, Antje; Kuusisto, Johanna; Laakso, Markku; Bornstein, Stefan R; Schwarz, Peter E H; Lakka, Timo A; Rauramaa, Rainer; Adair, Linda S; Smith, George Davey; Spector, Tim D; Illig, Thomas; de Faire, Ulf; Hamsten, Anders; Gudnason, Vilmundur; Kivimaki, Mika; Hingorani, Aroon; Keinanen-Kiukaanniemi, Sirkka M; Saaristo, Timo E; Boomsma, Dorret I; Stefansson, Kari; van der Harst, Pim; Dupuis, Josée; Pedersen, Nancy L; Sattar, Naveed; Harris, Tamara B; Cucca, Francesco; Ripatti, Samuli; Salomaa, Veikko; Mohlke, Karen L; Balkau, Beverley; Froguel, Philippe; Pouta, Anneli; Jarvelin, Marjo-Riitta; Wareham, Nicholas J; Bouatia-Naji, Nabila; McCarthy, Mark I; Franks, Paul W; Meigs, James B; Teslovich, Tanya M; Florez, Jose C; Langenberg, Claudia; Ingelsson, Erik; Prokopenko, Inga; Barroso, Inês

    2012-01-01

    Through genome-wide association meta-analyses of up to 133,010 individuals of European ancestry without diabetes, including individuals newly genotyped using the Metabochip, we have raised the number of confirmed loci influencing glycemic traits to 53, of which 33 also increase type 2 diabetes risk (q < 0.05). Loci influencing fasting insulin showed association with lipid levels and fat distribution, suggesting impact on insulin resistance. Gene-based analyses identified further biologically plausible loci, suggesting that additional loci beyond those reaching genome-wide significance are likely to represent real associations. This conclusion is supported by an excess of directionally consistent and nominally significant signals between discovery and follow-up studies. Functional follow-up of these newly discovered loci will further improve our understanding of glycemic control. PMID:22885924

  20. Good Boys Are Problems Too!

    ERIC Educational Resources Information Center

    Warren, Simon

    2003-01-01

    The "problem" of boys' achievement in the United Kingdom has emerged as part of a policy response to a crisis in the post-war social settlement. Post-Fordism has become the dominant meta-policy of education reform in the United Kingdom, constituting both policy problems and solutions as gender-neutral. However, the economic and political…

  1. Are Standards Preventing Good Teaching?

    ERIC Educational Resources Information Center

    Berube, Clair T.

    2004-01-01

    The National Standards movement seeks to raise the quality of the American educational system. According to one of its chief architects, Diane Ravitch (2000), national standards give clear expectations for students, teachers, parents, colleges, and employers that will result in improved student achievement. Forty-nine of the fifty states (save…

  2. Switch for Good Community Program

    SciTech Connect

    Crawford, Tabitha; Amran, Martha

    2013-11-19

    Switch4Good is an energy-savings program that helps residents reduce consumption from behavior changes; it was co-developed by Balfour Beatty Military Housing Management (BB) and WattzOn in Phase I of this grant. The program was offered at 11 Navy bases. Three customer engagement strategies were evaluated, and it was found that Digital Nudges (a combination of monthly consumption statements with frequent messaging via text or email) was most cost-effective.

  3. Defective production of interleukin-1 beta in patients with type 2 diabetes mellitus: Restoration by proper glycemic control.

    PubMed

    Kousathana, Foteini; Georgitsi, Marianna; Lambadiari, Vaia; Giamarellos-Bourboulis, Evangelos J; Dimitriadis, George; Mouktaroudi, Maria

    2017-02-01

    The underlying immune defect of susceptibility in diabetes mellitus type 2 to infections remains unknown. The qualitative changes in cytokine biosynthesis by circulating mononuclear cells (PBMCs) and its modulation by glycemic control were investigated. PBMCs were isolated from 39 patients and 25 controls. They were stimulated with purified ligands and heat-killed bacteria in the absence/presence of glucose and NLPR3 inflammasome ligands. Experiments were repeated after 3 and 6months. Cytokine production was measured in cell supernatants; pro-interleukin(IL)-1 β was measured in cell lysates. Gene expression of IL-1β and activity of caspase-1 were measured as well. Adequate release of interleukin (IL)-1β was found in 42.9% of patients compared to 90% of controls (p: 0.0001). This was related with down-regulation of the NLRP3 inflammasome since gene expression of IL-1β remained unaltered whereas both the ratio of IL-1β to the intracellular pro-IL-1β and the activity of caspase-1 was lower in patients than controls. Addition of glucose did not modify defective IL-1β production. IL-6 production was increased after stimulation with Pam3Cys, phytohemagglutinin and C. albicans. After proper glycemic control, release of IL-1β was increased and of IL-6 decreased; cells of patients with improved glycemic control responded better to LPS stimulation under increased concentrations of glucose. It is concluded that diabetes type 2 is characterized by defective production of IL-1β from circulating monocytes due to impaired activation of the NLRP3 inflammasome and increased production of the anti-inflammatory IL-6. Defects are restored with proper glycemic control.

  4. Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort.

    PubMed

    Pop-Busui, Rodica; Lu, Jiang; Lopes, Neuza; Jones, Teresa L Z

    2009-03-01

    We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15-2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.

  5. Glycemic Control in the Burn Intensive Care Unit: Focus on the Role of Anemia in Glucose Measurement

    DTIC Science & Technology

    2009-11-01

    1319 Glycemic Control in the Burn Intensive Care Unit: Focus on the Role of Anemia in Glucose Measurement MAJ Elizabeth A. Mann, R.N., M.S...outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin...resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred

  6. Pure Red Cell Aplasia Associated with Good Syndrome

    PubMed Central

    Okui, Masayuki; Yamamichi, Takashi; Asakawa, Ayaka; Harada, Masahiko; Horio, Hirotoshi

    2017-01-01

    Pure red cell aplasia (PRCA) and hypogammaglobulinemia are paraneoplastic syndromes that are rarer than myasthenia gravis in patients with thymoma. Good syndrome coexisting with PRCA is an extremely rare pathology. We report the case of a 50-year-old man with thymoma and PRCA associated with Good syndrome who achieved complete PRCA remission after thymectomy and postoperative immunosuppressive therapy, and provide a review of the pertinent literature. PMID:28382272

  7. In vitro digestibility and glycemic response of potato starch is related to granule size and degree of gelatinization.

    PubMed

    Parada, Javier; Aguilera, José M

    2009-01-01

    Starch granule microstructure affects the digestion of starch and its nutritional impact; however, the exact relationship between both factors is not clear. This study reports quantitative relationships between granule size (length and polygonal area), degree of gelatinization (DG), in vitro digestibility (by enzymatic methods), and glycemic response of potato starch granules gelatinized to various extents by heating at several constant temperatures in the range of 55 to 65 degrees C. DG measured by differential scanning calorimetry was closely related with heating temperature (R(2)= 0.997), size parameters of granules (measured by image analysis), in vitro digestion, and in vivo glycemic response (R(2) of adjusted models > 0.9); shape parameters of granules (measured by image analysis) were not related with DG. Results demonstrate that DG of starch strongly affects its digestibility in vitro, and may influence the postpandrial glycemic response. Future studies should be performed to investigate the effect of potato starch gelatinization on the nutritional impact at other temperatures and in more complex matrices.

  8. Long-term effects of provided low and high glycemic load low energy diets on mood and cognition.

    PubMed

    Cheatham, Rachel A; Roberts, Susan B; Das, Sai Krupa; Gilhooly, Cheryl H; Golden, Julie K; Hyatt, Raymond; Lerner, Debra; Saltzman, Edward; Lieberman, Harris R

    2009-09-07

    Energy-restricted low glycemic load diets are being used increasingly for weight loss. However, the long-term effects of such regimens on mood and cognitive performance are not known. We assessed the effects of low glycemic load (LG) and high glycemic load (HG) energy-restricted diets on mood and cognitive performance during 6 months of a randomized controlled trial when all food was provided. Subjects were 42 healthy overweight adults (age 35+/-5 years; BMI 27.8+/-1.6 kg/m(2)) with a mean weight loss of 8.7+/-5.0% that did not differ significantly by diet randomization. Mood was assessed by using the Profile of Mood States (POMS) questionnaire. Cognitive performance was assessed by using computerized tests of simple reaction time, vigilance, learning, short-term memory and attention, and language-based logical reasoning. Worsening mood outcome over time was observed in the HG diet group compared to the LG for the depression subscale of POMS (p=0.009 after including hunger as a covariate). There was no significant change over time in any cognitive performance values. These findings suggest a negative effect of an HG weight loss diet on sub-clinical depression but, in contrast to a previous suggestion, provide no support for differential effects of LG versus HD diets on cognitive performance.

  9. Tight glycemic control using an artificial endocrine pancreas may play an important role in preventing infection after pancreatic resection.

    PubMed

    Hanazaki, Kazuhiro

    2012-08-07

    It is well known that perioperative hyperglycemia is the main cause of infectious complications after surgery. To improve perioperative glycemic control, we wish to highlight and comment on an interesting paper published recently by the Annals of Surgery entitled: "Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy (PD)" by Eshuis et al. The authors concluded that early postoperative glucose levels more than 140 mg/dL was significantly associated with complications after PD. Since we recommend that perioperative tight glycemic control (TGC) is an effective method to prevent postoperative complications including surgical site infection after distal, proximal, and total pancreatic resection, we support strongly this conclusion drawn in this article. However, if early postoperative glucose control in patients undergoing PD was administrated by conventional method such as sliding scale approach as described in this article, it is difficult to maintain TGC. Therefore, we introduce a novel perioperative glycemic control using an artificial endocrine pancreas against pancreatogenic diabetes after pancreatic resection including PD.

  10. Manipulation of glycemic response with isomaltulose in a milk-based drink does not affect cognitive performance in healthy adults.

    PubMed

    Dye, Louise; Gilsenan, Mary B; Quadt, Frits; Martens, Vanessa E G; Bot, Arjen; Lasikiewicz, Nicola; Camidge, Diana; Croden, Fiona; Lawton, Clare

    2010-04-01

    Previous research suggests that glucoregulation and nutrient interventions, which alter circulating glucose, impact cognitive function. To examine the effect of modulating glycemic response using isomaltulose on cognitive function 24 healthy male adult participants consumed energy and macronutrient-matched milk-based drinks containing 50 g isomaltulose, 50 g sucrose or a water control in a counterbalanced within-subject design. Interstitial glucose was measured continuously in 12 subjects and all provided 9 capillary measures on each test day. A 30-min cognitive test battery was administered before and twice (+35 and +115 min) after drink ingestion. Immediate, delayed, recognition, verbal and working memory, and psychomotor performance were assessed. Glycemic profiles induced by the drinks differed significantly during the first but not the second post-drink test battery. Neither administration of the sucrose nor isomaltulose drinks produced consistent effects on verbal or working memory, or psychomotor performance. This study used isomaltulose as an investigative tool to lower glycemic response. Importantly, it demonstrates a lack of effect of modulating glucose on cognitive performance based on reliable, continuously measured glycemia. It refutes the hypothesis that glycemia is associated with cognitive performance and questions the suggestion that isomaltulose has an effect on cognitive performance.

  11. Relationship between Processing Method and the Glycemic Indices of Ten Sweet Potato (Ipomoea batatas) Cultivars Commonly Consumed in Jamaica.

    PubMed

    Bahado-Singh, Perceval S; Riley, Cliff K; Wheatley, Andrew O; Lowe, Henry I C

    2011-01-01

    This study investigated the effect of different traditional cooking methods on glycemic index (GI) and glycemic response of ten Sweet potato (Ipomoea batatas) cultivars commonly eaten in Jamaica. Matured tubers were cooked by roasting, baking, frying, or boiling then immediately consumed by the ten nondiabetic test subjects (5 males and 5 females; mean age of 27 ± 2 years). The GI varied between 41 ± 5-93 ± 5 for the tubers studied. Samples prepared by boiling had the lowest GI (41 ± 5-50 ± 3), while those processed by baking (82 ± 3-94 ± 3) and roasting (79 ± 4-93 ± 2) had the highest GI values. The study indicates that the glycemic index of Jamaican sweet potatoes varies significantly with the method of preparation and to a lesser extent on intravarietal differences. Consumption of boiled sweet potatoes could minimize postprandial blood glucose spikes and therefore, may prove to be more efficacious in the management of type 2 diabetes mellitus.

  12. Effects of prebiotic inulin-type fructans on structure, quality, sensory acceptance and glycemic response of gluten-free breads.

    PubMed

    Capriles, Vanessa D; Arêas, José A G

    2013-01-01

    The effect of adding increasing levels of prebiotic inulin-type fructans (ITFs) (0, 4, 8, 10 and 12%) on the sensory and nutritional quality of gluten-free bread (GFB) was assessed. ITFs can provide structure and gas retention during baking, thus improving GFB quality by yielding better specific volume, softer crumb, improved crust and crumb browning with enhanced sensory acceptance. During baking, approximately one-third of the ITFs was lost. The addition of 12% ITFs to the basic formulation is required in order to obtain GFB enriched with 8% ITFs (4 g of fructans per 50 g bread serving size), levels that can provide health benefits. 12% ITFs-addition level decreased GFB glycemic index (from 71 to 48) and glycemic load (from 12 to 8). Prebiotic ITFs are a promising improver for GFB that can provide nutritional (11% dietary fiber content, low glycemic response) and functional benefits to patients with celiac disease, since ITFs are prebiotic ingredients that can also increase calcium absorption.

  13. Preexercise high and low glycemic index meals and cycling performance in untrained females: randomized, cross-over trial of efficacy.

    PubMed

    Moore, Laura; Szpalek, Hannah M; McNaughton, Lars R

    2013-01-01

    This study examined the effects of high and low glycemic index (GI) carbohydrate preexercise meals (2.5 g CHO/kg body mass) on cycle performance in untrained females. Ten females, cycled at 60% VO(2 max) to exhaustion, on two occasions. After fasting, subjects ate an isocaloric, high glycemic index (HGI)/low glycemic index (LGI) meal in a random order. Blood samples were taken at rest/postprandial/during and after exercise and blood glucose and lactate were measured. Ingestion of the LGI meal resulted in a performance time of 67.4 ± 8.4 min versus an HGI time of 48.9 ± 10.0 min (p = 0.02). Fifteen minutes after the HGI meal there was a significant increase (p < 0.001) in glucose levels, which was not seen in the LGI trial. Twenty minutes into the HGI exercise trial, there was a large decline in blood glucose concentration beyond resting levels. Based on this work, we found that untrained female participants should utilize LGI meals preexercise for endurance activities rather than HGI meals.

  14. SALT and Spelling Achievement.

    ERIC Educational Resources Information Center

    Nelson, Joan

    A study investigated the effects of suggestopedic accelerative learning and teaching (SALT) on the spelling achievement, attitudes toward school, and memory skills of fourth-grade students. Subjects were 20 male and 28 female students from two self-contained classrooms at Kennedy Elementary School in Rexburg, Idaho. The control classroom and the…

  15. Iowa Women of Achievement.

    ERIC Educational Resources Information Center

    Ohrn, Deborah Gore, Ed.

    1993-01-01

    This issue of the Goldfinch highlights some of Iowa's 20th century women of achievement. These women have devoted their lives to working for human rights, education, equality, and individual rights. They come from the worlds of politics, art, music, education, sports, business, entertainment, and social work. They represent Native Americans,…

  16. Schools Achieving Gender Equity.

    ERIC Educational Resources Information Center

    Revis, Emma

    This guide is designed to assist teachers presenting the Schools Achieving Gender Equity (SAGE) curriculum for vocational education students, which was developed to align gender equity concepts with the Kentucky Education Reform Act (KERA). Included in the guide are lesson plans for classes on the following topics: legal issues of gender equity,…

  17. Achieving Peace through Education.

    ERIC Educational Resources Information Center

    Clarken, Rodney H.

    While it is generally agreed that peace is desirable, there are barriers to achieving a peaceful world. These barriers are classified into three major areas: (1) an erroneous view of human nature; (2) injustice; and (3) fear of world unity. In a discussion of these barriers, it is noted that although the consciousness and conscience of the world…

  18. Explorations in achievement motivation

    NASA Technical Reports Server (NTRS)

    Helmreich, Robert L.

    1982-01-01

    Recent research on the nature of achievement motivation is reviewed. A three-factor model of intrinsic motives is presented and related to various criteria of performance, job satisfaction and leisure activities. The relationships between intrinsic and extrinsic motives are discussed. Needed areas for future research are described.

  19. Increasing Male Academic Achievement

    ERIC Educational Resources Information Center

    Jackson, Barbara Talbert

    2008-01-01

    The No Child Left Behind legislation has brought greater attention to the academic performance of American youth. Its emphasis on student achievement requires a closer analysis of assessment data by school districts. To address the findings, educators must seek strategies to remedy failing results. In a mid-Atlantic district of the Unites States,…

  20. Appraising Reading Achievement.

    ERIC Educational Resources Information Center

    Ediger, Marlow

    To determine quality sequence in pupil progress, evaluation approaches need to be used which guide the teacher to assist learners to attain optimally. Teachers must use a variety of procedures to appraise student achievement in reading, because no one approach is adequate. Appraisal approaches might include: (1) observation and subsequent…

  1. Cognitive Processes and Achievement.

    ERIC Educational Resources Information Center

    Hunt, Dennis; Randhawa, Bikkar S.

    For a group of 165 fourth- and fifth-grade students, four achievement test scores were correlated with success on nine tests designed to measure three cognitive functions: sustained attention, successive processing, and simultaneous processing. This experiment was designed in accordance with Luria's model of the three functional units of the…

  2. Graders' Mathematics Achievement

    ERIC Educational Resources Information Center

    Bond, John B.; Ellis, Arthur K.

    2013-01-01

    The purpose of this experimental study was to investigate the effects of metacognitive reflective assessment instruction on student achievement in mathematics. The study compared the performance of 141 students who practiced reflective assessment strategies with students who did not. A posttest-only control group design was employed, and results…

  3. Achieving All Our Ambitions

    ERIC Educational Resources Information Center

    Hartley, Tricia

    2009-01-01

    National learning and skills policy aims both to build economic prosperity and to achieve social justice. Participation in higher education (HE) has the potential to contribute substantially to both aims. That is why the Campaign for Learning has supported the ambition to increase the proportion of the working-age population with a Level 4…

  4. Improving Educational Achievement.

    ERIC Educational Resources Information Center

    New York University Education Quarterly, 1979

    1979-01-01

    This is a slightly abridged version of the report of the National Academy of Education panel, convened at the request of HEW Secretary Joseph Califano and Assistant Secretary for Education Mary F. Berry, to study recent declines in student achievement and methods of educational improvement. (SJL)

  5. The Achievement Club

    ERIC Educational Resources Information Center

    Rogers, Ibram

    2009-01-01

    When Gabrielle Carpenter became a guidance counselor in Northern Virginia nine years ago, she focused on the academic achievement gap and furiously tried to close it. At first, she was compelled by tremendous professional interest. However, after seeing her son lose his zeal for school, Carpenter joined forces with other parents to form an…

  6. Achievement in Problem Solving

    ERIC Educational Resources Information Center

    Friebele, David

    2010-01-01

    This Action Research Project is meant to investigate the effects of incorporating research-based instructional strategies into instruction and their subsequent effect on student achievement in the area of problem-solving. The two specific strategies utilized are the integration of manipulatives and increased social interaction on a regular basis.…

  7. Essays on Educational Achievement

    ERIC Educational Resources Information Center

    Ampaabeng, Samuel Kofi

    2013-01-01

    This dissertation examines the determinants of student outcomes--achievement, attainment, occupational choices and earnings--in three different contexts. The first two chapters focus on Ghana while the final chapter focuses on the US state of Massachusetts. In the first chapter, I exploit the incidence of famine and malnutrition that resulted to…

  8. Advancing Student Achievement

    ERIC Educational Resources Information Center

    Walberg, Herbert J.

    2010-01-01

    For the last half century, higher spending and many modern reforms have failed to raise the achievement of students in the United States to the levels of other economically advanced countries. A possible explanation, says Herbert Walberg, is that much current education theory is ill informed about scientific psychology, often drawing on fads and…

  9. NCLB: Achievement Robin Hood?

    ERIC Educational Resources Information Center

    Bracey, Gerald W.

    2008-01-01

    In his "Wall Street Journal" op-ed on the 25th of anniversary of "A Nation At Risk", former assistant secretary of education Chester E. Finn Jr. applauded the report for turning U.S. education away from equality and toward achievement. It was not surprising, then, that in mid-2008, Finn arranged a conference to examine the…

  10. Canagliflozin Slows Progression of Renal Function Decline Independently of Glycemic Effects.

    PubMed

    Heerspink, Hiddo J L; Desai, Mehul; Jardine, Meg; Balis, Dainius; Meininger, Gary; Perkovic, Vlado

    2017-01-01

    Sodium-glucose cotransporter 2 inhibition with canagliflozin decreases HbA1c, body weight, BP, and albuminuria, implying that canagliflozin confers renoprotection. We determined whether canagliflozin decreases albuminuria and reduces renal function decline independently of its glycemic effects in a secondary analysis of a clinical trial in 1450 patients with type 2 diabetes receiving metformin and randomly assigned to either once-daily canagliflozin 100 mg, canagliflozin 300 mg, or glimepiride uptitrated to 6-8 mg. End points were annual change in eGFR and albuminuria over 2 years of follow-up. Glimepiride, canagliflozin 100 mg, and canagliflozin 300 mg groups had eGFR declines of 3.3 ml/min per 1.73 m(2) per year (95% confidence interval [95% CI], 2.8 to 3.8), 0.5 ml/min per 1.73 m(2) per year (95% CI, 0.0 to 1.0), and 0.9 ml/min per 1.73 m(2) per year (95% CI, 0.4 to 1.4), respectively (P<0.01 for each canagliflozin group versus glimepiride). In the subgroup of patients with baseline urinary albumin-to-creatinine ratio ≥30 mg/g, urinary albumin-to-creatinine ratio decreased more with canagliflozin 100 mg (31.7%; 95% CI, 8.6% to 48.9%; P=0.01) or canagliflozin 300 mg (49.3%; 95% CI, 31.9% to 62.2%; P<0.001) than with glimepiride. Patients receiving glimepiride, canagliflozin 100 mg, or canagliflozin 300 mg had reductions in HbA1c of 0.81%, 0.82%, and 0.93%, respectively, at 1 year and 0.55%, 0.65%, and 0.74%, respectively, at 2 years. In conclusion, canagliflozin 100 or 300 mg/d, compared with glimepiride, slowed the progression of renal disease over 2 years in patients with type 2 diabetes, and canagliflozin may confer renoprotective effects independently of its glycemic effects.

  11. Acarbose improves glycemic control and reduces body weight: Subanalysis data of South Asia region.

    PubMed

    Kalra, S; Sahay, R K; Schnell, O; Sheu, W H H; Grzeszczak, W; Watada, H; Soegondo, S; Yamamoto, N; Weng, J; Rathod, R

    2013-10-01

    Alpha-glucosidase inhibitors (AGIs) are widely used especially in Asian countries as a treatment option for type 2 diabetes patients with high postprandial glycaemia. However, data from South Asia region is very limited. In order to examine the effect of AGI in real-life setting, 10 PMS/NIS from all over the world from the launch of acarbose to date were pooled in one database and exploratory analysis was performed for glycemic parameters and weight. In total 62,905 patients were pooled from 21 countries and regions. Mean follow up (± SD) was 12.2 ± 4.8 weeks (range 0.1-108.9). From South Asia region (India and Pakistan), 8,738 Asian patients were enrolled. Mean PPG decreased from 240.0 and 261.1 mg/dl at baseline by 70.26 ± 65.10 and 82.96 ± 56.59 mg/dl at the last visit in total and South Asian populations, respectively (n = 53,883; n = 7,991, P < 0.0001 for both). Mean FPG decreased from 171.6 and 176.5 mg/dl at baseline by 38.48 ± 47.83 and 49.59 ± 41.41 mg/dl at the last visit in total and South Asian populations, respectively (n = 56,672; n = 7,837, P < 0.0001 for both). Mean HbA1c decreased from 8.4 and 8.4% at baseline by 1.11 ± 1.31% and 0.91 ± 0.93% at the last visit in total and South Asian populations, respectively (n = 38,843; n = 2,343, P < 0.0001 for both). Mean relative reduction of body weight (BW) was 1.40 ± 3.28% and 1.10 ± 3.39% at the last visit for mean baseline BW 73.6 and 74.2 kg in total and South Asian populations, respectively (n = 54,760; n = 7,718, P < 0.0001 for both). Consistent with RCT meta-analyses, post-hoc analysis of real-life data showed acarbose treatment improved glycaemic control and reduced the BW. Acarbose treatment in real life setting showed significant reductions in all glycemic parameters and BW in Asian patients from South Asia region.

  12. Adding concentrated solar power plants to wind farms to achieve a good utility electrical load match

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Texas has the greatest installed wind turbine capacity of any state in the United States, the percentage of wind capacity approaches 10% of the utilities capacity (in 2010 the total wind generated capacity in Texas was 8%). It is becomimg increasingly difficult for the utility to balance the elec...

  13. "Cheating" as Good Pedagogy: Bilingual Teachers Defying English-Only to Foster Student Achievement

    ERIC Educational Resources Information Center

    Reyes, Reynaldo, III

    2008-01-01

    "Cheating" is a form of resistance in pedagogy for bilingual educators. Bilingual educators "cheat" in classes where English as the only language of instruction is strictly imposed by school or district officials, but these teachers "cheat" by using the native language of their English language learners because they know they must. But, for many…

  14. From Good to Great: Designing a PDS Partnership that Increases Student Achievement by Preparing Better Educators

    ERIC Educational Resources Information Center

    Hill, Gloria; Lee, Valarie; Leftwich, Stacey

    2013-01-01

    The College of Education at Rowan University has held a long and continuing commitment to the tenets of the Professional Development School (PDS) movement. Two schools in the Rowan's network--Holly Glen Elementary and Edward R. Johnstone Elementary Schools--have a long history of exceptional commitment to continuous growth by all P-12 faculty and…

  15. Good News for New Orleans: Early Evidence Shows Reforms Lifting Student Achievement

    ERIC Educational Resources Information Center

    Harris, Douglas N.

    2015-01-01

    What happened to the New Orleans public schools following the tragic levee breeches after Hurricane Katrina is truly unprecedented. Within the span of one year, all public-school employees were fired, the teacher contract expired and was not replaced, and most attendance zones were eliminated. The state took control of almost all public schools…

  16. Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching.

    PubMed

    Lunt, Mark

    2014-01-15

    Matching on the propensity score is widely used to estimate the effect of an exposure in observational studies. However, the quality of the matches can be affected by decisions made during the matching process, particularly the order in which subjects are selected for matching and the maximum permitted difference between matched subjects (the "caliper"). This study used simulations to explore the effects of these decisions on both the imbalance of covariates and the closeness of matching, while allowing the numbers of potential matches and strengths of association between the confounding variable and the exposure to vary. It was found that, without a caliper, substantial bias was possible, particularly with a relatively small reservoir of potential matches and strong confounder-exposure association. Use of the recommended caliper reduced the bias considerably, but bias remained if subjects were selected by increasing or decreasing propensity score. A tighter caliper led to greatly reduced bias and closer matches, although some subjects could not be matched. This study suggests that a narrow caliper can improve the performance of propensity score matching. In situations where it is impossible to find appropriate matches for all exposed subjects, it is better to select subjects in order of the best available matches, rather than increasing or decreasing the propensity score.

  17. "A Good Student, Trapped": Urban Minority Males and Constructions of Academic Achievement

    ERIC Educational Resources Information Center

    Anderson, Noel

    2004-01-01

    This article centres on the findings of an interpretive case study conducted at a college preparation program at a prestigious university in a major U.S. city that is grappling with a high attrition of poor and working class African American and Latino young men. The purpose of the study is to examine the underlying assumptions about equity and…

  18. In vitro hydrolytic digestion, glycemic response in dogs, and true metabolizable energy content of soluble corn fibers.

    PubMed

    de Godoy, M R C; Knapp, B K; Parsons, C M; Swanson, K S; Fahey, George C

    2014-06-01

    The objective of this research was to measure in vitro hydrolytic digestion, glycemic and insulinemic responses in dogs, and true ME (TMEn) content of select soluble corn fibers (SCF) in roosters. The first generation (G1) SCF included hydrochloric acid-treated corn syrup (G1-CS-HCl), an SCF with an increased total dietary fiber (TDF) content (G1-SCF-HCl), an SCF that was spray-dried (G1-SCF-SD), and a hydrogenated SCF (G1-SCF-hydrog). The second generation (G2) SCF included those prepared using phosphoric acid catalyzation in both a liquid [G2-SCF-phos (Lq)] and powder [G2-SCF-phos (Pw)] form, and SCF that were prepared using hydrochloric acid catalyzation in both a liquid [G2-SCF-HCl (Lq)] and powder [G2-SCF-HCl (Pw)] form. Also, in the G2 set of samples were SCF prepared using the same method, but in 3 separate batches, all of which contained 70% TDF and 15% sugars. Two were in liquid form [G2-SCF-phos+HCl (Lq1)] and [G2-SCF-phos+HCl (Lq2)], and one in powder form ([G2-SCF-phos+HCl (Pw)]. A lower sugar form (80% TDF and 5% sugar) of SCF was also evaluated (G2-SCF-low sugar). Glucose was the major free sugar and bound monosaccharide in all SCF except for G1-SCF-hydrog that had greater concentrations of sorbitol. All SCF had intermediate to low amounts of monosaccharides released as a result of in vitro hydrolytic digestion, with glucose being the primary sugar component released. The G1-SCF were more digestible in vitro (approximately 50%) compared to G2-SCF (approximately 32%). All SCF had attenuated glycemic responses in adult dogs compared to a maltodextrin control (P < 0.05). The G2-SCF, on average, had lower glycemic responses and TMEn values in roosters than G1-SCF. All SCF had low free sugar concentrations with varying degrees of resistance to digestion, reduced caloric content, and attenuated glycemic and insulinemic responses in adult dogs. These ingredients are potential candidates for inclusion in reduced calorie and low glycemic canine diets.

  19. Markers of beta cell failure predict poor glycemic response to GLP-1 receptor agonist therapy in type 2 diabetes

    PubMed Central

    Jones, Angus G; McDonald, Timothy J; Shields, Beverley M; Hill, Anita V; Hyde, Christopher J; Knight, Bridget A; Hattersley, Andrew T

    2016-01-01

    Objective To assess whether clinical characteristics and simple biomarkers of beta cell failure are associated with individual variation in glycemic response to GLP-1 receptor agonist therapy in patients with type 2 diabetes. Research Design and Methods We prospectively studied 620 participants with type 2 diabetes and HbA1c ≥58mmol/mol (7.5%) commencing GLP-1 receptor agonist therapy as part of their usual diabetes care and assessed response to therapy over 6 months. We assessed the association between baseline clinical measurements associated with beta cell failure and glycemic response (HbA1c change 0 to 6 months, primary outcome) with change in weight (0 to 6 months) as a secondary outcome using linear regression and ANOVA with adjustment for baseline HbA1c and co-treatment change. Results Reduced glycemic response to GLP-1R agonists was associated with longer duration diabetes, insulin co-treatment, lower fasting C-peptide, lower post meal urine C-peptide creatinine ratio and positive GAD or IA2 islet autoantibodies (p≤0.01 for all). Participants with positive autoantibodies or severe insulin deficiency (fasting C-peptide ≤0.25nmol/L) had markedly reduced glycemic response to GLP-1RA therapy (autoantibodies: mean HbA1c change -5.2 vs -15.2 mmol/mol (-0.5 vs -1.4%), p=0.005 C-peptide <0.25nmol/L: mean change -2.1 vs -15.3mmol/mol (-0.2 vs -1.4%), p=0.002). These markers were predominantly present in insulin treated participants and were not associated with weight change. Conclusions Clinical markers of low beta cell function are associated with reduced glycemic response to GLP-1R agonist therapy. C-peptide and islet autoantibodies represent potential biomarkers for the stratification of GLP-1R agonist therapy in insulin treated diabetes. PMID:26242184

  20. Sleep Pattern, Duration and Quality in Relation with Glycemic Control in People with Type 2 Diabetes Mellitus

    PubMed Central

    Gozashti, Mohammad Hossein; Eslami, Nazanin; Radfar, Mohammad Hadi; Pakmanesh, Hamid

    2016-01-01

    Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. A cross-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA). The mean age was 58±11 years and mean HbA1c (%) was 7.8±11 (62±13 mmol/mol). Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114)=5.232, P=0.007, R2=0.084). A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol) decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66%) had a lower HbA1c (7.6±1) compared to others (8.1±1.3) (P=0.04). We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control. PMID:27853334

  1. Effect of Poor Glycemic Control in Newly Diagnosed Patients with Smear-Positive Pulmonary Tuberculosis and Type-2 Diabetes Mellitus

    PubMed Central

    Mahishale, Vinay; Avuthu, Sindhuri; Patil, Bhagyashri; Lolly, Mitchelle; Eti, Ajith; Khan, Sujeer

    2017-01-01

    Background: There is growing evidence that diabetes mellitus (DM) is an important risk factor for tuberculosis (TB). A significant number of DM patients have poor glycemic control. This study was carried out to find the impact of poor glycemic control on newly diagnosed smear-positive pulmonary tuberculosis patients with type-2 diabetes mellitus in a tertiary care hospital. Methods: In a hospital-based prospective study, newly diagnosed smear-positive pulmonary TB with DM patients were classified as poorly controlled diabetes (HBA1C≥7%) and optimal control diabetics (HbA1c<7%). Patients were started on anti-TB treatment and followed for 2 years for severity and treatment outcome. ANOVA was used for numerical variables in the univariable analysis. Logistic regression analysis was used for multivariable analysis of treatment outcome. The significance level was kept at a P≤0.05. Results: A total of 630 individuals who met the inclusion criteria were analyzed; of which 423 patients had poor glycemic control (PGC) and 207 patients had optimal glycemic control (OGC). The average HbA1c was 10±2.6 and 5±1.50 in the PGC and OGC groups, respectively. The mean symptom score was significantly higher in the PGC group compared with patients in the OGC group (4.55±0.80 vs. 2.70±0.82, P<0.001). PGC was associated with more extensive lung disease, lung cavitation, and positive sputum smear at the baseline. In PGC, sputum smears were significantly more likely to remain positive after 2 months of treatment. PGC patients had significantly higher rates of treatment failure (adj. OR 0.72, 95% CI 0.58-0.74, P<0.001) and relapse (adj. OR 2.83, 95% CI 2.60-2.92, P<0.001). Conclusion: Poor glycemic control is associated with an increased risk of advanced and more severe TB disease in the form of lung cavitations, positive sputum smear, and slower smear conversion. It has a profound negative effect on treatment completion, cure, and relapse rates in patients with pulmonary

  2. Faculty achievement tracking tool.

    PubMed

    Pettus, Sarah; Reifschneider, Ellen; Burruss, Nancy

    2009-03-01

    Faculty development and scholarship is an expectation of nurse educators. Accrediting institutions, such as the Commission on Collegiate Nursing Education, the National League for Nursing Accrediting Commission, and the Higher Learning Commission, all have criteria regarding faculty achievement. A faculty achievement tracking tool (FATT) was developed to facilitate documentation of accreditation criteria attainment. Based on criteria from accrediting organizations, the roles that are addressed include scholarship, service, and practice. Definitions and benchmarks for the faculty as an aggregate are included. Undergoing reviews from different accrediting organizations, the FATT has been used once for accreditation of the undergraduate program and once for accreditation of the graduate program. The FATT is easy to use and has become an excellent adjunct for the preparation for accreditation reports. In addition, the FATT may be used for yearly evaluations, advancement, and merit.

  3. Project ACHIEVE final report

    SciTech Connect

    1997-06-13

    Project ACHIEVE was a math/science academic enhancement program aimed at first year high school Hispanic American students. Four high schools -- two in El Paso, Texas and two in Bakersfield, California -- participated in this Department of Energy-funded program during the spring and summer of 1996. Over 50 students, many of whom felt they were facing a nightmare future, were given the opportunity to work closely with personal computers and software, sophisticated calculators, and computer-based laboratories -- an experience which their regular academic curriculum did not provide. Math and science projects, exercises, and experiments were completed that emphasized independent and creative applications of scientific and mathematical theories to real world problems. The most important outcome was the exposure Project ACHIEVE provided to students concerning the college and technical-field career possibilities available to them.

  4. Goode Gym Energy Renovation Project

    SciTech Connect

    Coleman, Andrena

    2014-12-11

    The Ida H. Goode Gymnasium was constructed in 1964 to serve as a focal point for academics, student recreation, and health and wellness activities. This 38,000 SF building contains a gymnasium with a stage, swimming pool, eight classrooms, a weight room, six offices and auxiliary spaces for the athletic programs. The gym is located on a 4-acre greenfield, which is slated for improvement and enhancement to future athletics program at Bennett College. The available funding for this project was used to weatherize the envelope of the gymnasium, installation of a new energy-efficient mechanical system, and a retrofit of the existing lighting systems in the building’s interior. The envelope weatherization was completed without disturbing the building’s historic preservation eligibility. The existing heating system was replaced with a new high efficiency condensing system. The new heating system also includes a new Building Automation System which provides additional monitoring. Proper usage of this system will provide additional energy savings. Most of the existing interior lighting fixtures and bulbs were replaced with new LED and high efficiency T-8 bulbs and fixtures. Occupancy sensors were installed in applicable areas. The Ida Goode Gymnasium should experience high electricity and natural gas savings as well as operational/maintenance efficiency increases. The aesthetics of the building was maintained and the overall safety was improved.

  5. Going public: good scientific conduct.

    PubMed

    Meyer, Gitte; Sandøe, Peter

    2012-06-01

    The paper addresses issues of scientific conduct regarding relations between science and the media, relations between scientists and journalists, and attitudes towards the public at large. In the large and increasing body of literature on scientific conduct and misconduct, these issues seem underexposed as ethical challenges. Consequently, individual scientists here tend to be left alone with problems and dilemmas, with no guidance for good conduct. Ideas are presented about how to make up for this omission. Using a practical, ethical approach, the paper attempts to identify ways scientists might deal with ethical public relations issues, guided by a norm or maxim of openness. Drawing on and rethinking the CUDOS codification of the scientific ethos, as it was worked out by Robert K. Merton in 1942, we propose that this, which is echoed in current codifications of norms for good scientific conduct, contains a tacit maxim of openness which may naturally be extended to cover the public relations of science. Discussing openness as access, accountability, transparency and receptiveness, the argumentation concentrates on the possible prevention of misconduct with respect to, on the one hand, sins of omission-withholding important information from the public-and, on the other hand, abuses of the authority of science in order to gain publicity. Statements from interviews with scientists are used to illustrate how scientists might view the relevance of the issues raised.

  6. Glycemic Response and Fermentation of Crystalline Short Linear α-Glucans from Debranched Waxy Maize Starch.

    PubMed

    Brewer, Lauren R; Weber, Casey; Haub, Mark; Cai, Liming; Shi, Yong-Cheng

    2015-11-04

    The glycemic index (GI) is used to rank foods based on postprandial blood glucose response. GI test requires that 50 g of available carbohydrate be used. Available carbohydrate is often calculated as total carbohydrate minus dietary fiber; yet, AOAC fiber methods do not always include resistant starch (RS). The objective of this study was to examine GI response and fermentation properties of crystalline short-chain α-glucan (CSCA), which has high RS content, but no total dietary fiber (TDF) content as measured by AOAC method 991.43. Using the standard GI method, 10 adults were fed 50 g of waxy maize starch and CSCA, consumed alone and in mixed formulation. Breath hydrogen was also determined over 6 h. Fifty grams of CSCA was not entirely available in vivo, and breath hydrogen testing indicated that CSCA was as likely to ferment. Products high in RS, but with no TDF, would yield reduced GI values, and this calls for the need of a method to define available carbohydrate.

  7. Glycemic index and postprandial blood glucose response to Japanese strawberry jam in normal adults.

    PubMed

    Kurotobi, Tomoka; Fukuhara, Kimiaki; Inage, Hiroko; Kimura, Shuichi

    2010-01-01

    We investigated in 30 healthy adults the glycemic index (GI) of five strawberry jams made from various sugar compositions. The jam containing the highest ratio of glucose showed a high GI, while that containing a high ratio of fructose, a jam made from polydextrose, showed a low GI. There was a high correlation (r=0.969, p=0.006) between the GI and the predicted GI calculated from the sugar composition of the jams. Moreover, the influence on postprandial blood glucose response after an intake of only 20 g of jam and one slice of bread with 20 g jam was measured in 8 healthy adults. The blood glucose level after an intake of 20 g of the high GI jam containing the high glucose ratio was higher than that of other jams at 15 min, but there was no significant difference after 30 min. Regardless of whether the GI was low or high, differences in the jams were not observed in the postprandial blood glucose level or the area under the curve after eating either one slice of bread (60 g) or one slice of bread with less than 20 g of jam.

  8. Preserving Mafa expression in diabetic islet β-cells improves glycemic control in vivo.

    PubMed

    Matsuoka, Taka-aki; Kaneto, Hideaki; Kawashima, Satoshi; Miyatsuka, Takeshi; Tochino, Yoshihiro; Yoshikawa, Atsushi; Imagawa, Akihisa; Miyazaki, Jun-ichi; Gannon, Maureen; Stein, Roland; Shimomura, Iichiro

    2015-03-20

    The murine Mafa transcription factor is a key regulator of postnatal islet β-cell activity, affecting insulin transcription, insulin secretion, and β-cell mass. Human MAFA expression is also markedly decreased in islet β-cells of type 2 diabetes mellitus (T2DM) patients. Moreover, levels are profoundly reduced in db/db islet β-cells, a mouse model of T2DM. To examine the significance of this key islet β-cell-enriched protein to glycemic control under diabetic conditions, we generated transgenic mice that conditionally and specifically produced Mafa in db/db islet β-cells. Sustained expression of Mafa resulted in significantly lower plasma glucose levels, higher plasma insulin, and augmented islet β-cell mass. In addition, there was increased expression of insulin, Slc2a2, and newly identified Mafa-regulated genes involved in reducing β-cell stress, like Gsta1 and Gckr. Importantly, the levels of human GSTA1 were also compromised in T2DM islets. Collectively, these results illustrate how consequential the reduction in Mafa activity is to islet β-cell function under pathophysiological conditions.

  9. Molecular variants and derivatives of insulin for improved glycemic control in diabetes.

    PubMed

    Bhatnagar, Sonika; Srivastava, Deepa; Jayadev, M S K; Dubey, A K

    2006-07-01

    Insulin is a historic molecule. It presents many first instances, such as the first protein to be fully sequenced, one of the first proteins to be crystallized in pure form, one among the early proteins whose structure was investigated using X-ray crystallography, the first protein to be chemically synthesized and the first Biotech drug. Therefore, the development of insulin in the early years is intricately intertwined with the progress in molecular and structural biology. In recent years, development of a range of insulin analogs has led to better control of glucose levels, thus preventing secondary complications and improving the quality of life in diabetic patients. Such analogs were obtained by modification of the native insulin sequence. They vary with regard to their pharmacokinetic profile, stability, tissue specificity and mode of administration. In addition, alterations involving incorporation of various chemical moieties in insulin and its co-crystallization with insoluble derivatives are used to modulate the time-action profile of the drug. This article traces the development of molecular variants and derivatives of insulin. It discusses future directions for further improvement in their properties to produce still better insulin therapeutics for tight glycemic control.

  10. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control

    PubMed Central

    Betônico, Carolina C R; Titan, Silvia M O; Correa-Giannella, Maria Lúcia C; Nery, Márcia; Queiroz, Márcia

    2016-01-01

    The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: “diabetes kidney disease” and “renal failure” in combination with “diabetes treatment” and “oral antidiabetic drugs” or “oral hypoglycemic agents.” The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population. PMID:26872083

  11. Polyunsaturated fatty acids and type 2 diabetes: impact on the glycemic control mechanism.

    PubMed

    Coelho, Olívia Gonçalves Leão; da Silva, Bárbara Pereira; Rocha, Daniela Mayumi Usuda Prado; Lopes, Lílian Lelis; Alfenas, Rita de Cássia Gonçalves

    2016-02-06

    There is a growing mortality related to co-morbidities associated with diabetes mellitus (DM). Polyunsaturated fatty acids (PUFA) intake has been associated with low cardiometabolic risk and reduction of inflammatory process. The objective of this paper is to review the impact of PUFA intake on glycemic control in diabetic patients, as well as elucidate the possible mechanisms involved. Medline/PubMed electronic database was searched to identify studies published within the last 5 years regarding the effect of PUFA intake on glucose metabolism in type 2 diabetics. The search terms used were: "polyunsaturated fatty acid (s)", "PUFA", and "diabetes." We included only intervetion studies that assessed the effects of PUFA intake on glucose metabolism - fasting glucose, serum insulin, HbA1c and HOMA-IR assessment- in type 2 diabetics. Initially, 48 articles were identified, which 1 was not available and 41 did not match the inclusion criteria. Within the selected studies, 3 showed an improvement on fasting blood glucose, 2 showed an increase on fasting glycemia and there was no effect of the intervention in only 1. Based on the analyzed clinical intervention studies, supplementation of 0,42-5,2 g PUFA/day for at least 8 weeks may be an alternative treatment for T2DM, particularly to Asian people.

  12. A low glycemic index meal before exercise improves endurance running capacity in men.

    PubMed

    Wu, Ching-Lin; Williams, Clyde

    2006-10-01

    This study investigated the effects of ingesting a low (LGI) or high (HGI) glycemic index carbohydrate (CHO) meal 3 h prior to exercise on endurance running capacity. Eight male recreational runners undertook two trials (LGI or HGI) which were randomized and separated by 7 d. After an overnight fast (12 h) the subjects ingested either a LGI or HGI meal 3 h prior to running at 70% VO2max until exhaustion. The meals contained 2 g/kg body mass CHO and were isocaloric and iso-macronutrient with calculated GI values 77 and 37 for the HGI and LGI respectively. The run times for the LGI and HGI trials were 108.8 +/- 4.1 min and 101.4 +/- 5.2 min respectively (P = 0.038). Fat oxidation rates were higher during exercise after the LGI meal than after the HGI meal (P < 0.05). In summary, ingestion of a LGI meal 3 h before exercise resulted in a greater endurance capacity than after the ingestion of a HGI meal.

  13. The effects of pre-exercise glycemic index food on running capacity.

    PubMed

    Karamanolis, I A; Laparidis, K S; Volaklis, K A; Douda, H T; Tokmakidis, S P

    2011-09-01

    This study examined the effects of pre-exercise food on different glycemic indexes (GI) on exercise metabolism and endurance running capacity. 9 subjects performed 3 exercise trials on different days 15 min after ingesting: lentils, (LGI), potatoes, (HGI), and placebo. Each subject ingested an equal amount of each food (1 g/kg body mass) and ran on a level treadmill for 5 min at 60%, 45 min at 70% and then at 80% of VO (2max) until exhaustion. Serum glucose concentrations were higher ( P<0.01) 15 min after the HGI trial compared to the LGI and placebo trials. In addition, serum glucose levels were higher ( P<0.05) during the LGI trial at the time of exhaustion compared to the HGI and placebo trials. Plasma insulin levels, 15 min after ingestion, were higher ( P<0.001) in the HGI trial as compared to the LGI and placebo trials. Exercise time was longer during the LGI trial ( P<0.05) compared to the placebo, but the time to exhaustion in the HGI condition did not differ from the placebo (LGI: 90.0 ± 7.9; HGI: 81.8 ± 5; placebo: 73.0 ± 6.4 min). These results suggest that lentils, the LGI food, ingested 15 min before prolonged exercise maintained euglycemia during exercise and enhanced endurance running capacity.

  14. Glycemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus

    PubMed Central

    Ngwiri, Thomas; Were, Fred; Predieri, Barbara; Ngugi, Paul; Iughetti, Lorenzo

    2015-01-01

    Background. Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder in children and adolescents worldwide. While data about prevalence, treatment, and complications are recorded in many countries, few data exist for Sub-Saharan Africa. The aim of this study was to determine the degree of control in patients with T1DM aged 1–19 years over a 6-month period in 3 outpatient Kenyan clinics. It also sought to determine how control was influenced by parameters of patient and treatment. Methods. Eighty-two children and adolescents with T1DM were included in the study. Clinical history regarding duration of illness, type and dose of insulin, and recent symptoms of hypoglycemia/hyperglycemia were recorded. Glycaemia, HbA1c, and ketonuria were tested. HbA1c of 8.0% and below was defined as the cut-off for acceptable control. Results. The median HbA1c for the study population was 11.1% (range: 6.3–18.8). Overall, only 28% of patients had reasonable glycemic control as defined in this study. 72% therefore had poor control. It was also found that age above 12 years was significantly associated with poor control. Conclusions. African children and with T1DM are poorly controlled particularly in adolescents. Our data strongly support the necessity of Kenya children to receive more aggressive management and follow-up. PMID:26494998

  15. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control.

    PubMed

    Betônico, Carolina C R; Titan, Silvia M O; Correa-Giannella, Maria Lúcia C; Nery, Márcia; Queiroz, Márcia

    2016-01-01

    The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: "diabetes kidney disease" and "renal failure" in combination with "diabetes treatment" and "oral antidiabetic drugs" or "oral hypoglycemic agents." The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population.

  16. The effect of glycemic index on plasma glucose and lactate levels during incremental exercise.

    PubMed

    Stannard, S R; Constantini, N W; Miller, J C

    2000-03-01

    Consumption of low glycemic index (GI) foods before submaximal endurance exercise may be beneficial to performance. To test whether this may also be true for high intensity exercise, 10 trained cyclists began an incremental exercise test to exhaustion 65 min after consuming equal carbohydrate portions of glucose (HGI), pasta (LGI), and a noncarbohydrate control (PL). Time to fatigue did not differ significantly (p = 0.05) between treatments. Plasma glucose concentration was significantly lower after LGI vs. HGI from 15 to 45 min of rest postprandial. During exercise, plasma glucose concentration was significantly lower after HGI vs. LGI from 200 W until exhaustion. Plasma lactate concentration following HGI was significantly higher than PL from 30 min of rest postprandial through to the end of the 200-W workload. Plasma lactate concentration following LGI was significantly lower than after HGI from 45 min of rest postprandial through to the end of the 100-W workload. At higher exercise intensities, there was no significant difference in plasma lactate levels between treatments. These findings suggest that a high GI carbohydrate meal (1 g/kg body wt) 65 min prior to exercise decreases plasma glucose and increases plasma lactate levels compared to a low GI meal, but not enough to be detrimental to incremental exercise performance.

  17. Liquid and solid carbohydrate foods: comparative effects on glycemic and insulin responses, and satiety.

    PubMed

    Ranawana, Viren; Henry, C Jeya K

    2011-02-01

    It is speculated that the physical form (liquid or solid) of the food substrate has an independent effect on the body's satiety mechanisms. Using a balanced and controlled design, the objective of the present study was to determine the glycemic response (GR), insulin response (IR) and subjective feelings of satiety to two solid (rice [BR] and spaghetti) and two liquid (orange juice and a sugar-sweetened fruit drink [SSD]) foods. Ten healthy participants consumed volume (576 ml) and carbohydrate (50 g) matched portions of the above test foods following a 12-h fast. Blood samples were obtained for the ensuing 120 min for glucose and insulin determination. The subjects also completed visual analog scales (VAS) providing data on subjective feelings of hunger, fullness and satiety. Although there were some significant differences in the total incremental areas under the curve for the GR and IR to liquids and solids, there were notable distinctions in the pattern of the response curves. The BR and SSD elicited significantly different levels of subjective hunger, fullness and satiety. The VAS ratings for all four treatments were at or below baseline by 30 min post-consumption. There were no associations between the GR/IR and VAS ratings. Although the GR and IR were not different between liquids and solids, their differential response patterns could have an impact on satiety and merits further investigation.

  18. A low-glycemic index diet and exercise intervention reduces TNF(alpha) in isolated mononuclear cells of older, obese adults.

    PubMed

    Kelly, Karen R; Haus, Jacob M; Solomon, Thomas P J; Patrick-Melin, Aimee J; Cook, Marc; Rocco, Michael; Barkoukis, Hope; Kirwan, John P

    2011-06-01

    Low-glycemic index diets and exercise independently improve glucose tolerance and reduce diabetes risk. However, the combined effect of a low-glycemic index diet and exercise on inflammation and glucose metabolism is not known. Therefore, we randomized 28 insulin-resistant adults (age: 66 ± 1 y; BMI: 34.2 ± 0.7 kg · m(-2)) to a 12-wk, low (LGI = 40) or high- (HGI = 80) glycemic index diet plus aerobic exercise (5 d · wk(-1), 60 min · d(-1), 80-85% heart rate(max)) intervention. All food and fluids were provided during the study. Inflammation was assessed from cytokine (TNFα and IL-6) secretion using peripheral blood mononuclear cells (MNC) stimulated overnight with LPS. Glycemic response was determined following ingestion of a 75-g glucose solution. Fasting blood samples were collected for additional cytokine [TNFα, IL-6, and monocyte chemoattractant protein 1 (MCP-1)] analysis. Both interventions decreased BMI (P < 0.001), fasting plasma glucose (P = 0.01), and insulin (P = 0.02). The glycemic response was reduced only in the LGI group (P = 0.04). Plasma and MNC-derived TNFα secretion were reduced in the LGI group (P = 0.02) but increased in the HGI group (P = 0.02). Secretion of IL-6 from MNC and plasma IL-6 and MCP-1 concentrations were reduced in the LGI group. The change in MNC-derived TNFα (r = 0.43; P = 0.04) and plasma MCP-1 (r = 0.44; P = 0.04) correlated with decreases in the glycemic response. These data highlight the importance of diet composition in the treatment and prevention of inflammation and hyperglycemia. A low-glycemic index diet has antiinflammatory and antidiabetogenic effects when combined with exercise in older, obese prediabetics.

  19. Many Good Years with Jila

    NASA Astrophysics Data System (ADS)

    Hall, Lindy

    It is a pleasure and privilege to add some words to this collection of writings. I think that I can claim to have known Jan longest of anyone in the world science culture, as we met in February, 1956 at Carnegie Institute of Technology in Pittsburgh, Pennsylvania. As a senior in physics, he was already taking advanced classes in that Department, so his decision that spring to transition into graduate school at CIT was an easy and natural one. The next five years were a golden time of fun and learning for us both. In our respective programs, there was a good mix of technical and humanistic specialties to study and lots of opportunities for practical application and problem solving. As we and others in our core group of students married and started families, a community of colleagues and friends developed with shared interests and interactions…

  20. What are narratives good for?

    PubMed

    Beatty, John

    2016-08-01

    Narratives may be easy to come by, but not everything is worth narrating. What merits a narrative? Here, I follow the lead of narratologists and literary theorists, and focus on one particular proposal concerning the elements of a story that make it narrative-worthy. These elements correspond to features of the natural world addressed by the historical sciences, where narratives figure so prominently. What matters is contingency. Narratives are especially good for representing contingency and accounting for contingent outcomes. This will be squared with a common view that narratives leave no room for chance. On the contrary, I will argue, tracing one path through a maze of alternative possibilities, and alluding to those possibilities along the way, is what a narrative does particularly well.

  1. 'The good of the child'

    PubMed

    Warnock, Mary

    1987-04-01

    Warnock, chair of Britain's Committee of Inquiry into Human Fertilisation and Embryology, discusses the implications of the "artificial family" for children born through the use of reproductive technologies. She considers both treatment of infertility and the possible use of assisted reproduction to enable persons other than infertile couples, such as single persons and homosexuals, to have children. Warnock has found that emphasis has been placed on the wants and well-being of the adult(s) involved, and that the "good of the child" is a "wide and vague concept, widely invoked, not always plausibly." She is particularly concerned about children born as a result of the delayed implantation of frozen embryos, AID children who are deceived about their origins, and children born of surrogate pregnancies. She recommends that a detailed study of existing "artificial family" children be conducted to aid public policy decisions on assisted reproduction.

  2. Coordinating towards a Common Good

    NASA Astrophysics Data System (ADS)

    Santos, Francisco C.; Pacheco, Jorge M.

    2010-09-01

    Throughout their life, humans often engage in collective endeavors ranging from family related issues to global warming. In all cases, the tragedy of the commons threatens the possibility of reaching the optimal solution associated with global cooperation, a scenario predicted by theory and demonstrated by many experiments. Using the toolbox of evolutionary game theory, I will address two important aspects of evolutionary dynamics that have been neglected so far in the context of public goods games and evolution of cooperation. On one hand, the fact that often there is a threshold above which a public good is reached [1, 2]. On the other hand, the fact that individuals often participate in several games, related to the their social context and pattern of social ties, defined by a social network [3, 4, 5]. In the first case, the existence of a threshold above which collective action is materialized dictates a rich pattern of evolutionary dynamics where the direction of natural selection can be inverted compared to standard expectations. Scenarios of defector dominance, pure coordination or coexistence may arise simultaneously. Both finite and infinite population models are analyzed. In networked games, cooperation blooms whenever the act of contributing is more important than the effort contributed. In particular, the heterogeneous nature of social networks naturally induces a symmetry breaking of the dilemmas of cooperation, as contributions made by cooperators may become contingent on the social context in which the individual is embedded. This diversity in context provides an advantage to cooperators, which is particularly strong when both wealth and social ties follow a power-law distribution, providing clues on the self-organization of social communities. Finally, in both situations, it can be shown that individuals no longer play a defection dominance dilemma, but effectively engage in a general N-person coordination game. Even if locally defection may seem

  3. Cultivating Hope through Learning for the Common Good

    ERIC Educational Resources Information Center

    McEwen, Rhonda M.; Herman, Wayne R.; Himes, Brant M.

    2016-01-01

    This article examines how an orientation toward "hope" can guide institutions of higher education in achieving their ultimate purpose of providing education for the common good of society. In today's cultural context, colleges and universities must navigate a multitude of challenges and competing philosophies, many of which question the…

  4. Making a Good Start As an Engineering Manager.

    ERIC Educational Resources Information Center

    Baird, Bruce F.

    1983-01-01

    Provides pointers for the new engineering manager on building self-confidence and establishing positive employer/employee relationships. Includes distinctive traits managers should have, ways to ease frustrations (such as giving a challenging first assignment and recognizing good work), a plan to achieve managerial goals, and relationships with…

  5. Health physics manual of good practices for tritium facilities

    SciTech Connect

    Blauvelt, R.K.; Deaton, M.R.; Gill, J.T.

    1991-12-01

    The purpose of this document is to provide written guidance defining the generally accepted good practices in use at Department of Energy (DOE) tritium facilities. A {open_quotes}good practice{close_quotes} is an action, policy, or procedure that enhances the radiation protection program at a DOE site. The information selected for inclusion in this document should help readers achieve an understanding of the key radiation protection issues at tritium facilities and provide guidance as to what characterizes excellence from a radiation protection point of view. The ALARA (As Low as Reasonable Achievable) program at DOE sites should be based, in part, on following the good practices that apply to their operations.

  6. Language Barriers, Physician-Patient Language Concordance, and Glycemic Control Among Insured Latinos with Diabetes: The Diabetes Study of Northern California (DISTANCE)

    PubMed Central

    Schillinger, Dean; Warton, E. Margaret; Adler, Nancy; Moffet, Howard H.; Schenker, Yael; Salgado, M. Victoria; Ahmed, Ameena; Karter, Andrew J.

    2010-01-01

    ABSTRACT BACKGROUND A significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown. OBJECTIVE To assess the association between limited English proficiency (LEP) and glycemic control and whether this association is modified by having a language-concordant physician. DESIGN Cross-sectional, observational study using data from the 2005–2006 Diabetes Study of Northern California (DISTANCE). Patients received care in a managed care setting with interpreter services and self-reported their English language ability and the Spanish language ability of their physician. Outcome was poor glycemic control (glycosylated hemoglobin A1c > 9%). KEY RESULTS The unadjusted percentage of patients with poor glycemic control was similar among Latino patients with LEP (n = 510) and Latino English-speakers (n = 2,683), and higher in both groups than in whites (n = 3,545) (21% vs 18% vs. 10%, p < 0.005). This relationship differed significantly by patient-provider language concordance (p < 0.01 for interaction). LEP patients with language-discordant physicians (n = 115) were more likely than LEP patients with language-concordant physicians (n = 137) to have poor glycemic control (27.8% vs 16.1% p = 0.02). After controlling for potential demographic and clinical confounders, LEP Latinos with language-concordant physicians had similar odds of poor glycemic control as Latino English speakers (OR 0.89; CI 0.53–1.49), whereas LEP Latinos with language-discordant physicians had greater odds of poor control than Latino English speakers (OR 1.76; CI 1.04–2.97). Among LEP Latinos, having a language discordant physician was associated with significantly poorer glycemic control (OR 1.98; CI 1.03–3.80). CONCLUSIONS Language barriers contribute to health disparities among Latinos with diabetes. Limited English proficiency is an independent

  7. Low glycemic index treatment for seizure control in Angelman syndrome: A case series from the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital.

    PubMed

    Grocott, Olivia R; Herrington, Katherine S; Pfeifer, Heidi H; Thiele, Elizabeth A; Thibert, Ronald L

    2017-03-01

    The low glycemic index treatment, a dietary therapy that focuses on glycemic index and reduced carbohydrate intake, has been successful in reducing seizure frequency in the general epilepsy population. Epilepsy is a common feature of Angelman syndrome and seizures are often refractory to multiple medications, especially in those with maternal deletions. Dietary therapy has become a more frequently used option for treating epilepsy, often in combination with other antiepileptic drugs, due to its efficacy and favorable side effect profile. This study aimed to assess the effectiveness of the low glycemic index treatment for seizure control in Angelman syndrome. Through a retrospective medical record review of 23 subjects who utilized the low glycemic index treatment at the Clinic and Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital, we found that the high level of seizure control and favorable side effect profile make the low glycemic index treatment a viable treatment for seizures in Angelman syndrome. The majority of subjects in our cohort experienced some level of seizure reduction after initiating the diet, 5 (22%) maintained complete seizure freedom, 10 (43%) maintained seizure freedom except in the setting of illness or non-convulsive status epilepticus, 7 (30%) had a decrease in seizure frequency, and only 1 (4%) did not have enough information to determine seizure control post-initiation. The low glycemic index treatment monotherapy was successful for some subjects in our cohort but most subjects used an antiepileptic drug concurrently. Some subjects were able to maintain the same level of seizure control on a liberalized version of the low glycemic index treatment which included a larger amount of low glycemic carbohydrates. No correlation between the level of carbohydrate restriction and level of seizure control was found. Few subjects experienced side effects and those that did found them to be mild and easily treated. The

  8. Sensory evaluation techniques - make "good for you" taste "good".

    PubMed

    Civille, Gail Vance; Oftedal, Katherine Nolen

    2012-11-05

    Sensory evaluation techniques are frequently used, however applied sensory is most often used within private industry. Basic sensory techniques can be an invaluable aid to research on nutritional or functional benefits of natural products such as whole fruits, nuts and vegetables (through varietal selection, breeding, etc.) in addition to clinical trials of botanicals. Products' sensory properties, including fruits and vegetables, must be tailored to ultimately appeal to the "consumer": no matter how healthy and nutritious a food is, if it does not appeal to its intended end user, it is unlikely to succeed in today's marketplace. This paper outlines the "5 S's" or basic principles of applied sensory testing; Subjects, Site, Samples, Statistics, and Sensory Methods. Two case studies are detailed where applied sensory is used to benefic academic research; one as a clinical trial of broccoli sprout extract, and the second as plant breeding research on strawberries. Finally, more in-depth techniques are discussed so that one can ensure that product sensory properties are aligned with consumer expectations, in other words, that sensory congruence is achieved.

  9. Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes.

    PubMed

    Anderson, Barbara J; Holmbeck, Grayson; Iannotti, Ronald J; McKay, Siripoom V; Lochrie, Amanda; Volkening, Lisa K; Laffel, Lori

    2009-06-01

    To identify aspects of family behavior associated with glycemic control in youth with type 1 diabetes mellitus during the transition to adolescence, the authors studied 121 9- to 14-year-olds (M = 12.1 yrs) and their parents, who completed the Diabetes Family Conflict Scale (DFCS) and the Diabetes Family Responsibility Questionnaire (DFRQ). From the DFRQ, the authors derived 2 dyadic variables, frequency of agreement (exact parent and child concurrence about who was responsible for a task) and frequency of discordance (opposite parent and child reports about responsibility). The authors divided the cohort into Younger (n = 57, M = 10.6 yrs) and Older (n = 64, M = 13.5 yrs) groups. Family conflict was significantly related to glycemic control in the entire cohort and in both the Younger and Older groups. However, only in the Younger group was Agreement related to glycemic control, with higher Agreement associated with better glycemic control. Findings suggest that Agreement about sharing of diabetes responsibilities may be an important target for family-based interventions aiming to optimize glycemic control in preteen youth.

  10. The impact of knowledge about diabetes, resilience and depression on glycemic control: a cross-sectional study among adolescents and young adults with type 1 diabetes

    PubMed Central

    2013-01-01

    Background The purpose of this study is to evaluate the relationship between glycemic control and the factors of knowledge about diabetes, resilience, depression and anxiety among Brazilian adolescents and young adults with type 1 diabetes. Methods This cross-sectional study included 85 adolescents and young adults with type 1 diabetes, aged between 11–22 years, with an average age of 17.7 ± 3.72 years. Glycemic control degree was evaluated through HbA1c. To assess psychosocial factors, the following questionnaires were used: resilience (Resilience Scale, RS) and anxiety and depression (Hospital Anxiety and Depression Scale, HADS). The Diabetes Knowledge Assessment Scale (DKNA) was used to assess knowledge about diabetes. Results Significant correlations were found between HbA1c and resilience, anxiety and depression. Multiple linear regression analysis revealed that the only variable which presented significant association with the value of HbA1c was depression. Conclusions Depression has a significant association with higher HbA1c levels, as demonstrated in a regression analysis. The results suggest that depression, anxiety and resilience should be considered in the design of a multidisciplinary approach to type 1 diabetes, as these factors were significantly correlated with glycemic control. Glycemic control was not correlated with knowledge of diabetes, suggesting that theoretical or practical understanding of this disease is not by itself significantly associated with appropriate glycemic control (HbA1c ≤ 7.5%). PMID:24289093

  11. Good news for coffee addicts.

    PubMed

    Lee, Thomas H

    2009-06-01

    Whether it's a basic Mr. Coffee or a gadget that sports a snazzy device for grinding beans on demand, the office coffee machine offers a place for serendipitous encounters that can improve the social aspect of work and generate new ideas. What's more, a steaming cup of joe may be as good for your health as it is for the bottom line, says Lee, a professor of medicine at Harvard Medical School and the CEO of Partners Community HealthCare. Fears of coffee's carcinogenic effects now appear to be unfounded, and, in fact, the brew might even protect against some types of cancer. What's more, coffee may guard against Alzheimer's disease and other forms of dementia and somehow soften the blow of a heart attack. Of course, its role as a pick-me-up is well known. So there's no need to take your coffee with a dollop of guilt, especially if you ease up on the sugar, cream, double chocolate, and whipped-cream topping.

  12. Achieving closure at Fernald

    SciTech Connect

    Bradburne, John; Patton, Tisha C.

    2001-02-25

    When Fluor Fernald took over the management of the Fernald Environmental Management Project in 1992, the estimated closure date of the site was more than 25 years into the future. Fluor Fernald, in conjunction with DOE-Fernald, introduced the Accelerated Cleanup Plan, which was designed to substantially shorten that schedule and save taxpayers more than $3 billion. The management of Fluor Fernald believes there are three fundamental concerns that must be addressed by any contractor hoping to achieve closure of a site within the DOE complex. They are relationship management, resource management and contract management. Relationship management refers to the interaction between the site and local residents, regulators, union leadership, the workforce at large, the media, and any other interested stakeholder groups. Resource management is of course related to the effective administration of the site knowledge base and the skills of the workforce, the attraction and retention of qualified a nd competent technical personnel, and the best recognition and use of appropriate new technologies. Perhaps most importantly, resource management must also include a plan for survival in a flat-funding environment. Lastly, creative and disciplined contract management will be essential to effecting the closure of any DOE site. Fluor Fernald, together with DOE-Fernald, is breaking new ground in the closure arena, and ''business as usual'' has become a thing of the past. How Fluor Fernald has managed its work at the site over the last eight years, and how it will manage the new site closure contract in the future, will be an integral part of achieving successful closure at Fernald.

  13. What is it to do good medical ethics? On the concepts of 'good' and 'goodness' in medical ethics.

    PubMed

    Solbakk, Jan Helge

    2015-01-01

    In his book The Varieties of Goodness Georg Henrik von Wright advocates that a useful preliminary to the study of the word 'good' is to compile a list of familiar uses and try to group them under some main headings. The present paper aims at exploring the question, 'What is it to do good medical ethics?', and notably from the vantage point of everyday expressions of the word 'good' and von Wright's grouping of them into six different types of goodness.

  14. The effect of moderate glycemic energy bar consumption on blood glucose and mood in dancers.

    PubMed

    Brown, Derrick; Wyon, Matthew

    2014-03-01

    Ingesting quality carbohydrates has been shown to be essential for dancers. Given that most dance classes take place in the morning, it has been recommended that dancers eat a well-balanced breakfast containing carbohydrates, fats, and protein as a means of fuelling this activity. The aim of this study was to determine the effect of a moderate glycemic index energy (MGI) bar or a fasting condition on dancers' blood glucose levels and perceived pleasure-displeasure response during the first dance class of the day. In a randomized counterbalanced design, 10 female preprofessional dance students took their regular scheduled contemporary dance class, on four separate occasions. On each occasion, they consumed either a commercially prepared carbohydrate (CHO)-dense energy bar (47.3 g CHO) or water (FAST). Plasma glucose responses and pleasure-displeasure affect were measured before and at two time points during the class. Dancers who consumed the MGI bar had significantly greater peak blood glucose levels at all time points than those who fasted (p<0.05). Regarding affective state measures, participants who had breakfast had significantly greater pleasure scores than those who only ingested water(p<0.05). In conclusion, results suggest that CHO with an MGI value positively impacts blood glucose concentrations during a dance class. Further, we conclude that skipping breakfast can have an unfavorable effect on the pleasure-displeasure state of dancers. These findings highlight the impact of breakfast on how one feels, as well as the physiological and metabolic benefits of CHO as an exogenous energy source in dancers.

  15. Sucralose Affects Glycemic and Hormonal Responses to an Oral Glucose Load

    PubMed Central

    Pepino, M. Yanina; Tiemann, Courtney D.; Patterson, Bruce W.; Wice, Burton M.; Klein, Samuel

    2013-01-01

    OBJECTIVE Nonnutritive sweeteners (NNS), such as sucralose, have been reported to have metabolic effects in animal models. However, the relevance of these findings to human subjects is not clear. We evaluated the acute effects of sucralose ingestion on the metabolic response to an oral glucose load in obese subjects. RESEARCH DESIGN AND METHODS Seventeen obese subjects (BMI 42.3 ± 1.6 kg/m2) who did not use NNS and were insulin sensitive (based on a homeostasis model assessment of insulin resistance score ≤2.6) underwent a 5-h modified oral glucose tolerance test on two separate occasions preceded by consuming either sucralose (experimental condition) or water (control condition) 10 min before the glucose load in a randomized crossover design. Indices of β-cell function, insulin sensitivity (SI), and insulin clearance rates were estimated by using minimal models of glucose, insulin, and C-peptide kinetics. RESULTS Compared with the control condition, sucralose ingestion caused 1) a greater incremental increase in peak plasma glucose concentrations (4.2 ± 0.2 vs. 4.8 ± 0.3 mmol/L; P = 0.03), 2) a 20 ± 8% greater incremental increase in insulin area under the curve (AUC) (P < 0.03), 3) a 22 ± 7% greater peak insulin secretion rate (P < 0.02), 4) a 7 ± 4% decrease in insulin clearance (P = 0.04), and 5) a 23 ± 20% decrease in SI (P = 0.01). There were no significant differences between conditions in active glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, glucagon incremental AUC, or indices of the sensitivity of the β-cell response to glucose. CONCLUSIONS These data demonstrate that sucralose affects the glycemic and insulin responses to an oral glucose load in obese people who do not normally consume NNS. PMID:23633524

  16. The Association of English Ability and Glycemic Control among Latinos with Diabetes

    PubMed Central

    Baig, Arshiya A.; Locklin, Cara A.; Foley, Edward; Ewigman, Bernard; Meltzer, David O.; Huang, Elbert S.

    2014-01-01

    Objective Language barriers may be significant contributors to diabetes disparities. We sought to assess the association of English speaking ability with glycemic control among Latinos with diabetes. Methods We analyzed 167 Latinos from a cross-sectional survey of adults with type 2 diabetes. The main outcome was HbA1c ≥7.0%. The main predictor was self-reported English speaking ability. Adjusted analyses accounted for age, gender, education, annual income, health insurance status, duration of diabetes, birth in the U.S., and years in the U.S. Results In unadjusted analyses, point estimates for the odds of having a high HbA1c revealed a U-shaped curve with English speaking ability. Those who spoke English very well (OR=2.32, 95% CI, 1.00–5.41) or not at all (OR=4.11, 95% CI 1.35–12.54) had higher odds of having an elevated HbA1c than those who spoke English well, although this was only statistically significant for those who spoke no English. In adjusted analyses, the U-shaped curve persisted with the highest odds among those who spoke English very well (OR=3.20, 95% CI 1.05–9.79) or not at all (OR 4.95, 95% CI 1.29–18.92). Conclusions The relationship between English speaking ability and diabetes management is more complex than previously described. Interventions aimed at improving diabetes outcomes may need to be tailored to specific subgroups within the Latino population. PMID:24620445

  17. The benefits of tight glycemic control in critical illness: Sweeter than assumed?

    PubMed

    Gardner, Andrew John

    2014-12-01

    Hyperglycemia has long been observed amongst critically ill patients and associated with increased mortality and morbidity. Tight glycemic control (TGC) is the clinical practice of controlling blood glucose (BG) down to the "normal" 4.4-6.1 mmol/L range of a healthy adult, aiming to avoid any potential deleterious effects of hyperglycemia. The ground-breaking Leuven trials reported a mortality benefit of approximately 10% when using this technique, which led many to endorse its benefits. In stark contrast, the multi-center normoglycemia in intensive care evaluation-survival using glucose algorithm regulation (NICE-SUGAR) trial, not only failed to replicate this outcome, but showed TGC appeared to be harmful. This review attempts to re-analyze the current literature and suggests that hope for a benefit from TGC should not be so hastily abandoned. Inconsistencies in study design make a like-for-like comparison of the Leuven and NICE-SUGAR trials challenging. Inadequate measures preventing hypoglycemic events are likely to have contributed to the increased mortality observed in the NICE-SUGAR treatment group. New technologies, including predictive models, are being developed to improve the safety of TGC, primarily by minimizing hypoglycemia. Intensive Care Units which are unequipped in trained staff and monitoring capacity would be unwise to attempt TGC, especially considering its yet undefined benefit and the deleterious nature of hypoglycemia. International recommendations now advise clinicians to ensure critically ill patients maintain a BG of <10 mmol/L. Despite encouraging evidence, currently we can only speculate and remain optimistic that the benefit of TGC in clinical practice is sweeter than assumed.

  18. Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012

    PubMed Central

    Øverby, Nina Cecilie; Sonestedt, Emily; Laaksonen, David E.; Birgisdottir, Bryndis Eva

    2013-01-01

    The aim of this study is to review recent data on dietary fiber (DF) and the glycemic index (GI), with special focus on studies from the Nordic countries regarding cardiometabolic risk factors, type 2 diabetes, cardiovascular disease, cancer, and total mortality. In this study, recent guidelines and scientific background papers or updates on older reports on DF and GI published between 2000 and 2011 from the US, EU, WHO, and the World Cancer Research Fund were reviewed, as well as prospective cohort and intervention studies carried out in the Nordic countries. All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet. All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes; lower risk of cardiovascular disease, type 2 diabetes, colorectal and breast cancer. None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy populations, although association was found in sub-groups, e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes. It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions. There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall. However, there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals. Issues regarding methodology, validity and practicality of the GI remain to be clarified. PMID:23538683

  19. Use of a Uniform Treatment Algorithm Abolishes Racial Disparities in Glycemic Control

    PubMed Central

    Rhee, Mary K.; Ziemer, David C.; Caudle, Jane; Kolm, Paul; Phillips, Lawrence S.

    2009-01-01

    Purpose The purpose of this study is to compare glycemic control between blacks and whites in a setting where patient and provider behavior is assessed, and where a uniform treatment algorithm is used to guide care. Methods This observational cohort study was conducted in 3542 patients (3324 blacks, 218 whites) with type 2 diabetes with first and 1-year follow-up visits to a municipal diabetes clinic; a subset had 2-year follow-up. Patient adherence and provider management were determined. The primary endpoint was A1c. Results At presentation, A1c was higher in blacks than whites (8.9% vs 8.3%; P < .001), even after adjusting for demographic and clinical characteristics. During 1 year of follow-up, patient adherence to scheduled visits and medications was comparable in both groups, and providers intensified medications with comparable frequency and amount. After 1 year, A1c differences decreased but remained significant (7.7% vs 7.3%; P = .029), even in multivariable analysis (P = .003). However, after 2 years, A1c differences were no longer observed by univariate (7.6% vs 7.5%; P = .51) or multivariable analysis (P = .18). Conclusions Blacks have higher A1c than whites at presentation, but differences narrow after 1 year and disappear after 2 years of care in a setting where patient and provider behavior are comparable and that emphasizes uniform intensification of therapy. Presumably, racial disparities at presentation reflected prior inequalities in management. Use of uniform care algorithms nationwide should help to reduce disparities in diabetes outcomes. PMID:18669807

  20. Acute effects of dietary glycemic index on antioxidant capacity in a nutrient-controlled feeding study.

    PubMed

    Botero, Diego; Ebbeling, Cara B; Blumberg, Jeffrey B; Ribaya-Mercado, Judy D; Creager, Mark A; Swain, Janis F; Feldman, Henry A; Ludwig, David S

    2009-09-01

    Oxidative stress, caused by an imbalance between antioxidant capacity and reactive oxygen species, may be an early event in a metabolic cascade elicited by a high glycemic index (GI) diet, ultimately increasing the risk for cardiovascular disease and diabetes. We conducted a feeding study to evaluate the acute effects of low-GI compared with high-GI diets on oxidative stress and cardiovascular disease risk factors. The crossover study comprised two 10-day in-patient admissions to a clinical research center. For the admissions, 12 overweight or obese (BMI: 27-45 kg/m(2)) male subjects aged 18-35 years consumed low-GI or high-GI diets controlled for potentially confounding nutrients. On day 7, after an overnight fast and then during a 5-h postprandial period, we assessed total antioxidant capacity (total and perchloric acid (PCA) protein-precipitated plasma oxygen radical absorbance capacity (ORAC) assay) and oxidative stress status (urinary F(2alpha)-isoprostanes (F(2)IP)). On day 10, we measured cardiovascular disease risk factors. Under fasting conditions, total antioxidant capacity was significantly higher during the low-GI vs. high-GI diet based on total ORAC (11,736 +/- 668 vs. 10,381 +/- 612 micromol Trolox equivalents/l, P = 0.002) and PCA-ORAC (1,276 +/- 96 vs. 1,210 +/- 96 micromol Trolox equivalents/l, P = 0.02). Area under the postprandial response curve also differed significantly between the two diets for total ORAC and PCA-ORAC. No diet effects were observed for the other variables. Enhancement in plasma total antioxidant capacity occurs within 1 week on a low-GI diet, before changes in other risk factors, raising the possibility that this phenomenon may mediate, at least in part, the previously reported effects of GI on health.