Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is re...Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired.Conversely,GE is influenced by the acute glycaemic environment acute hyperglycaemia slows,while acute hypoglycaemia accelerates it.Delayed GE(gastroparesis)occurs frequently in diabetes and critical illness.In diabetes,this poses challenges for management,particularly in hospitalised individuals and/or those using insulin.In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence.Substantial advances in knowledge relating to GE,which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and,the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists,which may profoundly impact GE,in the management of type 2 diabetes,has become commonplace.This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia,its implications in hospitalised patients and the relevance of dysglycaemia and its management,particularly in critical illness.Current approaches to management of gastroparesis to achieve more personalised diabetes care,relevant to clinical practice,is detailed.Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients,are required.展开更多
Gestational diabetes mellitus(GDM)represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term.Lifestyle intervention...Gestational diabetes mellitus(GDM)represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term.Lifestyle intervention remains the mainstay for the management of GDM.The efficacy of nutritional approaches(e.g.calorie restriction and small frequent meals)to improving the maternal-neonatal outcomes of GDM was attested to by Chinese population data,discussed in two articles in recent issues of this journal.However,a specific focus on the relevance of postprandial glycaemic control was lacking.Postprandial rather than fasting hyperglycaemia often represents the predominant manifestation of disordered glucose homeostasis in Chinese women with GDM.There is now increasing appreciation that the rate of gastric emptying,which controls the delivery of nutrients for digestion and absorption in the small intestine,is a key determinant of postprandial glycaemia in both health,type 1 and 2 diabetes.It remains to be established whether gastric emptying is abnormally rapid in GDM,particularly among Chinese women,thus contributing to a predisposition to postprandial hyperglycaemia,and if so,how this influences the therapeutic response to nutritional interventions.It is essential that we understand the role of gastric emptying in the regulation of postprandial glycaemia during pregnancy and the potential for its modulation by nutritional strategies in order to improve postprandial glycaemic control in GDM.展开更多
AIM:To assess the utility of hemoglobin A1c(HbA1c) in the early postpartum screening of women with gestational diabetes mellitus(GDM).METHODS:Over a 3 years period,HbA1c estimations were undertaken in addition to and ...AIM:To assess the utility of hemoglobin A1c(HbA1c) in the early postpartum screening of women with gestational diabetes mellitus(GDM).METHODS:Over a 3 years period,HbA1c estimations were undertaken in addition to and simultaneously with the traditional oral glucose tolerance test(OGTT),in 203 women with GDM as a part of early postpartum screening for dysglycaemia,at 6 wk post-partum.World Health Organization criteria was used for diagnosing diabetes:fasting blood glucose(FBG) ≥ 7.0 mmol/Land/or 2-h postprandial blood glucose(PPBG) ≥ 11.1 mmol/L and/or HbA1c ≥ 48 mmol/mol;and impaired glycaemiastate:impaired fasting glucose 6.1-6.9 mmol/L and/or impaired glucose tolerance 7.8-11.0 mmol/L and/or HbA1c:42-47 mmol/mol.RESULTS:Mean FBG,2-h PPBG and HbA1c were 4.9 ± 0.7 mmol/L,5.6 ± 2.0 mmol/L and 38 ± 5 mmol/mol respectively.FBG,2-h PPBG and HbA1c detected 6(3%),7(3.5%) and 11(5.4%) cases of diabetes respectively,and 11(5.4%),25(12.3%) and 23(11.3%) cases of pre-diabetes state respectively.HbA1c values ≥ 48 mmol/mol(≥ 6.5%) showed a diagnostic sensitivity of 71.4% and specificity of 98.5% for diabetes in comparison to OGTT in receiver operating characteristics curve analysis.At HbA1c cut-off 44 mmol/mol,sensitivity and specificity were 100% and 92.3% respectively [area under the curve:0.98(95%CI:0.96-1.00)].Sensitivity and specificity for detecting high risk "impaired glycaemia" state [HbA1c 42 mmol/mol(6.0%)] were 28% and 80%,respectively.CONCLUSION:HbA1c level ≥ 48 mmol/mol(≥ 6.5%) has reasonable sensitivity and high specificity in comparison to OGTT for early postpartum screening of diabetes in GDM.At 6 th week postpartum screening,if FBG is normal and HbA1c < 44 mmol/mol OGTT is not recommended.展开更多
A cost-effective nutritional approach to improve postprandial glycaemia is attractive considering the rising burden of diabetes throughout the world. Whey protein, a by-product of the cheese-making process, can be use...A cost-effective nutritional approach to improve postprandial glycaemia is attractive considering the rising burden of diabetes throughout the world. Whey protein, a by-product of the cheese-making process, can be used to manipulate gut function in order to slow gastric emptying and stimulate incretin hormone secretion, thereby attenuating postprandial glycaemic excursions. The function of the gastrointestinal tract plays a pivotal role in glucose homeostasis, particularly during the postprandial period, and this review will discuss the mechanisms by which whey protein slows gastric emptying and stimulates release of gut peptides, including the incretins. Whey protein is also a rich source of amino acids, and these can directly stimulate beta cells to secrete insulin, which contributes to the reduction in postprandial glycaemia. Appetite is suppressed with consumption of whey, due to its effects on the gut-brain axis and the hypothalamus. These properties of whey protein suggest its potential in the management of type 2 diabetes. However, the optimal dose and timing of whey protein ingestion are yet to be defined, and studies are required to examine the long-term benefits of whey consumption for overall glycaemic control.展开更多
An epidemic trend is observed in the evolution the epidemiology of diabetes mellitus worldwide. In a nationwide survey conducted in 2008, prevalence of diabetes was estimated to 2.6% in the hole Beninese population an...An epidemic trend is observed in the evolution the epidemiology of diabetes mellitus worldwide. In a nationwide survey conducted in 2008, prevalence of diabetes was estimated to 2.6% in the hole Beninese population and to 4.6% in Borgou department representing the highest in the country. Aim: To determine the prevalence of diabetes mellitus in the adult population and investigate associated factors in Borgou department. Method: A survey was conducted from September 30th to November 20th 2011. In a random sampling using the STEP wise approach of surveillance of chronic diseases recommended by the World Health Organization, 4597 subjects over 18 years old (1935 men and 2662 women) were selected. After informed consent, every subject was submitted to the STEP questionnaire and anthropometric measures. Capillary blood was drawn in fast condition to determine glycaemia. Diabetes was defined by fasting glycaemia above 1.26 g/l. Chi square test was used for statistical analysis and difference was considered significant with p < 0.05. Results: Prevalence of diabetes was 12.4%. There was not a significant difference between men (8.5%) and women (9.4%), p = 0.33. Prevalence of previously known diabetes was 1.2% suggesting a large proportion of undiagnosed diabetes. Prevalence of diabetes increased significantly with age (p < 0.0001). There was no association with instruction level (p = 0.21). Other factors significantly associated with diabetes were place of residency (p < 0.0001), ethnicity (p = 0.002), marital status (p < 0.0001), obesity (p = 0.017) and high blood pressure (p < 0.0004). Conclusion: There is a rapid increase in diabetes prevalence in Borgou department in Benin confirming the epidemic trend of the disease. A large proportion of these diabetic subjects remained undiagnosed, so untreated and then, exposed to precocious chronic complications and precocious mortality. These results strongly support need for active intervention program with objectives of primary, secondary and tertiary prevention of diabetes mellitus and associated factors.展开更多
Objective: To evaluate the antidiabetic effect of galactomannans extracted from Adenanthera pavonina's L.seeds(GAP) in streptozotocin(STZ) induced diabetic mice.Methods:The preliminary galactomannan yield from Ade...Objective: To evaluate the antidiabetic effect of galactomannans extracted from Adenanthera pavonina's L.seeds(GAP) in streptozotocin(STZ) induced diabetic mice.Methods:The preliminary galactomannan yield from Adenanthera pavonina L.plant and extraction products composition were evaluated.Various chemical characterization methods like thin layer chromatography, Fourier transform infrared spectroscopy, ~1H and ^(13)C nuclear magnetic resonance, and molecular weight by gel permeation chromatography have been employed to characterize the extracted galactomannan.The mice were divided in four groups: Normal control, diabetic control, GAP(1% and 2%) treated and standard drug treated groups.Diabetic mice received treatment daily for 30 d.Diabetes was induced by STZ at a single dose of 120 mg/kg.Body weight, water and food intake, fasting blood glucose, total cholesterol and triglycerides were measured.Histopathological analysis of pancreas and liver were performed to evaluate STZ-induced tissue injuries.Results: The isolated and extracted galactomannan from Adenanthera pavonina was confirmed by various chemical characterization methods.GAP exhibited a 1.46:1 mannose: galactose ratio, and high molar weight.Both GAP enriched food decreased glycaemia, total cholesterol and triacylglycerol.GAP didn't interfere on food intakes or body weight, although it increased water intake.Furthermore, the relative liver weight indicated toxic galactomannan effects on the histopathological changes of the pancreas in STZ induced diabetes.Conclusions: It is concluded that GAP is a natural product that contains potent galactomannan and is useful in preventing and treating diabetes.展开更多
文摘Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired.Conversely,GE is influenced by the acute glycaemic environment acute hyperglycaemia slows,while acute hypoglycaemia accelerates it.Delayed GE(gastroparesis)occurs frequently in diabetes and critical illness.In diabetes,this poses challenges for management,particularly in hospitalised individuals and/or those using insulin.In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence.Substantial advances in knowledge relating to GE,which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and,the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists,which may profoundly impact GE,in the management of type 2 diabetes,has become commonplace.This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia,its implications in hospitalised patients and the relevance of dysglycaemia and its management,particularly in critical illness.Current approaches to management of gastroparesis to achieve more personalised diabetes care,relevant to clinical practice,is detailed.Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients,are required.
文摘Gestational diabetes mellitus(GDM)represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term.Lifestyle intervention remains the mainstay for the management of GDM.The efficacy of nutritional approaches(e.g.calorie restriction and small frequent meals)to improving the maternal-neonatal outcomes of GDM was attested to by Chinese population data,discussed in two articles in recent issues of this journal.However,a specific focus on the relevance of postprandial glycaemic control was lacking.Postprandial rather than fasting hyperglycaemia often represents the predominant manifestation of disordered glucose homeostasis in Chinese women with GDM.There is now increasing appreciation that the rate of gastric emptying,which controls the delivery of nutrients for digestion and absorption in the small intestine,is a key determinant of postprandial glycaemia in both health,type 1 and 2 diabetes.It remains to be established whether gastric emptying is abnormally rapid in GDM,particularly among Chinese women,thus contributing to a predisposition to postprandial hyperglycaemia,and if so,how this influences the therapeutic response to nutritional interventions.It is essential that we understand the role of gastric emptying in the regulation of postprandial glycaemia during pregnancy and the potential for its modulation by nutritional strategies in order to improve postprandial glycaemic control in GDM.
文摘AIM:To assess the utility of hemoglobin A1c(HbA1c) in the early postpartum screening of women with gestational diabetes mellitus(GDM).METHODS:Over a 3 years period,HbA1c estimations were undertaken in addition to and simultaneously with the traditional oral glucose tolerance test(OGTT),in 203 women with GDM as a part of early postpartum screening for dysglycaemia,at 6 wk post-partum.World Health Organization criteria was used for diagnosing diabetes:fasting blood glucose(FBG) ≥ 7.0 mmol/Land/or 2-h postprandial blood glucose(PPBG) ≥ 11.1 mmol/L and/or HbA1c ≥ 48 mmol/mol;and impaired glycaemiastate:impaired fasting glucose 6.1-6.9 mmol/L and/or impaired glucose tolerance 7.8-11.0 mmol/L and/or HbA1c:42-47 mmol/mol.RESULTS:Mean FBG,2-h PPBG and HbA1c were 4.9 ± 0.7 mmol/L,5.6 ± 2.0 mmol/L and 38 ± 5 mmol/mol respectively.FBG,2-h PPBG and HbA1c detected 6(3%),7(3.5%) and 11(5.4%) cases of diabetes respectively,and 11(5.4%),25(12.3%) and 23(11.3%) cases of pre-diabetes state respectively.HbA1c values ≥ 48 mmol/mol(≥ 6.5%) showed a diagnostic sensitivity of 71.4% and specificity of 98.5% for diabetes in comparison to OGTT in receiver operating characteristics curve analysis.At HbA1c cut-off 44 mmol/mol,sensitivity and specificity were 100% and 92.3% respectively [area under the curve:0.98(95%CI:0.96-1.00)].Sensitivity and specificity for detecting high risk "impaired glycaemia" state [HbA1c 42 mmol/mol(6.0%)] were 28% and 80%,respectively.CONCLUSION:HbA1c level ≥ 48 mmol/mol(≥ 6.5%) has reasonable sensitivity and high specificity in comparison to OGTT for early postpartum screening of diabetes in GDM.At 6 th week postpartum screening,if FBG is normal and HbA1c < 44 mmol/mol OGTT is not recommended.
基金Supported by Royal Adelaide Hospital Dawes ScholarshipRoyal Adelaide Hospital Research Committee Early Career FellowshipNational Health and Medical Research Council funding(No.APP1066835)
文摘A cost-effective nutritional approach to improve postprandial glycaemia is attractive considering the rising burden of diabetes throughout the world. Whey protein, a by-product of the cheese-making process, can be used to manipulate gut function in order to slow gastric emptying and stimulate incretin hormone secretion, thereby attenuating postprandial glycaemic excursions. The function of the gastrointestinal tract plays a pivotal role in glucose homeostasis, particularly during the postprandial period, and this review will discuss the mechanisms by which whey protein slows gastric emptying and stimulates release of gut peptides, including the incretins. Whey protein is also a rich source of amino acids, and these can directly stimulate beta cells to secrete insulin, which contributes to the reduction in postprandial glycaemia. Appetite is suppressed with consumption of whey, due to its effects on the gut-brain axis and the hypothalamus. These properties of whey protein suggest its potential in the management of type 2 diabetes. However, the optimal dose and timing of whey protein ingestion are yet to be defined, and studies are required to examine the long-term benefits of whey consumption for overall glycaemic control.
文摘An epidemic trend is observed in the evolution the epidemiology of diabetes mellitus worldwide. In a nationwide survey conducted in 2008, prevalence of diabetes was estimated to 2.6% in the hole Beninese population and to 4.6% in Borgou department representing the highest in the country. Aim: To determine the prevalence of diabetes mellitus in the adult population and investigate associated factors in Borgou department. Method: A survey was conducted from September 30th to November 20th 2011. In a random sampling using the STEP wise approach of surveillance of chronic diseases recommended by the World Health Organization, 4597 subjects over 18 years old (1935 men and 2662 women) were selected. After informed consent, every subject was submitted to the STEP questionnaire and anthropometric measures. Capillary blood was drawn in fast condition to determine glycaemia. Diabetes was defined by fasting glycaemia above 1.26 g/l. Chi square test was used for statistical analysis and difference was considered significant with p < 0.05. Results: Prevalence of diabetes was 12.4%. There was not a significant difference between men (8.5%) and women (9.4%), p = 0.33. Prevalence of previously known diabetes was 1.2% suggesting a large proportion of undiagnosed diabetes. Prevalence of diabetes increased significantly with age (p < 0.0001). There was no association with instruction level (p = 0.21). Other factors significantly associated with diabetes were place of residency (p < 0.0001), ethnicity (p = 0.002), marital status (p < 0.0001), obesity (p = 0.017) and high blood pressure (p < 0.0004). Conclusion: There is a rapid increase in diabetes prevalence in Borgou department in Benin confirming the epidemic trend of the disease. A large proportion of these diabetic subjects remained undiagnosed, so untreated and then, exposed to precocious chronic complications and precocious mortality. These results strongly support need for active intervention program with objectives of primary, secondary and tertiary prevention of diabetes mellitus and associated factors.
基金support by Brazilian governmental agency FUNCAP(Ceara State Research Funding)
文摘Objective: To evaluate the antidiabetic effect of galactomannans extracted from Adenanthera pavonina's L.seeds(GAP) in streptozotocin(STZ) induced diabetic mice.Methods:The preliminary galactomannan yield from Adenanthera pavonina L.plant and extraction products composition were evaluated.Various chemical characterization methods like thin layer chromatography, Fourier transform infrared spectroscopy, ~1H and ^(13)C nuclear magnetic resonance, and molecular weight by gel permeation chromatography have been employed to characterize the extracted galactomannan.The mice were divided in four groups: Normal control, diabetic control, GAP(1% and 2%) treated and standard drug treated groups.Diabetic mice received treatment daily for 30 d.Diabetes was induced by STZ at a single dose of 120 mg/kg.Body weight, water and food intake, fasting blood glucose, total cholesterol and triglycerides were measured.Histopathological analysis of pancreas and liver were performed to evaluate STZ-induced tissue injuries.Results: The isolated and extracted galactomannan from Adenanthera pavonina was confirmed by various chemical characterization methods.GAP exhibited a 1.46:1 mannose: galactose ratio, and high molar weight.Both GAP enriched food decreased glycaemia, total cholesterol and triacylglycerol.GAP didn't interfere on food intakes or body weight, although it increased water intake.Furthermore, the relative liver weight indicated toxic galactomannan effects on the histopathological changes of the pancreas in STZ induced diabetes.Conclusions: It is concluded that GAP is a natural product that contains potent galactomannan and is useful in preventing and treating diabetes.
