Characteristics of blood glucose excursions in type 2 diabetes mellitus patients with three different Traditional Chinese Medicine syndromes

OBJECTIVE:To explore the characteristics of blood glucose excursions of type 2 diabetes mellitus patients with three different Traditional Chinese Medicine(TCM) syndromes.METHODS:One hundred and nine patients with type 2 diabetes mellitus were recruited from the Department of Endocrinology and the Department of TCM of the Sixth People's Hospital affiliated to Shanghai Jiao Tong University.Subjects were divided into three groups according to TCM syndrome:intrinsic Damp(n- 42),Yin deficiency and internal Heat(n = 25),and Qi and Yin deficiency(n- 42).Subcutaneous interstitial glucose was monitored with a continuous glucose monitoring system for 3consecutive days to investigate the glycemic profile in each group.Plasma C-peptide levels were measured,and an arginine test was taken in 10 patients randomly selected from each group.Glucose data and glycemic variability were analyzed to investigate the differences among the groups.The change in C-peptide levels and the results from arginine trial were used to evaluate β cell function.RESULTS:Indicators reflecting blood glucose level were the highest in subjects with Yin deficiency and internal Heat syndrome,and parameters reflecting glycemic variability were the lowest in those with Qi and Yin deficiency syndrome.The change in C-peptide levels showed that subjects with Qi and Yin deficiency syndrome had the best βcell function among the three groups;this was confirmed by the arginine trial.CONCLUSION:Patients with Qi and Yin deficiency syndrome had a more stable blood glucose profile,as glycemic variability was higher in those with intrinsic Damp syndrome and those with Yin deficiency and internal Heat syndrome.

Effects of glucagon-like peptide-1 receptor agonists on glucose excursion and inflammation in overweight or obese type 2 diabetic patients

BACKGROUND Currently,the lack of comparative studies between weekly and daily formulations of glucagon-like peptide-1 receptor agonists(GLP-1RAs)for glucose excursion is worth investigation.AIM To investigate the effects of weekly and daily formulations of GLP-1RA on glucose excursion and inflammation in overweight and obese patients with type 2 diabetes.METHODS Seventy patients with type 2 diabetes mellitus who were treated at our hospital between January 2019 and January 2022 were enrolled in this retrospective analysis.All patients were treated with metformin.We evaluated changes in blood glucose levels and a series of important indicators in patients before and after treatment with either a weekly or daily preparation of GLP-1RA(group A;n=33 and group B;n=37).RESULTS The degree of decrease in the levels of fasting blood glucose,mean blood glucose,mean amplitude of glycemic excursions,total cholesterol,triglycerides,tumor necrosis factor-α,interleukin-6,and high-sensitivity C-reactive protein after treatment in group A was higher than that in group B(P<0.05),whereas the 2-h postprandial blood glucose levels decreased more so in group B than in group A(P<0.001).However,there were no statistically significant differences in the levels of glycated hemoglobin,standard deviation of blood glucose,coefficient of variation,absolute mean of daily differences,percentage of time with 3.9 mmol/L<glucose<10 mmol/L,and high-and low-density lipoproteins between the two groups(P>0.05).The incidence of adverse reactions was significantly lower in group A than in group B(P<0.05).CONCLUSION The effect of the weekly preparation of GLP-1RA in controlling blood glucose levels in the patients,suppressing inflammation,and reducing adverse reactions was significantly higher than that of the daily preparations,which is worthy of clinical promotion.

The Relationship between Glucose Excursion and Cognitive Function in Aged Type 2 Diabetes Patients

Objective Evidence suggests that type 2 diabetes （T2DM） is associated with an increased risk of dementia and that glucose variability is an independent risk factor for diabetic complications. This study investigated the relationship between glucose excursion and cognitive function in aged T2DM patients. Methods A total of 248 aged T2DM patients wore a continuous glucose monitoring system （CGMS） for 3 days in order to evaluate glucose excursion, including mean amplitude of glycemic excursions （MAGE） and mean of daily difference （MODD）. All subjects were evaluated with a number of accepted cognitive function tests, including the mini-mental status examination （MMSE）. The relationship between MAGE and MODD and performance on these cognitive tests was assessed. Results The MAGE and MMSE score were negatively correlated, likewise with the correlation between MODD and MMSE. Liner multivariate regression analysis showed that MAGE and MODD were also negatively related to MMSE independent of age, sex, glycemic control, hypertension, smoking, or coronary heart disease history. Conclusion Glucose excursion is related to cognitive function in aged T2DM patients. Elevated glucose excursion decreased the MMSE score, which reflects general cognitive function. Thus, therapy aimed at controlling glucose excursion may be beneficial for maintaining cognitive function in aged T2DM patients.

Correlation between the Amplitude of Glucose Excursion and the Oxidative/Antioxidative System in Subjects with Different Types of Glucose Regulation

Objective To investigate effects of glucose excursion on the oxidative/antioxidative system in subjects with different types of glucose regulation. Methods A total of 30 individuals with normal glucose regulation (NGR), 27 subjects with impaired glucose regulation (IGR) and 27 subjects with newly diagnosed type 2 diabetes mellitus (T2DM) were selected and recruited for 3 days’ continuous glucose monitor system (CGMS) assessment. The data from CGMS was used to calculate the mean amplitude of glycemic excursion (MAGE), mean blood glucose (MBG) and its standard deviation (SDBG), area under the ROC curve when the blood glucose 5.6 mmol/L within 24 h (AUC 5.6), mean of daily differences (MODD), and mean postprandial glucose excursion (MPPGE). In all groups, the content or activity of malondialdehyde (MDA), total antioxidation capacity (TAOC) and glutathione peroxidase (GSH‐Px) were detected. Results Glucose excursion parameters of subjects with T2DM or IGR were higher than those of NGR subjects (P0.05 or 0.01). Moreover, Glucose excursion parameters of T2DM subjects were higher than those of IGR subjects (P0.05 or 0.01). Subjects with T2DM or IGR had significant higher MDA levels and lower GSH‐Px/MDA and TAOC/MDA levels compared to NGR subjects (P0.01). T2DM subjects had even higher MDA levels and lower GSH‐Px/MDA levels than IGR (P0.05 or 0.01). According to the median of normal population for MAGE, T2DM and IGR subjects were divided into MAGE2.6mmol/L Group and MAGE≤2.6mmol/L Group. MAGE2.6mmol/L Group had higher levels of MDA and lower levels of GSH‐Px/MDA than MAGE≤2.6mmol/L Group (P0.05). There was no significant difference between the two groups (P0.05) in terms of the levels of TAOC/MDA. Pearson correlation analysis showed that MDA was positively correlated with FPG, 2hPG, MAGE, and SBP. GSH‐Px/MDA was negatively correlated with MAGE and TC. TAOC/MDA was negatively correlated with FPG. Partial correlation analysis showed that the relationship between MDA and MAGE, GSH‐Px/MDA, and MAGE remained significant after adjustments for the other differences among groups. Conclusion Glucose excursion contributed significantly to promoting lipid peroxidation and decreasing antioxidation capacity than chronic sustained hyperglycemia did in the subjects with different types of glucose regulation.

Effects of Fuscoporia obliqua on Postprandial Glucose Excursion and Endothelial Dysfunction in Type 2 Diabetic Patients

Postprandial hyperglycemia has been reported to elicit endothelial dysfunction and provoke future cardiovascular complications. A reduction of postprandial blood glucose levels by the glucosidase inhibitor Fuscoporia obliqua was associated with a risk reduction of cardiovascular complications, but the effects of Fuscoporia obliqua on endothelial function have never been elucidated. This study is aimed to assess the efficacy of Fuscoporia obliqua on postprandial metabolic parameters and endothelial function in type 2 diabetic patients. Postprandial peak glucose (14.47±1.27 vs. 8.50±0.53 mmol/liter), plasma glucose excursion (PPGE), and change in the area under the curve (AUC) glucose after a single loading of test meal (total 450 kcal; protein 15.3%; fat 32.3%; carbohydrate 51.4%) were significantly higher in the diet-treated type 2 diabetic patients (n=14) than the age-and sex-matched controls (n=12). The peak forearm blood flow response and total reactive hyperemic flow (flow debt repayment) during reactive hyperemia, indices of resistance artery endothelial function on strain-gauge plethysmography, were unchanged before and after meal loading in the controls. But those of the diabetics were significantly decreased 120 and 240 min after the test meal. A prior administration of Fuscoporia obliqua decreased postprandial peak glucose, PPGE, and AUC glucose. The peak forearm blood flow and flow debt repayment were inversely well correlated with peak glucose, PPGE, and AUC glucose, but not with AUC insulin or the other lipid parameters. Even a single loading of the test meal was shown to impair the endothelial function in type 2 diabetic patients, and the postprandial endothelial dysfunction was improved by a prior use of Fuscoporia obliqua. Fuscoporia obliqua might reduce macrovascular complication by avoiding endothelial injury in postprandial hyperglycemic status.