Blood Glucose

Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society

Elizabeth R. Seaquist, John E. Anderson, Belinda P. Childs +7 more · Diabetes Care · 2013 · 1,384 citations

This consensus report confirms that hypoglycemia (low blood glucose) is a common, dangerous, and often underreported side effect of diabetes treatment, and provides updated definitions, risk factors, and prevention strategies that anyone managing blood sugar—whether for diabetes or experimental purposes—must understand to avoid harm.

A Randomized Controlled Trial of Resistance Exercise Training to Improve Glycemic Control in Older Adults With Type 2 Diabetes

Carmen Castañeda, Jennifer E. Layne, Leda Munoz-Orians +6 more · Diabetes Care · 2002 · 844 citations

Sixteen weeks of high-intensity resistance training three times per week reduced HbA1c from 8.7% to 7.6% in older adults with type 2 diabetes, allowed 72% of exercisers to reduce their diabetes medication, and improved body composition and blood pressure — while the control group got worse on every measure.

Metabolic responses to high glycemic index and low glycemic index meals: a controlled crossover clinical trial

Paula Guedes Cocate, Letícia Gonçalves Pereira, João CB Marins +3 more · Nutrition Journal · 2011 · 269 citations

Eating low glycemic index (LGI) meals for five consecutive days did NOT increase fat oxidation or improve blood glucose stability during high-intensity exercise compared to high glycemic index (HGI) meals — contrary to popular belief among athletes and fitness enthusiasts.

An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial

Mengxiao Ren, Huaiyu Zhang, Jindan Qi +6 more · Nutrients · 2020 · 141 citations

A 3-month almond-based low-carbohydrate diet significantly reduced depression scores and improved blood sugar control in people with type 2 diabetes compared to a standard low-fat diet, with effects linked to changes in gut bacteria and a hormone called GLP-1.

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

Ian H. de Boer, M. Luiza Caramori, Juliana C.N. Chan +14 more · Kidney International · 2020 · 1,393 citations

A Randomized Clinical Trial Assessing Continuous Glucose Monitoring (CGM) Use With Standardized Education With or Without a Family Behavioral Intervention Compared With Fingerstick Blood Glucose Monitoring in Very Young Children With Type 1 Diabetes

Strategies to Enhance New CGM Use in Early Childhood (SENCE) Study Group, Lori M. Laffel, Kara R. Harrington +77 more · Diabetes Care · 2020 · 84 citations

Continuous glucose monitoring (CGM) in very young children with type 1 diabetes did not improve time in the target glucose range (70–180 mg/dL) compared to fingerstick blood glucose monitoring, but it dramatically reduced time spent dangerously low (hypoglycemia) by roughly half, and adding a family behavioral intervention improved parental well-being and reduced fear of hypoglycemia.

Digital Twin-Enabled Personalized Nutrition Improves Metabolic Dysfunction-Associated Fatty Liver Disease in Type 2 Diabetes: Results of a 1-Year Randomized Controlled Study

Shashank Joshi, Paramesh Shamanna, Mala Dharmalingam +4 more · Endocrine Practice · 2023 · 61 citations

A digital twin (AI-powered personalized nutrition, activity, and sleep guidance) produced a 2.6% greater reduction in HbA1c and a 72.7% type 2 diabetes remission rate compared to standard care, alongside significant improvements in liver fat and fibrosis markers over 12 months.

Human postprandial responses to food and potential for precision nutrition

Sarah Berry, Ana M. Valdes, David A. Drew +22 more · Nature Medicine · 2020 · 815 citations

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

David B. Sacks, Mark A. Arnold, George L. Bakris +6 more · Clinical Chemistry · 2011 · 1,357 citations

BACKGROUND: Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH: An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT: In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (Hb A(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY: The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.

Kombucha tea as an anti-hyperglycemic agent in humans with diabetes – a randomized controlled pilot investigation

Chagai Mendelson, Sabrina Sparkes, Daniel Merenstein +7 more · Frontiers in Nutrition · 2023 · 44 citations

In a 4-week randomized controlled pilot trial, adults with type 2 diabetes who drank 240 mL (about 1 cup) of kombucha daily had their fasting blood glucose drop by an average of 30 mg/dL more than those who drank a placebo — an effect roughly equivalent to adding a second oral diabetes medication.

Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association

Jane L. Chiang, M. Sue Kirkman, Lori M. Laffel +2 more · Diabetes Care · 2014 · 962 citations

Type 1 diabetes is characterized by an immune-mediated depletion of b-cells that results in lifelong dependence on exogenous insulin. While both type 1 and type 2 diabetes result in hyperglycemia, the pathophysiology and etiology of the diseases are distinct and require us to consider each type of diabetes independently. As such, this position statement summarizes available data specific to the comprehensive care of individuals with type 1 diabetes. The goal is to enhance our ability to recognize and manage type 1 diabetes, to prevent its associated complications, and to eventually cure and prevent this disease.

Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomised controlled trial

Renata Micha, Peter J. Rogers, Michael Nelson · British Journal Of Nutrition · 2011 · 103 citations

The macronutrient composition of a breakfast that could facilitate performance after an overnight fast remains unclear. As glucose is the brain's major energy source, the interest is in investigating meals differing in their blood glucose-raising potential. Findings vary due to unaccounted differences in glucoregulation, arousal and cortisol secretion. We investigated the effects of meals differing in glycaemic index (GI) and glycaemic load (GL) on cognition and mood in school children. A total of seventy-four school children were matched and randomly allocated either to the high-GL or low-GL group. Within each GL group, children received high-GI and low-GI breakfasts. Cognitive function (CF) and mood were measured 95-140 min after breakfast. Blood glucose and salivary cortisol were measured at baseline, before and after the CF tests. Repeated-measures ANOVA was used to identify differences in CF, mood, glucose and cortisol levels between the breakfasts. Low-GI meals predicted feeling more alert and happy, and less nervous and thirsty (P < 0·05 for each); high-GL meals predicted feeling more confident, and less sluggish, hungry and thirsty (P < 0·05 for each). High-GL (P < 0·001) and high-GI (P = 0·05) meals increased glucose levels 90 min after breakfast, and high-GI meals increased cortisol levels (P < 0·01). When baseline mood, glucose and cortisol levels were considered, low-GI meals predicted better declarative-verbal memory (P = 0·03), and high-GI meals better vigilance (P < 0·03); observed GI effects were valid across GL groups. GI effects on cognition appear to be domain specific. On balance, it would appear that the low-GI high-GL breakfast may help to improve learning, and of potential value in informing government education policies relating to dietary recommendations and implementation concerning breakfast.

Ketone-Based Metabolic Therapy: Is Increased NAD+ a Primary Mechanism?

Marwa Elamin, David N. Ruskin, Susan A. Masino +1 more · Frontiers in Molecular Neuroscience · 2017 · 100 citations

The ketogenic diet’s anticonvulsant effects have been well-documented for nearly a century, including in randomized controlled trials. Some patients become seizure-free and some remain so after diet cessation. Many recent studies have explored its expanded therapeutic potential in diverse neurological disorders, yet no mechanism(s) of action have been established. The diet’s high fat, low carbohydrate composition promotes ketone bodies as an energy source and improves mitochondrial function and biogenesis. Cellular energy production depends on the metabolic coenzyme nicotinamide adenine dinucleotide (NAD), a marker for mitochondrial and cellular health. Furthermore, NAD activates downstream signaling pathways (such as the sirtuin enzymes) associated with major benefits such as longevity and reduced inflammation; thus, increasing NAD is a coveted therapeutic endpoint. Based on differential NAD+ utilization during glucose- versus ketone body-based acetyl-CoA generation for entry into the tricarboxylic cycle, we propose that a ketogenic diet will increase the NAD+/NADH ratio. When rats were fed ad libitum ketogenic diet significant increases in hippocampal NAD+/NADH ratio and blood ketone bodies were detected already at two days and remained elevated at three weeks, indicating an early and persistent metabolic shift. Based on diverse published literature and these initial data we suggest that increased NAD during ketolytic metabolism may be a primary mechanism behind the beneficial effects of this metabolic therapy in a variety of brain disorders and in promoting health and longevity.

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

David M. Nathan, John B. Buse, Mayer B. Davidson +4 more · Diabetes Care · 2008 · 3,832 citations

The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.

Diabetic Kidney Disease: A Report From an ADA Consensus Conference

Katherine R. Tuttle, George L. Bakris, Rudolf W. Bilous +12 more · American Journal of Kidney Diseases · 2014 · 896 citations

The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care^#

Moshe Hod, Anil Kapur, David A. Sacks +7 more · International Journal of Gynecology & Obstetrics · 2015 · 774 citations

Assessment of a Personalized Approach to Predicting Postprandial Glycemic Responses to Food Among Individuals Without Diabetes

Helena Mendes‐Soares, Tali Raveh-Sadka, Shahar Azulay +10 more · JAMA Network Open · 2019 · 207 citations

Importance: Emerging evidence suggests that postprandial glycemic responses (PPGRs) to food may be influenced by and predicted according to characteristics unique to each individual, including anthropometric and microbiome variables. Interindividual diversity in PPGRs to food requires a personalized approach for the maintenance of healthy glycemic levels. Objectives: To describe and predict the glycemic responses of individuals to a diverse array of foods using a model that considers the physiology and microbiome of the individual in addition to the characteristics of the foods consumed. Design, Setting, and Participants: This cohort study using a personalized predictive model enrolled 327 individuals without diabetes from October 11, 2016, to December 13, 2017, in Minnesota and Florida to be part of a study lasting 6 days. The study measured anthropometric variables, described the gut microbial composition, and assessed blood glucose levels every 5 minutes using a continuous glucose monitor. Participants logged their food and activity information for the duration of the study. A predictive model of individualized PPGRs to a diverse array of foods was trained and applied. Main Outcomes and Measures: Glycemic responses to food consumed over 6 days for each participant. The predictive model of personalized PPGRs considered individual features, including the microbiome, in addition to the features of the foods consumed. Results: Postprandial response to the same foods varied across 327 individuals (mean [SD] age, 45 [12] years; 78.0% female). A model predicting each individual's responses to food that considers several individual factors in addition to food features had better overall performance (R = 0.62) than current standard-of-care approaches using nutritional content alone (R = 0.34 for calories and R = 0.40 for carbohydrates) to control postprandial glycemic levels. Conclusions and Relevance: Across the cohort of adults without diabetes who were examined, a personalized predictive model that considers unique features of the individual, such as clinical characteristics, physiological variables, and the microbiome, in addition to nutrient content was more predictive than current dietary approaches that focus only on the calorie or carbohydrate content of foods. Providing individuals with tools to manage their glycemic responses to food based on personalized predictions of their PPGRs may allow them to maintain their blood glucose levels within limits associated with good health.

Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline

Philip E. Cryer, Lloyd Axelrod, Ashley Grossman +4 more · The Journal of Clinical Endocrinology & Metabolism · 2008 · 1,255 citations

OBJECTIVE: The aim is to provide guidelines for the evaluation and management of adults with hypoglycemic disorders, including those with diabetes mellitus. EVIDENCE: Using the recommendations of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, the quality of evidence is graded very low (plus sign in circle ooo), low (plus sign in circle plus sign in circle oo), moderate (plus sign in circle plus sign in circle plus sign in circle o), or high (plus sign in circle plus sign in circle plus sign in circle plus sign in circle). CONCLUSIONS: We recommend evaluation and management of hypoglycemia only in patients in whom Whipple's triad--symptoms, signs, or both consistent with hypoglycemia, a low plasma glucose concentration, and resolution of those symptoms or signs after the plasma glucose concentration is raised--is documented. In patients with hypoglycemia without diabetes mellitus, we recommend the following strategy. First, pursue clinical clues to potential hypoglycemic etiologies--drugs, critical illnesses, hormone deficiencies, nonislet cell tumors. In the absence of these causes, the differential diagnosis narrows to accidental, surreptitious, or even malicious hypoglycemia or endogenous hyperinsulinism. In patients suspected of having endogenous hyperinsulinism, measure plasma glucose, insulin, C-peptide, proinsulin, beta-hydroxybutyrate, and circulating oral hypoglycemic agents during an episode of hypoglycemia and measure insulin antibodies. Insulin or insulin secretagogue treatment of diabetes mellitus is the most common cause of hypoglycemia. We recommend the practice of hypoglycemia risk factor reduction--addressing the issue of hypoglycemia, applying the principles of intensive glycemic therapy, and considering both the conventional risk factors and those indicative of compromised defenses against falling plasma glucose concentrations--in persons with diabetes.

Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC)

Livia S. A. Augustin, Cyril W.C. Kendall, David J.A. Jenkins +18 more · Nutrition Metabolism and Cardiovascular Diseases · 2015 · 679 citations

Glycaemic index methodology

Fred Brouns, I. Björck, Keith N. Frayn +4 more · Nutrition Research Reviews · 2005 · 1,038 citations

The glycaemic index (GI) concept was originally introduced to classify different sources of carbohydrate (CHO)-rich foods, usually having an energy content of >80 % from CHO, to their effect on post-meal glycaemia. It was assumed to apply to foods that primarily deliver available CHO, causing hyperglycaemia. Low-GI foods were classified as being digested and absorbed slowly and high-GI foods as being rapidly digested and absorbed, resulting in different glycaemic responses. Low-GI foods were found to induce benefits on certain risk factors for CVD and diabetes. Accordingly it has been proposed that GI classification of foods and drinks could be useful to help consumers make 'healthy food choices' within specific food groups. Classification of foods according to their impact on blood glucose responses requires a standardised way of measuring such responses. The present review discusses the most relevant methodological considerations and highlights specific recommendations regarding number of subjects, sex, subject status, inclusion and exclusion criteria, pre-test conditions, CHO test dose, blood sampling procedures, sampling times, test randomisation and calculation of glycaemic response area under the curve. All together, these technical recommendations will help to implement or reinforce measurement of GI in laboratories and help to ensure quality of results. Since there is current international interest in alternative ways of expressing glycaemic responses to foods, some of these methods are discussed.

Continuous Glucose Monitoring in Adolescents With Obesity: Monitoring of Glucose Profiles, Glycemic Excursions, and Adherence to Time Restricted Eating Programs

Monica Naguib, Elizabeth Hegedus, Jennifer K. Raymond +6 more · Frontiers in Endocrinology · 2022 · 34 citations

Adolescents with obesity can wear continuous glucose monitors (CGMs) for 12 weeks with 96.4% adherence and no disruption to daily life, but an 8-hour time-restricted eating (TRE) window did not significantly change any measure of glucose variability compared to a 12-hour eating window—meaning the intervention itself may not have been potent enough to shift glucose regulation in this population.

Precision Medicine and Artificial Intelligence: A Pilot Study on Deep Learning for Hypoglycemic Events Detection based on ECG

Mihaela Porumb, Saverio Stranges, Antonio Pescapè +1 more · Scientific Reports · 2020 · 199 citations

Tracking the fluctuations in blood glucose levels is important for healthy subjects and crucial diabetic patients. Tight glucose monitoring reduces the risk of hypoglycemia, which can result in a series of complications, especially in diabetic patients, such as confusion, irritability, seizure and can even be fatal in specific conditions. Hypoglycemia affects the electrophysiology of the heart. However, due to strong inter-subject heterogeneity, previous studies based on a cohort of subjects failed to deploy electrocardiogram (ECG)-based hypoglycemic detection systems reliably. The current study used personalised medicine approach and Artificial Intelligence (AI) to automatically detect nocturnal hypoglycemia using a few heartbeats of raw ECG signal recorded with non-invasive, wearable devices, in healthy individuals, monitored 24 hours for 14 consecutive days. Additionally, we present a visualisation method enabling clinicians to visualise which part of the ECG signal (e.g., T-wave, ST-interval) is significantly associated with the hypoglycemic event in each subject, overcoming the intelligibility problem of deep-learning methods. These results advance the feasibility of a real-time, non-invasive hypoglycemia alarming system using short excerpts of ECG signal.

Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans.

Anne Flint, Anne Raben, Arne Astrup +1 more · Journal of Clinical Investigation · 1998 · 1,388 citations

We examined the effect of intravenously infused glucagon-like peptide 1 (GLP-1) on subjective appetite sensations after an energy-fixed breakfast, and on spontaneous energy intake at an ad libitum lunch. 20 young, healthy, normal-weight men participated in a placebo-controlled, randomized, blinded, crossover study. Infusion (GLP-1, 50 pmol/ kg.h or saline) was started simultaneously with initiation of the test meals. Visual analogue scales were used to assess appetite sensations throughout the experiment and the palatability of the test meals. Blood was sampled throughout the day for analysis of plasma hormone and substrate levels. After the energy-fixed breakfast, GLP-1 infusion enhanced satiety and fullness compared with placebo (treatment effect: P < 0.03). Furthermore, spontaneous energy intake at the ad libitum lunch was reduced by 12% by GLP-1 infusion compared with saline (P = 0.002). Plasma GLP-1, insulin, glucagon, and blood glucose profiles were affected significantly by the treatment (P < 0.002). In conclusion, the results show that GLP-1 enhanced satiety and reduced energy intake and thus may play a physiological regulatory role in controlling appetite and energy intake in humans.

Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions

Adnan Sharif, Manfred Hecking, Aiko P. J. de Vries +21 more · American Journal of Transplantation · 2014 · 517 citations

Dietary Fiber Intake, Dietary Glycemic Load, and the Risk for Gestational Diabetes Mellitus

Cuilin Zhang, Simin Liu, Caren G. Solomon +1 more · Diabetes Care · 2006 · 375 citations

OBJECTIVE: We aimed to examine whether pregravid dietary fiber consumptions from cereal, fruit, and vegetable sources and dietary glycemic load were related to gestational diabetes mellitus (GDM) risk. RESEARCH DESIGN AND METHODS: This study was a prospective cohort study among 13,110 eligible women in the Nurses' Health Study II. GDM was self-reported and validated by medical record review in a subsample. RESULTS: We documented 758 incident GDM cases during 8 years of follow-up. After adjustment for age, parity, prepregnancy BMI, and other covariates, dietary total fiber and cereal and fruit fiber were strongly associated with GDM risk. Each 10-g/day increment in total fiber intake was associated with 26% (95% CI 9-49) reduction in risk; each 5-g/day increment in cereal or fruit fiber was associated with a 23% (9-36) or 26% (5-42) reduction, respectively. Dietary glycemic load was positively related to GDM risk. Multivariate relative risk for highest versus lowest quintiles was 1.61 (1.02-2.53) (P for trend 0.03). The combination of high-glycemic load and low-cereal fiber diet was associated with 2.15-fold (1.04-4.29) increased risk compared with the reciprocal diet. CONCLUSIONS: These findings suggested that prepregnancy diet might be associated with women's GDM risk. In particular, diet with low fiber and high glycemic load was associated with an increased risk. Future clinical and metabolic studies are warranted to confirm these findings.

Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association

Jane L. Chiang, David M. Maahs, Katharine C. Garvey +5 more · Diabetes Care · 2018 · 498 citations

Table 1

Dietary Fructose Reduces Circulating Insulin and Leptin, Attenuates Postprandial Suppression of Ghrelin, and Increases Triglycerides in Women

Karen L. Teff, Sharon S. Elliott, Matthias H. Tschöp +7 more · The Journal of Clinical Endocrinology & Metabolism · 2004 · 744 citations

Previous studies indicate that leptin secretion is regulated by insulin-mediated glucose metabolism. Because fructose, unlike glucose, does not stimulate insulin secretion, we hypothesized that meals high in fructose would result in lower leptin concentrations than meals containing the same amount of glucose. Blood samples were collected every 30-60 min for 24 h from 12 normal-weight women on 2 randomized days during which the subjects consumed three meals containing 55, 30, and 15% of total kilocalories as carbohydrate, fat, and protein, respectively, with 30% of kilocalories as either a fructose-sweetened [high fructose (HFr)] or glucose-sweetened [high glucose (HGl)] beverage. Meals were isocaloric in the two treatments. Postprandial glycemic excursions were reduced by 66 +/- 12%, and insulin responses were 65 +/- 5% lower (both P < 0.001) during HFr consumption. The area under the curve for leptin during the first 12 h (-33 +/- 7%; P < 0.005), the entire 24 h (-21 +/- 8%; P < 0.02), and the diurnal amplitude (peak - nadir) (24 +/- 6%; P < 0.0025) were reduced on the HFr day compared with the HGl day. In addition, circulating levels of the orexigenic gastroenteric hormone, ghrelin, were suppressed by approximately 30% 1-2 h after ingestion of each HGl meal (P < 0.01), but postprandial suppression of ghrelin was significantly less pronounced after HFr meals (P < 0.05 vs. HGl). Consumption of HFr meals produced a rapid and prolonged elevation of plasma triglycerides compared with the HGl day (P < 0.005). Because insulin and leptin, and possibly ghrelin, function as key signals to the central nervous system in the long-term regulation of energy balance, decreases of circulating insulin and leptin and increased ghrelin concentrations, as demonstrated in this study, could lead to increased caloric intake and ultimately contribute to weight gain and obesity during chronic consumption of diets high in fructose.

Glycemic index and insulin index after a standard carbohydrate meal consumed with live kombucha: A randomised, placebo-controlled, crossover trial

Fiona Atkinson, Marc Cohen, Karen Lau +1 more · Frontiers in Nutrition · 2023 · 28 citations

Introduction Kombucha is a complex probiotic beverage made from fermented tea, yet despite extensive historical, anecdotal, and in-vivo evidence for its health benefits, no controlled trials have been published on its effect on humans. Methods We conducted a randomised placebo-controlled, cross-over study that examined the Glycemic Index (GI) and Insulin Index (II) responses after a standardised high-GI meal consumed with three different test beverages (soda water, diet lemonade soft drink and an unpasteurised kombucha) in 11 healthy adults. The study was prospectively registered with the Australian New Zealand Clinical Trials Registry ( anzctr.org.au : 12620000460909). Soda water was used as the control beverage. GI or II values were calculated by expressing the 2-h blood glucose or insulin response as a percentage of the response produced by 50 g of glucose dissolved in water. Results There was no statistically significant difference in GI or II between the standard meal consumed with soda water (GI: 86 and II: 85) or diet soft drink (GI: 84 and II: 81, ( p = 0.929 for GI and p = 0.374 for II). In contrast, when kombucha was consumed there was a clinically significant reduction in GI and II (GI: 68, p = 0.041 and II: 70, p = 0.041) compared to the meal consumed with soda water. Discussion These results suggest live kombucha can produce reductions in acute postprandial hyperglycemia. Further studies examining the mechanisms and potential therapeutic benefits of kombucha are warranted.

Validation of the effectiveness of a digital integrated healthcare platform utilizing an AI-based dietary management solution and a real-time continuous glucose monitoring system for diabetes management: a randomized controlled trial

Sung Woon Park, Gyuri Kim, You‐Cheol Hwang +3 more · BMC Medical Informatics and Decision Making · 2020 · 27 citations

Abstract Background Despite the numerous healthcare smartphone applications for self-management of diabetes, patients often fail to use these applications consistently due to various limitations, including difficulty in inputting dietary information by text search and inconvenient and non-persistent self-glucose measurement by home glucometer. We plan to apply a digital integrated healthcare platform using an artificial intelligence (AI)-based dietary management solution and a continuous glucose monitoring system (CGMS) to overcome those limitations. Furthermore, medical staff will be performing monitoring and intervention to encourage continuous use of the program. The aim of this trial is to examine the efficacy of the program in patients with type 2 diabetes mellitus (T2DM) who have HbA1c 53–69 mmol/mol (7.0–8.5%) and body mass index (BMI) ≥ 23 mg/m 2 . Methods This is a 48-week, open-label, randomized, multicenter trial consisting of patients with type 2 diabetes. The patients will be randomly assigned to three groups: control group A will receive routine diabetes care; experimental group B will use the digital integrated healthcare platform by themselves without feedback; and experimental group C will use the digital integrated healthcare platform with continuous glucose monitoring and feedback from medical staff. There are five follow-up measures: baseline and post-intervention at weeks 12, 24, 36, and 48. The primary end point is change in HbA1c from baseline to six months after the intervention. Discussion This trial will verify the effectiveness of a digital integrated healthcare platform with an AI-driven dietary solution and a real-time CGMS in patients with T2DM. Trial registration Clinicaltrials.gov NCT 04161170, registered on 08 November 2019. https://clinicaltrials.gov/ct2/show/NCT04161170?term=NCT04161170&amp;draw=2&amp;rank=1

Closed-Loop Artificial Pancreas Systems: Engineering the Algorithms

Francis J. Doyle, Lauren M. Huyett, Joon Bok Lee +2 more · Diabetes Care · 2014 · 387 citations

In this two-part Bench to Clinic narrative, recent advances in both the preclinical and clinical aspects of artificial pancreas (AP) development are described. In the preceding Bench narrative, Kudva and colleagues provide an in-depth understanding of the modified glucoregulatory physiology of type 1 diabetes that will help refine future AP algorithms. In the Clinic narrative presented here, we compare and evaluate AP technology to gain further momentum toward outpatient trials and eventual approval for widespread use. We enumerate the design objectives, variables, and challenges involved in AP development, concluding with a discussion of recent clinical advancements. Thanks to the effective integration of engineering and medicine, the dream of automated glucose regulation is nearing reality. Consistent and methodical presentation of results will accelerate this success, allowing head-to-head comparisons that will facilitate adoption of the AP as a standard therapy for type 1 diabetes.

The carbohydrate-insulin model: a physiological perspective on the obesity pandemic

David S. Ludwig, Louis J. Aronne, Arne Astrup +14 more · American Journal of Clinical Nutrition · 2021 · 278 citations

Global Guideline for Type 2 Diabetes

· Diabetes Research and Clinical Practice · 2014 · 1,065 citations

Improved Glycemic Control in Poorly Controlled Patients with Type 1 Diabetes Using Real-Time Continuous Glucose Monitoring

Dorothee Deiss, Jan Bolinder, Jean-Pierre Riveline +5 more · Diabetes Care · 2006 · 544 citations

Intensive self-management with frequent self-monitoring of blood glucose (SMBG) is important in type 1 diabetes to achieve good metabolic control (1–3). Nevertheless, many patients still experience episodes of unrecognized hypo- and hyperglycemia (4). Novel technologies for continuous glucose monitoring (CGM) that provide information about glucose excursions are now available. Previous studies reported the benefits of retrospective evaluation of CGM data (5–11), but few assessed effects on glycemic control (5,12–14), and only one showed improvements compared with SMBG (14). We evaluated the effect of a new real-time glucose monitor on glycemic control in patients with poorly controlled type 1 diabetes. The device, Guardian RT (Medtronic MiniMed, Northridge, CA), allows users to see glucose readings and set hypo- and hyperglycemic alarms and provides trend information on changing glucose values. The study included 81 children (median age 14.4 years [range 8.0–18.9]) and 81 adults (age 39.1 years [19.0–59.5]) with stable type 1 diabetes. All had adhered to intensified insulin treatment (continuous subcutaneous insulin infusion, n = 78; multiple daily injection, n = 84) but had HbA1c (A1C) levels ≥8.1%. Informed consent was obtained from patients regularly attending the eight participating centers. Subjects were randomly assigned 1:1:1 for 3 months to Guardian RT continuously (arm 1) or biweekly for 3-day periods every 2 weeks (arm 2) or to continue conventional SMBG (control). Treatment adjustments made by physicians and patients were based on SMBG profiles in control subjects and on real-time glucose profiles in arms 1 and 2. Patients were instructed to perform confirmatory SMBG measurements before therapeutical interventions or corrective action if hypo- or hyperglycemic alarms or symptoms occurred. …

Standards of Medical Care in Diabetes–2006

American Diabetes Association · Diabetes Care · 2006 · 974 citations

Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre

EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) · EFSA Journal · 2010 · 881 citations

This Opinion of the EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) deals with the establishment of Dietary Reference Values for carbohydrates and dietary fibre. Nutritionally, two broad categories of carbohydrates can be differentiated: "glycaemic carbohydrates", i.e. carbohydrates digested and absorbed in the human small intestine, and "dietary fibre", non-digestible carbohydrates passing to the large intestine. In this Opinion, dietary fibre is defined as non-digestible carbohydrates plus lignin. The absolute dietary requirement for glycaemic carbohydrates is not precisely known but will depend on the amount of fat and protein ingested. The Panel proposes 45 to 60 E% as the reference Intake range for carbohydrates applicable to both adults and children older than one year of age. Although high frequency of intake of sugar-containing foods can increase the risk of dental caries, there are insufficient data to set an upper limit for (added) sugar intake. Based on the available evidence on bowel function, the Panel considers dietary fibre intakes of 25 g/day to be adequate for normal laxation in adults. A fibre intake of 2 g/MJ is considered adequate for normal laxation in children from the age of one year. Although there is some experimental evidence that a reduction of the dietary glycaemic index and glycaemic load may have favourable effects on some metabolic risk factors such as serum lipids, the evidence for a role in weight maintenance and prevention of diet-related diseases is inconclusive.

Standards of Medical Care in Diabetes—2010

· Diabetes Care · 2009 · 3,463 citations

Added sugars and sugar-sweetened beverage consumption, dietary carbohydrate index and depression risk in the Seguimiento Universidad de Navarra (SUN) Project

Almudena Sánchez‐Villegas, Itzíar Zazpe, Susana Santiago +3 more · British Journal Of Nutrition · 2017 · 117 citations

The association between added sugars or sugar-sweetened beverage consumption and the risk of depression, as well as the role of carbohydrate quality in depression risk, remains unclear. Among 15 546 Spanish university graduates from the Seguimiento Universidad de Navarra (SUN) prospective cohort study, diet was assessed with a validated 136-item semi-quantitative FFQ at baseline and at 10-year follow-up. Cumulative average consumption of added sugars, sweetened drinks and an overall carbohydrate quality index (CQI) were calculated. A better CQI was associated with higher whole-grain consumption and fibre intake and lower glycaemic index and consumption of solid (instead of liquid) carbohydrates. Clinical diagnoses of depression during follow-up were classified as incident cases. Multivariable time-dependent Cox regression models were used to estimate hazard ratios (HR) of depression according to consumption of added sugars, sweetened drinks and CQI. We observed 769 incident cases of depression. Participants in the highest quartile of added sugars consumption showed a significant increment in the risk of depression (HR=1·35; 95 % CI 1·09, 1·67, P=0·034), whereas those in the highest quartile of CQI (upper quartile of the CQI) showed a relative risk reduction of 30 % compared with those in the lowest quartile of the CQI (HR=0·70; 95 % CI 0·56, 0·88). No significant association between sugar-sweetened beverage consumption and depression risk was found. Higher added sugars and lower quality of carbohydrate consumption were associated with depression risk in the SUN Cohort. Further studies are necessary to confirm the reported results.

Standards of Medical Care in Diabetes—2011

· Diabetes Care · 2010 · 2,884 citations

A. Classification of diabetes B. Diagnosis of diabetes C. Categories of increased risk for diabetes (prediabetes) II

Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come?

David C. Klonoff, Kevin T. Nguyen, Nicole Y. Xu +3 more · Journal of Diabetes Science and Technology · 2022 · 80 citations

BACKGROUND: Continuous glucose monitor (CGM) systems were originally intended only for people with diabetes. Recently, there has been interest in monitoring glucose concentrations in a variety of other situations. As data accumulate to support the use of CGM systems in additional states unrelated to diabetes, the use of CGM systems is likely to increase accordingly. METHODS: PubMed and Google Scholar were searched for articles about the use of CGM in individuals without diabetes. Relevant articles that included sufficient details were queried to identify what cohorts of individuals were adopting CGM use and to define trends of use. RESULTS: Four clinical user cases were identified: (1) metabolic diseases related to diabetes with a primary dysregulation of the insulin-glucose axis, (2) metabolic diseases without a primary pathophysiologic derangement of the insulin-glucose axis, (3) health and wellness, and (4) elite athletics. Seven trends in the use of CGM systems in people without diabetes were idenfitied which pertained to both FDA-cleared medical grade products as well as anticipated future products, which may be regulated differently based on intended populations and indications for use. CONCLUSIONS: Wearing a CGM has been used not only for diabetes, but with a goal of improving glucose patterns to avoid diabetes, improving mental or physical performance, and promoting motivate healthy behavioral changes. We expect that clinicians will become increasingly aware of (1) glycemic patterns from CGM tracings that predict an increased risk of diabetes, (2) specific metabolic glucotypes from CGM tracings that predict an increased risk of diabetes, and (3) new genetic and genomic biomarkers in the future.

Standards of Medical Care in Diabetes—2009

· Diabetes Care · 2008 · 2,208 citations

Hyperglycemia not sufficient to meet the diagnostic criteria for diabetes is catego-

Machine Learning Based Diabetes Classification and Prediction for Healthcare Applications

Umair Muneer Butt, Sukumar Letchmunan, Mubashir Ali +3 more · Journal of Healthcare Engineering · 2021 · 203 citations

The remarkable advancements in biotechnology and public healthcare infrastructures have led to a momentous production of critical and sensitive healthcare data. By applying intelligent data analysis techniques, many interesting patterns are identified for the early and onset detection and prevention of several fatal diseases. Diabetes mellitus is an extremely life-threatening disease because it contributes to other lethal diseases, i.e., heart, kidney, and nerve damage. In this paper, a machine learning based approach has been proposed for the classification, early-stage identification, and prediction of diabetes. Furthermore, it also presents an IoT-based hypothetical diabetes monitoring system for a healthy and affected person to monitor his blood glucose (BG) level. For diabetes classification, three different classifiers have been employed, i.e., random forest (RF), multilayer perceptron (MLP), and logistic regression (LR). For predictive analysis, we have employed long short-term memory (LSTM), moving averages (MA), and linear regression (LR). For experimental evaluation, a benchmark PIMA Indian Diabetes dataset is used. During the analysis, it is observed that MLP outperforms other classifiers with 86.08% of accuracy and LSTM improves the significant prediction with 87.26% accuracy of diabetes. Moreover, a comparative analysis of the proposed approach is also performed with existing state-of-the-art techniques, demonstrating the adaptability of the proposed approach in many public healthcare applications.

Beneficial effects of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: randomized crossover trials in Asian Indians with prediabetes

Seema Gulati, Anoop Misra, Rajneesh Tiwari +4 more · European Journal of Clinical Nutrition · 2023 · 11 citations

Eating 23 almonds (about 30 grams) 30 minutes before a carbohydrate-heavy meal reduced post-meal blood sugar spikes by 17–24% in people with prediabetes, with effects lasting at least 3 hours after eating.

High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative

James E. Gangwisch, Lauren Hale, Lorena García +5 more · American Journal of Clinical Nutrition · 2015 · 262 citations

The Loss of Postprandial Glycemic Control Precedes Stepwise Deterioration of Fasting With Worsening Diabetes

Louis Monnier, C Colette, Gareth Dunseath +1 more · Diabetes Care · 2007 · 494 citations

OBJECTIVE: The aim of the study was to determine whether the loss of fasting and postprandial glycemic control occurs in parallel or sequentially in the evolution of type 2 diabetes. RESEARCH DESIGN AND METHODS: In 130 type 2 diabetic patients, 24-h glucose profiles were obtained using a continuous glucose monitoring system. The individuals with type 2 diabetes were divided into five groups according to A1C levels: 1 (<6.5%, n = 30), 2 (6.5-6.9%, n = 17), 3 (7-7.9%, n = 32), 4 (8-8.9%, n = 25), and 5 (> or =9%, n = 26). The glucose profiles between the groups were compared. The overall glucose concentrations for the diurnal, nocturnal, and morning periods, which represent the postprandial, fasting, and the dawn phenomenon states, respectively, were also compared. RESULTS: Glucose concentrations increased steadily from group 1 to 5 in a stepwise manner. The initial differences in mean glucose concentrations reaching statistical significance occurred 1) between groups 1 and 2 (6.4 vs. 7.7 mmol/l, P = 0.0004) for daytime postprandial periods, followed by differences; 2) between groups 2 and 3 (7.5 vs. 9.3 mmol/l, P = 0.0003) for the morning periods (dawn phenomenon); and finally 3) between groups 3 and 4 (6.3 vs. 8.4 mmol/l, P < 0.0001) for nocturnal fasting periods. CONCLUSIONS: The deterioration of glucose homeostasis in individuals with type 2 diabetes progressed from postprandial to fasting hyperglycemia following a three-step process. The first step related to the three diurnal postmeal periods considered as a whole, the second step occurred during the morning period, and the third and final step corresponded to sustained hyperglycemia over the nocturnal fasting periods. Such a description of the key stages in the evolution of type 2 diabetes may be of interest for implementing antidiabetes treatment.

A Personalized Healthcare Monitoring System for Diabetic Patients by Utilizing BLE-Based Sensors and Real-Time Data Processing

Ganjar Alfian, Muhammad Syafrudin, Muhammad Fazal Ijaz +3 more · Sensors · 2018 · 244 citations

Current technology provides an efficient way of monitoring the personal health of individuals. Bluetooth Low Energy (BLE)-based sensors can be considered as a solution for monitoring personal vital signs data. In this study, we propose a personalized healthcare monitoring system by utilizing a BLE-based sensor device, real-time data processing, and machine learning-based algorithms to help diabetic patients to better self-manage their chronic condition. BLEs were used to gather users&rsquo; vital signs data such as blood pressure, heart rate, weight, and blood glucose (BG) from sensor nodes to smartphones, while real-time data processing was utilized to manage the large amount of continuously generated sensor data. The proposed real-time data processing utilized Apache Kafka as a streaming platform and MongoDB to store the sensor data from the patient. The results show that commercial versions of the BLE-based sensors and the proposed real-time data processing are sufficiently efficient to monitor the vital signs data of diabetic patients. Furthermore, machine learning⁻based classification methods were tested on a diabetes dataset and showed that a Multilayer Perceptron can provide early prediction of diabetes given the user&rsquo;s sensor data as input. The results also reveal that Long Short-Term Memory can accurately predict the future BG level based on the current sensor data. In addition, the proposed diabetes classification and BG prediction could be combined with personalized diet and physical activity suggestions in order to improve the health quality of patients and to avoid critical conditions in the future.

Standards of Medical Care in Diabetes

· Diabetes Care · 2005 · 953 citations

The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein

Thomas M.S. Wolever, Alison L. Gibbs, Christine C. Mehling +8 more · American Journal of Clinical Nutrition · 2008 · 333 citations

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

David B. Sacks, Mark A. Arnold, George L. Bakris +6 more · Clinical Chemistry · 2023 · 120 citations

BACKGROUND: Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH: An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT: Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY: The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.

Short-Term Consumption of Sucralose with, but Not without, Carbohydrate Impairs Neural and Metabolic Sensitivity to Sugar in Humans

Jelle R. Dalenberg, Barkha P. Patel, R Denis +5 more · Cell Metabolism · 2020 · 151 citations

Five-Week, Low–Glycemic Index Diet Decreases Total Fat Mass and Improves Plasma Lipid Profile in Moderately Overweight Nondiabetic Men

C. Bouché, Salwa W. Rizkalla, Jing Luo +6 more · Diabetes Care · 2002 · 287 citations

OBJECTIVE: To evaluate whether a 5-week low-glycemic index (LGI) diet versus a high-glycemic index (HGI) diet can modify glucose and lipid metabolism as well as total fat mass in nondiabetic men. RESEARCH DESIGN AND METHODS: In this study, 11 healthy men were randomly allocated to 5 weeks of an LGI or HGI diet separated by a 5-week washout interval in a crossover design. RESULTS: The LGI diet resulted in lower postprandial plasma glucose and insulin profiles and areas under the curve (AUCs) than the HGI diet. A 5-week period of the LGI diet lowered plasma triacylglycerol excursion after lunch (AUC, P < 0.05 LGI vs. HGI). These modifications were associated with a decrease in the total fat mass by approximately 700 g (P < 0.05) and a tendency to increase lean body mass (P < 0.07) without any change in body weight. This decrease in fat mass was accompanied by a decrease in leptin, lipoprotein lipase, and hormone-sensitive lipase RNAm quantities in the subcutaneous abdominal adipose tissue (P < 0.05). CONCLUSIONS: We concluded that 5 weeks of an LGI diet ameliorates some plasma lipid parameters, decreases total fat mass, and tends to increase lean body mass without changing body weight. These changes were accompanied by a decrease in the expression of some genes implicated in lipid metabolism. Such a diet could be of benefit to healthy, slightly overweight subjects and might play a role in the prevention of metabolic diseases and their cardiovascular complications.