Ocimum gratissimum leaf extract inhibits glycogen phosphorylase activity in streptozotocin-induced diabetic rats

In vitro intestinal glucose absorption in diabetic rats following treatment with extract of Ocimum gratissimum leaf

Carbohydrate Recognition and Counting Ability in Pediatric Residents

Background: Diabetes mellitus is a systemic disease affecting both the quality and duration of life. There is rapid escalation in prevalence of diabetes all over the globe due to population growth, urbanization, sedentary life style etc. As per the published data in recent years, the new epidemic of type 2 diabetes stands as one of the major causes of morbidity and mortality affecting the youth and that's why has became a clinical and health economic priority in developing countries. Before the patients are diagnosed as Diabetic they undergo pre-diabetic state in which there is evidence of glucose intolerance with bouts of hyper and hypo glycemia which can causes impairment in neuro physiological indices. Exercise is considered as cornerstone for management of diabetes and its benefits in preventing and treating diabetes are extensively accepted in elderly population. Not much data is availiable on the newly diagnosed T2DM patients. Therefore, this study was designed to evaluate the effect of exercise therapy on neuro physiological functions in T2DM patients of age group 20-45 years. 

Aim
1. To study the effects of six months structured exercise therapy neurophysiological parameters in young adults with newly diagnosed T2DM on dietary control and anti-diabetic drug of age group 20-45 years.
2. To study short term effects of the intervention (structured exercise therapy) on  neurophysiological parameters among interventional group at the end of 2nd month, 4th month and 6th month.


Method
The present study was conducted in the Research Laboratory, Department of Physiology, Jawaharlal Nehru Medical College, KLE University, Belagavi. All potentially eligible participants were informed about the study and screened for eligibility.Institutional Ethics Committee Approval and  individual Informed consent was obtained. The total of 148 patients were enrolled as per inclusion criteria and then randomly divided into Diabetic group (74) and Interventional Group (74) by computer generated, randomized number sequence. Sex, age and mean education level matched healthy individuals were taken into study as normal controls (74). Data management system was developed with help of Project engineer from the Research unit of J.N Medical College. Data was entered regularly along with the enrollment of the patients to ensure the integrity of the research project. The Primary Outcome measures were Nerve conduction Study and Audio Visual reaction time and Secondary Outcome measure were Socio Demographic Profile, HbA1c, BMI, Waist Hip Ratio, Body Fat%, Basal & Maximal Heart Rate, VO2 max. and Physical Fitness Index. The intervention therapy was six months of individually designed program of regular exercise consisting of aerobic and resistance exercises. First two weeks of the regimen consisted of supervised exercise training in Research Laboratory, Department of Physiology, J.N. Medical College, Belgaum. Later on the participants were advised to continue the exercise at 

Effects of structured exercise therapy on neuro-physiological parameters in newly diagnosed adults with T2DM - An RCT

Effectiveness of Triad Model Approach in Rural Diabetic Patients.

Aim: to study the role of teamwork in achieving glycemic control in rural patients using a cost effective triad model.

Material and methods
Of the 200 selected diabetic patients 60 subjects were eligible for the study. Inclusion criteria: 1) Age: men and women between age group 20 years to 70 years.  2) Type 2 Diabetes mellitus, 3) uncontrolled FBS and PPBS 4) HbA1c between 7 to 10 %. Exclusion criteria: Type 1diabetes mellitus, Pre-existing renal, hepatic or cardiac disease, Hba1c > 10 %. Tie up was made with the multipurpose health worker to visit the patients’ home and educate the patients on importance of regular treatment and diet in addition to distribution and observation of medicine intake. A triad was established between our center, health worker, and diabetes educator.

Results 
60 patients were randomly divided into two groups i.e. group A and B which comprised of 30 patients each. Patients were evaluated at the start of study with FBS, PPBS, HbA1c and lipid profile, Complete Blood picture, Complete Urinary Analysis, Liver function test, Serum Creatinine, BMI. Patients were followed up at 3 months with measurement of FBS, PPBS, and HbA1c and at 6 months with measurement of FBS, PPBS, HbA1c and lipid profile. Data obtained was measured with SPSS version 17 software the difference in mean was compared in both groups using independent t test. P value less than 0.05 was considered as significant. 

A triad was established between our center, health worker, and diabetes educator. These 30 patients of Group A were monitored on daily basis with the help of Health Worker for proper diet intake, regular intake of OHA without skipping of a single dose in entire 6 months duration whereas the Group B were monitored on Day 1 and these patient of Group B were explained the about the drug dosage, frequency of drug intake, with complete diet explanation and Life style modification, these both groups were followed on monthly basis in OPD clinic for review.  In Group A there were 20 males ( 66.7%) and 10 females  ( 33.3%) compared to Group B (males 17 ( 56.7 %) and females 13  (43.3%) P value = 0.426, chi square0.635. 
In the present study it was observed that there was no statistically significant difference in the mean age, creatinine, BMI and gender p >0.05.
There was no statistically significant difference in the mean FBS, PPBS, HbA1c and lipid profile at the start of study.
On first follow up after 3 months it was observed that the mean FBS, PPBS were significantly low in the group of patients who had regular follow up p <0.05. HbA1c was lower in patients who had regular follow up but the decrease was not found to be statistically significant p >0.05.
At 6 months it was observed that mean FBS, PPBS, HbA1c, total cholesterol, TGL, and LDL was significantly  low in the group of patients who had regular follow up p <0.05. There was no statistically significant difference in the mean H

Effectiveness of triad model approach in rural diabetic patients

First stratified diabetes prevalence data for Republic of Macedonia derived from the National eHealth System

Authors: Ivica Smokovski, Tatjana Milenkovic

Background: Republic of Macedonia is estimated to have the third highest diabetes prevalence in Europe [1]. National eHealth System has been introduced in the country since 2013 covering all citizens across primary, secondary and tertiary healthcare, integrating diabetes related data, and, for the first time, enabling stratified diabetes prevalence calculation based on diagnosed diabetes cases [2].

Aims: To find diabetes prevalence of diagnosed cases, stratified by gender, age and urban or rural population in Republic of Macedonia, based on data derived from the National eHealth System.

Method: National eHealth System was searched for all patients with ICD-10 diagnoses E10-E14 in their electronic healthcare records. Data records derived from the National eHealth System contained patient’s gender, date of birth, place of living and ICD-10 code.  
Results: Urban, rural and total population diagnosed with diabetes by age and gender are presented in Table 1, 2 and 3; n is the number of cases with diabetes in the group, and N is the total number of individuals (with and without diabetes) in the group. Total number of diagnosed diabetes cases was 84,568: 36,119 males (42.71%) and 48,449 females (57.29%). Diabetes prevalence of diagnosed cases in population 20-79 years was 5.01% (n=78,233; N=1,562,203).

Discussion:  These were the first findings on diabetes prevalence of diagnosed cases in Republic of Macedonia derived from the National eHealth System, stratified by age, gender and urban or rural population. Diabetes prevalence of diagnosed cases in total population was higher in females than in males (4.61% vs 3.42%); it was higher in rural than in urban population (5.62% vs 3.59%) and was highest in the age group 60-79 years (14.57%). These data could enable more precise estimation of the total diabetes prevalence in the country including both diagnosed and undiagnosed cases, and further analysis of the risk factors leading to higher diabetes prevalence in females and rural population in Republic of Macedonia. 

References:
1.	International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Brussels, Belgium: International Diabetes Federation, 2015. http://www.idf.org/diabetesatlas (accessed April 26, 2017).
2.	Smokovski I, Milenkovic T, Trapp C, Mitov A. Diabetes Care in Republic of Macedonia: Challenges and Opportunities. Annals of Global Health; 2015; 81(6): 792-802.

First stratified diabetes prevalence data for Republic of Macedonia derived from the National eHealth System

We are a small inner city surgery from Newport, Wales. Our patients come from a variety of culture and race, with a predominance of Asian population, which is most likely why the prevalence of diabetes is high in our practice comparing to national incidence of diabetes.  
Wales statistic shows that DM in Wales varies between 4.32-5.7% depending on area.(1) Our surgery has an incidence of DM of 9.23 % of our total population.
As part of National Guidelines,   patients with diabetes require to have regular reviews which includes: HBa1c, BMI, BP,  kidney function, lipids, smoking status, foot check and retinopathy screening.
With this retrograde study we wanted to to review our work in treating and monitoring our diabetic patients as a starting point for further improvement in our practice.

Diabetes mellitus: from national guidelines screening to practice

Audit by Dr Rania Alnounou, 2016 (Incretin drugs for diabetes management)
Aim of the study (objectives) 

To critically evaluate healthcare practice based on a literature background, and to suggest real practice improvement. 


Background:
The prevalence of type 2 diabetes, is increasing at an alarming rate, with only half of patients achieving the recommended HbA1c target. This study tends to focus on incretin based treatment for type 2 diabetes, and their utility in clinical practice specifically in private clinical practice in Abu Dhabi, the results of clinical audit, done in our organization will pave the way for new strategies in diabetes management, depending on supporting evidence.
The progressive nature of type 2 diabetes, results in a progressive decline in beta-cell function, and after 3 years of starting first line medication with MF (Metformin) and SU (Sulfonylureas), 50% of patients with type 2 diabetes require additional drug to maintain the glycosylated hemoglobin (HbA1c). 
Incretin drug group, stimulates insulin secretion and inhibit glucagon production, they also improve beta-cell health, slow gastric emptying, promote early satiety and reduce food intake (Nyenwe EA 2011)
The choice of anti-glycemic agents in type 2 diabetes should be guided by medical needs of patient and treatment should meet the goals in achieving optimum glycemic control, tolerability, safety, and cost-effectiveness. Some drug combinations appear to be promising and can reach the target in lowering HbA1c, in addition to beneficial extra glycemic effect, like heart safety.

This study is a clinical audit supported by literature review that shows new drugs for diabetes management and despite being expensive, still do not reach the target of diabetes control. A lot of gaps in our clinical practice, especially primary care level need to be modified to achieve holistic management. Our aim is to reach the target goal of care, manage complications, and teach self-management skills, especially when prescribing new medicine to treat a long-term condition for the first time, extra help and advises are needed through designated strategies for monitoring for at least one month, at the beginning and every three months thereafter.
Participants: I consided around 150 patients with type 2 DM who are taking Incretin drugs with or without other diabetic medication.
The drugs which be followed are:
GLP-1RA:
-	Liraglutide (victoza)
-	Dulaglutide (trulicity)
-	Exenatide (byetta, bydureon)
DPP-4 Inhibitors
-	Sitagliptin (Januvia, janumet)
-	Linagliptin (tradjenta,jentadueto)
-           Vildagliptin (Galvus,Galvusmet)

Variables: I followed five parameters, HBA1c, BG, BP, BW, and eGFR.

Settings: the audit conducted in the UAE, Abu Dhabi, Al Noor hospital, Al Bateen and musaffah branches, for 3-6 months between September and December 2016.
Results:
Criterion	Number sampled	achievement	standard
-	Main criterion: HbA1c< 7% (NICE)	97 patients	49%	70%
-	 Main criterion: HbA1c<8%(AL NO

Monitoring of incretin drugs for type2 diabetes in private health care in Abu Dhabi - Clinical audit

Authors : Viet Thanh Truong, Jocelyne Moisan, Edeltraut Kroëger, Serge Langlois, Jean-Pierre Grégoire
Title: Antidiabetic medication persistence and implementation in patients with chronic kidney disease
Background
Persistence with and implementation of antidiabetic drug (AD) treatment are important for patients with chronic kidney disease to slow disease progression and prevent cardiovascular complications. 
Aims
We aimed to evaluate AD persistence and implementation and to identify factors associated with persistence and with implementation.
Method
Using Quebec (Canada) medico-administrative data, we conducted a cohort study among patients newly diagnosed with chronic kidney disease between 1 January 2000 and 31 December 2011 who initiated afterwards an AD. We considered as persistent patients who were still taking any AD one year after initiation of AD treatment. Among persistent patients, those who had at least 80% of days covered with any AD in the 365-day period following treatment initiation, were considered to have adequately implemented their treatment. Factors associated with persistence and implementation were identified using a multivariate modified Poisson regression. 
Results
The cohort consisted of 6,671 patients newly diagnosed with chronic kidney disease who initiated an AD. Of them, 5,128 (76.9%) were persistent with their AD one year after initiation. Patients with medium (vs. high) socio-economic status, those being treated with a multi-therapy (vs. metformin monotherapy), and those who had comorbidities including hypertension, dyslipidemia, stroke and coronary disease were more likely to be persistent, whereas those who had more than 10 physician visits or were hospitalized in the year prior to the initial AD were less likely to be persistent. 
Among persistent individuals, 4,506 (87.9%) had adequate implementation. Female patients, those aged 82 years or over and those who had more than 10 physician visits in the year prior to AD initiation were more likely to adequately implement their AD treatment.
Discussion
Overall, about 32.4% of patients with chronic kidney disease who initiated an AD may not fully benefit from it as they were either non-persistent or had inadequate treatment implementation. The knowledge of factors associated with persistence and implementation could help to target patients who are likely to benefit from interventions aiming to optimize persistence and implementation.

Antidiabetic medication persistence and implementation in patients with chronic kidney disease

BACKGROUND: Adiposity is a key risk factor for chronic diseases such as diabetes, and has an important influence on metabolic and cardiovascular risk factors, including dyslipidemia. In recent years, novel lipidomic profiling methods have provided new insights into the pathophysiology of these chronic diseases. Yet, there are limited human studies examining the associations between adiposity and lipidomic profiles in overweight and obese non-diabetic adults. 

OBJECTIVE: We aimed to investigate the associations between whole plasma lipidomics and adiposity measured by gold-standard methods in overweight and obese but otherwise healthy young adults.

METHODS: Sixty-five overweight and obese (body mass index (BMI)≥ 25 kg/m2), but otherwise healthy, non-diabetic adults (35 males/ 19 females) were included in this study. We examined the associations between 459 lipid species across 26 lipid classes (measured by liquid chromatography electrospray ionization-tandem mass spectrometry) and adiposity (measured by gold-standard dual X-ray absorptiometry). Additional indices of obesity including BMI and waist-to-hip-ratio (WHR) were also measured. All analyses were adjusted for multiple testing using Benjamini-Hochberg correction. Multivariable regression analyses were performed to examine the associations between lipid species or classes and adiposity after adjustment for clinically relevant factors, including age and sex.

RESULTS: Mean BMI of participants was 31.5±5.2 kg/m2 and mean % body fat was 40.1±8.7%. On univariable analyses, BMI and WHR were not associated with lipid species or classes; however, total % body fat was inversely associated with eight lipid classes including ceramides, gangliosides, diacylglycerols, triacylglycerols, lysoalkylphosphatidylcholine, alkylphosphatidylethanolamine and plasmalogens: alkenylphosphatidylcholine and alkylphosphatidylethanolamine. In multivariable regression adjusted for age and sex, only the plasmalogen lipid class alkylphosphatidylethanolamine remained inversely associated with total % body fat.

CONCLUSION: Our novel data from a well-characterized cohort of overweight or obese adults suggest that increased body fat is associated with lower concentrations of the antioxidant plasmalogen lipid class- alkylphosphatidylethanolamine. Further large-scale studies are needed to confirm this finding.

Plasma lipidomics are associated with adiposity in overweight and obese but otherwise healthy young adults

Background:
Maternal vitamin D deficiency has been implicated in adverse cardiometabolic profiles during pregnancy as well as pregnancy outcomes, including gestational diabetes mellitus (GDM). Recent evidence suggests that the relationship between vitamin D and cardiometabolic risk and pregnancy outcomes may be mediated by inflammatory pathways, with growing interest in the potential role of adipokines. However, no previous studies have investigated whether associations between vitamin D and pregnancy-related outcomes may be mediated by underlying adipokine concentrations.

Aims:
We investigated relationships between maternal 25-hydroxyvitamin D (25(OH)D) concentrations and cardiometabolic risk factors during pregnancy and subsequent pregnancy outcomes. We also explored whether the associations between 25(OH)D and cardiometabolic risk factors and pregnancy outcomes may be mediated by circulating adipokine concentrations.

Methods:
In this retrospective cohort study, we used bio-banked samples collected at 12-15 weeks gestation from 102 overweight or obese pregnant women who were classified as being at high risk of GDM based on a validated risk prediction tool. We measured circulating serum 25(OH)D (chemiluminescent immunoassay), serum lipids (total, high-, and low- density cholesterol, and triglycerides) (ELISA), serum inflammatory markers: interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and novel adipokines: omentin-1, visfatin, and high molecular weight (HMW)-adiponectin (ELISA). Fasting, 1-hour, and 2-hour glucose levels were assessed by oral glucose tolerance tests conducted at 20-24 weeks gestation, and pregnancy outcomes were recorded at delivery. Multivariable linear and logistic regression models were performed with adjustment for maternal factors: age, body mass index (BMI), parity, smoking status, and country of birth. 

Results:
Participants were aged 31.9 ± 4.5 years (mean ± SD) with a BMI of 30.6 ± 6.6 kg/m2 and 25(OH)D level of 47.9 ± 16.0 nmol/L. In univariable analyses, serum 25(OH)D concentrations were associated with fasting glucose, 1-hour glucose, total cholesterol, triglycerides, and IL-6, and positively associated with HMW-adiponectin and length of gestation. Higher 25(OH)D concentrations were also associated with reduced risk of GDM. In multiple regression analyses adjusted for maternal factors, 25(OH)D concentrations remained negatively associated with fasting and 1-hour glucose, total cholesterol, and triglycerides, and positively associated with HMW-adiponectin and length of gestation. Higher 25(OH)D concentrations remained associated with reduced risk of GDM after adjustment for maternal factors, and became associated with reduced risk of preterm birth after additional adjustment for caesarean section. However, adding HMW-adiponectin to the multivariable models attenuated all associations, except fasting glucose and length of gestation. 

Discussion:
In a well-characterized cohort of overweight or obes

Vitamin D deficiency in early pregnancy is associated with increased cardiometabolic risk and gestational diabetes

BACKGROUND:  
Systemic inflammation is common in obesity and is a key risk factor in the development and progression of type 2 diabetes. In vitro and animal studies suggest that vitamin D has anti-inflammatory functions, which are thought to occur via inhibition of the nuclear factor kappa-B (NFκB) pathway. However, existing clinical trials of vitamin D supplementation are limited by short durations, low doses of vitamin D, and variability in participants’ vitamin D deficiency status, and no previous trials have investigated the effect of vitamin D supplementation on NFκB activity in vivo in humans. 

AIMS: 
We conducted a double-blind randomized placebo-controlled trial to investigate whether vitamin D supplementation, provided in a sufficient dose and duration to vitamin D-deficient individuals, would improve plasma inflammatory markers as well as reduce NFκB activity in peripheral blood mononuclear cells (PBMCs), compared to placebo.

METHODS: 
Sixty-five overweight or obese (body mass index (BMI)≥ 25 kg/m2), vitamin D-deficient (25-hydroxyvitamin D (25(OH)D)≤ 50 nmol/l) adults were randomized to either a bolus oral dose of 100,000 IU followed by 4,000 IU daily of cholecalciferol, or matching placebo for 16 weeks. Before and after intervention, we measured anthropometry: BMI, waist-to-hip ratio (WHR) and % body fat by dual energy X-ray absorptiometry; serum 25-hydroxyvitamin D (25(OH)D) concentrations (chemiluminescent immunoassays); plasma inflammatory markers: high sensitivity C-reactive protein (hsCRP; rate turbidimetry), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and interleukins (IL)-1β, -6, -8, -10, -12, -18, -23 and -33 (multiplex assay; flow cytometry); and NFκB activity in PBMCs (DNA-binding assays). Questionnaires were used to collect data on sun exposure habits and dietary vitamin D intake (3-day food record).

RESULTS: Fifty-four participants completed the study (35 males/ 19 females; age= 31.9 ± 8.5 years; BMI= 30.9 ± 4.4 kg/m2 (mean ± SD)). There were no differences in demographic, anthropometric, or biochemical parameters between vitamin D and placebo groups at baseline. Serum 25(OH)D concentrations increased with vitamin D supplementation compared with placebo (57.0 ± 21.3 versus 1.9 ± 15.1 nmol/l, p<0.001). There were no differences between vitamin D and placebo groups in changes in hsCRP, TNF- α, MCP-1, or any of the interleukins. Change in NFκB activity also did not differ between vitamin D and placebo groups. In multivariable models, differences in change in inflammatory markers and NFκB activity between groups remained non-significant after adjustment for baseline values, age, sex, and % body fat, and after further adjustment for season, sun exposure, and dietary vitamin D intake.

CONCLUSIONS: Although in-vitro studies suggest that vitamin D improves inflammation via inhibiting NFκB activity, our novel data from a randomized controlled trial suggest that vitamin D has no effect on inf

Effect of vitamin D supplementation on inflammation and nuclear factor kappa-B activity in overweight or obese adults

BACKGROUND: Chronic low-grade inflammation is common in obesity and related chronic conditions, including type 2 diabetes. Vitamin D has been proposed to have anti-inflammatory properties; however the effect of vitamin D supplementation on inflammation in type 2 diabetes has not been established. 

AIM: We conducted a systematic review and meta-analysis to examine the effect of vitamin D supplementation on inflammatory markers compared to placebo or usual care in patients with type 2 diabetes, and to identify relevant knowledge gaps. 

METHODS: Medline, CINAHL, EMBASE and All EBM were systematically searched (from inception to 25 January 2017) for randomized controlled trials (RCTs) investigating the effects of vitamin D supplementation on inflammatory markers in type 2 diabetes patients. Two independent reviewers screened all full text articles (no date or language limits) for RCTs of vitamin D supplementation (any form, route, duration, and co-supplementation) compared to placebo or usual care on all inflammatory marker outcomes in patients with type 2 diabetes (on any treatment regimen and with or without comorbidities). Meta-analyses and meta-regression were conducted using random-effects models to calculate standardized mean differences (SMD) and 95%CIs. Two independent reviewers extracted data and assessed risk of bias and quality using the grading of recommendations, assessment, development and evaluation (GRADE) approach.

RESULTS: Twenty-nine RCTs (n=1,780) met the inclusion criteria, 20 of which had available data for pooling. In meta-analyses of 20 RCTs (n=1,270), vitamin D-supplemented groups had lower follow-up levels of C-reactive protein (SMD: -0.23 mg/L (-0.37,-0.09); p=0.002), tumor necrosis factor-alpha (SMD: -0.49 pg/ml (-0.84,-0.15); p=0.005), and erythrocyte sedimentation rate (SMD: -0.47 mm/hr (-0.89,-0.05); p=0.03), and higher levels of leptin (SMD: 0.42 µg/L (0.04, 0.81); p=0.03), compared to placebo. No differences were observed for adiponectin, interleukin-6, or E-selectin (all p>0.05). In meta-regression and subgroup analyses, age, sex, BMI, diabetes duration, baseline vitamin D status, and supplementation dose and duration did not alter the results. There was no evidence of heterogeneity (p>0.1) or publication bias (p>0.1) and most studies were low to moderate risk of bias. 

CONCLUSIONS: Our meta-analysis provides level one evidence that vitamin D supplementation may improve chronic low-grade inflammation in patients with type 2 diabetes. Further studies are needed to establish whether improved inflammation following vitamin D supplementation would translate into improved health outcomes for patients with type 2 diabetes. 

PROSPERO registration number: CRD42016047755.

Effect of vitamin D supplementation on inflammation in type 2 diabetes: a meta-analysis of randomized controlled trials

DIET QUALITY IN OBESE PREGNANT WOMEN – COULD THERE BE EFFECTS ON GESTATIONAL DIABETES INDEPENDENT OF WEIGHT GAIN?

Background: 
Obesity, excess gestational weight gain and poor diet quality during pregnancy are associated with increased risk of both maternal and fetal complications, including Gestational Diabetes Mellitus (GDM)1. Yet in Australia, standard antenatal care does not include nutritional intervention for obese pregnant women. A gap in the literature was identified with respect to intervention studies to improve diet quality and related health outcomes for obese pregnant women. 

Whilst not statistically significant after adjusting for Asian ethnicity, lower rates of GDM were seen amongst obese pregnant women who received dietetic intervention when compared to the standard care control group (Opie et al 20162 (see table below)). Excess gestational weight gain is commonly believed to be associated with incidence of GDM1. However in our study, gestational weight gain was similar for both groups, posing the question of whether diet quality improvements could be an influential factor in the lower rates of GDM development. 


Aims: To create a Diet Quality Score to explore the degree to which changes in dietary quality occur as a result of a behavioural nutrition intervention, individually tailored for obese pregnant women in early pregnancy.

Methods: A Diet Quality Score was devised in order to produce a single value indicative of diet quality, and hence display dietary quality changes. This score was created based on intake of food group serves, and variety and quality within each food group aligned to Australian Guide to Healthy Eating recommendations for pregnancy3. The Diet Quality Score was scored out of 100; and participants had dietary intake analysed at baseline in early pregnancy (before 20 weeks), and at 36 weeks gestation. 
Results: Food and fluid intake of 43 diet group participants were analysed using the Diet Quality Score at both time points.  
35 women (81%) showed Diet Quality Score improvement from baseline, with an average improvement of 34.0%. 
8 women (19%) had a reduced Diet Quality Score, with an average deterioration of 5.6%.


A Spearman correlation was utilised to assess the strength of the relationship between the Diet Quality score and the Australian Guide to Healthy Eating. The relationship was found to be strong (r=0.816, p value < 0.001). Further validation of the score using a food database (Foodworks4) supported alignment between a high Diet Quality Score and improved macro and micronutrient intake.

Discussion: 
This dietary intervention study found that most obese pregnant women achieved improvements in diet quality, according to the Diet Quality score. Although there was no diet information available for comparison in the control group, there is evidence to suggest that overweight and obese women consume diets of poor quality during pregnancy5,6, 7 and research has suggested that diet quality deteriorat

Diet quality in obese pregnant women - Could there be effects on gestational diabetes independent of weight gain?

Background:
Vitamin D supplementation has been proposed as a potential strategy for preventing type 2 diabetes and cardiovascular disease (CVD). Existing clinical trials are limited by short durations, low doses of vitamin D, variability in participants’ vitamin D deficiency status, and use of surrogate measures of body composition, insulin sensitivity, and insulin secretion.  

Aims:
To address existing knowledge gaps, we conducted a double-blind randomized placebo-controlled trial to investigate whether vitamin D supplementation, provided in a sufficient dose and duration to vitamin D-deficient individuals, would improve cardiometabolic risk factors including body fat, insulin sensitivity and secretion as measured by gold-standard methods, as well as blood pressure, serum lipids and high-sensitivity C-reactive protein (hsCRP) concentrations. We hypothesized that vitamin D supplementation would improve cardiometabolic risk factors, compared to placebo. 

Methods:
Sixty-five overweight or obese (body mass index (BMI)≥ 25 kg/m2), vitamin D-deficient (25-hydroxyvitamin D (25OH)D)≤ 50 nmol/L) adults were randomized to either a bolus oral dose of 100,000 IU followed by 4,000 IU daily of cholecalciferol, or matching placebo for 16 weeks. Before and after intervention, participants had gold-standard assessment of body composition (% body fat by dual energy X-ray absorptiometry), insulin sensitivity (hyperinsulinemic-euglycemic clamps) and total, first phase, and second phase insulin secretion (intravenous glucose tolerance tests), as well as measurement of BMI, waist-to-hip ratio (WHR), blood pressure, pulse pressure (PP), mean arterial pressure (MAP), serum lipids (ELISA), and hsCRP (immunoturbidimetric assay). Multivariable regression was performed to assess differences between groups after adjustment for clinically relevant factors, and all analyses were adjusted for multiple testing using Bonferroni correction.

Results:
Fifty-four participants completed the study (35M/19F; age= 31.9 ± 8.5 years; BMI= 30.9 ± 4.4 kg/m2 (mean ± SD)). Serum 25(OH)D increased with vitamin D supplementation compared to placebo (57.0 ± 21.3 versus 1.9 ± 15.1nmol/L, p=0.02). Vitamin D and placebo groups did not differ in change in anthropometric measures including BMI (0.003 ± 0.9 versus -0.1 ± 1.2, p= 0.9), WHR (-0.01 ± 0.04 versus 0.001 ± 0.01) or % body fat (-0.4 ± 1.6 versus -0.3 ± 1.7, p=0.9). There were no differences between vitamin D and placebo groups in markers of glucose metabolism, including fasting glucose (0.04 ± 0.5 versus 0.2 ± 0.4 mmol/l, p=0.9), fasting insulin (0.1 ± 5.9 versus 2.1 ± 6.3 mlU/L) insulin sensitivity (0.02 ± 2.0 versus -0.03 ± 2.8mg/kg/min, p=0.9) or total insulin secretory response (insulin area under the curve (AUC)) (-6.9 ± 843 versus 130 ± 1092 mlU/L, p=0.9), respectively. First phase insulin AUC (-21 ± 212 versus 24 ± 184 mlU/L, p=0.9) and second phase insulin AUC (13 ± 598 versus 124 ± 818 mlU/L, p=0.9) also did not differ between vi

No effect of vitamin D supplementation on cardiometabolic risk in non-diabetic adults: a randomized controlled trial

Background: Our previous study indicated that serum 1,5-anhydroglucitol (1,5-AG) levels slightly increased after a glucose load, therefore, this study was conducted to explore short-term changes in 1,5-AG levels after a steamed bread meal test (SBMT) and compare the agreement of 1,5-AG, glycated albumin (GA), and glycated hemoglobin (HbA1c) levels between fasting and postprandial states after an SBMT.

Methods: 104 participants were recruited and underwent a 100 g SBMT. Fasting, 30 min, and 120 min of 1,5-AG, GA, and HbA1c were measured. Statistical analysis comprised an intra-class correlation coefficient model, Passing-Bablok regression and Bland-Altman difference plot.

Results: Levels of 1,5-AG slightly increased from 30 to 120 min after an SBMT (P < 0.01), HbA1c and GA levels showed stability at 30 and 120 min. The Passing-Bablok regression linear equation showed postprandial 1,5-AG, GA, and HbA1c levels were well fitted (all P > 0.05), and Bland-Altman difference plot showed that 100% of data points for HbA1c30 and HbA1c120 fell within the limits of agreement; 94.2%, 96.2%, 95.2%, and 95.2% of data points for 1,5-AG30, 1,5-AG120, GA30, and GA120 fell within the limits of agreement, respectively. Therefore, in the same circumstances, HbA1c showed better stability than both GA and 1,5-AG.

Conclusion: Agreement analyses indicated that good stability of 1,5-AG, GA, and HbA1c levels after the SBMT. HbA1c had an optimal stability, which was superior to that of GA or 1,5-AG. Further studies in different 1,5-AG transport models are needed to investigate the relevant metabolic pathways.

Effects of oral glucose tolerance test and steamed bread meal test on serum 1,5-anhydroglucitol levels

Background

Apart from blindness due to retinopathy due to diabetes, diabetic patients in diabetic patients who have not had complications up to now have studied, but cases in which it is difficult to obtain information in patients with patients with Complexity may increase in the future, and in such cases, it is effective to improve QOL.

Aim
To show effective educational contents.We started developing a program to improve complications of DM, glucose level and practical trial to improve healthy literacy with a group including T2DM patients with visual impairment living in the suburbs of Japan. With the arterial pulse wave velocity(PWV) and ABI as an outcome.

Method
Participants are an age 65 ± 15 year, their elderly people with visual impairment (age 65 ± 15 years) who learned aerobic exercise for the first time. As a program, three times a year, four- Month exposure crossover intervention adopted, I tried 6 kinds of programs during this time. 1.learning aerobic exercise. 2. Giving health information. 3. Learning their self the whole-body image of the patient itself by tactile drawing by artificial vision.4. Bicycle ergometer exercise. 5. Calorie calculation method using problem collection learning. 6. Reading of Braille picture book.How to recruit participants: Subscribers who can explain the conscious of visiting impaired, which the laboratory already supports activities, and cooperate in investigation of continuation of exercise I Gave an oral call for recruitment.The primary endpoint is 1) Program satisfaction, 2) the presence or absence of confidence (self-efficacy) of self-health, 3) deterioration of PWV of 6 or more 14% (14% when the total SD Exceeds 7%, 4) Improvement of the dispersion value of the repression time on the two-dimensional coordinates of the landmark. Outcome is the variance value of the repetition time on the two-dimensional coordinate of the landmark Before and after squat-like motion. Analysis: Descriptive statistics and ANCOVA using IBM-SPSS ver20.

Results
The program performed 6 variations over 2 years, and those with the highest acceptance rate (83%) confirmed the whole-body image of the patient itself by tactile drawing by artificial vision. As of the 3 months of this program, the stability of the performance was 3.16 ± 0.84 seconds (mean ± SD) for the first phase. 0.57 ± 0.16 sec, and the time of the third phase was 1.71 ± 0.48 sec. It shown stable autonomic nervous function (LF / HF). Pulse wave velocity after 3months after this program was the Highest improvement rate during the 2 years held.

Discussion
The high favorable selected program in 2 years was a learning their self the whole-body image of the patient itself by tactile drawing by artificial vision.

Which the high favorable selected program is for visually impaired T2DM patients living in the suburbs of Japan?

Genome wide association study of 'latent autoimmune diabetes in adults' provides novel insights into its pathogenesis

Non coding RNAs play important roles in cellular process. Both long noncoding RNAs (lncRNAs) and miRNA (miR) control gene expression, thus regulating pathologic changes. miR-9 targets important extracellular matrix(ECM) proteins, such as fibronectin (FN)  and collagen (Col), key molecules in cardiac fibrosis. In other systems, lncRNA  ZNFX1-AS1 has been shown to regulate miR-9 through methylation. We investigated the role of miR-9 in the endothelial cells (ECs) and in the heart of diabetic animals and possible regulatory mechanism through ZNFX1-AS1.
       PCR array was used to examine miR expression in ECs exposed to various glucose levels. miR-9 expression was validated by qPCR in ECs and in the mice hearts. Expression of ZNFX1-AS1 and ECM proteins targeted by miR-9 were examined. Luciferase assay was used to determine the interaction between miR-9 and its target genes. Cardiac tissues from streptozotocin (STZ)-induced diabetic mice were similarly examined. NGS based assays were used to quantify methylation.
PCR array showed glucose-induced alterations of multiple miRNAs in ECs. Fifty-one miRNAs were upregulated and 74 were downregulated. High glucose (HG) decreased miR-9 expression in association with increased ZNFX1-AS1 RNA. FN mRNA, Col mRNA and protein levels in ECs were also increased in HG. miR-9 mimic transfection prevented glucose-induced overexpression of these ECM proteins. Hypermethylation was seen at miR-9 promoter. Interestingly, chemical methylation blockade reduced ECM protein overexpression and increased miR9 expression, in spite of high ZNFX1-AS1 RNA. Luciferase assay showed the binding of FN to 3′-UTR of miR-9. miR-9 expression was also decreased in the hearts of the diabetic animals. However expression of ZNFX1-AS1 and ECM proteins were increased.      
These studies indicate a novel glucose-induced mechanism of increased ECM protein production, which is regulated by miR-9 possibly via ZNFX1-AS1 in the ECs and hearts diabetes. Identifying such mechanisms may lead to potential RNA based therapeutics.

Non-coding RNAs in cardiac fibrosis in diabetes

Background: Adipokines play an important role in the pathophysiology of type 2 diabetes and cardiovascular diseases. We have previously shown that carnosine supplementation improved glucose metabolism in non-diabetic individuals. 
Aim: To investigate whether the improvement in glucose metabolism was modulated by adipokines. 
Methods: Twenty-two overweight and obese otherwise healthy adults were randomly assigned to receive either 2g of carnosine (n=13) or identical placebo (n=9) for 12 weeks. Serum adiponectin, adipsin, leptin and resistin were analysed using a bead-based multiplex assay (LEGENDPlex™, BioLegend). Urinary carnosine, carnosine propanal and propanol were measured by mass spectrometry. 
Results: Carnosine supplementation decreased resistin levels compared to placebo (mean change from baseline: -35 ± 83 carnosine vs 35 ± 55 ng/ml placebo, p=0.04). There was also a trend for reduction in leptin levels after carnosine supplementation (-76 ± 165 carnosine vs 35 ± 55 ng/ml placebo, p=0.06). Adiponectin and adipsin levels were not different between the groups (both p>0.1). Change in leptin and resistin were inversely related to change in levels of urinary carnosine (r =-0.72, p = 0.0002; r=- 0.67, p=0.0009, respectively), carnosine propanal (r=- 0.56, p=0.005; r=- 0.63, p=0.001, respectively) and propanol (r=-0.61, p=0.002; r =- 0.61, p=0.002, respectively) and remained significant after adjustment for age, sex and body mass index (all p<0.001). Leptin and resistin levels did not correlate with markers of glucose metabolism (all p>0.1). 
Conclusion: These findings suggest that carnosine supplementation might reduce serum adipokines associated with obesity and insulin resistance. Future trials with larger sample sizes are needed.

Effect of carnosine supplementation on serum adipokines in overweight and obese adults: a randomised controlled trial

Abstract of paper:  
Title: "Using Quantitative Medicine to Control Type 2 Diabetes"
By:  Gerald C. Hsu, eclaireMD Foundation
Date: November 28, 2016 

BACKGROUND
The author has had long-term chronic diseases and suffered from type 2 diabetes, hyperlipidemia, and hypertension for a period of 20 years.  His primary health data in 2010 are listed as follows:
Weight:  205 lbs.
Waistline:  44 inches
One-time snap check of PPG:  350 mg/dL
90-days of averaged glucose:  280 mg/dL
A1C:  10.0%
ACR:  116 mg/mmol
Triglycerides:  1161 mg/dL

AIMS
The author spent 7 years (2010-2017) conducting research to find an effective way to control his severe diabetic condition.  As a result, he developed three mathematical models and various tools to control his chronic diseases, with an emphasis on type 2 diabetes.  During this process, he collected approximately one million "clean" data regarding his health condition.  He applied multiple disciplines, including advanced mathematics, computer science (e.g. database, big data analytic, cloud computing, and mobile technology), nonlinear and dynamic digitized engineering modeling, and artificial intelligence or "AI" (automation and machine learning) to simulate the human organic metabolic system. 

METHOD
The author created two prediction models of weight and glucose values in order to provide patients with an early warning to alter their lifestyle.  The glucose prediction model includes factors such as diabetes medication consumed, quality of food and meal, type of dining location (home or restaurant), exercise amount, stress and trauma, current residence location and weather condition, traveling category and frequency, decreasing internal organ function, and time delay impact on glucose measurement.  The weight prediction model includes factors such as quantity of food and meal, type of exercise, change in calories, sleep impact, water consumption, and other prominent factors.
The most significant achievement is that he successfully eliminated the use of all his diabetic medications within the past 2 years (2016-2017), while maintaining his A1C level within the range of 6.2% to 6.6%.  In addition, his hypertension and hyperlipidemia came under control.  

His recent summarized health data is listed below:
Weight:  172 lbs.
Waistline:  32 inches
Averaged 90-days glucose:  115 mg/dL
A1C:  6.3 - 6.5% (without any medication)
ACR:  12.6 mg/mmol

RESULTS AND DISCUSSION
His entire research and development efforts have been based on lifestyle management as a part of preventive medicine, using collection, processing, and analysis of quantitative medical and health data.  The results are displayed in 75 figures and diagrams which have hundreds to thousands of data within each illustration.  This paper has indicated many conclusive correlations among 11 categories. These categories include four health outputs (weight and waistline, glucose, blood pressure, lipid), six health inputs (food and meal, exercise, stress, sleep, water

Using quantitative medicine to control diabetes

Background: There have been several reports about target blood glucose levels in the perioperative period, and recently, glycemic variability was reported to be associated with mortality in surgical patients in the intensive care unit (ICU). Meanwhile, evaluation of protracted postoperative wound healing has been considered important for determining the outcomes in surgical patients. Infection, poor nutritional status, anemia, jaundice, and chronic renal failure have been identified as risk factors for protracted wound healing. In addition to these risk factors, glycemic variability may be associated with protracted wound healing or poor prognosis in non-critically ill surgical patients with diabetes. However, studies on the relationship between glycemic variability and protracted wound healing in these patients are limited.
Aims: To investigate the relationship between protracted wound healing and glycemic variability as well as known risk factors in non-critically ill surgical patients with diabetes who underwent interventions for glycemic control in the perioperative period.
Method: We retrospectively analyzed 372 non-critically ill surgical patients with diabetes who were hospitalized and whose glucose levels were monitored >3 times per day from April 2014 to March 2016 in two centers. Non-critically ill surgical patients were defined as surgical patients who did not require longer time of care in the ICU. Protracted wound healing was evaluated by the number of days from surgery to removal of stitches on a cutaneous wound (days of wound with stitches). White blood cell counts; levels of C-reactive protein, albumin, hemoglobin, and total bilirubin; estimated glomerular filtration rate; and body temperature were adopted as risk factors for protracted wound healing (known risk factors). Here, we analyzed the relationship between days of wound with stitches and perioperative changes in these factors (the day of stitch removal – preoperative) as well as preoperative these factors using linear regression analysis. Furthermore, hypoglycemia was defined as a blood glucose level <70 mg/dL on any test performed in the hospital. Hypoglycemia, glycemic variability (standard deviation [SD], coefficient of variation [CV], and average daily risk range [ADRR]), and mean glucose concentrations were determined from all the glycemic data collected during the period of days the wound had stitches. We analyzed the association between days of wound with stitches and these factors using linear regression analysis as well. We also analyzed the association of mortality with known risk factors on day 1 of hospital stay (preoperative) and change in these factors (day of discharge from hospital − day 1 of hospital stay [preoperative]) using logistic regression analysis. Lastly, we analyzed the association between mortality and those glycemic variability indexes that were determined from all the glycemic data collected during the entire hospital stay using logistic regre

Glycemic variability affects protracted postoperative wound healing in patients with diabetes ~multicenter study~

Primary and Secondary Prevention of Lower Extremity Arterial Disease in Chinese Type 2 Diabetes Patients: Current Status and Future Prospects
Xiaomei Zhang1, Zhangrong Xu2, Xingwu Ran3, Linong Ji4, on behalf of China DIA-LEAD Study Investigators
1.	Department of Endocrinology, Peking University International Hospital, Beijing 102206, China
2.	Diabetes Center, Department of Endocrinology, The 306th Hospital of PLA, Beijing, China
3.	Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, China
4.	Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing 100044, China

Background:
Lower extremity arterial disease (LEAD) is associated with a 5.9-fold increased risk of cardiovascular mortality in type 2 diabetes patients, but often neglected because of asymptomatic intermittent claudication in real practices. Furthermore, there is a paucity of data regarding the spectrums of preventing LEAD in Chinese diabetes patients in real-life setting.

Aims:
The present study is designed to determine the manifestations of primary and secondary prevention for LEAD in Chinese diabetes patients. We also tried to identify the treatment gaps relative to the guidelines recommendations and opportunities for LEAD management.

Methods:
Patients from China DIA-LEAD study, which consecutively enrolled 7,113 inpatients and 3,568 outpatients aged 50 years and older who had been diagnosed with diabetes from 30 hospitals across China between June 2016 and January 2017, were included in present analysis and stratified into the groups of primary and secondary prevention by the existence of LEAD. Data regarding patient demographics, cardiovascular risk profiles, pharmacotherapies, lipid parameters and blood glucose measurements were recorded and analyzed. LEAD was defined as patients with established LEAD or newly diagnosed at the time of study visit by the Ankle-Brachial Index (ABI) and/or lower limb ultrasonography according to the Chinese Diabetes Society 2013 Guidelines on LEAD screening and management. 

Results: 
Of the total 1,0681 patients, 78.8% (n=8,416) were in primary prevention group and 21.2% (n=2,265) were in secondary prevention group. Of the secondary prevention group, 10.6% (n=1,134) were diagnosed with LEAD before enrollment and 11.8% (n=1,131) newly diagnosed at the present visit. Patients in secondary prevention group were older than in primary group (68.0 vs. 63.2, p<0.001). There were no differences in the gender, BMI, alcohol consumption status, and family history of premature CVD between the primary prevention group and secondary prevention group. However, the proportions of patients smoking, comorbid with marcrovascular diseases and microvascular diseases in secondary prevention group were higher than those in the primary prevention group. The anti-hypertensive agents, lipid lowering therapies, anti-platelet agents, and vasodilator therapies were underused in both groups, compare

Primary and secondary prevention of lower extremity arterial disease in Chinese type 2 diabetes patients

Peripheral artery disease (PAD) is an independent risk factor for increasing morbidity and mortality of cardiovascular disease, especially in diabetic patients. PAD can lead to intermittent claudication, ulceration, and more severely limb amputation. An early predictor and good health management can retard the progression of PAD and reduce the risk of cardiovascular events.The study aimed to examine whether the spectrum analysis of radial pressure wave can predict PAD in patients with Type 2 diabetes.Radial pressure wave was measured by a piezoresistive sensor in 521 (Male: 299, Female: 222) Type 2 diabetic patients with PAD (n=103) and without PAD (n=418). For each patient, spectrum analysis of radial pressure wave was calculated and transformed into Fourier series coefficients Cn.The means of second (C2) harmonic of arterial pulse were significantly higher in patients with PAD (C2: 0.549±0.139) than in patients without PAD (C2:0.515±0.098, P<0.01respectively), while the means of fifth (C5) harmonic of arterial pulse were significantly lower in patients with PAD (C5: 0.124±0.039) than in patients without PAD (C5:0.133±0.04, P<0.05). Chi-square test proved there were associations between C2 and PAD (C2: P <0.05). The risks of PAD in patients with diabetes were raised by the increments of C2 (Odds ratio: 1.82, 95% C.I. 1.04-3.19, P<0.05). Multivariable regression analysis showed C2, C5, triglyceride, and duration of diabetes were associated with PAD(R=0.505, P<0.05 ). This report identified the second harmonics of radial pressure wave could be one of the important predictors for early diagnosis of PAD in type 2 diabetic patients.