Regular brief interruptions to sitting after a high-energy evening meal attenuate glycemic excursions in overweight/obese adults
Rachel E. ClimieMegan S. GraceRobyn N. LarsenPaddy C. DempseyJay OberoiNeale CohenNeville OwenBronwyn A. KingwellDavid W. Dunstan
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Increasing evidence supports the importance of postprandial glucose (PPG) in glycemic control with regard to the development of complications in patients with diabetes. PPG plays a critical role in determining overall glycemic control, particularly in patients who are close to their glycemic goals. Data also indicate that postprandial hyperglycemia may have a greater effect on the development of cardiovascular complications compared with elevated fasting plasma glucose. Several antidiabetic agents that specifically target PPG are currently available, including glinides, glucagon-like peptide-1 mimetics, dipeptidyl peptidase-4 inhibitors, and rapid-acting insulin analogs. A more intensive approach to managing PPG may improve the care of patients with diabetes and, ultimately, the outcome of these patients.
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In Brief Large interventional studies have shown that achieving and maintaining near-normal glycemic levels reduces the risk for microvascular and macrovascular complications in type 2 diabetes. The impact of postprandial glucose on glycemic control has become a topic of much discussion among clinicians. This article examines the literature related to the role of postprandial glucose in type 2 diabetes, both as a contributor to overall glycemia and as an independent risk factor for diabetes complications, and discusses the practicality of managing postprandial hyperglycemia in primary care settings.
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Although exercise has been shown as effective in lowering postprandial hyperglycemia in patients with type 2 diabetes, alternative approaches for those patients who face substantial barriers to physical activity remain less explored. PURPOSE: The aim of this study is to compare the effects of bitter melon intake versus exercise on postprandial glucose responses in type 2 diabetic patients who receive hypoglycemic agents. . METHODS: Using a 2 x 2 randomized cross-over design, a total of 8 patients with type 2 diabetes were randomly assigned to two sequences of treatments, including 1) 100 ml of bitter melon juice administered 15 minutes prior to the 75-g oral glucose load; 2) 30 minutes of moderate-intensity walking performed 15 minutes after the oral glucose load. All participants completed 2-hour oral glucose tolerance test after bitter melon or exercise interventions. Linear mixed models were used to test the effects of treatment, time, and treatment x time interaction on postprandial glucose values after adjustment for covariates. General linear model was used to test incremental area under curve (iAUC) difference between bitter melon and exercise groups after adjustment for covariates. RESULTS: The baseline glucose levels between bitter melon and waking conditions were similar (6.6 ± 0.9 vs. 6.8 ± 0.7 mmol/L, P=0.57). There were no statistical differences for the mean glucose during the 2-h postprandial period (13.7 ± 2.8 vs. 13.0 ± 2.4 mmol/L, P=.56) and 2-h postprandial glucose iAUC (12.6 ± 4.8 vs. 10.7 ± 3.6 mmol/L·h, P=0.38) between the bitter melon and walking conditions. There was no treatment x time interaction on glucose values (P=0.56). When comparing the glucose levels between the two conditions at each time point, there was also no statistical difference in glucose values at 30 minutes (12.4 ± 2.1 vs 10.5 ± 2.1 mmol/L, P=0.086), at 60 minutes (14.5 ± 2.8 vs 13.6 ± 2.7 mmol/L, P=0.56), 90 minutes (14.7 ± 3.7 vs 14.4 ± 3.3 mmol/L, P=0.88), or 120 minutes (13.5 ± 4.6 vs 13.4 ± 3.9 mmol/L, P=0.95), respectively, between bitter melon and waking conditions. CONCLUSIONS: Our findings suggest that, among patients with type 2 diabetes, the intake of 100 ml of bitter melon juice can elicit similar postprandial glucose responses, as compared with performing 30 minutes of walking at moderate-intensity.
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Background: Cardiometabolic profile is usually altered in obesity. Interestingly, the consumption of flavanol-rich foods might be protective against those metabolic alterations.Objective: To evaluate the postprandial cardiometabolic effects after the acute consumption of cocoa extract before and after 4 weeks of its daily intake. Furthermore, the bioavailability of cocoa extract was investigated.Design: Twenty-four overweight/obese middle-aged subjects participated in a 4-week intervention study. Half of the volunteers consumed a test meal enriched with 1.4 g of cocoa extract (415 mg flavanols), while the rest of the volunteers consumed the same meal without the cocoa extract (control group). Glucose and lipid profile, as well as blood pressure and cocoa metabolites in plasma, were assessed before and at 60, 120, and 180 min post-consumption, at the beginning of the study (Postprandial 1) and after following a 4-week 15% energy-restricted diet including meals containing or not containing the cocoa extract (Postprandial 2).Results: In the Postprandial 1 test, the area under the curve (AUC) of systolic blood pressure (SBP) was significantly higher in the cocoa group compared with the control group (p=0.007), showing significant differences after 120 min of intake. However, no differences between groups were observed at Postprandial 2. Interestingly, the reduction of postprandial AUC of SBP (AUC_Postprandial 2-AUC_Postprandial 1) was higher in the cocoa group (p=0.016). Furthermore, cocoa-derived metabolites were detected in plasma of the cocoa group, while the absence or significantly lower amounts of metabolites were found in the control group.Conclusions: The daily consumption of cocoa extract within an energy-restricted diet for 4 weeks resulted in a greater reduction of postprandial AUC of SBP compared with the effect of energy-restricted diet alone and independently of body weight loss. These results suggest the role of cocoa flavanols on postprandial blood pressure homeostasis.Keywords: blood pressure; cocoa; diet; bioavailability; polyphenols; weight loss(Published: 31 March 2016)Citation: Food & Nutrition Research 2016, 60: 30449 - http://dx.doi.org/10.3402/fnr.v60.30449
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Study results still conflict on the contribution of diurnal blood glucose (BG) values to Hb (A1c) in type 2 diabetes. We investigated the relationship between Hb (A1c) and diurnal BG obtained under standardized conditions - before breakfast, two hours after breakfast, before lunch, two hours after lunch, before dinner, two hours after dinner, and at 10 PM, 12 midnight and 3 AM in 68 type 2 diabetic patients before and after optimizing glycemic control. The areas under the curve above fasting BG (AUC1) and above 5.6 mmol/l (AUC2) were calculated for further evaluation. Hb (A1c) was measured at baseline and after a mean of 89 (74 to 108) days.Each BG value at baseline and after treatment optimization significantly correlated with baseline and follow-up Hb (A1c), respectively. The pre-breakfast BG showed the closest correlation with Hb (A1c). The relative contribution of postprandial BG concentrations (AUC1) to overall hyperglycemia (AUC2) decreased with poorer glycemic control. However, treatment optimization mainly resulted in improved blood glucose values in patients with the poorest glycemic control at baseline. Multiple regression analysis demonstrated that fasting (AUC2-AUC1) and postprandial (AUC1) hyperglycemia independently determined Hb (A1c) or the change in Hb (A1c) after treatment optimization.Our findings indicate that intensive blood glucose monitoring during fasting and postprandial states is important for glycemic control, and is therefore an essential part of good clinical practice.
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Objective:To observe postprandial glycemic excursions in gestational diabetes mellitus(GDM) patients using the Continuous Glucose Monitoring System(CGMS).Methods:Fifteen pregnant women were chosen to be evaluated with a 1 h/50 g glucose challenge test and a 3 h/100 g oral glucose tolerance test.The fifteen GDM patients using the CGMS were evaluated for 72 consecutive hours.The postprandial glycemic data taken from 0～180 by 30 minutes interval after each meal was analyzed.Results:There was a significant increment of postprandial glycemea after breakfast than lunch or dinner.Preprandial glycemic data revealed a vale in one day(5.15±0.01)mmol/L.Within postprandial 3 hours,the average of glycemic value was 5.96±1.63 mmol/L.There were significant excursions from the vale to peak of glycemic data from 3.36±0.47 mmol/L to 9.58±1.38 mmol/L.In GDM women,the postprandial 2 hours glycemic data was ≥7.2 mmol/L(7 cases),≥11.1 mmol/L(one case),and ≤3.9 mmol/L(4 cases).Conclusions:CGMS can help observe the postprandial glycemic excursions in GDM,and contribute to the decision of therapy approach:diet,exercise or drug treatment during pregnancy.
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ABSTRACTABSTRACTBackground: Decisions regarding diabetes management traditionally have been driven by the results of fasting plasma glucose measurement or measurement of glycosylated hemoglobin (A1C), yet glycemic control remains far from optimal in many individuals with diabetes. Mounting evidence implicates glycemic variability, manifested predominantly as postprandial glycemic spikes, as a key factor in the development of macrovascular complications. Recent studies suggest that newer therapies specifically targeting postprandial hyperglycemia can significantly reduce postprandial glucose levels and improve overall glycemic control.Methods: A Medline search was performed using the term ‘postchallenge’ or ‘postprandial’, together with glucose or diabetes. After excluding review articles and case studies, we reviewed primary articles, meta-analyses, and references therein and selected those that best addressed this topic. Selection bias may be considered a potential limitation of this approach.Findings: Although not conclusively demonstrated by prospective studies, a wealth of evidence suggests that postprandial hyperglycemia should not be ignored as an important target for preventing complications of diabetes.Conclusions: Improved detection and management of postprandial hyperglycemia and glycemic variability is necessary to optimize glycemic control. Meal-based self-monitoring of blood glucose (SMBG) has been shown to improve glycemic control as part of a comprehensive management strategy by helping patients understand the effects of food choices, physical activity, and medications on blood glucose concentrations. SMBG can also help healthcare professionals recognize postprandial hyperglycemia, guide therapeutic adjustments and receive more timely feedback regarding medication changes. The arrival of new therapies that specifically target postprandial hyperglycemia offer healthcare professionals the opportunity to optimally manage diabetes. Key words: : Glucose excursionsGlycemic variabilityPostprandial hyperglycemiaSelf-monitoring of blood glucose
Blood Glucose Self-Monitoring
Diabetes management
Blood glucose monitoring
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Intensive treatment has been shown to improve glycemic control and reduce the risk of diabetic complications in controlled clinical trials; however, glycemic control has substantial room for improvement in the diabetic population. Management strategies have traditionally focused on achieving A1c targets, with fasting glucose levels serving as the primary measure of day-to-day glycemic control. Considerable evidence indicates that postchallenge plasma glucose, a surrogate for postprandial hyperglycemia, is an independent cardiovascular risk factor, highlighting the fact that optimal glycemic control requires management of both fasting and postprandial glucose levels. Self-monitoring of blood glucose (SMBG) is an important adjunct for optimizing glycemic control, owing to its ability to differentiate between fasting and postprandial hyperglycemia and to provide feedback on the effects of food choices, medications, and exercise. New and emerging medications specifically targeting postprandial hyperglycemia offer the ability to customize pharmacologic therapy to address specific glycemic defects. Periodic glucose profiles and regular SMBG will remain an important tool for both patients and healthcare professionals when using these newer approaches.
Blood Glucose Self-Monitoring
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Individuals with type 2 diabetes (T2D) have poor glycemic control which contributes to cardiovascular disease and other diabetic comorbidities. The often relied upon measures of fasting glucose and glycosylated hemoglobin (HbA1c) do not accurately represent glycemic control because they do not reflect what occurs after meals and throughout the day in the free-living condition. An accumulating body of evidence now suggests that postprandial glucose fluctuations are more tightly correlated with microvascular and macrovascular morbidities and cardiovascular mortality than HbA1c or fasting glucose, stagnant measure of glycemia. Thus, effective therapies are needed which will improve not only HbA1c and fasting glucose, but also regulation of postprandial glycemia. Further, testing for glycemic control should employ a challenge that simulates the free-living condition to best determine how glucose is regulated after meals and throughout the day. Unlike medications, which generally have a poor effect at improving postprandial glucose, exercise is effective in reducing postprandial glycemic excursions in as little as a few days. However, how this is accomplished and the optimal prescription for reducing postprandial glycemic excursions and maintaining improvements in postprandial glycemic control have yet to be elucidated. Still further, the utility of a mixed meal test in providing the optimal challenge for detecting exercise-induced changes in postprandial glycemic control has value that warrants further investigation. Thus, the purpose of this review is to summarize the literature regarding exercise in treating postprandial glycemia in T2D and to review strengths and weaknesses in the current methodology for assessing changes in glycemic control.
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