-
Nutrients Sep 2023Although gestational diabetes mellitus (GDM) has several short- and long-term adverse effects on the mother and the offspring, no medicine is generally prescribed to... (Meta-Analysis)
Meta-Analysis Review
Although gestational diabetes mellitus (GDM) has several short- and long-term adverse effects on the mother and the offspring, no medicine is generally prescribed to prevent GDM. The present systematic review and meta-analysis aimed to investigate the effect of inositol supplementation in preventing GDM and related outcomes. Systematic search was performed in CENTRAL, MEDLINE, and Embase until 13 September 2023. Eligible randomized controlled trials (RCTs) compared the efficacy of inositols to placebo in pregnant women at high risk for GDM. Our primary outcome was the incidence of GDM, whereas secondary outcomes were oral glucose tolerance test (OGTT) and maternal and fetal complications. (PROSPERO registration number: CRD42021284939). Eight eligible RCTs were identified, including the data of 1795 patients. The incidence of GDM was halved by inositols compared to placebo (RR = 0.42, CI: 0.26-0.67). Fasting, 1-h, and 2-h OGTT glucose levels were significantly decreased by inositols. The stereoisomer myoinositol also reduced the risk of insulin need (RR = 0.29, CI: 0.13-0.68), preeclampsia or gestational hypertension (RR = 0.38, CI: 0.2-0.71), preterm birth (RR = 0.44, CI: 0.22-0.88), and neonatal hypoglycemia (RR = 0.12, CI: 0.03-0.55). Myoinositol decrease the incidence of GDM in pregnancies high-risk for GDM. Moreover, myoinositol supplementation reduces the risk of insulin need, preeclampsia or gestational hypertension, preterm birth, and neonatal hypoglycemia. Based on the present study 2-4 g myoinositol canbe suggested from the first trimester to prevent GDM and related outcomes.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Diabetes, Gestational; Premature Birth; Pre-Eclampsia; Hypertension, Pregnancy-Induced; Randomized Controlled Trials as Topic; Hypoglycemia; Insulin; Inositol
PubMed: 37836508
DOI: 10.3390/nu15194224 -
Nutrition Journal Oct 2023It is suggested that supplementation with milk protein (MP) has the potential to ameliorate the glycemic profile; however, the exact impact and certainty of the findings... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is suggested that supplementation with milk protein (MP) has the potential to ameliorate the glycemic profile; however, the exact impact and certainty of the findings have yet to be evaluated. This systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) assessed the impact of MP supplementation on the glycemic parameters in adults.
METHODS
A systematic search was carried out among online databases to determine eligible RCTs published up to November 2022. A random-effects model was performed for the meta-analysis.
RESULTS
A total of 36 RCTs with 1851 participants were included in the pooled analysis. It was displayed that supplementation with MP effectively reduced levels of fasting blood glucose (FBG) (weighted mean difference (WMD): -1.83 mg/dL, 95% CI: -3.28, -0.38; P = 0.013), fasting insulin (WMD: -1.06 uU/mL, 95% CI: -1.76, -0.36; P = 0.003), and homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: -0.27, 95% CI: -0.40, -0.14; P < 0.001) while making no remarkable changes in serum hemoglobin A1c (HbA1c) values (WMD: 0.01%, 95% CI: -0.14, 0.16; P = 0.891). However, there was a significant decline in serum levels of HbA1c among participants with normal baseline body mass index (BMI) based on sub-group analyses. In addition, HOMA-IR values were significantly lower in the MP supplement-treated group than their untreated counterparts in short- and long-term supplementation (≤ 8 and > 8 weeks) with high or moderate doses (≥ 60 or 30-60 g/d) of MP or whey protein (WP). Serum FBG levels were considerably reduced upon short-term administration of a low daily dose of WP (< 30 g). Furthermore, the levels of serum fasting insulin were remarkably decreased during long-term supplementation with high or moderate daily doses of WP.
CONCLUSION
The findings of this study suggest that supplementation with MP may improve glycemic control in adults by reducing the values of fasting insulin, FBG, and HOMA-IR. Additional trials with longer durations are required to confirm these findings.
Topics: Adult; Humans; Glycated Hemoglobin; Blood Glucose; Milk Proteins; Diabetes Mellitus, Type 2; Dietary Supplements; Insulin; Insulin Resistance; Whey Proteins
PubMed: 37798798
DOI: 10.1186/s12937-023-00878-1 -
International Journal of Molecular... Sep 2023The objective of this meta-analysis was to examine the impact of a low-ratio linoleic acid/α-linolenic acid (LA/ALA) diet on the glycemic profile of adults. A... (Meta-Analysis)
Meta-Analysis Review
The objective of this meta-analysis was to examine the impact of a low-ratio linoleic acid/α-linolenic acid (LA/ALA) diet on the glycemic profile of adults. A comprehensive search was performed across four databases (Web of Science, Scopus, Embase, and PubMed) to evaluate the influence of the low-ratio LA/ALA. Relevant references were screened up until February 2023. Intervention effects were analyzed by calculating change values as weighted mean differences (WMD) and 95% confidence intervals (CI) using fixed-effects models. Additionally, subgroup analysis and meta-regression were employed to investigate potential sources of heterogeneity. Twenty-one randomized controlled trials (RCTs) were included, and the low-ratio LA/ALA diet had no significant effect on fasting blood sugar (FBS, WMD: 0.00 mmol/L, 95% CI: -0.06, 0.06, = 0.989, I = 0.0%), insulin levels (WMD: 0.20 μIU/mL, 95% CI: -0.23, 0.63, = 0.360, I = 3.2%), homeostatic model assessment insulin resistance (HOMA-IR, WMD: 0.09, 95% CI: -0.06, 0.23, = 0.243, I = 0.0%), and hemoglobin A1c (HbA1c, WMD: -0.01%, 95% CI: -0.07, 0.06, = 0.836, I = 0.0%). Based on subgroup analyses, it was observed that the impact of a low-ratio LA/ALA diet on elevated plasma insulin (WMD: 1.31 μIU/mL, 95% CI: 0.08, 2.54, = 0.037, I = 32.0%) and HOMA-IR (WMD: 0.47, 95% CI: 0.10, 0.84, = 0.012, I = 0.0%) levels exhibited greater prominence in North America compared to Asian and European countries. Publication bias was not detected for FBS, insulin, HOMA-IR, and HbA1c levels according to the Begg and Egger tests. Furthermore, the conducted sensitivity analyses indicated stability, as the effects of the low-ratio LA/ALA diet on various glycemic and related metrics remained unchanged even after removing individual studies. Overall, based on the available studies, it can be concluded that the low-ratio LA/ALA diet has limited impact on blood glucose-related biomarker levels.
Topics: Adult; Humans; Glycated Hemoglobin; Linoleic Acid; alpha-Linolenic Acid; Glucose; Insulin
PubMed: 37762686
DOI: 10.3390/ijms241814383 -
Current Nutrition Reports Dec 2023Dietary patterns that include polyphenols may help manage cardiometabolic risk factors. Pigmented rice contains phenolic acids and flavonoids that contribute to its...
PURPOSE OF REVIEW
Dietary patterns that include polyphenols may help manage cardiometabolic risk factors. Pigmented rice contains phenolic acids and flavonoids that contribute to its antioxidant properties. This review examined the effect of polyphenol-containing pigmented rice on antioxidant status, lipid profile, glucose/insulin, blood pressure, and weight among adults. Four electronic databases including PubMed, ProQuest, EBSCOhost, and Google Scholar were systematically searched for relevant articles published in English since 2000, using PRISMA guidelines (PROSPERO registration: CRD42022358132). Two-staged screening resulted in the inclusion of seventeen (seven acute, ten chronic) randomized controlled trials. A random effects model was conducted on cardiometabolic outcomes reported in at least three studies.
RECENT FINDINGS
Acute intake increased plasma antioxidant activity and lowered postprandial glucose and insulin levels. Chronic consumption was associated with reductions in fasting glucose (WMD: -1.60 mg/dL; 95% CI:-3.05,-0.14, p = 0.03, k = 5, n = 349), weight (WMD: -0.23 kg, 95% CI: -0.44, -0.02, p = 0.03, k = 3, n = 182), and diastolic blood pressure (WMD: -1.39 mmHg, 95% CI: -2.21, -0.56, p = 0.001, k = 3, n = 185). No effect on total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, body mass index, and systolic blood pressure was found. The consumption of pigmented rice may improve cardiometabolic risk factors. However, the small number of studies and differences in study design, including participants' health status, form of rice utilized, and duration of intervention, support the need for more high-quality trials to further investigate these findings.
Topics: Adult; Humans; Antioxidants; Cardiovascular Diseases; Glucose; Insulins; Oryza; Randomized Controlled Trials as Topic
PubMed: 37676476
DOI: 10.1007/s13668-023-00496-7 -
European Journal of Pediatrics Nov 2023This is the first meta-analysis of the available literature about the efficacy of metformin exclusively in pediatric patients with non-alcoholic fatty liver disease... (Meta-Analysis)
Meta-Analysis
This is the first meta-analysis of the available literature about the efficacy of metformin exclusively in pediatric patients with non-alcoholic fatty liver disease (NAFLD). We conducted a systematic literature search through major electronic databases till March 12, 2023, investigating the efficacy and safety of metformin in pediatric NAFLD. Weighted mean difference (WD) and standard deviation (SD) were used for continuous outcomes. In total, 4 randomized controlled trials (RCTs) with 309 pediatric patients with NAFLD were included in the meta-analysis. Metformin could not reach a statistically significant improvement in alanine aminotransferase (ALT) levels [(ALT: WMD = - 1.55 IU/L, 95% CI: - 5.38 to 2.28, I = 16%, p = 0.43), but had a statistically significant impact (p < 0.05) in insulin and HOMA-IR regulation, triglycerides, and high-density lipoprotein level improvement. Conclusion: According to the data of this meta-analysis, treatment with metformin failed to statistically improve liver enzymes but may be beneficial in the improvement of lipid parameters and insulin metabolism regulation in pediatric patients with NAFLD. As there are not enough available studies in the literature, the influence of metformin on liver ultrasonography or histology in pediatric NAFLD should be further analyzed in future studies. What is Known: • Lifestyle modification with weight loss through physical activity and dietary modification is the recommended treatment option for pediatric NAFLD. • Metformin may reduce steatosis on ultrasound and may have a beneficial role in liver histology collated with insulin resistance improvement. What is New: • Metformin may improve insulin sensitivity and lipid parameters in children with obesity and NAFLD. • Metformin does not have a significant effect on transaminase levels in children with obesity and NAFLD.
Topics: Child; Humans; Alanine Transaminase; Insulin; Insulin Resistance; Metformin; Non-alcoholic Fatty Liver Disease; Obesity; Randomized Controlled Trials as Topic; Triglycerides
PubMed: 37639015
DOI: 10.1007/s00431-023-05169-9 -
Frontiers in Endocrinology 2023The aim of present meta-analysis was to determine the effects of exercise training (Exe) on insulin resistance (IR) and body weight in children and adolescents with... (Meta-Analysis)
Meta-Analysis
AIM
The aim of present meta-analysis was to determine the effects of exercise training (Exe) on insulin resistance (IR) and body weight in children and adolescents with overweight or obesity.
METHODS
PubMed, Web of Science, and Scopus were searched for original articles, published through October 2022 that included exercise versus control interventions on fasting glucose, insulin, HOMA-IR, and body weight outcomes in children and adolescents with overweight or obesity. Standardized mean differences (SMD) for fasting insulin, and weighted mean differences (WMD) for fasting glucose, HOMA-IR, body weight (BW), and 95% confidence intervals were determined using random effects models.
RESULTS
Thirty-five studies comprising 1,550 children and adolescents with overweight and obesity were included in the present meta-analysis. Exercise training reduced fasting glucose (WMD=-2.52 mg/dL, p=0.001), fasting insulin (SMD=-0.77, p=0.001), HOMA-IR (WMD=-0.82, p=0.001), and BW (WMD=-1.51 kg, p=0.001), as compared to a control. Subgroup analyses showed that biological sex, intervention duration, type of exercise training, BMI percentile, and health status (with or without diagnosed condition), were sources of heterogeneity.
CONCLUSION
Exercise training is effective for lowering fasting glucose, fasting insulin, HOMA-IR, and BW in children and adolescents with overweight or obesity and could provide an important strategy for controlling IR and related factors. With clear evidence for the effectiveness of exercise interventions in this vulnerable population, it is important to determine effective approaches for increasing exercise training in children and adolescents with overweight or obesity.
Topics: Adolescent; Child; Humans; Body Weight; Exercise; Glucose; Insulin; Insulin Resistance; Overweight; Pediatric Obesity
PubMed: 37635963
DOI: 10.3389/fendo.2023.1178376 -
Pharmacological Research Sep 2023Results from different studies on the effects of selenium supplementation on glycemic control are still debated. To fill this knowledge gap, we investigated the overall... (Meta-Analysis)
Meta-Analysis Review
Results from different studies on the effects of selenium supplementation on glycemic control are still debated. To fill this knowledge gap, we investigated the overall effects of selenium supplementation on some glycemic parameters such as fasting blood sugar (FBS), hemoglobinA1c (HbA1c), fasting insulin, quantitative insulin sensitivity check index (QUICKI), and homeostatic model assessment of insulin resistance (HOMA-IR). A comprehensive literature search was conducted from inception to April 2023 on Scopus, Web of Science, PubMed, Google Scholar, and Cochrane databases. All randomized controlled trials (RCTs) which reported an effect of selenium supplementation on glycemic parameters were included. A random-effects model was used to estimate the weighted mean difference (WMD) and 95% CI for each outcome. Between-studies heterogeneity was assessed by the I and Cochran's Q test. 20 trials were included in the meta-analysis. Pooled analysis showed that selenium intake significantly reduced fasting insulin (WMD: -3.02 µIu/mL, 95% CI; -5.13, -0.90, P = 0.005) and increased QUICKI levels (WMD: 0.01, 95% CI: 0.01, 0.02, P = 0.005). However, selenium supplementation did not change FBS (WMD: -1.32 mg/dL, 95% CI; -4.02, 1.37, P = 0.332), HbA1c (WMD = 0.05%, 95% CI: -0.19, 0.28, p = 0.701), and HOMA-IR (WMD: -0.82, 95% CI; -2.14, 0.50, P = 0.223). Moreover, we found that there is a non-linear association between selenium supplementation dosage and FBS (P-nonlinearity = 0.008). In conclusion, our study findings indicate some benefits of selenium on fasting insulin, and QUICKI compared with placebo, but elicits no effect on HbA1c, HOMA-IR, and FBS. Further well-designed RCTs with larger samples are necessary to ascertain the effects of selenium supplementation on glycemic control.
Topics: Humans; Glycated Hemoglobin; Blood Glucose; Dietary Supplements; Selenium; Randomized Controlled Trials as Topic; Insulin; Insulin Resistance
PubMed: 37574154
DOI: 10.1016/j.phrs.2023.106888 -
The Journal of Clinical Endocrinology... Jan 2024Polycystic ovary syndrome (PCOS) affects more than 1 in 10 women. (Meta-Analysis)
Meta-Analysis
CONTEXT
Polycystic ovary syndrome (PCOS) affects more than 1 in 10 women.
OBJECTIVE
As part of the 2023 International PCOS Guidelines update, comparisons between combined oral contraceptive pills (COCP), metformin, and combination treatment were evaluated.
DATA SOURCES
Ovid Medline, Embase, PsycINFO, All EBM, and CINAHL were searched.
STUDY SELECTION
Women with PCOS included in randomized controlled trials (RCTs).
DATA EXTRACTION
We calculated mean differences and 95% CIs regarding anthropometrics, metabolic, and hyperandrogenic outcomes. Meta-analyses and quality assessment using GRADE were performed.
DATA SYNTHESIS
The search identified 1660 publications; 36 RCTs were included. For hirsutism, no differences were seen when comparing metformin vs COCP, nor when comparing COCP vs combination treatment with metformin and COCP. Metformin was inferior on free androgen index (FAI) (7.08; 95% CI 4.81, 9.36), sex hormone binding globulin (SHBG) (-118.61 nmol/L; 95% CI -174.46, -62.75) and testosterone (0.48 nmol/L; 95% CI 0.32, 0.64) compared with COCP. COCP was inferior for FAI (0.58; 95% CI 0.36, 0.80) and SHBG (-16.61 nmol/L; 95% CI -28.51, -4.71) compared with combination treatment, whereas testosterone did not differ. Metformin lowered insulin (-27.12 pmol/L; 95% CI -40.65, -13.59) and triglycerides (-0.15 mmol/L; 95% CI -0.29, -0.01) compared with COCP. COCP was inferior for insulin (17.03 pmol/L; 95% CI 7.79, 26.26) and insulin resistance (0.44; 95% CI 0.17, 0.70) compared with combination treatment.
CONCLUSIONS
The choice of metformin or COCP treatment should be based on symptoms, noting some biochemical benefits from combination treatment targeting both major endocrine disturbances seen in PCOS (hyperinsulinemia and hyperandrogenism).
Topics: Female; Humans; Metformin; Polycystic Ovary Syndrome; Contraceptives, Oral, Combined; Hypoglycemic Agents; Testosterone; Insulins
PubMed: 37554096
DOI: 10.1210/clinem/dgad465 -
Journal of Diabetes Dec 2023Blood glucose control is central to the management of diabetes, and continuous glucose monitoring (CGM) improves glycemic control. We aimed to describe the perspectives...
AIMS
Blood glucose control is central to the management of diabetes, and continuous glucose monitoring (CGM) improves glycemic control. We aimed to describe the perspectives of people with diabetes using CGM.
MATERIALS AND METHODS
We performed a systematic review of qualitative studies.
RESULTS
Fifty-four studies involving 1845 participants were included. Six themes were identified: gaining control and convenience (reducing pain and time, safeguarding against complications, achieving stricter glucose levels, and sharing responsibility with family); motivating self-management (fostering ownership, and increasing awareness of glycemic control); providing reassurance and freedom (attaining peace of mind, and restoring social participation); developing confidence (encouraged by the endorsement of others, gaining operational skills, customizing settings for ease of use, and trust in the device); burdened with device complexities (bewildered by unfamiliar technology, reluctant to rely on algorithms, overwhelmed by data, frustrated with malfunctioning and inaccuracy, distressed by alerts, and bulkiness of machines interfering with lifestyle); and excluded by barriers to access (constrained by cost, lack of suppliers).
CONCLUSIONS
CGM can improve self-management and confidence in patients managing diabetes. However, the technical issues, uncertainty in readings, and cost may limit the uptake. Education and training from the health professionals may help to reduce the practical and psychological burden for better patient outcomes.
Topics: Humans; Diabetes Mellitus, Type 1; Blood Glucose; Blood Glucose Self-Monitoring; Continuous Glucose Monitoring; Quality of Life; Insulin Infusion Systems; Hyperinsulinism; Patient Outcome Assessment; Insulins; Insulin; Hypoglycemic Agents
PubMed: 37551735
DOI: 10.1111/1753-0407.13454 -
The American Journal of Clinical... Aug 2023Serving whey protein before a meal in order to lower postprandial blood glucose concentrations is known as a premeal. The underlying mechanisms are only partly... (Meta-Analysis)
Meta-Analysis
Whey Protein Premeal Lowers Postprandial Glucose Concentrations in Adults Compared with Water-The Effect of Timing, Dose, and Metabolic Status: a Systematic Review and Meta-analysis.
BACKGROUND
Serving whey protein before a meal in order to lower postprandial blood glucose concentrations is known as a premeal. The underlying mechanisms are only partly understood but may involve stimulation of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and insulin secretion together with a slower gastric emptying rate.
OBJECTIVES
The objective of this systematic review and meta-analysis was to review all randomized clinical trials investigating premeals with whey protein in comparison with a nonactive comparator (control) that evaluated plasma glucose, GLP-1, GIP, insulin, and/or gastric emptying rate. Secondary aims included subgroup analyses on the timing and dose of the premeal together with the metabolic state of the participants [lean, obese, and type 2 diabetes mellitus (T2DM)].
METHODS
We searched EMBASE, CENTRAL, PUBMED, and clinicaltrials.gov and found 16 randomized crossover trials with a total of 244 individuals. The last search was performed on 9 August, 2022.
RESULTS
Whey protein premeals lowered peak glucose concentration by -1.4 mmol/L [-1.9 mmol/L; -0.9 mmol/L], and the area under the curve for glucose was -0.9 standard deviation (SD) [-1.2 SD; -0.6 SD] compared with controls (high certainty). In association with these findings, whey protein premeals elevated GLP-1 (low certainty) and peak insulin (high certainty) concentrations and slowed gastric emptying rate (high certainty) compared with controls. Subgroup analyses showed a more pronounced and prolonged glucose-lowering effect in individuals with T2DM compared with participants without T2DM. The available evidence did not elucidate the role of GIP. The protein dose used varied between 4 and 55 g, and meta-regression analysis showed that the protein dose correlated with the glucose-lowering effects.
CONCLUSIONS
In conclusion, whey protein premeals lower postprandial blood glucose, reduce gastric emptying rate, and increase peak insulin. In addition, whey protein premeals may elevate plasma concentrations of GLP-1. Whey protein premeals may possess clinical potential, but the long-term effects await future clinical trials.
Topics: Humans; Adult; Whey Proteins; Glucagon; Blood Glucose; Diabetes Mellitus, Type 2; Water; Insulin; Glucagon-Like Peptide 1; Gastric Inhibitory Polypeptide; Glucose; Gastric Emptying; Postprandial Period
PubMed: 37536867
DOI: 10.1016/j.ajcnut.2023.05.012