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A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1_C.

ABSTRACT: To develop an accurate method for evaluating the relative contributions of basal glucose (BG) and postprandial glucose (PPG) to glycated haemoglobin (HbA1c) in subjects with hyperglycaemia using a Continuous Glucose Monitoring System (CGMS®). The subjects were divided into the normal glucose tolerance (NGT), impaired glucose tolerance (IGT), newly-diagnosed type 2 diabetes (NDDM), and drug-treated type 2 diabetes (T2DM) groups. We evaluated the relative contributions of BG and PPG to HbA1c in patients with hyperglycaemia according to three different baseline values. Subjects (n = 490) were grouped as follows: 92 NGT, 36 IGT, 131 NDDM, and 231 T2DM. The relative contributions of PPG to HbA1c were calculated using baseline values of 6.1 mmol/L, 5.6 mmol/L, and the 24-h glucose curve of the NGT group. The relative contribution of PPG to HbA1c decreased progressively from the IGT group to the T2DM group. Compared with the 24-h glucose curve as the baseline, the relative contribution of PPG was overestimated in 9.04% and 1.76% of the subjects when 6.1 mmol/L and 5.6 mmol/L were used as baselines, respectively (P < 0.01), in T2DM patients. The 24-h glucose curve of NGT is more suitable for studying the relative contributions of BG and PPG to HbA1c and it is more precise, as it considers physiological fluctuations in NGT after meals. However, 5.6 mmol/L can be used when the 24-h glucose curve for NGT is unavailable; using 6.1 mmol/L as a baseline value may overestimate the contribution to the HbA1c. There is no unified standard for assessing the contributions of basal glucose (BG) and postprandial glucose (PPG) to HbA1c. The 24-h glucose curve of NGT is more suitable for studying the relative contributions of BG and PPG to HbA1c, as it considers physiological fluctuations in NGT after meals. However, 5.6 mmol/L can be used when the 24-h glucose curve for NGT is unavailable; using 6.1 mmol/L as a baseline value may overestimate the contribution to the HbA1c.

SUBMITTER: Ma J

PROVIDER: S-EPMC8178390 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionFew prospective clinical trials have investigated the role of fasting blood glucose (FBG) and/or postprandial glucose (PPG) in assessing overall glycemic control by using different insulin regimens. In the present post hoc analysis, we assessed the contribution of FBG and/or PPG in overall glycemic control in Chinese patients under insulin treatment.MethodsCLASSIFY is a phase IV, randomized, open-label, 26-week, parallel-arm, treat-to-target, multinational, controlled study in patients with type 2 diabetes mellitus to compare the efficacy and safety of insulin lispro mix 25 (LM25) and insulin lispro mix 50 (LM50) as starter insulins. Insulin was titrated with an aim to target pre-meal blood glucose (BG) levels at > 3.9 and ≤ 6.1 mmol/L before breakfast and dinner. The primary outcome assessed was the change in HbA1c from baseline.ResultsChinese patients contributed 38.7% (N = 156) of the total population. The majority of patients were male (52.6%). The mean (SD) body mass index was 24.54 (3.04) kg/m2 and mean (SD) HbA1c was 8.54 (1.10) % at baseline. At week 26, LM50 showed a significantly greater reduction from baseline in HbA1c (- 2.03% vs - 1.55%, P < 0.001), average daily BG (- 3.21 vs - 2.34 mmol/L, P < 0.001), average post-meal BG (- 3.58 vs - 2.39 mmol/L, P < 0.001), and average prandial BG excursion (- 1.01 vs - 0.22 mmol/L, P = 0.006) than the LM25 group. The reductions in average pre-meal BG (- 2.59 vs - 2.28 mmol/L, P = 0.137) were not significantly different between the groups. The proportion of patients achieving HbA1c targets (< 7% or ≤ 6.5%) without nocturnal hypoglycemia or weight gain was greater (P < 0.05) with LM50 compared with LM25.ConclusionLM50 achieved better overall glycemic control than LM25 as a starter insulin in Chinese patients, which may be due to greater improvement in PPG levels.Trial registrationClinicaltrials.gov identification number: NCT01773473.FundingEli Lilly and Company, Shanghai, China.

Project description:Background: Asymmetric ?-carotene, a provitamin A carotenoid, is cleaved to produce retinol (vitamin A) and ?-retinol (with negligible vitamin A activity). The vitamin A activity of ?-carotene-containing foods is likely overestimated because traditional analytic methods do not separate ?-retinol derivatives from active retinol.Objective: This study aimed to accurately characterize intestinal ?-carotene cleavage and its relative contribution to postprandial vitamin A in humans after consumption of raw carrots.Design: Healthy adults (n = 12) consumed a meal containing 300 g raw carrot (providing 27.3 mg ?-carotene and 18.7 mg ?-carotene). Triglyceride-rich lipoprotein fractions of plasma were isolated and extracted, and ?-retinyl palmitate (?RP) and retinyl palmitate were measured over 12 h postprandially via high-performance liquid chromatography-tandem mass spectrometry. The complete profile of all ?-retinyl esters and retinyl esters was measured at 6 h, and total absorption of ?- and ?-carotene was calculated.Results: ?RP was identified and quantified in every subject. No difference in preference for absorption of ?- over ?-carotene was observed (adjusting for dose, 28% higher, P = 0.103). After absorption, ?-carotene trended toward preferential cleavage compared with ?-carotene (22% higher, P = 0.084). A large range of provitamin A carotenoid conversion efficiencies was observed, with ?-carotene contributing 12-35% of newly converted vitamin A (predicted contribution = 25.5%). In all subjects, a majority of ?-retinol was esterified to palmitic acid (as compared with other fatty acids).Conclusions: ?-Retinol is esterified in the enterocyte and transported in the blood analogous to retinol. The percentage of absorption of ?-carotene from raw carrots was not significantly different from ?-carotene when adjusting for dose, although a trend toward higher cleavage of ?-carotene was observed. The results demonstrate large interindividual variability in ?-carotene conversion. The contribution of newly absorbed ?-carotene to postprandial vitamin A should not be estimated but should be measured directly to accurately assess the vitamin A capacity of ?-carotene-containing foods. This trial was registered at clinicaltrials.gov as NCT01432210.

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A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1_C.

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Dataset Information

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1C.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1_C.