scholarly journals Canagliflozin: A New Therapeutic Option in Patients That Present Postprandial Hyperinsulinemic Hypoglycemia after Roux-en-Y Gastric Bypass: A Pilot Study

Obesity Facts ◽  
2021 ◽  
pp. 1-7
Author(s):  
Andreea Ciudin ◽  
Marta Sánchez ◽  
Irene Hernandez ◽  
Efrain Cordero ◽  
Enzamaria Fidilio ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Pilot Study ◽  
Therapeutic Option ◽  
Tolerance Test ◽  
Glucose Absorption ◽  
Late Complications ◽  
Hyperinsulinemic Hypoglycemia ◽  
Oral Glucose ◽  
Glucose Levels ◽  
Calcium Stimulation

<b><i>Introduction:</i></b> Roux-en-Y gastric bypass (RYGB) is the most common surgical procedure for morbid obesity. However, it can present serious late complications, like postprandial hyperinsulinemic hypoglycemia (PHH). Recent data suggested an increase in intestinal SGLT-1 after RYGB. However, there is no data on the inhibition of SGLT-1 to prevent PHH in patients with prior RYBG. On this basis, we aimed to evaluate (a) the effect of canagliflozin 300 mg on the response to 100 g glucose overload (oral glucose tolerance test [OGTT]); (b) the pancreatic response after intra-arterial calcium stimulation in the context of PHH after RYGB. <b><i>Materials and Methods:</i></b> This is a prospective pilot study including patients (<i>n</i> = 21) with PHH after RYGB, matched by age and gender with healthy controls (<i>n</i> = 5). Basal OGTT and after 2 weeks of daily 300 mg of canagliflozin was performed in all cases. In addition, venous sampling after intra-arterial calcium stimulation of the pancreas was performed in 10 cases. <b><i>Results:</i></b> OGTT after canagliflozin showed a significant reduction of plasma glucose levels (minute 30: 161.5 ± 36.22 vs. 215.9 ± 58.11 mg/dL; minute 60: 187.46 ± 65.88 vs. 225.9 ± 85.60 mg/dL, <i>p</i> &#x3c; 0.01) and insulinemia (minute 30: 95.6 ± 27.31 vs. 216.35 ± 94.86 mg/dL, <i>p</i> = 0.03; minute 60: 120.85 ± 94.86 vs. 342.64 ± 113.32 mIU/L, <i>p</i> &#x3c; 0.001). At minute 180, a significant reduction (85.7%) of the rate of hypoglycemia was observed after treatment with canagliflozin (<i>p</i> &#x3c; 0.00001). All cases presented normal pancreatic response after intra-arterial calcium administration. <b><i>Conclusion:</i></b> Canagliflozin (300 mg) significantly decreased glucose absorption and prevented PHH after 100 g OGTT in patients with RYGB. Our results suggest that canagliflozin could be a new therapeutic option for patients that present PHH after RYGB.

scholarly journals Model-Based Assessment of C-Peptide Secretion and Kinetics in Post Gastric Bypass Individuals Experiencing Postprandial Hyperinsulinemic Hypoglycemia

2021 ◽  
Vol 12 ◽  
Author(s):  
Michele Schiavon ◽  
David Herzig ◽  
Matthias Hepprich ◽  
Marc Y. Donath ◽  
Lia Bally ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Tolerance Test ◽  
Hyperinsulinemic Hypoglycemia ◽  
Oral Glucose ◽  
A Posteriori ◽  
Concentration Data ◽  
Mixed Meal ◽  
C Peptide ◽  
The One ◽  
Peptide Secretion

Assessment of insulin secretion is key to diagnose postprandial hyperinsulinemic hypoglycemia (PHH), an increasingly recognized complication following bariatric surgery. To this end, the Oral C-peptide Minimal Model (OCMM) can be used. This usually requires fixing C-peptide (CP) kinetics to the ones derived from the Van Cauter population model (VCPM), which has never been validated in PHH individuals. The objective of this work was to test the validity of the OCMM coupled with the VCPM in PHH subjects and propose a method to overcome the observed limitations. Two cohorts of adults with PHH after gastric bypass (GB) underwent either a 75 g oral glucose (9F/3M; age=42±9 y; BMI=28.3±6.9 kg/m2) or a 60 g mixed-meal (7F/3M; age = 43 ± 11 y; BMI=27.5±4.2 kg/m2) tolerance test. The OCMM was identified on CP concentration data with CP kinetics fixed to VCPM (VC approach). In both groups, the VC approach underestimated CP-peak and overestimated CP-tail suggesting CP kinetics predicted by VCPM to be inaccurate in this population. Thus, the OCMM was identified using CP kinetics estimated from the data (DB approach) using a Bayesian Maximum a Posteriori estimator. CP data were well predicted in all the subjects using the DB approach, highlighting a significantly faster CP kinetics in patients with PHH compared to the one predicted by VCPM. Finally, a simulation study was used to validate the proposed approach. The present findings question the applicability of the VCPM in patients with PHH after GB and call for CP bolus experiments to develop a reliable CP kinetic model in this population.

THE EFFECT OF THE PROGESTOGEN ETHYNODIOL DIACETATE ON GLUCOSE, INSULIN, AND GROWTH HORMONE AFTER SIX MONTHS TREATMENT

1972 ◽  
Vol 70 (2) ◽  
pp. 373-384 ◽  
Author(s):  
W. N. Spellacy ◽  
W. C. Buhi ◽  
S. A. Birk
Keyword(s):  
Growth Hormone ◽  
Blood Glucose ◽  
Plasma Insulin ◽  
Tolerance Test ◽  
Metabolic Effects ◽  
Oral Glucose ◽  
Hormone Levels ◽  
Glucose Levels ◽  
Ethynodiol Diacetate ◽  
Tolerance Curve

ABSTRACT Seventy-one women were treated with a daily dose of 0.25 mg of the progestogen ethynodiol diacetate. They were all tested with a three-hour oral glucose tolerance test before beginning the steroid and then again during the sixth month of use. Measurements were made of blood glucose and plasma insulin and growth hormone levels. There was a significant elevation of the blood glucose levels after steroid treatment as well as a deterioration in the tolerance curve in 12.9% of the women. The plasma insulin values were also elevated after drug treatment whereas the fasting ambulatory growth hormone levels did not significantly change. There was a significant association between the changes in glucose and insulin levels and the subject's age, control weight, or weight gain during treatment. The importance of considering the metabolic effects of the progestogen component of oral contraceptives is stressed.

Antidiabetic Effect of Aqueous Corrigiola telephiifolia in Streptozotocin- Induced Diabetic Rats

2020 ◽  
Vol 10 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Morad Hebi ◽  
Mohamed Eddouks
Keyword(s):  
Blood Glucose ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Diabetic Rats ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Phytochemical Screening ◽  
Antidiabetic Effect ◽  
Glucose Levels ◽  
Blood Glucose Levels

Background: Corrigiola telephiifolia Pourr, is a perennial species, woody distributed throughout the north of Africa. This plant is used in traditional Mediterranean preparations and has many traditional uses especially treatment of diabetes. Aim/Methods: The current research was carried out to evaluate the antidiabetic effect of Aerial Parts of Aqueous Extract (APAE) of Corrigiola telephiifolia (C. telephiifolia) on both normal and streptozotocin (STZ)-induced diabetic rats treated at a dose of 5 mg/kg for fifteen days. Additionally, the histopathological changes in the liver, morphometric analysis, Oral Glucose Tolerance Test (OGTT) in normal rats and preliminary phytochemical screening for various components were realized. Results: Single oral administration of the APAE of C. telephiifolia (5mg/kg) showed no significant change in glycaemia of normal and STZ-induced diabetic rats. In contrast, repeated oral administration of C. telephiifolia reduced blood glucose levels from 4.11 ± 0.10 mmol/L to 3.16 ± 0.16 mmol/L (p<0.01) 15 days after administration in normal rats. Furthermore, blood glucose levels decreased from 17.84 ± 1.75mmol/L to 1.93 ± 0.33 mmol/L (p<0.0001) in STZ diabetic rats after fifteen days of treatment. According to the oral glucose tolerance test, C. telephiifolia (5 mg/kg) was shown to prevent significantly the increase in blood glucose levels in normal treated rats 30 min after glucose administration when compared to the control group. Also, the liver architecture of diabetic rats treated by C. telephiifolia was improved when compared with the liver architecture of untreated diabetic rats. Concerning the preliminary phytochemical screening of C. telephiifolia, several compounds have been found such as polyphenols, flavonoids, saponins, mucilage and terpenoids. Conclusion: The results show that the aqueous extract of C. telephiifolia possesses significant antihyperglycemic activity.

scholarly journals Parameters of Glucose Homeostasis in the Recognition of the Metabolic Syndrome in Young Adults with Prader–Willi Syndrome

2021 ◽  
Vol 10 (23) ◽  
pp. 5635
Author(s):  
Graziano Grugni ◽  
Antonio Fanolla ◽  
Fiorenzo Lupi ◽  
Silvia Longhi ◽  
Antonella Saezza ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Glucose Homeostasis ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Prader Willi Syndrome ◽  
Insulinogenic Index ◽  
Glucose Levels ◽  
The Metabolic Syndrome ◽  
Diagnostic Threshold ◽  
Age Related

To verify the accuracy of different indices of glucose homeostasis in recognizing the metabolic syndrome in a group of adult patients with Prader–Willi syndrome (PWS), 102 PWS patients (53 females/49 males), age ±SD 26.9 ± 7.6 yrs, Body Mass Index (BMI) 35.7 ± 10.7, were studied. The following indices were assessed in each subject during an oral glucose tolerance test (OGTT): 1 h (>155 mg/dL) and 2 h (140–199 mg/dL) glucose levels, the oral disposition index (ODI), the insulinogenic index (IGI), the insulin resistance (HOMA-IR) were evaluated at baseline, 1 h and 2 h. Although minor differences among indices were found, according to the ROC analysis, no index performed better in recognizing MetS. Furthermore, the diagnostic threshold levels changed over the years and therefore the age-related thresholds were calculated. The easily calculated HOMA-IR at baseline may be used to accurately diagnose MetS, thus avoiding more complicated procedures.

scholarly journals A Nutraceutical Combination of Cinnamon, Purple Onion, and Tea Linked with Key Enzymes on Treatment of Type 2 Diabetes

2021 ◽  
Author(s):  
Lebin Weng ◽  
Ting-Hsu Chen ◽  
Liyue Huang ◽  
Dong Lai ◽  
Yaw-Syan Fu ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Maximal Response ◽  
Oral Glucose ◽  
Postprandial Plasma Glucose ◽  
Glucose Levels ◽  
High Fructose ◽  
Tea Extract

Abstract Background: Diabetes mellitus (DM) is concomitant with significant morbidity and mortality and its prevalence is accumulative worldwide. The conventional antidiabetic agents are known to mitigate the symptoms of diabetes; however, they may also cause adverse effects. This study explores the efficacy of polyherbal dietary supplement cinnamon, purple onion, and tea on the mediation of postprandial hyperglycemia for in the search of combinations with a maximal response. Materials and methods: A starch solution (3 g/kg Bwt) of oral starch tolerance test (OSTT) and glucose solution (4 g/kg Bwt) of oral glucose tolerance test (OGTT) with and without cinnamon, purple onion, tea extract (15 mg/kg Bwt), and mixture (each 5 mg/kg Bwt, 1:1:1), metformin (14 mg/kg Bwt), or acarbose (50 mg/kg Bwt) was administered to high fat plus high fructose-induced diabetic mice after an overnight fast. Postprandial plasma glucose levels were measured and incremental areas under the response curve were calculated. Results: Compared with acarbose, the mixture of extracts (purple onion, cinnamon, and tea) indicated decreasing blood glucose in OSTT. In OGTT, the mixture of extracts showed greater efficacy for hypoglycemia when compared with metformin. The molecular docking of α-Amylase, α-Glucosidase, and AMPK confirmed the putatively acting molecules from the extracts of purple onion, cinnamon, and tea. Conclusions: Overall, this investigation evidenced a beneficial mediation for the progression of lowering blood glucose with a combinatory extract of cinnamon, dietary onion, and tea, implicating their prospective as nutraceuticals that might ameliorate hyperglycemia in diabetes.

scholarly journals Gestational diabetes and fetal outcome: a study in a tertiary care centre

2017 ◽  
Vol 6 (10) ◽  
pp. 4458
Author(s):  
V. G. Vanamala
Keyword(s):  
Birth Weight ◽  
Gestational Diabetes ◽  
Tertiary Care ◽  
Tolerance Test ◽  
Fetal Outcome ◽  
Oral Glucose ◽  
Tertiary Care Centre ◽  
Glucose Levels ◽  
The People ◽  
Urine Examination

Background: Due to urbanization and sedentary lifestyle, dietary changes, and increased obesity of the people, the incidence of GDM is steadily on the rise. It is associated with severe morbidity to the mother and the child. It is therefore imperative that an early diagnosis needs to be done so that appropriate treatment can be given.Methods: 1654 women who were included in the study were in their 24 – 28 weeks of gestation. A standardized questionnaire was formatted and details regarding the age, weight, body mass index (BMI), parity, previous medical and obstetrics history and familial history of diabetes, tests for glucose levels, complete blood picture, routine urine examination. Oral glucose tolerance test was done for all the patients after fasting overnight.Results: 87 (5.3%) of them were positive for OGTT and were considered to have Gestational Diabetes mellitus. 67.8% of the patients were in the 25-30 age group. 41.4% were pregnant for the first time and 58.6% were multi gravid. The majority of the patients had a BMI between 26-30. Most of the babies had a birth weight of above 3kgs. Out of them, 39 (44.8%) had a birth weight between 3.1-3.5kgs. <2kgs were seen in 7 (8.0%) patients.Conclusions: GDM complicates pregnancy and results in higher frequency of adverse effects in the mother and new born. Thereby, early detection can result in prompt treatment and lowering the morbidity of the fetal outcomes.

scholarly journals Preliminary phytochemical screening and evaluation of hypoglycemic properties of the root extract of Uveria chamae

2015 ◽  
Vol 10 (2) ◽  
pp. 326 ◽  
Author(s):  
Emordi Jonathan Emeka ◽  
Agbaje Esther Oluwatoyin ◽  
Oreagba Ibrahim Adekunle ◽  
Iribhogbe Osede Ignis
Keyword(s):  
Single Dose ◽  
Blood Glucose ◽  
Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Phytochemical Screening ◽  
Glucose Levels ◽  
Blood Glucose Levels

<p>The purpose of this study is to evaluate the hypoglycaemic properties and preliminary phytochemical screening of <em>Uveria chamae</em>. The hypoglycaemic properties of <em>Uveria chamae</em> was assessed on normoglycaemic rat that received single dose of the extract at 250 and 500 mg/kg body weight and blood glucose levels estimated at 2, 4, and 6 hours (single dose study). The hypoglycaemic property of the extract was also evaluated in normoglycemic rats by oral glucose tolerance test. Phytochemical screening of the extract for the presence of secondary metabolites was performed with standard methods. The extract showed a significant (p&lt;0.05) reduction in blood glucose levels at 2h and 6h compared to control.  The oral glucose tolerance test  result also showed a significant decrease (p&lt;0.05) in blood glucose levels . The study showed that the extract, <em>Uveria chamae</em> has hypoglycaemic properties which may be accounted for by the presence of the phytochemicals.</p><p> </p>

scholarly journals Inhibition of α-Glucosidase, Intestinal Glucose Absorption, and Antidiabetic Properties by Caralluma europaea

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Hayat Ouassou ◽  
Touda Zahidi ◽  
Saliha Bouknana ◽  
Mohamed Bouhrim ◽  
Hassane Mekhfi ◽  
...  
Keyword(s):  
Ethyl Acetate Fraction ◽  
Inhibitory Effect ◽  
Tolerance Test ◽  
Glucose Absorption ◽  
Significant Inhibition ◽  
Oral Glucose ◽  
Glucosidase Activity ◽  
Intestinal Glucose Absorption

Many medicinal plants around the world are used for therapeutic purposes against several diseases, including diabetes mellitus. Due to their composition of natural substances that are effective and do not represent side effects for users, unlike synthetic drugs, in this study, we investigated the inhibitory effect of Caralluma europaea (CE) on α-glucosidase activity in vitro; then the kinetics of the enzyme were studied with increasing concentrations of sucrose in order to determine the inhibition type of the enzyme. In addition, this effect of Caralluma europaea (CE) was confirmed in vivo using rats as an experimental animal model. Among the five fractions of CE, only the ethyl acetate fraction of C. europaea (EACe) induced a significant inhibition of α-glucosidase and its inhibition mode was competitive. The in vivo studies were conducted on mice and rats using glucose and sucrose as a substrate, respectively, to determine the oral glucose tolerance test (OGTT). The results obtained showed that the EACe and the aqueous extract of C. europaea (AECe) have significantly reduced the postprandial hyperglycemia after sucrose and glucose loading in normal and diabetic rats. AECe, also, significantly decreased intestinal glucose absorption, in situ. The results obtained showed that Caralluma europaea has a significant antihyperglycemic activity, which could be due to the inhibition of α-glucosidase activity and enteric absorption of glucose.

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