Video Presentations on Diabetes and the Low Carbohydrate Ketogenic Diet


Dr. Mariela Glandt obtained her BA from the University of Pennsylvania and her medical education at the University of Texas-Houston Medical School. She then completed her residency in internal medicine at Harvard’s Beth Israel Deaconess Medical Center in Boston, where she conducted research on beta cell failure at the Joslin Diabetes Center. Thereafter, she had her endocrinology fellowship at Columbia Presbyterian Hospital in New York, focusing on the reversal of Type 2 diabetes.

Subsequently, Dr. Glandt assumed the role of director at the Diabetes Clinical Trials Center at Hadassah Hospital in Jerusalem alongside Prof. Itamar Raz, where she contributed significantly to international journals and clinical trials. Presently, she is an attending endocrinologist and associate program director of the internal medicine program at Bronx-Lebanon Hospital, dedicating time to enhancing patient and community health education, particularly in obesity and diabetes management.

With a distinguished career spanning over two decades, Dr. Glandt is renowned for her groundbreaking work, including the co-founding of OwnaHealth, a virtual clinic specializing in reversing type 2 diabetes through a comprehensive approach integrating medicine, nutrition, technology, and behavioral modification. Dr. Glandt also oversees the Glandt Center for Diabetes Care in Tel Aviv, Israel, where ketogenic diets are utilized in diabetes treatment. Furthermore, she co-created Eatsane, a company dedicated to producing low-carb foods free of artificial sweeteners, and founded Metabolix, a non-profit organization committed to educating individuals on metabolic health.

016: DIABETES-OBESITY WARRIORS of INDIA - Shashikant Iyengar/Anup Singh & 1st LOW CARB CONFERENCE!

In today's episode we welcome Mr. Shashikant Iyengar, a metabolic health coach of, as well as Mr. Anup Singh, founder of the low carb platform.

Shashikant Iyengar (Shashi) is a metabolic health coach based in India with multiple certifications in his field. He's a Certified Nutrition Network Coach Practitioner™ under the tutelage of the Noakes Foundation of Prof. Tim Noakes of South Africa. He is the first Accredited Metabolic Health Practitioner by The Society of Metabolic Health Practitioners (SMHP) (Low Carb-USA) and is also a recipient of the Ketogenic Diet in Mental Health clinical training from the Diagnosis:Diet platform of the nutritional and metabolic psychiatrist Dr. Georgia Ede. Today, his passion lies in transforming lives as a full-time Metabolic Health Coach, specializing in guiding individuals with type 2 diabetes, hypertension, as well as mental & neurological disorders. This has led to countless success stories, helping many clients achieve remission from type 2 diabetes with less and less dependency to the very medications which he used to promote as a pharmaceutical industry representative for 35 years with Abbot and Pfizer.

Anup Singh founded in 2014. He’s an engineer who graduated from India’s Ivy-league IIT Roorkee with a silver medal for his academic brilliance. He was diagnosed with Type 2 Diabetes since Feb 2011 but managed to completely turn around the game by going low carb, currently living a pill free life. He essentially pioneered what is now a widely quoted and practised idea of 100 gm carbs/day as the upper limit in a low carb diet for Indians. Today, dLife has more than 2,000 combined Indian success stories of diabetes, hypertension, weight loss, and fatty liver reversal. In 2021 Anup Singh & dLife got awarded with the prestigious “Icons of India Award” by India’s renowned media – the Outlook Group.

20 Years Low Carb Experience with Dr. Eric Westman, MD

Few people have as much experience helping patients use a low-carb lifestyle to improve their health as Dr. Westman. He has been doing this for over 20 years, and he approaches low-carb medicine from both a research and clinical perspective. Through the years, he's shared valuable insights about the clinical utility of low-carb lifestyles.

With his extensive knowledge, he's helped thousands of patients revitalize their heath. Interested in low carb? Then here's your chance to hear a veteran practitioner share his wisdom. 

"LCHF and Diabetes: Theory and Clinical Experience" - Dr. Eric Westman, MD

Dr. Eric C. Westman is an associate professor of medicine at Duke University Health System and director of the Duke Lifestyle Medicine Clinic.

Dr. Westman combines clinical research and clinical care to deliver lifestyle treatments for obesity, diabetes and tobacco dependence. He is an internationally known researcher specialising in low-carbohydrate nutrition and is co-author of 'The New Atkins For A New You', 'Keto Clarity' and 'Cholesterol Clarity'. He has also helped do several high-quality scientific studies on low carb.

Dr. Westman is currently the vice president of the American Society of Bariatric Physicians and a fellow of the Obesity Society and the Society of General Internal Medicine. 

"Carbohydrate Restriction for Diabetes: Clinical Trials, Experience & Guidelines" - Dr. William Yancy, MD

Dr. William Yancy is an Internal medicine doctor, obesity medicine specialist, researcher and Fellow of The Obesity Society and a diplomate of the American Board of Obesity Medicine. He has spent most of his career researching obesity and treatments for obesity. He is an associate professor of medicine at Duke University and a staff physician and a researcher at the Durham VA Medical Center.

He is also the director at Duke Diet and Fitness Center, an immersive, residential-style, comprehensive weight management program that serves patients from around the world who come to Duke for a week or longer to change their eating and activity lifestyles, lose weight, improve their health and learn strategies for long-term success.

Dr. Yancy has conducted multiple clinical trials investigating how different dietary and medicinal approaches affect body weight, cardiovascular risk and diabetes, with particular expertise regarding low-carbohydrate eating.

He has also performed a number of studies examining innovative approaches toward improving adherence to lifestyle recommendations and other treatments. He has received several awards for his research and published over 100 peer-reviewed scientific articles.

He received his medical degree from East Carolina University and completed his residency at the University of Pittsburgh. He also has a Masters in Health Sciences from Duke University.

Jeff Volek Explains the Power of Ketogenic Diets to Reverse Type 2 Diabetes

This episode features an important interview with Dr. Jeff Volek, a researcher who has spent the past 20 years studying how humans adapt to carbohydrate-restricted diets.  His most recent work, which is one of the key topics of today’s interview, has focused on the science of ketones and ketogenic diets and their use as a therapeutic tool to manage insulin resistance.

In 2014, Volek became a founder and the chief science officer of Virta Health, an online specialty medical clinic dedicated to reversing diabetes, a chronic disease that has become a worldwide epidemic. The company’s ambitious goal is to reverse type 2 diabetes in 100 million people by 2025.

In addition to his role at Virta, Volek is a registered dietitian and full professor in the department of human sciences at Ohio State University. He is a co-author of “The New Atkins for a New You,” which came out 2010 and spent 16 weeks on The New York Times best-seller list. The book is an updated, easier-to-use version of Dr. Robert Atkins’ original 1972 book, “Dr. Atkins’ Diet Revolution.”

Volek has co-authored four other books, including “The Art and Science of Low Carbohydrate Living” and “The Art and Science of Low Carbohydrate Performance.” Both books are co-authored with and delve somewhat deeper than “The New Atkins” did into the science and application of low-carb diets.

Although numerous studies have confirmed the validity and safety of low-carb and ketogenic diets, Volek and others who support carbohydrate restriction are often criticized for being so one-sided that their work comes across as more advocacy than science. But in “The Art and Science of Low Carbohydrate Living,” Volek writes:

“What is the proper response when three decades of debate about carbohydrate restriction have been largely one-sided and driven more by cultural bias than science? Someone needs to stand up and represent the alternate view and science.”

"Flipping the Switch: From Insulin Resistance to Type 2 Diabetes" - Dr. Benjamin Bikman

Dr. Benjamin Bikman earned his Ph.D. in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore in metabolic disorders. He is currently a professor of pathophysiology and a biomedical scientist at Brigham Young University in Utah.

Dr. Bikman's professional focus as a scientist and professor is to better understand chronic modern-day diseases, with a special emphasis on the origins and consequences of obesity and diabetes, with an increasing scrutiny of the pathogenicity of insulin and insulin resistance. He frequently publishes his research in peer-reviewed journals and presents at international science meetings.

Dr. Bikman has long been an advocate of a ketogenic diet in light of the considerable evidence supporting its use as a therapy for reversing insulin resistance. His website promotes dietary clarity, healing, and freedom through evidence-based science about insulin resistance. Employing cell-autonomous to whole-body systems, Dr. Bikman's recent efforts have focused on exploring the intimate associations between the metabolic and immune systems. 

Insulin and Ketones with Dr. Ben Bikman, PhD

"Insulin vs. Ketones - The Battle for Brown Fat" - Dr. Ben Bikman, PhD

"Ketogenic Diet and Diabetes" - Dr. Richard Feinman, PhD

"Carbohydrate: The Dose is the Poison!" - Dr. Gary Fettke

Dr. Gary Fettke is an Orthopaedic Surgeon practising in Launceston, Tasmania. Along with his wife Belinda, Gary opened the 'Nutrition for Life – Diabetes and Health Research Centre' based in Launceston which provides nutritional care around Tasmania and Australia.

Gary has a longstanding interest in the preventative aspects of health outcomes, particularly before operating on his patients. Recently an AHPRA (Australian Health Practitioner Regulation Agency)  investigation into Gary’s qualifications to give nutritional advice has concluded. This investigation (which lasted for more than two years) has resulted in Gary being issued a ‘caution’.

The Medical Board of Tasmania, under the umbrella of the Australian Health Practitioners Regulatory Authority, have advised him; ”In particular, that he does not provide specific advice or recommendations on the subject of nutrition and how it relates to the management of diabetes or the treatment and/or prevention of cancer.” Gary was later cleared of all charges and issued a formal apology from AHPRA.

"Type 2 Diabetes" - Dr. Gary Fettke

The Perfect Treatment for Diabetes and Weight Loss

What is the perfect treatment that can cure type 2 diabetes (!) and lead to effortless weight loss? Listen to the eloquent Dr. Jason Fung describe it in this 12-minute part of a longer interview.

** Observe: This treatment is extremely effective. If you have diabetes and take blood sugar lowering medication (especially insulin injections) you may need to reduce the doses a lot to avoid potentially dangerous hypoglycemia. You may instantly become too healthy for your medication. **

In the full 45 minute interview Dr. Fung goes into more detail about exactly how to add fasting to your low-carb diet, important things to consider and how to avoid potential problems.

"Diabetes Epidemic & You - An Introduction" - Dr. Joseph R. Kraft

Functional Hyperglycemia: Fact or Fiction and the "Diabetes Epidemic and You" - Dr. Joseph R. Kraft

It's the Insulin Resistance, Stupid! (Part One) - Prof. Dr. Tim Noakes

Professor Tim Noakes was born in Harare, Zimbabwe in 1949. As a youngster, he had a keen interest in sport and attended Diocesan College in Cape Town. Following this, he studied at the University of Cape Town (UCT) and obtained an MBChB degree in 1974, an MD in 1981 and a DSc (Med) in Exercise Science in 2002.

Prof. Noakes has published more than 750 scientific books and articles. He has been cited more than 19,000 times in scientific literature, has an H-index of 71 and has been rated an A1 scientist by the National Research Foundation of South Africa for a second 5-year term.  He has won numerous awards over the years and made himself available on many editorial boards.

In 2012, Tim founded 'The Noakes Foundation', a Non-Profit Corporation founded for public benefit which aims to advance medical science’s understanding of the benefits of a low-carb high-fat (LCHF) diet by providing evidence-based information on optimum nutrition that is free from commercial agenda. The foundation has also started the Eat Better South Africans campaign, which allows South Africans in even the poorest communities to adopt a high-fat, low-carb, extremely healthy diet for just three dollars per day. 

It's the Insulin Resistance, Stupid! (Part Two) - Prof. Dr. Tim Noakes

"Nine Years of Low Carb T2DM: Making a Long-Term Difference" - Dr. David Unwin & Dr. Jen Unwin

Dr. David Unwin is a practicing GP based in Southport in the United Kingdom and is a recognised international expert on the topic of carbohydrates and Type 2 diabetes. After 25 years of attempting to treat diabetes by conventional methods, Dr. Unwin stumbled upon the website and from this revelation now ignores official advice and treats his patients with a low-carbohydrate diet.

David is the RCGP National Champion for Collaborative Care and Support Planning in Obesity & Diabetes. In 2015 he won the North West NHS ‘Innovator of the Year Award’ and in 2016 he won the National NHS 'Innovator of the Year Award' for his work in treating diabetes with a low carb.

Dr. Jen Unwin is a consultant clinical health psychologist who has worked in the NHS for over 30 years, helping people with chronic illnesses to improve their lives. She is also former chair of the UK Association for Solution Focused Practice. 

David and Jen are both founding members of the Public Health Collaboration (U.K.) and together the Unwin's have helped pioneer the use of low carbohydrate diets in the treatment of obesity and diabetes through a patient-centric model of ‘hope’.

Doctor's Low Carb Transformation - with Dr. David Unwin

Dr. Unwin was on the verge of retiring as a general practice physician in the UK. Then he found the power of low-carb nutrition and helped hundreds of patients in ways he never thought possible! As a result, he won the prestigious NHS Innovator of the Year award and was named one of the top ten most influential GPs in the UK.

Unwin continues to help patients dramatically improve their health through low-carb living. His story is an inspiration to physicians and patients alike. Dr. Unwin is leading the way to spread the message: there's a better way to achieve health. 

Low Carb for Doctors: Explaining Low Carb in a Simple Way

How do you make low carb simple for patients? Dr. Unwin explains that carbs break down into surprising amounts of sugar in the body.

In the sixth part of our low carb for doctors series, Dr. Unwin explains how doctors can explain the concept of low carb in simple terms to their patients.

Scholarly Articles on Diabetes and the Ketogenic Diet

Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical TrialPurpose: Studies on long-term sustainability of low-carbohydrate approaches to treat diabetes are limited. We previously reported the effectiveness of a novel digitally-monitored continuous care intervention (CCI) including nutritional ketosis in improving weight, glycemic outcomes, lipid, and liver marker changes at 1 year. Here, we assess the effects of the CCI at 2 years.Materials and methods: An open label, non-randomized, controlled study with 262 and 87 participants with T2D were enrolled in the CCI and usual care (UC) groups, respectively. Primary outcomes were retention, glycemic control, and weight changes at 2 years. Secondary outcomes included changes in body composition, liver, cardiovascular, kidney, thyroid and inflammatory markers, diabetes medication use and disease status.Results: Reductions from baseline to 2 years in the CCI group resulting from intent-to-treat analyses included: HbA1c, fasting glucose, fasting insulin, weight, systolic blood pressure, diastolic blood pressure, triglycerides, and liver alanine transaminase, and HDL-C increased. Spine bone mineral density in the CCI group was unchanged. Use of any glycemic control medication (excluding metformin) among CCI participants declined (from 55.7 to 26.8%) including insulin (-62%) and sulfonylureas (-100%). The UC group had no changes in these parameters (except uric acid and anion gap) or diabetes medication use. There was also resolution of diabetes (reversal, 53.5%; remission, 17.6%) in the CC...
A Company Is Only as Healthy as Its Workers: A 6-Month Metabolic Health Management Pilot Program Improves Employee Health and Contributes to Cost SavingsChronic diet-related metabolic diseases, including diabetes and obesity, impose enormous burdens on patient wellness, healthcare costs, and worker productivity. Given the interdependent nature of the human and economic costs of metabolic disease, companies should be incentivized to invest in the health of their workforce. We report data from an ongoing pilot program in which employees of a manufacturing company with obesity, prediabetes, or diabetes are being treated by a metabolic health clinic using a carbohydrate restriction, community-orientated telemedicine approach. 10 patients completed the first 6 months of the program, and all lost weight, with a mean weight reduction of 38.4 lbs (17.4 kg). Improvements in HbA1c, fasting glucose, HOMA-IR, triglycerides, C-reactive protein, and systolic blood pressure were also observed across the group. Furthermore, the 10-year risk of having a major cardiovascular event, as calculated by the American Heart Association risk calculator, decreased from a mean of 9.22 to 5.18%, representing a 44% relative risk reduction. As a result of improvements in their metabolic health, patients were able to discontinue medications, leading to an estimated annualized cost savings of USD 45,171.70. These preliminary data provide proof-of-principle that when companies invest in the metabolic health of their workers, both parties stand to gain.
Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 yearsBackground In a single general practice (GP) surgery in England, there was an eightfold increase in the prevalence of type 2 diabetes (T2D) in three decades with 57 cases and 472 cases recorded in 1987 and 2018, respectively. This mirrors the growing burden of T2D on the health of populations round the world along with healthcare funding and provision more broadly. Emerging evidence suggests beneficial effects of carbohydrate-restricted diets on glycaemic control in T2D, but its impact in a ‘real-world’ primary care setting has not been fully evaluated. Methods Advice on a lower carbohydrate diet was offered routinely to patients with newly diagnosed and pre-existing T2D or prediabetes between 2013 and 2019, in the Norwood GP practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations, to help patients better understand the glycaemic consequences of their dietary choices with a particular focus on sugar, carbohydrates and foods with a higher Glycaemic Index. Those interested were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters. Results By 2019, 128 (27%) of the practice population with T2D and 71 people with prediabetes had opted to follow a lower carbohydrate diet for a mean duration of 23 months. For patients with T2D, the median (IQR) weight dropped from of 99.7 (86.2, 109.3) kg to 91.4 (79, 101.1) kg, p<0.001, while the median (IQR) HbA1c dropped from 65.5 (55, 82) mmol/mol to 48 (43, 55) mmol/mol, p<0.001. For patients with prediabetes, the median (IQR) HbA1c dropped from 44 (43, 45) mmol/mol to 39 (38, 41) mmol/mol, p<0.001. Drug-free T2D remission occurred in 46% of participants. In patients with prediabetes, 93% attained a normal HbA1c. Since 2015, there has been a relative reduction in practice prescribing of drugs for diabetes leading to a T2D prescribing budget £50 885 per year less than average for the area. Conclusions This approach to lower carbohydrate dietary advice for patients with T2D and prediabetes was incorporated successfully into routine primary care over 6 years. There were statistically significant improvements in both groups for weight, HbA1c, lipid profiles and blood pressure as well as significant drug budget savings. These results suggest a need for more empirical research on the effects of lower carbohydrate diet and long-term glycaemic control while recording collateral impacts to other metabolic health outcomes.
What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight lossBackground Type 2 diabetes (T2D) is often regarded as a progressive, lifelong disease requiring an increasing number of drugs. Sustained remission of T2D is now well established, but is not yet routinely practised. Norwood surgery has used a low-carbohydrate programme aiming to achieve remission since 2013. Methods Advice on a lower carbohydrate diet and weight loss was offered routinely to people with T2D between 2013 and 2021, in a suburban practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations and personal phone calls as necessary. Those interested in participating were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters. Results The cohort who chose the low-carbohydrate approach (n=186) equalled 39% of the practice T2D register. After an average of 33 months median (IQR) weight fell from 97 (84–109) to 86 (76–99) kg, giving a mean (SD) weight loss of −10 (8.9)kg. Median (IQR) HbA1c fell from 63 (54–80) to 46 (42–53) mmol/mol. Remission of diabetes was achieved in 77% with T2D duration less than 1 year, falling to 20% for duration greater than 15 years. Overall, remission was achieved in 51% of the cohort. Mean LDL cholesterol decreased by 0.5 mmol/L, mean triglyceride by 0.9 mmol/L and mean systolic blood pressure by 12 mm Hg. There were major prescribing savings; average Norwood surgery spend was £4.94 per patient per year on drugs for diabetes compared with £11.30 for local practices. In the year ending January 2022, Norwood surgery spent £68 353 per year less than the area average. Conclusions A practical primary care-based method to achieve remission of T2D is described. A low-carbohydrate diet-based approach was able to achieve major weight loss with substantial health and financial benefit. It resulted in 20% of the entire practice T2D population achieving remission. It appears that T2D duration <1 year represents an important window of opportunity for achieving drug-free remission of diabetes. The approach can also give hope to those with poorly controlled T2D who may not achieve remission, this group had the greatest improvements in diabetic control as represented by HbA1c. Data may be obtained from a third party and are not publicly available.
Adapting Medication for Type 2 Diabetes to a Low Carbohydrate DietHealthcare professionals in the primary care setting need to be competent to safely adapt diabetes medications when patients with Type 2 Diabetes (T2D) alter their diet. Safe prescribing practice is supported through an understanding of the clinical evidence, basic science, and pharmacology of medications. This review article supports clinicians in the practical application of this knowledge to achieve safe practice. Traditional medical training and clinical practice for chronic disease has long revolved around the teaching of intensifying therapy and evidenced based prescribing, a crucial skill when chronic disease progresses. Now that we are witnessing remission of Type 2 Diabetes through nutritional interventions specifically low carbohydrate diets (LCD) we must apply the same effort and thought to de-prescribing as the underlying metabolic condition improves. There is minimal guidance in the literature on how to actively de-prescribe. The American Diabetes Association in their Standards of Medical Care in Diabetes–2021 acknowledges low carbohydrate nutritional therapy (LCD) as a viable option in the management of Type 2 Diabetes (T2D). Thus, the goal of our paper is to help close the gap between the clinical evidence, basic science, and pharmacology of T2D medications to the practical application and teamwork needed to facilitate safe medication reduction in the primary care setting when applied to a LCD. The LCD is an increasingly popular and effective option for mana...
Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guideThe pathological changes associated with type 2 diabetes (T2D) can be reversed through lifestyle measures, in some cases leading to remission.1 The low carbohydrate diet (LCD) is recognised as an effective option that is clinically inexpensive with few side effects.2 Many patients are achieving significant improvements in glycaemic control, with associated reduction in drug costs from cessation of hypoglycaemic agents.3 Digital-technology behaviour change solutions for T2D remission are being delivered at scale.4 Primary care clinicians need to be competent to adjust diabetes medications appropriately in individuals who follow an LCD. An LCD comprises <130 g of digestible carbohydrates per day.5 Digestible carbohydrate refers to sugars and complex carbohydrates such as starch, which is digested to glucose. Aligned with national guidance, carbohydrate choices in an LCD will typically be higher fibre and low glycaemic index (GI).6 Reduced total carbohydrate ingestion and low GI choices give the LCD a low glycaemic load (GL). In T2D the GI and GL of food consumed is a determinant of blood glucose level and thus the requirement for hypoglycaemic medication. Blood glucose levels typically fall substantially when an individual adopts an LCD. This article discusses key considerations regarding hypoglycaemic medications for an LCD and provides practical suggestions to prescribers. The recommendations are developed from the experience of the authors, discussion with …
Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical TrialPurpose: Studies on long-term sustainability of low-carbohydrate approaches to treat diabetes are limited. We previously reported the effectiveness of a novel digitally-monitored continuous care intervention (CCI) including nutritional ketosis in improving weight, glycemic outcomes, lipid, and liver marker changes at 1 year. Here, we assess the effects of the CCI at 2 years.Materials and methods: An open label, non-randomized, controlled study with 262 and 87 participants with T2D were enrolled in the CCI and usual care (UC) groups, respectively. Primary outcomes were retention, glycemic control, and weight changes at 2 years. Secondary outcomes included changes in body composition, liver, cardiovascular, kidney, thyroid and inflammatory markers, diabetes medication use and disease status.Results: Reductions from baseline to 2 years in the CCI group resulting from intent-to-treat analyses included: HbA1c, fasting glucose, fasting insulin, weight, systolic blood pressure, diastolic blood pressure, triglycerides, and liver alanine transaminase, and HDL-C increased. Spine bone mineral density in the CCI group was unchanged. Use of any glycemic control medication (excluding metformin) among CCI participants declined (from 55.7 to 26.8%) including insulin (-62%) and sulfonylureas (-100%). The UC group had no changes in these parameters (except uric acid and anion gap) or diabetes medication use. There was also resolution of diabetes (reversal, 53.5%; remission, 17.6%) in the CC...
Improvement in Glucose Regulation Using a Digital Tracker and Continuous Glucose Monitoring in Healthy Adults and Those with Type 2 Diabetes - Diabetes TherapyIntroduction While continuous glucose monitoring (CGM) has been shown to decrease both hyper- and hypoglycemia in insulin-treated diabetes, its value in non-insulin-treated type 2 diabetes (T2D) and prediabetes is unclear. Studies examining the reduction in hyperglycemia with the use of CGM in non-insulin-treated T2D are limited. Methods We investigated the potential benefit of CGM combined with a mobile app that links each individual’s glucose tracing to meal composition, heart rate, and physical activity in a cohort of 1022 individuals, ranging from nondiabetic to non-insulin-treated T2D, spanning a wide range of demographic, geographic, and socioeconomic characteristics. The primary endpoint was the change in time in range (TIR), defined as 54–140 mg/dL for healthy and prediabetes, and 54–180 mg/dL for T2D, from the beginning to end of a 10-day period of use of the Freestyle Libre CGM. Logged food intake, physical activity, continuous glucose, and heart rate data were captured by a smartphone-based app that continuously provided feedback to participants, overlaying daily glucose patterns with activity and food intake, including macronutrient breakdown, glycemic load (GL), and glycemic index (GI). Results A total of 665 participants meeting eligibility and data requirements were included in the final analysis. Among self-reported nondiabetic participants, CGM identified glucose excursions in the diabetic range among 15% of healthy and 36% of those with prediabetes. In the group as a whole, TIR improved significantly (p < 0.001). Among the 51.4% of participants who improved, TIR increased by an average of 6.4% (p < 0.001). Of those with poor baseline TIR, defined as TIR below comparable A1c thresholds for T2D and prediabetes, 58.3% of T2D and 91.7% of healthy/prediabetes participants improved their TIR by an average of 22.7% and 23.2%, respectively. Predictors of improved response included no prior diagnosis of T2D and lower BMI. Conclusions These results indicate that 10-day use of CGM as a part of multimodal data collection, with synthesis and feedback to participants provided by a mobile health app, can significantly reduce hyperglycemia in non-insulin-treated individuals, including those with early stages of glucose dysregulation.
Diabetic status and the relation of the three domains of glycemic control tomortality in critically ill patients: an international multicenter cohort study - Critical CareIntroduction Hyperglycemia, hypoglycemia, and increased glycemic variability have each beenindependently associated with increased risk of mortality in critically illpatients. The role of diabetic status on modulating the relation of these threedomains of glycemic control with mortality remains uncertain. The purpose of thisinvestigation was to determine how diabetic status affects the relation ofhyperglycemia, hypoglycemia, and increased glycemic variability with the risk ofmortality in critically ill patients. Methods This is a retrospective analysis of prospectively collected data involving 44,964patients admitted to 23 intensive care units (ICUs) from nine countries, betweenFebruary 2001 and May 2012. We analyzed mean blood glucose concentration (BG),coefficient of variation (CV), and minimal BG and created multivariable models toanalyze their independent association with mortality. Patients were stratifiedaccording to the diagnosis of diabetes. Results Among patients without diabetes, mean BG bands between 80 and 140 mg/dl wereindependently associated with decreased risk of mortality, and mean BG bands> 140 mg/dl, with increased risk of mortality. Among patients withdiabetes, mean BG from 80 to 110 mg/dl was associated with increased risk ofmortality and mean BG from 110 to 180 mg/dl with decreased risk of mortality. Aneffect of center was noted on the relation between mean BG and mortality.Hypoglycemia, defined as minimum BG <70 mg/dl, was independently associatedwith increased risk of mortality among patients with and without diabetes andincreased glycemic variability, defined as CV > 20%, was independentlyassociated with increased risk of mortality only among patients without diabetes.Derangements of more than one domain of glycemic control had a cumulativeassociation with mortality, especially for patients without diabetes. Conclusions Although hyperglycemia, hypoglycemia, and increased glycemic variability is eachindependently associated with mortality in critically ill patients, diabeticstatus modulates these relations in clinically important ways. Our findingssuggest that patients with diabetes may benefit from higher glucose target rangesthan will those without diabetes. Additionally, hypoglycemia is independentlyassociated with increased risk of mortality regardless of the patient's diabeticstatus, and increased glycemic variability is independently associated withincreased risk of mortality among patients without diabetes. See related commentary by Krinsley, See related commentary by Finfer and Billot,
The association between glycemic index, glycemic load, and metabolic syndrome: a systematic review and dose–response meta-analysis of observational studies - European Journal of NutritionPurpose The association of glycemic index (GI) and glycemic load (GL) with metabolic syndrome (MetS) is controversial. Therefore, we conducted this first systematic review and dose–response meta-analysis of observational studies to quantify these associations. Methods We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies up to 1 April 2019. Summary odds ratios (OR) and 95% confidence intervals (CI) were calculated by a random-effects model. This study was registered with PROSPERO (CRD42019131788). Results We included eight high-quality (n = 5) or medium-quality (n = 3) cross-sectional studies in the final meta-analysis, comprising 6058 MetS events and 28,998 participants. The summary ORs of MetS for the highest versus lowest categories were 1.23 (95% CI 1.10–1.38, I2 = 0, tau2 = 0, n = 5) for dietary GI, 1.06 (95% CI 0.89–1.25, I2 = 36.2%, tau2 = 0.0151, n = 6) for dietary GL. The summary OR was 1.12 (95% CI 1.00–1.26, I2 = 0, tau2 = 0, n = 3) per 5 GI units, 0.96 (95% CI 0.83–1.10, I2 = 33.4%, tau2 = 0.0059, n = 2) per 20 GL units. Conclusions Dietary GI was positively associated with the prevalence of MetS. However, no significant association was found between dietary GL and the prevalence of MetS. Further studies with prospective design are needed to establish potential causal relationship between dietary GI and the MetS.
Dysregulated carbohydrate and lipid metabolism and risk of atrial fibrillation in advanced old ageObjective Obesity and dysmetabolism are major risk factors for atrial fibrillation (AF). Fasting and postload levels of glucose and non-esterified fatty acids (NEFAs) reflect different facets of metabolic regulation. We sought to study their respective contributions to AF risk concurrently. Methods We assessed levels of fasting and postload glucose and NEFA in the Cardiovascular Health Study to identify associations with AF incidence and, secondarily, with ECG parameters of AF risk available at baseline. Linear and Cox regressions were performed. Results The study included 1876 participants (age 77.7±4.4). During the median follow-up of 11.4 years, 717 cases of incident AF occurred. After adjustment for potential confounders, postload glucose showed an association with incident AF (HR per SD increment of postload glucose=1.11, 95% CI 1.02 to 1.21, p=0.017). Both glucose measures, but not NEFA, were positively associated with higher P wave terminal force in V1 (PTFV1); the association remained significant only for postload glucose when the two measures were entered together (β per SD increment=138 μV·ms, 95% CI 15 to 260, p=0.028). Exploratory analyses showed significant interaction by sex for fasting NEFA (pinteraction=0.044) and postload glucose (pinteraction=0.015) relative to AF, with relationships stronger in women. For postload glucose, the association with incident AF was observed among women but not among men. Conclusions Among older adults, postload glucose was positively associated with incident AF, with consistent findings for PTFV1. In exploratory analyses, the relationship with AF appeared specific to women. These findings require further study but suggest that interventions to address postprandial dysglycaemia late in life might reduce AF. Data are available upon reasonable request.
Postprandial blood glucose as a risk factor for cardiovascular disease in Type II diabetes: the epidemiological evidence - DiabetologiaThat cardiovascular disease occurs more frequently in patients with Type II (non-insulin-dependent) diabetes mellitus has been recognized for a long time. However, the extent to which hyperglycaemia contributes to atherosclerosis and cardiovascular disease is still not clear. Epidemiological studies published in recent years suggest that postprandial blood glucose might be an independent risk factor of cardiovascular disease. The main results of these studies, which are reviewed in this article, are that subjects from the general population with mild to moderate hyperglycaemia, following oral glucose load, but not in the fasting state, showed an increased cardiovascular risk. Furthermore, the post-challenge as well as postprandial glucose concentrations of subjects with Type II diabetes were found to be directly associated to incident cardiovascular disease independently of fasting glucose. Also, the correction of fasting hyperglycaemia or HbA1 c or both, disregarding the specific correction of postprandial hyperglycaemia was not found to significantly reduce the incidence of cardiovascular disease in patients with Type II diabetes. Finally, the strict control of both preprandial and postprandial hyperglycaemia yielded a substantial reduction of cardiovascular disease in Type II diabetes. Trials specifically designed to address this issue are needed to determine whether postprandial hyperglycaemia plays an independent and causative role in cardiovascular disease in patients with Type II diabetes. [Diabetologia (2001) 44: 2107–2114]
Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study - BMC Endocrine DisordersBackground The shapes of the plasma glucose concentration curve during the oral glucose tolerance test are related to different metabolic risk profiles and future risk of type 2 DM. We sought to further analyze the relationship between the specific shapes and hyperglycemic states, the metabolic syndrome and hormones involved in carbohydrate and lipid metabolism, and to isolate the effect of the shape by adjusting for the area under the glucose curve. Methods One hundred twenty one adult participants underwent a 2-h oral glucose tolerance test and were assigned to either the monophasic (n = 97) or the biphasic (n = 24) group based upon the rise and fall of their plasma glucose concentration. We evaluated anthropometric measures, blood pressure, lipid profile, high-sensitivity C-reactive protein, glycated hemoglobin, insulin sensitivity, beta-cell function, C-peptide, glucagon, adiponectin and pancreatic polypeptide. Results Subjects with monophasic curves had higher fasting and 2-h plasma glucose levels, while presenting lower insulin sensitivity, beta-cell function, HDL cholesterol, adiponectin and pancreatic polypeptide levels. Prediabetes and metabolic syndrome had a higher prevalence in this group. Glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein and glucagon were not significantly different between groups. After adjusting for the area under the glucose curve, only the differences in the 1-h and 2-h plasma glucose concentrations and HDL cholesterol levels between the monophasic and biphasic groups remained statistically significant. Conclusions Rates and intensity of metabolic dysfunction are higher in subjects with monophasic curves, who have lower insulin sensitivity and beta-cell function and a higher prevalence of prediabetes and metabolic syndrome. These differences, however, seem to be dependent on the area under the glucose curve.
Dietary sugar consumption and health: umbrella reviewObjective To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary sugar consumption and health outcomes. Design Umbrella review of existing meta-analyses. Data sources PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and hand searching of reference lists. Inclusion criteria Systematic reviews and meta-analyses of randomised controlled trials, cohort studies, case-control studies, or cross sectional studies that evaluated the effect of dietary sugar consumption on any health outcomes in humans free from acute or chronic diseases. Results The search identified 73 meta-analyses and 83 health outcomes from 8601 unique articles, including 74 unique outcomes in meta-analyses of observational studies and nine unique outcomes in meta-analyses of randomised controlled trials. Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected. Moderate quality evidence suggested that the highest versus lowest dietary sugar consumption was associated with increased body weight (sugar sweetened beverages) (class IV evidence) and ectopic fatty accumulation (added sugars) (class IV evidence). Low quality evidence indicated that each serving/week increment of sugar sweetened beverage consumption was associated with a 4% higher risk of gout (class III evidence) and each 250 mL/day increment of sugar sweetened beverage consumption was associated with a 17% and 4% higher risk of coronary heart disease (class II evidence) and all cause mortality (class III evidence), respectively. In addition, low quality evidence suggested that every 25 g/day increment of fructose consumption was associated with a 22% higher risk of pancreatic cancer (class III evidence). Conclusions High dietary sugar consumption is generally more harmful than beneficial for health, especially in cardiometabolic disease. Reducing the consumption of free sugars or added sugars to below 25 g/day (approximately 6 teaspoons/day) and limiting the consumption of sugar sweetened beverages to less than one serving/week (approximately 200-355 mL/week) are recommended to reduce the adverse effect of sugars on health. Systematic review registration PROSPERO CRD42022300982. The list of all meta-analyses not selected for data extraction and reanalysis is available if needed.
Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysisObjective To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. Design Updated meta-analysis. Data sources Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. Review methods Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. Results A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10). Conclusions Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.