A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: a randomized controlled clinical trial. Effect of alpha-lipoic acid on blood glucose, insulin resistance and glutathione peroxidase of type 2 diabetic patients. Effects of the Dietary Approaches to Stop Hypertension (DASH) Eating Plan on Cardiovascular Risks Among Type 2 Diabetic Patients Effect of Therapeutic Dose of Vitamin D on Serum Adiponectin and Glycemia in Vitamin D-Insufficient or Deficient Type 2 Diabetic Patients Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Prudent diet and the risk of insulin resistance. Lowering Uric Acid With Allopurinol Improves Insulin Resistance and Systemic Inflammation in Asymptomatic Hyperuricemia Pre-teen insulin resistance predicts weight gain, impaired fasting glucose, and type 2 diabetes at age 18-19 y: a 10-y prospective study of black and white girls. The Association between Adherence to the Mediterranean Diet and Fasting Indices of Glucose Homoeostasis: The ATTICA Study The effect of ginger powder supplementation on insulin resistance and glycemic indices in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial. Impact of treatment with oral calcitriol on glucose indices in type 2 diabetes mellitus patients. Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity: the OmniCarb randomized clinical trial. Comparison of glycaemic control over 1 year with pioglitazone or gliclazide in patients with Type 2 diabetes. Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study. Chromium Nicotinate Has No Effect on Insulin Sensitivity, Glycemic Control, and Lipid Profile in Subjects with Type 2 Diabetes Significance of an index of insulin resistance in non-diabetic patients with impaired fasting glucose with acute myocardial infarction and its correlation to short term outcome. Consumption of a Diet Low in Advanced Glycation End Products for 4 Weeks Improves Insulin Sensitivity in Overweight Women The Effects of Metformin on Body Mass Index and Glucose Tolerance in Obese Adolescents With Fasting Hyperinsulinemia and a Family History of Type 2 Diabetes Telmisartan reduced blood pressure and HOMA-IR with increasing plasma leptin level in hypertensive and type 2 diabetic patients. Efficacy and safety of glimepiride as initial treatment in Chinese patients with Type 2 diabetes mellitus Total and undercarboxylated osteocalcin predict changes in insulin sensitivity and β cell function in elderly men at high cardiovascular risk. Metformin Plus Low-Dose Glimeperide Significantly Improves Homeostasis Model Assessment for Insulin Resistance (HOMAIR) and β-Cell Function (HOMAβ-cell) Without Hyperinsulinemia in Patients With Type 2 Diabetes Mellitus
OBJECTIVE To our knowledge , no reports are available indicating the effects of the dietary approaches to stop hypertension ( DASH ) eating plan on insulin resistance , inflammation , and oxidative stress among pregnant women with gestational diabetes mellitus ( GDM ) . This study was design ed to investigate the effects of the DASH diet on insulin resistance , serum high-sensitivity C-reactive protein ( hs-CRP ) and biomarkers of oxidative stress among pregnant women with GDM . METHODS This r and omized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation . Participants were r and omly assigned to consume either the control ( n = 16 ) or DASH diet ( n = 16 ) for 4 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and was low in saturated fats , total fats , cholesterol , refined grains , and sweets , with a total of 2400 mg/d of sodium . The control diet contained 40 % to 55 % of its energy as carbohydrates , 10 % to 20 % as proteins , and 25 % to 30 % as total fats . Fasting blood sample s were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose ( FPG ) , serum insulin , and hs-CRP , homeostasis model of assessment -insulin resistance ( HOMA-IR ) , plasma total antioxidant capacity ( TAC ) , and total glutathione levels ( GSH ) . RESULTS Consumption of the DASH diet compared with the control diet result ed in decreased FPG ( -7.62 versus 3.68 mg/dL ; P = 0.02 ) , serum insulin levels ( -2.62 versus 4.32 μIU/mL , P = 0.03 ) , and HOMA-IR score ( -0.8 versus 1.1 ; P = 0.03 ) . Increased concentrations of plasma TAC ( 45.2 versus -159.2 mmol/L ; P < 0.0001 ) and GSH ( 108.1 versus -150.9 μmol/L ; P < 0.0001 ) also were seen in the DASH group compared with control group . We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets . Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet , while a significant increase in these biomarkers in the DASH diet . CONCLUSION Consumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG , serum insulin levels , HOMA-IR score , plasma TAC , and total GSH levels . The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies UNLABELLED This study was design ed to assess the effects of Dietary Approaches to Stop Hypertension ( DASH ) eating plan on insulin resistance and serum hs-CRP in overweight and obese women with PCOS . This r and omized controlled clinical trial was done on 48 women diagnosed with PCOS . Subjects were r and omly assigned to consume either the control ( n=24 ) or the DASH eating pattern ( n=24 ) for 8 weeks . The DASH diet consisted of 52 % carbohydrates , 18 % proteins , and 30 % total fats . It was design ed to be rich in fruits , vegetables , whole grains , and low-fat dairy products and low in saturated fats , cholesterol , refined grains , and sweets . Sodium content of the DASH diet was design ed to be less than 2 400 mg/day . The control diet was also design ed to contain 52 % carbohydrates , 18 % protein , and 30 % total fat . Fasting blood sample s were taken at baseline and after 8 weeks intervention to measure -insulin resistance and serum hs-CRP levels . -Adherence to the DASH eating pattern , compared to the -control diet , result ed in a significant reduction of serum insulin levels ( -1.88 vs. 2.89 μIU/ml , p=0.03 ) , HOMA-IR score ( -0.45 vs. 0.80 ; p=0.01 ) , and serum hs-CRP levels ( -763.29 vs. 665.95 ng/ml , p=0.009 ) . Additionally , a significant reduction in waist ( -5.2 vs. -2.1 cm ; p=0.003 ) and hip circumference ( -5.9 vs. -1 cm ; p<0.0001 ) was also seen in the DASH group compared with the control group . In conclusion , consumption of the DASH eating pattern for 8 weeks in overweight and obese women with PCOS result ed in the improvement of insulin resistance , serum hs-CRP levels , and abdominal fat accumulation . CLINICAL TRIAL REGISTRATION NUMBER www.i rct .ir : I RCT 201304235623N6 OBJECTIVE To examine the effects of alpha-lipoic acid ( ALA ) treatment over a period of 2 months on fasting blood glucose ( FBG ) , insulin resistance ( IR ) , and glutathione peroxidase ( GH-Px ) activity in type 2 diabetes ( T2DM ) patients . METHODS This study took place in Motahari Clinic , Shiraz , Iran , which is affiliated to Shiraz University of Medical Sciences from May to October 2006 . Type 2 DM patients ( n=57 ) were divided into 2 groups to receive either ALA ( 300 mg daily ) or placebo by systematic r and omization , and were followed-up for 8 weeks . After an overnight fasting and 2 hours after breakfast , patients ' blood sample s were drawn and tested for FBG , 2 hours  PPG , serum insulin level , and GH-Px activity .  RESULTS The result of the study showed a significant decrease in FBG and PPG levels , IR-Homeostasis Model Assessment ( IR-HOMA index ) and GH-Px level in the ALA group . The comparison of differences between FBG and IR at the beginning and at the end of study in the ALA treated group and the placebo group were also significant . CONCLUSION This study supports the use of ALA as an antioxidant in the care of diabetic patients OBJECTIVE To determine the effects of the Dietary Approaches to Stop Hypertension ( DASH ) eating pattern on cardiometabolic risks in type 2 diabetic patients . RESEARCH DESIGN AND METHODS A r and omized crossover clinical trial was undertaken in 31 type 2 diabetic patients . For 8 weeks , participants were r and omly assigned to a control diet or the DASH eating pattern . RESULTS After following the DASH eating pattern , body weight ( P = 0.007 ) and waist circumference ( P = 0.002 ) reduced significantly . Fasting blood glucose levels and A1C decreased after adoption of the DASH diet ( −29.4 ± 6.3 mg/dl ; P = 0.04 and −1.7 ± 0.1 % ; P = 0.04 , respectively ) . After the DASH diet , the mean change for HDL cholesterol levels was higher ( 4.3 ± 0.9 mg/dl ; P = 0.001 ) and LDL cholesterol was reduced ( −17.2 ± 3.5 mg/dl ; P = 0.02 ) . Additionally , DASH had beneficial effects on systolic ( −13.6 ± 3.5 vs. −3.1 ± 2.7 mmHg ; P = 0.02 ) and diastolic blood pressure ( −9.5 ± 2.6 vs. −0.7 ± 3.3 mmHg ; P = 0.04 ) . CONCLUSIONS Among diabetic patients , the DASH diet had beneficial effects on cardiometabolic risks Background : Lower vitamin D status has been reported in diabetic patients . Serum 25-hydroxyvitamin D and adiponectin were inversely associated with type 2 diabetes and insulin resistance . Vitamin D may involve in regulation of the adiponectin levels , which is directly related to insulin sensitivity . Objectives : The aim of this study was to investigate the effect of therapeutic dose of vitamin D on serum adiponectin and insulin resistance in vitamin D-insufficient or deficient type 2 diabetic patients . Material s and Methods : This double-blind , r and omized , clinical trial was conducted on 81 type 2 diabetic patients with vitamin D level of 10 - 30 ng/mL. Intervention was 50000 IU vitamin D or placebo once a week for 8 weeks . At the beginning and end of the study , blood sample s were collected after 12 hours of fasting and serum glucose , insulin , 25-hydroxyvitamin D , and adiponectin were measured . Insulin resistance was calculated by homeostasis model assessment ( HOMA-IR ) . Results : After 8-week intervention , serum 25-hydroxyvitamin D significantly increased and reached the normal levels in patients receiving vitamin D ( P < 0.001 ) and the levels of fasting serum glucose , insulin , and HOMA-IR were significantly decreased ( P = 0.04 , 0.02 and 0.007 , respectively ) . No significant changes were observed in these levels in the placebo group . Significant differences were observed in mean changes in the above-mentioned variables between the two groups ( P = 0.01 , 0.04 and 0.006 , respectively ) . No significant changes were found in serum adiponectin in the vitamin D and placebo groups ( P = 0.83 ) . Conclusions : Therapeutic dose of vitamin D can improve vitamin D status and glycemic indicators . But it seems that an 8-week intervention period was not sufficient to reveal the possible effects of vitamin D on serum adiponectin levels Although gestational diabetes mellitus ( GDM ) is associated with an increased risk of maternal and neonatal morbidity , there is no consensus as to the optimal approach of nutritional management in these patients . The present study was design ed to assess the effect of the Dietary Approaches to Stop Hypertension ( DASH ) eating plan on glucose tolerance and lipid profiles of pregnant women with GDM . The present r and omised controlled clinical trial was performed among thirty-four women diagnosed with GDM at 24 - 28 weeks of gestation . Subjects were r and omly assigned to consume either the control diet ( n 17 ) or the DASH eating pattern ( n 17 ) for 4 weeks . The control diet was design ed to contain 45 - 55 % carbohydrates , 15 - 20 % protein and 25 - 30 % total fat . The macronutrient composition of the DASH diet was similar to the control diet ; however , the DASH diet was rich in fruits , vegetables , whole grains and low-fat dairy products , and contained lower amounts of saturated fats , cholesterol and refined grains with a total of 2400 mg Na/d . Fasting blood sample s were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose , glycated Hb ( HbA1c ) and lipid profiles . Participants underwent a 3 h oral glucose tolerance tests and blood sample s were collected at 60 , 120 and 180 min to measure plasma glucose levels . Adherence to the DASH eating pattern , compared with the control diet , result ed in improved glucose tolerance such that plasma glucose levels reduced at 60 ( 21·86 v. 20·45 mmol/l , Pgroup = 0·02 ) , 120 ( 22·3 v. 0·2 mmol/l , Pgroup = 0·001 ) and 180 min ( 21·7 v. 0·22 mmol/l , Pgroup = 0·002 ) after the glucose load . Decreased HbA1c levels ( 20·2 v. 0·05 % , Pgroup = 0·001 ) was also seen in the DASH group compared with the control group . Mean changes for serum total ( 20·42 v. 0·31 mmol/l , Pgroup = 0·01 ) and LDL-cholesterol ( 20·47 v. 0·22 mmol/l , Pgroup = 0·005 ) , TAG ( 20·17 v. 0·34 mmol/l , Pgroup = 0·01 ) and total : HDL-cholesterol ratio ( 20·6 ( SD 0·9 ) v. 0·3 ( SD 0·8 ) , Pgroup = 0·008 ) were significantly different between the two diets . Additionally , consumption of the DASH diet favourably influenced systolic blood pressure ( 22·6 v. 1·7 mmHg , Pgroup = 0·001 ) . Mean changes of fasting plasma glucose ( 20·29 v. 0·15 mmol/l , Pgroup = 0·09 ) were nonsignificant comparing the DASH diet with the control diet . In conclusion , consumption of the DASH eating pattern for 4 weeks among pregnant women with GDM result ed in beneficial effects on glucose tolerance and lipid profiles compared with the control diet BACKGROUND AND AIM Diet is a potentially modifiable risk factor for diabetes .  Dietary patterns may exert greater effects on health than individual foods , nutrients or food groups . Data on associations between dietary patterns and the risk of insulin resistance and type  2 diabetes  are sparse . The aim of the study was to examine associations between dietary patterns and the risk of insulin resistance . METHODS AND RESULTS We performed a cross sectional study involving a group of 1018 men and women , sample d from 17 general practice lists in the South of Irel and , with a response rate of 69 % . Participants completed a detailed health and lifestyle question naire and provided fasting blood sample s for analysis of glucose , insulin and lipids . Dietary intake  was assessed using a food frequency question naire . The food frequency question naire was a modification of the UK arm of the European Prospect i ve Investigation into cancer , EPIC study , which was based on that used in the US Nurses ' Health Study . Dietary patterns were assessed by K cluster analysis . Insulin resistance was estimated on the basis of fasting glucose and insulin , using the glucose homeostasis model ( HOMA scores ) . Insulin resistance was defined as the upper quartile of the HOMA scores . Three dietary patterns were identified by cluster analysis ( traditional Irish diet , a prudent diet and an alcohol and convenience foods diet ) . Participants in clusters 1 ( traditional Irish diet ) and 3 ( high alcohol and convenience foods ) had a lower intake of more ' healthy ' food groups ( such as fruit , vegetables , low fat dairy products , poultry , fish and whole grain products ) and higher intake of foods richer in total and SFA content ( such as high fat dairy products , butter , meat and meat products ) . Cluster 2 ( prudent dietary pattern ) was characterized by a higher intake of food groups that are typically recommended in health promotion programs and a lower intake of meat ( read meat ) , meat products , sweets , high fat dairy and white bread ( white bread and unrefined cereal ) . The prudent diet had the lowest HOMA scores in analysis of covariance . The prevalence of insulin resistance in the prudent diet was lower than that in the traditional diet ( OR=0.53 ; 95%CI , 0.33 - 0.85 in fully adjusted analysis ) . CONCLUSION A prudent diet may be associated with enhanced insulin sensitivity and a lower risk of type 2 diabetes Background Hyperuricemia is an independent predictor of impaired fasting glucose and type 2 diabetes , but whether it has a causal role in insulin resistance remains controversial . Here we tested the hypothesis that lowering uric acid in hyperuricemic nondiabetic subjects might improve insulin resistance . Methods Subjects with asymptomatic hyperuricemia ( n = 73 ) were prospect ively placed on allopurinol ( n = 40 ) or control ( n = 33 ) for 3 months . An additional control group consisted of 48 normouricemic subjects .  Serum uric acid , fasting glucose , fasting insulin , HOMA-IR ( homeostatic model assessment of insulin resistance ) , and high-sensitivity C-reactive protein were measured at baseline and at 3 months . Results Allopurinol-treated subjects showed a reduction in serum uric acid in association with improvement in fasting blood glucose , fasting insulin , and HOMA-IR index , as well as a reduction in serum high-sensitivity C-reactive protein . The number of subjects with impaired fasting glucose significantly decreased in the allopurinol group at 3 months compared with baseline ( n = 8 [ 20 % ] vs n = 30 [ 75 % ] , 3 months vs baseline , P < 0.001 ) . In the hyperuricemic control group , only glucose decreased significantly and , in the normouricemic control , no end point changed . Conclusions Allopurinol lowers uric acid and improves insulin resistance and systemic inflammation in asymptomatic hyperuricemia . Larger clinical trials are recommended to determine if lowering uric acid can help prevent type 2 diabetes BACKGROUND Identifying early pre-teen predictors of  adolescent weight gain and the development of impaired fasting glucose ( IFG ) and type 2 diabetes ( T2DM ) at age 18 - 19 y could provide avenues for prevention . OBJECTIVE We evaluated possible pre-teen predictors for development of IFG , T2DM , and changes in body mass index at age 18 - 19 y in black and white girls . DESIGN In a prospect i ve cohort study , body habitus and fasting insulin and glucose were measured at ages 9 - 10 and 18 - 19 y , and multiple 3-d diet records were collected . Factors predicting 10-y change in body mass index and development of IFG and T2DM together were assessed . RESULTS In multivariate analyses , 10-y change in homeostatic model assessment of insulin resistance ( HOMA-IR ) and the age 9 - 10 y HOMA-IR x percentage of calories from fat interaction were positive predictors of 10-y changes in body mass index . At age 18 - 19 y , there were 5 incident cases of T2DM , 37 cases of IFG , and 597 noncases . Age 9 - 10 y IFG and HOMA-IR ( or insulin ) , 10-y change in HOMA-IR ( or insulin ) , and the age 9 - 10 y insulin x total caloric intake interaction predicted IFG and T2DM at age 18 - 19 y. CONCLUSIONS Pre-teen IFG , insulin resistance ( and insulin ) , and rapidly increasing insulin resistance during adolescence identifies girls who are at greater risk of future IFG and T2DM . In addition , insulin resistance , interacting with high-fat diets , identifies girls who are at risk of greater weight gain . These findings could open avenues to primary prevention of obesity , IFG , and T2DM in children Objective : We investigated the association between adherence to Mediterranean diet and fasting indices of glucose homoeostasis , in a Greek adult population . Methods : During 2001–2002 we r and omly enrolled 1514 men and 1528 women ( 18–89 years old ) without history of CVD , from the Attica area . Diabetes mellitus ( type 2 ) and impaired fasting glucose ( IFG ) were defined according to the established ADA criteria . Insulin resistance was evaluated by HOMA-IR .  Dietary habits  were assessed through a vali date d food frequency question  naire and a diet score  ( range 0–55 ) was developed ( higher values means greater adherence to the Mediterranean diet ) . Results : The overall prevalence of diabetes type 2 was 7.9 % in men and 6.0 % in women ( P = 0.05 ) . Mean diet score was 26.3 ± 6.8 in normoglycemic , 25.7 ± 6.4 in IFG and 22.2 ± 5.8 in diabetic subjects ( p < 0.001 ) . In normoglycemic subjects who were in the upper tertile of the diet score we observed 7 % lower glucose ( p < 0.05 ) , 5 % lower insulin ( p < 0.05 ) and 15 % lower HOMA-IR ( p < 0.01 ) levels compared to subjects in the lower tertile of the diet score . Additionally , in diabetic/IFG participants who where in the upper tertile of the diet score we observed 15 % lower glucose ( p < 0.05 ) , 15 % lower insulin ( p < 0.05 ) and 27 % lower HOMA-IR ( p < 0.01 ) levels compared to those in the lower tertile . However , multiple regression analysis , adjusted for age , sex , BMI , waist-to-hip ratio , physical activity , smoking status , and presence of hypertension and hypercholesterolemia , confirmed the previous associations in normoglycemic , but not in diabetic/IFG people . Conclusion : An inverse association was observed between adherence to Mediterranean diet  and indices of glucose homeostasis , only in normoglycemic people OBJECTIVE To identify the effect of some herbal products on insulin resistance . Regarding the scientific evidence s existing about ginger , this research was therefore carried out to identify the effect of ginger supplementation on insulin resistance and glycemic indices in diabetes mellitus . METHODS This is a r and omized , double-blind , placebo-controlled trial in which 88 participants affected by diabetes were r and omly assigned into ginger ( GG ) and placebo ( PG ) groups . The GG received 3 one-gram capsules containing ginger powder whereas the PG received 3 one-gram microcrystalline-containing capsules daily for 8 weeks . HbA1c , fructosamine , fasting blood sugar ( FBS ) , fasting insulin , homeostasis model assessment insulin resistance index ( HOMA-IR ) , β-cell function ( β% ) , insulin sensitivity ( S% ) and the quantitative insulin sensitivity check index ( QUICKI ) were assessed before and after the intervention . RESULTS FBS mean showed a decrease of 10.5 % ( p=0.003 ) in the GG whereas the mean had an increase of 21 % in the PG ( p=0.01 ) . Variation in HbA1c mean was in line with that of FBS . Statistical difference was found in the two groups before and after the intervention in terms of median of fasting insulin level , S% and HOMA-IR ( P<0.005 ) . Moreover QUICKI mean increased significantly in the two groups , the mean difference , however , was significantly higher in the GG . CONCLUSIONS The study demonstrated that daily consumption of 3 one-gram capsules of ginger powder for 8 weeks is useful for patients with type 2 diabetes due to FBS and HbA1c reduction and improvement of insulin resistance indices such as QUICKI index INTRODUCTION Type 2 diabetes is a major public health problem . Recent epidemiological evidence also points to a potential association of vitamin D insufficiency with adverse metabolic risks , including that for type 2 diabetes . SUBJECTS AND METHOD A double-blind r and omized placebo-controlled trial was carried out . Seventy subjects with type 2 diabetes , age 30 - 75 years old , were r and omly assigned in a double-blind fashion to two groups . One group received two capsules of calcitriol ( 0.25 μg 1,25-dihydroxy cholecalciferol per each capsule ) per day . The second group received placebo tablets . At the beginning , middle and the end of the 12 week supplementation trial , serum glucose , insulin , calcium and phosphorous , HbA1c and 25(OH ) vitamin D were measured . RESULTS There was no significant difference between two groups at baseline . At the end of the study , fasting plasma glucose increased in the control group ( p=0.038 ) , while it remained unchanged in calcitriol group . Level of insulin and HbA1c increased significantly in both groups ( p=0.013 and 0.0004 in treatment and control group ) . Regarding insulin resistance indices , there was a significant change in HOMA-IR and QUICKI in both groups ( p=0.023 and 0.002 in treatment and 0.001 and < 0.001 in control group respectively ) . Insulin secretion as assessed by HOMA-%β , remained relatively unchanged in the control group , while it increased significantly in the treatment group at the end of study ( p=0.009 ) . CONCLUSION Vitamin D supplementation attenuated the increase in glycemia , and increased insulin secretion , but had no effect on insulin resistance IMPORTANCE Foods that have similar carbohydrate content can differ in the amount they raise blood glucose . The effects of this property , called the glycemic index , on risk factors for cardiovascular disease and diabetes are not well understood . OBJECTIVE To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes . DESIGN , SETTING , AND PARTICIPANTS R and omized crossover-controlled feeding trial conducted in research units in academic medical centers , in which 163 overweight adults ( systolic blood pressure , 120 - 159 mm Hg ) were given 4 complete diets that contained all of their meals , snacks , and calorie-containing beverages , each for 5 weeks , and completed at least 2 study diets . The first participant was enrolled April 1 , 2008 ; the last participant finished December 22 , 2010 . For any pair of the 4 diets , there were 135 to 150 participants contributing at least 1 primary outcome measure . INTERVENTIONS ( 1 ) A high-glycemic index ( 65 % on the glucose scale ) , high-carbohydrate diet ( 58 % energy ) ; ( 2 ) a low-glycemic index ( 40 % ) , high-carbohydrate diet ; ( 3 ) a high-glycemic index , low-carbohydrate diet ( 40 % energy ) ; and ( 4 ) a low-glycemic index , low-carbohydrate diet . Each diet was based on a healthful DASH-type diet . MAIN OUTCOMES AND MEASURES The 5 primary outcomes were insulin sensitivity , determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test ; levels of low-density lipoprotein ( LDL ) cholesterol , high-density lipoprotein ( HDL ) cholesterol , and triglycerides ; and systolic blood pressure . RESULTS At high dietary carbohydrate content , the low- compared with high-glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units ( -20 % , P = .002 ) ; increased LDL cholesterol from 139 to 147 mg/dL ( 6 % , P ≤ .001 ) ; and did not affect levels of HDL cholesterol , triglycerides , or blood pressure . At low carbohydrate content , the low- compared with high-glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL ( -5 % , P = .02 ) . In the primary diet contrast , the low-glycemic index , low-carbohydrate diet , compared with the high-glycemic index , high-carbohydrate diet , did not affect insulin sensitivity , systolic blood pressure , LDL cholesterol , or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL ( -23 % , P ≤ .001 ) . CONCLUSIONS AND RELEVANCE In this 5-week controlled feeding study , diets with low glycemic index of dietary carbohydrate , compared with high glycemic index of dietary carbohydrate , did not result in improvements in insulin sensitivity , lipid levels , or systolic blood pressure . In the context of an overall DASH-type diet , using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00608049 AIMS To compare long-term ( 1 year ) efficacy and safety of pioglitazone and gliclazide in patients with Type 2 diabetes . METHODS This was a double-blind , multicentre , comparative , parallel group trial in 283 patients with Type 2 diabetes , who were r and omized to receive 1-year treatment with pioglitazone 30 - 45 mg/day or gliclazide 80 - 320 mg/day . Drug dose was titrated on the basis of self-monitored blood glucose ( SMBG ) measurements and HbA1c values . The 1-year changes in HbA1c , fasting blood glucose ( FBG ) , insulin , HOMA-S ( HOmeostatic Model Assessment ) and SMBG were compared . In a subgroup of patients ( n = 10 ) , systemic glucose production and utilization were determined by a combination of isotopic ( deuterated glucose ) and clamp techniques . RESULTS In both groups , there were similar decreases in HbA1c  ( pioglitazone : -0.79 % ; gliclazide : -0.79 % ) and FBG  ( pioglitazone : -1.0 mmol/l ; gliclazide : -0.7 mmol/l ) , whereas the slope of the reduction of fasting blood glucose was different between groups ( P = 0.004 ) . Insulin levels as well as insulin resistance assessed using HOMA-S decreased significantly only after pioglitazone treatment ( -11.94 pmol/l and -1.03 , respectively , both P = 0.002 vs. baseline ) . A significantly greater reduction in systemic glucose production was observed in the pioglitazone group ( -2.48 micromol/kg/min , P = 0.042 ) than in the gliclazide group ( -1.02 micromol/kg/min ) . A few , mild adverse events occurred in both groups . CONCLUSIONS A comparable decrease in HbA1c and FBG was observed with pioglitazone and gliclazide . However , with pioglitazone there was a continuous decrease in FBG over 1 year , whereas gliclazide failed to maintain a similar trend . This favourable effect of pioglitazone was due to its insulin-sensitizing effect and ability to decrease systemic glucose production Incidence rates and risk factors for type 2 diabetes in low-risk population s are not well documented . We investigated these in white individuals who were aged 40 - 79 years and from the population of Bruneck , Italy . Of an age- and sex-stratified r and om sample of 1,000 individuals who were identified in 1990 , 919 underwent an oral glucose tolerance test ( OGTT ) and an assessment of physiological risk factors for diabetes , including insulin resistance ( homeostasis model assessment , HOMA-IR ) , and  postchallenge insulin response  ( Sluiter 's Index ) . Diabetes at baseline by fasting or 2-h OGTT plasma glucose ( World Health Organization criteria , n = 82 ) was excluded , leaving 837 individuals who were followed for 10 years .  Incident cases of diabetes were ascertained by confirmed diabetes treatment or a fasting glucose > or=7.0 mmol/l . At follow-up , 64 individuals had developed diabetes , corresponding to a population -st and ardized incidence rate of 7.6 per 1,000 person-years . Sex- and age-adjusted incidence rates were elevated 11-fold in individuals with impaired fasting glucose at baseline , 4-fold in those with impaired glucose tolerance , 3-fold in overweight individuals , 10-fold in obese individuals , and approximately 2-fold in individuals with dyslipidemia or hypertension . Incidence rates increased with increasing HOMA-IR and decreasing Sluiter 's Index . As compared with normal insulin sensitivity and normal insulin response , individuals with low insulin sensitivity and low insulin response had a sevenfold higher risk of diabetes . Baseline impaired fasting glucose , BMI , HOMA-IR , and Sluiter 's Index were the only independent predictors of incident diabetes in multivariate analyses . We conclude that approximately 1 % of European white individuals aged 40 - 79 years develop type 2 diabetes annually and that " subdiabetic " hyperglycemia , obesity , insulin resistance , and impaired insulin response to glucose are independent predictors of diabetes Objective : To investigate the effect of chromium nicotinate supplementation on insulin sensitivity , glycemic control , and lipid profile in subjects with type 2 diabetes . Material s and Methods : In a double-blind clinical trial , 56 overweight individuals with type 2 diabetes were r and omized into 3 groups : placebo ( NC0 ) , 50 μg ( NC50 ) , and 200 μg ( NC200 ) of chromium as chromium nicotinate .  Chromium status , sensitivity to insulin , glycemic control , and lipid profile were assessed at the beginning of the study and 45 days and 90 days after . Results : In the beginning , most subjects showed low concentrations of serum chromium ( 71.88 % ) , regular levels of urinary chromium ( 80.65 % ) , and insulin resistance ( 73.80 % ) . The serum chromium concentrations did not differ among the groups over time ( p = 0.2549 ) . The changes in serum chromium and urine concentrations did not relate to changes in fasting glucose ( p > 0.05 ) . At 90 days of intervention , there was no significant difference between groups in fasting glucose , glycosylated hemoglobin , homeostasis model assessment insulin resistance ( HOMA-IR ) , total cholesterol , and low-density lipoprotein ( LDL ) ; there was increase in homeostasis model assessment β-cell function ( HOMA-β ; p = 0.0349 ) and high-density lipoprotein ( HDL ; p = 0.0425 ) in the NC0 group and a reduction of triglycerides in the NC0 ( p = 0.0177 ) and NC50 ( p = 0.0336 ) groups . Conclusion : Supplementation at 50 and 200 μg of chromium as chromium nicotinate did not promote glycemic control , increase insulin sensitivity , or change the lipid profile of subjects with diabetes AIMS AND OBJECTIVES To investigate the potential role of a simple insulin resistance index i.e. Homeostatic Model Assessment -Insulin Resistance ( HOMA-IR ) in identifying insulin resistance in patients admitted with an acute coronary syndrome without diabetes mellitus and its effect on short term outcome on cardiovascular morbidity and mortality . METHODS Seventy non-diabetic patients with impaired fasting glucose admitted with a diagnosis of acute myocardial infa rct ion and followed prospect ively for a median of six months for outcomes .  Admission fasting glucose and insulin concentrations  were measured and from these values an Insulin Resistance index was calculated . RESULTS During hospital course a high incidence of heart failure ( 11/;29 vs5/;41 ; p<0.05 ) and mortality ( 4/29 vs 1/41 ; p=0.152 ) was seen in patients with Index > 2 as compared to patients with Index < 2 , but mortality data failed to show any statistical significance because of small sample size . At six months patients with Index > 2 had high incidence of heart failure ( 9/25 vs 4/40 ; p<0.020 ) , reinfa rct ( 2/25 vs. 0 ; p=0.141 ) , repeated admissions ( 7/25 vs 3/40 ; p=0.092 ) and mortality ( 1/25 vs 1/40 ; p=0.181 ) . Six out of twenty-five ( p<0.001 ) patients with Index > 2 required antidiabetic treatment to achieve glycemic control . CONCLUSIONS A simple index of insulin resistance ( Homeostatic Model Assessment -Insulin Resistance ) measured on patients admitted with myocardial infa rct ion provides an important predictive measure of poor outcome and is superior to admission glucose measurement . It may be useful in identifying patients admitted with myocardial infa rct ion who could benefit from alternative early invasive strategies OBJECTIVE High-heat cooking of food induces the formation of advanced glycation end products ( AGEs ) , which are thought to impair glucose metabolism in type 2 diabetic patients . High intake of fructose might additionally affect endogenous formation of AGEs . This parallel intervention study investigated whether the addition of fructose or cooking methods influencing the AGE content of food affect insulin sensitivity in overweight individuals . RESEARCH DESIGN AND METHODS Seventy-four overweight women were r and omized to follow either a high- or low-AGE diet for 4 weeks , together with consumption of either fructose or glucose drinks .  Glucose and insulin concentrations — after fasting and 2 h after an oral glucose tolerance test — were measured before and after the intervention . Homeostasis model assessment of insulin resistance ( HOMA-IR ) and insulin sensitivity index were calculated . Dietary and urinary AGE concentrations were measured ( liquid chromatography t and em mass spectrometry ) to estimate AGE intake and excretion . RESULTS When adjusted for changes in anthropometric measures during the intervention , the low-AGE diet decreased urinary AGEs , fasting insulin concentrations , and HOMA-IR , compared with the high-AGE diet . Addition of fructose did not affect any outcomes . CONCLUSIONS Diets with high AGE content may increase the development of insulin resistance . AGEs can be reduced by modulation of cooking methods but is unaffected by moderate fructose intake Objectives . The prevalence of type 2 diabetes in American adolescents has increased markedly during the past generation . Although the factors that contribute to the development of type 2 diabetes are complex and not wholly eluci date d , the triad of severe obesity , hyperinsulinemia , and a family history of type 2 diabetes places a child at an increased risk for development of the disease . Current approaches to the prevention of type 2 diabetes , including dietary counseling and exercise , have had limited success . We reasoned that drugs that increase glucose tolerance in diabetic patients might prove useful in preventing the progression to glucose intolerance in high-risk patients . To that end , we conducted a double-blind , placebo-controlled study of the effects of metformin  on body mass index ( BMI ) , serum leptin , glucose tolerance , and serum lipids in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes . Methods . The study population consisted of 29 white and black adolescents aged 12 to 19 years . All had BMI s exceeding 30 kg/m2 . Criteria for enrollment included : 1 ) a fasting insulin concentration exceeding 15 μU/mL ; and 2 ) at least 1 first- or second-degree relative with type 2 diabetes . All patients had fasting plasma glucose concentrations < 110 mg% and hemoglobin A1c concentrations ≤6.0 % . All had normal linear growth and sexual development for age , with no marked hirsutism , severe acne , or menstrual irregularities characteristic of polycystic ovary syndrome . Eight participants had acanthosis nigricans . After baseline laboratory studies including a rapidly sample d intravenous glucose tolerance test , patients were r and omized to receive metformin ( 500 mg twice daily ) or a placebo for a total of 6 months . The effects of metformin  on BMI st and ard deviation score , serum leptin , glucose tolerance , and serum lipids were analyzed . The study was double-blinded and included no specific dietary restrictions . Results . Metformin caused a decline of 0.12 st and ard deviation in BMI in study participants ( −1.3 % from baseline ) , and a 5.5 % reduction in serum leptin in girls . In contrast , BMI and serum leptin rose 0.23 st and ard deviation ( 2.3 % ) and 16.2 % , respectively , in the placebo group during the treatment period . Metformin caused a progressive decline in fasting blood glucose ( from a mean of 84.9 to 75.1 mg% ) and a reduction in fasting insulin levels ( from 31.3 to 19.3 μU/mL ) . In contrast , fasting glucose levels in the placebo group rose slightly from 77.2 to 82.3 mg% , and fasting insulin levels did not change . Insulin sensitivity , as assessed by the ratio of fasting insulin to glucose concentrations and the quantitative insulin sensitivity check index ( 1/[log fasting insulin + log fasting glucose ] ) and homeostasis model assessment insulin resistance index ( fasting insulin × fasting glucose/22.5 ) indices , increased slightly in the metformin-treated participants . However , the insulin sensitivity measured using Bergman 's minimal model did not change . There were also no significant changes in glucose effectiveness , hemoglobin A1c , serum lipids , or serum lactate in the metformin or placebo groups . Metformin was tolerated well by the majority of patients . Transient abdominal discomfort or diarrhea occurred in 40 % of treated participants ; there were no episodes of vomiting or lactic acidosis . Conclusions . The treatment of obesity and insulin resistance in adults often proves ineffective because the vicious cycle leading to type 2 diabetes may have become entrenched and , to some extent , may be irreversible . Early detection and therapy of the obese adolescent with a family history of type 2 diabetes may interrupt the cycle of weight gain and insulin resistance that leads to glucose intolerance in adulthood . Through its ability to reduce fasting blood glucose and insulin concentrations and to moderate weight gain , metformin might complement the effects of dietary and exercise counseling and reduce the risk of type 2 diabetes in selected patients Telmisartan , a new angiotensin II type 1 receptor blocker ( ARB ) , was recently reported to stimulate PPARgamma , and stronger effects of Telmisartan on insulin sensitivity has been expected than the class effect of ARB . In the present study , we examined the effects of Telmisartan on insulin sensitivity and adipokine levels in hypertensive and type 2 diabetic patients . Out patients with both hypertension and type 2 diabetes mellitus ( n=36 ; male 23 , female 13 ) , received 20 - 40 mg Telmisartan orally once daily for 6 months . Physical examinations and blood or urine tests were performed before and 3 or 6 months after starting Telmisartan treatment . Results were statistically compared using Wilcoxon analysis . Telmisartan treatment for 3 or 6 months reduced systolic and diastolic blood pressure and urinary albumin excretion . Fasting plasma glucose , HbA1c , total and HDL-cholesterol , triglyceride , body weight , BMI and waist length were not changed . Fasting IRI and HOMA-IR were significantly decreased after Telmisartan treatment , suggesting the improved insulin sensitivity . Total and high molecular adiponectin were not changed . Interestingly , serum leptin was significantly increased by 3 months Telmisartan treatment , suggesting a possible involvement of leptin in improved insulin sensitivity . In conclusion , Telmisartan improved insulin resistance with increased serum leptin level in hypertensive and type 2 diabetic patients Abstract Objective : To investigate the efficacy and safety of glimepiride as initial mono-therapy in type 2 diabetes patients in China . Methods : This is a multi-center , open-label , single arm study . A total of 391 subjects were enrolled to receive glimepiride treatment for 16 weeks , the initiation dose was 1 mg/d , with titration to 2 mg/d and 4 mg/d according to the fasting blood glucose ( FBG ) level measured at each visit . The change in HbA1c , fasting plasma glucose ( FPG ) , 2 h postpr and ial blood glucose ( 2hPPG ) , HOMA-IR , weight , waist circumference and the incidence of hypoglycemia were evaluated . An exploratory analysis was conducted to identify the potential population prone to achieve target glycemic control . Results : HbA1c was reduced significantly from 8.6 ± 1.6 % to 6.9 ± 0.9 % ( p < 0.001 ) ; 60.9 % of the subjects achieved HbA1c < 7 % at study endpoint . The reduction in FPG and 2hPPG were 2.3 mmol/L and 4.4 mmol/L ( p < 0.001 ) respectively . Insulin resistance was improved significantly with HOMA-IR decreasing from 2.5 ± 2.3 to 2.2 ± 1.9 ( p = 0.009 ) . The incidence of confirmed hypoglycemia ( BG ≤ 3.9 mmol/L ) was 3.1 % . Conclusions : Glimepiride treatment as initial mono-therapy could effectively improve blood glucose control in type 2 diabetic patients , with a favorable safety profile . Lack of control group was the major limitation of this study . Clinical Trial.gov identifier : NCT00908921 BACKGROUND Osteocalcin has been related to insulin secretion in experimental models . Few prospect i ve studies have evaluated the association between circulating osteocalcin concentrations and insulin secretion and sensitivity in humans . OBJECTIVE The objective was to examine cross-sectional and longitudinal associations between circulating forms of osteocalcin and insulin secretion and sensitivity in elderly men at high cardiovascular risk . DESIGN We examined cross-sectional and longitudinal associations between serum measurements of total osteocalcin and undercarboxylated osteocalcin ( ucOC ) with fasting glucose , fasting insulin , HOMA-IR , and HOMA β cell function ( HOMA-BCF ) in 79 elderly men . We also examined the association between 2-y changes in osteocalcin and changes in fasting glucose , insulin , HOMA-IR , and HOMA-BCF . RESULTS In an adjusted multivariable linear regression analysis , increases in serum osteocalcin were significantly associated with an increase in HOMA-BCF ( β coefficient : 2.87 ; 95 % CI : 0.23 , 5.52 ; P = 0.033 ) , and changes in ucOC were linked to a decrease in HOMA-IR ( β coefficient : -0.31 ; 95 % CI : -0.60 , 0.03 ; P = 0.032 ) . Moreover , in subjects not taking oral antidiabetic drugs  , baseline osteocalcin concentrations were positively associated with higher fasting insulin concentrations and HOMA-BCF even after adjustment for BMI , physical activity , intervention group , presence of type 2 diabetes mellitus , and baseline values of each dependent variable . CONCLUSIONS Changes in serum osteocalcin and ucOC are associated with an improvement in insulin secretion and sensitivity , which suggests a possible role of bone in the development of type 2 diabetes . This trial is registered at clinical trials.gov as IS RCT N35739639 Objective : Type 2 diabetes mellitus is characterized by insulin resistance and defects in insulin secretion from pancreatic β-cells , which have been studied by using euglycemic/hyperinsulinemic clamps . However , it is difficult to study insulin resistance and β-cell failure by these techniques in humans . Therefore , the aim of this study was to evaluate the effect of three different antidiabetic therapeutic regimens on insulin resistance and β-cell activity by using a mathematical model , Homeostasis Model Assessment for insulin resistance ( HOMAIR ) and β-cell function ( HOMAβ-cell ) . Research design and methods : Seventy type 2 diabetic patients were r and omly assigned to one of three therapeutic regimens : ( A ) metformin + American Diabetic Association (ADA)-recommended diet + physical activity ; ( B ) metformin + low-dose glimepiride + ADA diet + physical activity ; or ( C ) ADA diet + physical activity ( no drugs ) . Blood sample s were obtained before and after the treatment to determine serum levels of fasting and post-pr and ial blood glucose , fasting insulin , and glycosylated hemoglobin ( HbA1c ) , and HOMAIR and HOMAβ-cell were calculated . Results : Fasting and post-pr and ial levels of glucose , HbA1c , and fasting insulin and calculated HOMAIR and HOMAβ-cell values before treatment were significantly higher than the respective values after treatment for all groups of patients ( P < 0.01 ) . Significant differences were also found when comparing the treatment-induced reduction in fasting blood glucose ( 51.8 % ; P < 0.01 ) , post-pr and ial blood glucose ( 55.0 % ; P < 0.05 ) , and HOMAIR ( 65.3 % ; P < 0.01 ) in patients of Group B with that in patients receiving other therapeutic options ( Groups A and C ) . Conclusions : Metformin plus low-dose glimepiride ( plus ADA diet and physical activity ) is a more effective treatment for type 2 diabetes than either metformin plus ADA diet and physical activity or ADA diet and physical activity alone . Determination of HOMAIR and HOMAβ-cell values is an inexpensive , reliable , less invasive , and less labor-intensive method than other tests to estimate insulin resistance and β-cell function in patients with type 2 diabetes mellitus
The DASH dietary pattern may lead to an improvement in insulin sensitivity independent of weight loss .
The DASH diet may play an important role in glycemic control in long- term interventions .
OBJECTIVE Type 2 diabetes is a major public health problem .
The Dietary Approaches to Stop Hypertension ( DASH ) eating pattern may contribute to managing risk factors of type 2 diabetes .
The objective of this study was to conduct a systematic review and meta- analysis on r and omized controlled trials ( RCTs ) that examine the effects of DASH diet consumption on the indices of glycemic control such as fasting blood glucose ( FBG ) , serum fasting insulin level , and Homeostatic Model Assessment insulin resistance ( HOMA-IR ) .