# Effects of _Gynura bicolor_ on Glycemic Control and Antioxidant Ability in Predicates
## 4 Discussion  
In 1988, [PERSON] described a cluster of risk factors for DM and CVD as \"syndrome X\", the former name of \"metabolic syndrome (Mets)\" [24]. Mets have several definitions. In Taiwan, Mets is defined as any three of the following five features: waist circumference >90 cm in men or >80 cm in women, HDL-C < 40 mg/dL in men or <50 mg/dL in women, FPG \(\geq\) 100 mg/dL, TG \(\geq\) 150 mg/dL and BP \(\geq\) 130/85 mmHg. Insulin resistance (IR) is considered one of the main pathophysiology that caused Mets. IR causes abnormal nutrient metabolism such as hepatic gluconeogenesis, lipid peroxidation and TG synthesis. Moreover, vasoconstriction, oxidative stress and inflammation happened. Under this condition, it increases the risk of developing CVD [25]. In previous studies, it showed that IR and \(\beta\)-cell dysfunction were already happening before developing to diabetes [26]. [PERSON] et al. performed a meta-analysis; it concluded that IFG and IGT are associated with modest increases in the risk of cardiovascular disease. Therefore, preDM is related to Mets [27]. In our study, all subjects' FPG levels were over 100 mg/dL and have a large waist circumference. We considered the subjects in this study to be at a higher risk of developing Mets and CVD than others. HOMA-IR was proposed as a simple and inexpensive alternative to more sophisticated techniques by [PERSON] et al., and had been evaluated to be reliably used in large-scale or epidemiological studies [28; 29]. QUICKI was first performed by [PERSON] et al. QUICKI is a novel, simple, accurate and reproductive method for determining insulin sensitivity in humans [30]. HOMA-IR and QUICKI can only use FPG and fasting insulin to assess the levels of insulin resistance (IR) and insulin sensitivity. The higher the HOMA-IR, the higher the levels of IR. QUICKI is the reverse to HOMA-IR. Several studies showed the different cutoff point of HOMA-IR and QUICKI. [PERSON] et al. observed 65 subjects aged 30-60 years in Spain, showing that subjects had IR when HOMA-IR > 2.6 and QUICKI < 0.33 [31]. [PERSON] et al. described that the cutoff point for diagnosis of IR is >2.5 for adults  
Figure 1: Effects of _Gymura bicolor_ on antioxidants, antioxidant capacity and inflammation marker. (**a**) Vitamin C (\(\mu\)g/mL), (**b**) total polyphenols (mg/mL), (**c**) FRAP (mM), (**d**) GSH-Px (nmol/min/mL), (**e**) MDA (\(\mu\)M), and (**f**) IL-6 (pg/mL). Values are mean \(\pm\) SEM (n = 9). \({}^{8}\)\(p\) < 0.05 between groups by Mann–Whitney U test; \({}^{*}\)\(p\) < 0.05 compared with Week 0 by Mann–Whitney U test; \({}^{\#}\) the difference value of Week 0 and Week 8 with a significant difference between groups by Mann–Whitney U test (\(p\) < 0.05) FRAP, ferric reducing ability of plasma; GSH-Px, glutathione peroxidase; MDA, malondialdehydedehyde; IL-6, interlukin-6. and >3.15 for adolescents [32]. In China, a total of 2217 subjects were observed. It increases the risks of developing Mets and diabetes when the quartile1 (Q1) of HOMA-IR > 2.8. No matter which cutoff point they are based on, HOMA-IR and QUICKI in both groups were abnormal before the intervention period. After an 8-week intervention of GB and a 4-week washout period, HOMA-IR in the GB group were significantly decreased when compared with baseline. The difference of QUICKI between baseline and the 8-week intervention was significantly decreased when compared to the control group. Therefore, we speculated that an intake of GB may improve the insulin resistance and elevate the insulin sensitivity. Furthermore, the efforts of improving insulin resistance can be maintained. Increased consumption of vegetables, whole grains, and soluble and insoluble fiber is recommended to treat preDM and diabetes individuals. [PERSON] and [PERSON] collected 14 randomized clinical trials on diabetes from the past decade.