<p>Obesity and nutrition-related non-communicable diseases continue to be major challenges that are increasing in severity worldwide. Science-centered carbohydrate dietary strategies may be a viable approach to help address such challenges. Recent reports from our laboratory indicate that certain carbohydrates with slow digestion profiles have the ability to trigger the gut-brain axis and reduce food intake and to slow gastric emptying and potentially affect appetite. Slow carbohydrate digestion may have other impacts on energy metabolism that have not been explored. In the current investigations, we sought to better understand the delayed gastric emptying profile of pearl millet-based foods as well as to understand how altering carbohydrate digestion rate impacts substrate utilization for energy.</p> <p>In the first study, the physical breakdown of pearl millet couscous particles in a simulated gastric environment (Human Gastric Simulator) was studied compared to wheat couscous matched in particle size, and select physicochemical properties of each type of couscous were characterized. Because we previously showed that pearl millet couscous had a marked delay in gastric emptying compared to white rice, boiled potatoes, and pasta in a human study in Mali, the objective of the first investigation was to test the hypothesis that pearl millet couscous was more resistant to breakdown in the stomach than wheat couscous and would take longer to empty. Our findings indicated that pearl millet couscous instead broke down into smaller, more numerous particles than wheat couscous. However, pearl millet had a slower starch hydrolysis property compared to wheat couscous per unit surface area. Pearl millet also had a smaller amylose chain length (839-963 DP) compared to wheat (1225-1563 DP), which may enable a denser packing of millet starch molecules that hinders hydrolysis. We also visually observed that the pearl millet particles formed a paste while breaking down that could reasonably generate viscosity in the stomach to potentially delay gastric emptying. </p> <p>Based off the findings from simulated gastric digestion, we next conducted a human study (<i>n</i>=14) in the U.S. to test the hypothesis that pearl millet-based foods (couscous – commercial and self-made, thick porridge) would reduce glycemic response, increase satiety, and delay gastric emptying compared to wheat couscous and white rice. We complemented this human study with additional <i>in vitro </i>work using an advanced gastrointestinal digestion system (TIMagc) to determine if the viscosity of pearl millet couscous particles as they were breaking down in the stomach was contributing to a decrease in gastric emptying. Our findings indicated that all the pearl millet-based foods and wheat couscous had lower overall glycemic response than white rice, but only the self-made millet couscous showed higher satiety through subjective appetitive response ratings. Surprisingly, there were no differences in gastric emptying among the foods. Additionally, the half-emptying times for these foods were all ~3 h, which is similar to the comparably low half-emptying times observed for white rice, boiled potatoes, and pasta in the previous Mali study. We now hypothesize that there may be diet-induced changes in gut-brain axis signaling when slowly digestible carbohydrates are consumed repeatedly over time, perhaps through modulating the number or sensitivity of small intestinal L-cells. We also found that millet couscous did not exhibit high viscosity in the TIMagc, suggesting that viscosity was not impacting its rate of gastric emptying. We conclude that at least some pearl millet-based foods possess a slow digestion property that may act to trigger the gut-brain axis or ileal brake to increase feelings of satiety or slow gastric emptying, but the discrepancy between U.S. and Malian populations requires further study. </p> <p>In the final investigation, we examined how altering carbohydrate digestion affected partitioning of carbohydrate versus fat for oxidation as well as the efficiency of switching oxidation between these two substrates (termed “metabolic flexibility”) in mice. Metabolic flexibility has been associated with good health related to decreased adipose tissue in the body and improved insulin sensitivity and may have implications on weight management. Carbohydrate digestion was adjusted by: (1) testing mice that lacked a complete set of enzymes by knocking out maltase-glucoamylase (Mgam; null) for moderating starch digestion versus testing wild-type mice; (2) using diets in these two groups of mice to moderate starch digestion that had different levels of resistant starch (53%, 35%, and 18%), had only raw corn starch or sucrose, or were high in fat; and (3) providing a supplement of fungal amyloglucosidase (AMG) to the mice treatment groups to increase starch digestion. Respiratory exchange ratio (RER) was measured through indirect calorimetry and mathematical modeling was used to characterize the diurnal shifts in RER (sine equation) as well as carbohydrate versus fat oxidation and metabolic flexibility (percent relative cumulative frequency [PRCF] with Weibull and Mixed Weibull Cumulative Distribution functions). Our results suggest that null mice lacking Mgam had somewhat increased metabolic flexibility than wild-type mice despite exhibiting minimal to no effects on carbohydrate oxidation. Intriguingly, the raw corn starch diet increased fat oxidation and generally promoted metabolic flexibility, although it did not increase carbohydrate oxidation relative to the other carbohydrate-predominant diets. Increasing carbohydrate digestion through AMG supplementation increased carbohydrate oxidation, and generally prompted earlier shifts to carbohydrate oxidation than without AMG supplementation. These findings provide a basis for better understanding the metabolic consequences of altering carbohydrate digestion and establish novel tools that can be utilized in future investigations. Overall, we propose that moderating carbohydrate digestion provides the ideal combination of balancing carbohydrate and fat oxidation while promoting metabolic flexibility. </p> <p>In conclusion, a slow digestion property may enable some types of pearl millet to trigger the ileal brake and gut-brain axis feedback systems to decrease glycemic response and increase satiety. Moreover, consuming carbohydrates with slow digestion may optimize substrate utilization for energy by the body. In addition to triggering the ileal brake and gut-brain axis, modulating carbohydrate digestion to more effectively switch between carbohydrate and fat for oxidation may be beneficial for weight management and metabolic disease prevention.</p>

Abstract Type 2 Diabetes Mellitus (T2DM) is the seventh leading cause of death in the United States with a projected increase of 552 million people worldwide who will be affected with this illness by 2030. The need to address this issue is vital to prevent complications and reduce healthcare spending. The DNP project is aimed at planning and designing a nutritional education program tailored toward specific ethnic groups in order to increase knowledge in making healthy food choices. This project is intended to educate Registered Nurses (RNs) on nutrition so that they can offer dietary knowledge to T2DM patients. Additional patients can be reached by educating the RNs rather than patients being limited to consultations with a Certified Diabetes Educator or Registered Dietician. This project focused on whether healthy nutrition tailored toward the individual's own ethnic foods helps to stabilize glycemic values for patients with Type 2 diabetes. A toolkit was utilized to aid with the RNs' learning on healthy nutrition and its impact on the management of blood glucose. It addressed areas such as food groups and calories, grocery shopping, preparation methods, and portion control. The framework for design utilized the basic concepts associated with the systems theory with an intended goal to prevent further complications and improve patients' glycemic value through consuming nutritious foods. The logic model will be used to evaluate the impact of healthy nutrition on blood glucose through pre- and post-program tests of the RNs' nutritional knowledge on healthy eating. The continuation of this program will promote positive social change by helping patients to achieve a healthier lifestyle and reduce healthcare expenditures.

Glycaemic control in critically ill patients has been a topic of considerable attention for the past 20 years. In literature and at scientific meetings, there have been ongoing debates regarding the efficacy of glycaemic control in these patients with frequently entirely opposite opinions. These range from a strict invasive approach with target glycaemia 4-6 mmol/l to a liberal approach tolerating even values higher than 12 mmol/l. In the preview of this PhD thesis we have analysed so far published literature and describe the reasons for this inconsistency. According to the results of recent studies, the most significant efficacy of tight glycaemic control has been observed in cardiac surgical patients. If we consider the concept of tight glycaemic control as efficient strategy, there are three important questions remaining unanswered as follow. Does the specific algorithm-protocol play a key part in the concept of tight glycaemic control alongside the knowledge and skills of nursing staff in safe and efficient blood glucose control? What is the ideal timing of starting the strategy of tight glycaemic control (TGC) in cardiac surgical patient? And is there any benefit in outcome respect to mortality or morbidity? Do we have any more safe and efficient option or add-on to standard perioperative...

Contexte théorique : L’encéphalopathie hypoxique ischémique (EHI) est une condition du nouveau-né dans laquelle les mécanismes des variables métaboliques ne sont pas totalement compris. Cette population est particulièrement à risque d’hypo- ou d’hyperglycémie néonatales (HHN). Devant le manque de données sur le fonctionnement métabolique à la suite d’une EHI, cette étude vise à déterminer l’association entre une HHN et l’activité cérébrale mesurée par électroencéphalographie (EEG). Méthodologie : 49 participants avec EHI ont été recrutés au CHU Sainte-Justine peu après leur naissance. Ils ont été monitorés en continu à l’aide de l’EEG et des segments d’intérêt se retrouvant dans les 48 premières heures de vie ont été analysés. L’anormalité de l’activité cérébrale est déterminée selon une analyse quantitative du niveau de discontinuité caractérisée par une proportion de faibles amplitudes (seuils de 25, 15, 12,5, 10 et 7,5 uV) dans le tracé EEG. Les données de glycémie ont été recueillies de façon intermittente par le biais de prises de sang et de glucomètres de chevet. Les participants ont été répartis en 4 groupes : normoglycémie, hyperglycémie, hypoglycémie et glycémie variable (hypo- et hyper-). Résultats : L’analyse de covariation non -paramétrique a relevé une différence significative entre les ratios de discontinuité pour le seuil de 15 uV (F = 3,070 p = 0,037). Les analyses de comparaisons appariées ont montré une différence positive entre le groupe VARIABLE et le groupe contrôle (NORMO-) pour tous les seuils ainsi qu’une différence positive entre le groupe HYPER- et le groupe contrôle pour 4 des 5 seuils (25, 15, 12,5 et 7,5 uV). Aucune différence n’a été relevé entre le groupe HYPO- et le groupe contrôle pour tous les seuils. Conclusions : La variabilité glycémique et l’hyperglycémie seule ont été montrées comme étant associées à une activité cérébrale altérée caractérisée par un tracé de plus faible amplitude mesurée avec l’EEG. / Background: Hypoxic ischemic encephalopathy (HIE) is a newborn condition in which the underlying mechanisms still require further understanding. This clinical population is particularly prone to neonatal hypo- and hyperglycemia (NHH). Given the need to improve our understanding of metabolic functioning following HIE, this study aims to determine the association of NHH on the brain’s background electrophysiological activity measured by electroencephalography (EEG). Methodology: Forty-nine newborns with HIE were recruited at Sainte-Justine University Hospital Center. Continuous EEG monitoring was started as soon as possible and segments of interest in the first 48h of life were analyzed. Brain activity was quantitatively assessed according to an index of discontinuity characterized by the proportion of low EEG amplitudes per segment (< 25, 15, 12.5, 10 and 7.5 uV cutoffs). Glucose measurements were intermittently collected using blood samples and bedside glucometers and were retrospectively retrieved from medical charts. Participants were separated in 4 groups : normoglycemia, hyperglycemia, hypoglycemia and both (hyper- and hypo-). Results: The non-parametric covariance analyses revealed a significant difference between the discontinuity index for the 15 uV threshold (F = 3.070 p = 0.037). The pairwise comparisons showed a positive difference between the group BOTH and the control group (NORMO-) for every thresholds, the labile glucose group having a higher discontinuity index. A similar difference was found between the HYPERGLYCEMIA group and the control group for 4 out 5 thresholds (25, 15, 12.5 and 7.5 uV). No difference was found between the HYPOGLYCEMIA group and the control group. Conclusion: An abnormal glycemic profile, particularly glucose lability and hyperglycemia alone, were shown to be associated with abnormal brain activity characterized by a higher discontinuity index on the EEG.

Research conducted with youth with type 1 diabetes (T1D) has shown that glycemic extremes and poorer T1D management are associated with poorer performance on measures of executive functioning (EF) compared to non-T1D counterparts. Deficits in EF may negatively impact the development of healthy T1D management skills. Our primary aim was to conduct a meta-analytic review of previous studies investigating the associations between glycemic control and EF in children with T1D across the developmental span. Comprehensive literature searches were conducted using PubMed, MedLine, PsycInfo, Google Scholar, and EBSCO for articles that met eligibility criteria. Eligibility criteria included correlational, randomized, and non-randomized studies published after 1985 involving participants ages 0-26 with a diagnosis of T1D. Studies evaluated EF using the Behavior Rating Inventory of Executive Functioning (BRIEF) or fMRI and evaluated glycemic control using Hemoglobin A1c. Across twelve studies examining the effect of glycemic control on EF in patients with T1D, 2,204 children, adolescents, and emerging adults were included in the study. Effect sizes (Hedges' g) were calculated between the T1D group and either control participants or a normative sample. Participant age was included as a moderator to determine whether the hypothesized association varied in magnitude across development. Participant A1c was used as a moderator to determine whether the hypothesized variation varied with diabetic management. A trend towards poorer performance on measures of executive functioning was observed in the T1D group compared to the normative sample (g = -0.22). In comparing age cohorts to the normative sample, a significantly poorer performance on measures of EF was observed in the 9-11, 15-17, and 18-26 age cohorts (g = -0.201, -0.258, and -0.452, respectively) compared to other age cohorts. Overall, research indicates that poor diabetic management may result in poorer performance on measures of EF compared to non-diabetic participants. These findings imply that this trend of poorer EF in children and adolescents with type 1 diabetes may lead to suboptimal diabetic management. Research suggests that suboptimal diabetic management often persists across the lifespan. Examining this association across critical periods where diabetes management may exert the most influence on the developing brain may provide guidance about when youth may benefit most from T1D management interventions.

Introducción: La pandemia por COVID-19 resaltó la importancia de un buen control glicémico de pacientes con diabetes mellitus tipo 2 para evitar complicaciones; sin embargo, también limitó el tratamiento y seguimiento de estos pacientes. En este contexto el uso de la telesalud fue promovido. Objetivo: Determinar la efectividad de la telesalud en el manejo de la diabetes mellitus tipo 2 en el Hospital Regional Lambayeque durante el año 2021. Materiales y métodos: estudio de cohortes retrospectivo, realizado en base de historias clínicas de pacientes diagnosticados con DM2 atendidos por teleconsulta de enero a marzo del 2021 que hubieran sido atendidos previamente de manera presencial y contarán con controles glicémicos. Resultados: Los pacientes con DM2 tuvieron una edad promedio de 60.73 ± 8.93 años, predominio del género femenino (70.7%), el 28.3% tenían más de 10 años de evolución y el 56.6% se trataba con antiglicémicos orales. La complicación más frecuente fue la neuropatía (46.5%) y la comorbilidad la IRC (18.2%). Solo 2-3% de los pacientes presentaron síntomas de hiperglicemia e hipoglicemia. En cuanto a las glicemias en ayunas obtenidas de manera presencial y por telesalud no tuvieron diferencia significativa. (p = 0.8) La hemoglobina glicosilada encontrada en el seguimiento presencial fue de 8.17 ± 2.34 y por telesalud fue de 8.53 ± 2.65, siendo significativa la diferencia entre ambas modalidades. (p = 0.021) Conclusión: El control glicémico obtenido por telesalud fue estadísticamente menor que el obtenido por vía presencial. (p=0.021) / Introduction: The COVID-19 pandemic highlighted the importance of good glycemic control in patients with type 2 diabetes mellitus to avoid complications; however, it also limited the treatment and follow-up of these patients. In this context the use of telehealth was promoted. Objective: determine the effectiveness of telehealth in the management of type 2 diabetes mellitus at the Lambayeque Regional Hospital during the year 2021. Materials and methods: retrospective cohort study, conducted based on medical records of patients diagnosed with DM2 attended by teleconsultation from January to March 2021 who had previously been attended in person and had glycemic controls. Results: Patients with DM2 had a mean age of 60.73 ± 8.93 years, with a predominance of women (70.7%), 28.3% had more than 10 years of evolution, and 56.6% were treated with oral antiglycemics. The most frequent complication was neuropathy (46.5%) and comorbidity CKD (18.2%). Only 2-3% of the patients presented symptoms of hyperglycemia and hypoglycemia. Regarding fasting glycemia obtained in person and by telehealth, there was no significant difference (p = 0.8). The glycosylated hemoglobin found by telehealth was 8.53 ± 2.65 and in the face-to-face follow-up it was 8.17 ± 2.34, the difference between both modalities being significant. (p = 0.021) Conclusion: The glycemic control obtained by telehealth was lower than that obtained in person. (p=0.021)

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Bakgrund: Diabetes är ett samlingsnamn för en grupp metabola sjukdomar med den gemensamma nämnaren att kroppen har en oförmåga att producera eller ta upp insulin Diabetes medför, bland annat, en risk för akuta glykemiska episoder relaterat till kroppens oförmåga att vidmakthålla en normal blodglukosnivå. Syfte: Att sammanställa kunskap om hur personer med insulinbehandlad diabetes upplever att medvetenheten om akuta glykemiska episoder påverkar det dagliga livet. Metod: En kvalitativ litteraturstudie baserad på elva vetenskapliga primärstudier inhämtade från databaserna PubMed respektive CINAHL. Resultat: Tre kategorier och sex underkategorier genererades; ”En förändrad vardag” med underkategorierna; ”Planera eller ge upp”, ”Ett behov av andras stöd” samt ”Ofrånkomliga utmaningar”, ”Att leva med oro” med underkategorierna; ”Varierande syn på lämplig blodglukosnivå”, ”Självkritik och skam” samt ”Rädsla för liv och hälsa” och ”Varierande strategier i vardagen” utan underkategorier. Slutsats: Personer med insulinbehandlad diabetes möter en mängd utmaningar i vardagen relaterat till medvetenhet om akuta glykemiska episoder. Utmaningarna inkluderar särskilda krav på minutiös planering och inte sällan förändringar i vardagen. Förändringar i vardagslivet kräver i de flesta fall implementering av nya strategier för att kunna hantera de utmaningar diabetessjukdomen medför. Utmaningarna är inte enbart av praktisk natur utan även av en mer psykosocial natur som leder till att många upplever att stigmatisering från omgivningen och orealistiska krav på sig själva resulterar i ohälsosam självkritik och ibland skam relaterat till de akuta glykemiska episoder de ofrånkomligen drabbas av i olika utsträckning. / Background: Diabetes is a collective name for a group of metabolic diseases with the denominator that the body experience an inability to produce, or absorb, insulin in sufficient quantities. Diabetes entails, amongst other potential problems, a non-unsubstantiated risk of acute glycemic episodes due to the body´s inadequate ability to maintain a normal blood glucose level. Aim: To compile knowledge on how persons suffering from insulin treated diabetes manage the awareness of the threat that acute glycemic episodes impose on everyday life. Method: A qualitative study based on eleven primary scientific studies that was obtained from the databases PubMed and CINAHL. Result: Three categories and six sub-categories emerged; “A change in everyday life” containing the sub-categories “plan or give up”, “A need for others” and “Unavoidable changes” “Living with worry” containing the sub-categories “Different views on blood glucose levels”, Self-criticism and shame” and “Fear for life and health” and lastly “Various strategies in day-to-day life” which was without sub-categories. Conclusion: People with insulin treated diabetes faces a variety of challenges in everyday life related to acute glycemic episodes. The variety of challenges include special requirements when it comes to planning and scheduling everyday life. Changes in everyday life often requires the implementation of new strategies to handle the challenges imposed by diabetes and it´s symptoms. Challenges which are not only practical in nature but also entails a more psychosocial aspect that can lead to feelings of stigmatization and unrealistic demands on one self. Feelings that can result in unhealthy self-criticism, and sometimes shame, related to the symptoms of inevitable acute glycemic episodes.

Bakgrund: Glykemisk kontroll hos personer med typ 1 diabetes kräver stöd och utbildning av vårdpersonal inom diabetesvården. För att förbättra behandlingsresultat och livskvalitet samt minska risken för komplikationer kan intensiva behandlingsstrategier användas för att sträva efter optimal glykemisk kontroll och hälsa. Syfte: Syftet är att beskriva hur intensivbehandling påverkar HbA1c och hälsa hos personer med diabetes typ 1. Metod: En retrospektiv studie, deskriptiv design med kvantitativ ansats. Urvalet skedde från en diabetesmottagning och utgick från redan insamlade data från ett intensivbehandlingsprojekt. 42 patienter med diabetes typ 1 och HbA1c ≥70 mmol/mol inkluderades i intensivbehandlingsprojektet. De variabler som undersöktes var HbA1c och EQ-VAS, för att undersöka sambandet mellan glykemiskkontroll och skattad hälsa. Huvudresultat: Resultatet visade ett svagt samband mellan sjunkande HbA1c och stigande EQ-VAS vid uppföljningen. Det starkaste signifikanta sambandet sågs i kategorin kontakt med dietist, kopplat till HbA1c och EQ-VAS. I kategorierna patienter med flerdosbehandling av insulinpenna, behandling med insulinpump samt utebliven kontakt med dietist visade inget signifikant samband kopplat till sjunkande HbA1c och stigande EQ-VAS.  Slutsats: Studien visar betydande förbättringar i både HbA1c och EQ-VAS hos patienter med diabetes typ 1 efter intensivbehandling. Positiva samband observerades mellan insulinpumpbehandling och högre EQ-VAS, samt dietistkontakt och minskat HbA1c. Fynden tyder på att intensivbehandlingen, särskilt med dietistrådgivning, effektivt förbättrar glykemisk kontroll och livskvalitet. Ytterligare forskning behövs för att bekräfta dessa resultat. / Background: Glycemic control in individuals with type 1 diabetes requires support and education from diabetes care professionals. To improve treatment outcomes and quality of life while reducing the risk of complications, intensive treatment strategies can be employed to achieve optimal glycemic control and health. Purpose: The purpose is to describe how intensive treatment affects HbA1c and health in individuals with type 1 diabetes. Method: A retrospective study with a descriptive design using a quantitative approach. The sample was selected from a diabetes clinic and relied on previously reported data from an intensive treatment project. 42 patients with type 1 diabetes and HbA1c ≥70 mmol/mol were included in the intensive treatment project. Data were analyzed using Spearman's rank correlation analysis to identify relationships between HbA1c and health. Main Results: The results showed a weak correlation between decreasing HbA1c and increasing EQ-VAS scores at follow-up. The strongest significant correlation was observed in the category of contact with a dietitian, linked to HbA1c and EQ-VAS. In the categories of patients using multiple daily injections with insulin pens, insulin pump therapy, and lack of contact with a dietitian, no significant correlation was found related to decreasing HbA1c and increasing EQ-VAS. Conclusion: The study shows significant improvements in both HbA1c and EQ-VAS in patients with type 1 diabetes after intensive treatment. Positive correlations were observed between insulin pump therapy and higher EQ-VAS scores, as well as between dietitian contact and reduced HbA1c. The findings suggest that intensive treatment, especially with dietitian counseling, effectively enhances glycemic control and quality of life. Further research is needed to confirm these results.