Pulse consumption improves indices of glycemic control in adults with and without type 2 diabetes: a systematic review and meta-analysis of acute and long-term randomized controlled trials.

Funder: University of LeedsPURPOSE: Findings from randomized controlled trials (RCTs) evaluating the effect of pulse intake on glycemic control are inconsistent and conclusive evidence is lacking. The aim of this study was to systematically review the impact of pulse consumption on post-prandial and long-term glycemic control in adults with and without type 2 diabetes (T2D). METHODS: Databases were searched for RCTs, reporting outcomes of post-prandial and long-term interventions with different pulse types on parameters of glycemic control in normoglycemic and T2D adults. Effect size (ES) was calculated using random effect model and meta-regression was conducted to assess the impact of various moderator variables such as pulse type, form, dose, and study duration on ES. RESULTS: From 3334 RCTs identified, 65 studies were eligible for inclusion involving 2102 individuals. In acute RCTs, pulse intake significantly reduced peak post-prandial glucose concentration in participants with T2D (ES  - 2.90; 95%CI  - 4.60,  - 1.21; p ≤ 0.001; I2 = 93%) and without T2D (ES  - 1.38; 95%CI  - 1.78,  - 0.99; p ≤ 0.001; I2 = 86%). Incorporating pulse consumption into long-term eating patterns significantly attenuated fasting glucose in normoglycemic adults (ES  - 0.06; 95%CI  - 0.12, 0.00; p ≤ 0.05; I2 = 30%). Whereas, in T2D participants, pulse intake significantly lowered fasting glucose (ES  - 0.54; 95%CI  - 0.83,  - 0.24; p ≤ 0.001; I2 = 78%), glycated hemoglobin A1c (HbA1c) (ES  - 0.17; 95%CI  - 0.33, 0.00; p ≤ 0.05; I2 = 78) and homeostatic model assessment of insulin resistance (HOMA-IR) (ES  - 0.47; 95%CI  - 1.25,  - 0.31; p ≤ 0.05; I2 = 79%). CONCLUSION: Pulse consumption significantly reduced acute post-prandial glucose concentration > 1 mmol/L in normoglycemic adults and > 2.5 mmol/L in those with T2D, and improved a range of long-term glycemic control parameters in adults with and without T2D. PROSPERO REGISTRY NUMBER: (CRD42019162322)

Glucose variability is associated with an adverse vascular profile but only in the presence of insulin resistance in individuals with type 1 diabetes (Brief report)

Background and aim: We hypothesised that the detrimental effect of high glucose variability (GV) in people with type 1 diabetes is mainly evident in those with concomitant insulin resistance. Materials and methods: We conducted secondary analyses on continuous glucose monitoring (CGM) from three randomised controlled trials and assessed the relationship with established vascular markers. Cluster analysis was employed to establish three GV clusters and the relationship with thrombotic biomarkers was investigated according to insulin resistance, assessed as estimated Glucose Disposal Rate (eGDR). Results: Of 107 patients, 48, 40, and 19 patients were assigned into low, intermediate, and high GV clusters, respectively. Thrombosis biomarkers increased in a stepwise fashion across all three GV clusters; this increase in thrombosis markers was evident in the presence of low but not high eGDR. Conclusion: Higher GV is associated with increased thrombotic biomarkers in type 1 diabetes but only in those with concomitant insulin resistance

Long Covid active case finding study protocol: A co-produced community-based pilot within the STIMULATE-ICP study (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways)

Background and aim Long Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups' experiences of Long Covid, and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area in London, United Kingdom to test the feasibility of a community-based approach of identifying Long Covid cases that have not been clinically diagnosed and have not been referred to Long Covid specialist services. We will explore the barriers to accessing recognition, care, and support, as well as experiences of stigma and perceived discrimination. Methods This protocol and study materials were co-produced with a Community Advisory Board (CAB) made up primarily of people living with Long Covid. Working with voluntary organisations, a study leaflet will be distributed in the local community to highlight Long Covid symptoms and invite those experiencing them to participate in the study if they are not formally diagnosed. Potential participants will be assessed according to the study's inclusion criteria and offered the opportunity to participate if they fit them. Awareness of Long Covid and associated symptoms, experiences of trying to access care, as well as stigma and discrimination will be explored through qualitative interviews with participants. Upon completion of the interviews, participants will be offered a referral to the local social prescribing team to receive support that is personalised to them potentially including, but not restricted to, liaising with their primary care provider and the regional Long Covid clinic

Postprandial vascular-inflammatory and thrombotic responses to high-fat feeding are augmented by manipulating the lipid droplet size distribution

Background and Aims Postprandial responses are influenced not only by the type and amount of fat ingested, but also lipid droplet size distribution. However, little research has investigated the impact of differential lipid size distributions within a mixed-macronutrient meal context on postprandial vascular health. Therefore, we examined whether manipulating the lipid droplet size distribution within a mixed-macronutrient meal impacts vascular-inflammatory and thrombotic parameters. Methods and Results In a randomised and counterbalanced fashion, sixteen adults (8 males; age 34±7 years; BMI of 25.3±4.5 kg/m2) completed three separate fasted morning-time feeding challenges, each separated by a minimum washout of 7-days. On each occasion, test-meals matched for carbohydrate and protein content differing only in fat amount and the lipid droplet size distribution were administered, such that participants consumed (1) a low-fat meal (LF) with negligible fat content, (2) an emulsified-high-fat meal with a fine lipid droplet size (FE), or (3) an emulsified-high-fat meal with a coarse lipid droplet size (CE). Periodic blood samples were retrospectively analysed for plasma triglycerides, tumour necrosis factor alpha (TNFα), tissue factor (TF), fibrinogen, and plasminogen activator inhibitor-1 (PAI-1). Triglyceride concentrations increased rapidly overtime under FE (P-time0.05) and was comparable to LF (P-condition>0.05). Similarly, FE induced a significant rise in TNFα, TF, fibrinogen, and PAI-1 (P-time0.05). Conclusion A high-fat mixed-macronutrient meal with a larger lipid droplet size distribution ameliorates the associated rise in vascular-inflammatory and thrombotic parameters

Health and social care experience and research perception of different ethnic minority populations in the East Midlands, United Kingdom (REPRESENT study)

AbstractIntroductionEthnic minority populations experience significant health and social care disparities; despite experiencing a greater burden of diseases, these groups are underrepresented in health and social care research. Consequently, related research can be less applicable to these population groups. The REPRESENT study aims to explore the health and social care experiences of ethnic minorities and other minoritised populations, their research interests and appropriate research practices.MethodsFocus groups and semistructured interviews were conducted between May and September 2022 with members of a number of ethnic minority communities in England. Data were audio recorded, transcribed and thematically coded using NVivo 12. Rigour was determined through extensive sampling, iterative data collection and analysis.FindingsFifty‐two ethnic minority members were engaged in group interviews and one‐to‐one interviews. Participants included representatives of the following groups: African Caribbean, Eastern European, Gypsy Travellers, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual+, Refugee/Asylum Seekers, Somali and South Asian communities. Interviews were also conducted with ethnic minority healthcare providers and researchers. Three overarching categories were identified: health information, medical service experiences, health and social care concerns and health research. Health and social care services challenges were mostly attributed to discrimination, delayed services, poor cultural relevance and language and cultural barriers. The most influential information sources were local community organisations and word‐of‐mouth. The main health and social care concerns were chronic long‐term health conditions, mental health, maternal health and child development. Recommendations for research involved understanding the motivations for participation, improving communication and empowering communities. Top research priorities were long‐term health conditions, health promotion and education, early care interventions and understanding community needs.InterpretationDiscrimination and bias in health and social care provision have severe implications for worsening ethnic health inequalities. Healthcare commissioning authorities and policymakers can leverage the preference of ethnic minority groups for pharmacy services and community organisations to improve access to care. Improving research interest and engagement requires understanding individual community needs, community sensitivity, research relevance and cultural appropriateness.Patient or Public ContributionMembers of ethnic minority Patient and Public Involvement and Engagement group and Community Advisory Board supported the REPRESENT study design, conceptualisation and report development.</jats:sec

Dietary fat intake is associated with insulin resistance and an adverse vascular profile in patients with T1D: a pooled analysis

Background: Insulin resistance (IR) increases vascular risk in individuals with Type 1 Diabetes (T1D). We aimed to investigate the relationship between dietary intake and IR, as well as vascular biomarkers in T1D. Methods: Baseline data from three randomised controlled trials were pooled. Estimated glucose disposal rate (eGDR) was used as an IR marker. Employing multivariate nutrient density substitution models, we examined the association between macronutrient composition and IR/ vascular biomarkers (tumour necrosis factor-α, fibrinogen, tissue factor activity, and plasminogen activator inhibitor-1). Results: Of the 107 patients, 50.5% were male with mean age of 29±6 years. Those with lower eGDR were older with a longer diabetes duration, higher insulin requirements and an adverse vascular profile (P8.7 mg/kg/min, p <0.001) and consumed a higher absolute and proportional amount of fat (47.6±18.6 vs 30.4±8.1 vs 25.8±10.4%, p<0.001). After adjusting for total energy intake, age, sex, and diabetes duration, increased carbohydrate intake offset by an isoenergetic decrease in fat was associated with higher eGDR (=0.103, 95%CI: 0.044 to 0.163). In contrast, increased dietary fat at the expense of dietary protein intake was associated with lower eGDR (= -0.119, 95%CI: -0.199 to -0.040). Replacing fat with 5% isoenergetic amount of carbohydrate resulted in decreased vascular biomarkers (P<0.05). Conclusion: Higher fat, but not carbohydrate, intake is associated with increased IR and an adverse vascular profile in patients with T1D

Vascular Structure and Functional Responses to Consecutive High-Fat Feeding between Insulin Treatment Regimens in Adults with Type 1 Diabetes and Matched Controls [Poster]

Background: Impaired vascular health is prevalent in type 1 diabetes (T1D); however, it remains unknown whether different insulin treatment regimens mediate indices of vascular structure or function. Methods: Sixteen individuals with T1D receiving either multiple daily injection therapy (MDI; n=8; age: 32±13years; BMI:26.0±5.9kg.m2; HbA1c:53.7±11.2mmol/mol [7.1±3.2%]) or continuous subcutaneous insulin infusion (CSII; n=8; age:35±18years; BMI:26.3±4.6kg.m2; HbA1c: 58.6±9.7mmol/mol [7.5±3.0%]) and ten matched controls (CON; age:31±13years; BMI: 24.3±2.9kg.m2) consumed two high fat (HF) meals at 4-hour intervals. Carotid artery intima-media thickness (CIMT) and flow mediated dilation (FMD) was assessed at baseline, with further FMD assessment at 3-hours following the ingestion of each meal using high resolution B-mode ultrasound. Bolus insulin dose was standardized using the carbohydrate-counting method. Results: CIMT was significantly higher in individuals with T1D compared to controls (p=0.039); treatment stratification within T1D revealed MDI mediated this effect (MDI vs. CON: p=0.049; CSII vs. CON: p=0.112). FMD remained unchanged following the first meal (p=0.204) but was significantly impaired following the second meal (p=<0.001); post hoc analysis revealed MDI mediated this effect of impaired FMD after the second meal (MDI vs. CON: p=0.048; CSII vs. CON: p=0.416). Conclusions: Our findings indicate that patients treated with MDI therapy have higher CIMT (a structural marker of subclinical atherosclerosis) compared to controls but not CSII therapy. FMD was impaired following a second HF meal irrespective of a diabetes status. Considering the pre-existing heightened cardiovascular disease risk in T1D therapeutic strategies to reduce postprandial risk warrants further research

Interrupted sitting improves 24-hour glucose control in people with type 1 diabetes [Conference abstract]

Background and aims: Interrupting prolonged periods of sitting with short, frequent light-intensity walking improves 24-hour glucose control Diabetologia in people with and at risk of Type 2 Diabetes. However, it is unknown whether and how such an intervention influences 24-hour glucose control, including risk of hypoglycaemia, in people with Type 1 Diabetes (T1D). Therefore, we evaluated the effect of short, frequent bouts of light-intensity walking on 24-hour glycaemia in people with T1D. Materials and methods: In a randomised crossover design, ten inactive adults with T1D (6 men; mean±SD: 30±34.7 years) completed two morning (~08:00am) laboratory visits in a fasted state, each separated by at least 1-week. On both visits, participants consumed a standardised carbohydrate-based meal with their usual insulin dose determined by the carbohydrate-counting method; the meal and insulin dose were identical on each visit. After consuming the meal, participants underwent two experimental conditions: (1) uninterrupted sitting (SIT); or (2) sitting interrupted with 5-minute bouts of light-intensity walking every 30- minutes for 4-hours (SIT-Less). Interstitial glucose responses were measured using continuous glucose monitoring (CGM) during the 4- hour laboratory visit for a further 20-hours under free-living conditions. Results: Compare to SIT, whole-day glycaemia was significantly lower following SIT-Less; 24-hour interstitial glucose Area Under the Curve was -14%[1.2%] under SIT-Less (p=0.023), accompanied by a significantly smaller average change in interstitial glucose from baseline (SIT: Δ1.5±2.5 vs. SIT-Less Δ-0.01±1.6 mmol/L, p=0.001), and lower average interstitial glucose peak (SIT:Δ7.7±3.0 vs. SIT-Less Δ3.9±1.4 mmol/L, p=0.002). Furthermore, with SIT-Less, Time in Range (TIR; 3.9-10 mmol/L), was significantly greater (TIR: SIT 991.5±286.86 vs. SIT-Less 1240.5±173.5 minutes, p=0.030), while time spent in hyperglycaemia was significantly lower (SIT 413.5±266.8 vs. SIT-Less 162±163.6 minutes, p=0.020). However, time spent in hypoglycaemia was similar between conditions (SIT 35±68.68 vs. SIT-Less 37.5±62.19 minutes, p=0.933). Glycaemic variability was lower with SIT-Less (CV%: SIT 29.4±7.6 vs. SIT-Less 22.1±7.5 %, p=0.021). Conclusion: Interrupting sitting time, with brief light-intensity walking activity, significantly improves whole-day glucose control in people with T1D. These preliminary findings suggest that interrupted sitting may serve as an effective and practical means of normalising daily glucose levels in people with T1D by increasing time in range and reducing glycaemic variability, without increasing the risk of hypoglycaemia