Relative roles of insulin and hypoglycaemia on induction of neuroendocrine responses to, symptoms of, and deterioration of cognitive function in hypoglycaemia in male and female humans

To assess the relative roles of insulin and hypoglycaemia on induction of neuroendocrine responses, symptoms and deterioration of cognitive function (12 cognitive tests) during progressive decreases in plasma glucose, and to quantitate glycaemic thresholds, 22 normal, non-diabetic subjects (11 males, 11 females) were studied on four occasions: prolonged fast (n = 8, saline euglycaemia study, SA-EU), stepped hypoglycaemia (plasma glucose plateaus of 4.3, 3.7, 3 and 2.3 mmol/l) or euglycaemia during insulin infusion at 1 and 2 mU · kg-1 · min-1 (n = 22, high-insulin hypoglycaemia and euglycaemia studies, HI-INS-HYPO and HI-INS-EU, respectively), and stepped hypoglycaemia during infusion of insulin at 0.35 mU · kg-1 · min-1 (n = 9, low- insulin hypoglycaemia study, LO-INS-HYPO). Insulin per se (SA-EU vs HI-INS- EU), suppressed plasma glucagon (-20%) and pancreatic polypeptide (~30%), whereas it increased plasma noradrenaline (~10%, p < 0.05). Hypoglycaemia per se (HI-INS-HYPO vs HI-INS-EU) induced responses of counterregulatory hormones (CR-HORM), symptoms and deteriorated cognitive function. With the exception of suppression of endogenous insulin secretion, which had the lowest glycaemic threshold of 4.44 ± 0.06 mmol/l, pancreatic polypeptide, glucagon, growth hormone, adrenaline and cortisol had similar glycaemic thresholds (~3.8-3.6 mmol/l); noradrenaline (3.1 ± 0.0 mmol/l), autonomic (3.05 ± 0.06 mmol/l) and neuroglycopenic (3.05 ± 0.05 mmol/l) symptoms had higher thresholds. All 12 tests of cognitive function deteriorated at a glycaemic threshold of 2.45 ± 0.06 mmol/l, but 7 out of 12 tests were already abnormal at a glycaemic threshold of 2.89 ± 0.06 mmol/l. Although all CR-HORM had a similar glycaemic threshold, the lag time of response (the time required for a given parameter to increase) of glucagon (15 ± 1 min) and growth hormone (14 ± 3 min) was shorter than adrenaline (19 ± 3 min) and cortisol (39 ± 4 min) (p < 0.05). With the exception of glucagon (which was suppressed) and noradrenaline (which was stimulated), insulin per se (HI- INS-HYPO vs LO-INS-HYPO) did not affect the responses of CR-HORM, and did not influence the symptoms or the cognitive function during hypoglycaemia. Despite lower responses of glucagon, adrenaline and growth hormone (but not thresholds) in females than males, females were less insulin sensitive than males during stepped hypoglycaemia

Efficacy of the holistic, psychonutritional approach of Centro DAI e Obesità di Città della Pieve in the management of type 2 diabetes among patients with obesity and dysfunctional eating

Purpose Dysfunctional eating is strongly associated with obesity and worsens type 2 diabetes (T2DM) outcomes. The aim of this study was to investigate the effectiveness of the psycho-nutritional treatment (PNT) of "Centro DAI e Obesita" of Citta della Pieve on weight loss and glucose management in dysfunctional eaters with obesity and T2DM. Methods PNT includes psychotherapeutical, nutritional, physical and social activities. Subjects with obesity, T2DM and dysfunctional eating habits who completed the 8 weeks residential program between 2010 and 2019 were compared with obese, T2DM, dysfunctional eaters who underwent to a conventional, hospital-based, nutritional treatment (CT). Anthropometric variables, glucolipid panel, and body composition were assessed at baseline and at the end of the program. Weight and HbA1c were also measured after one year from the completion. Results Sixty-nine patients completed the PNT and reduced weight (-7 +/- 3.2%; p < 0.001), BMI (-7 +/- 3.1%; p < 0.001), and triglycerides, AST, GGT and ALT (p <= 0.008); glycemic control improved (HbA1c: -1.1 +/- 1.5%, mean fasting glucose: -41 +/- 46 mg/dl, p < 0.001). Eleven% of subjects requiring diabetes medications at baseline discontinued the therapy. In the insulin treated group (49%), mean daily units were halved (-32.6 +/- 26.0, p < 0.001). At one year, weight loss (-6 +/- 7.4%, p < 0.001) and HbA1c reduction (-0.52 +/- 1.4%, p = 0.029) persisted. Fifty-five patients completed the CT: HbA1c reduced (p = 0.02), but weight (-0.6 +/- 3.7%), BMI (-0.7 +/- 3.8%), and insulin units' reduction (-2.5 +/- 11.7, p = 0.20) were lower compared to the PNT. Conclusion PNT is effective in improving T2DM management in patients with obesity and dysfunctional eating