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Re: Diabetes news for spring 2019

As per the report, exposure to fine particulate matter (PM 2.5) was the third leading risk factor for Type 2 diabetes deaths in 2017, after high blood sugar and excessive body weight.

According to the World Health Organisation, air pollution — both ambient and indoor — kills millions every year. While its link to pulmonary diseases is well-established, that it can be fatal for diabetics is alarming and a major cause of concern for patients, who are already at a heightened risk of heart and kidney disorders and stroke. Infamous as the world's diabetes capital, India faces the twin challenges of mitigating the disease's burden and combating air pollution. While policy interventions by the government and transition to renewable energy will go a long way in bettering air quality, citizens can do their bit by ditching private vehicles and wearing masks.

The same year, Type 2 diabetes accounted for over one million deaths and 57 million DALYs (disability adjusted life years). The burden has increased by 175% and 141% respectively since 1990. While the diabetes rate has gone up in all countries, the largest burden is found in China and India, shows the study. 

Doctors say once fine particulate matter enters the human blood stream, it leads to inflammation in veins and gradually reduces the quality and quantity of insulin production. 

However, doctors in Bengaluru say it’s tough to convince patients about the correlation between air pollution and diabetes. “Evidence will come only after air quality is improved. This can be better proven when we live amid clean air, with fresh diabetes cases gradually reducing,” said Dr Mohan Badgandi, consultant endocrinologist, Manipal Hospitals. 

According to Dr Badgandi, chemical air pollution — especially nitrogen dioxide and sulphur dioxide components — causes certain changes in body metabolism. “They lead to vascular endothelium damage, causing harm to blood vessels and inflammation. There is a biological link between air pollution, diabetes and diabetes deaths,” he explained. 

“Once the toxic chemicals in the air enter the blood barrier, the body treats them as foreign elements, leading to inflammation. This causes insulin resistance and also reduces insulin production. Air pollution and diabetes are interlinked,” said Dr Rahul Patil, consultant cardiologist, head, project Premature Coronary Artery Disease (PCAD), Sri Jayadeva Institute of Cardiovascular Sciences and Research, who is researching the effects of air pollution on human health. 

Although genetic and environmental factors play a major role in development of diabetes, other endocrine disruptors like PM 2.5 may play a pivotal role in younger individuals being afflicted in recent years, said Dr S Satish Kumar, endocrinologist and chairman of Ameya Healthcare. “Though the exact mechanism is yet to be found, research suggests inflammatory markers increase in the body leading to immune activation, which in turn increases insulin resistance. Central nervous system inflammation may also play a role,” he explained. 

Dr Satish said those exposed to PM 2.5 on a long-term basis were found to have higher blood glucose levels, blood sugar attached to haemoglobin, LDL cholesterol (bad cholesterol), common fat like triglycerides, low HDL cholesterol (good cholesterol), factors which lead to increased cardiovascular deaths.

Foul air killed 5 million people in 2017

As per the report, long-term exposure to outdoor and indoor air pollution contributed to nearly 5 million deaths from stroke, diabetes, heart attack, lung cancer and chronic lung disease in 2017. South Asian countries — Bangladesh, India, Nepal and Pakistan — formed the most polluted region in the world, with over 1.5 million air-pollution related deaths.

Who conducted study?

The State of Global Air 2019 annual report and accompanying interactive website have been put together by the Health Effects Institute in coordination with the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, University of British Columbia and University of Texas-Austin.

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Re: Diabetes news for spring 2019

A high-protein, low-fat snack before bed may help people with diabetes stabilize their blood sugar levels overnight.

Everyone's blood sugar levels change throughout the night. In people with type 1 diabetes or type 2 diabetes, these fluctuations can cause high blood sugar levels, or hyperglycemia, in the morning. A tactical late-night snack before bed may help balance these levels.

In this article, we investigate why having a bedtime snack can be a good idea for people with diabetes and discuss some snack options that can help keep blood glucose levels under control throughout the night.

How do glucose levels change overnight?

senior lady recording her glucose levels
A person can identify how their glucose levels change during the night by taking various readings.

A person's blood sugar levels change during the night, mainly, because of two processes:

  • The dawn phenomenon. Between roughly 3:00 a.m. and 8:00 a.m., blood sugar levels surge as part of the process of waking up. This causes high blood sugar levels in the morning.
  • The Somogyi effect. Glucose levels drop significantly between 2:00 a.m. and 3:00 a.m. The body responds by releasing hormones that raise blood sugar levels again. It can release too much of these hormones, leading to high blood sugar levels in the morning.

Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect.

A person can determine how their glucose levels change throughout the night by taking readings at various points, such as just before bed, between 2:00 a.m. and 3:00 a.m., and again when waking up.

Understanding how the body is processing blood sugar is the first step toward picking more healthful snacks in the evening and before bed.

According to the American Diabetes Association (ADA), being overweight or having obesity increases the risk of diabetes-related complications. A variety of bedtime snacks can fit into a balanced, healthful diet.


Best snacks before bed

People can tailor their snacking based on their weight goals and how their body reacts to sugar overnight. A dietician can help.


The best snacks for each person will depend on how the body responds to the dawn phenomenon and the Somogyi effect, as well as personal preferences and goals.

The ADA recommend that people develop a personalized meal plan with their healthcare team, and this can include snacks and their timings.

Little scientific evidence points to an ideal bedtime snack, but researchers believe that beneficial snacks will contain:

Foods with this composition may help limit blood glucose spikes during the night and ensure lower blood glucose levels in the morning.

Try one the following healthful snacks before bed to help manage blood sugar levels and satisfy nighttime hunger:

1. A handful of nuts

Almonds, walnuts, and peanuts contain plenty of vitamins, minerals, and healthful fats. Almonds also contain plenty of vitamin E, and walnuts are especially rich in omega-3 fatty acids.

2. A hard-boiled egg

Eggs are a great source of protein, with one large egg providing 6.29 grams (g). Eggs also contain very few carbohydrates.

Try eating the egg with a couple of whole-grain crackers to add fiber. Fiber slows down the digestive process, releasing the energy from the food over a longer period. This may help keep blood sugar levels stable.

3. Low-fat cheese and whole-wheat crackers

Cheese provides protein, while whole-wheat crackers add dietary fiber. Choose a healthful type of unprocessed cheese.

Whole-wheat and whole-grain crackers have lower glycemic index scores than white varieties, meaning that they have less of an impact on blood glucose levels.

4. Baby carrots, cherry tomatoes, or cucumber slices

Non-starchy vegetables are a great choice for a snack. They are very low in calories, fats, and carbohydrates, while offering plenty of vitamins and minerals.


These vegetables also provide antioxidants and a good dose of fiber to boost heart and gut health. For more protein, add a low-fat cheese slice to this low-calorie snack.

5. Celery sticks with hummus

Celery is a low-calorie, high-fiber food that also provides vitamins and minerals. Pair celery or another non-starchy vegetable with hummus to add a source of protein.

For the best results, avoid highly processed hummus, and try making it at home by blending chickpeas, tahini, and lemon.

6. Air-popped popcorn

Depending on the method of preparation, popcorn can be a light, healthful snack. It contains vitamins, minerals, fiber, and protein. Add in a few mixed nuts for a source of protein.

Learn more about popcorn and diabetes here.

7. Roasted chickpeas

Chickpeas provide a healthful boost of protein and fiber, providing 11.81 g and 10.6 g, respectively, per cup.

A person can prepare this easy snack in under 1 hour, for example by following this spicy roasted chickpeas recipe.

8. Sliced apple and peanut butter

Peanut butter is rich in protein, fiber, and healthful fats, an attractive nutritional profile for anyone looking to help control blood sugar levels.

Apples provide a range of vitamins, minerals, and antioxidants. The ADA say that apples can play a role in a healthful diet for people with diabetes.

Try cutting an apple and adding a light spread of peanut butter to each slice. Or, try a different type of nut butter, such as almond or cashew butter.

Learn more about apples and diabetes here.


9. Sugar-free Greek yogurt

The ADA advise that, along with skim milk and some reduced-fat cheeses, yogurt is one of the most healthful types of dairy. Yogurt contains calcium and high-quality protein.

10. A handful of seeds

Like nuts, seeds are a great source of protein, healthful fats, and fiber. Try a small handful of a mix of sunflower, sesame, and pumpkin seeds in the evening.

Best ways to snack before bed

apple and peanut butter diabetic snacks before bed
A person should choose a healthful snack before bed.

The ADA no longer provide specific carbohydrate counts or recommended diets for people with diabetes.

Instead, the ADA's Standards of Medical Care in Diabetes — 2019 suggest that a person follows an individualized meal plan tailored to their current eating patterns, preferences, and weight goals.

Some general tips that may be beneficial for everyone:

  • Eat mindfully by focusing on enjoying the food.
  • Avoiding snacking in front of the television or while reading, driving, or otherwise distracted.
  • Plan meals, snacks, and treats ahead of time.
  • Choose healthful snacks, rather than ones that contain empty calories and low-quality carbohydrates.
  • Learn about and pay attention to portion sizes.


Each person with diabetes can benefit from learning how their body processes blood sugar during the night.

Getting a sense of the rise and fall of blood sugar levels can help a person decide how much to eat in the evenings and whether to include a snack in a bedtime routine.

There are plenty of low-calorie, high-protein snacks to choose from. Add some fiber for extra health benefits.

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Re: Diabetes news for spring 2019

All women will face menopause at some point, but a new study reveals early menopause is linked to Type 2 diabetes.

For the past seven years, Dr. Supneet Ssaluja has been working with 70-year-old Bernadine Brodgon to get her Type 2 diabetes under control.

And the two are a perfect doctor- patient pair.

"When I met her my A1 C was 13.7 I believe when i met her, now it's down to 5," said Type 2 diabetes patient, Bernadine Brodgon.

Possible Meteor Spotted In Southeastern U.S.

There were nearly 500 reported sightings of a fireball over the Southeastern region of the U.S. early Thursday morning, according to the American Meteor Society. Reports of the possible meteor came from Florida, Georgia, South Carolina, North Carolina, Kentucky, Tennessee, Virginia and Alabama.
(Published Thursday, April 4, 2019)
When Bernadine was 32, she had endometriosis and one day on her menstrual cycle - heavy bleeding from a fibrod tumor led to an emergency surgery, that resulted in a hysterectomy.

"He found it back behind my large intestines and it was about the size of a grapefruit," said Brogdon.

A surgical hysterectomy, that saved her life but forced her into early menopause.

She later developed Type 2 diabetes.

Now 38 years later, analysis from data of 13 studies and published in Bottom Line health shows a link between early menopause and Type 2 diabetes.

Dr. Saluja says that link is likely caused by a number of changes that occur during menopause.

"Mood changes, sleep disturbance and weight gain and those are quite disturbing to women of this age but what also happens is a drop in estrogen levels and that can cause change in your fat distribution and that can put you at risk for diabetes," said physician Dr. Supneet Saluja.

Early menopause is considered to be anyone in their early 40's no matter if it's natural or surgical.

If you are experiencing the symptoms, Dr. Saluja says its important to talk to your doctor about the your overall health to lower your risk for diabetes later in life.

"I tell my patients to use a portion control diet and increase physical activity," said Dr. Saluja.

And though bernadine has been through a lot, she's a shining example of how you can get things back on track.

Doctors say making healthy lifestyle choices such as getting plenty of exercise and eating healthy foods can also help.


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Re: Diabetes news for spring 2019

Type 2 Diabetes Prevention Week: I had never been overweight, but I was at risk of type 2

Fri, 05 Apr 2019
Jack Woodfield

Type 2 Diabetes Prevention Week: I had never been overweight, but I was at risk of type 2
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• Type 2 Diabetes Prevention Week: From prediabetes to feeling fitter and healthier01 April 2019

Our final member being featured for Type 2 Diabetes Prevention Week has a different story than most, highlighting lifestyle changes could benefit everyone. 

It might be easy to assume that if you are a healthy weight you aren't at risk of type 2 diabetes. Low Carb Program member Anne Pollock thought her healthy BMI and Mediterranean diet meant her blood glucose levels would be fine. 

However, a glucose tolerance test revealed Anne had high blood glucose and she was at risk of developing type 2 diabetes. As her blood glucose levels began to worsen, Anne decided to join the Low Carb Program to help her make the switch to a new way of eating.

"Watching the videos week by week I could pace myself," Anne told the Low Carb Program. 

Anne had never eaten chocolate, cake or biscuits frequently, so her main change when starting to eat a low carb diet was cutting out bread, rice and starchy vegetables like potatoes.

By swapping these high carb foods with salad and vegetables the weight dropped off and Anne lost 9.5kg within nine months.

Anne made sure her new lifestyle was easy to maintain and stressed the importance of finding what works for your own life. 

"Find low carb swaps for foods such as bread, potatoes and rice to make it sustainable. I don't eat potatoes but do eat a small slice of bread most days, which is usually low carb or sourdough."

Anne starts her day with berries and Greek yoghurt and enjoys a handful of nuts for a mid-morning snack. Lunch is normally soup or a salad with healthy fats from avocado, cheese and eggs. A dinner time option for Anne and her husband is often homemade fishcakes.

One of Anne's top tips for fellow low carb members is, "If you find you slip up, it’s important to not punish yourself. I still eat chocolate and drink gin, in fact I eat more chocolate now than I did before! Except now it’s 85% dark chocolate."

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Re: Diabetes news for spring 2019

People with prediabetes and low thyroid function were more than twice as likely to progress to full-blown type 2 diabetes compared to those with normal thyroid hormone levels in a new study,1 published the journal, BMC Medicine. 

Unattended, Low Thyroid Function Doubles the Risk of Progressing to Type 2 Diabetes

In this study,1 researchers from the Erasmus Medical Center in the Netherlands followed 8,492 adults, ages 54 to 74, for nearly eight years. At the start, 1,338 had prediabetes and 7,114 had normal blood sugar levels.  After 7.9 years, 798 participants had developed type 2 diabetes (T2D). Overall, low thyroid function—even in the low-normal range—increased the risk for diabetes by 13%. But among those with prediabetes, the risk of progressing to type 2 diabetes ranged from 15% for those with normal thyroid function to 35% for those with signs of low function. Even “low normal” thyroid functioning increased risk.

It’s the first large study to track low and low-normal thyroid function and diabetes risk. “There are no other studies addressing the relation between diabetes and thyroid function in the euthyroid range or in individuals with prediabetes,” the researchers note.

Lead study author, Layal Chaker, MD, a Research and Curriculum Fellow at the Harvard T.H. Chan School of Public Health and a research fellow in the Department of Endocrinology  and Epidemiology at the Erasmus Medical Center tells EndocrineWeb, "it's too soon to recommend thyroid screening tests for people with prediabetes. " And while treating low thyroid can help people with T2D control their blood sugar, it’s not known whether treatment could prevent or delay it.  “Our findings suggest that screening in people with prediabetes could be considered for further research,” Dr. Chaker said. 

Examining the Impact of Hypothyroidism and Diabetes

“There are many ways in which low thyroid hormone levels can increase the risk of diabetes,” he says. “First of all, thyroid hormones are crucial for our body’s metabolism and energy expenditure. Low thyroid hormone levels are associated with higher Body Mass Index, which in turn is a risk factor for diabetes.”

But there seems to be a deeper connection. “When we account for [BMI] in our analyses we still see an association of thyroid hormone levels with the risk of diabetes, especially in individuals with glucose levels within the prediabetic range,” he says. “Thyroid hormone is also directly involved in the control of insulin secretion and glucose homeostasis. Hypothyroidism is associated with decreased insulin sensitivity and glucose tolerance and treatment of hypothyroidism has shown to improve these effects. The exact mechanism or mechanisms that are involved in the association need to be investigated.”

Participants in the study are all part of the large, on-going Rotterdam Study tracking the development of age-related diseases in residents of Ommoord, a large neighborhood in the Dutch city of Rotterdam. Volunteers’ thyroid status had already been checked by measuring levels of thyroid stimulating hormone (TSH) and thyroxine (also called T4). Elevated TSH and reduced T4 indicate low thyroid function.

If further research confirms a connection, in the future people with prediabetes and low or low-normal thyroid function might be more strongly encouraged to adopt healthy lifestyle changes to prevent prediabetes or even begin diabetes treatment or thyroid treatment sooner, the researchers note. 

If You Have Prediabetes, Should You Be Screened for Thyroid Disease?

Larry A. Distiller, FCP(SA), FRCP, FACE, an endocrinologist at the Centre for Diabetes and Endocrinology in South Africa,3 who has studied rates of hypothyroidism in people with type 2 diabetes agrees that there’s not enough evidence to suggest thyroid screening for people with prediabetes.

“Routine screening for hypothyroidism in those with diabetes or prediabetes is contentious,” Dr. Distiller tells EndocrineWeb. “Some guidelines recommend routine screening but most do not. Both hypothyroidism and diabetes are common conditions and common things occur commonly, so it is difficult to assume one leads to the other.”

It's important to heed the fact that there’s “no evidence” that treating hypothyroidism would prevent prediabetes from progressing to type 2 diabetes, he says. So the best plan is to work closely with your health provider to assure that your medical status is well cared for.


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Re: Diabetes news for spring 2019

Green-fingered researchers say Mother Nature could help to prevent blindness, potentially improving outcomes for those with diabetes-related eye problems.

A study has looked at the Hyacinthaceae plant family and the compounds they produce, which could have potential for developing future treatments.

Naturally occurring compounds have previously been shown to have anti-inflammatory and anti-oxidative effects, so researchers from the University of Surrey, UK, teamed with scientists from Kingston University and Indiana University, US, to experiment with this plant family due to its long tradition of being used by healers.

Several of the naturally grown compounds, called homoisoflavonoids, were isolated as being able to stop the growth of abnormal blood vessels which can be problematic as part of diabetic retinopathy.

Several isolated active compounds were shown to slow the growth of new blood vessels, with one synthetic derivate shown to be particularly promising.

"The relative effects of the natural products described here on each of these enzymes will be a valuable topic for future exploration," said the researchers. "Our results will open the doors to the development of further synthetic analogues [...] to treat blinding eye diseases."

Diabetic retinopathy is a common of diabetes caused by high blood glucose levels which damage the retina at the back of the eye. The signs of retinopathy can be recognised at an early stage, before vision is affected, by attending annual retinopathy screening appointments.

Attending retinopathy screening is important as the condition can lead to blindness if the condition is not spotted early and left untreated.

Keeping blood glucose levels within a normal range can help to lower the risk of diabetic retinopathy.

Professor Dulcie Mulholland, Head of Department of Chemistry at the University of Surrey, said: "It goes without saying that losing your eyesight is a devastating experience. We believe that our results hint at possible future treatments for many degenerative eye conditions and it appears that nature still has many secrets to reveal."

Dr Sianne Schwikkard, School of Life Sciences, Pharmacy and Chemistry, at Kingston University, said using natural resources for treatment has "huge potential". The researcher added that the work has "produced a real opportunity to further collaboration and has the potential to bring new breakthroughs in the treatment of degenerative eye-diseases".

The findings have been published in the American Chemical Society journal.


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Re: Diabetes news for spring 2019

Gout treatment may help prevent obesity-related type 2 diabetes, suggests small NIH study

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The drug colchicine, used to treat the arthritic condition gout, could potentially reduce complications accompanying metabolic syndrome, a combination of high blood pressure, high blood sugar and other conditions that increase the risk of heart disease and type 2 diabetes, according to researchers at the National Institutes of Health. Their study appears in Diabetes, Endocrinology, and Metabolism.

Previous studies have indicated that the system-wide inflammation that occurs in obesity plays a role in the development of type 2 diabetes. In the current study, researchers led by Jack A. Yanovski, M.D., Ph.D., of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) randomly assigned 21 study participants to received colchicine twice a day for 3 months, while 19 participants received a placebo. Colchicine suppresses a multi-protein complex called NLRP3, which triggers the inflammation seen in obesity.

Researchers looked at several measures that reflect how well insulin works in the body to clear sugar from the blood (insulin resistance). There was no difference between the two groups in insulin resistance determined by one measure of insulin use (the frequently sampled, insulin-modified intravenous glucose tolerance test). However, the colchicine group showed improvement on the Homeostatic Model Assessment of Insulin Resistance test, which also estimates how much insulin is needed to keep blood sugar at a normal level while fasting. Those in the colchicine group also scored lower on a blood test of C-reactive protein and other tests that indicate inflammation. The authors concluded that larger studies are needed to determine if colchicine could prevent the development of type 2 diabetes in people with metabolic syndrome.

The research was also supported by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases.


Jack Yanovski, M.D., Ph.D., Chief of the NICHD Section on Growth and Obesity, is available for comment.


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Re: Diabetes news for spring 2019

Researchers say eggs for breakfast benefits those with diabetes

UBC Associate Professor Jonathan Little says a high-fat, low-carb breakfast can help control blood sugar levels throughout the day. Credit: UBC Okanagan

While some cereals may be the breakfast of champions, a UBC professor suggests people with Type 2 Diabetes (T2D) should be reaching for something else.


Associate Professor Jonathan Little, who teaches in UBC Okanagan's School of Health and Exercise Sciences, published a study this week demonstrating that a high-fat, low-carb breakfast (LCBF) can help those with T2D control blood sugar levels throughout the day.

"The large blood sugar spike that follows breakfast is due to the combination of pronounced insulin resistance in the morning in people with T2D and because typical Western breakfast foods—cereal, oatmeal, toast and fruit—are high in carbohydrates," says Little.

Breakfast, he says, is consistently the "problem" meal that leads to the largest blood sugar spikes for people with T2D. His research shows that by eating a low-carb and high-fat meal first thing in the morning is a simple way to prevent this large spike, improve glycemic control throughout the day, and perhaps also reduce other diabetes complications.

Study participants, with well-controlled T2D, completed two experimental feeding days. On one day, they ate an omelette for breakfast and on another day, they ate oatmeal and some fruit. An identical lunch and dinner were provided on both days. A continuous glucose monitor—a small device that attaches to your abdomen and measures glucose every five minutes—was used to measure blood sugar spikes across the entire day. Participants also reported ratings of hunger, fullness and a desire to eat something sweet or savory.


Little's study determined that consuming a very low-carbohydrate high-fat breakfast completely prevented the blood sugar spike after breakfast and this had enough of an effect to lower overall glucose exposure and improve the stability of glucose readings for the next 24 hours.

"We expected that limiting carbohydrates to less than 10 per cent at breakfast would help prevent the spike after this meal," he says. "But we were a bit surprised that this had enough of an effect and that the overall glucose control and stability were improved. We know that large swings in blood sugar are damaging to our blood vessels, eyes, and kidneys. The inclusion of a very low-carbohydrate high-fat breakfast meal in T2D patients may be a practical and easy way to target the large morning glucose spike and reduce associated complications."


He does note that there was no difference in blood sugar levels in both groups later in the day, suggesting that the effect for reducing overall post-meal glucose spikes can be attributed to the breakfast responses with no evidence that a low-carb breakfast worsened glucose responses to lunch or dinner.

"The results of our study suggest potential benefits of altering macronutrient distribution throughout the day so that carbohydrates are restricted at breakfast with a balanced lunch and dinner rather than consuming an even distribution and moderate amount of carbohydrates throughout the day."

As another interesting aspect of the research, participants noted that pre-meal hunger and their cravings for sweet foods later in the day tended to be lower if they ate the low-carb breakfast. Little suggests this change in diet maybe a healthy step for anybody, even those who are not living with diabetes.


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Re: Diabetes news for spring 2019

Probiotics Effects On Insulin Resistance

Mar 12, 2019
Editor: David L. Joffe, BSPharm, CDE, FACA


Author: Dahlia Elimairi, Pharm D Student, UC Denver Skaggs School of Pharmacy


Probiotic supplements may be considered as an adjunct treatment for glycemic control in women who are pregnant and have gestational diabetes.

There is increasing evidence regarding the use of probiotics in the prevention of gestational diabetes. Theories by which probiotic intake may improve markers of insulin resistance and lipid profiles in patients with gestational diabetes include its anti-inflammatory effects, both locally in the gut and systemically, increased production of bacteriocins and short-chain fatty acids such as butyric acid, and by downregulating inflammation and blocking suppression of glucose transporter type 4. Still the effects of probiotic supplementation on markers of insulin resistance and lipid concentrations in patients with gestational diabetes are scarce.

A new randomized, double-blind, placebo-controlled trial published January 2019 aimed to evaluate the effect of probiotic supplements on insulin resistance in pregnant women with diet-controlled gestational diabetes mellitus.

The study was carried out between June 2016 and February 2017. Pregnant women with diet-controlled gestational diabetes mellitus were enrolled in the study at 24–28 weeks of gestation and randomized to receive either probiotic supplements containing Bifidobacterium and Lactobacillus or a placebo daily for four consecutive weeks. Primary outcomes were mean differences in insulin resistance (homeostatic model assessment for insulin resistance), fasting insulin and fasting plasma glucose between the two groups. Secondary outcomes were changes in maternal weight after the intervention.

Probiotic supplementation for four weeks during the late second to early third trimester resulted in favorable metabolic changes on fasting plasma glucose, fasting plasma insulin and Homeostatic model assessment for insulin resistance, compared with placebo. These effects occurred without significant differences in caloric intake, dietary macronutrient composition, fiber intake or weight gain between the placebo and probiotic groups. In addition, probiotic supplementation was shown to be well-tolerated and safe in the participants.

The study concluded that four weeks of probiotic supplements in women with diet-controlled gestational diabetes in the late second and early third trimester lowered fasting glucose and increased insulin sensitivity. Probiotic supplements may be considered an adjunct treatment for glycemic control in these patients.

In another study, N. Dolatkhah et al, aimed to assess the effect of a probiotic supplement capsule containing four bacterial strains on glucose metabolism indices and weight changes in women with newly diagnosed gestational diabetes. Sixty-four pregnant women with gestational diabetes were enrolled into a double-blind placebo-controlled randomized clinical trial. They were randomly assigned to receive either a probiotic or placebo capsule along with dietary advice for eight consecutive weeks. The trend of weight gain along with glucose metabolism indices was assayed.

During the first six weeks of the study, the weight gain trend was similar between the groups. However, in the last two weeks of the study, the weight gain in the probiotic group was significantly lower than in the placebo group. Fasting blood glucose decreased in both intervention and control groups significantly, and the decrease in the probiotic group was significantly higher than in the placebo group.

While these studies support the favorable effect of probiotics on fasting glucose levels, there is still conflicting data as seen in a large study conducted by K.L. Lindsay et al, in which 149 pregnant women with gestational diabetes who were randomized to either a daily probiotic (Lactobacillus salivarius) or placebo capsule for 4–6 weeks. There were no significant differences in fasting glucose levels between the two groups after the intervention. According to A. Kijanawat et al, this could be due to the lack of positive effects in fasting glucose levels seen in some studies could be due to a relatively mild degree of hyperglycemia in these women with diet-controlled gestational diabetes, and probiotics could not further lower glucose levels, as some of them might have been in the normal range at baseline.

This still shows that further research is needed to strengthen these results before recommendations can be made.

Practice Pearls:

  • Probiotic supplements have been shown to lower fasting glucose and decrease insulin resistance in patients with gestational diabetes.
  • There is still conflicting data from large trials showing no significant difference seen with the use of probiotics, therefore further research is warranted.


Kijmanawat A, Panburana P, Reutrakul S, Tangshewinsirikul C. Effects of probiotic supplements on insulin resistance in gestational diabetes mellitus: A double-blind randomized controlled trial. J Diabetes Investig. 2019 Jan;10(1):163-170.

Dolatkhah N, Hajifaraji M, Abbasalizadeh F, et al. Is there a value for probiotic supplements in gestational diabetes mellitus? A randomized clinical trial. J Health Popul Nutr 2015; 33: 25

Lindsay KL, Brennan L, Kennelly MA, et al. Impact of probiotics in women with gestational diabetes mellitus on metabolic health: a randomized controlled trial. Am J Obstet Gynecol 2015; 212: 496.e1–496.e11.

Dahlia Elimairi, Pharm D Student UC Denver Skaggs School of Pharmacy

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Re: Diabetes news for spring 2019

The food industry relies on alternatives to sugar for a vast range of diet foods. But are they safe to consume? Claudia Hammond investigates.


Many people buy diet drinks and sweeteners in a bid to reduce the amount of sugar they consume. Over the years concerns about their safety have been raised, but how much evidence is there that they’re bad for us?

Aspartame is probably the best-known artificial sweetener and the one that’s had the worst press. It’s an alternative to sugar, created from aspartic acid and phenylalanine. In 1996 a paper suggested that the increase in brain tumours might be linked to a rise in the popularity of aspartame. Fears continued, and other types of cancer began to be mentioned. There was so much concern that a vast study of almost half a million people was conducted by the US National Cancer Institute and published in 2006. It found no increase in the risk of brain cancer, leukaemia or lymphoma in people who consumed aspartame.

Likewise when the European Food Safety Authority conducted the most comprehensive review of the evidence to date, they concluded that at the recommended levels (40mg a day per kilogram of body weight) it was safe, even for children and pregnant women.

Tooth protector

The reason it doesn’t seem to have caused problems is that so little aspartame enters our blood system; it’s quickly broken down into by-products. But there is one exception. People with a rare genetic disorder called phenylketonuria or PKU can’t break down phenylalanine, one of aspartame’s by-products ‒ for them, it isn’t safe. This is why sweeteners for people to add at the table or to hot drinks are clearly labelled with a warning that they contain a source of phenylalanine.

Some sweeteners do come with side-effects, however. If you’ve ever eaten too many sugar-free mints containing xylitol then you might have experienced this for yourself. Xylitol is a type of carbohydrate made from birch and other hardwood trees. It contains 30% fewer calories than sugar and doesn’t seem to leave an aftertaste, but if you consume large amounts, it can cause water retention, resulting in diarrhoea. But there is evidence exciting some dentists that it can help prevent tooth decay. Chewing gum or mints sweetened with xylitol has been show to neutralise plaque acidity on the teeth.




The newest kid on the block is a sweetener that comes from the stevia plant, except that it isn’t really that new. In Paraguay and Brazil stevia has been used medicinally for centuries. It’s calorie-free and 300 times sweeter than sugar. In Japan it’s been sold as a sweetener for more than four decades. Native to tropical and sub-tropical areas of South and Latin America, sweet compounds called steviol glycosides are extracted from the leaves of the plant by steeping them in water. These compounds pass through the body without being absorbed. Stevia was approved at a food additive in the US in 2008 and in Europe in 2011. The downside is that some find it has a bitter aniseed-like aftertaste and for this reason it’s often mixed with artificial sweeteners.

But are steviol glysocides safe? The European Food Safety Authority thinks so after they conducted an analysis of all the available evidence done on both humans and animals in 2010. They concluded these compounds don’t cause cancer, are not toxic and are safe for children and pregnant women.

The great hope is that it helps people to satisfy their sweet tooth without putting on weight or developing diabetes, yet sweeteners have been available for some time and don’t seem to have halted the obesity crisis so far. Scientists still don’t know whether there are consequences when the brain registers the sweet taste, but then doesn’t get the hit of sugar it expects. The worry is that the sweetness might somehow trick the body into releasing too much insulin, something which could lead to weight gain in the long run. It’s not possible to say yet whether this is happening. But the European Food Safety Authority has concluded there’s not enough evidence to say that stevia helps to achieve or maintain a healthy body weight. 

Glucose intolerance 

Sweeteners don’t seem to deserve their poor reputation, it would appear. But just as it seemed that the evidence was clear, this year some curious new research from Israel was published, suggesting that far from helping to prevent Type 2 diabetes, the artificial sweeteners aspartame, saccharin and sucralose might contribute to it. Healthy mice were given drinking water with one of these three sweeteners added to it. When they measured their blood glucose levels they found that the mice who had consumed sweeteners were showing glucose intolerance, something associated with Type 2 diabetes, while the mice which drank plain water or water containing ordinary sugar didn’t. The reason appeared to lie in the bacteria found in the gut; if they had consumed sweeteners their gut bacteria was changed.

Results from mice can’t always be extrapolated to people and the usual diet of a mouse is of course very different from ours. But for the second part of their study the researchers used humans, feeding them the maximum daily allowance of saccharin, the equivalent of 40 cans of a typical diet drink. Within five days just over half the people showed some intolerance to glucose. Intriguingly those that did had different gut bacteria.




Then the researchers took it a step further, carrying out faecal transplants where faeces are passed from one person or animal to another. In this case they took the faeces from the humans and put them in the mice. The humans with glucose intolerance passed it on to the mice, suggesting these bacteria in the gut are the key. But before we decide that sweeteners are harmful after all, this is just a single study conducted mainly on mice, with just seven humans taking part. Even the researchers concede that more research is needed. This study tells us nothing about the long-term impact of sweeteners in humans.

In 2013 a vast study covering more than 300,000 people in eight European countries found no link between the development of Type 2 diabetes and eating or drinking artificial sweeteners.

There is one lesson from all these studies and that’s that there is no one category of “sweeteners” which are good or bad. Each is very different and needs to be researched and considered separately. Considering all this evidence, it seems to be far too soon to reach for the sugary drinks instead.