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      Convenient food made of extruded adzuki bean attenuates inflammation and improves glycemic control in patients with type 2 diabetes: a randomized controlled trial

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          Abstract

          Objective

          Extrusion is a widely used food processing technology. The aim of this study was to investigate the effects of extruded adzuki bean convenient food (EABCF) on glycemic and inflammation control in type 2 diabetes mellitus (T2DM) patients.

          Patients and methods

          In a randomized controlled trial, 120 T2DM patients were randomly assigned to a control diet group (the low glycemic index [LGI] group, assigned the traditional diabetic low glycemic index diet) or an intervention group (the EABCF group, assigned daily consumption of EABCF). Diet information and blood samples were collected at baseline and after a 4-week intervention. After excluding exogenous insulin users, a subgroup analysis based on baseline fasting insulin (FINS) levels was conducted, and Homeostasis Model Assessment (HOMA) was the target indicator.

          Results

          A total of 106 patients completed the trial, and 89 participants were included in the subgroup analysis. After the intervention, glycemic control improved in both groups compared to baseline, but the difference was not statistically significant ( p>0.05). However, the EABCF group showed decreased inflammation with significantly lower tumor necrosis factor alpha (TNF-α) level compared to the control group (adjusted p<0.01). There was also a slight increase in the interleukin-6 (IL-6) level in the EABCF group (adjusted p=0.004). Moreover, the subgroup analysis found that, after 4 weeks, a diet consisting of EABCF increased insulin secretion to normal levels in the group with hypoinsulinism (baseline FINS<5.2 mU/L). However, the difference only showed a trend toward statistical significance (0.05< p=0.079<0.1).

          Conclusion

          EABCF had a similar hypoglycemic effect as the traditional diabetic LGI diet and showed a greater inhibitory effect on inflammation in T2DM patients. However, further clinical studies are needed to explore the underlying mechanism.

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          Most cited references 22

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          Oral antidiabetic agents: current role in type 2 diabetes mellitus.

          Type 2 diabetes mellitus is a progressive and complex disorder that is difficult to treat effectively in the long term. The majority of patients are overweight or obese at diagnosis and will be unable to achieve or sustain near normoglycaemia without oral antidiabetic agents; a sizeable proportion of patients will eventually require insulin therapy to maintain long-term glycaemic control, either as monotherapy or in conjunction with oral antidiabetic therapy. The frequent need for escalating therapy is held to reflect progressive loss of islet beta-cell function, usually in the presence of obesity-related insulin resistance. Today's clinicians are presented with an extensive range of oral antidiabetic drugs for type 2 diabetes. The main classes are heterogeneous in their modes of action, safety profiles and tolerability. These main classes include agents that stimulate insulin secretion (sulphonylureas and rapid-acting secretagogues), reduce hepatic glucose production (biguanides), delay digestion and absorption of intestinal carbohydrate (alpha-glucosidase inhibitors) or improve insulin action (thiazolidinediones). The UKPDS (United Kingdom Prospective Diabetes Study) demonstrated the benefits of intensified glycaemic control on microvascular complications in newly diagnosed patients with type 2 diabetes. However, the picture was less clearcut with regard to macrovascular disease, with neither sulphonylureas nor insulin significantly reducing cardiovascular events. The impact of oral antidiabetic agents on atherosclerosis--beyond expected effects on glycaemic control--is an increasingly important consideration. In the UKPDS, overweight and obese patients randomised to initial monotherapy with metformin experienced significant reductions in myocardial infarction and diabetes-related deaths. Metformin does not promote weight gain and has beneficial effects on several cardiovascular risk factors. Accordingly, metformin is widely regarded as the drug of choice for most patients with type 2 diabetes. Concern about cardiovascular safety of sulphonylureas has largely dissipated with generally reassuring results from clinical trials, including the UKPDS. Encouragingly, the recent Steno-2 Study showed that intensive target-driven, multifactorial approach to management, based around a sulphonylurea, reduced the risk of both micro- and macrovascular complications in high-risk patients. Theoretical advantages of selectively targeting postprandial hyperglycaemia require confirmation in clinical trials of drugs with preferential effects on this facet of hyperglycaemia are currently in progress. The insulin-sensitising thiazolidinedione class of antidiabetic agents has potentially advantageous effects on multiple components of the metabolic syndrome; the results of clinical trials with cardiovascular endpoints are awaited. The selection of initial monotherapy is based on a clinical and biochemical assessment of the patient, safety considerations being paramount. In some circumstances, for example pregnancy or severe hepatic or renal impairment, insulin may be the treatment of choice when nonpharmacological measures prove inadequate. Insulin is also required for metabolic decompensation, that is, incipient or actual diabetic ketoacidosis, or non-ketotic hyperosmolar hyperglycaemia. Certain comorbidities, for example presentation with myocardial infarction during other acute intercurrent illness, may make insulin the best option. Oral antidiabetic agents should be initiated at a low dose and titrated up according to glycaemic response, as judged by measurement of glycosylated haemoglobin (HbA1c) concentration, supplemented in some patients by self monitoring of capillary blood glucose. The average glucose-lowering effect of the major classes of oral antidiabetic agents is broadly similar (averaging a 1-2% reduction in HbA1c), alpha-glucosidase inhibitors being rather less effective. Tailoring the treatment to the individual patient is an important principle. Doses are gradually titrated up according to response. However, the maximal glucose-lowering action for sulphonylureas is usually attained at appreciably lower doses (approximately 50%) than the manufacturers' recommended daily maximum. Combinations of certain agents, for example a secretagogue plus a biguanide or a thiazolidinedione, are logical and widely used, and combination preparations are now available in some countries. While the benefits of metformin added to a sulphonylurea were initially less favourable in the UKPDS, longer-term data have allayed concern. When considering long-term therapy, issues such as tolerability and convenience are important additional considerations. Neither sulphonylureas nor biguanides are able to appreciably alter the rate of progression of hyperglycaemia in patients with type 2 diabetes. Preliminary data suggesting that thiazolidinediones may provide better long-term glycaemic stability are currently being tested in clinical trials; current evidence, while encouraging, is not conclusive. Delayed progression from glucose intolerance to type 2 diabetes in high-risk individuals with glucose intolerance has been demonstrated with troglitazone, metformin and acarbose. However, intensive lifestyle intervention can be more effective than drug therapy, at least in the setting of interventional clinical trials. No antidiabetic drugs are presently licensed for use in prediabetic individuals.
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            Energy-restricted diets based on a distinct food selection affecting the glycemic index induce different weight loss and oxidative response.

            Low glycemic index (GI) based diets could influence the accompanying physiological adaptations to energy restriction in the treatment of obesity. It was aimed to investigate the effects of two energy-restricted diets with different food distribution and GI values on weight loss and energy metabolism in the nutritional treatment of obesity. Participants (n=32; BMI: 32.5+/-4.3 kg/m(2)) were randomly assigned to follow two energy-restricted diets with higher-GI or lower-GI for 8 weeks. The energy restriction was -30% in relation to energy expenditure. Anthropometry, energy expenditure and mitochondrial oxidation were assessed at baseline and at the endpoint of the intervention. Body weight was also measured one year after the treatment. The work was approved by the ethical committees of the University of Navarra (54/2006). Volunteers consuming the lower-GI diet showed a significantly higher weight loss than their counterparts (-5.3+/-2.6% vs -7.5+/-2.9%; p=0.032), although the decrease in resting energy expenditure (REE) was similar between groups (p=0.783). Mitochondrial oxidation was significantly affected by the type of diet (p=0.001), being activated after the lower-GI treatment (p=0.022). Interestingly, one year after the nutritional intervention weight regain was only statistically significant in the higher-GI group (p=0.033). Lower-GI energy-restricted diets achieved through a specific differential food selection can improve the energy adaptations during obesity treatment, favouring weight loss and probably weight maintenance compared with higher-GI hypocaloric diets.
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              A Determination of Potential α-Glucosidase Inhibitors from Azuki Beans (Vigna angularis)

              A 70% ethanol extract from azuki beans (Vigna angularis) was extracted further with CH2Cl2, EtOAc and n-BuOH to afford four fractions: CH2Cl2-soluble, EtOAc-soluble, n-BuOH-soluble and residual extract fractions. The EtOAc-soluble fractions showed the highest α-glucosidase inhibitory activity. Two pure flavonoid compounds, vitexin and isovitexin, were isolated (using the enzyme assay-guide fractionation method) from the EtOAc-soluble fractions. We further evaluated the interaction between the flavonoid compounds and α-glucosidase by fluorescence spectroscopy. Vitexin and isovitexin showed high inhibitory activities, with IC50 values of 0.4 mg·mL−1 and 4.8 mg·mL−1, respectively. This is the first study of the active compositions of azuki beans against α-glucosidase.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                09 May 2018
                : 14
                : 871-884
                Affiliations
                [1 ]Nutrition Department, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
                [2 ]Nutrition Department, Pinggu Hospital of Traditional Chinese Medicine, Beijing, China
                [3 ]Institute of Crop Sciences, Chinese Academy of Agricultural Sciences, Beijing, China
                Author notes
                Correspondence: Guixing Ren, Institute of Crop Sciences, Chinese Academy of Agricultural Sciences, No 80 Xueyuan South Road, Haidian District, Beijing 100081, China, Tel +86 10 6211 5596, Fax +86 10 6215 6596, Email renguixing@ 123456caas.cn
                [*]

                These authors contributed equally to this work

                Article
                tcrm-14-871
                10.2147/TCRM.S161649
                5953312
                © 2018 Liu et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Clinical Trial Report

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