Latest news with #glycemiccontrol
Medscape
16-07-2025
- Health
- Medscape
Sesame Oil Boosts Glycemic Control in Women With MASLD
TOPLINE: In women with metabolic dysfunction-associated steatotic liver disease (MASLD), supplementing a calorie-restricted diet with unheated sesame oil, such as that used on salads or cooked meals, significantly improved biomarkers of glycemic control and insulin resistance. METHODOLOGY: Sesame oil contains compounds that attenuate inflammation by suppressing proinflammatory cytokines, potentially improving glucose and lipid metabolism; however, studies on its role in MASLD are limited. Researchers in Iran conducted a clinical trial to investigate whether sesame oil supplementation influenced glycemic, metabolic, and stress biomarkers in women with MASLD (aged 20-50 years; BMI, 25-40) who regularly consumed sunflower oil. After a 2-week run-in period on their usual diet, patients were randomly assigned to consume 30 g/d of either sesame oil or sunflower oil in unheated form for 12 weeks, alongside a weight-loss diet with a calorie deficit of 500 kcal/d. Blood markers for glycemic control, insulin sensitivity, inflammation, and oxidative stress were measured at baseline and at 12 weeks. TAKEAWAY: Of 60 patients enrolled, 53 completed the study, 27 in the sesame oil group (mean age, 38.89 years) and 26 in the sunflower oil group (mean age, 39.35 years). The sesame oil group experienced reductions in fasting blood glucose of 18.2 mg/dL, fasting serum insulin of 3.2 μIU/mL, and homeostatic model assessment for insulin resistance of 1.4 units; these reductions were significantly greater than in the sunflower oil group (P < .001 for all). Markers of pancreatic beta cell function and glucose regulation improved significantly in patients in the sesame oil group; however, markers of inflammation and oxidative stress did not differ between the two groups. Both groups achieved significant weight loss, with no differences between them. IN PRACTICE: 'While both groups achieved significant weight loss, the superior glycemic improvements in the [sesame oil] group indicate effects beyond calorie restriction,' the authors of the study wrote. SOURCE: This study was led by Masoumeh Atefi, Shahroud University of Medical Sciences in Shahroud, Iran. It was published online in BMC Nutrition. LIMITATIONS: The study did not measure serum vitamin E levels, red blood cell fatty acid content, or serum A1c levels. Self-reported dietary intake might have introduced bias. Enrollment was restricted to women aged 20-50 years with a specified BMI, limiting generalizability. DISCLOSURES: The study received a grant from Isfahan University of Medical Sciences. The authors reported having no competing interests. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
03-07-2025
- Health
- Medscape
Automated Insulin Delivery Shows Promise in Young Children
TOPLINE: In children aged 2-6 years with type 1 diabetes (T1D) who required at least six units of insulin daily, using the auto mode of the MiniMed 780G hybrid closed-loop insulin delivery system improved glycemic control compared to the system's manual mode — without increasing insulin requirements — and maintained an acceptable safety profile. METHODOLOGY: Poor glycemic control during childhood can adversely affect both brain development and plasticity. Automated insulin delivery systems have shown promising results in children younger than 15 years. Researchers conducted a prospective, multinational trial to investigate the efficacy and safety of automated insulin delivery with the MiniMed 780G system, recruiting 98 children aged 2-6 years with T1D (mean hemoglobin A1c level, 7.53%; 49% girls) between March and September 2023, all of whom required at least six units of insulin daily. The trial began with a 2-week run-in phase, in which the MiniMed 780G system was used in manual mode along with the suspend-before-low (SBL) feature, with the low glucose threshold set at 65 mg/dL. This was followed by a 26-week randomly assigned crossover phase, where patients received either 12 weeks of the auto mode, a 2-week washout, and 12 weeks of the manual + SBL mode or the reverse sequence (manual + SBL mode, washout, and then auto mode). The primary endpoint was the adjusted difference in the percentage of time in range (70-180 mg/dL) between the auto and manual + SBL modes, with noninferiority defined as an absolute margin of 7.5 percentage points. Secondary endpoints included the adjusted difference in mean hemoglobin A1c levels at the end of each 12-week period, tested for noninferiority against an absolute margin of 0.4 percentage points; safety outcomes were also evaluated. TAKEAWAY: The mean time in range of the patients was 58.1% during the run-in phase and 68.3% and 58.3% when using the auto and manual + SBL modes, respectively; the adjusted difference in the time in range between the auto and manual + SBL modes was 9.9 percentage points (95% CI, 8.0-11.7). The adjusted difference in mean hemoglobin A1c levels between the auto and manual + SBL modes was −0.61 percentage points (95% CI, −0.76 to −0.46). The mean total daily insulin dose requirement was similar between the two modes. No severe hypoglycemia events or serious adverse events related to the device or procedure were reported. IN PRACTICE: 'These important findings add to the existing evidence on the safety and efficacy of hybrid closed-loop systems in this vulnerable population and, pending regulatory approval, will increase the options for young children and caregivers to choose their preferred hybrid closed-loop system,' Charlotte K. Boughton, MD, PhD, from the University of Cambridge, Cambridge, England, wrote in a related comment. SOURCE: This study was led by Tadej Battelino, MD, University of Ljubljana, Ljubljana, Slovenia. It was published online in The Lancet Diabetes & Endocrinology. LIMITATIONS: Each center managed its own hemoglobin A1c testing, potentially introducing variations. Excluding children who required fewer than six units of insulin per day may have limited the generalizability of the findings. This study did not capture data on food intake or physical activity, and its sample size was insufficient to assess safety events that occurred infrequently. DISCLOSURES: This study was funded by Medtronic. Four authors reported being employees of Medtronic. Several other authors reported receiving consultant or speaker fees, advisory board fees, research grants, and travel grants from Medtronic and various other pharmaceutical and healthcare companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
26-06-2025
- Health
- Medscape
Mifepristone Improves A1C in T2D With Hypercortisolism
CHICAGO — Mifepristone treatment improved glycemic control and led to weight loss and a reduction of waist circumference in patients with poorly controlled type 2 diabetes (T2D) and hypercortisolism, according to new data from the CATALYST trial. Results from the prevalence phase of the study, presented last year, indicated that 24% (253) of the 1055 patients enrolled had hypercortisolism, as determined by dexamethasone suppression test. The figure was surprising, as the expected prevalence was 8%. The current data were presented at the American Diabetes Association (ADA) 85th Scientific Sessions and simultaneously published in Diabetes Care . 'These findings demonstrate a potentially promising treatment solution' for these patients, who are often frustrated with their diabetes care, said study author John Buse, MD, PhD, Verne S. Caviness Distinguished Professor of Medicine at the University of North Carolina School of Medicine, Chapel Hill, North Carolina, in a press release. The CATALYST Trial: Latest Results In the second phase of CATALYST, individuals who had abnormal cortisol suppression were offered the opportunity to take part in a randomized trial of mifepristone, a medication that reduces the effects of cortisol. It is currently FDA approved for the treatment of elevated blood glucose in patients with hypercortisolism and prediabetes or T2D. The trial took place at 36 sites in the US. A total of 136 patients with T2D (A1c of 7.5%-11.5%, who were on multiple medications) and hypercortisolism were randomized 2:1 to mifepristone (300-900 mg once daily; 91 patients) or placebo (45 patients) for 24 weeks, with stratification by presence/absence of an adrenal imaging abnormality. Almost 40% of the patients were women, and the mean age was 63 years. The mean A1c was 8.55%, and mean BMI was 33.3. Twenty-eight percent of participants had adrenal imaging abnormalities. The medication reduced A1c by 1.5% (95% CI, -1.79 to -1.14). For those taking placebo, A1c declined 0.2% from 8.41% to 8.36% (95% CI, -0.56 to 0.27). Within the first 12 weeks, 30% of those taking mifepristone reduced or discontinued fast-acting insulin compared to 11% of those taking placebo. And half reduced or discontinued long-acting insulin compared to 13% of those taking placebo. 'As their A1c came down, they didn't need the insulin,' Buse told reporters at a press conference at the meeting. Patients taking mifepristone also lost 4.4 kg of body weight and had a 5.2 cm (2.05 in) reduction in waist circumference from baseline. However, almost 50% of those taking mifepristone discontinued due to adverse events compared to just 18% of those taking placebo. A total of 62% of patients on mifepristone reported having treatment-related adverse events, said Buse, adding that people on mifepristone primarily experience glucocorticoid withdrawal syndrome or hypokalemia. Mifepristone 'is a challenging drug to use,' he said, and 'it's important to set expectations appropriately with patients about steroid withdrawal symptoms and how to manage them.' CATALYST already demonstrated that hypercortisolism was likely a culprit in almost a quarter of patients with poorly controlled diabetes, and screening with a dexamethasone suppression test is relatively easy, said Buse. The treatment phase of CATALYST showed 'that identifying and addressing hypercortisolism is a novel path to improving diabetes care in millions of people worldwide,' he added. The CATALYST investigators 'believe that there's sufficient evidence now to suggest guideline changes at the American Diabetes Association and other international health organizations.' This study was funded by Corcept Therapeutics. Buse disclosed serving on an advisory panel/as a consultant for Altimmune, Antag Therapeutics, Amgen, APstem Therapeutics, Aqua Medical, AstraZeneca, Boehringer Ingelheim, CeQur, Corcept Therapeutics, Dexcom, Eli Lilly, embecta, GentiBio, Glyscend, Insulet, Medtronic MiniMed, Mellitus Health, Metsera, Novo Nordisk, Pendulum Therapeutics, Praetego, Stability Health, Tandem Diabetes Care, Terns Pharmaceuticals, Vertex Pharmaceuticals, and Zealand Pharma; and having stocks/shares in Glyscend, Mellitus Health, Metsera, Pendulum Therapeutics, Praetego, and Stability Health.
Medscape
23-06-2025
- Health
- Medscape
AID Systems Need Upgrades for Premenopausal Glucose Control
Insulin requirements fluctuated significantly throughout the menstrual cycle without a consistent pattern, prompting a substantial proportion of premenopausal women with type 1 diabetes (T1D) to manually adjust their automated insulin delivery (AID) system settings to achieve better glycemic control. METHODOLOGY: Although insulin requirements vary across phases of the menstrual cycle, understanding specific adjustments and strategies to manage cycle-induced changes in glucose control remains limited. Researchers conducted a combined quantitative and qualitative study to determine how often premenopausal women with T1D manually adjust their insulin delivery settings to offset hormonal fluctuations and maintain glucose control. They analyzed 354 menstrual cycles from data provided by 70 women with T1D using AID systems and complemented the quantitative results with qualitative insights from seven focus groups, including semi-structured interviews with 38 participants. TAKEAWAY: A substantial proportion (43%) of women regularly adjusted their insulin delivery settings to counteract hormone-related fluctuations. Women who made insulin adjustments achieved a 5-percentage point greater time in range than those who did not adjust settings. To counteract menstrual cycle-induced glucose swings, women mainly tweaked their basal insulin rates, target glucose settings, and correction factors and — in some cases — resorted to ad hoc tactics like inputting fictitious carbohydrate amounts or deliberately underbolusing. IN PRACTICE: "Our findings highlight the limitations of current AID systems to fully automate glucose control for premenopausal women. As AID systems play an increasing role in diabetes care, it is crucial that they can appropriately adapt to factors affecting glucose levels," the authors wrote. SOURCE: The study was led by Stefanie Hossmann, University of Bern in Switzerland. It was presented on June 23, 2025, at the American Diabetes Association 85th Scientific Sessions held at the McCormick Place Convention Center, Chicago (June 20-23, 2025). LIMITATIONS: No limitations were discussed in this abstract. DISCLOSURES: One author disclosed being an employee of Tidepool and serving on the Advisory Panel of Diabetes Center Berne. Another author reported being an employee of Abbott. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
