Improving postprandial hyperglycemia in patients with type 2 diabetes already on basal insulin therapy: Review of current strategies

Abstract

A large number of patients with type 2 diabetes (T2D) on basal insulin do not reach their HbA1c goals and require additional therapy to address postprandial hyperglycemia. Guidelines from expert bodies have outlined several approaches to accomplish postprandial glucose (PPG) control, and recent literature suggests several more. This article provides strategies for primary care physicians caring for patients with T2D who do not achieve glycemic control with basal insulin alone. Current treatment guidelines and strategies for improving PPG control are reviewed, including the efficacy, safety, and cost-effectiveness of rapid-acting insulin (RAI) analogs, premixed insulin, glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and α-glucosidase inhibitors. Other approaches, such as combinations of newer basal insulin plus RAI and a fixed-ratio combination of basal insulin and a GLP-1 RA, are also described.

Antidiabetic effect of Euterpe oleracea Mart. (açaí) extract and exercise training on high-fat diet and streptozotocin-induced diabetic rats: A positive interaction

“…Another important mechanism for glycemic control, GLP-1 an incretin synthesized in the intestine and secreted postprandially, has been reported to stimulate insulin secretion, suppress glucagon secretion and slow gastric emptying [ 50 ]. In the present study, the treatment with ASE alone, or associated with exercise training, increased serum GLP-1 levels in type 2 diabetic rats, similar to antidiabetic drugs as exenatide and liraglutide [ 51 ].…”

Unlocking the biological potential of proteins from edible insects through enzymatic hydrolysis: A review

“…Cross-reactivity of proteins (more particularly tropomyosin and arginine kinase) extracted from T. molitor with sera from patients suffering from house dust mite or crustacean allergy was reported (Verhoeckx et al, 2014). The allergenicity of proteins extracted from three edible mealworms (T. molitor, Zophobas atratus and A. diaperinus) has recently been evaluated in vitro by studying their cross-reactivity in sera of human subjects suffering from crustacean or house dust mite allergies (van Broekhoven, Bastiaan-Net, de Jong, & Wichers, 2016). For specific insects such as crickets, most allergy cases appear to be occupational while food related allergies are rare (Pener, 2016).…”

“…-Glucosidase is a metabolic enzyme involved in the breakdown of oligosaccharides into glucose in the small intestine during the post-prandial phase. Inhibition of -glucosidase may currently be used to reduce intestinal uptake of glucose and subsequently lower post-prandial hyperglycemia in type 2 diabetics (Umpierrez et al, 2017). Animal studies describing the antihypertensive (Onsa-ard et al, 2013;Yuan, Wang, & Zhou, 2012), antioxidant (Sangwong, Sumida, & Sutthikhum, 2016;Yuan et al, 2012), antidiabetic (Han, Lee, Lee, Suh, & Park, 2016;Jung et al, 2010), memory enhancement (Kang, Lee, Kang, & Kang, 2013) and hypocholesterolemic (Lapphanichayakool, Sutheerawattananonda, & Limpeanchob, 2017) properties of silk protein hydrolysates have been reported.…”

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“…α-Glucosidase is a metabolic key enzyme in the gut during the post-prandial phase, which cleaves oligosaccharides into glucose. The inhibition of α-glucosidase may presently be used to decrease glucose uptake in the small intestine and successively reduce post-prandial hyperglycemia in the condition of type 2 diabetes [54][55][56] . In the present study, the protein hydrolysate of raw, boiled and backed of seven edible insects have significant α-glucosidase inhibitory activity.…”