Beneficial Effects of Soy Phytoestrogen Intake in Postmenopausal Women With Type 2 Diabetes
Vijay Jayagopal , MRCP 1 ,
Paula Albertazzi , MRCOG 1 ,
Eric S. Kilpatrick , MRCPath 2 ,
Elaine M. Howarth ..., MSC 3 ,
Paul E. Jennings , FRCP 1 4 ,
David A. Hepburn , FRCP 1 and
Stephen L. Atkin , FRCP 1
1 Department of Medicine, University of Hull, Hull, U.K.
2 Department of Clinical Biochemistry and Immunology, Hull Royal Infirmary, Hull, U.K.
3 Department of Applied Statistics, University of Hull, Hull, U.K.
4 Department of Medicine, York District General Hospital, York, U.K.
Abstract
OBJECTIVE —Phytoestrogen consumption has been shown to reduce risk factors for cardiovascular disease. Type 2 diabetes confers an adverse
cardiovascular risk profile particularly in women after menopause. The aim of this study was to determine whether a dietary
supplement with soy protein and isoflavones affected insulin resistance, glycemic control, and cardiovascular risk markers
in postmenopausal women with type 2 diabetes.
RESEARCH DESIGN AND METHODS —A total of 32 postmenopausal women with diet-controlled type 2 diabetes completed a randomized, double blind, cross-over
trial of dietary supplementation with phytoestrogens (soy protein 30 g/day, isoflavones 132 mg/day) versus placebo (cellulose
30 g/day) for 12 weeks, separated by a 2-week washout period.
RESULTS —Compliance with the dietary supplementation was >90% for both treatment phases. When compared with the mean percentage change
from baseline seen after 12 weeks of placebo, phytoestrogen supplementation demonstrated significantly lower mean values for
fasting insulin (mean ± SD 8.09 ± 21.9%, P = 0.006), insulin resistance (6.47 ± 27.7%, P = 0.003), HbA 1c (0.64 ± 3.19%, P = 0.048), total cholesterol (4.07 ± 8.13%, P = 0.004), LDL cholesterol (7.09 ± 12.7%, P = 0.001), cholesterol/HDL cholesterol ratio (3.89 ± 11.7%, P = 0.015), and free thyroxine (2.50 ± 8.47%, P = 0.004). No significant change occurred in HDL cholesterol, triglycerides, weight, blood pressure, creatinine, dehydroepiandrosterone
sulfate, androstenedione, and the hypothalamic-pituitary-ovarian axis hormones.
CONCLUSIONS —These results show that dietary supplementation with soy phytoestrogens favorably alters insulin resistance, glycemic control,
and serum lipoproteins in postmenopausal women with type 2 diabetes, thereby improving their cardiovascular risk profile.
CVD, cardiovasular disease
HOMA-IR, insulin resistance measured by Homeostasis Model Assessment
OGTT, oral glucose tolerance test
Footnotes
Address correspondence and reprint requests to Dr. Vijay Jayagopal, Michael White Centre for Diabetes and Endocrinology, Brocklehurst
Building, Hull Royal Infirmary, 220-236, Anlaby Road, Hull, HU3 2RW, U.K. E-mail: v.jayagopal{at}hull.ac.uk .
Received for publication 18 March 2002 and accepted in revised form 1 July 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
DIABETES CARE
Statistical analysis Mean percentage changes obtained at the end of isoflavone treatment were compared with those at the end of the placebo phase, using the paired Student's f test if they followed a ...Gaussian distribution or the Wilcoxon's signed-rank test if those changes violated the assumption of normality when tested using the Kolmogorov-Smirnov test (C-reactive protein and HOMA-IR data). Epidemiological studies (19,20) have indicated that there is no significant association between the standard western dietary intake of isoflavones (0.369 - 0.770 mg/day) and the reduction of cardiovascular events or lipid levels in different cohorts of postmenopausal women over prolonged periods of time (4-6 years).
Good glycaemic control confers an outcome benefit in both diabetic and non-diabetic critically unwell patients. Critically unwell patients receiving intravenous insulin in the intensive care unit ...(ICU) require hourly glucose monitoring. This brief communication highlights the impact of the introduction of the FreeStyle Libre glucose monitor, a form of continuous glucose monitoring, on the frequency of glucose recordings in patients receiving intravenous insulin in the ICU at York Teaching Hospital NHS Foundation Trust.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Abstract Background Foot complications in diabetes are common and destructive, resulting in substantial healthcare costs and high rates of morbidity. Coastal areas have a significantly higher burden ...of disease. People with diabetes experience disproportionately high rates of psychological health issues, including anxiety, depression and diabetes distress. These can affect self‐management and concordance with preventive measures and treatments of foot complications, negatively impacting on outcomes. Access to psychological health services is variable across the United Kingdom and there is a paucity of high‐quality evidence for the effectiveness of treatments for diabetes distress. This study aimed to explore experiences of psychosocial burden and perceptions and experiences of psychosocial support, among patients with diabetes and foot complications living in a coastal area. Methods Patients were eligible to participate if they had experienced diabetes‐related foot complications (amputation, ulceration and/or Charcot neuroarthropathy) within the last 5 years and scored positive for diabetes distress on a validated screening tool (DDS2). Eligible patients completed cross‐sectional questionnaires describing symptoms of diabetes distress (DDS17), anxiety (GAD‐7) and depression (PHQ‐9) and to take part in a face‐to‐face, semi‐structured interview. Questionnaires were analysed using frequencies and interviews were analysed using reflexive thematic analysis. Results A total of 183 patients completed the DDS2 screening questionnaire. Of these, 56 (30.6%) screened positive for diabetes distress. Twenty‐seven patients completed DDS17, GAD‐7 and PHQ‐9 questionnaires. Eleven (40.7%) participants indicated high levels of diabetes distress and four (14.8%) indicated moderate distress. Seventeen participants (age range 52–81 years; 12 men) took part in an interview. Four key themes were identified: impact of living with foot problems; emotional consequences of foot problems; experiences and perceptions of psychological support; and strategies to cope with the emotional impact of foot problems. Conclusion Diabetes distress was prevalent among patients with diabetes‐related foot complications. Foot problems impacted on participants' daily activities, social lives and ability to work. Despite expressing feelings of ongoing fear, worry and depression relating to their foot problems, only one participant had accessed formal psychological support. Many participants relied on talking to podiatrists at routine appointments and described developing various strategies to cope. The psychosocial burden of living with foot complications in diabetes must not be overlooked by health professionals. Findings from this study can inform the design of future services and interventions.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
The use of flash glucose monitoring has been shown to reduce hypoglycaemic episodes and improve diabetes control, but there is little evidence regarding its psychological impact. Here, a pilot ...evaluation is presented which assesses whether or not the use of FreeStyle Libre impacted on patient anxiety scores.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Biological Variation of Homeostasis Model Assessment-Derived Insulin Resistance in Type 2 Diabetes
Vijay Jayagopal , MRCP 1 ,
Eric S. Kilpatrick , MRCPATH 2 ,
Paul E. Jennings , FRCP 1 3 ,
David A. ...Hepburn , FRCP 1 and
Stephen L. Atkin , FRCP 1
1 Department of Medicine, University of Hull, Hull, U.K
2 Department of Clinical Biochemistry, Hull Royal Infirmary, Hull, U.K
3 Department of Medicine, York District General Hospital, York, U.K
Abstract
OBJECTIVE —Individuals with type 2 diabetes are particularly vulnerable to cardiovascular disease. Insulin resistance is a major determinant
of this increased risk and is a potential therapeutic target. This study was undertaken to establish the natural biological
variation of insulin resistance in individuals with type 2 diabetes.
RESEARCH DESIGN AND METHODS —The biological variation of insulin resistance was assessed by measuring insulin resistance at 4-day intervals on 10 consecutive
occasions in 12 postmenopausal women with diet-controlled type 2 diabetes and in 11 weight- and age-matched postmenopausal
women without type 2 diabetes. Insulin resistance was derived using the homeostasis model assessment for insulin resistance
(HOMA-IR) method.
RESULTS —The distribution of HOMA-IR was log Gaussian in the type 2 diabetic study group and Gaussian in the control group. The HOMA-IR
in the type 2 diabetic group was significantly greater than that of the control group (mean ± SD: 4.33 ± 2.3 vs. 2.11 ± 0.79
units, P = 0.001). After accounting for analytical variation, the mean intraindividual variation was also substantially greater in
the type 2 diabetic group than in the control group (mean 1.05 vs. 0.15, P = 0.001). Consequently, at any level of HOMA-IR, a subsequent sample must increase by >90% or decrease by >47% to be considered
significantly different from the first.
CONCLUSIONS —HOMA-IR is significantly greater and more variable for individuals with type 2 diabetes. Therefore, this inherent variability
needs to be accounted for in studies evaluating therapeutic reduction of HOMA-IR in this group.
HOMA-IR, homeostasis model assessment for insulin resistance
Footnotes
Address correspondence and reprint requests to Dr. V. Jayagopal, Michael White Centre for Diabetes and Endocrinology, Brocklehurst
Building, Hull Royal Infirmary, 220-236 Anlaby Rd., Hull, HU3 2RW, U.K. E-mail: v.jaygopal{at}hull.ac.uk .
Received for publication 7 February 2002 and accepted in revised form 22 July 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
DIABETES CARE
Biosimilar insulins have the potential to offer the NHS a considerable cost saving. The acceptability and use of biosimilar insulin by clinicians and patients may, however, be limited by lack of ...experience, understanding and concerns about safety and tolerability. This article summarises information on the advantages and disadvantages of using biosimilar insulins and an overview of the published evidence in relation to efficacy, tolerability and safety of current and expected Biosimilar Insulins. The position of the ABCD on the use of Biosimilar Insulin is stated along with the key practical considerations for healthcare staff involved in insulin prescription and administration.
During the coronavirus 2019 (COVID-19) pandemic, the implementation of non-contact infrared thermometry (NCIT) became an increasingly popular method of screening body temperature. However, data on ...the accuracy of these devices and the standardisation of their use are limited. In the current study, the body temperature of non-febrile volunteers was measured using infrared (IR) thermography, IR tympanic thermometry and IR gun thermometry at different facial feature locations and distances and compared with SpotOn core-body temperature. Poor agreement was found between all IR devices and SpotOn measurements (intra-class correlation coefficient <0.8). Bland–Alman analysis showed the narrowest limits of agreement with the IR gun at 3 cm from the forehead (bias = 0.19°C, limits of agreement (LOA): −0.58°C to 0.97°C) and widest with the IR gun at the nose (bias = 1.40°C, LOA: −1.15°C to 3.94°C). Thus, our findings challenge the established use of IR thermometry devices within hospital settings without adequate standard operating procedures to reduce operator error.
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GEOZS, IJS, IMTLJ, IZUM, KILJ, KISLJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Obstructive sleep apnea (OSA) is associated with an increased risk of diabetes-related complications. Hence, it is plausible that continuous positive airway pressure (CPAP) could have a favorable ...impact on these complications. We assessed the feasibility of conducting a randomized control trial in patients with type 2 diabetes and OSA over 2 years.
We conducted an open-label multicenter feasibility randomized control trial of CPAP vs no CPAP in patients with type 2 diabetes and OSA. Patients with resting oxygen saturation < 90%, central apnea index > 15 events/h, or Epworth Sleepiness Scale ≥ 11 were excluded. OSA was diagnosed using a multichannel portable device (ApneaLink Air, ResMed). The primary outcome measures were related to feasibility and the secondary outcomes were changes in various clinical and biochemical parameters related to diabetes outcomes.
Eighty-three (40 CPAP vs 43 no CPAP) patients were randomly assigned, with a median (interquartile range) follow-up of 645 (545, 861) days. CPAP compliance was inadequate, with a median usage of approximately 3.5 hours/night. Early CPAP use predicted longer-term compliance. The adjusted analysis showed a possible favorable association between being randomly assigned to CPAP and several diabetes-related end points (chronic kidney disease, neuropathy, and quality of life).
It was feasible to recruit, randomly assign, and achieve a high follow-up rate over 2 years in patients with OSA and type 2 diabetes. CPAP compliance might improve by a run-in period before randomization. A full randomized control trial is necessary to assess the observed favorable association between CPAP and chronic kidney disease , neuropathy, and quality of life in patients with type 2 diabetes.
Registry: ISRCTN; Name: The impact of sleep disorders in patients with type 2 diabetes; URL: https://www.isrctn.com/ISRCTN12361838; Identifier: ISRCTN12361838.
Makhdom EA, Maher A, Ottridge R, et al. The impact of obstructive sleep apnea treatment on microvascular complications in patients with type 2 diabetes: a feasibility randomized controlled trial.
. 2024;20(6):947-957.
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