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Introduction: Numerous clinical trials have investigated the effects of fenugreek, a traditional herbal medicine, on type 2 diabetes mellitus (T2DM). However, the results from these studies have been inconsistent. Therefore, we aimed to perform a meta-analysis on the effects of fenugreek supplementation on weight, body mass index (BMI), lipid profile, and glycemic indices in patients with T2DM. Methods: We searched PubMed, Scopus, Embase, ISI Web of Science, and Cochrane Library databases to identify clinical trial studies until October 2023. The data were analyzed using a random-effects model and presented as the weighted mean difference (WMD) along with the associated 95 % confidence interval (CI). Results: A total of 19 studies were included in the meta-analysis. The results indicated a significant impact of fenugreek supplementation on lowering fasting plasma glucose (FPG) (WMD: 20.32 mg/dl; 95 % CI: 26.65 to -13.99), hemoglobin A1C (HbA1c) (WMD: 0.54 %; 95 % CI: 0.80 to -0.28), homeostatic model assessment of insulin resistance (HOMA-IR) (WMD: 0.36; 95 % CI: 0.67 to -0.05), total cholesterol (TC) (WMD: 33.10 mg/dL; 95 % CI: 64.31 to -1.88), low-density lipoprotein cholesterol (LDL-C) (WMD: 29.14 mg/dL; 95 % CI: 55.45 to -2.83), BMI (WMD: 0.73 kg/m2; 95 % CI: 1.40 to -0.07), and increasing the high-density lipoprotein cholesterol (HDL-C) (WMD: 5.68 mg/dL; 95 % CI: 3.51 to 7.85). However, the effect on fasting insulin, triglycerides, and weight was not significant. Conclusions: Fenugreek supplementation has been shown to improve FPG, HbA1C, HOMA-IR, TC, LDL-C, HDL-C, and BMI in patients with T2DM. The overall results suggest that fenugreek may have protective and therapeutic effects on T2DM parameters.

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Curcumin, an inherent polyphenolic compound, has the potential to influence glycemic indices. Nevertheless, the conclusions drawn from extant meta-analyses remain contentious. To determine the impact of curcumin supplementation on these indices, the current umbrella meta-analysis included existing systematic reviews and meta-analyses. A thorough systematic search was conducted using databases Embase, PubMed, WOS, Scopus, and the Cochrane Library to acquire peer-reviewed literature published before January 2024. The random-effects model was employed to conduct a meta-analysis. The present analysis incorporated a total of 22 meta-analytic studies. The findings of our study indicate that the administration of curcumin supplements leads to a significant decrease in fasting blood sugar levels (FBS) (ES: -1.63; 95 % CI: -2.36, -0.89, P<0.001; I2=88.4 %, P<0.001), homeostasis model assessment-estimated insulin resistance (HOMA-IR) (ES: -0.38; 95 % CI: -0.48, -0.28, P<0.001; I2=35.9 %, P=0.142), hemoglobin A1c (HbA1c) (ES: -0.44; 95 % CI: -0.67, -0.21, P<0.001; I2=65.0 %, P=0.014), and insulin (ES: -0.86; 95 % CI: -1.52, -0.21, P=0.010; I2=92.5 %, P<0.001). The results of this study suggest that the administration of curcumin supplements may be a beneficial intervention for enhancing glycemic indices.

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BACKGROUND: The study investigates substituting non-nutritive sweeteners (NNS) for sugar to address health concerns related to excess sugar intake. It specifically examines how stevia affects insulin and blood glucose levels. The systematic review and meta-analysis aim to evaluate stevia's impact on glycemic indices. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines, including 26 studies with 1439 participants. The PROSPERO registration number for this research is CRD42023414411. We systematically searched PubMed (MEDLINE), Scopus, Web of Science, and Google Scholar. Additionally, we thoroughly reviewed the reference lists of the articles we extracted and relevant reviews. Two evaluators independently carried out screening, quality assessment, and data extraction. The GRADE (grading of recommendations, assessment, development, and evaluation) approach was utilized to evaluate the certainty of the evidence. RESULTS: Stevia consumption was associated with significantly reducing blood glucose levels (WMD: -3.84; 95 % CI: -7.15, -0.53; P = 0.02, low certainty), especially in individuals with higher BMI, diabetes, and hypertension. Dose-response analysis revealed a decrease in blood glucose for ≥3342 mg/day of stevia consumption. Stevia consumption has been shown to reduce blood glucose levels within 1-4 months, as evidenced by dose-response analysis (less than 120 days) and subgroup analysis (more than four weeks). However, stevia did not significantly affect insulin concentration or HbA1C levels (very low and low certainty, respectively). CONCLUSIONS: Low certainty evidence showed that stevia improved blood glucose control, especially when consumed for less than 120 days. However, more randomized trials with higher stevia dosages are required.

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Diabetes is a common, chronic, and complex disorder that leads to several disabilities and serious complications. Certain nutrients can be effective in the management of diabetes mellitus. In the present study, we aimed to investigate the effects of dietary nitrate, nitrite, dietary total antioxidant capacity (DTAC), and nitric oxide (NO) index on some cardiometabolic parameters in patients with diabetes. This cross-sectional study was conducted on 100 participants with type 2 diabetes. A validated, semi-quantitative, food frequency questionnaire was collected to evaluate dietary intakes. Anthropometric parameters, blood pressure, and biochemical parameters, including glycemic indices, lipid profile, high-sensitive C-reactive protein (hs-CRP), and serum NO were measured using standard methods. Higher intakes of nitrate and nitrite in our study were primarily attributed to drinking water, vegetables, grains (for nitrate), dairy products, and legumes (for nitrite) rather than higher meat intakes. After adjustment for total energy, MET, BMI, and age, higher intake of nitrate was related to lower HbA1C (p = 0.001) and hs-CRP (p = 0.0.23), and greater HDL-C (p < 0.001) and serum NO (p = 0.008). Moreover, a greater nitrite intake was associated with lower DBP (p = 0.017), HbA1C (p = 0.040), FPG (p = 0.011), and higher serum NO values (p = 0.001). Higher amounts of DTAC and NO index were also related to greater DBP (p < 0.001, and p = 0.004, respectively) and lower hs-CRP (p = 0.004, and p = 0.009, respectively). High intakes of dietary nitrate and nitrite, in the context of high DTAC, are significantly associated with the improvement of some cardiometabolic parameters in patients with diabetes.

A higher intake of nitrite is related to improving glycemic indices.A higher intake of nitrate is related to increasing HDL-C and decreasing hs-CRP.A higher intake of nitrate and nitrite, with a high DTAC index, is related to reduced cardiometabolic parameters.

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PURPOSE: Cardiovascular disease (CVD) is the primary cause of death worldwide but there is a variation in its burden across some nations that seems to be related to dietary habits. Mediterranean populations have lower rates of morbidity and mortality from CVD. Thus, this systematic review and meta-analysis aimed to assess the impacts of the Mediterranean diet (MedDiet) enriched with olive oil on blood lipids, glycemic indices, blood pressure, and anthropometric indices. METHODS: A comprehensive search of the Web of Science, PubMed (MEDLINE), Scopus, Cochrane Library, Google Scholar, Embase, and CINAHL databases until March 2024 was conducted to identify clinical trials studying the effects of MedDiet enriched with olive oil on the aforementioned parameters. RESULTS: In total, 3303 records were retrieved. A total of 18 clinical trials met the inclusion criteria after records were screened for eligibility. According to the pooled analysis from the random-effects model, the MedDiet enriched with olive oil significantly reduced triglycerides (TG) compared with the control group (WMD = -2.40 mg/dl; 95%CI, -4.533 to -0.262; P = 0.027). Strong heterogeneity was observed. Sensitivity analysis did not change our results and no significant effect of any trial on the overall effect sizes of all variables were found. There was a concern about the reporting bias for some studies which reported some main outcomes. CONCLUSION: MedDiet enriched with olive oil showed no consistent effects on any of the reported markers of cardiovascular health except on TG. SYSTEMATIC REVIEW REGISTRATION: CRD42023424641.

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PURPOSE: Even though various randomized controlled trials (RCTs) have assessed the effect of propolis on glycemic indices and liver enzyme concentrations in adults, results have been inconsistent, without conclusive evidence. This systematic review and meta-analysis of RCTs sought to evaluate the effects of propolis consumption on glycemic indices and liver enzymes, fasting blood glucose, insulin, homeostatic model assessment of insulin resistance, glycosylated hemoglobin, alanine transaminase, aspartate aminotransferase, and gamma-glutamyl transferase in adults. METHODS: Two independent researchers systematically searched PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library for English-language RCTs published up to April 2024. The results were generated through a random-effects model and presented as the weighted mean difference (WMD) with a 95% CI. The Cochrane Risk of Bias Tool for RCTs and Grading of Recommendations Assessment, Development, and Evaluation assessment were used to evaluate quality assessment and certainty of evidence. FINDINGS: A total of 21 RCTs were included. A pooled analysis of 24 trials reported that propolis consumption led to a significant reduction in fasting blood glucose (WMD, -9.75 mg/dL; 95% CI, -16.14 to -3.35), insulin (WMD, -1.64 µU/mL; 95% CI, -2.61 to -0.68), glycosylated hemoglobin (WMD, -0.46%; 95% CI, -0.71 to -0.21), homeostatic model assessment of insulin resistance (WMD, -0.54; 95% CI, -0.98 to -0.09), alanine transaminase (WMD, -2.60 IU/L; 95% CI, -4.58 to -0.61), and aspartate aminotransferase (WMD, -2.07 IU/L; 95% CI, -3.05 to -1.09). However, there were no significant effects on gamma-glutamyl transferase in comparison with the control group. IMPLICATIONS: This meta-analysis has shown that propolis supplementation may have beneficial effects on glycemic indices and liver enzymes. Future high-quality, long-term RCTs are needed to confirm our results. CLINICALTRIALS: gov identifiers: CRD42024524763. (Clin Ther. 2024;46:XXX-XXX) © 2024 Elsevier HS Journals, Inc.

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BACKGROUND: We aimed to explore how probiotics, prebiotics, or synbiotics impact glycemic indices in patients with diabetes mellitus. METHOD: A comprehensive search was conducted on PubMed, Scopus, and Web of Science from inception up to April 2023. The random-effects model was employed for the study analysis. Furthermore, sensitivity and subgroup analyses were conducted to investigate potential sources of heterogeneity. AMSTAR2 checklist was used to determine the quality of studies. Comprehensive meta-analysis version 3 was used for the study analysis. RESULT: A total of 31 studies were included in the final analysis. Based on the results of the meta-analysis, gut microbial therapy could significantly decrease serum fasting blood glucose levels in patients with type 2 diabetes mellitus (effect size: -0.211; 95 % CI: -0.257, -0.164; P < 0.001). Additionally, significant associations were also found between gut microbial therapy and improved serum levels of fasting insulin, glycated hemoglobin, and homeostatic model assessment for insulin resistance (effect size: -0.087; 95 % confidence interval: -0.120, -0.053; P < 0.001; effect size: -0.166; 95 % confidence interval: -0.200, -0.132; P < 0.001; effect size: -0.230; 95 % confidence interval: -0.288, -0.172; P < 0.001, respectively). CONCLUSION: Our results revealed promising effects of gut microbiota modulation on glycemic profile of patients with type 2 diabetes mellitus. The use of these agents as additional treatments can be considered.

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BACKGROUND: The Glycemia Risk Index (GRI) was developed in adults with diabetes and is a validated metric of quality of glycemia. Little is known about the relationship between GRI and type 1 diabetes (T1D) self-management habits, a validated assessment of youths' engagement in habits associated with glycemic outcomes. METHOD: We retrospectively examined the relationship between GRI and T1D self-management habits in youth with T1D who received care from a Midwest pediatric diabetes clinic network. The GRI was calculated using seven days of continuous glucose monitor (CGM) data, and T1D self-management habits were assessed ±seven days from the GRI score. A mixed-effects Poisson regression model was used to evaluate the total number of habits youth engaged in with GRI, glycated hemoglobin A1c (HbA1c), age, race, ethnicity, and insurance type as fixed effects and participant ID as a random effect to account for multiple clinic visits per individual. RESULTS: The cohort included 1182 youth aged 2.5 to 18.0 years (mean = 13.8, SD = 3.5) comprising 50.8% male, 84.6% non-Hispanic White, and 64.8% commercial insurance users across a total of 6029 clinic visits. Glycemia Risk Index scores decreased as total number of habits performed increased, suggesting youth who performed more self-management habits achieved a higher quality of glycemia. CONCLUSIONS: In youth using CGMs, GRI may serve as an easily obtainable metric to help identify youth with above target glycemia, and engagement/disengagement in the T1D self-management habits may inform clinicians with suitable interventions for improving glycemic outcomes.

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BACKGROUND: The glycemia risk index (GRI) is a composite metric developed and used to estimate quality of glycemia in adults with diabetes who use continuous glucose monitor (CGM) devices. In a cohort of youth with type 1 diabetes (T1D), we examined the utility of the GRI for evaluating quality of glycemia between clinic visits by analyzing correlations between the GRI and longitudinal glycated hemoglobin A1c (HbA1c) measures. METHOD: Using electronic health records and CGM data, we conducted a retrospective cohort study to analyze the relationship between the GRI and longitudinal HbA1c measures in youth (T1D duration ≥1 year; ≥50% CGM wear time) receiving care from a Midwest pediatric diabetes clinic network (March 2016 to May 2022). Furthermore, we analyzed correlations between HbA1c and the GRI high and low components, which reflect time spent with high/very high and low/very low glucose, respectively. RESULTS: In this cohort of 719 youth (aged = 2.5-18.0 years [median = 13.4; interquartile range [IQR] = 5.2]; 50.5% male; 83.7% non-Hispanic White; 68.0% commercial insurance), baseline GRI scores positively correlated with HbA1c measures at baseline and 3, 6, 9, and 12 months later (r = 0.68, 0.65, 0.60, 0.57, and 0.52, respectively). At all time points, strong positive correlations existed between HbA1c and time spent in hyperglycemia. Substantially weaker, negative correlations existed between HbA1c and time spent in hypoglycemia. CONCLUSIONS: In youth with T1D, the GRI may be useful for evaluating quality of glycemia between scheduled clinic visits. Additional CGM-derived metrics are needed to quantify risk for hypoglycemia in this population.

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Background and aims: Momordica charantia L. (M. charantia) has been traditionally utilized as a medicinal intervention for managing type 2 diabetes mellitus (T2DM). The current study was designed to offer a GRADE-assessed systematic review and meta-analysis of randomized controlled trials (RCTs) examining the impact of M. Charantia intake on glycemic indexes and the lipid profile of patients with T2DM. Methods: A comprehensive search was conducted across several databases, including PubMed, EMBASE, Web of Science, and Cochrane Library, from the inception of each database until April 22, 2023. The Hartung-Knapp adjustment was applied to ensure conservative summary estimates with broad confidence intervals. Results: A total of eight trials involving 423 patients with T2DM were included in this study. Compared to the control group, the intake of M. charantia supplementation resulted in significant reductions in fasting blood glucose (FBG) (WMD: -0.85 mmol/L; 95%CI: -1.44, -0.26; p = 0.005; I2 = 73.4 %), postprandial glucose (PPG) (WMD: -2.28 mmol/L; 95%CI: -3.35, -1.21; p = 0.000; I2 = 66.9 %), glycosylated hemoglobin A1c (HbA1c) (WMD: -0.38 %; 95%CI: -0.53, -0.23; p = 0.000; I2 = 37.6 %), and total cholesterol (TC) (WMD: -0.38 mmol/L; 95%CI: -0.70, -0.07; p = 0.017; I2 = 63.6 %). These results remained statistically significant even after applying the Hartung-Knapp adjustment. However, no significant differences were observed in terms of triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Conclusions: The findings of this study suggest that M. charantia could serve as a potential alternative for individuals with T2DM, particularly those with elevated total cholesterol levels. However, further high-quality studies are necessary to validate these results.

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Background: The current evidence on the effect of Sumac consumption on cardiovascular parameters has produced controversial findings. Methods: We systematically searched several databases, including PubMed-Medline, SCOPUS, and ISI Web of Science, to find eligible studies until January 2023. Meta-analysis to calculated the weighted mean difference (WMD) and 95 %CI, Sub-group meta-analysis and meta-regression analysis were conducted throughout the study. Results: 16 randomized controlled trials comprising a total number of 1,225 participants were included. The results of meta-analysis revealed that Sumac significantly affected low-density lipoprotein (WMD: -8.66 mg/dL; 95% CI: -14.2, -3.12), high-density lipoprotein (WMD: 3.15 mg/dL; 1.99,4.31), triglycerides (WMD: -11.96 mg/dL; -19.44, -4.48), fasting blood glucose (WMD: -4.15 mg/dL; -7.31, -0.98), insulin (WMD: -1.72; -3.18, -0.25), homeostasis model assessment of insulin resistance (HOMA-IR; WMD: -0.61; -1.22, -0.01), and anthropometric indices (p < 0.05). Moreover, the results significantly reduced total cholesterol when the intervention duration was ≥12 weeks (WMD: -8.58 mg/dL; -16.8, -0.37). Conclusion: These findings suggest that Sumac is potentially an effective complementary intervention to improve cardiometabolic parameters. Thus, patients could utilize Sumac as part of their diet to improve their overall cardiometabolic status.

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Background Dates have a special position in Middle Eastern countries, especially Saudi Arabia, and are essential to Arabic and Muslim diets. They are eaten in different forms according to their stage of maturation. In this study, we aimed to estimate the glycemic index (GI), glycemic load (GL), and glycemic response of different stages of date fruit maturation. Materials and methods This prospective clinical trial was conducted at King Abdul-Aziz Medical City, Jeddah, Saudi Arabia. Thirteen healthy participants, seven males and six females, received 50 g of glucose as reference food and 50 g of equivalent carbohydrates from three samples of Khalas dates and three samples of Barhi dates at different maturation stages (Khalal, Rutab, and Tamer). The GI, GL, and glycemic response for each type was calculated. Results The calculated means±SD of GI of the different stages of date maturation were 60.57±25.93, which raged from 53±16.49 to 71.06±32.97. The Khalal stage had the highest GI value, while the Tamer stage had a low GI value of 69.14 and 53.09, respectively. The GL ranged from 7.81 to 18.81. The Rutab stage had the highest GL, whereas the Khalal stage had the lowest GL values of 17.66±6.94 and 9.64±4.72, respectively. There was no significant difference in GI between different date maturation stages (p = 0.48). However, the GL presented a significant difference (p = 0.001) between different maturation stages. Conclusion The present study demonstrated that the stage of date maturation can affect the GI, GL, and glycemic response results. Therefore, healthcare providers and dietitians should address the lower GI and GL stages of date maturation in choosing a suitable carbohydrate source for healthy and diabetic individuals.

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BACKGROUND: It is suggested that supplementation with milk protein (MP) has the potential to ameliorate the glycemic profile; however, the exact impact and certainty of the findings have yet to be evaluated. This systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) assessed the impact of MP supplementation on the glycemic parameters in adults. METHODS: A systematic search was carried out among online databases to determine eligible RCTs published up to November 2022. A random-effects model was performed for the meta-analysis. RESULTS: A total of 36 RCTs with 1851 participants were included in the pooled analysis. It was displayed that supplementation with MP effectively reduced levels of fasting blood glucose (FBG) (weighted mean difference (WMD): -1.83 mg/dL, 95% CI: -3.28, -0.38; P = 0.013), fasting insulin (WMD: -1.06 uU/mL, 95% CI: -1.76, -0.36; P = 0.003), and homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: -0.27, 95% CI: -0.40, -0.14; P < 0.001) while making no remarkable changes in serum hemoglobin A1c (HbA1c) values (WMD: 0.01%, 95% CI: -0.14, 0.16; P = 0.891). However, there was a significant decline in serum levels of HbA1c among participants with normal baseline body mass index (BMI) based on sub-group analyses. In addition, HOMA-IR values were significantly lower in the MP supplement-treated group than their untreated counterparts in short- and long-term supplementation (≤ 8 and > 8 weeks) with high or moderate doses (≥ 60 or 30-60 g/d) of MP or whey protein (WP). Serum FBG levels were considerably reduced upon short-term administration of a low daily dose of WP (< 30 g). Furthermore, the levels of serum fasting insulin were remarkably decreased during long-term supplementation with high or moderate daily doses of WP. CONCLUSION: The findings of this study suggest that supplementation with MP may improve glycemic control in adults by reducing the values of fasting insulin, FBG, and HOMA-IR. Additional trials with longer durations are required to confirm these findings.

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Although several studies have revealed the benefits of purslane on glycemic indices, the results of some studies reject such effect. Therefore, aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the effects of purslane supplementation on glycemic indices. Scientific international databases as Scopus, Web of Sciences, PubMed, Embase, and the Cochrane library were searched up to December 2022. For net changes in glycemic indices, weighted mean differences (WMDs) were calculated using random-effects models. Purslane supplementation had a statistically significant reduction in fasting blood glucose [FBG, WMD: -6.37; 95% CI: -9.34, -3.40, p < 0.001]. In addition, purslane did not significant effect on serum levels of insulin [WMD: -0.74; 95% CI: -2.58, 1.10; p = 0.430], homeostasis model assessment for insulin resistance [HOMA-IR, WMD: -0.25; 95% CI: -0.88, 0.37, p = 0.429], and QUICKI [WMD: -0.01; 95% CI: -0.01, 0.03, p = 0.317] compared with the control group. The results of our meta-analysis revealed a beneficial effect of purslane supplementation as a tool to decrease FBG levels, but not to HOMA-IR, insulin, and QUICKI levels. However, future high-quality, long-term clinical trials are needed to confirm our results.

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Objectives: Diabetes mellitus is a serious health-treated problem identified by disorders such as insulin resistance, dyslipidemia, and inflammation. Irisin, a newly discovered myokine/adipokine, is involved in metabolic homeostasis. The present study was carried out to investigate the potential relationship between serum irisin with inflammatory cytokines, oxidative stress biomarkers, glycemic indices, and lipid profiles in obese patients with type 2 diabetes mellitus. Methodology: This analytical cross-sectional study was conducted on 62 participants (n=32 obese participants with diabetes, n=30 participants with normal weight). The participants answered a demographic questionnaire. Serum irisin, glycemic indices, lipid profiles, inflammatory cytokines and oxidative stress biomarkers were measured using standard methods. The difference between groups was assessed by independent-sample t-test or by a non-parametric equivalent. For qualitative variables, the Chi-Square test was used. Pearson rho coefficient was used to determine the potential relationship between irisin and inflammatory cytokines, oxidative stress biomarkers, glycemic indices, and lipid profiles. A p<0.05 was defined as significant. Results: The median (IQR) age of the obese participants with diabetes was 54.0 years (52.2-60.7) and in the normal weight group was 38.0 years (30.0-47.2) (p<0.001). About 78% and 60% of participants in the obese with diabetes and the normal weight groups were females (p>0.05), respectively. Significant differences were observed in serum irisin levels between the two groups, with lower levels (218.74 ng/mL, [144.98-269.26]) noted in the obese with diabetes group compared to the normal weight group (266.68 ng/mL, [200.64-336.57]) with a p=0.024. There was a substantial difference between the two groups regarding IL-6, TNF-α, and hs-CRP (p<0.05). IL-6 had a moderate negative correlation with irisin in obese patients with T2DM (r=-0.478, p=0.006). Conclusion: Irisin concentration was detected to be lower in obese people with diabetes. A negative relationship was detected between irisin and IL-6. Considering emerging evidence about the beneficial functions of irisin in improving metabolic abnormalities, designing future studies with greater sample sizes that will validate these results is needed.

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Background: Atherosclerosis can develop as a result of an increase in oxidative stress and concurrently rising levels of inflammation. Astaxanthin (AX), a red fat-soluble pigment classified as a xanthophyll, may be able to prevent the vascular damage induced by free radicals and the activation of inflammatory signaling pathways. The objective of the current study is to assess the effects of AX supplementation on cardiometabolic risk factors in individuals with coronary artery disease (CAD). Methods: This randomized double-blind placebo-controlled clinical trial was conducted among 50 CAD patients. Participants were randomly allocated into two groups to intake either AX supplements (12 mg/day) or placebo for 8 weeks. Lipid profile, glycemic parameters, anthropometric indices, body composition, Siruin1 and TNF-α levels were measured at baseline and after 8 weeks. Results: Body composition, glycemic indices, serum levels of TNF-α, Sirtuin1 did not differ substantially between the AX and placebo groups (p > 0.05). The data of AX group showed significant reduction in total cholesterol (-14.95 ± 33.57 mg/dl, p < 0.05) and LDL-C (-14.64 ± 28.27 mg/dl, p < 0.05). However, TG and HDL-C levels could not be affected through AX supplementation. Conclusion: Our results suggest that AX supplementation play a beneficial role in reducing some components of lipid profile levels. However, further clinical investigations in CAD patients are required to obtain more conclusive findings. Clinical trial registration: www.Irct.ir., identifier IRCT20201227049857N1.

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BACKGROUND: Vitamin D supplementation exerts several supporting effects on improving glycemic status, however, results are inconclusive. Thus, in the present study, we aimed to conduct an umbrella of meta-analysis regarding the impact of vitamin D on type 2 diabetes (T2DM) biomarkers. METHODS: The Scopus, PubMed, Web of Science, Embase, and Google Scholar online databases were searched up to March 2022. All meta-analyses evaluating the impact of vitamin D supplementation on T2DM biomarkers were considered eligible. Overall, 37 meta-analyses were included in this umbrella meta-analysis. RESULTS: Our findings indicated that vitamin D supplementation significantly decreased fasting blood sugar (FBS) (WMD = - 3.08; 95% CI: - 3.97, - 2.19, p < 0.001, and SMD = - 0.26; 95% CI: - 0.38, - 0.14, p < 0.001), hemoglobin A1c (HbA1c) (WMD = - 0.05; 95% CI: - 0.10, - 0.01, p = 0.016, and SMD = - 0.16; 95% CI: - 0.27, - 0.05, p = 0.004), insulin concentrations (WMD = - 2.62; 95% CI: - 4.11, - 1.13; p < 0.001, and SMD = - 0.33; 95% CI: - 0.56, - 0.11, p = 0.004), and homeostatic model assessment for insulin resistance (HOMA-IR) (WMD = - 0.67; 95% CI: - 1.01, - 0.32, p < 0.001, and SMD = - 0.31; 95% CI: - 0.46, - 0.16, p < 0.001). CONCLUSION: This umbrella meta-analysis proposed that vitamin D supplementation may improve T2DM biomarkers.

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Background: Non-alcoholic fatty liver disease (NAFLD) as the hepatic manifestation of metabolic syndrome is closely associated with type 2 diabetes mellitus. Myo-inositol (MI)-a 6-C sugar alcohol-with insulin-mimetic, anti-diabetic, lipid-lowering, and anti-inflammatory properties has exerted favorable effects on insulin resistance-related disorders and metabolic disease, while recent animal studies revealed its positive effects on liver function. This study aimed to investigate the effects of MI supplementation on cardiometabolic factors, anthropometric measures, and liver function in obese patients with NAFLD. Methods: This double-blinded placebo-controlled randomized clinical trial was carried out on 48 obese patients with NAFLD who were randomly assigned to either MI (4g/day) or placebo (maltodextrin 4g/day) along with dietary recommendations for 8 weeks. Glycemic indices, lipid profile, liver enzymes anthropometric measures, and blood pressure were evaluated pre- and post-intervention. Dietary intakes were assessed using a 3-day 24 h recall and analyzed by Nutritionist IV software. Insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR), and beta-cell function (HOMA-B) was also estimated. Results: Anthropometric measures decreased significantly in both groups, while the reduction in weight (p = 0.049) and systolic blood pressure (p = 0.006) in the MI group was significantly greater than in the placebo group after adjusting for baseline values and energy intake. Although energy and macronutrient intakes decreased significantly in both groups, between-group differences were not significant after adjusting for the potential confounders. MI supplementation led to a significant reduction in serum fasting insulin (p = 0.008) and HOMA-IR (p = 0.046). There were significant improvements in lipid profile, liver enzymes, and aspartate aminotransferase/alanine aminotransferase ratio as well as serum ferritin level in the MI group, compared to the placebo group at the endpoint. By MI supplementation for eight weeks, 1 in 3 patients reduced one- grade in the severity of NAFLD. Conclusion: MI supplementation could significantly improve IR, lipid profile, and liver function in patients with NAFLD. Further clinical trials with larger sample sizes, longer duration, different MI doses, and other inositol derivatives are recommended.

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This study investigated the effect of eight weeks of aerobic training (AT) combined with silymarin (S)consumption on glycemic indices and liver enzymes in men with type 2 diabetes (T2D). In this clinical trial, 60 middle-aged male volunteers were randomly divided into 4 groups, including: (1) C + placebo(C) (2) AT + placebo (3), S and (4) AT + S. AT was performed for eight weeks, three sessions per week, each session for 20-45 minutes at an intensity of 60-85% of maximal heart rate reserve, and S receiving groups consumed 140 mg/kg S daily (in two servings). AT reduced glycemic indices and liver enzymes in men with T2D (p ≤ .05). S decreased blood glucose, insulin, HOMA-IR, AST, ALT and ALP in men with T2D (p ≤ .05). Exercise along with silymarin decreased blood glucose, insulin, HOMA-IR, AST, ALT and ALP. Also, reduction of AST and blood glucose in the AT + S group was more favourable than the effect of S alone (p ≤ .05). It seems that simultaneous AT and S has interactive effects on reducing glycemic indices and liver enzymes in men with T2D.

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Present study investigated the interactive effect of swimming training and fenugreek on glycemic index and lipid profile of diabetic rats. Forty-eight diabetic rats were randomly assigned to (1) control(C), (2) training(T), (3) fenugreek(F), and (4) training + fenugreek(T + F) groups and 12 healthy rats were placed in healthy control (HC) group. During 4 weeks, groups 2 and 4 performed swimming training for 5 sessions per week and groups 3 and 4 received 100 mg/kg fenugreek. training, fenugreek and training + fenugreek significantly decreased glucose, insulin, insulin resistance, LDL, VLDL, TG and TC as well as increased HDL (p ≤ .05) also training + fenugreek had more favourable effects on improving glycemic indices and lipid profile compared to training and fenugreek alone (p ≤ .05). It seems that training and fenugreek alone or synergistically improve the glycemic indices and lipid profile in diabetic rats, nevertheless the synergistic effects of training and fenugreek can be more desirable than the effect of each alone.

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