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Background: A woman with a history of GDM has a high risk of developing type two diabetes (T2DM) in her future life. Lifestyle modifications are known to attenuate the progression of GDM to T2DM. Therefore, the aim of this study was to assess the impact of a simple, cost effective, culturally acceptable lifestyle intervention programme on the trajectory towards T2DM in women with a history of GDM. Methods: This cluster randomized trial was conducted in 100 postpartum women in three selected districts of Sri Lanka. The subjects were divided into intervention (n = 50) and control groups (n = 50) by cluster randomization method. A culturally adapted protocol (comprised of dietary and physical activity modifications) was administered to the intervention group. The glycemic profile was assessed using fasting and 2-hour post-OGTT plasma glucose and HbA1c, and insulin resistance by HOMA-IR at baseline and after one year of intervention. Results: The mean age (SD) of the subjects in the intervention and control groups were 33.0 (5.1) and 34.3 (6.5) years respectively. All glycemic and insulin resistance parameters (i.e. Fasting plasma glucose- FPG, 2-hour post-OGTT plasma glucose, HbA1c and HOMA-ir) were comparable (p > 0.05) between the two groups at baseline. FPG, 2 h post OGTT, HbA1c and HOMA-ir values between intervention vs. control (p) at 12 months were 87.3 vs. 123.2 (< 0.01); 106.5 vs. 156.1 (0.01); 5.3 vs. 6.8 (< 0.01) and 0.9 vs. 2.3 (< 0.01) respectively. All glycemic parameters showed a significant reduction in the intervention group at 12 months compared to baseline. In contrast, the control group showed a significant increase in FPG, 2-hour post-OGTT plasma glucose and HbA1c at 12 months compared to baseline. In multiple linear regression model adjusted for age, parity and family history, the control group showed an approximately 33 times risk of developing insulin resistance compared to the intervention group. Conclusion: The culturally acceptable and individualized lifestyle intervention was able to produce remarkable reductions in glycaemic and insulin resistance parameters among postpartum women with a history of GDM. Trial registration: Ethical clearance was obtained from the Ethics Review Committee of the University of Sri Jayewardenepura, Sri Lanka (ERC 52/14), Sri Lanka Clinical trial registration number Sri Lanka Clinical Trials Registry (SLCTR/2015/021 date 25.09.2015). [ABSTRACT FROM AUTHOR]

Background: Energy homeostasis plays a vital role in achieving glycemic control in people with type 2 diabetes mellitus (T2DM). Exercise is known to increase energy expenditure. However, its role in energy intake has not been explored in people with T2DM. Thus, this study aimed at determining the impact of long-term aerobic and combined exercises in modulating hunger, satiety and energy intake in T2DM. Methods: A randomized controlled trial, with 108 people with T2DM, aged 35–60 years were assigned into an aerobic, combined (aerobic and resistance) and a control group. Primary outcomes were subjective levels of hunger and satiety measured by a 100 mm visual analogue scale in relation to a standard breakfast meal (453 kcal) and energy and macronutrient intake determined by a 3-day diet diary at 0, 3 and 6 months. Results: Aerobic and combined groups exhibited reduced hunger and increased satiety at 3 and 6 months (p < 0.05). The combined group demonstrated a profound increase in satiety at 3 and 6 months compared to aerobics (3 months; p = 0.008, 6 months; p = 0.002) and controls (3 months; p = 0.006, 6 months, p = 0.014). Mean daily energy intake was reduced only at 6 months in the aerobic group (p = 0.012), whereas it was reduced in the combined group at 3 and at 6 months compared to controls (3 months: p = 0.026, 6 months: p = 0.022). Conclusions: Long-term aerobic and combined exercises produced a reduction in hunger, energy intake and increase satiety in people with T2DM. Despite energy expenditure, exercise seems to play a significant role in reducing energy intake as well. Combined exercises show more advantages over aerobic exercise since combined exercises have a greater impact on satiety and energy intake in people with T2DM. Trial registration number: SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029. [ABSTRACT FROM AUTHOR]

Background: Regular exercise is a key element in the management of type 2 diabetes mellitus (T2DM). Although the importance of regular exercises on glycemic control in people with diabetes is studied extensively, evidence is lacking on its impact on sweet taste perception. Thus, the aim of this study was to determine the impact of aerobic exercises on taste perception for sucrose in people with diabetes. Methods: A sample of 225 people with diabetes aged 35-60 years was assigned randomly into 3 groups; aerobic exercise, combined exercise and a control group. The outcomes of the combined exercise group is not reported. The aerobic exercise group performed brisk walking 30min/day, 4-5days/week for 6 months. The primary outcome measures were supra-threshold intensity ratings and preference for sucrose assessed at baseline, at 3 and 6 months using 'general Labeled Magnitude Scale' and 'Monell 2-series-forced choice method' respectively. Glycated haemoglobin (HbA1c) level was assessed at baseline and at 6 months to determine glycemic control. Results: Aerobic exercise group showed significantly increased ratings (mm) for higher sucrose concentrations at 3 months (mean difference for 2.02M; +6.63±2.50, p=0.048 and for 0.64M; +7.26±2.76, p=0.026) and at 6 months (mean difference for 0.64M; +7.79±4.49, p= 0.044) compared to baseline and also when compared to controls (mean difference for 2.02M between baseline and 3 months; intervention: +6.63±2.50, control: -4.01±1.79, p=0.02 and between baseline and 6 months for 2.02M; intervention: +3.15±0.57, control: -7.96±0.40, p=0.022 and for 0.64M; intervention: +7.79±4.49, control: -8.98±0.99, p=0.003). A significantly reduced preference (mol/L) was seen both at 3 (mean difference; -0.03±0.02, p= 0.037) and at 6 months (mean difference; -0.05±0.12, p=0.011) compared to baseline within the intervention group. Also, a significant reduction was seen in the intervention group compared to controls at 6 months (mean difference; intervention: -0.05±0.12, control: 0.01±0.03, p=0.044). HbA1c was significantly reduced in the intervention group compared to controls at 6 months (mean difference; intervention -0.43±1.6%, control +0.33±1.8%, p=0.018). Conclusion: Regular aerobic exercises increase the sweet taste sensitivity, especially for higher concentrations of sucrose and decrease sweet taste preference in people with diabetes. These alterations in sweet taste perception, are likely to contribute to a better glycemic control in people with diabetes. Trial registration: This trial was registered at the Sri Lanka Clinical Trial registry on 16/12/2015. (Trial registration number- SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029). [ABSTRACT FROM AUTHOR]