Search Results (446)

Background: Dietary metabolizable energy (ME) and crude protein (CP) levels are important for lactation performance and metabolic responses in dairy ruminants. This study aimed to evaluate the effects of dietary ME and CP levels on lactation performance and postprandial metabolic responses in lactating dairy goats. Methods: Goats were randomly assigned to a 4 × 4 two-factor Latin square experiment consisting of four 14 d periods. The dietary treatments were high energy, high protein (HEHCP); high energy, low protein (HELCP); low energy, high protein (LEHCP); and low energy, low protein (LELCP). Serial postprandial arterial blood samples were collected at 17 daytime time points to characterize temporal changes in plasma amino acids, biochemical parameters and hormones. Results: Increasing CP supply elevated milk yield (+6%) and lactose yield (+5%) but decreased milk fat yield (−8%; p ≤ 0.04). Increasing ME supply tended to enhance milk yield and milk fat yield and increased milk lactose content only under the high CP condition (ME × CP interaction: p = 0.04), suggesting that the response to ME supply depended partly on dietary CP level. High CP increased plasma branched chain amino acid concentrations, whereas high ME reduced Leu and Val under the high CP condition. Most plasma amino acids exhibited marked postprandial dynamics, decreasing initially and then stabilizing, with CP × time interactions observed for Leu, Met, and Phe (p ≤ 0.05). High ME decreased plasma AST activity and tended to reduce urea N concentration and also reduced ALT activity and increased glucose concentration under the high CP diet. Following morning feeding, plasma urea N showed a progressive postprandial decline (p = 0.02), with glucagon decreasing and both prolactin and growth hormone increasing, despite no dietary effects on mean plasma hormone concentrations. Conclusions: Overall, dietary ME and CP levels affected lactation performance and selected plasma metabolic indicators in lactating dairy goats. Coordinated energy and protein supply should be considered when formulating diets for lactating dairy goats. Serial postprandial sampling further revealed temporal changes in plasma metabolites and hormones, providing useful information for refining precision nutrition strategies during lactation. Full article

Objectives: This study investigated the short- and long-term metabolic effects of two β-sitosterol with propionic acid cocrystals (CCA and CCB) compared with commercial β-sitosterol in male hamsters. Methods: Five experiments were conducted, including three acute and two chronic dietary interventions. Acute experiments evaluated the metabolic response to a single dose of commercial β-sitosterol (S) or its cocrystals (513 mg/kg) administered with a pork-fat load following 40% caloric restriction. Blood samples were collected before and 5 h after the lipid challenge. Long-term studies assessed daily supplementation with CCA (264 mg/kg) or CCB (at two doses, 114 and 342 mg/kg) during exposure to high-fat (HF) or Western diets (WD), respectively, for 21 days. Results: Acutely, CCA attenuated postprandial triglyceride increases in adult animals, while CCB induced a reduced rise in postprandial cholesterol across the three studies compared to S. Young animals treated with CCA and CCB exhibited a reduction in postprandial glucose levels. Long-term, in HF-fed hamsters, CCA lowered plasma cholesterol and triglyceride levels on day 14 and, at the endpoint, decreased liver weight and increased circulating sitosterol levels, unlike its commercial counterpart. In WD-fed animals, CCB supplementation dose-dependently elevated plasma sitosterol levels. At the low dose, CCB treatment reduced body weight gain and cholesterol increase and improved adipocyte morphology, whereas the high dose reduced diet-induced hepatic detrimental outcomes, showing a stronger hepatoprotective effect compared to S-treated animals. Together, these results indicate improved postprandial lipid handling in the short-term and a modulation of metabolic adaptation to obesogenic diets in the long-term. Conclusions: β-sitosterol with propionic acid cocrystals improved metabolic responses more effectively than commercial β-sitosterol, enhancing bioavailability and potential therapeutic value against diet-induced metabolic disturbances. Full article

The increase in the prevalence of non-communicable diseases globally has been attributed in part to poor lifestyle choices, including unhealthy dietary habits. Dietary polysaccharides, including resistant starch and non-starch polysaccharides, have gained increasing attention due to their potential role in the regulation of glucose and lipid metabolism. Therefore, the aim of this review was to evaluate the role of dietary polysaccharides in the regulation of blood glucose and lipid parameters. Method: A narrative review approach was adopted for this review. Searches were conducted through EBSCOHost and involved the following databases: Medline, APA PsycInfo, CINAHL Plus with Full Text, Psychology and Behavioural Sciences collection, Academic Search Premier and APA PsycArticles. Searches were conducted on 14 April 2026 and covered all records available from database inception to the search date. Search terms were combined using Boolean operators (AND/OR). The reference list of articles was also searched for more articles. Results: Twenty-one studies from thirteen different countries were included in this review. Based on narrative synthesis, five themes were identified: the effects of dietary polysaccharides on glycaemia, insulin, lipids, energy intake and satiety/appetite. The findings demonstrated considerable heterogeneity across studies. While several studies reported improvements in fasting glucose, postprandial glucose, glycated haemoglobin and insulin responses following resistant starch and non-starch polysaccharide interventions, other studies found no significant effects on glycaemic control or insulin levels. Lipid outcomes were similarly inconsistent, although some studies reported reductions in total cholesterol and low density lipoprotein cholesterol. Effects on energy intake and satiety varied according to the type and physicochemical characteristics of the polysaccharide investigated. Conclusion: The findings of this review suggest that dietary polysaccharides may contribute to improvements in glucose control and lipid metabolism, although the magnitude and consistency of these effects vary across populations, intervention types and study designs. The most frequently reported beneficial findings related to blood glucose parameters, although substantial heterogeneity remained across studies. Further, well-designed studies, including randomised controlled trials with longer durations, are needed to fully establish the role of dietary polysaccharides in the control of blood glucose and lipid parameters. Full article

Glycemic variability is a stand-alone risk factor for diabetic complications. Background/Objectives: We investigated whether combining quercetin-rich Allium cepa L. (white onion) juice with the sodium-glucose cotransporter-2 (SGLT2) inhibitor dapagliflozin could reduce glycemic variability beyond that achieved with monotherapy in experimental diabetes. Methods: Wistar rats were made diabetic with streptozotocin (35 mg/kg) and maintained for 60 days in the following groups: vehicle, dapagliflozin (0.1 mg/day), fresh onion juice (5 mL twice daily), and dapagliflozin + fresh onion juice (5 mL twice daily). Diabetic Wistar rats (n = 10/group) were gavaged with vehicle, dapagliflozin (0.1 mg/day), fresh onion juice (5 mL twice daily), or both. The juice was expected to contain phytochemicals (quercetin derivatives and organosulfur compounds) based on published reports on similar A. cepa cultivars. A validated immunoassay was used to measure glycated hemoglobin (HbA1c) every 10 days. All treatments reduced HbA1c to the same level (~7.1–7.2%) as compared to diabetic controls (9.0 ± 0.3%) (p < 0.001), though only the combination treatment reduced glycemic variability (HbA1C coefficient of variation 3.9 ± 0.6% vs. 7.8 ± 1.2% with dapagliflozin and 11.2 ± 1.8% with onion) (p < 0.001). Results: Across the 10-day sampling schedule, the combination kept HbA1c within a narrow 6.8–7.2% band, whereas the monotherapies fluctuated more widely; because intraday and postprandial glucose were not captured, effects on short-term excursions could not be directly assessed. There were no cases of severe hypoglycemia and only infrequent and non-repeated cases of mild hypoglycemia. Conclusions: In this exploratory, hypothesis-generating study, the additive interaction between onion phytochemicals and dapagliflozin was associated with lower glycemic variability via mechanisms proposed in the literature; quercetin-rich A. cepa juice may therefore warrant further investigation as an adjunct in diabetes management, pending batch-specific phytochemical characterization and confirmatory studies. Full article

Ficus carica L. is traditionally used for diabetes management. This study evaluated the antihyperglycemic activity, safety, possible mechanisms, and phytochemical composition of its aqueous leaf extract (EAcFc). EAcFC activity was evaluated in streptozotocin–nicotinamide-induced type 2 diabetic (ST2D) mice under acute and subchronic conditions. EAcFc showed low acute toxicity (LD₅₀ > 3000 mg/kg). Acute and subchronic oral administration of EAcFc (300 mg/kg) significantly reduced blood glucose levels in ST2D mice. Although sustained HbA1c reduction was not observed, EAcFc improved lipid profiles, notably reducing triglyceride concentrations in ST2D males (from 156 ± 19.4 to 89.7 ± 3.3 mg/dL at week 4) and females (from 138 ± 2.0 to 77 ± 16.0 mg/dL at week 4). In oral sucrose and lactose tolerance tests (3 g/kg load), EAcFc (300 mg/kg) significantly attenuated postprandial hyperglycemia at 30, 60, and 120 min, an effect comparable to acarbose (50 mg/kg). No significant activity was observed during the oral glucose tolerance test (1.5 mg/kg load), suggesting the effect is not mediated by SGLT-1 inhibition. Preparative TLC and NMR analysis identified narcissin, nicotiflorin, and β-sitosterol. Thus, EAcFc possesses antihyperglycemic and lipid-modulating properties partially associated with α-glucosidase inhibition and bioactive flavonoids and phytosterol. Full article

Background/Objectives: Weight loss achieved through lifestyle interventions has been demonstrated to improve the clinical prognosis of female hyperandrogenism. However, the interplay between such interventions, androgens, and glucose–lipid metabolism remains heterogeneous. This study evaluated the effects of lifestyle-induced weight loss on glucose and lipid metabolism and androgen levels in Chinese women of reproductive age with hyperandrogenism and examined the association between the degree of weight loss and changes in androgen levels, glucose and lipid metabolism, exercise capacity, and dietary patterns. Methods: This observational study, based on real-world clinical settings, collected medical records of women of reproductive age with hyperandrogenism who underwent weight-loss interventions between July 2023 and September 2025. Correlation analysis employed Spearman’s rank correlation coefficient, whilst pre- and post-weight-loss comparisons utilised paired t-tests or Wilcoxon signed-rank tests. Results: After a follow-up of 6 to 7 months, a total of 66 participants achieved a mean weight loss of 5.67 ± 4.27 kg. Statistically significant reductions were observed in testosterone (0.40 ± 0.10 vs. 0.30 ± 0.10 ng/mL, p < 0.001), androstenedione (p < 0.001), and the free androgen index (p < 0.001). Glucose metabolism showed statistically significant improvement, with decreases in HOMA-IR (p = 0.040), fasting glucose (p = 0.001), and fasting/2 h postprandial insulin (p < 0.001). However, lipid profiles showed no statistically significant changes. Multiple linear regression revealed that change in testosterone was independently and inversely associated with change in apolipoprotein A1 (β = −0.496, p = 0.008), while change in dehydroepiandrosterone sulfate was inversely associated with change in fasting insulin (β = −0.357, p = 0.032). A non-linear, inverted U-shaped relationship was found between weight loss magnitude and change in sex hormone-binding globulin, with moderate weight loss (5–10%) yielding the greatest increase (p = 0.044). Marked weight loss (≥10%) was associated with the lowest follow-up fasting insulin levels (p = 0.039). Conclusions: Weight loss achieved through lifestyle interventions is associated with improvements in androgen levels and glucose metabolism, though its impact on lipid metabolism remains limited. The degree of improvement in insulin sensitivity correlates more strongly with the magnitude of weight reduction. Full article

Blue honeysuckle (Lonicera caerulea L.) is a polyphenol-rich berry increasingly recognized as a functional food ingredient for postprandial glycemic management. However, it remains unclear whether its polyphenols can modulate intestinal glucose transport in addition to inhibiting carbohydrate-digesting enzymes. In this study, blue honeysuckle polyphenol extract (BHPE) was characterized by UPLC-QTOF-MS/MS, and its effects on α-glucosidase activity and intestinal glucose transport were evaluated using enzyme kinetics, fluorescence quenching, molecular docking, and differentiated Caco-2 monolayers. A total of 24 phenolic compounds were tentatively identified, with anthocyanins and chlorogenic acid derivatives as the major constituents. BHPE exhibited a mixed-type, static-quenching inhibition of α-glucosidase (IC₅₀ = 75.05 μg/mL). Furthermore, molecular docking revealed that key constituents, including cyanidin-3-O-glucoside, chlorogenic acid, and proanthocyanidin B1, bind the enzyme via hydrogen bonding and hydrophobic interactions. In Caco-2 cell monolayers, BHPE reduced glucose transport by up to 51.56% under simulated postprandial conditions and coordinately downregulated SGLT1 and GLUT2 mRNA expression to 0.58- and 0.51-fold, respectively. These findings extend the bioactivity profile of blue honeysuckle polyphenols from enzyme-level inhibition to functional regulation at the intestinal epithelial barrier, highlighting their potential as multi-target natural ingredients for the attenuation of postprandial hyperglycemia. Full article

Objective: To evaluate the clinical significance of a flat oral glucose tolerance test (OGTT) pattern and its association with obstetric and perinatal outcomes, focusing on fetal growth. Methods: This retrospective cohort study was conducted at a tertiary referral center between January 2023 and November 2025. A total of 1198 women who underwent a two-step OGTT between 24 and 32 weeks of gestation were screened, and 685 eligible participants were included. A flat OGTT pattern was defined as fasting glucose < 95 mg/dL with all postprandial values < 100 mg/dL. The primary outcome was small-for-gestational-age (SGA); secondary outcomes included fetal growth restriction (FGR) and other obstetric outcomes. Logistic regression analyses were performed to assess independent associations. Results: Thirty-nine women (5.7%) exhibited a flat OGTT pattern. These pregnancies were characterized by a markedly attenuated postprandial glycemic response and lower fasting glucose levels. Most maternal and neonatal outcomes were similar between groups. However, SGA was significantly more frequent in the flat OGTT group (20.5% vs. 6.7%, p = 0.001). In multivariable analysis, a flat OGTT pattern remained independently associated with SGA (aOR 4.05, 95% CI 1.70–9.68, p = 0.002). Both SGA and FGR were more frequent among women with a flat OGTT pattern, although the association appeared stronger for SGA. Conclusions: A flat OGTT pattern appears to represent a distinct glycemic response characterized by an attenuated postprandial glucose response and lower fasting glucose levels. Although this pattern was not associated with a generalized increase in adverse obstetric or neonatal outcomes, it was associated with an increased risk of small-for-gestational-age infants. Full article

Rice starch (RS) is widely consumed, but is usually rapidly digested, which may increase postprandial blood glucose levels. Therefore, regulating RS digestibility is important for development functional starch-based foods. In this study, sodium alginate (NaAlg) was incorporated into RS gels and subsequently crosslinked with Ca²⁺ to form a calcium alginate (CaAlg) network, and its effects on the physicochemical properties, digestion behavior, and physiological responses of RS gels were evaluated. Rheological measurement showed that the Ca²⁺-crosslinked alginate network increased the viscosity and viscoelastic moduli of RS gels. Low-field nuclear magnetic resonance analysis showed that the Ca²⁺-crosslinked alginate network reduced free water mobility. Structural characterization using Fourier-transform infrared spectroscopy, X-ray diffraction, and cold-field scanning electron microscopy shows that the Ca²⁺-crosslinked alginate network was associated with enhanced intermolecular interactions and a more continuous gel network, while all gelatinized samples exhibited predominantly amorphous structures. In vitro digestion experiments showed that the hydrolysis degree at 120 min decreased from 92.3% in RS to 85.6% in HCaAlg/RS. The rapidly digestible starch content significantly decreased from 72.4% to 68.4% (p < 0.05), while resistant starch significantly increased from 7.7% to 14.4% (p < 0.05). First-order kinetic fitting showed that C_∞ significantly decreased from 93.0% to 86.0%, and k significantly decreased from 0.027 to 0.013 min⁻¹ (p < 0.05). In vivo experiments showed that the Ca²⁺-crosslinked alginate/RS gels were associated with a lower postprandial glycemic response, with the incremental area under the curve significantly decreased from 747.2 to 591.7 mmol·min/L (p < 0.05), and the intestinal propulsion rate decreased from 89.6% to 75.3% (p < 0.05). These results suggest that Ca²⁺-crosslinked alginate network formation may modulate the structural properties, digestion behavior, and digestion-related physiological responses of RS gels, providing a basis for the development of starch-based functional foods with improved glycemic control. Full article

Food-derived bioactive peptides have become a research hotspot in diabetes nutritional intervention due to their high safety, wide availability, and multi-target activities. This review addresses this by proposing a systems biology integration framework that defines these peptides as pleiotropic regulators of the gut microbiota-immune inflammation-metabolic signaling network, offering a novel systems-level perspective beyond previous reviews focused on single enzymes or pathways. The framework consists of three synergistic tiers. Tier 1 inhibits α-amylase, α-glucosidase or dipeptidyl peptidase-IV (DPP-IV) to control postprandial blood glucose. Tier 2 corrects insulin resistance by modulating phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt), activating nuclear factor erythroid 2-related factor 2 (Nrf2), and suppressing nuclear factor kappa-B (NF-κB). Tier 3 uses the gut as a hub to remotely coordinate metabolism via the gut–liver and gut–pancreas axes. The review also systematically summarizes the major sources and preparation methods of food-derived antidiabetic peptides, analyzes their advantages including multi-target network regulation, safety, and sustainability, as well as challenges such as oral bioavailability, insufficient clinical evidence, processing stability, and regulatory hurdles. Finally, it outlines future directions focusing on three actionable priorities: AI-assisted design, oral delivery systems, and high-quality clinical studies. This framework offers a new perspective for applying food-derived peptides in precision nutrition intervention for diabetes. Full article

Background: Effective postprandial glycemic regulation is essential for preventing metabolic disorders such as type 2 diabetes. While pharmacological interventions like GLP-1 (Glucagon-Like Peptide-1) receptor agonists are effective, dietary strategies using low-digestible carbohydrates (LDCs) may offer a sustainable and complementary approach. Methods: Two human physiological investigations were conducted to evaluate the acute metabolic responses to allulose, 1-kestose, resistant maltodextrin (RD), and fructo-oligosaccharide powder (FOP), administered both in isolation and in conjunction with a reference meal (RM). Results: In Study 1, all tested LDCs elicited minimal plasma glucose responses when consumed alone. In Study 2, distinct metabolic benefits were observed depending on the type of LDCs. Allulose exhibited the strongest effects, significantly reducing postprandial glucose and insulin levels while increasing plasma GLP-1 concentrations. 1-Kestose exhibited significantly lower plasma glucose and insulin incremental area under the curve (iAUC) compared to RM alone, indicating improved glycemic regulation. RD significantly enhanced subjective satiety between 30 and 180 min post-consumption. These findings highlight that each LDC exerts unique physiological effects. Conclusions: Collectively, these results demonstrate that acute LDCs consumption distinctly regulates metabolic responses, supporting their application as functional ingredients in targeted nutritional strategies for managing glycemic and metabolic health. Full article

Clinical trials suggest that daily vinegar ingestion improves fasting blood glucose concentrations, postprandial glucose excursions, and hemoglobin A1c levels in patients with prediabetes and type 2 diabetes. With the recent commercialization of continuous glucose monitoring (CGM) technologies, diabetes patients as well as other health-conscious individuals can evaluate the impact of food choices in real-time and make data-driven decisions to improve dietary behaviors. This 9-day, randomized crossover study documented CGM-derived glycemic patterns during vinegar ingestion in adults with prediabetes. Participants consumed two tablespoons of vinegar twice daily with meals for four days or a control tablet each morning for four days in random order. For each phase, fasting blood glucose on day four, average blood glucose across three days, and peak glucose excursion across three days were calculated. Fasting glucose concentrations of participants (n = 10 women; 36.6 ± 15.6 y; 33.9 ± 6.5 kg/m²) averaged 105.8 ± 20.6 mg/dL at baseline. Vinegar ingestion was associated with significant reductions in the mean glucose concentration (−4.4 mg/dL) and the frequency of blood glucose excursions > 140 mg/dL (−10%) in comparison to the control treatment, but fasting glucose concentrations were unaffected. These data suggest that vinegar-induced improvements in blood glucose can be observed in real-time using a CGM device in adults with prediabetes. Full article

This review examines sorghum digestibility from molecular structure to clinical implications, focusing on compositional factors, processing methods, and health outcomes. We evaluate how sorghum’s unique protein–starch interactions influence digestibility and explore emerging technologies that can modulate these properties for targeted nutritional benefits. Cooked sorghum generally has lower digestibility than raw sorghum and other cereals due to heat-induced protein–starch cross-linking and the formation of disulfide bonds by sorghum proteins (kafirins), which restrict enzymatic access. Enzyme inhibitors in sorghum further reduce starch hydrolysis. This reduced digestibility may negatively impact malnourished individuals and those relying on sorghum as a dietary staple. However, it can be advantageous to individuals with diabetes by lowering postprandial blood glucose levels. Sorghum consumption may also beneficially influence the gut microbiome. Certain processing methods have been shown to significantly enhance digestibility while preserving beneficial bioactive compounds. Improving digestibility through these strategies may enhance sorghum’s value for vulnerable populations while maintaining its metabolic advantages. Balancing increased nutrient bioavailability with preservation of beneficial functional properties is critical for optimizing sorghum as a health-promoting grain across diverse populations. Full article

Background: The global healthcare system faces a significant challenge due to the escalating prevalence of type 2 diabetes, affecting over 10% of the world’s population. Suppression of postprandial hyperglycemia through inhibition of carbohydrate-hydrolyzing enzymes is an effective therapeutic strategy. Although curcumin effectively inhibits α-amylase and α-glucosidase activities, its lower solubility and bioavailability restrict its clinical application. In this study, five mono-carbonyl curcumin analogues (CA1–CA5) were synthesized and evaluated for their antidiabetic potential following selective experimental methods both in vitro, and in vivo. Enhanced delivery for the most potent analogue was achieved through PEGylated graphene oxide (PEG-GO) to overcome the shortcomings of curcumin compounds. Methods: In silico ADME profiling was conducted using SwissADME, and molecular docking studies were performed with AutoDock Vina (v1.5.7) to assess enzyme binding interaction. The synthesized compounds were further evaluated using in vitro α-amylase and α-glucosidase inhibition assays, followed by in vivo blood profile analysis. The most active analogue CA3 (chloro derivative) was loaded onto PEG-GO and characterized using UV–visible spectroscopy, Fourier-transform infrared spectroscopy, and scanning electron microscopy. Results: Among all of the compounds, CA3 exhibits the strongest binding affinity and highest enzyme inhibitory activity, followed by CA2 and CA4. PEG-GO-CA3 demonstrated significantly enhanced biological activity compared to its free form. In vivo studies showed marked improvements in body weight and lipid profile, along with significant reductions in blood glucose, glycated hemoglobin, urea, creatinine, alanine aminotransferase, and aspartate aminotransferase levels over a 28-day treatment period as compared to a diabetic control. Spectroscopic and morphological analyses confirmed successful loading of CA3 onto PEG-GO (27.7–31.5%) with a release profile of 38–57% after 12 and 36 h in a controlled environment at pH 7. Conclusions: These findings suggest that PEG-GO-loaded mono-carbonyl curcumin analogues represent promising therapeutic candidates for the management of T2DM. Full article

Postprandial variability in glucose and protein levels is one of the elements of insulin resistance (IR) and prediabetes, which is an area precursor to type 2 diabetes mellitus (DM). The objective of the study was a comprehensive proteomic analysis according to glucose tolerance in the general population who did not self-report DM or other diseases. We used Olink^® Reveal, a novel, high-throughput platform by Olink Proteomics based on their Proximity Extension Assay (PEA), to identify levels of 1034 circulating proteins in small volumes (4 µL) of plasma samples. The study enrolled 508 participants (mean age 52 ± 10.5 years, 47.2% men) from the population-based study, Bialystok PLUS Polish Longitudinal University Study. The study population was categorized according to glucose metabolism in comparison to impaired fasting blood glucose (IFG), impaired glucose tolerance (IGT), and newly diagnosed DM. Analysis of variance (ANOVA) adjusted for age, weight, fat mass, lean mass, and body mass index (BMI), identified 19 proteins significantly associated with categories of glucose tolerance. Of the five markers with the greatest ability to distinguish newly diagnosed diabetes from non-diabetic participants, paralemmin 2 performed best (AUC = 0.81; 77% sensitivity, 75% specificity), whereas furin was the most accurate for detecting any abnormal glucose regulation (AUC = 0.69). A linear regression model adjusted for the same confounding factors showed statistically significant associations between Hb_A1c levels and 37 proteins. Our findings highlight multiple proteins with significantly different levels across categories of glucose tolerance, especially between the healthy controls and the group with newly diagnosed DM. The consistent patterns of protein level differences, independent of body composition, suggest potential involvement in the progression of glucose metabolism disturbances and provide unique insights into pathomechanisms. These findings identify PALM2, FURIN, PDZK1, ACAA1, and IL18R1 as potential biomarkers of early dysglycemia. Full article