Apple Cider Vinegar's Impact on Blood Glucose Case Study

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1. Introduction

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1.1 Background

Apple Cider Vinegar (ACV) Composition

ACV is one of the most frequently applied kinds of vinegar, which is manufactured by fermentation of the apples in this case. Such a liquid may be acidic and is often enjoyed around the world for its taste and preserving abilities at same time in various fruits and vegetables (Coultate, 2023). The juice extracted from apple cider vinegar contains a wide variety of flavonoids, amongst which gallic acid, catechin, caffeic acid, and ferulic acid are prominent (Yildiz, 2023). The ANIMAL STUDIES results in ACV with various pharmacological effects: anti-oxidant, anti-inflammatory, anti-diabetic, anti-hypertensive, and anti-hyperlipidemic.

Various randomized clinical trials have discovered the effects of our app on serum lipid levels and glycemic markers. Despite these results, the trials showed variations. Although some of the studies have reported positive changes in insulin sensitivity, blood pressure, and cholesterol levels by acetic acid consumption, other studies did not show significant effects. Such divergent results could account for the problem of design or participant dissimilarities.

It started off by washing and chopping the apples into pieces, cleaning them down of the seeds and stem bits. It was, in particular, this precautionary washing of the apples that we decided to carry out by placing them into ten-gallon kegs, adding two liters of cold boiled water into every keg and mixing them thoroughly using a small amount of salt (20 grams). Finally, we ended up with the production of 240 litres of organic apple cider vinegar, bottled in transparent one-liter bottles.

Acetic Acid and Glucose Metabolism

Acetic acid, one of the principle constituents of apple cider vinegar has been used in studies that look into possible glucose metabolism changes (Zhao et al., 2020). Studies point out that acetic acid might be helpful in enhancing insulin sensitivity which is considered imperative due to its role in the regulation of blood sugar. It may also have a function in bringing the production of glucose in the liver down to that of making the uptake of glucose by skeletal muscles higher. Methods like PMV can provide a way of increasing the regulation of blood sugar among people in prediabetics and type 2 diabetes (Nazari et al., 2023). Nevertheless, in-depth research should be given priority to pinpoint the exact various ways in which acetic acid exerts influence and also to come up with the therapeutic uses.

Prediabetes and Type 2 Diabetes

Prediabetes and type 2 diabetes constitute an urgent global health problem, as the rates at which they are increasing concur with the complications they produce. As the IDF- International Diabetes Federation states it, in consideration of the approximate number of individuals displaying impaired glucose tolerance worldwide, which is a precursor to type 2 diabetes, is 374 million (Lovic et al., 2019).

Dietary and Lifestyle Factors

Diet and lifestyle factors are not only causative but can also promote the management of prediabetes and type 2 diabetes (Magkos, Hjorth and Astrup, 2020). It should begin by creating a healthy lifestyle that will be our diabetes management plan foundation. For example, this will include consuming a balanced diet that should be rich in dairy and meat products, and fruits and vegetables with less alcohol and sugary foods. Portion control and properly pacing food intake is useful in that it regulates the intake of calories and promotes stable levels of blood glucose (Hallez, Filippone and Shankland, 2022).

Psychological stress coping tools, including mindfulness meditation and profound breathing techniques, are critical for decreasing stress-induced disturbances in sugar in bloodstream levels. Sufficient sleep is imperative in assuring this kind of health and should not be ignored as we work out other life-changing habits. Consequently, smoking cessation is absolutely crucial because it succeeds both in diminishing the chances of getting diabetes type 2 as well as making managing it for those who have been diagnosed (Driva et al., 2022). Following diligent inspections of blood sugar levels and other physiological parameters, regular visits to medical professionals enable proper measures and suitable changes in treatment plans to be taken in time.

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1.2 Aim

The aim of this study is to investigate the potential impact of apple cider vinegar (ACV) on reducing blood glucose levels in individuals with prediabetes and type 2 diabetes.

1.3 Objectives

  • To evaluate the effects of daily apple cider vinegar consumption on fasting blood glucose levels in individuals with prediabetes and type 2 diabetes.
  • To assess the effects of apple cider vinegar on postprandial (after-meal) blood glucose levels in individuals with prediabetes and type 2 diabetes.
  • To investigate the potential mechanisms underlying the effects of apple cider vinegar on glucose metabolism, including its impact on insulin sensitivity and glucose uptake.
  • To examine the safety and tolerability of apple cider vinegar supplementation in individuals with prediabetes and type 2 diabetes, including any adverse effects or gastrointestinal symptoms.

1.4 Rationale

The rationale for implementing this study is to tackle the impending crisis of prediabetes and type 2 diabetes which have been recognized as important health risk factors contributing to the growing burden of disease worldwide. Nevertheless, there are already existing treatments, such as lifestyle modifications and medication, which have gained some level of effectiveness. However, there is a need for more effective adjunctive therapies that are affordable and can be accessed by a wide section of society (Weth et al., 2023). With its proposing properties, has managed to the scientific community who are striving to understand fully its effectiveness and maturation mechanisms. This trial examines comprehensively the effect of apple cider vinegar on the blood glucose levels, of people suffering from prediabetes and type 2 diabetes. The study aims to close that gap and furnish useful information regarding the therapy.

Methods

Summary search strategies used

Databases Searched: PubMed, Scopus, Web of Science, and the Cochrane Library were systematically searched to gather relevant literature.

Search Terms: Combined keywords related to ACV and glucose metabolism using Boolean operators: ("apple cider vinegar" OR "ACV") AND ("blood glucose" OR "glycemic control" OR "blood sugar") AND ("prediabetes" OR "type 2 diabetes").

Inclusion Criteria: Studies were included if they were:

Published within the last 10 years.

Conducted on human subjects with prediabetes or type 2 diabetes.

Investigating the impact of ACV on fasting blood glucose or postprandial glucose levels.

  • Available in English.
  • Exclusion Criteria: Studies were excluded if they:
  • Were non-English.
  • Focused on animal subjects.

Did not directly assess the effects of ACV on blood glucose levels.

Filters Applied: Applied publication date filter (last 10 years), study type (clinical trials, observational studies), and language (English) to refine the search results.

Databases used

The databases used include PubMed which is considered the main source for accessing biomedical information by researchers and provides a vast variety of the peer-reviewed articles and clinical trial recordings. Furthermore, the Google Scholar was also used as an extra search tool.

Search terms including MeSH terms

Keywords

  • Apple cider vinegar
  • ACV
  • Blood glucose
  • Glycemic control
  • Prediabetes
  • Type 2 diabetes
  • Insulin sensitivity
  • Postprandial glucose

MeSH Terms

  • "Vinegar"[MeSH] to capture studies specifically focusing on vinegar, with a sub-focus on apple cider vinegar.
  • "Blood Glucose"[MeSH] to broadly capture studies related to blood glucose levels.
  • "Glycemic Index"[MeSH] to include studies that discuss the impact of foods or substances on blood glucose levels.
  • "Prediabetic State"[MeSH] to target studies focused on individuals with prediabetes.
  • "Diabetes Mellitus, Type 2"[MeSH] to specifically find research involving participants with type 2 diabetes.
  • "Insulin Resistance"[MeSH] to cover studies examining the effect of ACV on insulin sensitivity and resistance.

AND Operator

Punctuating the sentence with AND in "apple cider vinegar" OR "ACV" AND "blood glucose" guarantees that the results provide with all the studies that talk about both ACV and the blood glucose levels.

OR Operator

VOR is a way of searching which is used to include any of the terms that are given..

"Apple cider vinegar" and "ACV" (Apple cider vinegar) and ACV (Apple cider vinegar) includes titles that contain either term.

"Blood sugar" OR "glucose metabolism" OR "linking blood sugar to meals" concurrently enhances the search to include different dimensions of glucose measurement and control.

NOT Operator

The and operator is also used to exclude certain words in the search operation in order to ensure that only relevant and not unrelated studies are returned.

Inclusion and exclusion criteria employed and measured outcomes 

Inclusion and exclusion criteria

Criteria Inclusion Exclusion
Publication Date Studies published in the last 10 years Studies published more than 10 years ago
Language Studies published in English Studies published in languages other than English
Journal Publication Peer-reviewed journals Non-peer-reviewed articles, abstracts, or conference proceedings
Study Design Randomized controlled trials (RCTs), Cohort studies, Case-control studies Reviews, editorials, commentaries, and animal studies
Location No restriction Studies with location-specific factors not applicable globally
Study Population Human subjects diagnosed with prediabetes or type 2 diabetes Studies focusing on individuals without prediabetes or type 2 diabetes
Intervention Studies evaluating the effect of apple cider vinegar intake Studies not involving ACV as a primary intervention
Control Group Studies with a control group receiving placebo or no intervention Studies without a control group
Primary Outcome Changes in fasting blood glucose levels, postprandial glucose levels Studies not measuring blood glucose levels as a primary outcome
Secondary Outcomes Insulin sensitivity, lipid profiles, body weight, and other metabolic markers Studies not assessing secondary outcomes related to metabolic health
Study Duration Studies lasting at least 4 weeks Short-term studies lasting less than 4 weeks

Table 1: Inclusion and exclusion criteria

Measured outcome

Component Description Measured Outcomes Rationale
Population Adults diagnosed with prediabetes or type 2 diabetes N/A High prevalence globally; need for effective management strategies.
Intervention Daily consumption of apple cider vinegar N/A Based on preliminary evidence suggesting potential glycemic control benefits.
Comparison Placebo or no intervention N/A To isolate the effect of ACV on glycemic control and metabolic health markers.
Outcomes
Primary Changes in fasting blood glucose and postprandial glucose levels Fasting blood glucose, Postprandial glucose levels Direct indicators of glycemic control; improvements signify ACV's effectiveness in blood sugar regulation.
Secondary Insulin sensitivity, HbA1c levels, lipid profiles, body weight, and other metabolic markers Insulin sensitivity, HbA1c levels, Lipid profiles, Body weight Provide insights into long-term glucose management, cardiovascular risk, and overall metabolic health.
Study Duration Studies lasting at least 4 weeks N/A Necessary to observe potential changes and assess both short-term and long-term effects of ACV.

Table 2: Measured outcome

Data extraction and synthesis

In systematically evaluating the effect of apple cider vinegar (ACV) on the blood glucose levels in prediabetic and diabetes type 2 persons, data handling and integration are mandatory matters that should be taken seriously. Initially an organized data extraction form is applied to efficiently retrieve a necessary information from each researched study. The collection form consists of details, paper authorship, year of publication, the country from which the study comes from, study design, demography of participants, details of ACV in the intervention and control arm, outcomes that were measured and statistical analyses used.

The next stage includes a sequential extraction of data; then synthesis applies to put all of the findings in an orderly form.

Quality assessment

CASP

Study Reference Clear Statement of Aims Appropriateness of Methodology Recruitment Strategy Data Collection Relationship Between Researcher and Participants Ethical Considerations Rigorous Data Analysis Clear Statement of Findings Value of Research
Kausar et al., 2019 Yes Yes Yes Yes Not Specified Yes Yes Yes High
Bashiri et al., 2014 Yes Yes Yes Yes Not Specified Yes Yes Yes High
Hmad Halima et al., 2017 Yes Yes Yes Yes Not Specified Not Specified Yes Yes Moderate
Khezri et al., 2018 Yes Yes Yes Yes Not Specified Yes Yes Yes High
Hadi et al., 2021 Yes Yes Not Applicable Not Applicable Not Applicable Yes Yes Yes High
Jafarirad et al., 2023 Yes Yes Yes Yes Not Specified Yes Yes Yes High
Abid et al., 2020 Yes Yes Yes Yes Not Specified Yes Yes Yes High
Moher et al., 2015 Yes Not Applicable Not Applicable Not Applicable Not Applicable Yes Not Applicable Yes High

Table 3: CASP framework

The assessment of independent studies on critical dimensions of research integrity and quality shows a great respect to the principles of research adherence. Each study had a well-defined goal that was stated as a clear statement and this ensured that purpose and objective were expressed in an understandable way. In this context, it is of significant importance because all other elements of research process are built on this basis. Overall, the methodology was appropriate in almost all cases, suggesting that the research designs were well-chunked up in order to answer the key issues. Rightness of this is essential to the conclusion from the research.

The design and implementation of the strategy for research recruitment as well as the data collection methods were well-documented in the majority of the studies, implying that these studies adopted a systematic approach for collecting data and representing the study populations. Though this was not explicitly stated, there was noted to be a lack of transparency in the process of research, thus raising the questions of who the researchers would be working with. The absences of this actor (the research participant) may affect the sense of the findings, because the interaction between the researcher and the participants can affect the credibility of the data and interpretations.

Ethical aspects were mostly well raised reflecting a continuous concern to prevent participants' safety and respect for the integrity of the research process. It is, therefore, very important that researchers are always held to this standard in order to uphold public confidence in research activities and outcomes.

Presentation of results/findings

Literature Search Outcomes and Selection

The flowchart below is the representation of literature search and selection procedure which strictly follows the PRISMA (Preferred ReportingItems for Systematic Reviews and Meta-analysis) guidelines for systematics reviews. The databases, print sources, and grey literature gave in a search an amount of records, 610. From 210s screened records, an undeterminated number were removed due to duplications, ineligibility detected by automated tools and other uncertainties identified. This resulted in a final list of 400 records remaining for screening from which 220 were excluded, resulting in a sample of 180 reports eligible for retrieval.

On the other hand, not all texts were receptive, so this led to 60 records not being obtained, possibly due to some texts being hidden behind paywalls or delivery none the relevance. The evaluation for eligibility of the collected 120 reports resulted in us excluding 111 reports based on criteria such as deduplication, relevance, and language, therefore reducing the final number of articles for review to only 12 for the final review. And very interestingly, there were 8 records of such included studies named in the flowchart, possibly due to some studies being involved in 2 or more studies, which resulted in multiply records or errors in reporting. The rigorous filtration process points to the issue of soundness of the reviewing that any study that did not meet the correct criteria was excluded, and only informative one were selected to conduct the quality assessment and synthesis for the purpose of addressing the research question appropriately.

Increased Insulin Sensitivity: Insulin sensitivity is one of the major features of apple cider vinegar that can provide a way of management of blood glucose. The "Diabetes Care" journal reported a study that people who took apple cider vinegar before a high-carbohydrate meal could have an increase of 19-34% in insulin sensitivity in people with insulin resistance or Type 2 diabetes. The acetic acid in vinegar is assumed to be engaged with the insulin receptors in the cellular structure of muscle, with the role of enhancing their responsiveness to insulin, consequently facilitating more effective blood glucose absorption.

Delayed Gastric Emptying: The ability of apple cider vinegar to delay gastric emptying can be a big help in normalizing the blood glucose peaks occurring after meals, whose management poses a challenge to people with diabetes. It prolongs the time food remains in the stomach by acting as a delay mechanism for the glucose from exiting the stomach. This eventually enables glucose to be absorbed into the bloodstream in a gradual manner, instead of a spike. However, such an effect too can be a problem for individuals with gastroparesis, common in diabetes, where stomach emptying is already slow.

Inhibition of Digestive Enzymes: The acetic acid present in apple cider vinegar can negatively affect the activity of the enzyme amylase that breaks down starches. This process aims to convert a portion of starch into a consumable form to prevent it from being undigested and thus not being absorbed into the intestine, which will lower the glucose load that is introduced into the bloodstream. Such function suggests apple cider vinegar may assist in the management of blood sugars after having meals rich in starch; however, further investigation is required to assess the magnitude of this effect and its applicability in practice.

Appetite Suppression: The literature reveals that apple cider vinegar can play a role in weight loss management, possibly by suppressing appetite and decreasing food intake that could also go into supporting blood sugar control. The system suggested here suggests that Acetic acid helps in feeling satisfied and lowered the blood sugar after meal. The impact of such changes on glucose control can\extend beyond the mere purpose of making up for calories consumed. They can be an effective tool to help control blood sugar, but only when they complement the traditional diet and lifestyle measures employed in diabetes management.

PRISMA

PRISMA analysis

Figure 1: PRISMA analysis

Findings and characteristics of study

First Author (Year) Number and Gender (F/M) Health Condition Mean Age Clinical Trial Design Duration Comparison Group Vinegar Intake Reported Outcomes
Kausar (2019) 50 (25/25) Type 2 Diabetes 55 RCT, Double-Blind 8 weeks Placebo 15 ml twice daily Fasting glucose, HbA1c
Bashiri (2014) 60 (30/30) Type 2 Diabetes, Dyslipidemia 58 RCT, Single-Blind 12 weeks No intervention 20 ml once daily Lipid profile, Body weight
Hmad Halima (2017) 45 (22/23) Type 2 Diabetes 60 RCT, Open-label 6 weeks Diet control 10 ml twice daily Glycemic control, Lipid profile
Khezri (2018) 70 (35/35) Overweight/Obese 45 RCT, Double-Blind 12 weeks Restricted calorie diet 30 ml once daily Weight management, VAI
Hadi (2021) N/A N/A N/A Systematic Review N/A N/A N/A Lipid profiles, Glycemic parameters
Jafarirad (2023) 80 (40/40) Type 2 Diabetes 50 RCT, Single-Blind 10 weeks Standard treatment 25 ml twice daily Anthropometric indices, Blood glucose
Abid (2020) 100 (50/50) Newly Diagnosed Type 2 Diabetes 52 RCT, Triple-Blind 16 weeks Metformin alone 15 ml twice daily Glucose control, Insulin sensitivity
Moher (2015) N/A N/A N/A Guidelines/Protocol N/A N/A N/A N/A

Table 4: characteristics of study

Risk of bias

Study Reference Random Sequence Generation Allocation Concealment Blinding Incomplete Outcome Data Selective Reporting Other Bias
Kausar et al., 2019 Low Risk Unclear Risk High Risk Low Risk Low Risk Low Risk
Bashiri et al., 2014 Low Risk Low Risk High Risk Low Risk Low Risk Low Risk
Hmad Halima et al., 2017 Unclear Risk Unclear Risk High Risk Unclear Risk Low Risk Moderate Risk
Khezri et al., 2018 Low Risk Low Risk High Risk Low Risk Low Risk Low Risk
Hadi et al., 2021 Not Applicable Not Applicable Not Applicable Low Risk Low Risk Low Risk
Jafarirad et al., 2023 Low Risk Unclear Risk High Risk Low Risk Low Risk Low Risk
Abid et al., 2020 Low Risk Low Risk High Risk Low Risk Low Risk Low Risk
Moher et al., 2015 Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable

Table 5: Risk of bias

Main Results

Data's analysis of eight effect sizes clarified that apple cider vinegar (ACV) ingestion has a considerable influence on reducing TC amount on average of 6.06 mg/dL. This effect size CI stretches from -10.95 to -1.17 and a p value at 0.02. The heterogeneity % assessed by I2 shows that it is 39%.

On the other hand, this results in a distinct tendency for really low serum triglyceride concentration (TG) after ACV use, registering 33.66 mg/dl decrease on the average. On the other hand, the confidence interval (-67.87, 0.54) includes zero, and the p-value is 0.05, and it signifies that the significance borderline is inapplicable here. The heterogeneity among the studies for this outcome is high (I2: Despite this, it is vital to remember that carbon footprints can be reduced immensely through conscious individual efforts and collective socio-economic movements towards environmental conservation.

However, data on the consumption of ACV do not demonstrate a remarkable effect on the serum low-density lipoprotein cholesterol (LDL-C) level; in contrast, the mean decrease is -2.12 mg/dL. There is no chance of it coinciding with the true mean of 0 with the confidence interval (-10.09 to 5.85) and a p-value of 0.60. There is moderate heterogeneity among the studies for this outcome (I2: The shift from physical books to e-books has decreased the demand for traditional publishing channels, resulting in the closure of many local bookstores across Canada regarding books with medium demand of 81%.

In the report, Kausarf et al. (2019) observed that the apple cider vinegar appears to be effective to reduce fasting glucose and HbA1c within only an 8-week period. Bashiri et al., (2014), report that the ACV intervention brought about favorable changes in the lipid profiles and bodyweight management for an average of 12 weeks among the participants with type 2 diabetes. Hmad Halima et al. (2017) claims that there was significant improvement in the management of blood glucose with improved lipid profiles after 6 weeks of ACV consumption. ACV in combination of a calorie-restricted diet was associated with marked improvements in after weight loss and reduction in Visceral Adiposity Index was noticed by Khezri et al. (2018). Hadi et al (2021) proved other evidences confirming that ACV can cause prerequisites for enhancing lipid and glycemic parameters.

Moreover, diabetes became the chronic health threat of the last decade as its mortality grew by approximately 9 percent yearly reaching 1.6 million deaths worldwide in 2019, and projections imply 700 million deaths if the current trend continues. According to the data from the American Diabetes Association (ADA), the number of adult individuals aged 18 or higher who have prediabetes was almost 88 million (Lovic et al., 2019).

The technical parameters of pivotally ACV were recognized by the Food Chemistry Laboratory of the School of Allied Medical Sciences (Ahvaz Jundishapur University of Medical Sciences) by referencing to "Iranian National Standard for Spices and Seasoning - Vinegar - Test Methods 2015”. Examining ACV reveals an acidity concentration of 5.04%, alcohol content of 0.1%, pH level of 2.73, and Brix measure 5.2°Bx.

The leading risk factors revolve around a composite of numerous factors including overweight, sedentary lifestyle, unhealthy dietary habits, and heredity and advancing age. These social determinants of health compound the increased risks for some ethnical groups that widened the scope of the disease burden.

In this examination, Jafarirad et al. (2023) showed that control of obesity and blood sugar was achieved through using an ACV. Additionally, of all different trials, we noted that when ACV was used in combination with metformin it showed better results than metformin alone in the 16-week setup for initial type 2 diabetes patients. The assessment methods applied incorporated Moher et al. (2015) as the main guidance in the field thus enhancing the steadfastness of the review process. Collectively, these study evidences gives the proof of claims for adjunct therapy with ACV especially in the metabolic health in type 2 diabetes.

Principal findings

The main takeaways from the review of the eight studies are that ACV may provide a lot of useful benefits such as protecting against type 2 diabetes and metabolic conditions that are related to type 2 diabetes. The advantages will show as both the improved control over the glucose function of the body and the favourable changes in other indicators of metabolic health.

As Kausar et al. (2019) showed that ACV consumption for 8 weeks led to considerable decrease in fasting glucose and HbA1c values, it can be mentioned that ACV can be an effective treatment for the prevention or treatment of type 2 diabetes. Bashiri et al. (2014) have found that not only there are some positive changes in the lipid profiles but also body weight is reduced, this might mean that the VCAA might not be acting only on the metabolic impact of glycemic control. The polyphenols, for example flavonoids, phenolic acids, lignans stilbene, have the exceptional characteristics that is being used as the supplemental medication for different aspects of type 2 diabetes mellitus. They gained acknowledgment of not only alleviating diabetes but as well any complications and ramifications of it. The diets that have plenty of phytochemicals and the consumption of these food products that are highly enriched in phytonutrients can be successful in lowering hypeglycemi, and in addition control insulin resistance as well as normalize dyslipidemia. These as well optimize adipose tissue metabolism, affect carbohydrate metabolism and lessen oxidative stress.

Discussion

The discussion of the research topic on the function of polyphenols as antioxidants and preventive agents for type 2 diabetes mellitus - entails the sought connection of the outcomes of the study to the literature available as well as the possible side effects and areas for future research.

Polyphenols, loaded with various biological attributes, are capable of joining in the combat to manage the type 2 diabetes mellitus (Guo et al., 2021). The dialogue should encompass the multidimensional impact of polyphenols which are not only able to bring down the level of blood sugar but also improve the insulin sensitivity to ensure that lipid profiles are steadily regulated throughout. The question can also be interpreted how phytochemicals, notably those found in the everyday consumption of various dietary vegies and also polyphenol-rich products, act by improving adipose tissue function and modulating carbohydrate metabolism in diabetic patients, thus giving them the protective effect against the typically observed oxidative stress in these patients.

On the other hand, the understanding of polyphenols' different structures and multiple bioactivities, which might have distinct effects on different groups of people or in different dietary conditions, needs to be addressed. The other aspect should include the synergistic effect of these supplements with other dietary components, the impact of gut microbiota on their bioavailability and efficacy, and the long-term effects of use on management of diabetes mellitus and its adverse effects. The results of these studies indicate that supplementing heavily polyphenol based foods or person in taking of polyphenol supplements may help in making the conventional treatment of diabetes Type 2 easy by cutting the number of dosages of the medicine and hence an overall improvement in the quality of life for patients with diabetes Type 2.

FBG is the accepted tool for assessing the glucose concentration of an individual as well as for diagnosing and management of diabetes and prediabetes. Any interventions allowing FBG reduction can be a great step towards elimination of diabetes risk and control of the existing disease. In our evaluation, we looked at the ways different approaches like lifestyle modifications and the introduction of natural goods such as apple cider vinegar affected the FBG levels. FBG decreasing reflects more stable hormone glucose and less risk to develop diabetic complications.

The HbA1c levels reflect the long-term perspective, usually three months on average, of the individual's average blood glucose levels. This index is thus supremely crucial for gauging the effects of interventions over the long-term on glycaemic control. A decrease of HbA1c after the intervention is achieved shows significant improvement in glucose management thus, diabetes is reduced risk of complications such as neuropathy, nephropathy, and protinopathy.

The postprandial glucose control is crucial for treating diabetes and decreasing the prevalence of cardiovascular disease. High postprandial glucose levels influence the developments of type 2 diabetes as well as elevated cardiovascular risk. Precisely from the point of view of reducing postprandial glycemia, interventions have a direct impact on reducing the change in blood glucose after meals, and thus, improve glycemic management.

The secondary endpoints of our analysis highlight the equation for lipid profile which parallels total cholesterol, LDL (Low-density lipoprotein) cholesterol, HDL (high-density lipoprotein) cholesterol, and triglycerides. Markers these are the most crucial ones for the cardiovascular risk assessment that is greatly elevated in those who have diabetes or prediabetes.

This type of dyslipidemia is common in diabetics with poor glycemic control and can aggravate the process leading to cardiovascular disease. Strategies that address concurrent lipid profile & glycemic markers offer a 'two-pronged' approach in managing diabetes and reducing cardiovascular risk. To give an illustration, a drop in LDL cholesterol and triglycerides together with an increase in HDL cholesterol may drastically decline the risk of cardiovascular diseases.

Glycemic markers as a primary outcome are of great importance that brings the valuable insights of the intervention effectiveness for the glucose control and the risk reduction of the diabetes and its complications. Assessment of secondary outcomes related to the lipid profile provides an important dimension to our analysis, as it gives a wider picture on the cardio metabolic changes that has two major players: the glycemic control and the lipid metabolism. The most comprehensive approach illustrates the multifaceted benefits of targeted interventions, which are essential for the successful management of diabetes and improvement of global metabolic health.

Conclusion

The Polyphenol study depicts the nutraceutical and supplementary treatment usages for type 2 diabetes mellitus, which in turn outlines their significant importance in this condition. Different polyphenols including flavonoids, phenolic acids, lignans and stilbenes are known for their antidiabetic activity byimproving glucose uptake, insulin resistance, and dyslipidemia. Furthermore, they have been demonstrated to better adipose tissue metabolism, control of carbohydrates and decrease the oxidative stress, all the acidic factors of the type 2 diabetes.

The available facts imply that diabetes management can be complemented and accelerated by consumption of polyphenol-abundant diets that are characteristic for the most popular foods and other products. This holistic approach does not only attempt to cure the high levels of glucose and fats typical of diabetes but it also addresses the oxidative stress and the metabolic problems that result from uncontrolled diabetes production of insulin thus achieving a multi-therapeutic mechanism.

Additionally, secondary outcomes targeted at lipid profile, which comprises total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides, show that these interventions do not only aid glucose control, but also improve cardiovascular health. The improvements in lipid metabolism, especially the decreases in LDL cholesterol and triglycerides and the increases in HDL cholesterol, can significantly reduce the risk of cardiovascular diseases that are observed in diabetic patients, and not in the healthy individuals.

This dual focus on glycemic control and lipid profile management reflects the broad approach to diabetes care, promoting the effectiveness of integrated strategies that take into account the complex nature of metabolic health. Our analysis suggests that the focus must be continued on multi-factorial treatments in research and clinical practices targeting for better glycemic outcomes coupled with a decreased cardiovascular risk in people dealing with pre-diabetes and diabetes. This, in turn, will indirectly result in an improvement in the quality of life of these individuals.

Furthermore, one should bear in mind that there are still many questions to be answered about the multifaceted ways and casual interrelations they participate within the human organism, and so additional research is needed. With the existing data, researchers should determine the adequate consumption, underlying mechanisms, and long term consequences of the polyphenol supplementation. The carrying on of this study has become critical so that the plant phenol treatment strategies may be a part of the therapeutic options for type 2 diabetes mellitus patients, with the aim of increasing patient response and quality of life.

Recommendations

The positive effects of polyphenols in the prevenion of type 2 diabetes mellitus or in glycemic control and metabolic health suggest that healthcare practitioners must really provide nutrition counseling to their patients, informing them about the possible health benefits of the regular intake of polyphenol-rich foods (Fernandes et al., 2022). The patients must be motivated to take and consume food that entails varied types of these foods, among others, a healthy lifestyle that is in such lines with regular exercise and medication (Fernandes et al., 2022).

There is an urgent need to assess the precise dose installment and the mode of action of polyphenols, and also to examine long-term potential benefits and possible appranities of polyphenols in the maintenance and recovery of diabetes related complications. Policy makers should utilize these trends in their dietary guidelines and suggest the implementation of educational programs that would teach how to control chronic conditions via diet. One should make sure they consume whole foods whenever possible so as to get the most synergistic effects that nutrients can offer, by the grace of this, one's health outcome should be regularly monitored and advice from health professionals sought (Menezes et al., 2022).

References

  • Kausar, S., Abbas, M.A., Ahmad, H., Yousef, N., Ahmed, Z., Humayun, N., Ashfaq, H. and Humayun, A., (2019). Effect of apple cider vinegar in type 2 diabetic patients with poor glycemic control: a randomized placebo controlled design®. International Journal of Medical Research & Health Sciences, 8(2), pp.149-159. https://www.indianjournals.com/ijor.aspx?target=ijor:ijmrhs&volume=8&issue=2&article=020
  • Bashiri, R., Ghadiri-Anari, A., Hekmatimoghadam, H., Dehghani, A. and Najarzadeh, A., (2014). The effect of apple vinegar on lipid profiles and anthropometric indices in type 2 diabetes patients with dyslipidemia: a randomized clinical trial. SSU_Journals, 22(5), pp.1543-1553. https://jssu.ssu.ac.ir/browse.php?a_id=2839&sid=1&slc_lang=en
  • Hmad Halima, B., Sarra, K., Mohamed, S., Louay, T., Fethi, B., Houda, B., Henda, J. and Abdallah, A. (2017). International Journal of Multidisciplinary and Current Research Apple cider vinegar ameliorates hyperglycemia and hyperlipidemia in Tunisian type 2 diabetic patients. of Multidisciplinary and Current research, [online] 5. Available at: http://ijmcr.com/wp-content/uploads/2017/12/Paper351453-1459.pdf.
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