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Jonathan Hazlehurst Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

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Bernard Khoo Endocrinology, Division of Medicine, University College London, London, UK

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Carolina Brito Lobato Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Department of Medicine, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark

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Ibiyemi Ilesanmi Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK

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Sally Abbott Department of Dietetics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

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Tin Chan Faculty of Medicine, Chinese University of Hong Kong, Hong Kong

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Sanesh Pillai Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK

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Kate Maslin School of Nursing and Midwifery, University of Plymouth, Plymouth, UK

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Sanjay Purkayastha Brunel University, London, UK
Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK

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Barbara McGowan Endocrinology, Guys’ and St Thomas’s NHS Foundation Trust, London, UK

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Rob Andrews University of Exeter Medical School, Exeter, UK

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Eveleigh Nicholson Portsmouth Hospitals University NHS Trust, Portsmouth, UK

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Katherine McCullough Royal Surrey County Hospital, Guildford, UK

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Lorraine Albon University Hospitals Sussex NHS Foundation Trust, Worthing, UK

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Rachel Batterham Endocrinology, Division of Medicine, University College London, London, UK

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Georgios K Dimitriadis King's College Hospital NHS Foundation Trust, London, UK

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Shareen Forbes BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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Gavin Bewick School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK

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Tricia M-M Tan Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK

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nutritional deficiencies according to accepted guidance. High 2.3 Dietary advice for PBH should include eating controlled portions of carbohydrates, together with reinforcement of the post-bariatric eating strategy. Suggested strategies include

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Shane M Regnier Committee on Molecular Metabolism and Nutrition, Chicago, Illinois, USA
Pritzker School of Medicine, Chicago, Illinois, USA
University of Chicago, Chicago, Illinois, USA

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Andrew G Kirkley University of Chicago, Chicago, Illinois, USA
Committee on Molecular Pathogenesis and Molecular Medicine, Chicago, Illinois, USA

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Daniel Ruiz Committee on Molecular Metabolism and Nutrition, Chicago, Illinois, USA
University of Chicago, Chicago, Illinois, USA

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Wakanene Kamau University of Chicago, Chicago, Illinois, USA

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Qian Wu Wadsworth Center, New York Department of Health, Albany, New York, USA

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Kurunthachalam Kannan Wadsworth Center, New York Department of Health, Albany, New York, USA

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Robert M Sargis Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA

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in a diet enriched in saturated and trans fats as well as simple carbohydrates that promote the development of obesity and diabetes ( 7 , 8 ). Recently, exposures to endocrine-disrupting chemicals (EDCs) have been implicated as novel metabolic

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Leanne Hodson Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospital Trusts, Oxford, UK

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Fredrik Karpe Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospital Trusts, Oxford, UK

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glucose metabolism The factors regulating hepatic glucose output have long been debated. The traditional view is after consumption of a meal containing carbohydrate, hepatic insulin reduces the transcription of gluconeogenic enzymes, leading to direct

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Patricia Arroyo Tardio University Hospital Basel, Basel, Switzerland

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Gabriela Baldini University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland

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Eleonora Seelig University Hospital Basel, Basel, Switzerland
University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland

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, participants were asked to consume a study meal containing 2080 kcal within 15 min. The study meal consisted of two buns, 162 g of cheese, two hard-boiled eggs, and two chocolate-flavored protein milkshakes, each with 40 g of added sugar (40% carbohydrates, 35

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Svjatoslavs Kistkins Pauls Stradiņš Clinical University Hospital, Riga, Latvia

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Othmar Moser Division of Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, Bayreuth, Germany

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Vitālijs Ankudovičs Pauls Stradiņš Clinical University Hospital, Riga, Latvia

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Dmitrijs Blizņuks Institute of Smart Computing Technologies, Riga Technical University, Riga, Latvia

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Timurs Mihailovs Institute of Smart Computing Technologies, Riga Technical University, Riga, Latvia

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Sergejs Lobanovs Pauls Stradiņš Clinical University Hospital, Riga, Latvia

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Harald Sourij Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetolgoy, Medical University of Graz, Graz, Austria

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Andreas F H Pfeiffer Department of Endocrinology and Metabolic Medicine, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm, Berlin, Germany

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Valdis Pīrāgs Pauls Stradiņš Clinical University Hospital, Riga, Latvia
Faculty of Medicine, University of Latvia, Riga, Latvia

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maintain normoglycaemia and normal body weight. Increased intake of carbohydrates stimulates GLP-1 secretion and insulin secretion, both GLP-1 and insulin decrease glucagon secretion. In this scenario, increased insulin levels promote glucose uptake and

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David Q Pham Western University of Health Sciences, College of Pharmacy, Pomona, California, USA
Mary & Dick Allen Diabetes Center at Hoag Hospital, Newport Beach, California, USA

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Ashley Thorsell Sansum Diabetes Research Institute, Santa Barbara, California, USA

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Kristin Castorino Sansum Diabetes Research Institute, Santa Barbara, California, USA

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Brandon Cobb Sansum Diabetes Research Institute, Santa Barbara, California, USA

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the dietary intake of women who were pregnant or planning (UK population only) Overall caloric and carbohydrate intake was similar in both groups. Fat and nonrecommended carbohydrate sources (sugars, preserves, biscuits, cakes) were high in both

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Henryk F Urbanski Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, USA
Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA
Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
Department of Physiology & Pharmacology, Oregon Health & Science University, Portland, Oregon, USA

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Kevin Mueller Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA

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Cynthia L Bethea Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, USA
Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA

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.), which provided calories with 36% fat, 44% carbohydrates (includes 18.5% sugars) and 18% protein. In comparison, regular monkey chow provides calories with 13% fat, 69% complex carbohydrates (includes 6% sugars) and 18% protein. Additional enrichment

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Rama Lakshman Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK

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Charlotte Boughton Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
Cambridge University Hospitals NHS Foundation Trust, Wolfson Diabetes and Endocrine Clinic, Cambridge, UK

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Roman Hovorka Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK

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in children, with a decrease in hypoglycaemia in both cohorts ( 63 , 64 ). Future: emerging directions in automated insulin delivery Simplified meal announcements All currently available HCL systems require users to count carbohydrates

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David P Sonne Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Asger Lund Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Jens Faber Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Jens J Holst Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Tina Vilsbøll Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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Filip K Knop Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark
Department of Medicine, Department of Biomedical Sciences, Department of Endocrinology, Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark

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carbohydrate and 13 g protein; medium fat: 10 g fat, 93 g carbohydrate and 11 g protein and high fat: 40 g fat, 32 g carbohydrate and 3 g protein). Four type 2 diabetes patients were treated with diet alone, eight were also treated with metformin and three with

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Po-Chung Cheng Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan

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Chia-Hung Kao Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan

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). Specifically, patients were instructed to limit saturated fat to less than 5% of total calories and increase whole grain intake. Furthermore, participants learned the carbohydrate counting technique and their daily recommended carbohydrate intake

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