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Objective: Recent epidemiological and prospective trial evidence suggests that consumption of a low glycaemic index (LGI) diet will reduce coronary risk. We hypothesise that introduction of an LGI diet will improve the metabolic profile of patients who have undergone coronary artery bypass grafting. Design: We conducted a randomised parallel group trial comparing a control group (n ¼ 29, age 61.879 y), who received currently advocated healthy eating dietary advice only, to an intervention group, who received healthy eating advice emphasising LGI carbohydrates (n ¼ 26, age 63.679.4 y) over a 12-week period in free-living patients with coronary heart disease. Outcome measures included fasting glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, very lowdensity lipoprotein cholesterol, low density lipoprotein cholesterol and triglycerides. Results: A significant lower dietary glycaemic index was achieved in the group assigned to an LGI diet compared to the healthy eating control group (7171 vs 8171); fibre intake was also higher in the LGI group (2071 vs 1571 g). All biochemical markers of glucose and lipid metabolism measured were similar after 12 weeks of the LGI diet or control diet. Discussion: The LGI group achieved a significant LGI and a higher dietary fibre intake. However, there was no measurable significant effect of either the LGI diet or the health eating diet on lipid levels; this may have been hidden by concurrent drug therapy.

Objective: Roux-en-Y gastric bypass (RYGB) is an established treatment for type 2 diabetes. The study objective was to establish RYGB's effects on glycaemic variability (GV) and hypoglycaemia. Research Design and Methods: Prospective observational study of 10 participants with prediabetes/Type 2 diabetes undergoing RYGB, studied before surgery (Pre), 1 month (1m), 1 year (1y) and 2 years (2y) post-surgery with continuous glucose measurement (CGM). A mixed meal test (MMT) was performed at Pre, 1m and 1y. [ClinicalTrials.gov NCT01945840] Results: After RYGB, mean CGM glucose fell (at 1m, 1y and 2y), and GV increased (at 1y and 2y). Fifty percent (5/10) of participants exhibited a percentage time in range <3.0 mmol/L [54 mg/dl] (%TIR<3.0) greater than the consensus target of 1% at 1y or 2y. Peak glucagon-like peptide-1 (GLP-1) and glucagon area-under-curve (AUC) during MMT were respectively positively and negatively associated with contemporaneous %TIR<3.0. Conclusions: Patients undergoing RYGB are at risk of developing post-bariatric hypoglycaemia due to a combination of reduced mean glucose, increased GV and increased GLP-1 response.

Lifestyle clinics facilitate beneficial lifestyle changes which impact positively on morbidity risk factors demonstrating an improvement on current service offered within the NHS. There is an obvious resource implication of offering an intensive management package. There is need for a randomized control trial with analysis to evaluate whether there is cost benefit from this type of intervention.