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Background A key source of energy from the diet is the molecule glucose. After eating a meal, glucose from the meal is released into the blood while also activating production of the hormone insulin from the pancreas to be released into the blood. As a result, shortly after the meal there is an increase in blood glucose and insulin. The increase in blood insulin then helps to lower blood glucose levels by allowing glucose to enter into the cells that need it for energy purposes. This results in a lowering of the level of glucose in the blood. However, in the case of type 2 diabetes (T2D), the levels of blood glucose and insulin are abnormally high. This condition of uncontrolled blood glucose can also prevent glucose from gaining entry into the cells that need this molecule as an energy source despite higher levels of insulin, which is known as insulin resistance. Finding treatments to help regain normal blood glucose and insulin responses are imperative to treating T2D Experimental Design In this study, researchers recruited subjects that were already diagnosed with T2D. One group of subjects was given the diabetes medication metformin, which helps to control blood glucose. The other group of subjects was given both metformin and Ginko biloba extract. Both groups were tested for several indicators of T2D as well as possible side effects at baseline (day O) and after 90 days on their respective treatments. Glucose and insulin were tested by collecting blood samples from subjects during fasting conditions. A portion of the blood known as serum was then isolated and tested for fasting serum glucose and insulin. A blood glucose level showing 3 126 mg/dL indicates the presence of T2D. The figure below shows measurements for HbA1C (%), serum insulin, fasting serum glucose, and the insulin resistance index. Additional definitions are listed here to define the measurements shown on the graphs to assist you answering the questions below.1 HbA1C: Hemoglobin from red blood cells that have sugar molecules attached. It is an indicator of blood glucose levels. Given that red blood cells live for 120 days, the level of % HbA1c indicates the degree of blood glucose control over this period of time. Insulin Resistance Index: The degree of insulin resistance · 15.0 12.5 10.0 7.5 5.0 2.5 0.0 200 150 100 O 50 Met+placebo, n 20 Met+GKB, n-27 Met+placebo, n=20 Met+GKB, n-27 E 25 5 15 2 10 Met+placebo, n-20 Met+GKB, n-27 Met+placebo, n-20 Met+GKB,n-27 Baseline After 90 days Figure 1. T2D subjects receiving Metformin (1.24+0.67 grams/day) treatment with or without Ginko biloba extract (120 mg/day) for 90 days were fasted for 12 hours and blood collected at baseline and after 90 days. Blood samples were analyzed for (A) hemoglobin A1C %, (B) serum glucose, (C) serum insulin, and (D) insulin resistance index. Statistical analysis compares the 90-day versus baseline measurements within each treatment group where asterisks () indicate significant differences. Data are representative of 20 subjects in the Metformin only group (n-20) and 27 subjects in the Metformin plus Ginko biloba extract group (n-27) What is the most accurate interpretation of the data shown for Figure 1B? OIn subjects receiving Metformin and Ginko biloba extract, fasting serum glucose was not significantly altered. However, subjects receiving Metformin only showed a significant decrease in fasting serum glucose after the 90-day treatment period. O Fasting serum glucose was significantly reduced in subjects receiving Metformin only. In addition, subjects receiving Metformin plus Ginko biloba extract also showed a significant reduction in serum glucose levels after 90 days. O Fasting serum glucose was significantly lower compared to baseline conditions in subjects taking both Metformin and Ginko biloba extract whereas subjects receiving only Metformin did not show significant changes in these measures after 90 days. Under conditions of Metformin plus Ginko biloba extract, subjects demonstrated no significant changes in fasting serum glucose. In additions, subjects receiving Metformin plus Ginko biloba extract also did not show significant changes. O After treatment with Metformin and Ginko biloba extract for 90 days, subjects showed a significant increase in fasting serum glucose whereas subjects receiving the Metformin only did not show significant changes in fasting serum glucose. 15.0 12.5 10.0 200 150 100 O 50 2.5 0.0 Met+placebo, n 20 Met+GKB, n-27 Met+placebo, n-20 Met+GKB,n-27 E 25 2 10 Met+placebo, n-20 Met+GKB, n-27 Met+placebo, n=20 Met+GKB,n=27 Baseline After 90 days Figure 1. T2D subjects receiving Metformin (1.24+0.67 grams/day) treatment with or without Ginko biloba extract (120 mg/day) for 90 days were fasted for 12 hours and blood collected at baseline and after 90 days. Blood samples were analyzed for (A) hemoglobin A1C %, (B) serum glucose, (C) serum insulin, and (D) insulin resistance index. Statistical analysis compares the 90-day versus baseline measurements within each treatment group where asterisks () indicate significant differences. Data are representative of 20 subjects in the Metformin only group (n-20) and 27 subjects in the Metformin plus Ginko biloba extract group (n-27) 9 From Figure 1D, what is the impact of Ginko biloba extract on insulin resistance in the subjects tested? 15.0 12.5 10.0 200 150 100 50 ︶ 5.0 2.5 0.0 Met+placebo, n 20 Met+GKB, n-27 Met+placebo, n=20 Met+GKB.n-27 E 25 20 5 15 Met+placebo, n=20 Met+GKB, n=27 Met+placebo, n 20 Met+GKB, n-27 Baseline After 90 days Figure 1. T2D subjects receiving Metformin (1.24+0.67 grams/day) treatment with or without Ginko biloba extract (120 mg/day) for 90 days were fasted for 12 hours and blood collected at baseline and after 90 days. Blood samples were analyzed for (A) hemoglobin A1C %, (B) serum glucose, (C) serum insulin, and (D) insulin resistance index. Statistical analysis compares the 90-day versus baseline measurements within each treatment group where asterisks () indicate significant differences. Data are representative of 20 subjects in the Metformin only group (n-20) and 27 subjects in the Metformin plus Ginko biloba extract group (n-27). 9 Based on the results presented here in Figure 1, what could be a possible conclusion about Ginko biloba extract and T2D? O Ginko biloba extract in combination with Metformin results in a worsening of the disease state overall with a pronounced inability of subjects to control long-term blood glucose levels and insulin resistance. O The use of existing T2D medications like Metformin show superior results in improving the diabetic disease state. The addition of other medicines will not improve diabetic disease conditions any further. O The addition of cost-effective plant-derived traditional medicines can act to further improve long-term glucose control and insulin resistance when treating T2D with existing therapies that target blood glucose levels O The addition of sugar-sweetened beverages into the diet of subjects with T2D can act to improve the diabetes disease state beyond improvements demonstrated by existing T2D medications. O The addition of traditional medicines like Ginko biloba extract in conjunction with existing T2D medications is a cure for T2D. After this combined treatment subjects can resume living life without concern for diabetes complications. Which of the following would you do if you needed to get more information to reinforce the evidence presented in this new article? Ask a friend or family member who has type 2 diabetes what they think about using Ginko biloba extract to treat their disease and whether or not they have noticed if this plant-based supplement has lowered their fasting blood glucose. Study the peer-reviewed research article from which these findings originated to arrive at your own conclusions. If needed locate and retrieve additional peer-reviewed articles that may challenge or support the research findings. O Use popular search engines like Google or Yahoo and read the first or second search result regarding plant- based traditional medicines and type 2 diabetes to determine the benefits of Ginko biloba extract in treating this disease. O Search social media websites and read postings or comments from type 2 diabetes patients about their experiences with plant-based traditional medicines as it relates to diagnostic measurements of the disease. O Search the internet for news articles from credible sources and learn more about the benefits of using Ginko biloba extract including how it may possibly delay or reduce the effects of type 2 diabetes

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