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Prediabetes and the risk of type 2 diabetes investigating the roles of depressive and anxiety symptoms in the Lifelines Cohort Study.

Depression and anxiety may increase the risk of progressing from prediabetes to type 2 diabetes. The present study examined the interactions between prediabetes status and elevated depressive and anxiety symptoms with the risk of type 2 diabetes. Participants (N72,428) were adults aged 40 years and above without diabetes at baseline from the Lifelines Cohort Study (58% female mean age51.4 years). The Mini-International Neuropsychiatric Interview screened for elevated symptoms of major depressive disorder and generalized anxiety disorder. Glycated hemoglobin A1c (HbA1c) levels determined prediabetes status at baseline (2007-2013), and HbA1c and self-reported diabetes diagnoses determined diabetes status at follow-up (2014-2017). Groups were formed for elevated depressive and anxiety symptoms, respectively, and prediabetes status at baseline (elevated depressiveanxiety symptoms with prediabetes, elevated depressiveanxiety symptoms alone, and prediabetes alone), and compared to a reference group (no prediabetes or anxietydepression) on the likelihood of developing diabetes during the follow-up period. N1,300 (1.8%) participants developed diabetes. While prediabetes alone was associated with incident diabetes (OR5.94 95% CI5.10-6.90, p<.001), the group with combined prediabetes and depressive symptoms had the highest likelihood of developing diabetes over follow-up (OR8.29 95% CI5.58-12.32, p<.001). Similar results were found for prediabetes and anxiety symptoms (OR6.57 95% CI4.62-9.33, p<.001), compared to prediabetes alone (OR6.09 95% CI5.23-7.11, p<.001), though with a smaller effect. The interaction between depressive symptoms and prediabetes was synergistic in age-and-sex adjusted analyses. Individuals with elevated depressive, and to some extent anxiety, symptoms in combination with prediabetes may represent a high-risk subgroup for type 2 diabetes.

It is in our hands-Why wait until you are sick Perceptions about diabetes prevention of Latina mothers in Mexico and the United States.

This study aimed to understand the perceptions driving type 2 diabetes mellitus prevention and management behaviours of Mexican and Latina mothers in Mexico and the United States. Low-income Mexican mothers in San Luis Potosí, Mexico and Latina mothers in Illinois, United States, were recruited by the Holistic Obesity Prevention Study (HOPS). Verbatim transcripts of the semistructured interviews conducted in Spanish (n 24) and English (n 1) were analysed using the Health Belief Model (HBM) framework. Of the 25 participants, 22 (88%) indicated knowing someone with diabetes-specifically a father (n 8), mother (n 6) or grandparent (n 7). Using the HBM, themes showed that mothers perceived that Type 2 diabetes can happen to anyone, are attributable to genetic predisposition and may be driven by strong emotions (perceived susceptibility). Type 2 diabetes introduces severe comorbidities and emotional difficulties for people and their families (perceived severity). Adopting a healthier diet, exercising and staying in good spirits were recognized as benefits of Type 2 diabetes prevention (perceived benefits). The costs of food, challenges of exercising, dieting, modifying habits and time limitations were recognized as perceived costs. Cues to action included doctors recommendations (external) and fear (internal). Mothers acknowledged they could live a healthy life by controlling their weight, exercising, adhering to treatmentsmedications and having the determination to carry-on (self-efficacy). Mothers sought to prevent Type 2 diabetes and live healthy lives, particularly, after receiving a diagnosis of gestational diabetes or when learning about their childrens risks for Type 2 diabetes but perceived significant barriers to Type 2 diabetes prevention.

Comparative Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-Like Peptide 1 Receptor Agonists, and Nonsteroidal Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease and Type 2 Diabetes A Systematic Review and Network Meta-Analysis.

This network meta-analysis compares relative efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT-2i), glucagon-like peptide 1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRA) in improving cardiovascular and renal outcomes in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). We searched PubMed, Embase, and Cochrane Library from inception through November 25, 2022. We selected randomized controlled trials that studied patients with CKD and T2D with follow-up of at least 24 weeks and compared SGLT-2i, GLP-1RA, and nsMRA with each other and with placebo. Primary outcomes were major adverse cardiovascular events (MACE) and composite renal outcomes (CRO). Secondary outcomes were cardiovascular death, all-cause death, stroke, myocardial infarction, and heart failure hospitalization (HFH). A frequentist approach was used to pool risk ratios (RR) with 95% confidence intervals (CI). 29 studies with 50,938 participants for MACE and 49,965 participants for CRO were included. SGLT-2i did not significantly reduce MACE but were associated with significantly lower risks of CRO compared with GLP-1RA (RR, 0.77 95% CI, 0.64-0.91 p 0.003) and nsMRA (RR, 0.78 95% CI, 0.68-0.90 p 0.001). Compared with GLP-1RA and nsMRA, SGLT-2i significantly reduced HFH (RR, 0.69 95% CI, 0.55-0.88 p 0.002) and (RR, 0.78 95% CI, 0.63-0.95 p 0.016), respectively, but did not significantly reduce other secondary outcomes. There were no significant differences between GLP-1RA and nsMRA in lowering all outcomes. SGLT-2i were associated with better cardiorenal protection than GLP-1RA and nsMRA in patients with CKD and T2D. This article is protected by copyright. All rights reserved.

New Drug Tirzepatide (Mounjaro

Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and is a chronic and progressive illness. Millions of Americans have T2DM and many patients do not achieve the recommended blood glucose levels. Glucagon-like peptide 1 (GLP-1) based therapy is an established treatment for the management of T2DM and is recommended early in the treatment algorithm. GLP-1 therapy is associated with better glycemic control, weight reduction, and favorable cardiovascular outcomes. Tirzepatide (Mounjaro™) is a novel dual glucose-dependent insulinotropic polypeptide (GIP) receptor and GLP-1 receptor agonist. Evidence from five SURPASS clinical trials has demonstrated that tirzepatide has potent glucose lowering and weight loss with adverse effects comparable to GLP-1 receptor agonists. This paper gives an overview of tirzepatide and SURPASS clinical trials.

Prevalence and trends of adult overweight and obesity in Nigeria - A systematic review and meta-analysis.

The prevalence of obesity and its attendant complications are on the increase globally-sub-Saharan Africa inclusive. Obesity confers an increased risk of coronary artery disease, type 2 diabetes, ischemic stroke, and some cancers. In Nigeria, several individual reports estimate an exponential increase in the prevalence of overweight and obesity. In this study, we aimed to estimate the current prevalence of overweight and obesity in Nigeria through a systematic review and meta-analyses. A systematic review and meta-analysis were conducted on the prevalence of obesity in Nigeria using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format following searches on major search engines, performed in PubMed, Science Direct, Google Scholar, Africa Journals Online (AJOL), and the WHO African Index Medicus database. Studies on the subject area conducted from the year 2000 to 2018 were included. The forest plot was used to graphically present the results, while confidence interval at 95% was used to display the rates. A total of 77 articles on the prevalence of obesity involving 107, 781 individuals were used in the study. We found a pooled estimate of overweight of 26.0% (95% CI 23.0-29.0) and that of obesity as 15.0% (95% CI 13.0-16.0). There was an increasing trend in the prevalence of obesity in Nigeria from the study especially among urban dwellers. The prevalence of obesity and overweight in Nigeria is high with a rising trend over the years. A Nigerian national health survey of non-communicable diseases especially the burden of overweightobesity is recommended to through more light on the subject. There is need for concerted effort to tame the tide of rising obesity rates in Nigeria.

Diabetic Foot Risk Assessment among Patients with Type 2 Diabetes in Kenya.

Screening for diabetic foot complications is often neglected, especially during routine andor annual diabetes check-ups. We assessed the risk of diabetic foot complications among patients with type 2 diabetes in Kenya using the International Working Group on Diabetic Foot risk stratification guidelines to highlight the need for improved foot care. We conducted a descriptive cross-sectional study in Mathari National Teaching and Referral Hospital in Kenya between July and October 2015. Seven hundred patients with type 2 diabetes were identified and 147 were systematically sampled. A trained podiatrist examined patients, and urine and blood samples were taken for biochemical tests and assessed by the investigating team. In total, 44(29.9%) men and 103(70.1%) women were sampled 75(51.0%) were aged over 55 years, 113(76.9%) were overweightobese, 117(79.6%) had poor glycaemic control and 125(85%) had never had their feet screened for complications. Thirty participants (20.4%) were categorised as being at high risk for developing diabetic foot complications while 54(36.7%) had moderate risk, 53(36.1%) had low risk and 10(6.8%) had no risk. Compared to other risk groups, those with moderate risk for developing diabetic foot problems had higher mean levels of glycated haemoglobin (9.4%), albumin-creatinine ratio (50.3) and high-density lipoprotein cholesterol (1.4 mmolL) at presentation. No other differences in clinical and laboratory profiles were noted. Our results show high rates of obesity, and poor glycaemic control in patients with type 2 diabetes and 56.5% of patients are categorised as being a moderate-to-high risk for foot problems. This highlights the need for healthcare professionals and patients in Kenya to be sensitised regarding the importance of foot screening to prevent lower-extremity complications.

Understanding comorbidities and health disparities related to COVID-19 a comprehensive study of 776 936 cases and 1 362 545 controls in the state of Indiana, USA.

To characterize COVID-19 patients in Indiana, United States, and to evaluate their demographics and comorbidities as risk factors to COVID-19 severity. EHR data of 776 936 COVID-19 cases and 1 362 545 controls were collected from the COVID-19 Research Data Commons (CoRDaCo) in Indiana. Data regarding county population and per capita income were obtained from the US Census Bureau. Statistical analysis was conducted to determine the association of demographic and clinical variables with COVID-19 severity. Predictive analysis was conducted to evaluate the predictive power of CoRDaCo EHR data in determining COVID-19 severity. Chronic obstructive pulmonary disease, cardiovascular disease, and type 2 diabetes were found in 3.49%, 2.59%, and 4.76% of the COVID-19 patients, respectively. Such COVID-19 patients have significantly higher ICU admission rates of 10.23%, 14.33%, and 11.11%, respectively, compared to the entire COVID-19 patient population (1.94%). Furthermore, patients with these comorbidities have significantly higher mortality rates compared to the entire COVID-19 patient population. Health disparity analysis suggests potential health disparities among counties in Indiana. Predictive analysis achieved F1-scores of 0.8011 and 0.7072 for classifying COVID-19 cases versus controls and ICU versus non-ICU cases, respectively. Black population in Indiana was more adversely affected by COVID-19 than the White population. This is consistent to findings from existing studies. Our findings also indicate other health disparities in terms of demographic and economic factors. This study characterizes the relationship between comorbidities and COVID-19 outcomes with respect to ICU admission across a large COVID-19 patient population in Indiana.

Optic Neuritis in a Child With Poorly Controlled Type 1 Diabetes Mellitus A Case Report.

Type 1 diabetes stands among the most prevalent endocrinological diseases in the pediatric age group. The incidence rate continues to rise globally. Optic neuritis has been described in the literature in association with type 2 diabetes however, cases of optic neuritis with type 1 diabetes are very few. Here we describe a rare case of a 15-year-old patient with type 1 diabetes mellitus presenting with optic neuritis. Due to the hyperglycemia that steroids can induce in some patients, management with steroids can be difficult. A multidisciplinary team approach is required to ensure that these patients optic neuritis is properly handled while avoiding steroid side effects.

Women With Polycystic Ovary Syndrome A Review of Susceptibility to Type 2 Diabetes.

The polycystic ovarian syndrome affects many women today. Previous research has demonstrated a direct link between it and serious ailments such as type 2 diabetes, heart disease, and infertility. Originally thought to be a reproductive disorder, polycystic ovarian syndrome (PCOS) is now understood to be a metabolic and psychological disorder. Women of reproductive age suffering from PCOS undergo hormonal imbalances in which progesterone, insulin, and testosterone are produced in excess. PCOS exhibits a variety of characteristics as well as a heterogeneity of symptoms, including acne, hirsutism, androgenic alopecia, irregular menstruation, infertility, obesity, and mood disorders like despair and anxiety. Chronic anovulation, hyperandrogenism, type 2 diabetes, dyslipidemia, and an elevated threat of coronary artery disease are some of its defining characteristics. PCOS develops due to interacting genetic and environmental factors. From a gynaecological curiosity, it grew into a multisystem endocrinopathy. It is fascinating to learn how hormonal issues result in gynaecological problems. Insulin resistance, compensatory hyperinsulinism, and an increase in ovarian androgenic hyperresponsiveness to circulating insulin are all directly related to hyperandrogenism and anovulation. Independent of weight, insulin resistance is more common with PCOS and plays a crucial role in the syndromes metabolic and reproductive complications. Anovulation, polycystic ovaries, and elevated luteinizing hormones, which increase circulating androgen, are all caused by a reduction in follicle-stimulating hormone. High androgen levels cause hyperinsulinemia, which leads cells to become insulin resistant and makes PCOS patients more likely to develop diabetes mellitus. Later research established that women with polycystic ovarian shape and persistent anovulation are the only ones susceptible to insulin resistance. Insulin resistance is thus a distinct characteristic of the condition. The purpose of this review paper is to investigate how PCOS ultimately results in type 2 diabetes mellitus.

Multifocal C-cell Hyperplasia and Marked Hypercalcitoninemia in a Diabetic Patient Treated With Glucagon-Like Peptide-1 Agonist With Concurrent Multinodular Goiter and Hyperparathyroidism.

Thyroid C-cell hyperplasia (CCH) is divided into physiologic or reactive CCH and neoplastic CCH. Glucagon-like peptide-1 receptor agonists (GLP-1 Ra) is a group of medications used to treat type 2 diabetes that has documented C-cell stimulation effect in rodents, leading to subsequent CCH and medullary thyroid carcinoma (MTC) in rats andor mice. Currently, there is no sufficient evidence supporting the association between GLP-1 Ra and human thyroid CCH andor MTC. Here, we present a case of significant hypercalcitoninemia in a 53-year-old diabetic male patient receiving GLP-1 Ra treatment with concurrent multinodular goiter and hyperparathyroidism. Total thyroidectomy and central neck dissection revealed multifocal CCH involving bilateral thyroid lobes and several negative lymph nodes. Subsequent genetic testing did not detect germline mutation of

The Roles of Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists and Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors in Decreasing the Occurrence of Adverse Cardiorenal Events in Patients With Type 2 Diabetes.

Diabetes mellitus is a metabolic disorder characterized by increased serum glucose due to errors in insulin production or response. The prevalence of diabetes mellitus has continued to rise globally over the years, with roughly 7079 persons per 100,000 expected to be impacted by 2030. A vast number of patients with diabetes mellitus experience unfavorable side effects such as weight gain, hypoglycemia, and hepatorenal toxicity from the several diabetic medications available. These adverse effects may result in life-threatening consequences with a high likelihood of occurrence therefore, ongoing efforts continue to develop medications with improved tolerability and better glycemic control. Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT-2i) are examples of new innovative targeted therapies to manage diabetes mellitus and potentially improve cardiorenal conditions. This review article details the specific mechanisms of action, potential side effects, and cardiorenal benefits of GLP-1RA and SGLT-2i therapies to fully understand their roles in combating type 2 diabetes mellitus (T2D).

Effects of Non-surgical Periodontal Therapy on Saliva and Gingival Crevicular Fluid Levels of Chemerin in Periodontitis Subjects With and Without Type 2 Diabetes Mellitus.

Background Evidence had shown a bi-directional link between diabetes mellitus and periodontitis. Chemerin, an adipose tissue-specific adipokine plays a significant role in adipocyte initiation and differentiation that directly influences glucose metabolism, lipid metabolism, and inflammatory mediators. Non-surgical periodontal therapy (NSPT) for patients with periodontitis and diabetes mellitus improves the periodontal condition and regulates glycemic level. Aims and objectives To assess the impact of chemerin on periodontal disease and diabetes mellitus pathogenesis and to analyze the impact of NSPT on saliva and gingival crevicular fluid (GCF) chemerin levels in patients with periodontitis with and without type 2 diabetes mellitus (T2DM). Materials and methods A total of 60 patients were divided into four groups Group I Systemically and periodontally healthy subjects (n15), Group II Systemically healthy subjects with periodontitis (n15), Group III Subjects with periodontitis and T2DM (n15), Group IV Periodontally healthy subjects with T2DM (n15). Indices and parameters like plaque index (PI), gingival index (GI), periodontal probing depth (PPD), and clinical attachment level (CAL) were assessed at baseline in all four groups and six weeks after NSPT in Group II and Group III. A glycated hemoglobin (HbA1c) test was taken to assess the patients blood glucose level. Fasting blood sugar (FBS) level was taken at baseline in all the groups and six weeks after NSPT in Group II and Group III subjects. Saliva and GCF chemerin levels were assessed at baseline in all four groups and six weeks after NSPT in Group II and Group III subjects. Results A statistically significant difference was observed in comparing chemerin levels at baseline with all four groups (p < 0.001). After NSPT, there was a reduction in clinical parameters, FBS, and chemerin levels in Group II and Group III. A positive correlation was observed between salivary chemerin and FBS in Group II, GCF chemerin, PI, and FBS in Group II, and PPD and FBS in Group III. A negative correlation was observed between salivary chemerin and all parameters in Group II and between salivary chemerin and GCF chemerin in Group III. Conclusion Based on the observed relationship between chemerin and the parameters, their utility as a dual biomarker for diagnosis and prognosis in periodontal disease seems promising. However, further studies with a larger sample size on the role of chemerin in health and various states of diseases are required to substantiate the result of the study.

A novel model for predicting prolonged stay of patients with type-2 diabetes mellitus a 13-year (2010-2022) multicenter retrospective case-control study.

Length of stay (LOS) is an important metric for evaluating the management of inpatients. This study aimed to explore the factors impacting the LOS of inpatients with type-2 diabetes mellitus (T2DM) and develop a predictive model for the early identification of inpatients with prolonged LOS. A 13-year multicenter retrospective study was conducted on 83,776 patients with T2DM to develop and validate a clinical predictive tool for prolonged LOS. Least absolute shrinkage and selection operator regression model and multivariable logistic regression analysis were adopted to build the risk model for prolonged LOS, and a nomogram was taken to visualize the model. Furthermore, receiver operating characteristic curves, calibration curves, and decision curve analysis and clinical impact curves were used to respectively validate the discrimination, calibration, and clinical applicability of the model. The result showed that age, cerebral infarction, antihypertensive drug use, antiplatelet and anticoagulant use, past surgical history, past medical history, smoking, drinking, and neutrophil percentage-to-albumin ratio were closely related to the prolonged LOS. Area under the curve values of the nomogram in the training, internal validation, external validation set 1, and external validation set 2 were 0.803 (95% CI confidence interval 0.799-0.808), 0.794 (95% CI 0.788-0.800), 0.754 (95% CI 0.739-0.770), and 0.743 (95% CI 0.722-0.763), respectively. The calibration curves indicated that the nomogram had a strong calibration. Besides, decision curve analysis, and clinical impact curves exhibited that the nomogram had favorable clinical practical value. Besides, an online interface ( httpscytjt007.shinyapps.ioprolongedlos ) was developed to provide convenient access for users. In sum, the proposed model could predict the possible prolonged LOS of inpatients with T2DM and help the clinicians to improve efficiency in bed management.

Retinal microvascular markers in type 2 diabetes subphenotypes and latent autoimmune diabetes of adults.

To estimate if newly diagnosed patients with different subphenotypes of type 2 diabetes (T2DM) or latent autoimmune diabetes of adults (LADA) differ with respect to subclinical retinal microvascular structure or diabetic retinopathy (DR). This population-based, cross-sectional study of 340 patients (675 eyes) classified patients with recently diagnosed T2DM in different subphenotypes according to beta cell function and insulin sensitivity in to classical (n 218), hyperinsulinaemic (n 86), insulinopenic (n 20), or LADA (n 16). Retinal 6-field images were graded according to the International Clinical DR Severity Scale by a retinal expert. Retinal microvascular structures were analysed in eyes by a semiautomatic software. Median age and duration of diabetes were 58.1 (49.9 65.5) and 0.9 (0.5 2.4) years, respectively, and 56.8% were male. In a multivariate linear mixed model regression analysis of eyes without DR (n 570), there was no statistically significant difference in retinal venular or arteriolar width between subtypes and patients with classical T2DM. In addition, eyes from different subphenotypes did not differ according to vessel density, tortuosity or fractal dimension. In a multivariate logistic regression model adjusted for age, sex, HbA1c, diabetes duration, body mass index, mean arterial blood pressure and history of cardiovascular disease, there was a tendency towards persons with hyperinsulinaemic T2DM to be more likely to have DR (OR 1.97, 95% CI 0.95 4.09) compared to classical T2DM. We found no difference in retinal microvascular structure in patients with newly diagnosed subtypes of T2DM. However, DR may be more prevalent in newly diagnosed patients with hyperinsulinaemic T2DM compared to individuals with classical T2DM.

Impaired antibody responses were observed in patients with type 2 diabetes mellitus after receiving the inactivated COVID-19 vaccines.

Patients with type 2 diabetes mellitus (T2DM) have been reported to be more susceptible to 2019 novel coronavirus (2019-nCoV) and more likely to develop severe pneumonia. However, the safety and immunological responses of T2DM patients after receiving the inactivated vaccines are not quite definite. Therefore, we aimed to explore the safety, antibody responses, and B-cell immunity of T2DM patients who were vaccinated with inactivated coronavirus disease 2019 (COVID-19) vaccines. Eighty-nine patients with T2DM and 100 healthy controls (HCs) were enrolled, all of whom had received two doses of full-course inactivated vaccines. At 21-105 days after full-course vaccines first, the safety of the vaccines was assessed by questionnaires second, the titers of anti-receptor binding domain IgG (anti-RBD-IgG) and neutralizing antibodies (NAbs) were measured third, we detected the frequency of RBD-specific memory B cells (RBD-specific MBCs) to explore the cellular immunity of T2DM patients. The overall incidence of adverse events was similar between T2DM patients and HCs, and no serious adverse events were recorded in either group. Compared with HCs, significantly lower titers of anti-RBD-IgG (p 0.004) and NAbs (p 0.013) were observed in T2DM patients. Moreover, the frequency of RBD-specific MBCs was lower in T2DM patients than in HCs (p 0.027). Among the 89 T2DM patients, individuals with lower body mass index (BMI) had higher antibody titers (anti-RBD-IgG p 0.009 NAbs p 0.084). Furthermore, we found that sex, BMI, and days after vaccination were correlated with antibody titers. Inactivated COVID-19 vaccines were safe in patients with T2DM, but the antibody responses and memory B-cell responses were significantly decreased compared to HCs. NCT05043246. September 14, 2021. (Clinical Trials.gov).

Interaction between gut microbiota and sex hormones and their relation to sexual dimorphism in metabolic diseases.

Metabolic diseases, such as obesity, metabolic syndrome (MetS) and type 2 diabetes (T2D), are now a widespread pandemic in the developed world. These pathologies show sex differences in their development and prevalence, and sex steroids, mainly estrogen and testosterone, are thought to play a prominent role in this sexual dimorphism. The influence of sex hormones on these pathologies is not only reflected in differences between men and women, but also between women themselves, depending on the hormonal changes associated with the menopause. The observed sex differences in gut microbiota composition have led to multiple studies highlighting the interaction between steroid hormones and the gut microbiota and its influence on metabolic diseases, ultimately pointing to a new therapy for these diseases based on the manipulation of the gut microbiota. This review aims to shed light on the role of sexual hormones in sex differences in the development and prevalence of metabolic diseases, focusing on obesity, MetS and T2D. We focus also the interaction between sex hormones and the gut microbiota, and in particular the role of microbiota in aspects such as gut barrier integrity, inflammatory status, and the gut-brain axis, given the relevance of these factors in the development of metabolic diseases.

Perceived barriers, benefits, facilitators, and attitudes of health professionals towards type 2 diabetes management in Oujda, Morocco a qualitative focus group study.

In Morocco, the treatment of type 2 diabetes (T2D) is mainly focused on medication and only 2% of patients are coached towards a healthier lifestyle. In Oujda, Eastern Morocco the prevalence of T2D is 10.2%, and the current trend is alarming, especially for women. Therefore, the aim of this study is to explore healthcare professionals (HCP) views on the perceived barriers and benefits of an integrated care approach in primary healthcare centers (PHCCs) to T2D management in Oujda. A qualitative descriptive study using focus groups in 8 PHCCs. This resulted in a sample of 5 doctors and 25 nurses caring for diabetes patients. The transcripts of all conversations were coded to allow for thematic analysis. The participants mentioned different barriers to an integrated approach to DM management excessive workload poor reimbursement policy lack of staff and equipment interrupted drug supply poor working environment limited referral gap in the knowledge of general practitioners health beliefs poverty advanced age gender the use of psychotropic drugs. An integrated approach could be facilitated by simplified electronic records and referrals uninterrupted free care staff recruitment continuous professional development internships. structured care promotion of care in PHCCs empowerment of self-management. HCP views reflect the urge to strengthen the management of T2D in PHCCs. There is a need for HCP with expertise in physical activity and nutrition to solve the current gap in the multidisciplinary integrated care approach. The specific local context in this Eastern Moroccan region, with limited resources and remote hard-to-reach rural areas, can contribute to patients reluctance to change their lifestyles, and is a challenge to provide care in an efficient and sustainable manner. More research is needed to see how a patient-centered multidisciplinary approach to T2D management can help motivate patients in Morocco to change to a healthier lifestyle.

Efficacy and Safety of Tirzepatide in Type 2 Diabetes and Obesity Management.

The combination of glucagon-like peptide-1 (GLP-1) with other gut hormones including the glucose-dependent insulinotropic peptide (GIP) has been explored to complement and enhance further the GLP-1 effects on glycemia and weight loss. Tirzepatide is the first dual co-agonist (acting on GLP-1GIP receptors) which has been approved for treatment of type 2 diabetes mellitus (T2DM) based on the findings from the SURPASS programme (phase 3 clinical trials). The SURPASS 1-5 trials assessed the safety and efficacy of tirzepatide in people with T2DM of duration ranging from 4 to 14 years, from monotherapy through to insulin add-on in global populations, with another two trials dedicated to Japanese population. Over periods of treatment up to 104 weeks, once weekly tirzepatide 5, 10, and 15 mg reduced glycosylated hemoglobin (1.87% to 3.02%) and body weight (5.4 to 12.9 kg), improved multiple cardiometabolic risk factors (including reduction in liver fat, new-onset macroalbuminuria, blood pressure, and lipids) across the spectrum of T2DM. Tirzepatide 5 to 15 mg once weekly provided better efficacy than placebo and other commonly used glucose-lowering medications such as semaglutide 1 mg, dulaglutide, insulin degludec, and glargine. All tirzepatide doses were well tolerated with similar side-effect profile to the GLP-1 receptor analogues. The ongoing SURPASS-CVOT study will assess the cardiovascular safety of tirzepatide. In people without diabetes, tirzepatide 5 to 15 mg once weekly for the treatment for obesity (SURMOUNT-1) resulted in substantial reductions in body weight (16.5% to 22.4%) over 72 weeks. Overall, the SURPASS programme and SURMOUNT-1 study suggest that tirzepatide is marking a new era in T2DM andor obesity management through dual agonism of gut hormones.

Effects of mussel polysaccharide on type 2 diabetes and the intestinal microflora imbalance induced by glycolipid metabolism disorder in mice.

Type 2 diabetes mellitus ( T2D ) is a major metabolic disease, and its incidence and lethality have increased significantly in recent years, making it a serious threat to human health. Among numerous previous studies, polysaccharides have been shown to alleviate the adverse effects of T2D, but there are still problems such as insufficient analysis and poor understanding of the mechanisms by which polysaccharides, especially those of marine origin, regulate T2D. In this study, we used multiple allosteric approaches to further investigate the regulatory effects of mussel polysaccharides (MP) on type 2 diabetes and gut microbiota disorders in mice by identifying changes in genes, proteins, metabolites and target organs associated with glucolipid metabolism using an animal model of T2D fed with high-fat diets, and to explore the underlying molecular mechanisms. After mussel polysaccharide intervention, serum levels of SOD, GSH-Px and HDL-C were upregulated, and blood glucose and lipid levels were effectively reduced in T2D mice. Activation of signaling molecules related to the upstream and downstream of the insulin PI3KAkt signaling pathway reduced hepatic insulin resistance. The relative abundance of short-chain fatty acid (SCFA)-producing bacteria (including Akkermansia, Siraeum Eubacterium and Allobaculum) increased and harmful desulfurizing Vibrio decreased. In addition, the levels of short-chain fatty acids were increased. These results suggest that MP can increase SCFA levels by altering the abundance of intestinal flora, thereby activating the PI3KAKT signaling pathway and exerting hypoglycemic effects. This article is protected by copyright. All rights reserved.

Assessing Corneal Confocal Microscopy and Other Small Fiber Measures in Diabetic Polyneuropathy.

Objectives Damage to small nerve fibers is common in diabetic polyneuropathy (DPN) and the diagnosis of DPN relies on subjective symptoms and signs in a combination with objective confirmatory tests, typically electrophysiology or intraepidermal nerve fiber density (IENFD) from skin biopsy. Corneal confocal microscopy (CCM) has been introduced as a tool to detect DPN. However, it is unclear if CCM can reliably be used to diagnose DPN and how the technique compares with other commonly used measures of small fiber damage, such as IENFD, cold detection threshold (CDT) and warm detection threshold (WDT). Therefore, we assessed and compared the use of CCM, IENFD, CDT and WDT in the diagnosis of DPN in patients with type 2 diabetes. In this cohort study, the participants underwent detailed neurological examination, electrophysiology, quantification of IENFD, CCM, and quantitative sensory testing. Definition of DPN was made in accordance with the Toronto criteria for diabetic neuropathy (without relying on IENFD and thermal thresholds). A total of 214 patients with at least probable DPN, 63 patients without DPN and 97 controls without diabetes were included. Patients with DPN had lower CCM measures (corneal nerve fiber length (CNFL), nerve fiber density and branch density), IENFD, CDT, and WDT compared to patients without DPN (p<0.001, <0.001, 0.002, p<0.001, p0.003 and <0.005, respectively), whereas there was no difference between controls and diabetes patients without DPN. All three CCM measures showed a very low diagnostic sensitivity with CNFL showing the highest (14.4% (95% CI 9.818.4)) and a specificity of 95.7% (88.099.1). In comparison, the sensitivity of abnormal CDT andor WDT was 30.5% (24.437.0) with a specificity of 84.9% (74.692.2). The sensitivity of abnormal IENFD was highest among all measures with a value of 51.1% (43.758.5) and a specificity of 90% (79.596.2). CCM measures did not correlate with IENFD, CDTWDT or neuropathy severity in the group of patients with DPN. CCM measures showed the lowest sensitivity compared to other small fiber measures, in the diagnosis of DPN. This indicates that CCM is not a sensitive method to detect DPN in recently diagnosed type 2 diabetes. This study provides Class III evidence that CCM measures aid in the detection of diabetic polyneuropathy in recently diagnosed type 2 diabetics, but with a low sensitivity when compared to other small fiber measures.

Disparities in Shared Decision-Making Research and Practice The Case for Black American Patients.

The extent of shared decision making (SDM) use in the care of Black patients is limited. We explored preferences, needs, and challenges of Black patients to enhance SDM offerings. We performed interviews with 32 Black patients receiving type 2 diabetes care in safety-net primary care practices caring predominantly for Black people. The following 4 themes emerged preference for humanistic communication, need to account for the role of family in decision making, need for medical information sharing, and mistrust of clinicians. Given the dearth of research on SDM among ethnic and racial minorities, this study offers patient-perspective recommendations to improve SDM offerings for Black patients in primary care settings. To enhance SDM with Black patients, acknowledgment of the importance of storytelling as a strategy, to place medical information in a context that makes it meaningful and memorable, is recommended. Triadic SDM, in which family members are centrally involved in decision making, is preferred over classical dyadic SDM. There is a need to reconsider the universalism assumption underlying contemporary SDM models and the relevancy of current SDM practices that were developed mostly without the feedback of participants of ethnic, racial, and cultural minorities.

Relationship between dietary fiber intake and glucose metabolism in the elderly of China in 2015.

To investigate the dietary fiber intake status and analyze the relationship between dietary fiber and glucose metabolic disorder of the elderly in China. Data were collected from the participants of Chinese adult chronic diseases and nutrition surveillance in 2015. General information were collected by standardized questionnaires, anthropometric index and blood pressure of respondents were measured according to standard method. Food intake was collected by three consecutive day 24 h dietary recalls, dietary fiber was calculated through China food composition. Fasting venous blood were collected to measure glucose, HbA1C, and other related biochemical index. Subjects were divided into three groups normal glucose(NG, normal glucose), pre-diabetes(Pre-DM, pre-diabetes mellitus) and diabetes(T2DM, type 2 diabetes mellitus). Multiple logistic regression model was used to analyze the relationship between dietary fiber intake and Pre-DM as well as T2DM. A total of 20 996 elderly people aged 60 years and above were included. There 10 773 cases were males(51.3%) and 10 223 cases were females(48.7%), the age of both gender were(68.21±6.26) years and(67.67±6.26) years. A total of 6526 cases of pre-diabetes were detected in 20 996 elderly participants with detection rate of 31.1%. There 3274 cases were male and 3252 cases were female, the detection rates of both genders were 30.4% and 31.8%, respectively. While 1572 participants were detected as T2DM(784 of males and 788 of females), the detection rate of T2DM was 7.5%, 7.3% for males and 7.7% for females. There were significant differences in mean age, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, TC, TG, HDL-C, LDL-C, HbA1c level among different dietary intake groups(Plt0.005). With the increase of dietary fiber intake, the proportion of overweight and obesity, central obesity and dyslipidemia showed an increasing trend(Plt0.05), and the proportion of hypertension showed a decreasing trend(Plt0.000 1). After adjusting for potential confounding factors, compared to participants with lowest fiber intake, participants in subgroups of lower, minor lower, and higher fiber intake were associated with decreased risk of pre-diabetes, the OR and 95%CI were(OR0.911, 95%CI 0.835-0.993), (OR 0.861, 95%CI 0.790-0.938) and(OR 0.913, 95%CI 0.838-0.994), respectively. However, there was only a statistically significant negative association between the higher intake of dietary fiber and T2DM(OR 0.848, 95%CI 0.726-0.991). Dietary fiber intake was negatively related with diabetes and pre-diabetes mellitus. The risk of glucose metabolic disorder was decreased with the increase of dietary fiber intake.

Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries a modelling study.

Overweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer and other conditions. The objective of this study was to estimate the burden of disease attributable to the consumption of SSBs and the costs to the healthcare systems in Argentina, Brazil, El Salvador, and Trinidad and Tobago. Following a systematic review of models, a comparative risk assessment framework was developed to estimate the health and economic impact associated with the consumption of SSBs. Argentina, Brazil, El Salvador, and Trinidad and Tobago. Overall population. The model estimated the effects of SSB consumption on health through two causal pathways one mediated by body mass index (BMI) and health conditions associated with BMI and another that reflected the independent effects of SSB consumption on T2DM and cardiovascular diseases. The model results indicated that for all four countries, in 1 year, SSB consumption was associated with 18 000 deaths (3.2% of the total disease-related deaths), seven million disease events (3.3% of the total disease-related events), a half-million DALYs and US$2 billion in direct medical costs. This included 1.5 million cases of overweight and obesity in childrenadolescents (12% of the excess weight cases) and 2.8 million cases in adults (2.8%) 2.2 million cases of type 2 diabetes (19%) 200 000 cases of heart disease (3.8%) 124 000 strokes (3.9%) 116 000 cases of musculoskeletal disease (0.2%) 102 000 cases of kidney disease (0.9%) and 45 000 episodes of asthma (0.4%). The Trinidad and Tobago population were the most affected by disease events. The study results indicate that the consumption of SSBs is associated with a significant burden of disease and death in Latin America and the Caribbean.

Explaining the UKs high-risk approach to type 2 diabetes prevention findings from a qualitative interview study with policy-makers in England.

When seeking to prevent type 2 diabetes, a balance must be struck between individual approaches (focusing on peoples behaviour choices) and population approaches (focusing on the environment in which those choices are made) to address the socioeconomic complexity of diabetes development. We sought to explore how this balance is negotiated in the accounts of policy-makers developing and enacting diabetes prevention policy. Twelve semistructured interviews were undertaken with nine UK policy-makers between 2018-2021. We explored their perspectives on disease prevention strategies and what influenced policy decision-making. Interviews were transcribed and analysed thematically using NVIVO. We used Shiffmans political priority framework to theorise why some diabetes prevention policy approaches gather political support while others do not. The distribution of power and funding among relevant actors, and the way they exerted their power determined the dominant approach in diabetes prevention policy. As a result of this distribution, policy-makers framed their accounts of diabetes prevention policies in terms of individual behaviour change, monitoring personal quantitative markers but with limited ability to effect population-level approaches. Such an approach aligns with the current prevailing neoliberal political context, which focuses on individual lifestyle choices to prevent disease rather than on infrastructure measures to improve the environments and contexts within which those choices are made. Within new local and national policy structures, there is an opportunity for collaborative working among the National Health Service, local governments and public health teams to balance the focus on disease prevention, addressing upstream drivers of ill health as well as targeting individuals with the highest risk of diabetes.

Gestational Diabetes Mellitus and Its Implications across the Life Span.

Gestational diabetes mellitus (GDM) has historically been perceived as a medical complication of pregnancy that also serves as a harbinger of maternal risk of developing type 2 diabetes mellitus (T2DM) in the future. In recent decades, a growing body of evidence has detailed additional lifelong implications that extend beyond T2DM, including an elevated risk of ultimately developing cardiovascular disease. Furthermore, the risk factors that mediate this lifetime cardiovascular risk are evident not only after delivery but are present even before the pregnancy in which GDM is first diagnosed. The concept thus emerging from these data is that the diagnosis of GDM enables the identification of women who are already on an enhanced track of cardiometabolic risk that starts early in life. Studies of the offspring of pregnancies complicated by diabetes now suggest that the earliest underpinnings of this cardiometabolic risk profile may be determined in utero and may first manifest clinically in childhood. Accordingly, from this perspective, GDM is now seen as a chronic metabolic disorder that holds implications across the life span of both mother and child.

Comparison of Operational Definition of Type 2 Diabetes Mellitus Based on Data from Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey.

We evaluated the validity and reliability of the operational definition of type 2 diabetes mellitus (T2DM) based on the Korean National Health Insurance Service (NHIS) database. Adult subjects (≥40 years old) included in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2017 were merged with those from the NHIS health check-up database, producing a cross-sectional dataset. We evaluated the sensitivity, specificity, accuracy, and agreement of the NHIS criteria for defining T2DM by comparing them with the KNHANES criteria as a standard reference. In the study population (n13,006), two algorithms were devised to determine from the NHIS dataset whether the diagnostic claim codes for T2DM were accompanied by prescription codes for anti-diabetic drugs (algorithm 1) or not (algorithm 2). Using these algorithms, the prevalence of T2DM was 14.9% (n1,942 algorithm 1) and 20.8% (n2,707 algorithm 2). Good reliability in defining T2DM was observed for both algorithms (Kappa index, 0.73 algorithm 1, 0.63 algorithm 2). However, the accuracy (0.93 vs. 0.89) and specificity (0.96 vs. 0.90) tended to be higher for algorithm 1 than for algorithm 2. The validity (accuracy, ranging from 0.91 to 0.95) and reliability (Kappa index, ranging from 0.68 to 0.78) of defining T2DM by NHIS criteria were independent of age, sex, socioeconomic status, and accompanied hypertension or dyslipidemia. The operational definition of T2DM based on population-based NHIS claims data, including diagnostic codes and prescription codes, could be a valid tool to identify individuals with T2DM in the Korean population.

Impaired calcium handling mechanisms in atrial trabeculae of diabetic patients.

The aim of this study was to investigate cardiomyocyte Ca

Factors associated with relapse of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy in Japanese subjects a subgroup analysis of J-SMART study.

Laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients often result in remission of type 2 diabetes (T2DM), but diabetes relapses in some of those patients. The frequency of T2DM relapse in Asians and the factors involved have not been adequately investigated. The J-SMART study was conducted on 322 Japanese subjects with body mass index (BMI) ≥ 32 kgm2 who underwent LSG at 10 accredited centers in Japan between 2011 and 2014. Of these, 82 T2DM subjects with diabetes in complete or partial remission at 1 year after LSG and followed postoperatively for 5 years were included in the subgroup analysis, and classified into two groups diabetes remission maintained and diabetes relapse. The mean age of all included subjects was 49.2 years, median BMI was 41.5 kgm2, and median was HbA1c 6.7%. Compared with the diabetes remission maintained group, the diabetes relapse group at 5 years after LSG had significantly higher preoperative HbA1c, number of antidiabetic medications, and high-density lipoprotein cholesterol level and lower BMI and homeostasis model assessment-beta cell function (HOMA-β). As many as 83.0% of the subjects were able to achieve HbA1c < 7% at 5 years after LSG, but 26.8% of the subjects had diabetes relapse. Preoperative HbA1c significantly contributed to diabetes relapse (odds ratio 1.54, p 0.049). In addition, the diabetes relapse group tended to have lower percent total weight loss (%TWL) at 1 year after LSG and higher percent weight regain (%WR) from postoperative nadir weight, compared with the diabetes remission maintained group. The hazard ratio for diabetes relapse was 3.14-fold higher in subjects with %TWL ≥ 20% and %WR ≥ 25%, and 5.46-fold higher in those with %TWL < 20% and %WR ≥ 25%, compared with %TWL ≥ 20% and %WR < 25%. While LSG provides a high remission rate for T2DM, relapse is not uncommon. Preoperative HbA1c, poor weight loss and excess weight regain after LSG contribute to diabetes relapse, suggesting the importance of treatment strategies focusing on these factors.

Hydrogen sulfide regulates SERCA2a SUMOylation by S-Sulfhydration of SENP1 to ameliorate cardiac systole-diastole function in diabetic cardiomyopathy.

Diabetic cardiomyopathy (DCM) is a serious complication of diabetes mellitus that eventually progresses to heart failure. The sarco(endo)plasmic reticulum calcium ATPase 2a (SERCA2a), an important calcium pump in cardiomyocytes, is closely related to myocardial systolic-diastolic function. In mammalian cells, hydrogen sulfide (H

Basal InsulinGLP-1 RA Fixed-Ratio Combinations as an Option for Advancement of Basal Insulin Therapy in Older Adults With Type 2 Diabetes.

The prevalence of type 2 diabetes (T2D) is increasing, and owing to the aging population, the number of older adults with T2D is growing rapidly. By virtue of their age, older adults are likely to have been living with the disease longer than their younger counterparts. This, coupled with differences in T2D pathophysiology between younger and older patients, means that older adults often require advancement of treatment from basal insulin. However, older adults with T2D represent a heterogeneous population, for whom the goals of treatment are complex, and overtreatment can increase the risk of complications. These factors highlight the need for individualized glycemic targets and therapeutic strategies. In this roundtable, the authors discuss the management of older adults with T2D--a large patient population who often require treatment simplification.

Allopurinol and the Risk of Diabetic Macular Edema among U.S. Veterans with Type 2 Diabetes.

By inhibiting xanthine oxidase, subsequent inflammatory cytokine release and the resulting breakdown of the blood-retina barrier, allopurinol may limit the inflammation-driving diabetic macular edema (DME). We examined the relationship between allopurinol and DME among type 2 diabetic United States veterans using a retrospective cohort study. We used propensity score matching and Cox hazard models to estimate the risk of DME. Propensity score-matched Cox models revealed allopurinol was associated with a 24.6% reduction in the risk of DME (HR 0.754 95% CI (0.684-0.831)). Allopurinol could reduce the risk of DME, one of the major causes of visual disturbance among diabetic patients. Further research into the effects of allopurinol on DME is warranted.

Increased Resting-State Functional Connectivity as a Compensatory Mechanism for Reduced Brain Volume in Prediabetes and Type 2 Diabetes.

To investigate the contribution of alterations in brain structure and function to cognitive function and their interactions in individuals with diabetes and patients with type 2 diabetes mellitus (T2DM). This population-based study included 2,483 participants who underwent structural MRI (n 569 with normal glucose metabolism (NGM), n 1,353 with prediabetes, and n 561 with T2DM) and cognitive testing. Of these, 2145 participants also underwent functional MRI (n 496 NGM, n 1,170 prediabetes, and n 479 T2DM). Multivariate linear regression models were used to assess the association of brain volume and functional connectivity with cognition, as well as the association of brain volume and functional connectivity. Compared with NGM participants, those with T2DM had lower brain volume in a wide range of brain regions and stronger functional connectivity between the bilateral thalamus and brain functional network (visual network and default mode network), and those with prediabetes had lower brain volume in specific local regions (subcortical gray matter volume and subcortical subregions bilateral thalamus, bilateral nucleus accumbens, and right putamen) and stronger functional connectivity between the right thalamus and visual network. Cognition was associated with greater right thalamus volume and lower functional connectivity between the right thalamus and visual network. Functional connectivity between the right thalamus and visual network was associated with lower right thalamus volume. Cognition was associated with greater brain volume and lower functional connectivity in T2DM. Increased functional connectivity may indicate a compensatory mechanism for reduced brain volume that begins in the prediabetic phase.

Plasma proteomic risk markers of incident type 2 diabetes reflect physiologically distinct components of glucose-insulin homeostasis.

High-throughput proteomics allow researchers to simultaneously explore the roles of thousands of biomarkers in the pathophysiology of diabetes. We conducted proteomic association studies of incident type 2 diabetes and physiologic responses to an intravenous glucose tolerance test (IVGTT) to identify novel protein contributors to glucose homeostasis and diabetes risk. We tested 4,776 SomaScan® proteins measured in relation to 18-year incident diabetes risk in participants from the Cardiovascular Health Study (CHS, N2,631), and IVGTT-derived measures in participants from the HERITAGE Family Study (N752). We characterize 51 proteins that were associated with longitudinal diabetes risk, using their respective 39, 9, and 8 concurrent associations with insulin sensitivity (SI), acute insulin response to glucose (AIRG), and glucose effectiveness (SG). Twelve of the 51 diabetes associations were novel, including beta-glucuronidase, which associated with increased diabetes risk and lower SG, suggesting an alternative pathway to insulin for glucose disposal and plexin-B2 which also associated with increased diabetes risk, but with lower AIRG, and not with SI, indicating a mechanism related instead to pancreatic dysfunction. Other novel protein associations included alcohol dehydrogenase-1C, fructose-bisphosphate aldolase-B, and sorbitol dehydrogenase with elevated type 2 diabetes risk, and leucine rich repeat containing protein-15 and myocilin with decreased risk.

Effectiveness of a Culturally Responsive mHealth Gaming Application to Improve Diabetes Health Literacy in India A Randomized Controlled Trial.

The purpose of this study was to determine the effectiveness of a culturally responsive interactive gaming mHealth educational application designed to improve diabetes health literacy among an underserved urban population in India when compared with a traditional approach of verbal education. In addition, relationships between participant sociodemographic variables and participant knowledge were assessed. A randomized controlled trial was conducted using a two-arm parallel, single-blinded intervention and control group design. The parallel groups were the mHealth Education group serving as the intervention group and the Verbal Education group serving as the control group. The mHealth application was as effective in improving diabetes health literacy as verbal education. Results for the difference in posttest and pretest score between the two groups indicated there was no statistically significant difference between groups (P .9306). However, there was a significant improvement in the difference in posttest and pretest scores for each group (P < .0001), indicating that the culturally responsive type 2 diabetes educational content was effective in improving type 2 diabetes health literacy among both groups. This study answers a call by the World Health Organization that advocates for evidence-based mHealth interventions that offer unique opportunities for cost-effective informatics service delivery in low- and middle-income countries.

Effectiveness of Insulia® App in French Patients with Type 2 Diabetes Mellitus treated with Basal Insulin. A Longitudinal Observational Study.

For patients with Type 2 diabetes (T2DM), calculating daily dose of their basal insulin may be challenging. INSULIA® is a digital remote monitoring solution that uses clinical algorithms to recommend basal insulin doses. A predecessor device was evaluated in the Telediab-2 randomized control trial showing that a higher percentage of patients using the app achieved their target FBG level as in the control group and insulin doses were adjusted to higher levels without hypoglycemia. As INSULIA was then available in France, our study was designed to verify if these results were observed in current practice. A retrospective observational analysis of data collected through the device in adult French patients with T2DM treated with basal insulin ± oral antihyperglycemic agents using the system since at least 6 months was conducted. Analyses were descriptive and distinguished the results in a subpopulation of regular and compliant users of the app. Glycemic outcomes were estimated considering the percentage of patients who achieve their individualized fasting blood glucose target between 5.5 and 6 months following the initiation of the device use but also the frequency of hypoglycemia resulting in a change in treatment over the 6 months period of exposure and evolution of the average HbA1c level over the same period of time. Of the 484 users, 373 (77.0%) performed at least one dose calculation. 59.2% were men. When they started to use the app, mean age, BMI, HbA1c, and basal insulin dose were respectively 55.8 years (SD 11.9), 30.6 kgm2 (SD 5.9), 10.1% (SD 2.0) and 25.5 IUday (SD 15.8). Over a median duration of use of 5.0 3.8-5.7 months, patients have used the system 5.8 timesweek (SD 1.6) on average and 73.4% of their injected doses were consistent with the doses suggested by the app. Among regular and compliant user patients (n91, ≥5 measurementsweek and ≥80% adherence to calculated doses), 60.4% achieved the FBG target (±5%) at 6 months versus 51.1% of the other patients (p 0.1504). There was an increase in the proportion of patients achieving their target FBG for regular and compliant users (1.86% every two weeks) without clear improvement in other patients. A logistic model did not identified variables which were significantly associated with this outcome among regular and compliant users. In the overall population, incidence of reported hypoglycaemia has decreased simultaneously (-0.16%month) Among 82 patients for whom measures were available, mean HbA1c decreased from 9.9% to 7.2% at 6 months. In real life, an improvement in glycaemic control as measured by the percentage of patients reaching their FBG individualized target range without increasing hypoglycaemic risk was observed in patients using the INSULIA® application especially among regular users following the dose recommendations of the algorithm.

Admission eGFR predicts in-hospital mortality independently of admission glycemia and C-peptide in patients with type 2 diabetes mellitus and COVID-19.

Type 2 diabetes mellitus (T2DM) and impaired kidney function are associated with a higher risk of poor outcomes of COVID-19. We conducted a retrospective study in hospitalized T2DM patients with COVID-19 to assess the association between in-hospital mortality and admission values of different hematologicalbiochemical parameters, including estimated glomerular filtration rate (eGFR), plasma glucose and C-peptide (as a marker of beta-cell function). The study included T2DM patients with confirmed SARS-CoV-2 infection who were consecutively admitted to our Institution between October 1, 2020 and April 1, 2021. Patients (n 74) were categorized into survivors (n 55) and non-survivors (n 19). Non-survivors exhibited significantly higher median WBC count, D-dimer, neutrophil-to-lymphocyte ratio, hsCRP, and procalcitonin levels, as well as significantly lower median serum 25(OH)D levels compared to survivors. Non-survivors exhibited significantly higher median admission plasma glucose (APG) values compared to survivors (210 vs 166 mgdL p 0.026). There was no statistically significant difference in median values of plasma C-peptide between non-survivors and survivors (3.55 vs 3.24 ngmL p 0.906). A significantly higher percentage of patients with an eGFR < 60 mLmin1.73 m Admission eGFR and WBC count predict in-hospital COVID-19 mortality among T2DM patients, independently of traditional risk factors, APG and random plasma C-peptide. Hospitalized patients with COVID-19 and comorbid T2DM associated with impaired kidney function at admission should be considered at high risk for adverse outcomes and death.

Empagliflozin versus sitagliptin for ameliorating intrahepatic lipid content and tissue-specific insulin sensitivity in patients with early-stage type 2 diabetes with nonalcoholic fatty liver disease A prospective randomized study.

To compare the effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 inhibitors on ectopic fat accumulation and tissue-specific insulin sensitivity. This randomized controlled trial enrolled 44 patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). They were randomly assigned to receive either empagliflozin 10 mgday or sitagliptin 100 mgday for 12 weeks. The primary endpoint was the change in intrahepatic lipid content (IHL) measured using proton magnetic resonance spectroscopy ( At baseline, the mean duration of diabetes, HbA1c level, and IHL were 3.7 years, 7.2%, and 20.9%, respectively. The median NAFLD activity score was 3.0. IHL was significantly more decreased in the empagliflozin group than that in the sitagliptin group (between-group difference was -5.2 ± 1.1 and -1.9 ± 1.2%, respectively, (95% confidence interval) -3.3 (-6.5, -0.1), p 0.044). However, there were no significant between-group differences in the change of insulin sensitivity in the liver, muscle, or adipose tissues. Interestingly, hepatic insulin sensitivity was significantly increased only in the empagliflozin group and was significantly negatively associated with the change in IHL. Empagliflozin significantly improves hepatic steatosis compared to sitagliptin, and this may protect against subsequent hepatic insulin resistance. Early administration of SGLT2 inhibitors is preferable for T2DM patients with NAFLD. This article is protected by copyright. All rights reserved.

Urinary insulin signaling pathway related proteins may serve as potential biomarkers for monitoring diabetes mellitus without hypertension and hyperlipidemia.

The insulin signaling pathway plays an important role in the development of diabetes mellitus. The expression of insulin signaling pathway related proteins in the urine of diabetic patients has not been reported. The aim of this study was to analyze and verify the expression of insulin signaling pathway related proteins in the urine of diabetic patients without hypertension and hyperlipidemia, and to explore their clinical application value. Based on data-independent acquisition proteomics technology and bioinformatics, the urinary protein expression profile of diabetic patients without hypertension and hyperlipidemia was established. Western blot and enzyme-linked immunoassay were performed to verify the expression of insulin signaling pathway related proteins in the urine of diabetic patients. Sixteen proteins related to the insulin signaling pathway were screened in urine, and 7 of them were differentially expressed in the urine of diabetic patients without hypertension and hyperlipidemia. Further quantitative analysis showed that the downregulation of protein kinase CAMP-dependent type II regulatory subunit α, growth factor receptor bound protein 2, and guanine nucleotide-binding protein G(s) in the urine of diabetic patients without hyperlipidemia and hypertension was consistent with the preliminary screening results. In this exploratory study, we detected the expression of insulin signaling pathway related proteins in the urine of diabetic patients without hypertension and hyperlipidemia. protein kinase CAMP-dependent type II regulatory subunit α, growth factor receptor bound protein 2, and guanine nucleotide-binding protein G(s) in the urine of diabetic patients were downregulated, which was associated with diabetes. They may be promising noninvasive biomarkers for monitoring diabetes.

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as markers of stable ischemic heart disease in diabetic patients An observational study.

Ischemic heart disease (IHD) is a pressing public health concern with high prevalence, mortality, and morbidity. Although the value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as markers of the acute coronary syndrome are well recognized, there is a paucity of data deciphering their role in screening for stable ischemic heart disease (SIHD) in the presence of type 2 diabetes mellitus (T2DM). The present study investigates the value of NLR and PLR as markers of SIHD in T2DM. We evaluated the predictive value of NLR and PLR for SIHD by comparing T2DM patients having angiographically proven SIHD to T2DM patients without IHD at different cutoff levels by evaluating the area under the curve (AUC) obtained from receiver-operating-characteristic analysis. Raised NLR and PLR were significantly associated with SIHD ( P < .001 for each). On performing AUC-receiver-operating-characteristic analysis, NLR of > 2.39 and PLR of > 68.80 were associated with the highest prevalence of SIHD (NLR, AUC 0.652 0.605-0.699 CI 95% P < .001, PLR, AUC 0.623 0.575-0.671 CI 95% P < .001). The sensitivities and specificities for these cutoff values were 50% and 73% for NLR and 73% and 46% for PLR, respectively. NLR and PLR were significantly higher in SIHD compared to those without however, these markers had limited predictive potential in the setting of T2DM.

Discovery of Novel PTP1B Inhibitors with Once-Weekly Therapeutic Potential for Type 2 Diabetes Design, Synthesis, and

Poor medication adherence in patients with type 2 diabetes mellitus has become one of the main causes of suboptimal glycemic control. Once-weekly drugs can markedly improve the convenience, adherence, and quality of life of T2DM patients thus, they are clinically needed and preferred. PTP1B plays a negative role in both insulin and leptin signaling pathways, which makes it an important target for diabetes. Herein, we design and synthesize 35 analogues of core BimBH3 peptide

Retention in care for type 2 diabetes management in Sub-Saharan Africa A systematic review.

Diabetes prevalence has risen rapidly in Sub-Saharan Africa, but rates of retention in diabetes care are poorly understood. We conducted a systematic review and meta-analysis to determine rates of retention in care of persons with type 2 diabetes. We searched MEDLINE, Global Health and CINAHL online databases for cohort studies and randomised control trials (RCTs) published up to 12 October 2021, that reported retention in or attrition from care for patients with type 2 diabetes in Sub-Saharan Africa. Retention was defined as persons diagnosed with diabetes who were alive and in care or with a known outcome, while attrition was defined as loss from care. From 6559 articles identified, after title and abstract screening, 209 articles underwent full text review. Forty six papers met the inclusion criteria, comprising 22,610 participants. Twenty one articles were of RCTs of which 8 trials had 1 year or more of follow-up and 25 articles were of non-randomised studies of which 19 had 12 months or more of follow-up. A total of 11 studies (5 RCTs and 6 non-randomised) were assessed to be of good quality. Sixteen RCTs were done in secondary or tertiary care settings. Their pooled retention rate (95% CI) was 80% (77%, 84%) in the control arm. Four RCTs had been done in primary care settings and their pooled retention rate (95% CI) was 53% (45%, 62%) in the control arm. The setting of one trial was unclear. For non-randomised studies, retention rates (95% CI) were 68% (62%, 75%) among 19 studies done in secondary and tertiary care settings, and 40% (33%, 49%) among the 6 studies done in primary care settings. Rates of retention in care of people living with diabetes are poor in primary care research settings.

A two-decade population-based study on the effect of hypertension in the general population with obesity in the United States.

With rising prevalence of hypertension and obesity, the effect of hypertension in obesity remains an important global issue. The prognosis of the US general population with obesity based on hypertension control was examined. This study examined participants from the National Health and Nutrition Examination Survey between 1999 and 2018. Individuals with obesity were stratified into no hypertension, controlled hypertension, and uncontrolled hypertension. The study outcome was all-cause mortality. Cox regression of all-cause mortality was adjusted for age, sex, ethnicity, diabetes, and previous myocardial infarction. Of 16,386 individuals with obesity, 53.1% had no hypertension, 24.7% had controlled hypertension, and 22.2% had uncontrolled hypertension. All-cause mortality was significantly higher in uncontrolled hypertension (17.1%), followed by controlled hypertension (14.8%) and no hypertension (4.0%). Uncontrolled hypertension had the highest mortality risk (hazard ratio HR 1.34, 95% CI 1.13-1.59, p 0.001), followed by controlled hypertension (HR 1.21, 95% CI 1.10-1.34, p < 0.001), compared with no hypertension after adjustment. The excess mortality trend was more pronounced in females, those with diabetes, and those older than age 65 years. The incremental mortality risk in controlled and uncontrolled hypertension, compared with the normotensive counterparts, irrespective of sex, age, and diabetes status, urges health care providers to optimize hypertension control and advocate weight loss to achieve better outcomes in obesity.

Congo Red-Derived Carbon Dots Simultaneously as Fluorescence Probe for Protein Aggregates, Inhibitor for Protein Aggregation, and Scavenger of Free Radicals.

The pathological aggregation of some proteins is claimed to be highly related to several human diseases, such as β-amyloid 1-42 (Aβ

Acute testicular infarction in the setting of SARS-CoV-2 infection and diabetic vasculopathy.

Acute testicular pain with no arterial flow on Doppler ultrasonography is highly consistent with testicular torsion. In adults, there are rare etiologies of testicular infarction other than torsion, including infection, vasculitis, and trauma. We describe a 41-year-old man with type 2 diabetes complicated by severe vasculopathy and positive SARS-CoV-2 status presenting with acute right testicular pain. Surgical exploration and pathology were concerning for arteriosclerosis and vasculitis. These observations suggest that medically complex patients presenting with acute testicular pain in the setting of COVID-19 infection could be at risk for ischemia causes of testicular pain beyond torsion should be considered.

Genetic Variants of

Type 2 diabetes (T2D) is a highly heterogeneous and polygenic disease. To date, genetic causes and underlying mechanisms for T2D remain unclear. SIRT1, one member of highly conserved NAD-dependent class III deacetylases, has been implicated in many human diseases. Accumulating evidence indicates that SIRT1 is involved in insulin resistance and impaired pancreatic

Association between Intrapancreatic Fat Deposition and Lower High-Density Lipoprotein Cholesterol in Individuals with Newly Diagnosed T2DM.

Intrapancreatic fat deposition (IPFD) usually occurs in individuals with type 2 diabetes mellitus (T2DM), but its physiopathological influence remains controversial. The present study aimed to investigate IPFD and its associations with various aspects of glucose and lipid metabolism in individuals with newly diagnosed T2DM. A total of 100 individuals were included, consisting of 80 patients with newly diagnosed T2DM and 20 age- and sex-matched healthy controls. Then, we assessed IPFD using magnetic resonance imaging (MRI) and various parameters of glucose and lipid metabolism. Individuals with newly diagnosed T2DM had a significantly higher IPFD (median 12.34% IQR, 9.19-16.60%) compared with healthy controls (median 6.35% IQR, 5.12-8.96%) ( Lower HDL-C was an independent predictor for a high degree of IPFD.

Circadian rhythm disruption is associated with skeletal muscle dysfunction within the blind Mexican Cavefish.

Circadian control of physiology and metabolism is pervasive throughout nature, with circadian disruption contributing to premature aging, neurodegenerative disease, and type 2 diabetes (Musiek et al. 2016 Panda, 2016). It has become increasingly clear that peripheral tissues, such as skeletal muscle, possess cell-autonomous clocks crucial for metabolic homeostasis (Gabriel et al. 2021). In fact, disruption of the skeletal muscle circadian rhythm results in insulin resistance, sarcomere disorganization, and muscle weakness in both vertebrates and non-vertebrates - indicating that maintenance of a functional muscle circadian rhythm provides an adaptive advantage. We and others have found that cavefish possess a disrupted central circadian rhythm and, interestingly, a skeletal muscle phenotype strikingly similar to circadian knock-out mutants namely, muscle loss, muscle weakness, and insulin resistance (Olsen et al. 2022 Riddle et al. 2018 Mack et al. 2021). However, whether the cavefish muscle phenotype results from muscle-specific circadian disruption remains untested. To this point, we investigated genome-wide, circadian-regulated gene expression within the skeletal muscle of the

Electrocardiogram abnormalities and renal impairment in patients with type 2 diabetes mellitus A healthcare facilities-based cross-sectional study in Dang district of Nepal.

The global burden of diabetes mellitus is rising substantially, with a further increase in cardiovascular and kidney disease burden. These public health problems are highly prevalent in low- and middle-income countries, including Nepal. However, there is limited evidence on cardiac and renal conditions among patients with type 2 diabetes mellitus. We determined the status of electrocardiogram (ECG) abnormalities and renal impairment among patients with type 2 diabetes mellitus in Nepal. We carried out a cross-sectional study in Tulsipur Sub-Metropolitan City of Nepal using a multistage stratified sampling technique to recruit patients with type 2 diabetes mellitus. We used World Health Organization stepwise approach to surveillance (WHO STEPS) questionnaires and carried out resting ECG to collect data of 345 patients with type 2 diabetes mellitus. Logistic regression analysis assessed the factors associated with ECG abnormalities and renal impairment. The study showed that 6.1% of participants had major ECG abnormalities (95% confidence interval CI 3.8-8.6%), which were associated with hypertension (P 0.01%) and low socioeconomic status (P 0.01). The proportion of major andor minor ECG abnormalities was 47.8% (95% CI 40.5-51%), and were significantly associated with age (odds ratio OR 1.04, 95% CI 1.01-1.07), higher education (OR 3.50, 95% CI 1.31-9.33), unemployment (OR 3.02, 95% CI 1.08-8.48), body mass index (OR 1.09, 95% CI 1.02-1.17) and duration of type 2 diabetes mellitus >5 years (OR 2.42, 95% CI 1.19-4.93). The proportion of renal impairment was 3.5% (95% CI 1.5-4.5%) which was associated with older age (OR 1.08, 95% CI 1.00-1.17) and hypertension (OR 12.12, 95% CI 1.07-138.22). A significant proportion of patients with type 2 diabetes mellitus had ECG abnormalities and renal impairment, which were significantly associated with hypertension. Therefore, hypertension management and early screening are essential to prevent future cardiorenal complications among patients with type 2 diabetes mellitus.

Sleep duration and food intake in people with type 2 diabetes mellitus and factors affecting confectionery intake.

We carried out a cross-sectional study of people with type 2 diabetes mellitus to elucidate the association between sleep duration and food intake. Overall, 2,887 participants with type 2 diabetes mellitus (mean age 63.0 years 61.1% men mean glycated hemoglobin level 7.5%) were included in this study. The participants self-reported dietary habits and sleep duration were evaluated using a brief self-administered dietary history questionnaire and Pittsburgh Sleep Quality Index, respectively. The participants were categorized into the following four groups based on sleep duration <6, 6-6.9, 7-7.9 (reference) and ≥8 h. No significant differences were observed between the groups regarding energy intake (kcalday), absolute intake (gday) or relative intake (% energy) of carbohydrates, total fat, proteins and fibers. However, confectionery intake was higher in the <6 h group and lower in the ≥8 h group than in the reference group after adjustment for confounding factors. In multivariate analysis, sleep durations <6 h and ≥8 h significantly correlated with increased (95% confidence interval 0.55 to 3.6 P 0.0078) and decreased (95% confidence interval -4.0 to -0.32 P 0.021) confectionery intake, respectively. Confectionery intake was positively correlated with female sex, glycated hemoglobin level and dyslipidemia, whereas it was negatively correlated with alcohol consumption and current smoking status. Short sleep duration is associated with high confectionery intake in people with type 2 diabetes mellitus this might disturb their glycemic control. Therefore, short sleepers with type 2 diabetes mellitus could improve their glycemic control by avoiding confectionery intake and maintaining adequate sleep duration.

GIP reduces osteoclast activity and improves osteoblast survival in primary human bone cells.

Drugs targeting the glucose-dependent insulinotropic polypeptide (GIP) receptor (GIPR) are emerging as treatments for type-2 diabetes and obesity. GIP acutely decreases serum markers of bone resorption and transiently increases bone formation markers in short-term clinical investigations. However, it is unknown whether GIP acts directly on bone cells to mediate these effects. Using a GIPR-specific antagonist, we aimed to assess whether GIP acts directly on primary human osteoclasts and osteoblasts. Osteoclasts were differentiated from human CD14 monocytes and osteoblasts from human bone. GIPR expression was determined using RNA-seq in primary human osteoclasts and in situ hybridization in human femoral bone. Osteoclastic resorptive activity was assessed using microscopy. GIPR signaling pathways in osteoclasts and osteoblasts were assessed using LANCE cAMP and AlphaLISA phosphorylation assays, intracellular calcium imaging and confocal microscopy. The bioenergetic profile of osteoclasts was evaluated using Seahorse XF-96. GIPR is robustly expressed in mature human osteoclasts. GIP inhibits osteoclastogenesis, delays bone resorption, and increases osteoclast apoptosis by acting upon multiple signaling pathways (Src, cAMP, Akt, p38, Akt, NFκB) to impair nuclear translocation of nuclear factor of activated T cells-1 (NFATc1) and nuclear factor-κB (NFκB). Osteoblasts also expressed GIPR, and GIP improved osteoblast survival. Decreased bone resorption and improved osteoblast survival were also observed after GIP treatment of osteoclast-osteoblast co-cultures. Antagonizing GIPR with GIP(3-30)NH2 abolished the effects of GIP on osteoclasts and osteoblasts. GIP inhibits bone resorption and improves survival of human osteoblasts, indicating that drugs targeting GIPR may impair bone resorption, whilst preserving bone formation.

The performance of the MODY calculator in a non-Caucasian, mixed-race population diagnosed with diabetes mellitus before 35 years of age.

A maturity-onset diabetes of the young (MODY) calculator has been described and validated for use in European Caucasians. This study evaluated its performance in Brazilians diagnosed with diabetes mellitus (DM) before 35 years of age. The electronic records of 391 individuals were reviewed in 2020 at the diabetes clinic of a quaternary hospital in São Paulo were analyzed 231 with type 1 DM (T1DM), 46 with type 2 (T2DM) and 114 with MODY. The MODY calculator was applied to the three groups. A receiver operating characteristic curve was calculated to obtain cut-off points for this population. The principal differences between the MODY and the T1DM and T2DM groups were body mass index, a positive family history of diabetes and mean HbA1c level. Age at diagnosis in the MODY group was only significantly different compared to the T2DM group. Specificity and sensitivity were good for the cut-off points of 40%, 50% and 60%, with the accuracy of the model for any of these cut-off points being > 95%. The capacity of the calculator to identify Brazilian patients with MODY was good. Values ≥ 60% proved useful for selecting candidates for MODY genetic testing, with good sensitivity and specificity.

Exploring the active components and potential mechanisms of Rosa roxburghii Tratt in treating type 2 diabetes mellitus based on UPLC-Q-exactive OrbitrapMS and network pharmacology.

Type 2 diabetes mellitus (T2DM) is a global disease with growing prevalence that is difficult to cure. Rosa roxburghii Tratt is an edible and medicinal plant, and modern pharmacological studies have shown that it has potential anti-diabetic activity. This is the first study to explore the active components and potential mechanisms of Rosa roxburghii Tratt fruit for treating T2DM based on UPLC-Q-Exactive OrbitrapMS and network pharmacology. The active components of Rosa roxburghii Tratt fruit were obtained from UPLC-Q-Exactive OrbitrapMS analysis and retrieval in the SciFinder, PubMed, Web of Science, and CNKI databases. The potential targets of the active components were obtained from the SwissTargetPrediction and PharmMapper databases. The disease targets for T2DM were obtained from GeneCards, OMIM, TTD, DisGENent, and GEO databases. The intersection of the two datasets was used to obtain the potential targets of Rosa roxburghii Tratt fruit against T2DM. The target protein interaction network was constructed using the String database and Cytoscape software. The R software ClusterProfiler package was used for target enrichment analysis and the Cytoscape CytoNCA plug-in was used to screen core targets. Molecular docking and result visualization were performed using PyMOL and Autodock Vina software. We obtained 20 bioactive ingredients, including alphitolic acid, quercetin, and ellagic acid, as well as 13 core targets, such as AKT1, TNF, SRC, and VEGFA. All bioactive ingredients in Rosa roxburghii Tratt fruit were active against T2DM-related therapeutic targets. Rosa roxburghii Tratt fruit may play a therapeutic role in T2DM by regulating the PI3KAKT, RAS, AGE-RAGE, and other signaling pathways. This study explored the active components and potential mechanisms of Rosa roxburghii Tratt fruit in the treatment of T2DM, laying the foundation for a further experimental study based on pharmacodynamic substances and their mechanisms of action.

Young and undamaged recombinant albumin alleviates T2DM by improving hepatic glycolysis through EGFR and protecting islet β cells in mice.

Albumin is the most abundant protein in serum and serves as a transporter of free fatty acids (FFA) in blood vessels. In type 2 diabetes mellitus (T2DM) patients, the reduced serum albumin level is a risk factor for T2DM development and progression, although this conclusion is controversial. Moreover, there is no study on the effects and mechanisms of albumin administration to relieve T2DM. We examined whether the administration of young and undamaged recombinant albumin can alleviate T2DM in mice. The serum albumin levels and metabolic phenotypes including fasting blood glucose, glucose tolerance tests, and glucose-stimulated insulin secretion were studied in dbdb mice or diet-induced obesity mice treated with saline or young, undamaged, and ultrapure rMSA. Apoptosis assays were performed at tissue and cell levels to determine the function of rMSA on islet β cell protection. Metabolic flux and glucose uptake assays were employed to investigate metabolic changes in saline-treated or rMSA-treated mouse hepatocytes and compared their sensitivity to insulin treatments. In this study, treatment of T2DM mice with young, undamaged, and ultrapure recombinant mouse serum albumin (rMSA) increased their serum albumin levels, which resulted in a reversal of the disease including reduced fasting blood glucose levels, improved glucose tolerance, increased glucose-stimulated insulin secretion, and alleviated islet atrophy. At the cellular level, rMSA improved glucose uptake and glycolysis in hepatocytes. Mechanistically, rMSA reduced the binding between CAV1 and EGFR to increase EGFR activation leading to PI3K-AKT activation. Furthermore, rMSA extracellularly reduced the rate of fatty acid uptake by islet β-cells, which relieved the accumulation of intracellular ceramide, endoplasmic reticulum stress, and apoptosis. This study provided the first clear demonstration that injections of rMSA can alleviate T2DM in mice. Our study demonstrates that increasing serum albumin levels can promote glucose homeostasis and protect islet β cells, which alleviates T2DM.

The relationship between the CUN-BAE body fatness index and incident diabetes a longitudinal retrospective study.

The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index has been recommended as an ideal indicator of body fat and exhibited significant correlation with cardiometabolic risk factors. However, whether the CUN-BAE index correlates with incident diabetes in Asian populations is unknown. Therefore, this longitudinal study was designed to evaluate the association between baseline CUN-BAE index and type 2 diabetes mellitus (T2DM). This retrospective longitudinal study involved 15,464 participants of 18-79 years of age in the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study over the period of 2004-2015. Cox proportional hazards regression was performed to test the relationship between the baseline CUN-BAE index and diabetes incidence. Further stratification analysis was conducted to ensure that the results were robust. The diagnostic utility of the CUN-BAE index was tested by the receiver operating characteristic (ROC) curve. Over the course of an average follow-up of 5.4 years, 373 (2.41%) participants developed diabetes. A higher diabetes incidence was associated with higher CUN-BAE quartiles (P for trend< 0.001). Each 1 unit increase in CUN-BAE index was associated with a 1.08-fold and 1.14-fold increased risk of diabetes after adjustment for confounders in males and females, respectively (both P < 0.001). Stratification analysis demonstrated a consistent positive correlation between baseline CUN-BAE and diabetes incidence. Moreover, based on ROC analysis, CUN-BAE exhibited a better capacity for diabetes prediction than both body mass index (BMI) and waist circumference (WC) in both sexes. The baseline CUN-BAE level was independently related to the incidence of diabetes. Increased adiposity determined by CUN-BAE could be used as a strong nonlaboratory predictor of incident diabetes in clinical practice.

A novel inflammatory biomarker, high-sensitivity C-reactive protein-to-albumin ratio, is associated with 5-year outcomes in patients with type 2 diabetes who undergo percutaneous coronary intervention.

Patients with coronary artery disease (CAD) combined with diabetes have a higher risk of cardiovascular events, and high-sensitivity C-reactive protein (hs-CRP)-to-albumin ratio (CAR) is a novel inflammatory biomarker. However, whether the CAR can identify high-risk patients with CAD and type 2 diabetes (T2DM) remains unclear. The present study was based on a prospective and observational cohort with 10,724 individuals who undergo percutaneous coronary intervention (PCI) in Fu Wai Hospital throughout the year 2013 consecutively enrolled. The primary endpoint was all-cause mortality. The secondary endpoint was cardiac mortality. CAR was calculated with the formula hs-CRP (mgL)albumin (gL). According to the optimal cut-off value of CAR for all-cause mortality, patients were divided into higher CAR (CAR-H) and lower CAR (CAR-L) groups. A total of 2755 patients with T2DM who underwent PCI and received dual antiplatelet therapy were finally enrolled. During a follow-up of 5 years (interquartile range 5.0-5.1 years), 126 (4.6%) all-cause mortalities and 74 (2.7%) cardiac mortalities were recorded. In the multivariable Cox model, CAR-H was associated with a higher risk of all-cause mortality (hazard ratio HR 1.634, 95% confidence interval CI 1.121-2.380, p 0.011) and cardiac mortality (HR 1.733, 95% CI 1.059-2.835, p 0.029) compared with CAR-L. When comparing the predictive value, CAR was superior to hs-CRP for all-cause mortality (area under the curve AUC 0.588 vs. 0.580, p 0.002) and cardiac mortality (AUC 0.602 vs. 0.593, p 0.004). In this real-world cohort study, a higher level of CAR was associated with worse 5-year outcomes among diabetic patients with PCI.

Impact of chronic GLP-1 RA and SGLT-2I therapy on in-hospital outcome of diabetic patients with acute myocardial infarction.

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 inhibitors (SGLT-2i) demonstrated cardiovascular and renal protection. Whether their benefits occur also during hospitalization for acute myocardial infarction (AMI) in patients with diabetes mellitus (DM) is not known. We evaluated in-hospital outcomes of patients hospitalized with AMI according to their chronic use of GLP-1 RA andor SGLT-2i. Using the health administrative databases of Lombardy, patients hospitalized with AMI from 2010 to 2019 were included. They were stratified according to DM status, then grouped into three cohorts using a propensity score matching non-DM patients DM patients treated with GLP-1 RA andor SGLT-2i DM patients not treated with GLP-1 RASGLT-2i. The primary endpoint of the study was the composite of in-hospital mortality, acute heart failure, and acute kidney injury requiring renal replacement therapy. We identified 146,798 patients hospitalized with AMI (mean age 71 ± 13 years, 34% females, 47% STEMI 26% with DM). After matching, 3,090 AMI patients (1030 in each group) were included in the analysis. Overall, the primary endpoint rate was 16% (n 502) and progressively increased from non-DM patients to DM patients treated with and without GLP-1 RASGLT-2i (13%, 16%, and 20%, respectively P < 0.0001). Compared with non-DM patients, DM patients with GLP-1 RASGLT-2i had a 30% higher risk of the primary endpoint, while those not treated with GLP-1 RASGLT-2i had a 60% higher risk (P < 0.0001). Chronic therapy with GLP-1 RA andor SGLT-2i has a favorable impact on the clinical outcome of DM patients hospitalized with AMI.

Triglyceride glucose index predicts all-cause mortality in oldest-old patients with acute coronary syndrome and diabetes mellitus.

Acute coronary syndrome (ACS) and diabetes mellitus (DM) are the leading health risks for the elderly. Triglyceride-glucose (TyG) index is a novel and reliable indicator of insulin resistance (IR). This study aims to explore the relationship between the TyG index and all-cause mortality in oldest-old patients with ACS and DM. Seven hundred twenty hospitalized patients with ACS aged ≥ 80 years were enrolled, and 699 patients signed informed consent for the study. During the follow-up period, 37 were lost to follow-up, and the follow-up rate was 94.7%. 231 ACS patients with DM were selected for the studys analyses. Kaplan-Meier curve, Cox regression model and receiver operating characteristic (ROC) curve were used to analyze the association between the TyG index and all-cause mortality. The mean age of participants was 81.58 ± 1.93 years, and 32.47% were women. Compared to TyG tertile 1, the Hazard Ratio (HR) 95% confidence interval (CI) of all-cause mortality was 2.04 (1.09, 3.81) for TyG tertile 3 in the fully adjusted model. For the TyG index per standard deviation (SD) increment, the HR (95% CI) of all-cause mortality was 1.44 (1.13, 1.83). Further, the association between the TyG index and all-cause mortality was dose-response (P for trend 0.026). ROC curve analyses indicated that the TyG index outperformed FBG and TG in the prediction of mortality risk and improved the prognostic value of the Gensini score combined with LVEF. The TyG index predicts the risk of all-cause mortality in the oldest-old ACS patients with DM.

Separate and combined effects of semaglutide and empagliflozin on kidney oxygenation and perfusion in people with type 2 diabetes a randomised trial.

Glucagon-like peptide-1 receptor agonists (GLP-1ras) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) have shown kidney-protective effects. Improved kidney oxygenation and haemodynamic changes are suggested mechanisms however, human data are scarce. We therefore investigated whether semaglutide (GLP-1ra), empagliflozin (SGLT2i) or their combination improve kidney oxygenation and perfusion. The trial was undertaken at Aarhus University Hospital, Denmark. A total of 120 people with type 2 diabetes (HbA Our model estimated a common baseline R2 value across all four groups in the cortex and the medulla. At baseline, the value was 24.5 (95% CI 23.9, 24.9) Hz in the medulla. After 32 weeks, the R2 values in the medulla were estimated to be 25.4 (95% CI 24.7, 26.2) Hz in the empagliflozin group and 24.5 (95% CI 23.9, 25.1) Hz in the placebo group (p0.016) (higher R2 corresponds to a lower oxygenation). Semaglutide decreased perfusion in both the cortex and the medulla. Empagliflozin increased erythropoietin and haematocrit. All three active treatments decreased GFR but not UACR. Ten serious adverse events were reported, among them two occurrences of semaglutide-associated obstipation. Our hypothesis, that semaglutide, empagliflozin or their combination improve kidney oxygenation, was rejected. On the contrary, empagliflozin induced a reduction in medullary kidney oxygenation. Semaglutide substantially reduced kidney perfusion without affecting oxygenation. Clinicaltrialsregister.eu EudraCT 2019-000781-38 FUNDING Novo Nordisk Foundation, Central Denmark Region Research Fund and Danish Medical Associations Research Foundation.

Insulin Fact Sheet in Type 1 and 2 Diabetes Mellitus and Trends of Antidiabetic Medication Use in Insulin Users with Type 2 Diabetes Mellitus 2002 to 2019.

This study investigated the trends of insulin use among Korean patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Changes in prescription of antidiabetic medications in T2DM patients taking insulin therapy were evaluated. We analyzed data from the National Health Insurance Service database in Korea to evaluate the prevalence of insulin users and trends of insulin use in T1DM and T2DM patients from January 2002 to December 2019. We also investigated numbers and types of antidiabetic medications in insulin users with T2DM. The overall total number of insulin users increased from 2002 to 2019, reaching 348,254 for T2DM and 20,287 for T1DM in 2019 compared with 109,974 for T2DM and 34,972 for T1DM in 2002. The proportion of patients using basal analogs and short acting analogs have increased and those using human insulin, premixed insulin, or biphasic human insulin have decreased (rapid acting analogs 71.85% and 24.12% in T1DM and T2DM, respectively, in 2019 basal analogs 76.75% and 75.09% in T1DM and T2DM, respectively, in 2019). The use of other antidiabetic medication in addition to insulin increased for T2DM, especially in dual therapy, reaching up to 52.35% in 2019 compared with 16.72% in 2002. The proportion of the patients using basal or rapid acting analogs increased among all insulin users in both T1DM and T2DM patients. Among patients with T2DM, the proportion of patients using antidiabetic medications in addition to insulin was significantly increased compared to those who used insulin alone.

Causal associations of sleep apnea and snoring with type 2 diabetes and glycemic traits and the role of BMI.

Sleep apnea and snoring have been associated with type 2 diabetes, with BMI playing a role in the pathway, but the directions of causality are unclear. This study examined the causal associations of sleep apnea and snoring with type 2 diabetes while assessing the role of BMI using multiple genetic methods. Five genetic methods were used two-sample bidirectional univariable Mendelian randomization (MR) inverse variance-weighted (MR-IVW) multivariable MR-IVW network MR and latent causal variable method. Compared with univariable MR-IVW, the odds ratio (95% CI) of type 2 diabetes for genetically predicted sleep apnea and snoring using the largest genome-wide association study decreased dramatically, from 1.61 (95% CI 1.16-2.23) to 1.08 (95% CI 0.59-1.97) and from 1.98 (95% CI 1.25-3.13) to 1.09 (95% CI 0.64-1.86) after adjustment for BMI. Network MR showed that BMI accounts for 67% and 62% of the total effect of sleep apnea and snoring on type 2 diabetes, respectively. The latent causal variable suggested that sleep apnea and snoring have no direct causal effect on type 2 diabetes. These results first suggest that the associations of sleep apnea and snoring with type 2 diabetes were mainly driven by BMI. The possible indirect effects of sleep apnea and snoring on type 2 diabetes through BMI cannot be ruled out.

Health literacy levels in patients with type 2 diabetes in an affluent Gulf country a cross-sectional study.

To identify health literacy levels in patients with type 2 diabetes mellitus in the United Arab Emirates (UAE). Nationwide cross-sectional survey. Individuals with type 2 diabetes mellitus attending outpatient diabetes clinics in all emirates of the UAE were surveyed between January 2019 and May 2020. Out of 832 patients approached, 640 met the inclusion criteria and agreed to participate. The outcome variable of interest was the health literacy level, which was measured using the Eastern-Middle Eastern Adult Health Literacy 13 Questionnaire. The association of health literacy level with age, gender and education was conducted using the Χ Only 11% of respondents had adequate health literacy levels. Age and education were directly correlated with health literacy levels. Patients under age 50 years had statistically significant higher rates of marginal (106 of 238, 44.5%) and adequate literacy (67 of 238, 28.2%, p<0.001) than the older population. Participants with bachelors or postgraduate degrees also had significantly higher adequate health literacy levels (24 of 79, 30.4%, p<0.001). The low health literacy levels found in outpatients with diabetes may be a major challenge to optimising diabetes care in the UAE. In addition to health services strategies, targeted educational and behavioural interventions for the older population and those with less formal education are necessary.

Subtypes of type 2 diabetes and their association with outcomes in Korean adults - A cluster analysis of community-based prospective cohort.

Little is known about the subtypes of type 2 diabetes (T2D) and their association with clinical outcomes in Asians. We performed data-driven cluster analysis in patients with newly diagnosed drug-naive T2D (n 756) from the Korean Genome and Epidemiology Study. Clusters were based on five variables (age at diagnosis, BMI, HbA1c, and HOMA2 β-cell function, and insulin resistance). We identified four clusters of patients with T2D according to k-means clustering cluster 1 (22.4 %, severe insulin-resistant diabetes SIRD), cluster 2 (32.7 %, mild age-related diabetes MARD), cluster 3 (32.7 %, mild obesity-related diabetes MOD), and cluster 4 (12.3 %, severe insulin-deficient diabetes SIDD). During 14 years of follow-up, individuals in the SIDD cluster had the highest risk of initiation of glucose-lowering therapy compared to individuals in the other three clusters. Individuals in the MARD and SIDD clusters showed the highest risk of chronic kidney disease and cardiovascular disease, and individuals in the MOD clusters showed the lowest risk after adjusting for other risk factors (P < 0.05). Patients with T2D can be categorized into four subgroups with different glycemic deterioration and risks of diabetes complications. Individualized management might be helpful for better clinical outcomes in Asian patients with different T2D subgroups.

Chronic physiologic hyperglycemia impairs insulin-mediated suppression of plasma glucagon concentration in healthy humans.

Hyperglucagonemia is a characteristic feature of type 2 diabetes mellitus (T2DM). We examined the effect of chronic (48-72 h) physiologic increase (50 mgdl) in plasma glucose concentration on suppression of plasma glucagon concentration by insulin and by hyperglycemia in normal glucose tolerant (NGT) individuals. Study One 16 NGT subjects received OGTT and 3-step hyperinsulinemic (10, 20, 40 mUm During all 3 insulin clamp steps (Study 1), plasma glucagon concentration was increased compared to baseline study, and plasma glucagoninsulin ratio was significantly reduced by 24 % (p < 0.05). The rate of insulin-stimulated glucose disposal was inversely correlated with plasma glucagoninsulin ratio (r -0.44, p < 0.05) and with glucagon AUC (r -0.48, p < 0.05). During the 2-step hyperglycemic clamp (Study 2) plasma glucagon was similar before and after 72 h of glucose infusion however, glucagoninsulin ratio was significantly reduced (p < 0.05). Incremental area under plasma insulin curve during the first (r -0.74, p < 0.001) and second (r -0.85, p < 0.001) hyperglycemic clamp steps was strongly and inversely correlated with plasma glucagoninsulin ratio. Sustained (48-72 h) physiologic hyperglycemia (50 mgdl) caused whole body insulin resistance and impaired insulin-mediated suppression of glucagon secretion, suggesting a role for glucotoxicity in development of hyperglucagonemia in T2DM.

Substituent effects of sulfonamide derivatives of metformin that can dually improve cellular glucose utilization and anti-coagulation.

Metformin, the most frequently prescribed medicine for the management of type 2 diabetes, has been shown to reduce cardiovascular events in diabetic patients in pre-clinical and clinical studies. The present work reports the design, synthesis, and biological assessment of the impact of six benzenesulfonamide biguanides on various aspects of hemostasis, cell function, red blood cell integrity (RBC), and their ability to uptake glucose in human umbilical endothelial cells (HUVECs). It was found that all synthesized o- and m-benzenesulfonamides, particularly derivatives with nitro (3) and amino groups (4), are characterized by a good safety profile in HUVECs, which was further confirmed in the cellular integrity studies. The biguanide analogues with methoxy group (1, 2) and an amino substituent (5, 6) significantly increased glucose utilization in HUVECs, similarly to the parent drug. Intriguingly, compounds 1, 3, and 6 favourably influenced some of the coagulation parameters. Furthermore, derivative 3 also slowed the process of fibrin polymerization, indicating more beneficial anti-coagulant properties than metformin. None of the novel metformin analogues interact strongly with the erythrocyte lipid-protein bilayer. Our findings indicate that derivative 3 has highly desirable anti-coagulant properties, and compounds 1 and 6 have potential dual-action activity, including anti-hyperglycaemic properties and anti-coagulant activity. As such, these derivatives can be used as lead molecules for further development of anti-diabetic agents with a beneficial effect on hypercoagulability.

Plasma-derived exosomal miRNAs as potentially novel biomarkers for latent autoimmune diabetes in adults.

To characterize the exosomal miRNA profiles of latent autoimmune diabetes in adults (LADA) and evaluate the biomarker potential of selected miRNAs to distinguish LADA from type 2 diabetes (T2D). Plasma-derived exosomal miRNA expression profiles were measured in patients with LADA (N 5) and control subjects (N 5). Five differentially expressed miRNAs were selected to validate their expression levels and assess their diagnostic potential by quantitative real-time PCR (qRT-PCR) in a larger cohort. Seventy-five differentially expressed plasma-derived exosomal miRNAs were identified in LADA patients compared to healthy subjects. The expression levels of three exosomal miRNAs (hsa-miR-146a-5p, hsa-miR-223-3p and hsa-miR-21-5p) were significantly different between the LADA group and the T2D group. The three miRNAs exhibited areas under the receiver operating characteristic curves of 0.978, 0.96 and 0.809, respectively. This study uncovers the miRNA profiles of plasma-derived exosomes from LADA patients and identifies exosomal miRNAs as potential biomarkers to discriminate LADA from T2D for the first time. Our data demonstrate the function of exosomal miRNAs in the development of LADA and contribute to an in-depth understanding of the precise mechanisms underlying the pathogenesis of LADA.

Outcomes in children of women with type 2 diabetes exposed to metformin versus placebo during pregnancy (MiTy Kids) a 24-month follow-up of the MiTy randomised controlled trial.

Metformin is increasingly being used during pregnancy, with potentially adverse long-term effects on children. We aimed to examine adiposity in children of women with type 2 diabetes from the Metformin in Women with Type 2 Diabetes in Pregnancy (MiTy) trial, with and without in-utero exposure to metformin, up to 24 months of age. MiTy Kids is a follow-up study that included infants of women who participated in the MiTy randomised controlled trial, receiving either oral 1000 mg metformin twice daily or placebo. Caregivers and researchers remained masked to the type of medication (metformin or placebo) mothers received during their pregnancy. Anthropometric measurements, including weight, height, and skinfold thicknesses, were taken at 3, 6, 12, 18, and 24 months. At 24 months, linear regression was used to compare the BMI Z score and sum of skinfolds in the metformin versus placebo groups, adjusted for confounders. Fractional polynomials were used to assess growth trajectories. This study is registered with ClinicalTrials.gov, NCT01832181. Of the 465 eligible children, 283 (61%) were included from 19 centres in Canada and Australia. At 24 months, there was no difference between groups in mean BMI Z score (0·84 SD 1·52 with metformin vs 0·91 1·38 with placebo mean difference 0·07 95% CI -0·31 to 0·45, p0·72) or mean sum of skinfolds (23·0 mm 5·2 vs 23·8 mm 5·4 mean difference 0·8 mm -0·7 to 2·3, p0·31). Metformin was not a predictor of BMI Z score at 24 months of age (mean difference -0·01 95% CI -0·42 to 0·37, p0·92). There was no overall difference in BMI trajectory but, in males, trajectories were significantly different by treatment (p0·048) BMI in the metformin group was higher between 6 and 24 months. Children of women with type 2 diabetes were approximately 1 SD heavier than the WHO reference population. Anthropometrics were similar in children exposed and those not exposed to metformin in utero hence, overall, data are reassuring with regard to the use of metformin during pregnancy in women with type 2 diabetes and the long-term health of their children. Canadian Institute for Health Research.

CO-OCCURRENCE OF NEPHRONOPHTHISIS TYPE 1 AND ALSTRÖM SYNDROME A CASE REPORT.

We describe the unique case of a patient in whom two ciliopathies with autosomal recessive transmission were clinically and molecularly diagnosed Nephronophthisis type1 (NPHP1) and Alström Syndrome (AS). NPHP1 is one of the main genetic causes of terminal kidney failure in childhood. AS is an ultra-rare multi-systemic disease, characterized by progressive kidney disease, hepatic failure, dystrophy of the rods and cones to blindness, slowly progressive neuro-sensory deafness, dilated cardiomyopathy, obesity, insulin resistance type 2 diabetes mellitus. The coexistence in the same patient of two rare syndromes with overlapping clinical manifestations but genetically different is an eventuality to be considered. This case report would describe the onset and progression of the multi-organ manifestations of both syndromes to highlight that ciliopathies present a strong phenotype overlap but also specific peculiarities. Therefore, to make a correct diagnosis, that is essential to achieve the best clinical management, could be challenging.

A review on the role of ADAMTS9-AS2 in different disorders.

Recent decade has seen a tremendous progress in identification of the role of different long non-coding RNAs (lncRNAs) in human pathologies. ADAMTS9-AS2 is an example of lncRNAs with different roles in human disorders. It is mostly acknowledged as a tumor suppressor lncRNA in different types of cancers. However, it has been reported to be up-regulated in tongue squamous cell carcinoma, salivary adenoid cystic carcinoma and glioblastoma. Moreover, ADAMTS9-AS2 is possibly involved in the pathoetiology of pulpitis, acute ischemic stroke, type 2 diabetes and its complications. This lncRNA sponges miR-196b-5p, miR-223-3p, miR-130a-5p, miR-600, miR-223-3p, miR-27a-3p, miR-32, miR-143-3p, miR-143-3p and miR-182-5p in order to regulate downstream mRNAs. This review aims at summarization of the role of ADAMTS9-AS2 in different disorders with a particular focus on its diagnostic and prognostic values.

Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes A Systematic Review and Meta-analysis of Individual Participant Data From 3 Randomized Clinical Trials.

The role of vitamin D in people who are at risk for type 2 diabetes remains unclear. To evaluate whether administration of vitamin D decreases risk for diabetes among people with prediabetes. PubMed, Embase, and ClinicalTrials.gov from database inception through 9 December 2022. Eligible trials that were specifically designed and conducted to test the effects of oral vitamin D versus placebo on new-onset diabetes in adults with prediabetes. The primary outcome was time to event for new-onset diabetes. Secondary outcomes were regression to normal glucose regulation and adverse events. Prespecified analyses (both unadjusted and adjusted for key baseline variables) were conducted according to the intention-to-treat principle. Three randomized trials were included, which tested cholecalciferol, 20 000 IU (500 mcg) weekly cholecalciferol, 4000 IU (100 mcg) daily or eldecalcitol, 0.75 mcg daily, versus matching placebos. Trials were at low risk of bias. Vitamin D reduced risk for diabetes by 15% (hazard ratio, 0.85 95% CI, 0.75 to 0.96) in adjusted analyses, with a 3-year absolute risk reduction of 3.3% (CI, 0.6% to 6.0%). The effect of vitamin D did not differ in prespecified subgroups. Among participants assigned to the vitamin D group who maintained an intratrial mean serum 25-hydroxyvitamin D level of at least 125 nmolL (≥50 ngmL) compared with 50 to 74 nmolL (20 to 29 ngmL) during follow-up, cholecalciferol reduced risk for diabetes by 76% (hazard ratio, 0.24 CI, 0.16 to 0.36), with a 3-year absolute risk reduction of 18.1% (CI, 11.7% to 24.6%). Vitamin D increased the likelihood of regression to normal glucose regulation by 30% (rate ratio, 1.30 CI, 1.16 to 1.46). There was no evidence of difference in the rate ratios for adverse events (kidney stones 1.17 CI, 0.69 to 1.99 hypercalcemia 2.34 CI, 0.83 to 6.66 hypercalciuria 1.65 CI, 0.83 to 3.28 death 0.85 CI, 0.31 to 2.36). Studies of people with prediabetes do not apply to the general population. Trials may not have been powered for safety outcomes. In adults with prediabetes, vitamin D was effective in decreasing risk for diabetes. None. (PROSPERO CRD42020163522).

Effects of Meditation Intervention on Self-management in Adult Patients With Type 2 Diabetes A Systematic Literature Review and Meta-analysis.

Diabetes complications are prevalent and cause adverse effects on the physical, psychological, and economic status of adult patients with type 2 diabetes. Meditation may positively affect self-management and, in turn, reduce diabetes complications. However, the systematic examination of the effects of meditation without additional components on self-management in this population have been rarely examined. The aim of this study was to examine the effects of meditation interventions on self-management (ie, control of glucose, blood pressure, cholesterol, and obesity and self-management) among adult patients with type 2 diabetes in randomized controlled trials. In this systematic review and meta-analysis, 6 electronic databases were searched using major keywords of meditation, diabetes, and self-management during March 2022. Eight studies (9 articles) using mindfulness-based meditation were included. The meta-analysis showed that meditation improved hemoglobin A1c (effect size -0.75 95% confidence interval, -1.30 to -0.21 P .007) but not fasting blood glucose. Only a few studies examined meditation effects on other types of self-management (eg, blood pressure, body mass index, cholesterol, diet, exercise, foot care, and monitoring of blood glucose), and the effects were inconsistent. In 1 study, meditation improved diabetes self-management. Mindfulness-based meditation reduced hemoglobin A1c levels in adult patients with type 2 diabetes but did not consistently improve other types of self-management in a few studies examined. This may imply the need for additional intervention components to improve different types of self-management. Further studies are needed to examine the effects of different types of meditations with additional components on different types of self-management.

Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis.

The increasing prevalence of diabetic ketoacidosis (DKA) related admissions poses a significant burden on the healthcare systems globally. However, data regarding the predictors of healthcare resource utilization in DKA is limited and inconsistent. This study aimed to identify key predictors of hospital length of stay (LOS), readmission and recurrent DKA episodes. We undertook a retrospective cross-sectional analysis of all DKA admissions from 2015 to 2021 across four hospitals in Qatar. The primary outcomes were the length of stay (LOS), 90-day readmission and 6-month and 1-year DKA recurrence. We included 922 patients with a median age of 35 years (25-45). 62% were males with type-1 diabetes-mellitus (T1DM) and type-2 DM (T2DM), present in 52% and 48% of patients. The median LOS was 2.6 days (IQR 1.1-4.8), and the median DKA resolution time was 18 h (10.5-29). Male-gender, new-onset DM, higher Charlson Comorbidity Index (CCI), lower haemoglobin, sodium and potassium, higher urea, longer DKA duration and MICU admission predicted a longer LOS in a multivariate regression analysis. None of the factors were significantly associated with 90-day readmission. Patients with pre-existing T1DM were more likely to have a six-month DKA recurrence than pre-existing T2DM. Patients with a 6-month DKA recurrence, female gender and T1DM had higher odds of 12-month recurrence, whereas a consult with a diabetes educator at the index admission was associated with decreased odds of recurrence. This is the most extensive study from the Middle-East region reporting on LOS, readmissions and the recurrence of DKA. Results from this study with a diverse population may be valuable for physicians and healthcare systems to decrease the diabetes-related healthcare burden in DKA patients.

Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes.

Gestational diabetes (GD) affects up to 10% of pregnancies and increases lifetime risk of type 2 diabetes 10-fold postpartum diabetes evaluation and primary care follow-up are critical in preventing and detecting type 2 diabetes. Despite clinical guidelines recommending universal follow-up, little remains known about how often individuals with GD access primary care and type 2 diabetes screening. To describe patterns of primary care follow-up and diabetes-related care among individuals with and without GD in the first year post partum. This cohort study used a private insurance claims database to compare follow-up in the first year post partum between individuals with GD, type 2 diabetes, and no diabetes diagnosis. Participants included postpartum individuals aged 15 to 51 years who delivered between 2015 and 2018 and had continuous enrollment from 180 days before to 366 days after the delivery date. Data were analyzed September through October 2021 and reanalyzed November 2022. Primary care follow-up visits and diabetes-related care (blood glucose testing and diabetes-associated visit diagnoses) were determined by evaluation and management, Current Procedural Terminology, and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, respectively. A total of 280 131 individuals were identified between 2015 and 2018 (mean age 31 years 95% CI, 27-34 years) 12 242 (4.4%) had preexisting type 2 diabetes and 18 432 (6.6%) had GD. A total of 50.9% (95% CI, 49.9%-52.0%) of individuals with GD had primary care follow-up, compared with 67.2% (95% CI, 66.2%-68.2%) of individuals with preexisting type 2 diabetes. A total of 36.2% (95% CI, 35.1%-37.4%) of individuals with GD had diabetes-related care compared with 56.9% (95% CI, 55.7%-58.0%) of individuals with preexisting diabetes. Only 36.0% (95% CI, 34.4%-37.6%) of individuals with GD connected with primary care received clinical guideline concordant care with blood glucose testing 12 weeks post partum. In this cohort study of postpartum individuals, individuals with GD had lower rates of primary care and diabetes-related care compared with those with preexisting type 2 diabetes, and only 36% of those with GD received guideline-recommended blood glucose testing in the first 12 weeks post partum. This illustrates a missed opportunity for early intervention in diabetes surveillance and prevention and demonstrates the need to develop a multidisciplinary approach for postpartum follow-up.

Comparing Effectiveness and Safety of SGLT2 Inhibitors vs DPP-4 Inhibitors in Patients With Type 2 Diabetes and Varying Baseline HbA1c Levels.

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy has been associated with cardiovascular benefits and a few adverse events however, whether the comparative effectiveness and safety profiles vary with differences in baseline hemoglobin A1c (HbA1c) levels is unknown. To compare cardiovascular effectiveness and safety of treatment with SGLT2i vs dipeptidyl peptidase 4 inhibitor (DPP-4i) in adults with type 2 diabetes (T2D) (1) overall and (2) at varying baseline HbA1c levels. A new-user comparative effectiveness and safety research study was conducted among 144 614 commercially insured adults, initiating treatment with SGLT2i or DPP-4i and with a recorded T2D diagnosis at baseline and at least 1 HbA1c laboratory result recorded within 3 months before treatment initiation. The intervention consisted of the initiation of treatment with SGLT2i or DPP-4i. Primary outcomes were a composite of myocardial infarction, stroke, or all-cause death (modified major adverse cardiovascular events MACE) and hospitalization for heart failure (HHF). Safety outcomes were hypovolemia, fractures, falls, genital infections, diabetic ketoacidosis (DKA), acute kidney injury (AKI), and lower-limb amputation. Incidence rate (IR) per 1000 person-years, hazard ratios (HR) and rate differences (RD) with their 95% CIs were estimated controlling for 128 covariates. A total of 144 614 eligible adults (mean SD age, 62 12.4 years 54% male participants) with T2D initiating treatment with a SGLT2i (n 60 523) or a DPP-4i (n 84 091) were identified 44 099 had an HbA1c baseline value of less than 7.5%, 52 986 between 7.5% and 9%, and 47 529 greater than 9%. Overall, 87 274 eligible patients were 11 propensity score-matched 24 052 with HbA1c less than 7.5% 32 290 with HbA1c between 7.5% and 9% and 30 932 with HbA1c greater than 9% (to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01). The initiation of SGLT2i vs DPP-4i was associated with a reduction in the risk of modified MACE (IR per 1000 person-years 17.13 vs 20.18, respectively HR, 0.85 95% CI, 0.75-0.95 RD, -3.02 95% CI, -5.23 to -0.80) and HHF (IR per 1000 person-years 3.68 vs 8.08, respectively HR, 0.46 95% CI, 0.35 to 0.57 RD -4.37 95% CI, -5.62 to -3.12) over a mean follow-up of 8 months, with no evidence of treatment effect heterogeneity across the HbA1c levels. Treatment with SGLT2i showed an increased risk of genital infections and DKA and a reduced AKI risk compared with DPP-4i. Findings were consistent by HbA1c levels, except for a more pronounced risk of genital infections associated with SGLT2i for HbA1c levels of 7.5% to 9% (IR per 1000 person-years 68.5 vs 22.8, respectively HR, 3.10 95% CI, 2.68-3.58 RD, 46.22 95% CI, 40.54-51.90). In this comparative effectiveness and safety research study among adults with T2D, SGLT2i vs DPP-4i treatment initiators had a reduced risk of modified MACE and HHF, an increased risk of genital infections and DKA, and a lower risk of AKI, regardless of baseline HbA1c.

Weight recurrence after Sleeve Gastrectomy versus Roux-en-Y gastric bypass a propensity score matched nationwide analysis.

Literature remains scarce on patients experiencing weight recurrence after initial adequate weight loss following primary bariatric surgery. Therefore, this study compared the extent of weight recurrence between patients who received a Sleeve Gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) after adequate weight loss at 1-year follow-up. All patients undergoing primary RYGB or SG between 2015 and 2018 were selected from the Dutch Audit for Treatment of Obesity. Inclusion criteria were achieving ≥ 20% total weight loss (TWL) at 1-year and having at least one subsequent follow-up visit. The primary outcome was ≥ 10% weight recurrence (WR) at the last recorded follow-up between 2 and 5 years, after ≥ 20% TWL at 1-year follow-up. Secondary outcomes included remission of comorbidities at last recorded follow-up. A propensity score matched logistic regression analysis was used to estimate the difference between RYGB and SG. A total of 19.762 patients were included, 14.982 RYGB and 4.780 SG patients. After matching 4.693 patients from each group, patients undergoing SG had a higher likelihood on WR up to 5-year follow-up compared with RYGB OR 2.07, 95% CI (1.89-2.27), p < 0.01 and less often remission of type 2 diabetes OR 0.69, 95% CI (0.56-0.86), p < 0.01, hypertension (HTN) OR 0.75, 95% CI (0.65-0.87), p < 0.01, dyslipidemia OR 0.44, 95% CI (0.36-0.54), p < 0.01, gastroesophageal reflux OR 0.25 95% CI (0.18-0.34), p < 0.01, and obstructive sleep apnea syndrome (OSAS) OR 0.66, 95% CI (0.54-0.8), p < 0.01. In subgroup analyses, patients who experienced WR after SG but maintained ≥ 20%TWL from starting weight, more often achieved HTN (44.7% vs 29.4%), dyslipidemia (38.3% vs 19.3%), and OSAS (54% vs 20.3%) remission compared with patients not maintaining ≥ 20%TWL. No such differences in comorbidity remission were found within RYGB patients. Patients undergoing SG are more likely to experience weight recurrence, and less likely to achieve comorbidity remission than patients undergoing RYGB.

Adverse childhood event subtypes and routine diabetes care utilization among U.S. adults with Type 2 diabetes.

Adverse childhood events (ACEs) have significant impacts on adulthood health, including greater risk of Type 2 diabetes (T2D). While there is a known connection to increased use of outpatient and emergency healthcare services, the potential role of ACEs in routine diabetes care utilization remains unclear. This study uses ACE subtypes to explain pathways to routine diabetes care utilization among adults with T2D. Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System, a survey of a representative sample of U.S. adults. Eligible participants resided in a state that completed both the Adverse Childhood Experiences (ACEs) and Diabetes modules and were diagnosed with non-gestational diabetes ( Factor loadings were strong, and fit indices indicated good measurement model and full structural model fits. In the full structural equation model, household dysfunction was associated with decreased likelihood of meeting frequency recommendations for A1C testing (β -0.22, Specific types of ACEs may differentially relate to routine diabetes care utilization in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Piloting of virtual group education for diabetes in Cape Town An exploratory qualitative study.

Diabetes is a major public health problem. During the coronavirus disease 2019 (COVID-19) pandemic, patient education and counselling (PEC) for diabetes were curtailed. This project explored the possibility of offering group empowerment and training (GREAT) for diabetes via computer or tablets and Zoom video conferencing. The aim was to explore whether this was feasible in the low-income community context of primary health care in Cape Town, South Africa. Three dieticians facilitated four sessions of GREAT for diabetes with a group of five patients with type-2 diabetes. Once the programme was completed, focus group interviews were held with the facilitators and the patients to explore their experience. Interviews were recorded and analysed using a simplified framework method. Usual primary care was not offering PEC and service delivery was brief and mechanistic. The content, resources and group processes were successfully translated into the virtual environment. The guiding style of communication was more difficult. Patients reported changes in their self-management and appreciated being able to save time and money while participating from home. Patients required considerable support and training to use the technology. All participants were concerned about safety and crime with the hardware. It was feasible to conduct GREAT for diabetes via tablets and Zoom video conferencing in this low-income community. To implement at scale, a number of concerns need to be addressed. The feasibility of conducting the sessions via smartphone technology should be evaluated.Contribution Demonstrates how digital technology could be used to develop new ways of empowering people with type 2 diabetes.

Contextual factors for the successful implementation of self-management interventions for chronic diseases A qualitative review of reviews.

To identify and describe the most relevant contextual factors (CFs) from the literature that influence the successful implementation of self-management interventions (SMIs) for patients living with type 2 diabetes mellitus, obesity, COPD andor heart failure. We conducted a qualitative review of reviews. Four databases were searched, 929 reviews were identified, 460 screened and 61 reviews met the inclusion criteria. CFs in this paper are categorized according to the Tailored Implementation for Chronic Diseases framework. A great variety of CFs was identified on several levels, across all four chronic diseases. Most CFs were on the level of the patient, the professional and the interaction level, while less CFs were obtained on the level of the intervention, organization, setting and national level. No differences in main themes of CFs across all four diseases were found. For the successful implementation of SMIs, it is crucial to take CFs on several levels into account simultaneously. Person-centered care, by tailoring SMIs to patients needs and circumstances, may increase the successful uptake, application and implementation of SMIs in real-life practice. The next step will be to identify the most important CFs according to various stakeholders through a group consensus process.

Impaired Early Insulin Response to Glucose Load Predicts Episodic Memory Decline A 10-Year Population-Based Cohort Follow-Up of 45-74-Year-Old Men and Women.

Diabetes increases the risk for cognitive decline, but the mechanisms behind this association remain unknown. Impaired early insulin secretion in elderly men and insulin resistance, both of which are pathophysiological features of type 2 diabetes, have previously been linked to Alzheimers disease. To examine if the early insulin response to oral glucose load predicts cognitive performance after 10 years in men and women aged 45-74 years. This study was based on a subpopulation of the Health 2000 Survey, a Finnish nationwide, population-based health examination study, and its follow-up, the Health 2011 Study. In total, 961 45-74-year-old individuals (mean age at baseline 55.6 years, 55.8% women) were examined. An oral glucose tolerance test was performed in 2001-2002, and early insulin response was defined as the ratio of the 30-min increment in insulin concentration to that of glucose concentration. Cognitive function was evaluated at baseline and follow-up with categorical verbal fluency, word-list learning, and word-list delayed recall. Statistical analyses were performed using multivariable linear models adjusted for age, sex, education, APOEz.epsi4 genotype, vascular risk factors including diabetes, and depressive symptoms. A lower early insulin response to glucose load predicted lower performance (β 0.21, p 0.03) and greater decline (β 0.19, p 0.03) in the word-list delayed recall test. Baseline early insulin response did not predict verbal fluency or word-list learning (all p-values≥0.13). Our results suggest that decreased early insulin secretion predicts episodic memory decline in middle-aged to elderly men and women.

Robustness of Multiple Imputation Methods for Missing Risk Factor Data from Electronic Medical Records for Observational Studies.

Evaluating appropriate methodologies for imputation of missing outcome data from electronic medical records (EMRs) is crucial but lacking for observational studies. Using US EMR in people with type 2 diabetes treated over 12 and 24 months with dipeptidyl peptidase 4 inhibitors (DPP-4i, The online version contains supplementary material available at 10.1007s41666-022-00119-w.

International evidence-based guidelines on hypertension and type 2 diabetes mellitus A systematic review.

This systematic review provides a high-quality, comprehensive summary of recommendations on hypertension (HT) and type 2 diabetes mellitus (T2DM), accentuating patient blood pressure, HbA1c levels, patterns of drug treatment, management, and screening of these diseases. The overall objective of the review is to support adapting existing clinical practice guidelines in Indonesia, Vietnam, and Myanmar. The database PubMed and the web search engines Google and Google Scholar were searched from October to December 2019 for evidence-based guidelines covering the overall disease management in Europe, the United States of America, and low and middle-income countries (Indonesia, Vietnam, and Myanmar-IVM later on). Nine studies were selected for the review, seven concerning HT and five T2DM. Guidelines in IVM and Europe identified HT as increased blood pressure (BP ≥14090 mmHg). IVM guidelines also recommended commencing drug treatment if lifestyle interventions were not successful. Four international HT guidelines recommended monitoring BP every few months, and the other three guidelines gave recommendations based on the patients current BP levels. All five T2DM guidelines recommended target HbA1c levels below 7%-6.5%, but only IVM guidelines included re-examination every 3-6 months. Metformin was recommended as the first choice of medical treatment, if not contraindicated. Amid the guidelines recommendations, there were no major variations in the Class of recommendation and Level of evidence (except IVM guidelines where COR and LOE were missing). Revision and completion of IVM guidelines by this grading system would enhance evidence-based and informed decisions in clinical care.

Effectiveness and safety of hydrogen inhalation as an adjunct treatment in Chinese type 2 diabetes patients A retrospective, observational, double-arm, real-life clinical study.

To analyze the effectiveness and safety of hydrogen inhalation (HI) therapy as an adjunct treatment in Chinese type 2 diabetes mellitus (T2DM) patients in a real-life clinical setting. This observational, non-interventional, retrospective, double-arm, 6-month clinical study included T2DM patients receiving conventional anti-diabetes medication with or without HI initiation from 2018 to 2021. Patients were assigned to the HI group or non-HI group (control group) after 11 propensity score matching (PSM). The mean change in glycated hemoglobin (HbA1c) after 6 months in different groups was evaluated primarily. The secondary outcome was composed of the mean change of fasting plasma glucose (FPG), weight, lipid profile, and homeostasis model assessment. Logistics regression was performed to evaluate the likelihood of reaching different HbA1c levels after 6-month treatment between the groups. Adverse event (AE) was also evaluated in patients of both groups. In total, 1088 patients were selected into the analysis. Compared to the control group, subjects in HI group maintained greater improvement in the level of HbA1c (-0.94% vs -0.46%), FPG (-22.7 mgdL vs -11.7 mgdL), total cholesterol (-12.9 mgdL vs -4.4 mgdL), HOMA-IR (-0.76 vs -0.17) and HOMA-β (8.2% vs 1.98%) with all p< 0.001 post the treatment. Logistics regression revealed that the likelihood of reaching HbA1c< 7%, ≥ 7% to< 8% and > 1% reduction at the follow-up period was higher in the HI group, while patients in the control group were more likely to attain HbA1c ≥ 9%. Patients in HI group was observed a lower incidence of several AEs including hypoglycemia (2.0% vs 6.8%), vomiting (2.6% vs 7.4%), constipation (1.7% vs 4.4%) and giddiness (3.3% vs 6.3%) with significance in comparison to the control group. HI as an adjunct therapy ameliorates glycemic control, lipid metabolism, insulin resistance and AE incidence of T2DM patients after 6-month treatment, presenting a noteworthy inspiration to existing clinical diabetic treatment.

Implementation of five machine learning methods to predict the 52-week blood glucose level in patients with type 2 diabetes.

For the patients who are suffering from type 2 diabetes, blood glucose level could be affected by multiple factors. An accurate estimation of the trajectory of blood glucose is crucial in clinical decision making. Frequent glucose measurement serves as a good source of data to train machine learning models for prediction purposes. This study aimed at using machine learning methods to predict blood glucose for type 2 diabetic patients. We investigated various parameters influencing blood glucose, as well as determined the most effective machine learning algorithm in predicting blood glucose. 273 patients were recruited in this research. Several parameters such as age, diet, family history, BMI, alcohol intake, smoking status et al were analyzed. Patients who had glycosylated hemoglobin less than 6.5% after 52 weeks were considered as having achieved glycemic control and the rest as not achieving it. Five machine learning methods (KNN algorithm, logistic regression algorithm, random forest algorithm, support vector machine, and XGBoost algorithm) were compared to evaluate their performances in prediction accuracy. R 3.6.3 and Python 3.12 were used in data analysis. The statistical variables for which p< 0.05 was obtained were BMI, pulse, Na, Cl, AKP. Compared with the other four algorithms, XGBoost algorithm has the highest accuracy (Accuracy99.54% in training set and 78.18% in testing set) and AUC values (1.0 in training set and 0.68 in testing set), thus it is recommended to be used for prediction in clinical practice. When it comes to future blood glucose level prediction using machine learning methods, XGBoost algorithm scores the highest in effectiveness. This algorithm could be applied to assist clinical decision making, as well as guide the lifestyle of diabetic patients, in pursuit of minimizing risks of hyperglycemic or hypoglycemic events.

Real world effectiveness of subcutaneous semaglutide in type 2 diabetes A retrospective, cohort study (Sema-MiDiab01).

Aim of the present study was to evaluate the real-world impact of once-weekly (OW) subcutaneous semaglutide on different end-points indicative of metabolic control, cardiovascular risk factors, and beta-cell function in type 2 diabetes (T2D). This was a retrospective, observational study conducted in 5 diabetes clinics in Italy. Changes in HbA1c, fasting blood glucose (FBG), body weight, blood pressure, lipid profile, renal function, and beta-cell function (HOMA-B) during 12 months were evaluated. Overall, 594 patients (97% GLP-1RA naïve) were identified (mean age 63.9 ± 9.5 years, 58.7% men, diabetes duration 11.4 ± 8.0 years). After 6 months of treatment with OW semaglutide, HbA1c levels were reduced by 0.90%, FBG by 26 mgdl, and body weight by 3.43 kg. Systolic blood pressure, total and LDL-cholesterol significantly improved. Benefits were sustained at 12 months. Renal safety was documented. HOMA-B increased from 40.2% to 57.8% after 6 months (p<0.0001). The study highlighted benefits of semaglutide on metabolic control, multiple CV risk factors, and renal safety in the real-world. Semaglutide seems to be an advisable option for preservation of β-cell function and early evidence suggests it might have a role in modifying insulin resistance (HOMA-IR), the pathogenetic basis of prediabetes and T2D.

Integrated lipids biomarker of the prediabetes and type 2 diabetes mellitus Chinese patients.

Dyslipidemia is a hallmark of T2DM, and as such, analyses of lipid metabolic profiles in affected patients have the potential to permit the development of an integrated lipid metabolite-based biomarker model that can facilitate early patient diagnosis and treatment. Untargeted and targeted lipidomics approaches were used to analyze serum samples from newly diagnosed 93 Chinese participants in discovery cohort and 440 in validation cohort Through these analyses, we developed a novel integrated biomarker signature composed of LPC 226, PC(160204), PE(226160), Cer(d181240)SM(d181190), Cer(d181240)SM(d180160), TG(181182182), TG(160160203), and TG(180160182). The area under the curve (AUC) values for this integrated biomarker signature for prediabetes and T2DM patients were 0.841 (cutoff 0.565) and 0.894 (cutoff 0.633), respectively. Furthermore, theresults of western blot analysis of frozen adipose tissue from 3 week (prediabetes) and 12 week (T2DM) Goto-Kakizaki (GK) rats also confirmed that acid sphingomyelinase is responsible for significant disruptions in ceramide and sphingomyelin homeostasis. Network analyses of the biomarkers associated with this biosignature suggested that the most profoundly affected lipid metabolism pathways in the context of diabetes include

Effect of nocturnal hypoxemia on glycemic control among diabetic Saudi patients presenting with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a prevalent disease that is associated with an increased incidence of type II diabetes mellitus (DM) if left untreated. We aimed to determine the association between glycosylated hemoglobin (HbA1c) levels and both nocturnal hypoxemia and apnea-hypopnea index (AHI) among a Saudi patients with OSA. A cross-sectional study that enrolled 103 adult patients diagnosed with DM and confirmed to have OSA by full night attended polysomnography between 2018 and 2021. Those who presented with acute illness, chronic obstructive pulmonary disease (COPD)restrictive lung diseases causing sleep-related hypoxemia, or no available HbA1c level within 6 months before polysomnography were excluded from the study. Univariate and multivariate linear regression analyses between HbA1c levels and parameters of interest were tested. Sixty-seven (65%) of the studied population had uncontrolled DM (HbA1c ≥7%). In univariate regression analysis, there was a significant positive association between HbA1c, and sleep time spent with an oxygen saturation below 90% (T90), female gender, and body mass index (BMI) (p<0.05) but not AHI, or associated comorbidities (p>0.05). In the multivariate analysis, HbA1c was positively associated with increasing T90 (p<0.05), and ODI (p<0.05), but not with AHI (p>0.05). Nocturnal hypoxemia could be an important factor affecting glycemic control in patients with OSA suffering from DM irrespective of the severity of both diseases.

Type 2 Diabetes Mellitus and its comorbidity, Alzheimers disease Identifying critical microRNA using machine learning.

MicroRNAs (miRNAs) are critical regulators of gene expression in healthy and diseased states, and numerous studies have established their tremendous potential as a tool for improving the diagnosis of Type 2 Diabetes Mellitus (T2D) and its comorbidities. In this regard, we computationally identify novel top-ranked hub miRNAs that might be involved in T2D. We accomplish this

Type 2 diabetes mellitus, physical activity, and neuromusculoskeletal complications.

The objectives of the study were to investigate the neuromusculoskeletal complications of Type 2 diabetes mellitus (T2DM) and their associated factors, including the level of physical activity (PA) and clinicodemographic characteristics. In this cross-sectional analysis, we included 370 participants diagnosed with T2DM for no <1 year who satisfied the inclusion and exclusion criteria. Demographic and clinical characteristics were noted and a thorough clinical examination was performed on all the participants. International PA Questionnaire-Short Form was used to evaluate the level of PA of the participants. The continuous data is presented as mean ± SD and the categorical data is presented as the number of participants (n) and percentage (%). A logistic regression model was used to investigate the predictors for the prevalence of the complications. The mean duration of T2DM was 7.32 ± 5.53 years and the mean hemoglobin A1C (HbA1c) level (%) was 8.16±1.67. A majority of the participants were having uncontrolled diabetes with an HbA1c level ≥7.5% ( Neuromusculoskeletal complications of T2DM are common and can result in significant disability in this population. Low PA is very common among T2DM patients and an important contributor to the development of complications. Health-care providers should consider PA an integral component of the management protocol for T2DM patients.

Systemic Photodynamic Therapy With Chlorine e6 as a Photosensitizer for the Treatment of Nodular BCC A Case Report.

Evaluation of Indian Diabetes Risk Score and Random Blood Sugar Testing for Opportunistic Screening of Type 2 Diabetes Patients at a District Hospital of Gujarat.

India is home to 69.2 million diabetics. For opportunistic screening of type 2 diabetes mellitus (DM), random capillary blood sugar (RBS) testing is used. Another method is Indian Diabetes Risk Score (IDRS), which is a simple and cost effective method for opportunistic screening of type 2 DM patients. The aim is to evaluate the screening test parameters of RBS testing and IDRS for opportunistic screening of undiagnosed type 2 DM patients. A cross-sectional study was done during February 2017 to August 2017 at a district hospital of Western Gujarat. A sample size of 317 patients was calculated using Buderers formula. Systematic random sampling was used and every third patient was selected from the general Outpatient Department(OPD) attendees of 30 years or more. MS Excel and Epi Info v7.2 was used for statistical analysis. Screening parameters and accuracy of IDRS and RBS were calculated taking result of the oral glucose tolerance test as clinical reference. The mean age of study participants was 50.9 (SD 12.17) years with 44.2% males and 55.8% females. Sensitivity and specificity of RBS was 72.4% and 69.1%. Sensitivity and specificity of IDRS was 93.1% and 29.0%. On simultaneous (parallel) screening by IDRS and RBS, sensitivity was 98.3% and specificity was 23.2%. In sequential screening, where IDRS was used followed by RBS, sensitivity was 67.2% and specificity was 74.9%. This study has found that sequential screening using a simple diabetes risk score like IDRS followed by RBS is having higher accuracy and reduced cost of opportunistic screening of type 2 diabetes. Adopting sequential screening using IDRS as first step of screening followed by RBS in those found as high risk by IDRS is recommended.

Research strategies in nutrition in health and disease The failure of mechanistic research.

This paper critically evaluates different research methods in order to assess their value for establishing which dietary changes are most effective for protecting health and preventing disease. The evidence demonstrates that the combined use of observational studies (mainly cohort studies) and randomized controlled trials (RCTs) is the most successful strategy. Studies of the details of body mechanisms in health and disease (mechanistic research) is another commonly used research strategy. However, much evidence demonstrates that it is a far less successful strategy. In order to support the above conclusions research studies from the following areas are discussed obesity and dietary fat heart disease and saturated fat the Mediterranean diet and cardiovascular disease type 2 diabetes and dietary fiber and cancer and micronutrients. While mechanistic research has a poor track record in nutrition, it has achieved some success in other areas of biomedical science. This is shown by examining the role of mechanistic research in the discovery of new drugs.

Impact of metabolic control on all-cause mortality in a nationwide cohort of patients with diabetes from Colombia.

The magnitude of the mortality benefit conferred by good integral metabolic control in diabetes in not sufficiently known, especially among Latin American patients. We prospectively studied the association between sustained control of blood glucose (HbA1c<7%), systolic blood pressure (SBP) (<130 mmHg) and LDL (LDLc, <100mgdL) and non-HDL (non-HDLc, <130 mgdL) cholesterol, and death from any cause among all adult patients with diagnosed diabetes in Colombia. We retrospectively analyzed data from a nationwide, centralized, mandatory registry of all patients with diagnosed diabetes assisted by the Colombian health system between July 1, 2015, and June 30, 2019. We estimated the associations of sustained achievement of each goal, and of the joint triple goal (HbA1c SBP LDLc) with all-cause death. Associations were assessed after adjustment for sex, age, race, insurance type and BMI in multivariable logistic models. We studied 1 352 846 people with diabetes. Sustained SBP (OR 0.42 0.41-0.43), HbA1c (OR 0.25 0.24-0.26) and LDLc (OR 0.28 0.27-0.29) control had strong negative associations with death. Moreover, among the 5.4% of participants who achieved joint, sustained metabolic control, the OR for death was 0.19 (0.18-0.21). Importantly, the impact of sustained, joint metabolic control was significantly smaller for patients of black race compared to other races (OR 0.31 0.23-0.43 Sustained and simultaneous metabolic control was associated with remarkably lower odds of death.

Benefits of Huang Lian mediated by gut microbiota on HFDSTZ-induced type 2 diabetes mellitus in mice.

Huang Lian (HL), one of the traditional Chinese medicines (TCMs) that contains multiple active components including berberine (BBR), has been used to treat symptoms associated with diabetes for thousands of years. Compared to the monomer of BBR, HL exerts a better glucose-lowering activity and plays different roles in regulating gut microbiota. However, it remains unclear what role the gut microbiota plays in the anti-diabetic activity of HL. In this study, a type 2 diabetes mellitus (T2DM) mouse model was induced with a six-week high-fat diet (HFD) and a one-time injection of streptozotocin (STZ, 75 mgkg). One group of these mice was administrated HL (50 mgkg) through oral gavage two weeks after HFD feeding commenced and continued for four weeks the other mice were given distilled water as disease control. Comprehensive analyses of physiological indices related to glycolipid metabolism, gut microbiota, untargeted metabolome, and hepatic genes expression, function prediction by PICRUSt2 were performed to identify potential mechanism. We found that HL, in addition to decreasing body fat accumulation, effectively improved insulin resistance by stimulating the hepatic insulin-mediated signaling pathway. In comparison with the control group, HL treatment constructed a distinct gut microbiota and bile acid (BA) profile. The HL-treated microbiota was dominated by bacteria belonging to Bacteroides and the Clostridium innocuum group, which were associated with BA metabolism. Based on the correlation analysis, the altered BAs were closely correlated with the improvement of T2DM-related markers. These results indicated that the anti-diabetic activity of HL was achieved, at least partly, by regulating the structure of the gut microbiota and the composition of BAs.

Finerenone in type 2 diabetes and renal outcomes A random-effects model meta-analysis.

The nonsteroidal mineralocorticoid antagonist finerenone is a new addition to the list of agents (angiotensin converting enzyme inhibitors and sodium glucose cotransporter 2 inhibitors) conferring renal protection to patients with diabetic kidney disease. Two recent meta-analyses using the fixed effect model in patients with chronic kidney disease (both diabetic and nondiabetic populations) came to a conflicting conclusion on the effect of finerenone on eGFR decline. This meta-analysis was undertaken exclusively in the type 2 diabetes (T2D) population to explore the robustness and heterogeneity of the effect size by conducting a random effects model meta-analysis along with draft plots and prediction intervals. A database search was conducted using the Cochrane library, PubMed, and Embase to identify relevant citations. Analysis was conducted on the 14 A pooled population of 13,943 patients from four citations was included for analysis. The Cochrane risk of bias was used to assess the quality of the studies. There was a significant 16% reduction in the renal composite (kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes) HR 0.84, 95% CI 0.77-0.92, There are significant benefits in renal outcomes associated with finerenone treatment in T2D patients with established chronic kidney disease with a side effect profile comparable to placebo.

Theabrownin ameliorates liver inflammation, oxidative stress, and fibrosis in MCD diet-fed C57BL6J mice.

Nonalcoholic steatohepatitis (NASH), also known as metabolic steatohepatitis, is a clinical syndrome with pathological changes like alcoholic hepatitis but without a history of excessive alcohol consumption. NASH is closely related to metabolic disorders such as obesity, insulin resistance, type 2 diabetes mellitus, and hyperlipidemia. Its main characteristics are hepatocyte steatosis with hepatocyte injury and inflammation. In severe cases, it can develop into liver cirrhosis. At present, there is no special treatment for NASH. Theabrownin (TB) is the main pigment substance in fermented tea. Theabrownin has beneficial effects on lipid metabolism and intestinal flora. However, the effect of theabrownin on NASH has not been studied. This study was aimed at exploring the effects of theabrownin from Fuzhuan brick tea on NASH. 8-week-old mice were randomly assigned to three groups and fed with chow diet (CD), methionine and choline sufficient (MCS) diet (MCS Ctrl), which is a Methioninecholine deficient (MCD) control diet, and MCD diet. After 5 weeks of feeding, the MCD group mice were randomly divided into two groups and were gavaged with double distilled water (MCD Ctrl) or theabrownin (MCD TB) (200mgkg body weight, dissolved in double distilled water) every day for another 4 weeks respectively, while continuing MCD diet feeding. We found that theabrownin treatment could not improve liver mass loss and steatosis. However, theabrownin ameliorated liver injury and decreased liver inflammatory response. Theabrownin also alleviated liver oxidative stress and fibrosis. Furthermore, our results showed that theabrownin increased hepatic level of fibroblast growth factor 21 (FGF21) and reduced the phosphorylation of mitogen-activated protein kinase p38 in MCD diet-fed mice.

The protective effects of lipoxin A4 on type 2 diabetes mellitus A Chinese prospective cohort study.

Several cellular and animal studies have suggested that lipoxin A4 (LXA4) has a protective effect on type 2 diabetes mellitus (T2DM) development. However, little is known about whether LXA4 influences T2DM development at the population level. We included 2755 non-diabetic participants from a cohort study in China who were followed for about seven years. Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between LXA4 and incident T2DM. Mediation models were used to examine how serum lipids as mediators impact the association between LXA4 and T2DM. In total, 172 newly diagnosed T2DM cases were identified. Multivariate-adjusted HR for T2DM in the fourth compared with the first quartile of LXA4 was 0.62 (95% CI 0.40-0.96). When used the optimal cutoff value determined by the receiver operating characteristic curve, the results showed participants with LXA4 > 2.84 ngmL had a decreased T2DM risk compared to those with LXA4 ≤ 2.84 ngmL (HR 0.63, 95% CI 0.45-0.89). The effect of LXA4 on incident T2DM was significantly modified by gender ( Higher LXA4 levels are significantly associated with a lower risk of T2DM development. The present findings would be helpful in understanding the effect of LXA4 on T2DM development at the population level.

Effects of magnesium supplementation on improving hyperglycemia, hypercholesterolemia, and hypertension in type 2 diabetes A pooled analysis of 24 randomized controlled trials.

Previous studies have demonstrated that diabetes is often accompanied with lower magnesium status. However, practical details regarding the influences of magnesium intervention on hyperglycemia, hypercholesterolemia, and hypertension in type 2 diabetes (T2D) need to be further investigated. Web of Science, ScienceDirect, and PubMed were searched for relevant literatures published through April 30, 2022, and high-quality data were pooled to evaluate the effects of magnesium supplementation on glycemic, circulating lipids, and blood pressure control in T2D, and to explore the associated practical details. Pooled analyses of 24 randomized controlled trials with 1,325 T2D individuals revealed that subjects who received magnesium supplementation had statistically significant reductions in fasting plasma glucose, glycated hemoglobin, systolic blood pressure and diastolic blood pressure, with WMD values of -0.20 mM (95% CI -0.30, -0.09), -0.22% (95% CI -0.41, -0.03), -7.69 mmHg (95% CI -11.71, -3.66) and -2.71 mmHg (95% CI -4.02, -1.40), respectively. Detailed subgroup analyses demonstrated that health status of participants including age, body mass index, country, duration of disease, baseline magnesium level and baseline glycemic control condition as well as magnesium formulation, dosage and duration of intervention influenced the effects of magnesium addition. Dose-effect analysis showed that 279 mgd for 116 d, 429 mgd for 88 d and 300 mgd for 120 d are the average optimal dosages and durations for improving glycemic, circulating lipids, and blood pressure controls, respectively. Our findings provide clinically relevant information on the adjuvant therapy of magnesium for improving hyperglycemia, hypercholesterolemia, and hypertension in T2D.

Effectiveness of Diabetes Case Conferencing Program on Diabetes Management.

Diabetes case conferencing is where an endocrinologist visits a general practitioner (GP) to advise on the care of patients with diabetes. Past case conferencing studies have reported improved diabetes management and clinical outcomes in primary care. This study investigated the effectiveness of a diabetes case conferencing program in South Western Sydney, Australia. Complex diabetes cases were referred by general practitioners to a visiting endocrinologist for review after obtaining patient consent. The patient was not usually present. After the case discussion, a diabetes management plan was developed jointly by the general practicespecialist team. Clinical data were compared at baseline and each year up to three years (2017-2020) after the consultation using paired t-test. The primary outcome was HbA1c. Clinical data were collected for 645775 patients (mean age 64 ± 15(SD) years 351 (54.4%) males from 4043 general practices 96.4% had type 2 diabetes 6.5% were insulin treated, 54.3% non-insulin treated, 31.5% both insulin and non-insulin treated and 3.4% diet only. There were reductions in HbA1c by 1.0 ± 1.7% (11 ± 19 mmolmol) (p < 0.001), systolic blood pressure 8.2 ± 18.1 mmHg (p < 0.001), diastolic blood pressure 2.7 ± 11.6 mmHg (p < 0.001), total cholesterol 0.2 ± 1.7 mmoll (p 0.007), low-density lipoprotein 0.2 ± 1.0 mmoll (p < 0.001), weight 3.3 ± 10.1 kg (p < 0.001) and body mass index (BMI) 1.3 ± 3.5 kgm Glycaemia, weight and cardiovascular risk factors improved following case conferencing consultations in a primary care setting.

Association between occupation type and development of type 2 diabetes A population-based Panasonic cohort study 3.

Due to a lack of investigation on the association between the type of occupation and the development of type 2 diabetes among Japanese individuals, we aimed to assess this association in 98,935 Japanese individuals. This long-term retrospective cohort study included participants selected from medical health checkup programs conducted at the Panasonic Corporation, Osaka, Japan, from 2008 to 2018. Cox regression analyses were used to evaluate the association between occupation type and the incidence of type 2 diabetes. From 2008 to 2018, 5,008 participants developed type 2 diabetes. The proportion of never smokers, those with slow eating speeds, and those working with a flextime system was higher in men with technical jobs than in salespersons, manufacturers, and office workers ( This study demonstrated that occupation type might be an independent factor in the development of type 2 diabetes in Japanese men.

Stress CMR T1-mapping technique for assessment of coronary microvascular dysfunction in a rabbit model of type II diabetes mellitus Validation against histopathologic changes.

Coronary microvascular dysfunction (CMD) is an early character of type 2 diabetes mellitus (T2DM), and is indicative of adverse events. The present study aimed to validate the performance of the stress T1 mapping technique on cardiac magnetic resonance (CMR) for identifying CMD from a histopathologic perspective and to establish the time course of CMD-related parameters in a rabbit model of T2DM. New Zealand white rabbits ( The stress ΔT1 values were 6.21 ± 0.59%, 4.88 ± 0.49%, 3.80 ± 0.40%, and 3.06 ± 0.54% in the control, T2DM 5-week, 10-week, and 15-week groups, respectively ( The stress T1 response correlated well with the histopathologic measures in T2DM rabbits, indicating that it may serve as a sensitive CMD-related indicator in early T2DM.

Cognitive impairment with Type 2 Diabetes Mellitus among community-dwelling older adults in Chile Prevalence, risk factors and cognitive characteristics.

The aim of this study is to determine prevalence and risk factors of Cognitive Impairment (CI) and its association with Type 2 Diabetes Mellitus (T2DM) in subjects aged 65 years and above. Additionally, we attempt to provide a cognitive profile for T2DM group. A cross-sectional analytical study to assess CI was carried out. We evaluated a sample of community-dwelling residents from Chile. All participants underwent a general interview, lifestyle questionnaires and a comprehensive neuropsychological battery. Regression analyses were performed to evaluate risk of CI with T2DM and influencing factors. Results between groups in the different domains of the neuropsychological assessment were compared by Students Among all 358 subjects, overall T2DM prevalence were 17.3%. The prevalence of CI was higher in T2DM group compared to the healthy participants (30.7%, The present study confirms the high prevalence of CI with T2DM among Chilean older adults in a community-based population. T2DM is significantly associated with a higher risk of CI, and age, education, presence of dyslipidemia, and duration of T2DM are risk factors. T2DM patients with CI are impaired in multiple cognitive domains, even after adjusting covariables, resulting in an amnesic multi-domain cognitive profile.