Improving nursing care protocols for diabetic patients through a systematic review and meta-analysis of recent years

BACKGROUND

Diabetes mellitus has become one of the major pandemics of the 21st century. In this scenario, nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus. Nursing interventions are crucial for managing the disease and preventing complications.

AIM

To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.

METHODS

This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables, such as glycated haemoglobin and fasting plasma glucose.

RESULTS

After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables, a descriptive analysis of the studies with the most significant changes was conducted. Based on this, an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient's technological skills.

CONCLUSION

The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.

Efficacy of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists on proteinuria and weight in a diabetes cohort

BACKGROUND

With accumulating evidence showing a benefit in the renal and cardiovascular systems, diabetes guidelines recommend that patients with diabetes and chronic kidney disease (CKD) be treated with sodium-glucose cotransporter-2 inhibitor (SGLT2i) and/or glucagon like peptide-1 receptor agonists (GLP-1RAs) for renal protection. The real-world efficacy of the two medications on the urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) remains to be explored.

AIM

To evaluate the SGLT2i and GLP-1RA application rates and UACR alterations after intervention in a real-world cohort of patients with diabetes.

METHODS

A cohort of 5482 patients with type 2 diabetes were enrolled and followed up at the Integrated Care Clinic for Diabetes of Peking University First Hospital for at least 6 months. Propensity score matching was performed, and patients who were not recommended for GLP-1RA or SGLT2i with comparable sex categories and ages were assigned to the control group at a 1:2 ratio. Blood glucose, body weight, UACR and eGFR were evaluated after 6 months of treatment in real-world clinical practice.

RESULTS

A total of 139 (2.54%) patients started GLP-1RA, and 387 (7.06%) received SGLT2i. After 6 months, the variations in fasting blood glucose, prandial blood glucose, and glycosylated hemoglobin between the GLP-1RA group and the SGLT2i and control groups were not significantly different. UACR showed a tendency toward a greater reduction compared with the control group, although this difference was not statistically significant (GLP-1RA vs control, -2.20 vs 30.16 mg/g, P = 0.812; SGLT2i vs control, -20.61 vs 12.01 mg/g, P = 0.327); eGFR alteration also showed no significant differences. Significant weight loss was observed in the GLP-1RA group compared with the control group (GLP-1RA vs control, -0.90 vs 0.27 kg, P < 0.001), as well as in the SGLT2i group (SGLT2i vs control, -0.59 vs -0.03 kg, P = 0.010).

CONCLUSION

Compared with patients who received other glucose-lowering drugs, patients receiving SGLT2i or GLP-1RAs presented significant weight loss, a decreasing trend in UACR and comparable glucose-lowering effects in real-world settings.

Pelvic floor dysfunction in patients with gestational diabetes mellitus

In this editorial, we comment on an article by Wang et al. Recent literature shows an increase in research on pelvic organ prolapse (POP). Although the true incidence of POP remains uncertain, its impact on quality of life is substantial. Anatomical studies report high incidence rates, surpassing those observed in symptom-based surveys. Weakness of the endopelvic fascia is a primary anatomical risk factor for POP. Additionally, gestational diabetes mellitus (GDM) has emerged as a growing concern, as poor glycemic control increases complications for both mother and fetus. GDM and POP are interconnected, with factors like maternal obesity, macrosomia, and hormonal changes exacerbating pelvic floor dysfunction. Modifiable risk factors, such as obesity and chronic hyperglycemia, along with multiparity, instrumental deliveries, and obstetric trauma, further increase susceptibility. For patients with GDM, gynecological exams, Pelvic Organ Prolapse Quantification staging, and pelvic floor ultrasonography are valuable diagnostics, with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses. Imaging, though uncomfortable during pregnancy, is safe in the early postpartum period. This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.

Association between body mass index and lumbar spine volumetric bone mineral density in diabetic and non-diabetic patients

BACKGROUND

The association between body mass index (BMI) and bone mineral density (BMD) has shown inconsistent results, varying by sex and skeletal site. Despite normal or elevated bone mass, individuals with type 2 diabetes have an increased risk of hip and vertebral fractures.

AIM

To assess lumbar spine trabecular volumetric BMD (vBMD) across different BMI categories in individuals with and without diabetes.

METHODS

This cross-sectional study included 966 men over 50 years old and 1001 postmenopausal women from the Pinggu Metabolic Disease Study. The vBMD of lumbar vertebrae 2 through 4 was measured using quantitative computed tomography. Total adipose tissue, subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and lumbar skeletal muscle area were also quantified.

RESULTS

In men with obesity (P = 0.038) and overweight (P = 0.032), vBMD was significantly higher in the diabetes group compared to non-diabetic men. After adjusting for age and sex, no significant saturation effect between BMI and BMD was found in participants with diabetes or in women without diabetes. However, a BMI threshold of 22.33 kg/m² indicated a saturation point for vBMD in non-diabetic men. Independent predictors of vBMD in men included age (r = -0.387, P < 0.001), BMI (r = 0.130, P = 0.004), and VAT (r = -0.145, P = 0.001). For women, significant predictors were age (r = -0.594, P < 0.001), BMI (r = 0.157, P = 0.004), VAT (r = -0.112, P = 0.001), and SAT (r = -0.068, P = 0.035).

CONCLUSION

The relationship between BMI and trabecular vBMD differs in individuals with and without diabetes. Overweight and obese men with diabetes exhibit higher vBMD.

Associations between food insecurity with gestational diabetes mellitus and maternal outcomes mediated by dietary diversity: A cross-sectional study

BACKGROUND

Food insecurity (FI) during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), resulting in adverse outcomes for both mother and baby.

AIM

To investigate the relationships between FI and pregnancy outcomes, particularly GDM and PIH, while also examining the mediating role of the dietary diversity score (DDS).

METHODS

A cross-sectional study was undertaken to examine this relationship, involving 600 pregnant women. Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes. The FI was measured via the Household Food Security Survey Module, with GDM defined as fasting plasma glucose levels of ≥ 5.1 mmol/L or a 2-hour oral glucose tolerance test value of ≥ 8.5 mmol/L. The DDS is determined by evaluating one's food consumption based on nine distinct food groups. A logistic regression model was used to explore the relationship between FI and PIH, and GDM.

RESULTS

Seventeen percent of participants reported experiencing FI during pregnancy. The study found a significant association between FI and an elevated risk of GDM [odds ratio (OR) = 3.32, 95%CI: 1.2-5.4]. Once more, food-insecure pregnant women had higher rates of PIH (OR = 0.10, 95%CI: 0.02-0.45) and they also faced a higher likelihood of neonatal complications, such as neonatal intensive care unit's admissions and the birth of infants with extremely low birth weight. The FI was further linked to metabolic disruptions, such as elevated fasting blood sugar (FBS), low-density lipoprotein cholesterol, and triglyceride levels. Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM. In particular, the mediation analysis showed that approximately 65% of the effect was mediated through DDS (P = 0.002).

CONCLUSION

These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health. Additionally, the study explored how DDS mediates the relationship between FI and the incidence of GDM.

Application of Dorzagliatin in peritoneal dialysis patients with type 2 diabetes mellitus: A case report

BACKGROUND

Treating diabetes in dialysis patients remains a challenge, with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.

CASE SUMMARY

This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes (T2DM) who had struggled to control her blood sugar for more than a year. She had a history of high blood pressure for 30 years, had undergone continuous ambulatory peritoneal dialysis for more than two years, was 163 cm tall, weighed 77 kg, and had a body mass index of 28.98 kg/m2. Despite intensive insulin therapy at a daily dose of 150 units, adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage. After one month of follow-up, the fasting plasma glucose was 6-8 mmol/L, and the 2-hour postprandial glucose was 8-12 mmol/L.

CONCLUSION

To our knowledge, this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control. Dorzagliatin, a novel glucokinase activator primarily metabolized by the liver, exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease. It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis, potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.

Efficacy, safety and treatment satisfaction of transition to a regimen of insulin degludec/aspart: A pilot study

BACKGROUND

There is a lack of clinical evidence on the efficacy and safety of transitioning from a thrice-daily pre-mixed insulin or basal-prandial regimen to insulin deglu-dec/aspart (IDegAsp) therapy, with insufficient data from the Chinese popu-lation.

AIM

To demonstrate the efficacy, safety, and treatment satisfaction associated with the transition to IDegAsp in type 2 diabetes mellitus (T2DM).

METHODS

In this 12-week open-label, non-randomized, single-center, pilot study, patients with T2DM receiving thrice-daily insulin or intensive insulin treatment were transitioned to twice-daily injections of insulin IDegAsp. Insulin doses, hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG), hypoglycemic events, a Diabetes Treatment Satisfaction Questionnaire, and other parameters were assessed at baseline and 12-weeks.

RESULTS

This study included 21 participants. A marked enhancement was observed in the FBG level (P = 0.02), daily total insulin dose (P = 0.03), and overall diabetes treatment satisfaction (P < 0.01) in the participants who switched to IDegAsp. There was a decrease in HbA1c levels (7.6 ± 1.1 vs 7.4 ± 0.9, P = 0.31) and the frequency of hypoglycemic events of those who switched to IDegAsp decreased, however, there was no statistically significant difference.

CONCLUSION

The present findings suggest that treatment with IDegAsp enhances clinical outcomes, particularly FBG levels, daily cumulative insulin dose, and overall satisfaction with diabetes treatment.

Acellular fish skin grafts in diabetic foot ulcer care: Advances and clinical insights

Diabetic foot ulcers (DFUs) represents a significant public health issue, with a rising global prevalence and severe potential complications including amputation. Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization. This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management. Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure, reducing dressing changes, and enhancing patient outcomes with a lower socio-economic burden. Despite their promise, challenges such as limited availability, patient acceptance, and the need for further research persist. Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds.

Prediabetes and atrial fibrillation risk stratification, phenotyping, and possible reversal to normoglycemia

Patients admitted with prediabetes and atrial fibrillation are at high risk for major adverse cardiac or cerebrovascular events independent of confounding variables. The shared pathophysiology between these three serious but common diseases and their association with atherosclerotic cardiovascular risk factors establish a vicious circle culminating in high atherogenicity. Because of that, it is of paramount importance to perform risk stratification of patients with prediabetes to define phenotypes that benefit from various interventions. Furthermore, stress hyperglycemia assessment of hospitalized patients and consensus on the definition of prediabetes is vital. The roles lifestyle and metformin play in prediabetes are well established. However, the role of glucagon-like peptide agonists and metabolic surgery is less clear. Prediabetes is considered an intermediate between normoglycemia and diabetes along the blood glucose continuum. One billion people are expected to suffer from prediabetes by the year 2045. Therefore, real-world randomized controlled trials to assess major adverse cardiac or cerebrovascular event risk reduction and reversal/prevention of type 2 diabetes among patients are needed to determine the proper interventions.

Role of macrophage polarization in diabetic foot ulcer healing: A bibliometric study

BACKGROUND

Diabetic foot ulcers (DFUs) are a significant contributor to disability and mortality in diabetic patients. Macrophage polarization and functional regulation are promising areas of research and show therapeutic potential in the field of DFU healing. However, the complex mechanism, the difficulty in clinical translation, and the large heterogeneity present significant challenges. Hence, this study was to comprehensively analyze the publication status and trends of studies on macrophage polarization and DFU healing.

AIM

To examine the relevant literature on macrophage polarization in DFU healing.

METHODS

A bibliometric analysis was conducted using the Web of Science database. Relevant literature was retrieved from the Web of Science Core Collection database between 2013 to 2023 using literature visualization and analysis software (VOSviewer and CiteSpace) and bibliometric online platforms. The obtained literature was then subjected to visualization and analysis of different countries/regions, institutions, journals, authors, and keywords to reveal the research's major trends and focus.

RESULTS

The number of publications on the role of macrophage polarization in DFU healing increased rapidly from 2013 to 2023, especially in the latter period. Chinese researchers were the most prolific in this field, with 217 publications, while American researchers had been engaged in this field for a longer period. Qian Tan of Nanjing Drum Tower Hospital and Qian Ding of Nanjing University were the first to publish in this field. Shanghai Jiao Tong University was the institution with the most publications (27). The keywords "bone marrow", "adjustment, replacement, response, tissue repair", and "activation, repair, differentiation" appeared more frequently. The study of macrophage polarization in DFU healing focused on the regulatory mechanism, gene expression, and other aspects.

CONCLUSION

This study through the bibliometric method reveals the research trends and development trends in this field of macrophage polarization in DFU healing from 2013 to 2023 in the Web of Science Core Collection database. The key hotspots in this field mainly include the regulation of macrophage activation, gene expression, wound tissue repair, and new wound materials. This study provides references for future research directions.

Diabetes mellitus and glymphatic dysfunction: Roles for oxidative stress, mitochondria, circadian rhythm, artificial intelligence, and imaging

Diabetes mellitus (DM) is a debilitating disorder that impacts all systems of the body and has been increasing in prevalence throughout the globe. DM represents a significant clinical challenge to care for individuals and prevent the onset of chronic disability and ultimately death. Underlying cellular mechanisms for the onset and development of DM are multi-factorial in origin and involve pathways associated with the production of reactive oxygen species and the generation of oxidative stress as well as the dysfunction of mitochondrial cellular organelles, programmed cell death, and circadian rhythm impairments. These pathways can ultimately involve failure in the glymphatic pathway of the brain that is linked to circadian rhythms disorders during the loss of metabolic homeostasis. New studies incorporate a number of promising techniques to examine patients with metabolic disorders that can include machine learning and artificial intelligence pathways to potentially predict the onset of metabolic dysfunction.

Diabetes-inducing effects of bronchial asthma

BACKGROUND

The relationship between diabetes mellitus (DM) and asthma is complex and can impact disease trajectories.

AIM

To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.

METHODS

We systematically reviewed the literature on the relationship between DM and asthma, focusing on their impacts, mechanisms, and therapeutic implications. Various studies were assessed, which investigated the effect of glycemic control on asthma outcomes, lung function, and exacerbations. The study highlighted the role of specific diabetes medications in managing asthma.

RESULTS

The results showed that poor glycemic control in diabetes can exacerbate asthma, increase hospitalizations, and reduce lung function. Conversely, severe asthma, especially in obese individuals, can complicate diabetes management and make glycemic control more difficult. The diabetes-associated mechanisms, such as inflammation, microangiopathy, and oxidative stress, can exacerbate asthma and decrease lung function. Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.

CONCLUSION

The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes. Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes, while asthma severity, especially in obese individuals, complicates diabetes control. However, the current research has limitations, and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.

Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes

BACKGROUND

Inadequate glycemic control in patients with type 2 diabetes (T2DM) is a major public health problem and a significant risk factor for the progression of diabetic complications.

AIM

To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin (HbA1c) ≥ 10% and varying backgrounds of glycemic control.

METHODS

This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months. Participants were categorized into four groups based on prior glycemic history: Newly diagnosed, previously well controlled with recent worsening, previously off-target but now worsening, and HbA1c consistently above 10%. HbA1c levels were monitored quarterly, and patients received medical, educational, and dietary support as needed. The analysis focused on the success rates of good glycemic control and the associated factors within each group.

RESULTS

The study showed significant improvements in HbA1c levels in all participants. The most significant improvement was observed in individuals newly diagnosed with diabetes: 65% achieved an HbA1c target of ≤ 7%. The results varied between participants with different glycemic control histories, followed by decreasing success rates: 39% in participants with previously good glycemic control, 21% in participants whose glycemic control had deteriorated compared to before, and only 10% in participants with persistently poor control, with mean HbA1c levels of 6.3%, 7.7%, 8.2%, and 9.7%, respectively. After one year, 65.2% of the "newly diagnosed patients", 39.3% in the "previously controlled group", 21.9% in the "previously off-target but now worsened'" group and 10% in the "poorly controlled from the start" group had achieved HbA1c levels of 7 and below.

CONCLUSION

In poorly controlled diabetes, the rate at which treatment goals are achieved is associated with the glycemic background characteristics, emphasizing the need for tailored strategies. Therefore, different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.

Intestinal glucagon-like peptide-1: A new regulator of impaired counterregulatory responses to hypoglycemia in type 1 diabetes mellitus

In this article, we review the study by Jin et al, which examined the role of intestinal glucagon-like peptide-1 (GLP-1) in counterregulatory responses to hypoglycemia in patients with type 1 diabetes mellitus (T1DM). With the global rise of T1DM, there is an increased burden on society and healthcare systems. Due to insulin therapy and islet dysfunction, T1DM patients are highly vulnerable to severe hypoglycemia, a leading cause of mortality. In healthy individuals, counterregulatory mechanisms restore blood glucose during hypoglycemia, but repeated episodes impair these responses. Jin et al demonstrated that overexpression of GLP-1 attenuates the sympathetic-adrenal reflex and disrupts the secretion of counterregulatory hormones such as glucagon during hypoglycemia, leading to counterregulatory dysfunction. These findings highlight the critical role of GLP-1 in the impaired counterregulatory response to hypoglycemia in T1DM patients and provide new insights into the potential application of GLP-1-related therapies in T1DM patients.

Mizagliflozin ameliorates diabetes induced kidney injury by inhibitor inhibit inflammation and oxidative stress

BACKGROUND

Mizagliflozin (MIZ) is a specific inhibitor of sodium-glucose cotransport protein 1 (SGLT1) originally developed as a medication for diabetes.

AIM

To explore the impact of MIZ on diabetic nephropathy (DN).

METHODS

Diabetic mice were created using db/db mice. They were administered either a low dose (0.5 mg/kg) or a high dose (1.0 mg/kg) of the SGLT1 inhibitor MIZ via stomach gavage for 8 weeks. Subsequently, mesangial cells (MCs) were isolated and subjected to high glucose conditions in culture to assess the effects of MIZ on DN.

RESULTS

The results showed that low doses of MIZ significantly reduced albuminuria to a level comparable to that achieved with high doses in db/db mice. High doses of MIZ led to a substantial increase in body weight in mice, along with decreased blood glucose levels and food intake. Moreover, the intervention with high-dose MIZ notably decreased the expression of extracellular matrix genes, such as collagen type 1 alpha 1 mRNA levels. While the expression of SGLT1 increased after exposure to high glucose, it decreased following treatment with MIZ. Furthermore, MIZ intervention was more effective in improving lactate dehydrogenase levels in MCs induced by high glucose compared to canagliflozin. MIZ also significantly elevated levels of antioxidant enzymes superoxide dismutase, catalase, and glutathione, while reducing malondialdehyde levels.

CONCLUSION

These findings indicate that MIZ can ameliorate DN by inhibiting SGLT1, inflammation, and oxidative stress.

Enhancing metformin efficacy with cholecalciferol and taurine in diabetes therapy: Potential and limitations

Diabetes mellitus, particularly type 2 diabetes mellitus (T2DM), poses a significant global health challenge. Traditional management strategies primarily focus on glycemic control; however, there is a growing need for comprehensive approaches addressing the complex pathophysiology of diabetes complications. The recent study by Attia et al explores the potential of a novel therapy combining metformin with cholecalciferol (vitamin D3) and taurine to mitigate T2DM-related complications in a rat model. The findings indicate that this treatment combination improves glycemic control and reduces oxidative stress, inflammation, and lipid abnormalities. However, the study is limited by a lack of safety profile data and in-depth molecular mechanism insights. This editorial critically highlights the study's strengths and weaknesses, compares it against other combination therapy research in T2DM, and underscores the need to explore further the mechanisms underpinning the observed therapeutic effects and investigate the safety profile of this novel approach.

Ubiquitination in diabetes and its complications: A perspective from bibliometrics

BACKGROUND

Diabetes has a substantial impact on public health, highlighting the need for novel treatments. Ubiquitination, an intracellular protein modification process, is emerging as a promising strategy for regulating pathological mechanisms. We hypothesize that ubiquitination plays a critical role in the development and progression of diabetes and its complications, and that understanding these mechanisms can lead to new therapeutic approaches.

AIM

To uncover the research trends and advances in diabetes ubiquitination and its complications, we conducted a bibliometric analysis.

METHODS

Studies on ubiquitination in diabetes mellitus and its complications were retrieved from the Web of Science Core Collection. Visual mapping analysis was conducted using the CiteSpace software.

RESULTS

We gathered 791 articles published over the past 23 years, focusing on ubiquitination in diabetes and its associated complications. These articles originated from 54 countries and 386 institutions, with China as the leading contributor. Shanghai Jiao Tong University has the highest number of publications in this field. The most prominent authors contributing to this research area include Wei-Hua Zhang, with Zhang Y being the most frequently cited author. Additionally, The Journal of Biological Chemistry is noted as the most cited in this field. The predominant keywords included expression, activation, oxidative stress, phosphorylation, ubiquitination, degradation, and insulin resistance.

CONCLUSION

The role of ubiquitination in diabetes and its complications, such as diabetic nephropathy and cardiomyopathy, is a key research focus. However, these areas require further investigations.

Influence of gut bacteria on type 2 diabetes: Mechanisms and therapeutic strategy

The onset and progression of type 2 diabetes mellitus (T2DM) are strongly associated with imbalances in gut bacteria, making the gut microbiome a new potential therapeutic focus. This commentary examines the recent publication in World Journal of Diabetes. The article explores the association between T2DM and gut microbiota, with a focus on the pathophysiological changes related to dysbiosis. It proposes innovative microbiome-targeted therapeutic strategies and evaluates the challenges and future directions of such approaches. This editorial summarizes the key points of their discussion of the role of the gut microbiome in T2DM and elaborates on the influence of specific gut microbial species on the disease through the host-microbiota metabolic axis. It provides new insights for future research on gut-microbiota-based interventions for T2DM.

Protein nanoparticles as potent delivery vehicles for polycytosine RNA-binding protein one

Ma et al recently reported in the World Journal of Diabetes that ferroptosis occurs in osteoblasts under high glucose conditions, reflecting diabetes pathology. This condition could be protected by the upregulation of the gene encoding polycytosine RNA-binding protein 1 (PCBP1). Additionally, Ma et al used a lentivirus infection system to express PCBP1. As the authors' method of administration can be improved in terms of stability and cost, we propose delivering PCBP1 to treat type 2 diabetic osteoporosis by encapsulating it in protein nanoparticles. First, PCBP1 is small and druggable. Second, intravenous injection can help deliver PCBP1 across the mucosa while avoiding acid and enzyme-catalyzed degradation. Furthermore, incorporating PCBP1 into nanoparticles prevents its interaction with water or oxygen and protects PCBP1's structure and activity. Notably, the safety of the protein materials and the industrialization techniques for large-scale production of protein nanoparticles must be comprehensively investigated before clinical application.

Association between age at diagnosis of diabetes and ocular disease: Insights from a recent article

In this article, we discuss Ye et al's recent article on the association between age at diabetes diagnosis and subsequent risk of age-related ocular diseases. The study, which utilized United Kingdom Biobank data, highlighted a strong link between early diabetes onset and major eye conditions, such as cataracts, glaucoma, age-related macular degeneration, and vision loss, independent of glycemic control and disease duration. This finding challenges the previous belief that diabetic eye disease primarily correlates with hyperglycemia. As lifestyles evolve and the age of diabetes diagnosis decreases, understanding this relationship may reveal the complex pathogenesis underlying diabetes-related complications. This editorial summarizes potential mechanisms connecting the age of diabetes onset with four types of ocular diseases, emphasizing the significance of early diagnosis.

Betaine combined with traditional Chinese medicine ointment to treat skin wounds in microbially infected diabetic mice

BACKGROUND

Skin wounds are highly common in diabetic patients, and with increasing types of pathogenic bacteria and antibiotic resistance, wounds and infections in diabetic patients are difficult to treat and heal.

AIM

To explore the effects of betaine ointment (BO) in promoting the healing of skin wounds and reducing the inflammation and apoptosis of skin cells in microbially infected diabetic mice.

METHODS

By detecting the minimum inhibitory concentrations (MICs) of betaine and plant monomer components such as psoralen, we prepared BO with betaine as the main ingredient, blended it with traditional Chinese medicines such as gromwell root and psoralen, and evaluated its antibacterial effects and safety in vitro and in vivo. The skin infection wound models of ordinary mice and diabetic mice were constructed, and the OTC drugs mupirocin ointment and Zicao ointment were used as controls to evaluate the antibacterial effects in vivo and the anti-inflammatory and anti-apoptotic effects of BO.

RESULTS

The MICs of betaine against microorganisms such as Staphylococcus aureus (S. aureus), Candida albicans and Cryptococcus neoformans ranged from 4 to 32 μg/mL. Gromwell root and psoralea, both of which contain antimicrobial components, mixed to prepare BO with MICs ranging from 16 to 64 μg/mL, which is 32-256 times lower than those of Zicao ointment, although the MIC is greater than that of betaine. After 15 days of treatment with BO for USA300-infected ordinary mice, the wound scab removal rates were 83.3%, while those of mupirocin ointment and Zicao ointment were 66.7% and 0%, respectively, and the differences were statistically significant. In diabetic mice, the wound scab removal rate of BO and mupirolacin ointment was 80.0%, but BO reduced wound inflammation and the apoptosis of skin cells and facilitated wound healing.

CONCLUSION

The ointment prepared by mixing betaine and traditional Chinese medicine can effectively inhibit common skin microorganisms and has a strong effect on the skin wounds of sensitive or drug-resistant S. aureus-infected ordinary mice and diabetic mice.

Clinical study on the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes

BACKGROUND

At present, the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent, to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes, the report is as follows.

AIM

To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus (T2DM).

METHODS

We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis. Metabolic indicators were collected preoperatively, as well as at 3 and 6 months postoperative. The metabolic indicators analyzed included body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), 2-hour blood glucose (PBG), glycated hemoglobin (HbA1c), fasting C-peptide, 2-hour C-peptide (PCP), fasting insulin (Fins), 2-hour insulin (Pins), insulin resistance index (HOMA-IR), β Cellular function index (HOMA-β), alanine aminotransferase, aspartate aminotransferase, serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein, and uric acid (UA) levels.

RESULTS

SBP, DBP, PBG, HbA1c, LDL-C, and TG were all significantly lower 3 months postoperative vs preoperative values; body weight, BMI, SBP, DBP, FBG, PBG, HbA1c, TC, TG, UA, and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months; and PCP, Fins, Pins, and HOMA-β were all significantly higher 6 months postoperative vs at 3 months (all P < 0.05).

CONCLUSION

Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.

Risk factors for developing osteoporosis in diabetic kidney disease and its correlation with calcium-phosphorus metabolism, FGF23, and Klotho

BACKGROUND

The progression of diabetic kidney disease (DKD) affects the patient's kidney glomeruli and tubules, whose normal functioning is essential for maintaining normal calcium (Ca) and phosphorus (P) metabolism in the body. The risk of developing osteoporosis (OP) in patients with DKD increases with the aggravation of the disease, including a higher risk of fractures, which not only affects the quality of life of patients but also increases the risk of death.

AIM

To analyze the risk factors for the development of OP in patients with DKD and their correlation with Ca-P metabolic indices, fibroblast growth factor 23 (FGF23), and Klotho.

METHODS

One hundred and fifty-eight patients with DKD who were admitted into the Wuhu Second People's Hospital from September 2019 to May 2021 were selected and divided into an OP group (n = 103) and a normal bone mass group (n = 55) according to their X-ray bone densitometry results. Baseline data and differences in Ca-P biochemical indices, FGF23, and Klotho were compared. The correlation of Ca-P metabolic indices with FGF23 and Klotho was discussed, and the related factors affecting OP in patients with DKD were examined by multivariate logistic regression analysis.

RESULTS

The OP group had a higher proportion of females, an older age, and a longer diabetes mellitus duration than the normal group (all P < 0.05). Patients in the OP group exhibited significantly higher levels of intact parathyroid hormone (iPTH), blood P, Ca-P product (Ca × P), fractional excretion of phosphate (FeP), and FGF23, as well as lower estimated glomerular filtration rate, blood Ca, 24-hour urinary phosphate excretion (24-hour UPE), and Klotho levels (all P < 0.05). In the OP group, 25-(OH)-D3, blood Ca, and 24-hour UPE were negatively correlated with FGF23 and positively correlated with Klotho. In contrast, iPTH, blood Ca, Ca × P, and FeP exhibited a positive correlation with FGF23 and an inverse association with Klotho (all P < 0.05). Moreover, 25-(OH)-D3, iPTH, blood Ca, FePO4, FGF23, Klotho, age, and female gender were key factors that affected the lumbar and left femoral neck bone mineral density.

CONCLUSION

The Ca-P metabolism metabolic indexes, FGF23, and Klotho in patients with DKD are closely related to the occurrence and development of OP.

Current perspectives and the future of disease-modifying therapies in type 1 diabetes

Use of immunomodulating agents to prevent the progression of autoimmune β-cell damage leading to type 1 diabetes mellitus (T1DM) is an interesting area for research. These include non-specific anti-inflammatory agents, immunologic vaccination and anti-inflammatory agents targeting specific immune cells or cytokines. Teplizumab is an anti-CD3-molecule that binds to and leads to the disappearance of the CD3/TCR complex and rendering the T cell anergic to its target antigen. Preclinical and clinical trials have demonstrated its efficacy in reducing the decline in serum C-peptide levels and the need for insulin therapy if used early in the disease process of T1DM. The benefits have been apparent as early as six months to as long as seven years after therapy. It has recently been approved by the Food and Drug Administration to delay the onset of clinical (stage 3) type 1 diabetes in children above 8 years of age. In their recent meta-analysis published in the World Journal of Diabetes, Ma et al found that those in the teplizumab treatment group have a greater likelihood of reduction in insulin use, change in C-peptide response, and better glycemic control compared to the control group with a good safety profile. However, all the included randomized control trials have been conducted in high-income countries. High cost of therapy and unknown utility of the molecule in stage 3 disease limit its widespread use.

Unveiling mitochondrial mysteries: Exploring novel tRNA variants in type 2 diabetes mellitus

The recent study of Ding et al provides valuable insights into the functional implications of novel mitochondrial tRNATrp and tRNASer(AGY) variants in type 2 diabetes mellitus (T2DM). This editorial explores their findings, highlighting the role of mitochondrial dysfunction in the pathogenesis of T2DM. By examining the molecular mechanisms through which these tRNA variants contribute to disease progression, the study introduces new targets for therapeutic strategies. We discuss the broader implications of these results, emphasizing the importance of understanding mitochondrial genetics in addressing T2DM.