Diagnosis and classification of diabetes mellitus

Fabrication of Au Nanostructured Thin Film via Femtosecond Laser Glass Texturing for Enhanced Glucose Sensing

Accurate glucose sensing is crucial for diabetes management, with nonenzymatic electrochemical devices promising enhanced durability and sensitivity. Nonetheless, widespread commercialization remains challenging, with the market still being dominated by their enzymatic counterparts. This study reports on the feasibility of femtosecond-laser texturing of glass followed by thin gold layer deposition to create a highly active and microchip-compatible glucose sensing platform. The laser treatment enables significant nanostructuring of the glass substrate, remarkably resulting in an 8 times greater surface area compared to flat gold films on glass. The electrodes were calibrated via both potentiostatic and potentiodynamic techniques. The laser-treated electrodes displayed in chronoamperometry a sensitivity to glucose of 63.9 ± 1.2 μA·cm-2·mM-1 in the 0.25 mM to 4 mM range and of 42.6 ± 0.8 μA·cm-2·mM-1 ranging from 5 mM to 10 mM. Compared to the flat film gold electrodes, the sensitivity was strikingly 5-fold and 10-fold greater for the two linear ranges. The effect of chlorides on gold was discussed both in terms of leaching from the Ag|AgCl reference electrode during sulfuric acid cycling and in terms of sensitivity decay in phosphate buffer solutions with physiological chloride concentrations. The combination of femtosecond-laser texturing with thin film deposition aims to facilitate the integration with preexisting glass-supported integrated sensing platforms, such as microfluidic systems for point-of-care applications. Its implementation offers substantial versatility, allowing for fine-tuning of the physicochemical properties of the electrode through straightforward adjustments in the deposition protocol parameters.

Applications and prospects of biomaterials in diabetes management

Diabetes is a widespread metabolic disorder that presents considerable challenges in its management. Recent advancements in biomaterial research have shed light on innovative approaches for the treatment of diabetes. This review examines the role of biomaterials in diabetes diagnosis and treatment, as well as their application in managing diabetic wounds. By evaluating recent research developments alongside future obstacles, the review highlights the promising potential of biomaterials in diabetes care, underscoring their importance in enhancing patient outcomes and refining treatment methodologies.

Development and validation of a machine learning model for prediction of type 2 diabetes in patients with mental illness

BACKGROUND

Type 2 diabetes (T2D) is approximately twice as common among individuals with mental illness compared with the background population, but may be prevented by early intervention on lifestyle, diet, or pharmacologically. Such prevention relies on identification of those at elevated risk (prediction). The aim of this study was to develop and validate a machine learning model for prediction of T2D among patients with mental illness.

METHODS

The study was based on routine clinical data from electronic health records from the psychiatric services of the Central Denmark Region. A total of 74,880 patients with 1.59 million psychiatric service contacts were included in the analyses. We created 1343 potential predictors from 51 source variables, covering patient-level information on demographics, diagnoses, pharmacological treatment, and laboratory results. T2D was operationalised as HbA1c ≥48 mmol/mol, fasting plasma glucose ≥7.0 mmol/mol, oral glucose tolerance test ≥11.1 mmol/mol or random plasma glucose ≥11.1 mmol/mol. Two machine learning models (XGBoost and regularised logistic regression) were trained to predict T2D based on 85% of the included contacts. The predictive performance of the best performing model was tested on the remaining 15% of the contacts.

RESULTS

The XGBoost model detected patients at high risk 2.7 years before T2D, achieving an area under the receiver operating characteristic curve of 0.84. Of the 996 patients developing T2D in the test set, the model issued at least one positive prediction for 305 (31%).

CONCLUSION

A machine learning model can accurately predict development of T2D among patients with mental illness based on routine clinical data from electronic health records. A decision support system based on such a model may inform measures to prevent development of T2D in this high-risk population.

Adiponectin may play a crucial role in the metabolic effects of GLP-1RAs treatment in patients with Type 2 Diabetes Mellitus: a preliminary longitudinal study

PURPOSE

Type 2 diabetes mellitus (T2DM) stands as the most prevalent metabolic disorder globally. T2DM entails numerous cardiovascular complications, which contribute significantly to morbidity, mortality, and increased public spending worldwide. The real challenge for new diabetes drugs lies not only in reducing blood glucose levels and glycated hemoglobin but also in preventing cardiovascular risk. Emerging receptor agonists for glucagon-like peptide-1 (GLP-1RAs) have demonstrated a pivotal role in diabetes management and mitigating cardiovascular risk.

METHODS

We conducted a 12-month longitudinal investigation evaluating the cardio-metabolic effects of GLP-1RAs on a cohort of 65 Caucasian patients diagnosed with T2DM who were scheduled for treatment with GLP-1RAs. Fifty-four T2DM patients successfully completed the 12-month study period, with 30 receiving dulaglutide and 24 receiving semaglutide.

RESULTS

In our study population, GLP-1RAs resulted in several positive changes beyond the observed weight loss: a shift in fat distribution, indicated by a reduction in the percentage of visceral fat (1.21 vs. 1.17, p < 0.05); a significant decrease in LDL cholesterol levels (p < 0.05) and triglycerides (p < 0.01); and a significant increase in serum adiponectin levels (p < 0.05), potentially indicating a reduction in insulin resistance and inflammation. Additionally, we observed a significant decrease in microalbuminuria and media-intimal thickness at the carotid vessel level (p < 0.05).

CONCLUSIONS

In patients with T2DM 1-year therapy with GLP-1RAs has a positive effect on the main determinants of cardiovascular risk including body weight, visceral fat, dyslipidemia, and atherosclerosis. Moreover, the increase in adiponectin may play a pivotal role in controlling the inflammatory state and the mechanisms of vascular damage.

Association of wide pulse pressure with coronary collateral flow in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

Coronary collateral flow (CCF) is crucial for myocardial viability in patients with obstructive coronary artery disease, specifically ST-elevation myocardial infarction (STEMI). However, hypertension can contribute to vascular dysfunction and hinder the formation of CCF. Wide pulse pressure (WPP), defined as ≥65 mmHg, may better reflect impaired cardiovascular health compared to classic blood pressure indices. The effect of WPP on CCF remains unclear. Therefore, we aimed to evaluate the impact of WPP on CCF. This retrospective study included 1180 STEMI patients that underwent primary percutaneous coronary intervention (PCI) between 2021 and 2023 at a tertiary healthcare center. Patients were classified into good and poor CCF groups based on the Rentrop classification. Out of these patients, 272 (23.1%) had good CCF, while 908 (76.9%) had poor CCF. Two distinct models were constructed using multivariable logistic regression analysis to identify independent predictors of good CCF, including pulse pressure (Model 1) and WPP (Model 2). Covariates such as age, gender, diabetes mellitus, smoking, pre-infarction angina, Killip Class 3/4, multivessel disease, peak troponin, pre-thrombolysis in myocardial infarction (TIMI) flow 0, and previous PCI were added to both models. WPP was identified as an independent predictor that negatively influences good CCF (OR: 0.511, 95% CI: 0.334-0.783, p = 0.002). Moreover, diabetes, pre-infarction angina, Killip class III/IV, multivessel disease, and pre-TIMI flow 0 were also found to be independent predictors of CCF. WPP, derived from blood pressure measurements, has been associated with poor CCF in STEMI patients undergoing primary PCI and may serve as a predictor of poor CCF.

Influence of rs1292037 Genetic Variant on miR-21 Gene Expression in Patients With Type 1 Diabetes Mellitus: A Case-Control Study

Background and Aims

Alterations in the expression pattern of miRNAs seem to be linked with autoimmune diseases such as type 1 diabetes mellitus (T1DM). Regarding the importance of assessing this potential link, we aimed to evaluate the relationship between miR-21 rs1292037 single-nucleotide polymorphism (SNP) and T1DM susceptibility. Furthermore, we investigated the miR-21 expression level in T1DM.

Methods

A total of 250 T1DM patients and 250 controls were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and miR-21 expression levels were assessed using real-time PCR. Moreover, the potential targets of miR-21 were investigated using different bioinformatics web servers.

Results

Our results showed that the T/C genotype and the C allele were more frequent in T1DM patients than in controls. Individuals carrying the T/C genotype in overdominant model were 2.74-fold at a higher risk of T1DM (OR = 2.74; 95%CI, 1.78-4.27; p < 0.0001). In addition, miR-21 expression was more than twofold higher in patients than in controls (p < 0.0001) and it was found to be significantly upregulated when carrying the T/C genotype. Regarding miR-21 predicted target genes, its overexpression may be associated with beta cell death, diabetic nephropathy, inflammatory responses, impaired insulin production or secretion, and T-cell cytotoxicity, which are important in the initiation and progression of T1DM.

Conclusion

Our results suggested that miR-21 rs1292037 may confer genetic susceptibility to T1DM. Therefore, it seems that this genetic link should be further investigated to enhance diagnostic and therapeutic strategies in these patients.

A dual-mode biosensor based on metal organic framework-coated upconversion composites with near-infrared luminescence and peroxidase-like activity for the detection of alkaline phosphatase and glucose

An abnormal level of alkaline phosphatase (ALP) in serum is related to many diseases, such as breast cancer, prostate cancer, hepatitis, and diabetes. The level of glucose in the blood is related to diabetes or hypoglycemia. Given the close correlation between ALP and glucose in various diseases, it is essential to establish an accurate, sensitive, and selective assay for monitoring the levels of ALP and glucose in serum. As luminescent materials, upconversion nanoparticles (UCNPs) stand out in the design of biosensors because of their high photostability, large anti-Stokes shifts and low background interference. Additionally, metal organic frameworks (MOFs) are a class of functional porous materials, and their adjustable pore size structure and high specific surface area expose many catalytic sites, making MOFs excellent catalysts and ideal materials for constructing artificial enzymes. Herein, a fluorescent and colorimetric dual-mode probe based on a multifunctional composite (UCNP@MOF) with upconversion luminescence and peroxidase-like activity was proposed for the detection of ALP and glucose. Under the optimal conditions, the detection limits of ALP and glucose by the fluorescence method were 0.046 U/L and 0.079 μM, respectively. Furthermore, the method was used to determine ALP and glucose in serum samples, and the detection results were similar to those of commercial kits; moreover, the recoveries were in the range of 92.7-105.4 %, indicating great potential for accurate and sensitive detection of ALP and glucose in biological samples.

Associations between dose-response of serum creatinine and type 2 diabetes mellitus risk: consistent and robust evidence from a systematic review and meta-analysis

BACKGROUND

Skeletal muscle is the key target of insulin action. Therefore, a reduction in skeletal muscle mass may trigger insulin resistance, a mechanism of diabetes. Creatinine is the only metabolite of creatine phosphate in the skeletal muscle. Exploring the association between serum creatinine level and T2DM is helpful for the early identification and prevention of T2DM.

RESEARCH DESIGN AND METHODS

Five electronic databases, PubMed, Scopus, Web of Science, Embase, and Epistemonikos, were searched for relevant articles published up to June 2024. Cohort studies and case-control studies were evaluated using the Joanna Briggs Institute (JBI) checklist. The random-effects model calculated the pooled risk ratio and 95% confidence intervals (CIs) based on a heterogeneity test (I2 statistics). Egger's test was used to evaluate publication bias.

RESULTS

The pooled RR of diabetes type 2 for the lowest versus the highest serum creatinine was 1.39 (95% CI: 1.17-1.64); I2 = 90.1%; p = 0.002. We found a non-linear association between low serum creatinine level and T2DM risk (pNonlinearity = 0.02), and a decrease of each 0.1 mg/dL serum creatinine increases 1% risk of T2DM [RR = 1.49 (95% CI: 1.17-2.82), I2 = 0%, p = 0.999].

CONCLUSIONS

This meta-analysis offers evidence of the negative relationship between serum creatinine levels and the risk of developing T2DM in a linear dose-response pattern.

Serum Ferritin Combined with Glycated Hemoglobin for Early Prediction of Gestational Diabetes Mellitus: A Retrospective Cohort Study

OBJECTIVE

To investigate the value of serum ferritin (SF) in conjunction with glycated hemoglobin (HbA1c) for the early prediction of gestational diabetes mellitus (GDM) and to provide insights that could enhance health care standards for women and newborns.

METHODS

A retrospective cohort study was conducted involving 650 pregnant women who received regular prenatal check-ups at our institution from January 2019 to April 2024. Participants were categorized into four groups based on their SF concentration quartiles during the 11th to 13th weeks of gestation. Logistic regression analyses were conducted to assess the predictive value of early GDM risk factors, with the lowest quartile group serving as a reference.

RESULTS

The incidence rate of GDM rose progressively with increasing SF concentrations at 11-13 weeks of gestation, with rates of 18.79%, 21.25%, 24.38%, and 25.45% respectively. Notably, the incidence rate in the highest quartile group (quartile 4) was significantly higher compared to the lowest (quartile 1), with an odds ratio of 1.48 and a 95% confidence interval of 1.12 to 1.93. Additionally, the predictive model incorporating both SF concentration and HbA1c (Model 2) outperformed the model with SF alone (Model 1), indicating a heightened predictive accuracy for GDM when these two biomarkers are used in combination.

CONCLUSION

The findings of this study highlight the potential utility of SF and HbA1c as early predictors of GDM risk, especially when employed in combination.

Comprehensive treatment of diabetic endothelial dysfunction based on pathophysiological mechanism

Vascular endothelium is integral to the regulation of vascular homeostasis and maintenance of normal arterial function in healthy individuals. Endothelial dysfunction is a significant contributor to the advancement of atherosclerosis, which can precipitate cardiovascular complications. A notable correlation exists between diabetes and endothelial dysfunction, wherein chronic hyperglycemia and acute fluctuations in glucose levels exacerbate oxidative stress. This results in diminished nitric oxide synthesis and heightened production of endothelin-1, ultimately leading to endothelial impairment. In clinical settings, it is imperative to implement appropriate therapeutic strategies aimed at enhancing endothelial function to prevent and manage diabetes-associated vascular complications. Various antidiabetic agents, including insulin, GLP-1 receptor agonists, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, α-glucosidase inhibitors, thiazolidinediones (TZDs), and metformin, are effective in mitigating blood glucose variability and improving insulin sensitivity by lowering postprandial glucose levels. Additionally, traditional Chinese medicinal compounds, such as turmeric extract, resveratrol, matrine alkaloids, tanshinone, puerarin, tanshinol, paeonol, astragaloside, berberine, and quercetin, exhibit hypoglycemic properties and enhance vascular function through diverse mechanisms. Consequently, larger randomized controlled trials involving both pharmacological and herbal interventions are essential to elucidate their impact on endothelial dysfunction in patients with diabetes. This article aims to explore a comprehensive approach to the treatment of diabetic endothelial dysfunction based on an understanding of its pathophysiology.

Association of GGT and hs-CRP with hypertension across different glycemic states in Saudi adults: A cross-sectional study

Introduction

Atherosclerosis, hypertension, and diabetes (DM) is preceded by inflammation and endothelial dysfunction. Early detection of these risk factors is expected to improve prognosis. We aimed to examine the association between gamma-glutamyl transferase (GGT) and highly sensitive C-reactive protein (hs-CRP) with hypertension (HTN) in the presence and absence of dysglycaemia among Saudi adults not previously diagnosed with DM.Methods: adults were recruited randomly from public healthcare centres in Jeddah. Demographic information, blood pressure, and anthropometric measurements were taken. Fasting blood samples were drawn to measure glucose, glycated haemoglobin, lipid profile, hs-CRP, and GGT. Blood was drawn again following a 1-h oral glucose tolerance test, and plasma glucose was measured.

Results

Mean GGT and hs-CRP were higher in people with HTN and dysglycaemia than those without both (P < 0.001). In people with HTN, those with intermediate hyperglycaemia (pre-DM) had significantly higher means of GGT and hs-CRP compared with those without (P < 0.001 and 0.013, respectively). In people with pre-DM, those with HTN had significantly higher means of GGT than those without (P = 0.008), but the increase in mean hs-CRP was not statistically significant. Mean GGT was higher in people with DM compared to means of those with pre-DM and HTN (P = 0.04).

Conclusion

An association between higher serum levels of hs-CRP and GGT and dysglycaemia exists, especially in hypertensive people. Monitoring both biomarkers in dysglycaemic people, especially if they have elevated blood pressure, is recommended to initiate therapeutic interventions.

Finerenone Ameliorates High Glucose-Induced Podocytes Epithelial-Mesenchymal Transition Through the Regulation of Krüppel-Like Factor 5 in Diabetic Nephropathy

Introduction

Diabetic nephropathy (DN) could impair the function of the glomerular filtration barrier by damaging the podocytes. Extant research has demonstrated that aldosterone plays a crucial role in this progression. Finerenone is a novel, high-selective mineralocorticoid receptor antagonist that has been demonstrated to be efficacious in renal protection in DN patients, albeit with an unclear underlying mechanism.

Methods

Podocytes were stimulated with RPMI 1640 medium containing different concentrations of glucose and treated with finerenone to evaluate the protective effect of finerenone on podocytes in high glucose environment. Intraperitoneal injection of STZ was used to induce diabetic nephropathy rats and intragastric administration with finerenone or vehicles, and the changes of renal function, renal pathological changes and renal tissue protein expression were assayed.

Results

Cell experiment showed that high glucose could induce epithelial-mesenchymal transition (EMT). After finerenone treatment, we accessed the EMT-related protein and found EMT was reversed. Besides, the cell migration capacity and cytoskeleton were also ameliorated. To further explore the mechanism, we found that finerenone could upregulate the expression of Krüppel-like factor 5 (KLF5) which was downregulated in a high glucose environment. After the silence of KLF5 in the presence of finerenone, the rescue experiment showed the protective function of finerenone is counteracted by KLF5. In animal experiment, after the treatment of finerenone, the level of blood creatinine decreased compared with the DN group while blood urea nitrogen (BUN) and potassium showed no significant difference. The pathological alterations of the treatment group also got ameliorated. Finerenone could normalize the level of EMT-related protein, nephrin, and KLF5 of kidney tissue in DN rats.

Conclusion

Our results suggest that finerenone could alleviate high glucose-induced podocyte EMT via regulating KLF5. Further investigation is warranted to elucidate the precise underlying mechanism.

Correlation between circulating microRNAs and vascular biomarkers in type 2 diabetes based upon physical activity: a biochemical analytic study

BACKGROUND

This research investigated how physical activity (PA) might impact the expression of several microRNAs, specifically miR-126, miR-146a, miR-34a, miR-124a, miR-155, and miR-221, in the blood of elderly individuals with type 2 diabetes (T2D). Additionally, the study examined the relationship between these microRNAs and markers of vascular endothelial dysfunction, including vascular endothelial growth factor (VEGF), apolipoprotein A-I (apoA-I), and apolipoprotein B (apoB), to assess their potential in the prevention, early detection, and treatment of diabetes.

METHODS

This correlational observational study involved 100 male participants, aged between 18 and 65 years, all of whom had been living with type 2 diabetes (T2D) for over six years. The participants were divided into three groups: inactive, moderate, and active, depending on their level of physical activity (PA). Real-time PCR and immunoassays were employed to measure the expression of selected miRNAs, as well as VEGF, apoA-I, apoB, and diabetic management indicators. PA levels were determined using ACTi graph GT1M accelerometer (model WAM 7164; Fort Walton Beach, FL) and energy expenditure was measured in the form of metabolic equivalent (MET) by indirect calorimetry method.

RESULTS

The expression levels of miR-146a, miR-34a, and miR-124a were significantly higher in patients with higher physical activity, while no such increase was observed for the other miRNAs in less active participants. Additionally, PA-active individuals showed a more pronounced decrease in fasting blood sugar (FBS), insulin resistance (IR), fasting insulin (FINS), HOMA-IR, HbA1c (%), and levels of VEGF, apoAI, apoB, and the apoB/apoA-I ratio. The alteration in miRNA expression was positively associated with physical activity, VEGF, apoAI, apoB, the apoB/apoA-I ratio, and diabetes-related metrics, while being inversely related to BMI.

CONCLUSIONS

In diabetic patients with higher physical activity levels, circulating miR-146a, miR-34a, and miR-124a showed elevated expression, accompanied by a notable decrease in vascular biomarkers, including apoAI, apoB, and the apoB/apoA-I ratio. The findings revealed a strong correlation between these vascular biomarkers and the physiological responses of miR-146a, miR-34a, and miR-124a, though larger studies are required to validate these results further.

TRIAL REGISTRATION

Not applicable.

Association Between ABCG1/TCF7L2 and Type 2 Diabetes Mellitus: An Intervention Trial Based on a Case-Control Study

Background and Objective: Type 2 diabetes mellitus (T2DM) is the result of both genetic and environmental factors. Environmental factors may contribute to the occurrence and development of T2DM by influencing epigenetic modification. The objective of this study was to explore the potential functions of two SNP-CG sites (rs7901695 of TCF7L2 and cg06500161 of ABCG1) that are most strongly associated with T2DM. Given that Uyghur population has been less studied, we conducted an intervention trial in Uyghur people to provide evidence for personalized health management of T2DM in them. Methods: From May to July 2022, 320 patients with T2DM and 332 patients without T2DM were treated with dietary pagoda-based health education intervention. The demographic data were collected before intervention and basic physical biochemical indexes before and after intervention by questionnaire and physical biochemical examination. SNP typing was performed by the TaqMan-MGB probe method, and gene methylation was detected by the pyrosequencing method. Results: The rs7901695 genotype difference of TCF7L2 was statistically significant between the case group and the control group (p < 0.05). After adjusting for covariates (smoking, alcohol consumption, exercise, fasting blood glucose (FPG), obesity, and hypertension), the genotype of rs7901695 in the TCF7L2 gene was associated with genetic susceptibility to T2DM in additive (TC vs. TT,p = 0.047; CC vs. TT,p = 0.010), dominant (p = 0.015), and recessive (p = 0.039) models. Before intervention, there were significant differences in the intake of water between the case group and the control group (p < 0.05). After intervention, there was statistical significance in the intake of coarse grains, fruits, aquatic products, eggs, dairy products, soy products, nuts, edible oils, and water between the case group and the control group (ps < 0.05). Logistic regression analysis showed that methylation of the ABCG1 gene was correlated with T2DM susceptibility after adjustment of covariable before intervention (p = 0.015, odds ratio (OR): 1.023; 95% confidence interval (CI): 1.004~1.041) but not after intervention. Generalized multifactor dimensionality reduction (GMDR) showed that the rs7901695 locus of the TCF7L2 gene and the cg06500161 locus of the ABCG1 gene had interaction with hypertension, dyslipidemia, abdominal obesity, and obesity and also had interaction with drinking, smoking, and exercise. Conclusions: The interaction of the rs7901695 site of the TCF7L2 gene and the cg06500161 site of the ABCG1 gene with environmental factors may increase the risk of T2DM in Uyghurs. The interaction between the cg06500161 site of the ABCG1 gene and environmental factors on T2DM varied with the intervention. The cg06500161 site of ABCG1 may serve as a biomarker to evaluate the effect of T2DM interventions.

ACSS2 and metabolic diseases: from lipid metabolism to therapeutic target

Elevated incidence of metabolic disorders has been reported worldwide in the recent decade, highlighting the need for developing efficient therapies. These diseases result from a complex interplay of various factors that contribute to disease progression, complications, and resistance to current treatment options. Acetyl-CoA Synthetase Short Chain Family Member 2 (ACSS2) is a nucleo-cytosolic enzyme with both lipogenic and metabolic regulatory roles. Studies on ACSS2 have shown that it is involved in pathways commonly dysregulated in metabolic disorders, leading to fat deposition and disrupted cellular signaling. Although multiple studies have suggested a role of ACSS2 in the metabolic rewiring during tumorigenesis, few studies have examined its involvement in the pathophysiology of metabolic diseases. Recent evidence indicates that ACSS2 may contribute to the pathogenesis of various metabolic disorders making its examination of great interest and potentially aiding in the development of new therapeutic strategies. The objective of this review is to summarize the current understanding of ACSS2's role in metabolic disorders and its potential as a therapeutic target.

Prospective associations between muscle strength and genetic susceptibility to type 2 diabetes with incident type 2 diabetes: a UK Biobank study

BACKGROUND

This study explored whether the prospective associations between muscle strength and incident type 2 diabetes (T2D) differ by varying levels of genetic susceptibility to T2D.

METHODS

This study included 141,848 white British individuals from the UK Biobank. Muscle strength was expressed as the relative value of grip strength (measured by a hand dynamometer) divided by fat-free mass (measured via bioelectrical impedance analysis). Three categories of muscle strength (low, medium and high) were generated based on the sex- and age-specific tertiles. Genetic risk of T2D was estimated using a weighted polygenic risk score based on 138 independent single-nucleotide polymorphisms for T2D. During a median 7.4-year follow-up, 4,743 incident T2D cases were accrued. Cox regression with age as the underlying timescale was fit.

RESULTS

High muscle strength was associated with a 44% lower hazard of T2D (HR:0.56, 95%CI:0.52-0.60), compared with low muscle strength, after adjustment for genetic risk of T2D. The inverse association between muscle strength and incident T2D was weaker in individuals with high genetic susceptibility. There was evidence of interaction between muscle strength and genetic susceptibility to T2D (p-additive = 0.010, p-multiplicative = 0.046). The estimated 8-year absolute risk of T2D was lower for high genetic risk-high muscle strength (2.47%), compared with low (2.89%) or medium (4.00%) genetic risk combined with low muscle strength.

CONCLUSIONS

Higher muscle strength was associated with lower relative risk of developing T2D, irrespective of genetic susceptibility to T2D, while such association was weaker in the high genetic risk group. Individuals at high genetic risk of T2D but with high muscle strength may have a lower 8-year absolute risk of developing T2D, compared with those at low or medium genetic risk but with low muscle strength. Our findings inform future clinical trials to prevent or delay the onset of T2D by implementing muscle-strengthening interventions among individuals of varying levels of genetic susceptibility to T2D, including those with high genetic risk.

The burden of prediabetes in low- and middle-income countries: a systematic review and meta-analysis

The global burden of diabetes is rising sharply, with a significant proportion of cases emerging in low- and middle-income countries (LMICs). Prediabetes, a condition characterized by elevated blood glucose levels that do not yet meet the threshold for diabetes, serves as a crucial stage for intervention and prevention. Despite its importance, comprehensive data on prediabetes prevalence in LMICs are sparse. Thus, we conducted a systematic review and meta-analysis to ascertain the prevalence of prediabetes in LMICs. We systematically reviewed studies on prediabetes in Low- and Middle-Income Countries (LMICs) from 1st January 2003 and 31st July 2024 using PubMed, Scopus, and Web of Science databases. The NIH study quality assessment tool assessed bias, and pooled prevalence was determined via a random-effects model. We examined publication bias through funnel plot analysis and Begg's and Egger's tests. The prevalence of prediabetes estimated from 164 studies conducted in LMICs was 13.1% (95% CI: 11.7%, 14.5%) based on the World Health Organization (WHO) criteria, and 27.0% (95% CI: 24.5%, 29.5%) based on the American Diabetes Association (ADA) criteria. The pooled prevalence did not significantly differ between males and females for both diagnostic criterias and by study design. The analysis indicated a noteworthy degree of heterogeneity in the pooled estimates (I2 > 70%; p < 0.05). The findings from this study indicated a higher burden of prediabetes within LMICs with regional variations.

Exploring the Role of Hypoxia and HIF-1α in the Intersection of Type 2 Diabetes Mellitus and Endometrial Cancer

Diabetes and Cancer are the most complex chronic diseases, accounting for significant global mortality and morbidity. The association between Type 2 DM (T2DM) and endometrial cancer (EC) is multifaced, sharing numerous risk factors, including insulin resistance, obesity, hypoxia, and oxidative stress. Hypoxia plays a vital role in T2DM pathogenesis by altering the insulin level and pancreatic β-cell failure through an imbalance between antioxidant enzymes and cellular oxidative levels, while chronic inflammation contributes to EC malignancy. HIF-1α is a potent transcription factor involved in modulating cellular responses to hypoxia within the disease environment. Targeting the HIF-1α signaling cascade, a major metabolic regulator may contribute to advanced therapeutic advances. This review focuses on the association between T2DM and EC, especially focusing on hypoxia and HIF signaling pathways. These intersect with key pathways involved in T2DM and EC pathology, such as insulin signaling, PI3K/AKT, mTOR pathway, MUC1/HIF-1α pathway, and hormonal imbalance. Understanding this complex relationship paves the way for future researchers to develop HIF-1α-targeted therapies that could lead to novel combination therapies to treat these comorbid conditions.

A visually-induced optogenetically-engineered system enables autonomous glucose homeostasis in mice

With the global population increasing and the demographic shifting toward an aging society, the number of patients diagnosed with conditions such as peripheral neuropathies resulting from diabetes is expected to rise significantly. This growing health burden has emphasized the need for innovative solutions, such as brain-computer interfaces. brain-computer interfaces, a multidisciplinary field that integrates neuroscience, engineering, and computer science, enable direct communication between the human brain and external devices. In this study, we developed an autonomous diabetes therapeutic system that employs visually-induced electroencephalography devices to capture and decode event-related potentials using machine learning techniques. We present the visually-induced optogenetically-engineered system for therapeutic expression regulation (VISITER), which generates diverse output commands to control illumination durations. This system regulates insulin expression through optogenetically-engineered cells, achieving blood glucose homeostasis in mice. Our results demonstrate that VISITER effectively and precisely modulates therapeutic protein expression in mammalian cells, facilitating the rapid restoration of blood glucose homeostasis in diabetic mice. These findings underscore the potential for diabetic patients to manage insulin levels autonomously by focusing on target images, paving the way for a more self-directed approach to blood glucose control.

The application of procyanidins in diabetes and its complications: a review of preclinical studies

Diabetes mellitus (DM) and its various complications, including diabetic nephropathy, retinopathy, neuropathy, cardiovascular disease, and ulcers, pose significant challenges to global health. This review investigates the potential of procyanidins (PCs), a natural polyphenolic compound, in preventing and managing diabetes and its complications. PCs, recognized for their strong antioxidant, anti-inflammatory, and anti-hyperglycemic properties, play a crucial role in reducing oxidative stress and enhancing endothelial function, which are essential for managing diabetic complications. This review elucidates the molecular mechanisms by which PCs improve insulin sensitivity and endothelial health, thereby providing protection against the various complications of diabetes. The comprehensive analysis underscores the promising therapeutic role of PCs in diabetes care, indicating the need for further clinical studies to confirm and leverage their potential in comprehensive diabetes management strategies.

Prospective transitions in hemoglobin A1c following gestational diabetes using multistate Markov models

We characterized the state-to-state transitions in postpartum hemoglobin A1c levels after gestational diabetes, including remaining in a state of normoglycemia or transitions between prediabetes or diabetes states of varying severity. We used data from the APPLE Cohort, a postpartum population-based cohort of individuals with gestational diabetes between 2009 and 2011, and linked A1c data with up to 9 years of follow-up (n = 34 171). We examined maternal sociodemographic and perinatal characteristics as predictors of transitions in A1c progression using Markov multistate models. In the first year postpartum following gestational diabetes, 45.1% of people had no diabetes, 43.1% had prediabetes, 4.6% had controlled diabetes, and 7.2% had uncontrolled diabetes. Roughly two-thirds of individuals remained in the same state in the next year. Black individuals were more likely to transition from prediabetes to uncontrolled diabetes (adjusted hazard ratio [aHR] = 2.32; 95% CI, 1.21-4.47) than White persons. Perinatal risk factors were associated with disease progression and a lower likelihood of improvement. For example, hypertensive disorders of pregnancy were associated with a stronger transition (aHR = 2.06; 95% CI, 1.39-3.05) from prediabetes to uncontrolled diabetes. We illustrate factors associated with adverse transitions in incremental A1c stages and describe patient profiles that may warrant enhanced postpartum monitoring.

Nonlinear relationship between hepatic steatosis index and reversion to normal glucose regulation in Chinese adults with prediabetes

The hepatic steatosis index (HSI) has been demonstrated to have a significant correlation with prediabetes and diabetes; however, its potential association with reversion to normal glucose regulation (NGR) from prediabetes remains insufficiently investigated. The primary objective of this study was to elucidate the relationship between HSI levels and the probability of reversion to NGR among Chinese adults with prediabetes. This retrospective cohort study utilized health examination data from 11,241 Chinese adults with prediabetes. Cox proportional hazard models were employed to calculate hazard ratios (HR) and 95% confidence intervals (CI) to assess the association between HSI levels and reversion to NGR. Additionally, a Cox proportional hazards regression model incorporating cubic spline functions and smooth curve fitting was utilized to determine any nonlinear relationships between HSI levels and reversion to NGR. The results of the multivariate analyses demonstrated a significant association between reduced HSI levels and an increased likelihood of reversion to NGR (HR = 0.92, 95%CI: 0.89-0.95, P < 0.0001). Furthermore, a nonlinear relationship was identified between HSI levels and the reversion to NGR, with a critical threshold at an HSI value of 43.08. Below this threshold, a strong negative association was observed, markedly enhancing the probability of returning to normoglycemic status (HR = 0.91, 95% CI: 0.88-0.94, P < 0.0001). This study reveals a negative, nonlinear correlation between HSI levels and the reversion to NGR in individuals with prediabetes. These findings highlight the essential role of effectively managing HSI as part of comprehensive prediabetes treatment strategies, which may significantly enhance the likelihood of achieving normoglycemic status.

Metabolic control and its associated factors in type 1 diabetic people: longitudinal trajectory modeling

BACKGROUND

Diabetes is a chronic disease, and hyperglycemia can increase the risk of diabetic complications and the need for more inpatient services. Therefore, the prevention and control of diabetes are important. This study aimed to identify the trajectories of metabolic control and its correlates in people with type 1 diabetes.

METHOD

This is a longitudinal study with 2020 type 1 diabetic individuals aged 18 to 59 years. The participants' glycosylated hemoglobin (HbA1c) was measured three times with a six-month interval between each measurement. The data were analyzed using group-based trajectory modeling. Multinomial logistic regression was used to determine the factors related to these groups.

RESULTS

The results showed four trajectories of safe controlled (46.2%), moderate stable risk (28.7%), moderate increasing risk (12.5%), and high decreasing risk trajectory (12.6%) (entropy = 0.70). The results of multinomial logistic regression showed dyslipidemia could increase the odds of being in the three risk trajectories. Education, physical inactivity, and poor psychological status could also increase the odds of being in the moderate stable and high decreasing trajectories. Moreover, sex, job, and BMI could increase the odds of being in the high decreasing risk group (p < 0.05).

CONCLUSION

Since there are different trajectories of metabolic control of diabetes, it is necessary for healthcare providers and health experts to plan behavioral interventions based on the location of individuals in different trajectories and the related significant risk factors. In this way, appropriate prevention, care, and treatment programs can be provided for the people in each group.

Associations between ABO, FUT2 and chronic pancreatitis: A comprehensive meta-analysis of multiple cohorts and public biobanks

OBJECTIVES

Associations of ABO blood group specifying transferases A/B (ABO) and fucosyltransferase 2 (FUT2) with CP remain inconclusive. We aimed to comprehensively investigate the associations by Chinese sequencing cohorts and external cohorts.

METHODS

First, we analyzed the distributions of ABO blood groups and FUT2 status, along with lead single nucleotide polymorphisms (SNPs) at ABO (rs8176693 C/T) and FUT2 (rs632111 A/G) gene loci in Chinese low-coverage whole-genome sequencing discovery cohort. Subsequently, we investigated the associations of CP with ABO and FUT2 SNPs in Chinese whole-exome sequencing validation cohort and three public biobanks (FinnGen, UK Biobank, and BioBank Japan). Finally, comprehensive meta-analysis was performed by integrating data from two Chinese cohorts, reported cohorts and public biobanks.

RESULTS

Firstly, in Chinese discovery cohort, the distribution of blood types in CP patients showed no significant difference compared to healthy controls, and similar results were observed in subgroup analyses and in meta-analysis with the reported cohorts. Secondly, results indicated no association between rs8176693 or rs632111 and CP in Chinese cohorts and meta-analysis of three biobanks, though ABO SNP was found to be significantly associated with CP in UK Biobank (odds ratio [OR] = 1.27, P = 0.04). Finally, no association was observed between rs8176693 (OR = 1.03, P = 0.29) or rs632111 (OR = 1.04, P = 0.10) and CP in comprehensive meta-analysis.

CONCLUSIONS

No association was found between lead SNPs of ABO or FUT2 and CP in meta-analysis, nor was there an association between ABO blood group or FUT2 secretor status and CP in Chinese cohort. ABO and FUT2 might play limited role in CP development.

Influence of Smoking and Controlled Medical Conditions on the Risks of Branch Retinal Vein Occlusion in South Korea: A Population-Based Study

PURPOSE

To evaluate the effect of controlled medical conditions and risk of lifetime smoking history on the prevalence of branch retinal vein occlusion (BRVO) based on the Korea National Health and Nutrition Survey (KNHANES) database from 2017-2021.

METHODS

The study population consisted of individuals aged ≥ 40 years who had completed ophthalmological questionnaires, underwent comprehensive ophthalmological examinations, and had at least one good-quality readable fundus photograph. Age, sex, hypertension status, diabetes status, dyslipidemia status, body mass index status, a history of chronic kidney disease (CKD), a lifetime smoking history of ≥ 100 cigarettes, and glaucoma were subjected to univariate and multivariate logistic regression analyses.

RESULTS

The estimated prevalence (± standard error) of RVO was 0.5% (±0.1%). Significant risk factors were one-year increase in age, female sex, hypertension (stage 1, controlled, uncontrolled, and undiagnosed hypertension), underweight, pre-obesity, history of CKD, lifetime smoking history of ≥ 100 cigarettes, and glaucoma. Controlled diabetes decreased the risk of BRVO by 55% (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.22-0.89, p = 0.022) and controlled hyper-high-density-lipoprotein (HDL)-cholesterolemia decreased the risk by 69% (OR = 0.31, 95% CI = 0.13-0.76, p = 0.010).

CONCLUSION

This study, for the first time, reported the association between lifetime smoking history of ≥ 100 cigarettes and BRVO in Korea. The risk of BRVO was lower in participants with controlled diabetes and hypo-HDL-cholesterolemia.

Structure-based molecular docking and molecular dynamics simulations study for the identification of dipeptidyl peptidase 4 inhibitors in type 2 diabetes

Inhibition of dipeptidyl peptidase-4 (DPP4) activity has emerged as a promising therapeutic approach for the treatment of type 2 diabetes mellitus (T2DM). Bioinformatics-driven approaches have emerged as crucial tools in drug discovery. Molecular docking and molecular dynamics (MD) simulations are effective tools in drug discovery, as they reduce the time and cost associated with experimental screening. In this study, we employed structure-assisted in-silico methods, including molecular docking and MD simulations, to identify SRT2183, a small molecule that may potentially inhibit the activity of DPP4 enzyme. The interaction between the small molecule "SRT2183" and DPP4 exhibited a binding affinity of -9.9 Kcal/Mol, leading to the formation of hydrogen bonds with the amino acid residues MET348, SER376, and THR351 of DPP4. The MD simulations over a period of 100 ns indicated stable protein-ligand interactions, with no significant conformational rearrangements observed within the simulated timeframe. In conclusion, our results suggest that the small molecule SRT2183 may have the potential to inhibit the DPP4 enzyme and pave the way for the therapeutics of T2DM.Communicated by Ramaswamy H. Sarma.

The link between the ANPEP gene and type 2 diabetes mellitus may be mediated by the disruption of glutathione metabolism and redox homeostasis

Aminopeptidase N (ANPEP), a membrane-associated ectoenzyme, has been identified as a susceptibility gene for type 2 diabetes (T2D) by genome-wide association and transcriptome studies; however, the mechanisms by which this gene contributes to disease pathogenesis remain unclear. The aim of this study was to determine the comprehensive contribution of ANPEP polymorphisms to T2D risk and annotate the underlying mechanisms. A total of 3206 unrelated individuals including 1579 T2D patients and 1627 controls were recruited for the study. Twenty-three common functional single nucleotide polymorphisms (SNP) of ANPEP were genotyped by the MassArray-4 system. Six polymorphisms, rs11073891, rs12898828, rs12148357, rs9920421, rs7111, and rs25653, were found to be associated with type 2 diabetes (Pperm ≤ 0.05). Common haplotype rs9920421G-rs4932143G-rs7111T was strongly associated with increased risk of T2D (Pperm = 5.9 × 10-12), whereas two rare haplotypes such as rs9920421G-rs4932143C-rs7111T (Pperm = 6.5 × 10-40) and rs12442778A-rs12898828A-rs6496608T-rs11073891C (Pperm = 1.0 × 10-7) possessed strong protection against disease. We identified 38 and 109 diplotypes associated with T2D risk in males and females, respectively (FDR ≤ 0.05). ANPEP polymorphisms showed associations with plasma levels of fasting blood glucose, aspartate aminotransferase, total protein and glutathione (P < 0.05), and several haplotypes were strongly associated with the levels of reactive oxygen species and uric acid (P < 0.0001). A deep literature analysis has facilitated the formulation of a hypothesis proposing that increased plasma levels of ANPEP as well as liver enzymes such as aspartate aminotransferase, alanine aminotransferase and gammaglutamyltransferase serve as an adaptive response directed towards the restoration of glutathione deficiency in diabetics by stimulating the production of amino acid precursors for glutathione biosynthesis.

Evaluation of parotid and submandibular salivary glands with ultrasonography in diabetic patients

OBJECTIVES

The main symptom of diabetes mellitus (DM) is hyperglycaemia, and patients with DM often have microvascular complications, such as retinopathy, neuropathy, and nephropathy; macrovascular complications, such as coronary heart disease, peripheral arterial disease and cerebrovascular disease; and oral complications, such as xerostomia, hyposalivation and periodontal disease. The main aim of this study was to evaluate the submandibular and parotid glands in type 2 DM patients and healthy individuals and to determine the changes in the salivary glands caused by diabetes.

MATERIALS AND METHODS

In this study, the salivary glands of 100 patients (50 individuals with type 2 DM and 50 healthy individuals) were evaluated by ultrasonography (US). Echogenicity, parenchymal homogeneity, hypoechogenic and hyperechogenic areas, margin characteristics, and vascularity of the glands were analysed. The anteroposterior, superoinferior, and mediolateral lengths and volumes of the submandibular glands were measured.

RESULTS

Statistically significant differences in submandibular gland echogenicity, parotid gland vascularity, and hyperechogenic reflections of the parotid glands were observed between the groups (p < 0.05). In addition, the volume and dimensions of the submandibular glands were significantly greater in the type 2 DM group.

CONCLUSIONS

DM leads to changes in the salivary glands. US, which has many advantages for salivary gland imaging, is a highly effective method for investigating these changes in individuals with diabetes.

CLINICAL RELEVANCE

US, which is well tolerated by patients and does not involve ionizing radiation, can be used for long-term monitoring of the effects of diabetes mellitus on the salivary glands.

Genetic Polymorphism of Zinc Transporter-8 Gene (SLC30A8), Serum Zinc Concentrations, and Proteome Profiles Related to Type 2 Diabetes in Elderly

Background and Aims: Older adults are particularly susceptible to type 2 diabetes mellitus (T2DM) due to factors such as age-related insulin resistance, decreased physical activity, and deficiency of micronutrients, especially zinc. Studies have suggested that the risk allele of the zinc transporter 8 gene (SLC30A8) single-nucleotide poly-morphism (SNP) rs13266634 may contribute to T2DM susceptibility in addition to the complex protein interactions and alterations in the protein expressions and modifications associated with T2DM. This study was implemented to study the associations between SLC30A8 polymorphism, serum zinc levels, and the profiles of proteins differentially expressed in nondiabetic (n = 116) and prediabetic/diabetic (n = 149) subjects. Methods: SNP genotyping using TaqMan® assay and proteomic analysis by LC-MS/MS were performed in each group. Results: The results showed a higher risk of diabetes in individuals with the risk genotype CC accompanied by a low serum zinc level than in those with other genotypes. Profiles of proteins differentially expressed between the groups were identified and shown to be particularly associated with zinc-related functions, zinc transporter 8, and glucose metabolism. Proteins exclusively expressed in prediabetes/diabetes were assigned to a Reactome pathway related to zinc transporter and insulin processing. Conclusions: Our findings suggest that individuals carrying at least one copy of SLC30A8 rs13266634 accompanied by a low serum zinc level might be susceptible to T2DM, which could be due to alterations in insulin signaling and zinc metabolism. Understanding this relationship deepens our understanding of the genetic and molecular mechanisms underlying T2DM risk, offering potential targets for therapeutic intervention and prevention strategies.

Self-reported physical activity properties and 20-year all-cause and cardiovascular mortality among community-dwelling older adults

PURPOSE

Physical activity was previously associated with decreased mortality. Current guidelines recommend >150 min/week or >75 min/week of moderate or high-intensity exercise to maintain a healthy lifestyle; however, exercise properties most strongly associated with low mortality among the elderly may still be explored.

METHODS

A total of 1210 community-dwelling older adults, from the third phase (1999-2004) of the Israel Study on Glucose Intolerance, Obesity, and Hypertension, were followed until 2016 and 2019 for cardiovascular and all-cause mortality, respectively. Physical activity properties were recorded and evaluated against all-cause and cardiovascular mortality.

RESULTS

Mean age at baseline was 73 ± 7 years, with 638 (53%) females, and 585 (48%) reported habitual exercise. When compared to sedentary individuals, multivariable Cox regressions showed a significantly lower risk for all-cause mortality among currently active individuals [hazard ratio (HR) = 0.72, 95% confidence interval (CI): 0.59-0.88, P = .002], those engaging in light-moderate activity (HR = 0.72, 95% CI: 0.57-0.89, P = .003), those with diverse exercise types (HR = 0.59, 95% CI: 0.44-0.80, P = .001), more sessions/week (HR = 0.94, 95% CI: 0.92-0.97, P < .001), those meeting current exercise recommendations (HR = 0.79, 95% CI: 0.58-0.89, P = .03), those who engaged in walking (HR = 0.58, 95% CI: 0.45-0.76, P < .001), and swimming (HR = 0.66, 95% CI: 0.45-0.96, P = .03). Similar HRs were found for cardiovascular mortality, although a somewhat stronger protective association was observed for swimming (HR = 0.48, 95% CI: 0.24-0.95, P = .04) compared to a sedentary lifestyle.

CONCLUSION

The study further supports current exercise guidelines among the elderly. It also underscores the importance of physical activity in older individuals while prioritizing a greater number of sessions/week in addition to the total duration, and highlights specific activity features associated with lower long-term mortality among older adults. Key message • What is already known on this topic - Physical activity was associated with a lower risk for mortality, although the specific properties and the preferred type of exercise among older adults are still debatable. • What this study adds - The study suggests the optimal activity characteristics in older adults while prioritizing activity sessions over time, light-moderate exercise over strenuous activity, diverse activity, and walking and swimming over other activities. • How this study might affect research, practice or policy - Future exercise guidelines should focus on increasing activity sessions throughout the week and not on the cumulative time to maximize the effect on mortality.

Hypomagnesemia, insulin secretion and action in patients without diabetes, 1 year after kidney transplantation

Introduction

Hypomagnesemia after kidney transplantation has been reported as a potential risk factor for development of post-transplant diabetes mellitus.

Methods

In kidney transplant recipients undergoing an oral glucose tolerance test during one-year surveillance follow-up we estimated insulin sensitivity with the Matsuda index, a modified Stumvoll index, and HOMA-2IR. First and second phase insulin secretion was assessed using the Stumvoll equation. Participants were categorized into tertiles by plasma magnesium levels, (<0.7, 07-0.78,>0.78 mmol/L).

Results

We included 208 patients (62% men, median age 51 years). Patients in the lowest compared to the highest magnesium tertile had higher measured GFR (mean 59 vs. 49 mL/min, p = 0.002), tacrolimus trough concentration (mean 6.7 vs. 5.5 μg/L, p < 0.001), and fasting plasma glucose (mean 5.5 vs. 5.3 mmol/L, p = 0.03). There was no significant difference in the Matsuda index between magnesium tertiles, nor in insulin sensitivity assessed by modified Stumvoll index, HOMA-2IR, first or second phase insulin. Results indicate a non-significant trend toward lower disposition index in the lowest vs. highest tertile (p = 0.052).

Conclusion

In kidney transplant recipients with lower compared to normal plasma magnesium levels we found a higher fasting plasma glucose but no differences in insulin sensitivity indexes nor dynamic insulin measurements.

Association between hyperuricemia and dietary retinol intake in Southwest China: a cross-sectional study based on CHNS database

Background

Hyperuricemia is increasingly common in Southwestern China and poses significant health risks, including gout and cardiovascular disease. Retinol intake has been hypothesized to affect uric acid levels, but this relationship remains unclear.

Methods

Data from 4,658 participants in the China Health and Nutrition Survey (CHNS) from 1991 to 2018 were analyzed. Dietary retinol intake was categorized using quantile-based methods, and hyperuricemia was identified as the primary outcome. Logistic regression models were used to estimate odds ratios and 95% confidence intervals, with analyses stratified by gender. Restricted cubic splines were utilized to evaluate the dose-response relationship.

Results

The average age of participants was 40 ± 17.83 years, and 20.29% met the criteria for hyperuricemia. Logistic regression analysis identified a positive association between dietary retinol intake and hyperuricemia, with a more pronounced effect observed in men. The restricted cubic spline analysis revealed that the odds of hyperuricemia increased significantly when dietary retinol intake exceeded 3,538 IU/day for men and 4,504 IU/day for women.

Conclusion

High dietary retinol intake is associated with an increased risk of hyperuricemia, with a stronger association observed in males. These findings suggest that dietary retinol intake under recommendation levels might be necessary to prevent hyperuricemia-related adverse health outcomes.

Differences in splicing factors may predict type 2 diabetes remission in the CORDIOPREV study

Alternative splicing is a post-transcriptional process resulting in multiple protein isoforms from a single gene. Abnormal splicing may lead to metabolic diseases, including type 2 diabetes mellitus (T2DM). To identify the splicing factor expression that predicts T2DM remission in coronary heart disease (CHD) patients, we identified newly diagnosed T2DM at baseline (n = 190) from the CORDIOPREV study. Patients were classified as Responders (T2DM remission during 5 years without antidiabetic drugs) or non-Responders. Baseline dysregulation in 5 splicing factors (MBNL1, RBM5, hnRNP G/RBMX, CD44, NT5E) distinguished Responders from non-Responders. Adding these factors to clinical variables [AUC = 0.67], insulin resistance, and beta-cell indexes [AUC = 0.76], improved T2DM remission prediction [AUC = 0.80]. Cox regression analysis showed those with higher remission scores had a 2.63-fold increased remission probability. To conclude, a set of splicing factors that contribute to predicting T2DM remission in patients with CHD has been identified. Further research is needed to elucidate these findings' clinical relevance.

Health-related quality of life and associated factors in people with Type 2 diabetes mellitus in Nepal: Baseline findings from a cluster-randomized controlled trial

This study aims to assess the status of health-related quality of life (HRQOL) and its associated factors in people with Type 2 diabetes mellitus (T2DM) in Nepal. HRQOL of 481 participants with T2DM in Kavrepalanchok and Nuwakot was measured using European Quality of life Visual Analogue Scale (EQVAS) and European Quality of life 5 dimensions (EQ5D) index from the EQ5D-3L tool. Associated correlates of T2DM were examined using linear regression analyses. The study participants generally reported higher HRQOL. Being 60 years or older was associated with a significantly lower EQVAS whereas, urban residence, higher education, testing glycated haemoglobin regularly were significantly associated with a higher EQVAS. Not having depressive symptoms was significantly associated with higher EQVAS and EQ5D-3L index. Encouraging screening of depressive symptoms, improving awareness on the importance of regular blood glucose monitoring and T2DM self-management education should be incorporated within primary diabetes care to improve HRQOL in Nepal.

Immunometabolic alterations in type 2 diabetes mellitus revealed by single-cell RNA sequencing: insights into subtypes and therapeutic targets

Background

Type 2 Diabetes Mellitus (T2DM) represents a major global health challenge, marked by chronic hyperglycemia, insulin resistance, and immune system dysfunction. Immune cells, including T cells and monocytes, play a pivotal role in driving systemic inflammation in T2DM; however, the underlying single-cell mechanisms remain inadequately defined.

Methods

Single-cell RNA sequencing of peripheral blood mononuclear cells (PBMCs) from 37 patients with T2DM and 11 healthy controls (HC) was conducted. Immune cell types were identified through clustering analysis, followed by differential expression and pathway analysis. Metabolic heterogeneity within T cell subpopulations was evaluated using Gene Set Variation Analysis (GSVA). Machine learning models were constructed to classify T2DM subtypes based on metabolic signatures, and T-cell-monocyte interactions were explored to assess immune crosstalk. Transcription factor (TF) activity was analyzed, and drug enrichment analysis was performed to identify potential therapeutic targets.

Results

In patients with T2DM, a marked increase in monocytes and a decrease in CD4+ T cells were observed, indicating immune dysregulation. Significant metabolic diversity within T cell subpopulations led to the classification of patients with T2DM into three distinct subtypes (A-C), with HC grouped as D. Enhanced intercellular communication, particularly through the MHC-I pathway, was evident in T2DM subtypes. Machine learning models effectively classified T2DM subtypes based on metabolic signatures, achieving an AUC > 0.84. Analysis of TF activity identified pivotal regulators, including NF-kB, STAT3, and FOXO1, associated with immune and metabolic disturbances in T2DM. Drug enrichment analysis highlighted potential therapeutic agents targeting these TFs and related pathways, including Suloctidil, Chlorpropamide, and other compounds modulating inflammatory and metabolic pathways.

Conclusion

This study underscores significant immunometabolic dysfunction in T2DM, characterized by alterations in immune cell composition, metabolic pathways, and intercellular communication. The identification of critical TFs and the development of drug enrichment profiles highlight the potential for personalized therapeutic strategies, emphasizing the need for integrated immunological and metabolic approaches in T2DM management.

The efficacy of Lacticaseibacillus paracasei MSMC39-1 and Bifidobacterium animalis TA-1 probiotics in modulating gut microbiota and reducing the risk of the characteristics of metabolic syndrome: A randomized, double-blinded, placebo-controlled study

Modern treatment, a healthy diet, and physical activity routines lower the risk factors for metabolic syndrome; however, this condition is associated with all-cause and cardiovascular mortality worldwide. This investigation involved a randomized controlled trial, double-blind, parallel study. Fifty-eight participants with risk factors of metabolic syndrome according to the inclusion criteria were randomized into two groups and given probiotics (Lacticaseibacillus paracasei MSMC39-1 and Bifidobacterium animalis TA-1) (n = 31) or a placebo (n = 27). The participants had a mean age of 42.29 ± 7.39 and 43.89 ± 7.54 years in the probiotics and placebo groups, respectively. Stool samples, anthropometric data, and blood chemistries were taken at baseline and at 12 weeks. The primary outcome was achieved by the probiotics group as their low-density lipoprotein-cholesterol level dramatically lowered compared to the placebo group (the difference was 39.97 ± 26.83 mg/dl, p-value <0.001). Moreover, significant reductions in body weight, body mass index, waist circumference, systolic blood pressure, and total cholesterol were observed in the volunteers treated with probiotics compared to the placebo. In the gut microbiome analysis, the results showed statistically significant differences in the beta diversity in the post-intervention probiotics group. Blautia, Roseburia, Collinsella, and Ruminococcus were among the gut microbiomes that were more prevalent in the post-intervention probiotics group. In addition, this group exhibited increases in the predicted functional changes in ATP-binding cassette (ABC) transporters, as well as ribonucleic acid transport, the biosynthesis of unsaturated fatty acids, glycerophospholipid metabolism, and pyruvate metabolism. In conclusion, this research demonstrated that the probiotics L. paracasei MSMC39-1 and B. animalis TA-1 have the efficacy to lower risk factors associated with metabolic syndrome.

Empagliflozin-based quadruple oral therapy for type 2 diabetes: a prospective cohort study

The management of Type-2 Diabetes Mellitus (T2DM) remains challenging in cases of poor glycemic control despite triple Oral Hypoglycemic Agent (OHA) therapy. This prospective cohort study aimed to assess the effectiveness of Empagliflozin as part of a quadruple OHA regimen over a 7-year follow-up period in 575 adult patients with uncontrolled T2DM on a triple OHA regimen and who were unwilling to initiate insulin therapy. Overall, 92.5% of patients achieved their target HbA1c levels. Significant reductions were observed in all glycemic parameters after 68 months (p < 0.001). Weight and BMI significantly decreased, whereas waist circumference remained unchanged. Lipid profiles showed significant improvements in total cholesterol, LDL, and triglycerides, while HDL levels did not change significantly. Blood pressure trends revealed significant reductions in both diastolic blood pressure (DBP) and mean arterial pressure (MAP), though systolic blood pressure (SBP) remained relatively stable. Our study indicates that adding empagliflozin to a drug regimen consisting of multiple OHAs can effectively control glycemia in T2DM patients with more pronounced target achievement (< 7%) and HbA1c reduction along with improvement in cardiometabolic parameters, suggesting its potential as a promising alternative for long-term glycemic management.

Differential Impact of Medical Therapies for Acromegaly on Glucose Metabolism

Acromegaly is a rare endocrine disorder caused by excessive growth hormone (GH) production, due, in the vast majority of cases, to the presence of a GH-secreting pituitary tumour. The chronic elevation of GH and the resulting high circulating levels of insulin-like growth factor-1 (IGF-1) cause the characteristic tissue overgrowth and a number of associated comorbidities, including several metabolic changes, such as glucose intolerance and overt diabetes mellitus (DM). Elevated GH concentrations directly attenuate insulin signalling and stimulate lipolysis, decreasing glucose uptake in peripheral tissues, thus leading to the development of impaired glucose tolerance and DM. Acromegaly treatment aims to normalize plasma GH and IGF-1 levels using surgery, medical treatment, or radiotherapy. The effect of the different medical therapies on glucose homeostasis varies. This literature review explores the impact of the currently available pharmacological therapies for acromegaly (first- and second-generation somatostatin receptor ligands, a GH receptor antagonist, and dopamine agonists) on glucose homeostasis. We also discuss the underlying biological mechanisms through which they impact glucose metabolism.

Effect of Combined Proteinuria and Increased Renal Resistive Index on Chronic Kidney Disease Progression: A Retrospective Longitudinal Study

Introduction: An increased renal resistive index (RRI) and proteinuria can predict an estimated glomerular filtration rate (eGFR) decline in patients with chronic kidney disease (CKD) of various causes. This study hypothesized that the RRI and proteinuria interact to determine disease progression in patients with CKDs of unknown origin. Patients and Methods: One hundred and fifty six patients (age 76.0 ± 8.1 years, 63.5% males) were analyzed for anthropometric, kidney morphology, blood pressure, 24 h urinary protein excretion, and RRI. The CKD-EPI equation was used to calculate the eGFR at baseline and after a two-year follow-up. Patients with an elevated (≥0.80) or normal (<0.80) RRI and significant (≥150 mg/day) or physiological (<150 mg/day) proteinuria were evaluated for the likelihood of at least a 30% drop in the eGFR or the onset of end-stage kidney disease (endpoint). Results: Hypertension and diabetes were the predominant cardiovascular risk factors (90.4%). Fifty patients (32%) met the endpoint. Elevated RRIs (odds ratio, OR, 4.28; 95% confidence interval, CI, 1.82-10.6; p = 0.001) and significant proteinuria (OR 3.59, 95% CI 1.59-8.48, p = 0.003) were independent predictors of the endpoint in a multivariate logistic model. Patients with an elevated RRI and significant proteinuria were more likely to meet the endpoint (R1P1: 65.2%) compared to those with only proteinuria (R0P1: 39.5%, p = 0.043) or both normal factors (R0P0: 10.9%, p < 0.001) but not to those with only an elevated RRI (R1P0: 42.3%, p = 0.094). Continuous RRIs (partial correlation r = -0.245, p < 0.001) and 24 h urinary protein excretion (partial r = -0.226, p = 0.003) were inversely and independently correlated with eGFR% change. R1P1 showed a higher eGFR% reduction (-38.0% ± 20.4%) compared to R0P1 (-25.3% ± 19.0%, p = 0.043) and R0P0 (-8.8% ± 25.1%, p < 0.001) but not to R1P0 (-29.6% ± 21.0%, p = 0.192). Conclusions: An increased RRI and proteinuria were independent predictors of disease progression. When interaction was considered, the negative effect of an elevated RRI on CKD progression was evident in both proteinuric and non-proteinuric patients, whereas the negative effect of proteinuria on disease progression was only significant in patients with no elevated RRIs.

The Putative Antidiabetic Effect of Hypericum perforatum on Diabetes Mellitus

Diabetes mellitus (DM), a global disease that significantly impacts public health, has become increasingly common over time. In this review, we aim to determine the potential benefits of St. John's Wort (SJW) as an adjunct therapy for DM. We gathered information from studies conducted in vitro, in vivo, and in humans. In vitro studies investigated the concentrations of SJW extracts capable of inhibiting certain enzymes or factors involved in the inflammatory pathway, such as the β-signal transducer and activator of transcription 1, nuclear factor κB, methylglyoxal, and oxidative stress (OS). The extract was found to have positive effects on OS and anti-inflammatory properties in DM, suggesting it could serve as a protective agent against diabetic vascular complications, cell damage, and apoptosis. According to in vivo research, the essential components of the extract can stimulate thermogenesis in adipose tissue, inhibit several key inflammatory signaling pathways, and delay the early death of pancreatic β cells, all of which contribute to combating obesity. The extract may also help treat prediabetes and significantly reduce neuropathic pain. Human studies have also confirmed some of these results. However, some of the plant's side effects need further investigation through clinical research before it can be used to treat DM.

The predictive value of combined insulin resistance and β-cell secretion in Yemeni school-aged children for type 2 diabetes mellitus

The present study aimed to determine the predictive power of the diabetic markers and metabolic syndrome factors in School-aged children for developing Type 2 DM. In this cross-sectional study, 1288 students aged 12-13 were recruited from public schools in the capital city of Sana'a. Anthropometric measurements and blood pressure were recorded and body mass index (BMI) was calculated. Fasting venous blood (5 ml) was collected for biochemical analysis including FBG, HbA1c, insulin, and lipid profile. Insulin resistance (HOMA-IR) and β-cell function (HOMA-β) were calculated. Our results showed that neither insulin, HOMA-IR nor HOMA-β individually were good predictors for Type 2 DM as assessed by the ROC curve with AUC < 0.75. However, the ROC curve of combined HOMA-IR and HOMA-β (Model 1) gave a superior AUC of 0.998 (p = 2.7 × 10-9) and predicted 140 (10.9%) children to develop Type 2 DM. This model picked up all impaired fasting glucose (IFG), 74% of metabolic glucose, and 71% of metabolic syndrome (MetS) groups. On the other hand, the ROC curve for metabolic syndrome (Model 2) gave an AUC of 0.751 (p = 0.003) and predicted a higher number of 416 (32.3%) children to develop prediabetes and Type 2 DM. This model picked up 75% of IFG, 71% of MetS, 82% of those having two factors of MetS, and 72% of obesity groups. Moreover, the 53 children common between the two models include 75% of IFG and 43% of MetS groups. Therefore, the combined HOMA-IR and HOMA-β model in children proved to be a good predictor for Type 2 DM development, whereas the MetS model predicts the development of prediabetes and Type 2 DM.

Impact of Diabetes Mellitus on Coronary Artery Disease Severity: A Comparative Analysis of Diabetic and Non-diabetic Patients

Background One of the main risk factors for coronary artery disease (CAD), which is a significant source of morbidity and death, is diabetes mellitus (DM), which also speeds up the disease's course and severity. This study aimed to compare the severity of CAD between diabetic and non-diabetic patients, providing insights to guide clinical decision-making and improve therapeutic outcomes. Methodology A prospective, observational study was conducted at the Sheikh Mohamed Bin Zayed Al Nahyan Institute of Cardiology, Quetta, from August 2018 to July 2019, involving 204 adult patients with CAD, consisting of 102 patients with diabetes and 102 without diabetes. Demographic, clinical, and laboratory data were collected, and coronary angiography was performed to assess the severity of CAD, which was defined as a binary outcome variable (1 = severe CAD, 0 = not severe CAD), based on criteria such as multi-vessel involvement and degree of stenosis. Statistical analysis was carried out using IBM SPSS Statistics for Windows, V. 25.0 (IBM Corp., Armonk, NY, USA), with chi-squared tests used for categorical variables (e.g., number of affected vessels, plaque distribution) and independent t-tests for continuous variables (e.g., fasting blood glucose, hemoglobin A1c(HbA1c) levels, lipid profiles). Logistic regression was employed to identify independent predictors of CAD severity, and odds ratios (ORs) with 95% confidence intervals (CI) were calculated, with statistical significance defined as a p-value of less than 0.05. Results Diabetic patients exhibited significantly higher rates of multi-vessel disease (70 (68.63%) vs. 52 (50.98%); p = 0.02), three-vessel involvement (37 (36.27%) vs. 25 (24.51%); p = 0.01), and severe stenosis (64 (62.75%) vs. 52 (50.98%); p = 0.019) compared to non-diabetic patients. Fasting blood glucose (158.21 ± 45.63 mg/dL vs. 98.31 ± 12.74 mg/dL; p < 0.001) and HbA1c (8.21 ± 1.34% vs. 5.62 ± 0.41%; p < 0.001) levels were significantly higher in diabetics. Multivariate regression analysis revealed that diabetes (OR = 2.12; 95% CI: 1.35-3.32; p = 0.001), hypertension (OR = 1.45; 95% CI: 1.01-2.08; p = 0.04), elevated glucose levels (fasting blood glucose OR = 1.04; 95% CI: 1.02-1.06; p < 0.001; HbA1c OR = 1.27; 95% CI: 1.15-1.41; p < 0.001), and age (OR = 1.03; 95% CI: 1.01-1.05; p = 0.02) were significant predictors of CAD severity, with each increase in fasting blood glucose, HbA1c, and age associated with higher odds of severe CAD. Other variables, such as gender, hyperlipidemia, smoking history, sedentary lifestyle, and regular exercise, did not show significant associations with CAD severity (p > 0.05). However, a family history of CAD was identified as a significant predictor (OR = 1.56; 95% CI: 1.06-2.31; p = 0.02), suggesting that those with a family history of CAD had 56% higher odds of experiencing severe CAD. Systolic blood pressure (OR = 1.18; 95% CI: 1.07-1.30; p = 0.002) was associated with CAD severity, with each 10 mmHg increase in systolic blood pressure increasing the odds of severe CAD.  Conclusion DM is linked to more severe CAD, with high blood pressure, HbA1c, and blood glucose levels contributing to increased severity, emphasizing the need for early detection and aggressive treatment to mitigate its impact on heart health, and further research, including long-term follow-up and therapeutic interventions, is needed to enhance management for diabetic CAD patients.

Processed and ultra-processed foods are associated with depression and anxiety symptoms in a cross-sectional sample of urban Lebanese adults

While low dietary quality has been linked to poor mental health, evidence on more direct relations of specific dietary quality indicators, namely degrees of food processing, with mental health disorders remains limited. This study aims to investigate the association between food groups' intakes, defined based on their degree of food processing, with depression and anxiety symptoms in a sample of Lebanese adults. We hypothesized that higher intakes of ultra-processed foods (UPF) will be related to higher risk of depression and anxiety while an opposite association will be observed for unprocessed or minimally processed foods (MPF). Data come from a Lebanese cross-sectional study (n = 188 adults). The NOVA classification was adopted for evaluating the intakes of the 4 food groups: unprocessed or minimally processed foods (MPF); processed culinary ingredients (PCI); processed foods (PF) and ultra-processed foods (UPF). Associations between food group intakes in quartiles with depression and anxiety symptoms were analyzed using multivariable regression analyses adjusted for several confounders. Median energy intake was 2481.65 (2617.2) kcal/d, with 36.12% of Total Energy Intakes coming from MPF, 29.71% from PF, 25.25% from UPF, and 5.75% from PCI. Among participants, 33% and 27.7% had elevated depression and anxiety symptoms, respectively. Higher PF intake was associated with significantly lower odds of both depression and anxiety symptoms while a higher UPF intake was associated with higher odds of depression. Results confirm the hypothesized links between UPF and adverse mental health outcomes and highlight the need for further studies on PF intakes and mental health given the culture-specific nature of foods constituting this group.

Effects of Diabetes and Hyperlipidemia in Physiological Conditions - A Review

BACKGROUND

Diabetes mellitus (DM) is an autoimmune manifestation defined by persistent hyperglycemia and alterations in protein, fatty substances, and carbohydrate metabolism as an effect of problems with the secretion of insulin action or both. Manifestations include thirst, blurred eyesight, weight loss, and ketoacidosis, which can majorly lead to coma. There are different types of diabetes according to class or by cellular level. They are interrelated with hyperlipidemia as they are involved in the metabolism and regulation of physiological factors. Most parameters are seen at cellular or humoral levels, yet the underlying concern remains the same.

OBJECTIVE

To create a systematic correlation between the disease and locate the exact mechanism and receptors responsible for it. So, this article covers a proper way to resolve the conditions and their manifestation through literacy and diagrammatic.

CONCLUSION

Hence, this will be an insight for many scholars to understand the exact mechanism involved in the process.

Hepatic effects of GLP-1 mimetics in diabetic milieu: A mechanistic review of involved pathways

Patients with diabetic are at a higher risk of developing hepatic disorders compared to non-diabetic individuals. This increased risk can be attributed to the diabetic environment, which triggers and exacerbates harmful pathways involved in both diabetic complications and hepatic disorders. Therefore, it is important to consider the use of antidiabetic agents that offer benefits beyond glycemic control and have positive effects on liver tissues. Glucagon-like peptide-1 (GLP-1) mimetics are a novel class of antidiabetic medications known for their potent blood sugar-lowering effects. Emerging evidence suggests that these drugs also have favorable effects on the liver. However, the precise effects and underlying mechanisms are not yet fully understood. In this review, we aim to provide a mechanistic perspective on the liver benefits of GLP-1 mimetics and outline the mediating mechanisms involved.

Diabetes Fact Sheets in Korea 2024

BACKGRUOUND

This study aimed to investigate the prevalence, management, and comorbidities of diabetes mellitus among Korean adults.

METHODS

Data from the Korea National Health and Nutrition Examination Survey (2019-2022) were analyzed to assess the prevalence, treatment, risk factors, and comorbidities of diabetes. Comparisons between young and older adults with diabetes were emphasized.

RESULTS

Among Korean adults aged ≥30 years, the prevalence of diabetes is 15.5% during 2021-2022. Of these, 74.7% were aware of their condition, 70.9% received antidiabetic treatment, and only 32.4% achieved glycosylated hemoglobin (HbA1c) <6.5%. Moreover, 15.9% met the integrated management targets, which included HbA1c <6.5%, blood pressure <140/85 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL. In young adults aged 19 to 39 years, the prevalence of diabetes was 2.2%. Among them, 43.3% were aware of their condition, 34.6% received treatment, and 29.6% achieved HbA1c <6.5%. Obesity affected 87.1%, and 26.9% had both hypertension and hypercholesterolemia. Among adults aged ≥65 years, the prevalence of diabetes was 29.3%, with awareness, treatment, and control rates of 78.8%, 75.7%, and 31.2%, respectively. Integrated management targets (HbA1c <7.5%, hypertension, and lipids) were achieved by 40.1%.

CONCLUSION

Diabetes mellitus remains highly prevalent among Korean adults, with significant gaps in integrated glycemic, blood pressure, and lipid control. Older adults with diabetes show higher awareness and treatment rates but limited integrated management outcomes. Young adults with diabetes bear a significant burden of obesity and comorbidities, alongside low awareness and treatment rates. Therefore, early intervention programs, education, and strategies tailored to younger populations are urgently required.

Optimal path length identification for accurate glucose sensing with photoacoustic derived optical rotation

Non-invasive glucose monitoring is crucial for diabetes management. This study explores the use of photoacoustic (PA) signals based on optical rotation estimation at multiple depths for detection of glucose concentrations. Experiments were performed with glucose samples mixed in bovine serum albumin with different polarization incidences-vertical (V), 45° linear (P), and right circular (R) polarization. Polarized Monte Carlo (PMC) simulations were performed to understand the depth-dependent behavior between optical and photoacoustic detection of optical rotation, which allows the estimate of glucose concentration. Notably, a specific depth range exhibited both maximum rotation and a better linear relationship with concentration, which are ideal for sensing. Both experimental and simulation studies indicated significant depolarization beyond a depth of 4 mm. Additionally, the change in rotation with respect to depth (Δα) was higher for larger concentration differences compared to smaller concentration differences. Our study identified that the optimal depth for accurate glucose sensing (based on Clarke's error grid (CEG)) was found to be around 3-3.2 mm for the different polarized incidences. These findings showcase the potential of our approach for non-invasive glucose sensing and a calibration procedure to pinpoint optimal sensing depths, extendable to other chiral molecules.

Analysis of thyroid autoantibodies and the risk of insulin depletion after the clinical onset of acute-onset type 1 diabetes in Japanese patients: the TIDE-J study

Introduction

Type 1 diabetes is often accompanied by autoimmune thyroid disease. We aimed to investigate the clinical characteristics of Japanese patients with acute-onset type 1 diabetes and thyroid autoantibodies, focusing on decreased endogenous insulin secretion.

Materials and methods

We examined 80 patients with acute-onset type 1 diabetes, classifying them into two groups with and without thyroid autoantibodies and compared the clinical characteristics of the two groups. A fasting serum C-peptide immunoreactivity (CPR) of less than 0.1 ng/mL was defined as insulin depletion.

Results

In patients with thyroid autoantibodies, the median fasting serum CPR levels at the fourth year after the onset of type 1 diabetes were significantly lower than in those without thyroid autoantibodies (p = 0.02). The cumulative incidence of insulin depletion at 5 years of duration after diagnosis of type 1 diabetes was significantly higher in thyroid autoantibody-positive group than in thyroid autoantibody-negative group (p = 0.01). In the Cox proportional models adjusted for selected baseline factors (age, sex, and BMI), the presence of thyroid autoantibodies did not increase the risk of insulin depletion within 5 years after the onset. However, in bivariate Cox proportional hazards models that investigated the association between thyroid autoantibodies and each baseline factor, the presence of thyroid autoantibodies significantly increased the risk of insulin depletion.

Conclusions

Our study showed that Japanese patients with acute-onset type 1 diabetes and positive for thyroid autoantibodies had a higher risk of insulin deficiency within 5 years after the onset than those without thyroid autoantibodies.

Technology for the Management of Type 1 Diabetes Mellitus in Saudi Arabia and MENA Region: A Systematic Review

BACKGROUND

Diabetes technology in the form of digital health or medical devices holds a promise for improving the quality of life and glycemic outcomes. A comprehensive insight into diabetes technology and its impact in Saudi Arabia and the MENA region may improve type 1 diabetes mellitus (T1DM) management.

OBJECTIVE

This study aimed to assess the impact of different DM-specific technologies: Insulin pump therapy, continuous glucose monitoring (CGM), and automated insulin delivery system in terms of glycemic control and QoL among T1DM patients in Saudi Arabia and the MENA region.

METHOD

A systematic literature search was performed in PubMed and Scopus from 2005 until August 2023. The search was based on the PICO strategy, focusing on T1DM patients, diabetes technology, and QoL. The inclusion criteria were studies illustrating the effect of diabetes technologies on glycemic control or quality of life or both among T1DM patients. Systematic reviews, books, letters, or studies, including type 2 diabetes mellitus, were excluded.

RESULTS

From 101 articles, eighteen studies were duplicated, and thirty-three studies were excluded after reading the title and abstract. Of the 50 articles analyzed, twenty-five articles did not meet the inclusion criteria. Therefore, 25 articles involving a total of 3088 participants were enrolled in the study. It was shown that a continuous glucose monitoring system and continuous subcutaneous insulin infusion improved the glycemic control and the QoL of T1DM patients.

CONCLUSION

There was a positive impact of insulin pumps, continuous glucose monitoring (CGM) systems, and telemedicine in achieving optimal glucose control and better QoL. Further studies are recommended to clarify the significant role of advanced diabetes technologies.