Does the Consumption of Metformin Correlate With a Reduction in Mortality Among Patients With Type 2 Diabetes and COVID-19 in Morocco?

OBJECTIVES

To assess whether metformin therapy for type 2 diabetes (T2DM) was associated with a reduced mortality rate in patients hospitalized for COVID-19 compared to other antihyperglycemic drugs.

METHODS

This retrospective study included patients with T2DM who tested positive for SARS-CoV-2 between 1 August 2020 and 1 August 2021. The patients were required to be aged over 18 years old and to be undergoing treatment for hyperglycemia, whether with metformin, other oral antidiabetic drugs, or insulin. A data exploitation sheet was completed for each patient. The Jamovi (https://www.jamovi.org/) software was applied to conduct the statistical analyses. Multivariate logistic regression was used to determine whether metformin use was associated with reduced mortality among patients with T2DM and COVID-19.

RESULTS

We identified 115 COVID-19 patients with T2DM, of whom 41 were on metformin, 35 patients were on insulin, and 39 patients were on other oral antihyperglycemic agents; the average age of patients was 65.5±13.2 years, and 52.2% were male. The mortality rate was lower in the metformin user group (21.1%) compared to the non-user group (78.9%). The multivariate logistic regression model indicated that age (OR=1.06; 95% CI (1.02-1.10); p=0.002) and glycemia (OR=1.49; 95% CI (1.05-2.11); p=0.024) were significantly associated with mortality in patients with T2DM and COVID-19. Whereas, the use of metformin was identified as a protective factor (OR=0.34 95% CI (0.12-0.95); p=0.041).

CONCLUSION

This study highlighted that metformin seems to be associated with significantly decreased mortality in adults with T2DM and COVID-19.

Prevention of cardiovascular disease in women with type 2 diabetes: the role of incretin mimetics and sodium-glucose cotransporter-2 inhibitors

Cardiovascular disease (CVD) is the leading cause of death among individuals with type 2 diabetes (T2D), with women experiencing a disproportionate risk of events compared with men. Women have an amplified burden of cardiovascular risk factors once T2D is diagnosed. Incretin mimetics now plays a central role in managing cardiovascular risk by improving glycemic control, promoting weight loss, and potentially exerting direct cardioprotective effects. Similarly, sodium-glucose cotransporter-2 inhibitors contribute to CVD prevention through various nonglucose-lowering mechanisms. Both classes of medications are integral to personalized treatment strategies aimed at addressing the heightened cardiovascular risk faced by women with diabetes. This mini-review addresses possible mechanisms underlying the increased cardiovascular risk and explores the role of incretin mimetics and SGLT2 inhibitors in mitigating CVD in women with T2D. Emphasizing personalized and sex-specific approaches in diabetes care is crucial for optimizing treatment outcomes and improving cardiovascular health.

Genetic and Epigenetic Determinants of COVID-19 Susceptibility: A Systematic Review

BACKGROUND

The molecular mechanisms regulating coronavirus pathogenesis are complex, including virus-host interactions associated with replication and innate immune control. However, some genetic and epigenetic conditions associated with comorbidities increase the risk of hospitalization and can prove fatal in infected patients. This systematic review will provide insight into host genetic and epigenetic factors that interfere with COVID-19 expression in light of available evidence.

METHODS

This study conducted a systematic review to examine the genetic and epigenetic susceptibility to COVID-19 using a comprehensive approach. Through systematic searches and applying relevant keywords across prominent online databases, including Scopus, PubMed, Web of Science, and Science Direct, we compiled all pertinent papers and reports published in English between December 2019 and June 2023.

RESULTS

The findings reveal that the host's HLA genotype plays a substantial role in determining how viral protein antigens are showcased and the subsequent immune system reaction to these antigens. Within females, genes responsible for immune system regulation are found on the X chromosome, resulting in reduced viral load and inflammation levels when contrasted with males. Possessing blood group A may contribute to an increased susceptibility to contracting COVID-19 as well as a heightened risk of mortality associated with the disease. The capacity of SARS-CoV-2 involves inhibiting the antiviral interferon (IFN) reactions, resulting in uncontrolled viral multiplication.

CONCLUSION

There is a notable absence of research into the gender-related predisposition to infection, necessitating a thorough examination. According to the available literature, a significant portion of individuals affected by the ailment or displaying severe ramifications already had suppressed immune systems, categorizing them as a group with elevated risk.

Practical Considerations for Using Continuous Glucose Monitoring in Patients with Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is the most prevalent metabolic complication during pregnancy. GDM is associated with adverse perinatal, neonatal, and long-term health consequences. Studies have demonstrated that the use of continuous glucose monitoring (CGM) reduces the incidence of maternal and neonatal complications in pregnant women with type 1 diabetes. Although the use of CGM in GDM has not been well studied, a growing body of evidence is showing potential benefits in the GDM population. This article discusses the advantages and challenges of CGM and provides practical guidelines for using this technology in the GDM population.

Reevaluating diabetes and COVID-19 outcomes using national-level data

PURPOSE

Using a US nationally representative survey of adults, we aimed to evaluate the association between prevalent diabetes and the uptake of COVID-19 testing, rate of positive testing and symptom severity.

METHODS

Data were sourced from the 2020-2021 National Health Interview Survey. COVID-19 outcomes were defined as: (1) test uptake (2) test positivity (3) diagnosis of COVID-19 and (4) severe disease symptoms with a positive COVID-19 test result. We compared the prevalence of COVID-19 outcomes by diabetes status and examined their associations using multivariate adjusted logistic and ordered logistic regression models.

RESULTS

The prevalence of test uptake and test positivity were 50.7 % and 9.4 % in the US population, respectively. 10.3 % were diagnosed with COVID-19 infection by health professionals. There were no statistically significant differences in the outcomes by diabetes status. However, individuals with diabetes were more likely to have severe symptoms. In adjusted regression model, we found no significant associations of diagnosed diabetes with all outcomes.

CONCLUSIONS

Our findings contrast with prior evidence derived from hospitalized patients. Researchers and policy makers are encouraged to review the properties of data sources and their impact on public health recommendations, particularly in response to future pandemics.

Environmental microbiome, human fungal pathogens, and antimicrobial resistance

Traditionally, antifungal resistance (AFR) has received much less attention compared with bacterial resistance to antibiotics. However, global changes, pandemics, and emerging new fungal infections have highlighted global health consequences of AFR. The recent report of the World Health Organisation (WHO) has identified fungal priority pathogens, and recognised AFR among the greatest global health threats. This is particularly important given the significant increase in fungal infections linked to climate change and pandemics. Environmental factors play critical roles in AFR and fungal infections, as many clinically relevant fungal pathogens and AFR originate from the environment (mainly soil). In addition, the environment serves as a potential rich source for the discovery of new antifungal agents, including mycoviruses and bacterial probiotics, which hold promise for effective therapies. In this article, we summarise the environmental pathways of AFR development and spread among high priority fungal pathogens, and propose potential mechanisms of AFR development and spread. We identify a research priority list to address key knowledge gaps in our understanding of environmental AFR. Further, we propose an integrated roadmap for predictive risk management of AFR that is critical for effective surveillance and forecasting of public health outcomes under current and future climatic conditions.

The relevance of remnant cholesterol as a guide for lipid management in Indian subjects undergoing coronary revascularization

BACKGROUND

The atherogenic potential of remnant cholesterol, which refers to the cholesterol content of triglyceride-rich, non-low-density lipoprotein (LDL) particles in circulation, has gained increasing attention recently. Unfortunately, very limited information is available regarding remnant cholesterol levels in Indian subjects.

METHODS

This was a retrospective study conducted at a premier, tertiary care center in North India. A total of 3064 consecutive subjects [mean age 61.3 ± 10.3 years, 2550 (83.2%) men] with newly diagnosed coronary artery disease (CAD) undergoing coronary revascularization were included. Enzymatic assays were used for measuring various lipid parameters. Remnant cholesterol was calculated by subtracting LDL cholesterol (LDL-C) and high-density lipoprotein cholesterol from total cholesterol. A value >30 mg/dL was considered elevated.

RESULTS

The mean LDL-C was 79.1 ± 33.1 mg/dL with 46.4% of all subjects having LDL-C <70 mg/dL and only 16.9% having LDL-C <50 mg/dL. The median remnant cholesterol level was 17.0 mg/dL (interquartile range 12.0-24.0 mg/dL) with only 11.9% of subjects having values >30 mg/dL. Only 4.5% of the patients with LDL-C <70 mg/dL and 2.9% of those with LDL-C <50 mg/dL had elevated remnant cholesterol. These proportions were significantly greater in patients with serum triglycerides >200 mg/dL.

CONCLUSION

Our study shows that in a North-Indian population with CAD, elevated remnant cholesterol was present in only a small proportion. The prevalence of elevated remnant cholesterol decreased further as the LDL-C control improved. These findings suggest that elevated remnant cholesterol may not be a clinically relevant therapeutic target in most patients with LDL-C below the currently recommended goals.

Long-term antibody responses to COVAXIN and COVISHIELD vaccines in rheumatoid arthritis patients and healthy control population - A cross-sectional study

Background

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation and damage in the joints. It often requires treatment with disease-modifying antirheumatic drugs (DMARDs) to manage symptoms and prevent progression. The study investigates the long-term antibody responses to COVAXIN and COVISHIELD vaccines in RA patients.

Methodology

This cross-sectional study (IEC approval no: AlIMS/BBN/IEC/AUG/2021/60-R dated Sept 05, 2022, and Ref No: 799/U/IEC/ESICMC/F490/09/2022 dated Oct 31, 2022) enrolled 103 diagnosed RA patients receiving DMARDs and 183 healthy controls. The participants who completed 1 year after the second dose of vaccination were included, and detailed information on demographic, medical, and vaccination were collected. Laboratory investigations included complete blood count, inflammatory markers, and antispike antibody levels. Statistical analyses assessed differences between COVAXIN and COVISHIELD subgroups, considering DMARDs usage and disease duration.

Results

Among RA patients, both COVAXIN and COVISHIELD groups exhibited low disease activity. No significant (P > 0.05) differences were found in IL-6, CRP, or antispike antibody levels between COVAXIN and COVISHIELD subgroups in RA patients and healthy controls. Notably, 89% of female RA patients received COVISHIELD. Co-morbidities, including hypothyroidism (44%), were prevalent in COVISHIELD-received RA patients. Antibody concentration varied significantly among DMARDs usage groups in COVAXIN-vaccinated RA patients, with a notable difference between three-drug and HCQ-alone regimens. However, no such difference was observed in the COVISHIELD group. Disease duration did not significantly impact antispike antibody concentration in either of the vaccination group.

Conclusion

RA patients had a decreased antibody response, 1 year after receiving the second dose of the COVID-19 vaccine. Nonetheless, there was no discernible difference in the antispike antibody concentration between the COVISHIELD and COVAXIN vaccination groups. Additionally, immunosuppressive medications significantly impact serological responses to these vaccines.

New Onset Diabetes After COVID 19 (NODAC) is predominantly due to exacerbated Insulin Resistance (IR) rather than beta cell dysfunction: Lessons from tertiary care hospital data during confluence of two epidemics

PURPOSE

To investigate determinants of new onset diabetes after COVID-19 (NODAC) and its recovery at 6 months.

METHODS

This was an observational follow up study conducted from August, 2020 to July, 2023, recruiting patients with preexisting DM and COVID 19 patients with no history of DM. Multivariate regression analysis was used to determine the factors responsible for severity of COVID 19 infection in preexisting DM group. Clinical, laboratory and glycometabolic parameters were estimated at baseline and 6 months in NODAC and euglycemic group to determine the factors responsible for NODAC and its persistence at 6 months.

RESULTS

Of 1310 patients, 855 (65.3%) COVID 19 patients were further divided based on their glycemic status: preexisting DM (19%), NODAC (8.5%) and euglycemia (72.5%). Older age and male gender were independent risk factors for severe COVID 19 disease in patients with preexisting diabetes. Prevalence of NODAC in present study was 8.5%. Patients with NODAC had higher mean fasting blood glucose (FBG), random blood glucose (RBG) and HbA1c at baseline as compared to COVID with euglycemic group with no difference in serum C-peptide levels. Female gender, family history of DM, signs of insulin resistance, higher BMI, WHR, HbA1c, serum insulin levels, FBG and RBG predicted persistence of NODAC at 6 months.

CONCLUSION

Preexisting DM is a risk factor for severe COVID 19 disease. Patients with NODAC have evidence of persistence insulin resistance on follow up, underscoring the need for long term glycemic monitoring.

A Glimpse for the subsistence from pandemic SARS-CoV-2 infection

COVID-19 is an emerging viral pandemic caused by SARS-CoV-2, which is the causative agent of unprecedented disease-causing public health threats globally. Worldwide, this outbreak is wreaking havoc due to failure in risk assessment regarding the urgency of the pandemic. As per the reports, many secondary complications which include neurological, nephrological, gastrointestinal, cardiovascular, immune, and hepatic abnormalities, are linked with COVID -19 infection which is associated with prominent respiratory disorders including pneumonia. Hindering the initial binding of the virus with Angiotensin-converting enzyme 2 (ACE2) through the spike protein is one potential boulevard of monoclonal antibodies. Although some drug regimens and vaccines have shown safety in trials, none have been entirely successful yet. This review highlights, some of the potential antibodies (tocilizumab, Sarilumab, Avdoralimab, Lenzilumab, Interferon (alfa /beta /gamma)) screened against SARS-CoV-2 and the most promising drugs (Favipiravir, Hydroxychloroquine, Niclosamide, Ribavirin, Baricitinib, Remdesivir, Arbidol Losartan, Ritonavir, Lopinavir, Baloxavir, Nitazoxanide, Camostat) in various stages of development with their synthetic protocol and their clinical projects are discussed to counter COVID -19.

Persistence of SARS-CoV-2 Antibodies for a Year Following SARS-CoV-2 Vaccinations (BBV152 and ChAdOx1 nCoV-19)

The first two vaccines administered in the COVID-19 vaccination campaign of India were Covaxin (BBV152) and Covishield (ChAdOx1-nCoV-19). In this study, we evaluate the longevity and sustainability of the humoral immune response after vaccination and various factors influencing it. An observational study was conducted in individuals who received both doses of Covaxin or Covishield vaccine, and their blood samples were analyzed for total-antiRBD-SARS-CoV-2 antibodies. Then, antibody titers were classified based on monthly time-intervals up to 360 days and their trend was analyzed. In addition, the correlation between antibody titers and factors such as previous SARS-CoV-2-infection status, vaccine type and presence of comorbidities was examined. Of the 2069 participants, most (1767;85.4%) had been vaccinated with Covaxin, but the higher antibody titers were induced by Covishield vaccine at all time points. However overall, antibodies persisted for at least 1 year, although a drop in antibody titers occurred in the 3rd and 6th months. In addition, 430 (20.8%) participants had prior SARS-CoV-2 infection (hybrid immunity) with a significantly higher humoral immune response compared with vaccine-induced immunity (naive immunity). No significant differences were observed in antibody titers related to age, sex and presence of comorbidities. We concluded that vaccine-mediated immunity lasts for at least one year. However, antibody titers decrease over time, which may be more pronounced in certain groups such as Covaxin vaccine, vaccine-induced-immunity, presence of comorbidities and > 60 years which should be considered when recommending booster vaccination, as these individuals may have a stronger and longer-lasting immune response to the virus.

Exploring the interaction between Fe3+ and REGLE motif of the high-affinity iron permease (Ftr1): An in silico approach

Mucormycosis is an invasive fungal infection with high mortality rate in immunocompromised individuals. Due to COVID-19 pandemic, the disease has resurfaced recently and lack of appropriate antifungals resulted in a poor outcome in patients. The iron uptake mechanism in Rhizopus delemar, the predominant causal agent, is crucial for its survival and pathogenesis in human host. The current study is first of its kind to focus on structural dynamics of high affinity iron permease (Ftr1), a virulence factor for Mucormycosis. Ftr1 is a transmembrane protein which is responsible for transport of Fe3+ ion from extracellular milieu to cytoplasm under iron starving conditions in Rhizopus. In this work, the three-dimensional modelling of Ftr1 was carried out. The Ftr1 possessed seven transmembrane helices with N- & C-termini in extracellular and intracellular regions respectively. Moreover, the present study delineates interaction of glutamic acid residues, found in the REGLE motif of fourth transmembrane helix with Fe3+. The molecular dynamics simulation study revealed that the glycine present in the motif destabilizes the helix thereby bringing E157 closer to positively charged ion. Understanding the interaction between Fe3+ ion and Ftr1 would be helpful in designing effective small molecule drugs against this novel therapeutic target for treating mucormycosis.

Modulation of Angiotensin-II and Angiotensin 1-7 Levels Influences Cardiac Function in Myocardial Ischemia-reperfusion Injury

The angiotensin-converting enzyme-2 (ACE-2) alters the pathophysiology of various fatal cardiovascular diseases, including ischemic heart disease, whereas angiotensin 1-7 (Ang 1-7) exerts a wide range of actions. The effects of ischemia-reperfusion (IR) injury include damage to myocardial tissue that initiates protease action, causing cardiac cell death. Angiotensin- II (Ang-II) contributes through the renin-angiotensin system (RAS) to the IR injury, whereas Ang 1-7 paradoxically exerts a protective effect through the same. Thus, the myocardial ischemic reperfusion injury (MIRI) may be altered by the RAS of the heart. This review paper focuses on ACE-2, angiotensin-converting enzyme (ACE), and Ang 1-7 regulation in the RAS of the heart in the pathophysiology of MIRI. The treatment in such conditions using ACE-2 activator, ACE inhibitor, and Ang-II antagonists may promote vascular functions as well as cardio- protection.

Estimation of the pattern of ocular manifestations, risk factors, and imaging of rhino-orbital-cerebral mucormycosis in COVID-19 patients

Purpose

To estimate the pattern of ocular manifestations, as observed clinically and radiologically, and associated risk factors in cases of coronavirus disease 2019 (COVID-19)-related rhino-orbital cerebral mucormycosis (ROCM) during the second wave at presentation to the hospital in northern India.

Materials and Methods

A total of 35 patients of ROCM associated with active cases of COVID-19 or recovered cases of COVID-19 presenting to the Ophthalmology outpatient department or admitted in the COVID ward of the hospital with clinical features suggestive of ROCM. They were confirmed as mucormycosis on KOH and fungal cultures of nasal scrapings and histopathology of debrided tissue. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessment of ROCM-associated COVID-19 during the second outbreak of the COVID-19 pandemic.

Results

The total patients included were 35, which ranged in the age group of 52.91+/- 11.93 years, and the male-to-female ratio was 24:11. The duration between the first positive COVID report and onset of COVID-19-associated ROCM was 9.46+/-11.63 days. The majority (82.9%; n-29) either were diabetics or had high blood glucose levels during the recent COVID-19 infection. 45.7% of patients gave a history of steroid therapy. The most common ocular clinical features were ptosis (80%) and loss of vision 48.7%, respectively. There was diffuse involvement of sinuses in 18 cases (51.4%). Staging based on magnetic resonance imaging scans showed that 7 (20%) had stage II, 20 (57.1%) had stage III, and 28.7% had stage IV disease. Ten patients had varied intracranial extension ranging from meningitis and cavernous sinus thrombophlebitis/thrombosis to brain abscess.

Conclusions

COVID-associated ROCM was very rapidly spreading and more destructive. Ptosis and loss of vision related to third nerve involvement and CRAO, respectively, were alarming signs and bad prognostic indicators to the patient. Intracranial involvement and CRAO were poor prognostic features in this type of mucormycosis.

Impact of COVID-19 on the prevalence of oral and maxillofacial disorders: A retrospective cohort study

ObjectiveThe COVID-19 pandemic has impacted various health conditions. Emerging evidence suggests that COVID-19 may trigger or exacerbate oral and maxillofacial conditions, yet data from Iraq and the broader Middle East remain limited. This retrospective cohort study, conducted at the Laboratory of Oral Pathology, College of Dentistry, University of Baghdad, explores potential links between COVID-19 infection and maxillofacial disorders.MethodsThis was a retrospective cohort study using data from the Laboratory of Oral Pathology, College of Dentistry, University of Baghdad. Cases were divided into pre-COVID-19 and post-COVID-19 periods. Chi-square tests assessed differences in oral pathologies incidence, while logistic regression analyzed associations with COVID-19 status and corticosteroid use.ResultsMucormycosis cases demonstrated a significant increase from 3 (pre-COVID-19) to 23 (post-COVID-19), with 65.22% of post-COVID-19 patients testing COVID-19-positive. A significant increase in mucormycosis severity was observed after COVID-19 (χ² = 14.24, p = 0.0026). Logistic regression identified age (coefficient 0.8738) as having a significant association with severe mucormycosis, while COVID-19 status (coefficient 0.1272) exerted a lesser effect. Sjögren's syndrome increased from 15 to 25 cases, with a model area under the curve of 0.8, indicating substantial ability to distinguish symptom changes pre- vs. post-COVID-19.ConclusionThe findings suggest that the pandemic has considerably impacted the incidence and severity of mucormycosis and Sjögren's syndrome. Older age and COVID-19 positivity may be key drivers of severe mucormycosis, whereas COVID-19 infection appeared to exacerbate Sjögren's syndrome symptoms. These results underscore the importance of vigilant monitoring and targeted therapeutic strategies for managing oral and maxillofacial conditions during and after viral pandemics.

Slow Metabolism-Driven Amplification of Hepatic PPARγ Agonism Mediates Benzbromarone-Induced Obesity-Specific Liver Injury

Obesity and nonalcoholic fatty liver disease (NAFLD) are established risk factors for drug-induced liver injury (DILI). The previous study demonstrates that benzbromarone (BBR), a commonly prescribed pharmaceutical agent for managing gout and hyperuricemia, exacerbates hepatic steatosis and liver injury specifically in obese individuals. However, the precise mechanism underpinning this adverse effect remains incompletely elucidated. Given the significance of BBR and its analogs in anti-gout/hyperuricemia drug discovery, elucidating the mechanism by which BBR exacerbates obesity-specific DILI warrants further investigation. In this study, through a combined multi-omics, pharmacological, and pharmacokinetic approaches, it is found that BBR-induced obesity-specific DILI is primarily through the potentiation of peroxisome proliferator-activated receptor gamma (PPARγ) signaling pathways. Further in vivo and in vitro pharmacokinetic analyses reveal that obese db/db mice exhibited a diminished capacity to metabolize BBR in their livers. This reduction leads to prolonged retention of BBR, subsequently resulting in chronic and sustained hepatic PPARγ agonism. This study demonstrates that a slow metabolism-driven amplification of hepatic PPARγ agonism mediates BBR-induced obesity-specific hepatic steatosis and subsequent DILI, which also emphasizes the importance of the reduced hepatic drug metabolism capacity in patients with obesity or pre-existing NAFLD in both clinical practice and drug discovery processes.

Long term health outcomes in people with diabetes 12 months after hospitalisation with COVID-19 in the UK: a prospective cohort study

Background

People with diabetes are at increased risk of hospitalisation, morbidity, and mortality following SARS-CoV-2 infection. Long-term outcomes for people with diabetes previously hospitalised with COVID-19 are, however, unknown. This study aimed to determine the longer-term physical and mental health effects of COVID-19 in people with and without diabetes.

Methods

The PHOSP-COVID study is a multicentre, long-term follow-up study of adults discharged from hospital between 1 February 2020 and 31 March 2021 in the UK following COVID-19, involving detailed assessment at 5 and 12 months after discharge. The association between diabetes status and outcomes were explored using multivariable linear and logistic regressions.

Findings

People with diabetes who survived hospital admission with COVID-19 display worse physical outcomes compared to those without diabetes at 5- and 12-month follow-up. People with diabetes displayed higher fatigue (only at 5 months), frailty, lower physical performance, and health-related quality of life and poorer cognitive function. Differences in outcomes between diabetes status groups were largely consistent from 5 to 12-months. In regression models, differences at 5 and 12 months were attenuated after adjustment for BMI and presence of other long-term conditions.

Interpretation

People with diabetes reported worse physical outcomes up to 12 months after hospital discharge with COVID-19 compared to those without diabetes. These data support the need to reduce inequalities in long-term physical and mental health effects of SARS-CoV-2 infection in people with diabetes.

Funding

UK Research and Innovation and National Institute for Health Research. The study was approved by the Leeds West Research Ethics Committee (20/YH/0225) and is registered on the ISRCTN Registry (ISRCTN10980107).

Prevalence and Prognostic Impact of Diabetes Mellitus in Hospitalized COVID-19 Patients: A Monocentric Study From India

Background COVID-19 has been a fatal pandemic in modern history, with diabetes mellitus (DM) as a common comorbidity. However, data on the effect of DM on Indian COVID-19 patients are still scarce. We aimed to evaluate the prevalence and prognostic impact of DM in COVID-19 patients hospitalized at Index Medical College Hospital and Research Center (IMCHRC), Indore, Madhya Pradesh. Methods This is a retrospective monocentric observational study including all consecutive adult COVID-19 patients admitted to our center from July 2021 to March 2022. Data including demographics, clinical features, DM history, laboratory investigations, comorbidities, disease severity, intensive care unit (ICU) admission, invasive fungal infections, multi-organ dysfunction, and death were retrieved from the medical records of the patients and analyzed. Results A total of 357 COVID-19 patients (236 males) with a mean age of 52+9.7 years were evaluated. The overall prevalence of DM in the patients was 32% (115/357), comprising of 23% (83/357) cases of pre-existing DM and 9% (32/357) cases of new onset of DM. Vascular comorbidities consisting of hypertension (62% vs 27%; p=0.002), cardiovascular disease (39% vs 21%; p=0.016), and kidney disease (42% vs 27%; p=0.019) were significantly associated with DM. Diabetic versus non-diabetic COVID-19 patients had a higher rate of ICU admission (23% vs 10%; p=0.042), severe disease (43% [49/115] vs 5% [13/242]; p=0.002), acute respiratory distress syndrome (25% vs 7%), secondary infections (30% vs 11%; p=0.033), multi-organ dysfunction (16% vs 9%; p=0.045), and in-hospital mortality (21% [24/115] vs 6% [15/242]; p=0.011). Conclusions Our study shows a high prevalence of DM in COVID-19 patients and an adverse effect of DM on the prognosis of COVID-19 patients including increased disease severity and in-hospital mortality.

Humoral and cellular immune response to AZD1222 /Covishield and BV152/Covaxin COVID-19 vaccines among adults in India

Several COVID-19 vaccines were developed using different approaches to prevent both symptomatic COVID-19 cases and fatalities. The adults were vaccinated with two doses of AZD1222/Covishield (n = 77) [manufactured by Serum Institute of India Pvt Ltd] vaccine and BV152/Covaxin (n = 99) [manufactured by Bharat Biotech] vaccine. They were assessed for immune response at pre-vaccination, 1 month post first and 6 months post second dose for anti-SARS-CoV-2 IgG antibody, surrogate neutralizing antibody (NAbs), immune phenotypes, antigen specific NK, B and T cell response, their effector functionality by ELISPOT and plasma cytokine profile. Both vaccines elicited enhanced IgG antibody and Nab levels compared to the baseline. BV152/Covaxin, the whole virus inactivated vaccine exhibited higher IgG (70% vs 100%), Nab (90% vs 100%), and robust T cell (31% vs 96%) responses at 6 months post second dose compared to 1 month post first dose justifying the utility of the second dose. Detection of SARS-CoV-2 WV and S1 specific CD4+ central T cell memory response in AZD1222/Covishield vaccinee at 6 months post second dose and higher CD4+ and CD8+ naïve and central memory T cell response in BV152/Covaxin vaccinee at 1 month post first dose indicated the involvement of memory T cells. Persistent IgG and NAb responses along with IgG+B and IgG+memory B cells in AZD1222/Covishield recipients at 6 months post second dose indicated sustained immune memory response. Continued heightened IFN-γ secreting T cell response (ELISPOT) displayed by both the vaccine platforms could serve as a co correlate of protection, further to evaluation in follow up studies. Overall, our data suggest that coordinated functions of humoral and cellular branches of adaptive immunity may pave ways toward protective immunity against COVID-19.

Emergence of coinfection with visceral Leishmania infantum in COVID-19 patients: a case‒control field study in an endemic area of visceral leishmaniasis in Iran

BACKGROUND

COVID-19 is a pandemic involving coinfection with other opportunistic microorganisms, including parasites such as Leishmania infantum. The present study aimed to determine the frequency of L. infantum infection and its role in disease and mortality among symptomatic COVID-19 patients in comparison with the non-COVID-19 control group in the endemic area of visceral leishmaniasis (VL) in Iran.

METHODS

A total of 250 blood samples from hospitalized COVID-19 patients and 231 blood samples from non-COVID-19 patients as a control group were collected in Mashkin Shahr city, Iran from October 2020 to May 2021, and anti-Leishmania infantum antibodies were detected via direct agglutination test (DAT). For confirmation of non-COVID-19 samples as the control group, anti-COVID-19 IgG antibodies were measured via indirect ELISA. Additionally, demographic data, clinical data, and disease outcomes were recorded.

RESULTS

Overall, 46 (18.4%) COVID-19 patients and 18 (7.8%) non-COVID-19 patients had anti-Leishmania infantum antibodies at titers of 1:200 or higher according to the DAT (p value[Formula: see text] 0.05). In the COVID-19 group, there was no statistically significant association between coinfection with L. infantum and sex, residency, treatment outcome, or symptoms.

CONCLUSION

The results of this study revealed that the overall seroprevalence of L. infantum infection among patients with COVID-19 was 2.66 times greater than that in the control group, which was statistically significant. It seems that L. infantum infection can be considered a risk factor for COVID-19, particularly in VL endemic areas.

CLINICAL TRIAL NUMBER

Not applicable.

Antidiabetic potency of glimepiride and naringin: an in silico and in vitro investigation

Glimepiride (GLM) is one of the potential antidiabetic drugs used in clinics for a long time. It is currently used in combination with metformin along with other drugs, but has shown various complications in patients from long-term use. Thus, the hypothesis is to use a lower dose of GLM with a non-toxic class of flavonoid, naringin (NARN), for better therapy with minimal side-effects. Initially, we assessed the binding efficacy of GLM and NARN against nine putative target enzymes using AutoDock 4.2 software. We also analysed the drug chemistry, drug-ability, and cytotoxicity, as well as performed molecular dynamic (MD) simulation at 100 ns with individual and combination states using GROMACS-2022 software. Both candidates showed higher binding efficacy, especially against the AKT-serine/threonine kinase-1 (AKT1) target enzyme (-11.85 kcal/mol), and demonstrated higher stability and compatibility with AKT1 from MD-simulation (based on RMSD, Rg, RMSF, and H-bond plots) in combination than individual form. The in vitro cytotoxicity with human embryonic kidney (HEK-293) cells suggested 100 µg/mL (observed 80% of the cell viability) as a non-toxic dose for further study. Alpha-amylase, alpha-glucosidase, and DPP-IV inhibition assays revealed that both GLM and NARN inhibited up to 60% at 100 µg/mL in a concentration-dependent manner. At the end, selecting a lower dose of GLM and a higher dose of NARN (2:8 v/v ratio) showed up to 87% inhibition at 100 µg/mL. Both in silico and in vitro studies suggest that the investigated formulation could be a potential and non-toxic dose for diabetics.

Impact of COVID-19 and recovery of routine diabetic retinopathy digital screening across different regions in England: an analysis of publicly available data

OBJECTIVE

This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).

DESIGN

Retrospective data analysis.

SETTING

DESPs of England.

PARTICIPANTS

Individuals with diabetes who were invited to take part in the DESP programmes.

METHODS

Publicly available data from Public Health England (2018-2019) and National Health Service England (2019-2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.

PRIMARY OUTCOME MEASURES

Rate of uptake of RDS.

RESULTS

The national uptake of RDS decreased from 82% (2019-2020) to 68% (2020-2021) and then increased to 78% (2021-2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019-2020) to 53% (2020-2021), increasing to 73% (2021-2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020-2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021-2022 of 33%, 21% and 31%, they did not reach prepandemic (2018-2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%-89%) in 2020-2021.

CONCLUSION

COVID-19 had an impact on England's diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.

The Severity of the COVID-19 Among Chronic Disease Patients in the Selected Hospitals in Riyadh, Saudi Arabia - A Retrospective Study

Background and Aims

Chronic disease is a lifelong disorder that necessitates continuing medical care and is more prone to infections such as COVID-19, compared to healthy individuals. Therefore, this study aimed to assess the severity of COVID-19 among chronic disease patients in the Kingdom of Saudi Arabia.

Methods and Materials

A cross-sectional study was conducted in selected hospitals in the Riyadh region in Saudi Arabia, over 6 months in 2022. All participants' records were reviewed for socio-demographic data including age, gender, residence, marital status, level of education, occupation, and special habits such as smoking or addiction. In addition to this main complaint and present history, history of chronic illnesses, drug intake, surgical interference, general examination findings including vital signs, state of consciousness, general condition at admission and discharge, and outcome of cases were recorded.

Results

The mean age of the patient was 54.46 ± 15.85 (median of 53.67 years). In this study, the severity of COVID-19 was significantly associated with chronic diseases. For instance, 22.31% of the patients with diabetes reported mild symptoms, compared with 77.69% of the patients without diabetes. The current findings reported 2.18% of COVID-19 patients with respiratory diseases and 97.82% of the patients without respiratory diseases reported mild symptoms of COVID-19 infection. In comparison, 97.75% of COVID-19 patients without respiratory diseases and 2.25% of patients with respiratory diseases reported moderately severe COVID-19 infection.

Conclusion

The current findings revealed that 66.2% of the COVID-19 patients with chronic diseases were free of symptoms, 5.3% of them died and 0.9% of the patients were in a worse situation. The severity of COVID-19 was significantly associated with the presence of chronic diseases. Additionally, medical practitioners must be more knowledgeable about the long-term illnesses that put patients at risk for serious COVID-19 challenges and mortality.

Efficacy of Ulinastatin in the Treatment of COVID-19: A Retrospective Study

Purpose

This retrospective study aimed to evaluate the efficacy of ulinastatin in the treatment of COVID-19 patients compared to conventional therapy.

Patients and Methods

A total of 437 COVID-19 patients admitted to the Respiratory Oncology Department of our hospital between December 31, 2022, and July 8, 2023, were included in the study. Patients were classified into the observation group (n=62) receiving ulinastatin in addition to standard treatment and the control group (n=347) receiving standard treatment only. Clinical information, laboratory results, and treatment outcomes were collected and analyzed.

Results

The observation group showed an improvement in lymphocyte count compared to the control group. The clinical improvement rate in patients receiving ulinastatin for 7 days or longer was 92.1%, significantly higher than that of patients treated for less than 7 days (62.5%) and those receiving standard treatment (71.0%). No significant difference in total length of hospitalization was observed between the two groups, and no related adverse events occurred in either group.

Conclusion

Ulinastatin treatment improves lymphocyte counts in severe COVID-19 patients, and the clinical improvement rate is significantly higher with treatment duration of 7 days or longer. Larger-scale randomized controlled trials are warranted to further explore the role of ulinastatin in the management of COVID-19.

Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications

The last two decades have provided far more options f both patients and their physicians in the treatment of diabetes mellitus. While dipeptidyl peptidase-4 inhibitors (DPP-4is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been approved for nearly two decades, sodium-glucose cotransporter 2 inhibitors (SGLT-2is) are relatively new. Of interest to perioperative physicians, these drugs present specific perioperative concerns, prompting many societies to issue guidelines. Retained gastric contents due to slow gastric emptying is a significant drawback of GLP-1RAs, increasing the risk of aspiration. Recommendations include withholding GLP-1RAs for a predefined period of time, performing gastric ultrasound to evaluate gastric contents, modifying anesthesia management, particularly with regard to the airway, or canceling the scheduled (elective) surgery or procedure. SGLT-2is are known to increase the risk of euglycemic ketoacidosis. The benefits of both GLP-1RAs and SGLT-2is extend beyond the treatment of diabetes. As a result, perioperative physicians may encounter their use outside of their traditional indications. SGLT-2is are being used extensively to treat heart failure and obesity, for example. There have been other developments as well. For instance, Imeglimin, a variant of metformin available in Japan and India, Icodec, a once-weekly basal insulin formulation, and IcoSema, a once-weekly combination of Icodec plus semaglutide, are all being explored, although in their early stages or facing approval challenges.

Incidence and Outcomes of Vertebral Compression Fracture Among Patients Infected with COVID-19

Background/Objectives: Early studies have suggested that the SARS-CoV-2 virus has a deleterious effect on bone mineral density and may increase the risk of pathological fractures. This study characterized vertebral compression fractures in patients with and without a prior diagnosis of COVID-19. Methods: Using a nationwide claims database, this retrospective study used ICD-10 billing codes to identify patients with a diagnosis of vertebral compression fracture from January 2020 to April 2022. Two cohorts were created based on whether the patients had a concurrent diagnosis of COVID-19. Patient demographics, comorbidities, and outcome measures were characterized by descriptive analysis. Results: In total, 413,425 patients met the inclusion criteria. Among them, a total of 23,148 patients (5.60%) had a diagnosis of COVID-19 at the time of their compression fracture. Among the COVID-19 patients, the incidences of vertebral compression fracture were 0.42% in 2020 and 0.33% in 2021, in comparison to the historical average yearly incidence of 0.17% across all patients. The patients with COVID-19 at the time of compression fracture diagnosis had a higher rate of vitamin D deficiency (OR: 1.25) and a lower rate of routine healing (OR: 0.61). The patients without COVID-19 were more likely to be osteoporotic (OR: 0.88), experience additional compression fractures (OR: 0.38), and have kyphoplasty or vertebroplasty (OR: 0.73). Conclusions: Despite lower rates of osteoporosis, patients with a concomitant COVID-19 diagnosis exhibited a higher incidence of compression fractures. Although more research is needed, these results support increasing bone health surveillance in patients with a history of COVID-19 infection.

Research progress on the mechanism of hyperuricemic nephropathy based on multi-omics technique: A review

Hyperuricemic nephropathy is a metabolic disease in which renal uric acid deposition and excretion are impaired due to elevated levels of uric acid in the blood, leading to impaired renal tubule function and chronic renal disease. Hyperuricemic nephropathy is one of the important complications of hyperuricemia, which seriously affects the quality of life and prognosis of patients. The pathogenesis of hyperuricemic nephropathy involves a variety of factors, including: amino acid metabolism disorder, energy metabolism abnormality, increased nucleotide metabolism, lipid metabolism disorder and bile acid metabolism imbalance, REDOX process disorder, cell cycle and apoptosis imbalance, signal transduction and inflammatory response enhancement, and intestinal flora imbalance. In recent years, omics techniques such as metabolomics, transcriptomics and intestinal microecology have been used to reveal the metabolic, gene and microflora characteristics of hyperuricemic nephropathy from different levels, as well as their interactions and regulatory mechanisms. This paper reviews these studies, analyzes the existing problems and challenges, and puts forward future research directions and suggestions, aiming at providing new theoretical basis and practical guidance for the prevention and treatment of hyperuricemic nephropathy.

Variations in Furin SNPs, a Major Concern of SARS-CoV-2 Susceptibility Among Different Populations: An In-Silico Approach

COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) had an adverse effect globally because it caused a global pandemic with several million deaths. This virus possesses spike protein that is cleaved or activated by Furin-like protease enzymes occurring by mammalian lung or respiratory cells to enter the mammalian body. The addition of the Furin cleavage site in SARS-CoV-2 makes it a more infectious and emerging virus than its ancestor's viruses. Phylogenetic relationships of coronavirus spike proteins have analyzed and mapped Furin recognition motif on the tree using bioinformatics tools such as GTEx, KEGG, GO, NCBI, PolyPhen-2, SNAP2, PANTHER, Hidden Markov Models (Fathmm), Phd-single-nucleotide polymorphism (SNP), I-TASSER, Modpred, Phobius, SIFT, iPTREE-STAB, and PROVEAN. During this study, it has been found that in certain regions, Furin SNPs have some relation with the susceptibility to SARS-CoV-2. Whereas in other regions, the effects are very negligible. Finally, our study demonstrates that Furin SNPs have a strong relationship with susceptibility to SARS-CoV-2. As it helps to cleave the spike protein of the virus, thus it can be targeted to inhibit at a particular site to prevent the SARS-CoV-2 from the entrance into the body.

EpiGePT: a pretrained transformer-based language model for context-specific human epigenomics

The inherent similarities between natural language and biological sequences have inspired the use of large language models in genomics, but current models struggle to incorporate chromatin interactions or predict in unseen cellular contexts. To address this, we propose EpiGePT, a transformer-based model designed for predicting context-specific human epigenomic signals. By incorporating transcription factor activities and 3D genome interactions, EpiGePT outperforms existing methods in epigenomic signal prediction tasks, especially in cell-type-specific long-range interaction predictions and genetic variant impacts, advancing our understanding of gene regulation. A free online prediction service is available at http://health.tsinghua.edu.cn/epigept .

AMP kinase: A promising therapeutic drug target for post-COVID-19 complications

The COVID-19 pandemic, caused by SARS-CoV-2, has resulted in severe respiratory issues and persistent complications, particularly affecting glucose metabolism. Patients with or without pre-existing diabetes often experience worsened symptoms, highlighting the need for innovative therapeutic approaches. AMPK, a crucial regulator of cellular energy balance, plays a pivotal role in glucose metabolism, insulin sensitivity, and inflammatory responses. AMPK activation, through allosteric or kinase-dependent mechanisms, impacts cellular processes like glucose uptake, fatty acid oxidation, and autophagy. The tissue-specific distribution of AMPK emphasizes its role in maintaining metabolic homeostasis throughout the body. Intriguingly, SARS-CoV-2 infection inhibits AMPK, contributing to metabolic dysregulation and post-COVID-19 complications. AMPK activators like capsaicinoids, curcumin, phytoestrogens, cilostazol, and momordicosides have demonstrated the potential to regulate AMPK activity. Compounds from various sources improve fatty acid oxidation and insulin sensitivity, with metformin showing opposing effects on AMPK activation compared to the virus, suggesting potential therapeutic options. The diverse effects of AMPK activation extend to its role in countering viral infections, further highlighting its significance in COVID-19. This review explores AMPK activation mechanisms, its role in metabolic disorders, and the potential use of natural compounds to target AMPK for post-COVID-19 complications. Also, it aims to review the possible methods of activating AMPK to prevent post-COVID-19 diabetes and cardiovascular complications. It also explores the use of natural compounds for their therapeutic effects in targeting the AMPK pathways. Targeting AMPK activation emerges as a promising avenue to mitigate the long-term effects of COVID-19, offering hope for improved patient outcomes and a better quality of life.

The prevention opportunities of retinopathy in diabetic patients - position paper endorsed by the Polish Lipid Association

Cardiovascular diseases (CVD) prevention does not only mean effective fight against the existing and well-recognized cardiovascular risk factors, but also against their complications, including micro- and macrovascular complications. Only then we might comprehensively reduce CVD burden and cardiovascular and cause-specific morbidity and mortality. In relation to obesity, prediabetes and especially diabetes, we recognize a number of potential dangerous non-cardiovascular complications, such as neuropathy, nephropathy and retinopathy. The latter's prevalence is even 30-40% and may appear in as many as 15% of patients with prediabetes. If not treated well it might result in the need for eye surgery or even vision loss. Fenofibrate has had a long history of evidence suggesting its preventive role in primary and especially secondary prevention of retinopathy, what has been investigated since the FIELD trial 19 years ago. Thus, given the obesity (the prevalence of 30% in Poland) and diabetes (10% which is predicted to be doubled in next 25 years) epidemic, we should look for the effective methods not only to optimize fasting blood glucose and haemoglobin A1C, but also atherogenic dyslipidaemia and their complications, including retinopathy. In this Position Paper by the Polish Lipid Association (PoLA) we have reviewed the current stage of knowledge on possible mechanisms by which fenofibrate may contribute to retinopathy prevention, available data on safety and efficacy, to finally recommend administering fenofibrate in prevention of this dangerous diabetic complication, which significantly affects quality of life and disability-adjusted life-years (DALY). This intervention - well-recognized and already in common use in diabetic patients - may significantly improve population health in Poland and worldwide.

Unveiling risk factors for post-COVID-19 syndrome development in people with type 2 diabetes

Introduction

Post-COVID-19 syndrome (PCS) is a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-associated chronic condition characterized by long-term violations of physical and mental health. People with type 2 diabetes (T2D) are at high risk for severe COVID-19 and PCS.

Aim

The current study aimed to define the predictors of PCS development in people with T2D for further planning of preventive measures and improving patient outcomes.

Materials and methods

The data were collected through the national survey targeting persons with T2D concerning the history of COVID-19 course and signs and symptoms that developed during or after COVID-19 and continued for more than 12 weeks and were not explained by an alternative diagnosis. In total, 469 patients from different regions of Ukraine were enrolled in the study. Among them, 227 patients reported PCS development (main group), while 242 patients did not claim PCS symptoms (comparison group). Stepwise multivariate logistic regression and probabilistic neural network (PNN) models were used to select independent risk factors.

Results

Based on the survey data, 8 independent factors associated with the risk of PCS development in T2D patients were selected: newly diagnosed T2D (OR 4.86; 95% CI 2.55-9.28; p<0.001), female sex (OR 1.29; 95% CI 0.86-1.94; p=0.220), COVID-19 severity (OR 1.35 95% CI 1.05-1.70; p=0.018), myocardial infarction (OR 2.42 95% CI 1.26-4.64; p=0.002) and stroke (OR 3.68 95% CI 1.70-7.96; p=0.001) in anamnesis, HbA1c above 9.2% (OR 2.17 95% CI 1.37-3.43; p=0.001), and the use of insulin analogs (OR 2.28 95% CI 1.31-3.94; p=0.003) vs human insulin (OR 0.67 95% CI 0.39-1.15; p=0.146). Although obesity aggravated COVID-19 severity, it did not impact PCS development. In ROC analysis, the 8-factor multilayer perceptron (MLP) model exhibited better performance (AUC 0.808; 95% CІ 0.770-0.843), allowing the prediction of the risk of PCS development with a sensitivity of 71.4%, specificity of 76%, PPV of 73.6% and NPV of 73.9%.

Conclusions

Patients who were newly diagnosed with T2D, had HbA1c above 9.2%, had previous cardiovascular or cerebrovascular events, and had severe COVID-19 associated with mechanical lung ventilation were at high risk for PCS.

A genome-wide association study of anti-Müllerian hormone (AMH) levels in Samoan women

Study question

Can a genome-wide association study (GWAS) and transcriptome-wide association study (TWAS) help identify genetic variation or genes associated with circulating anti-Müllerian hormone (AMH) levels in Samoan women?

Summary answer

We identified eleven genome-wide suggestive loci (strongest association signal in ARID3A 19-946163-G-C [ p = 2.32 × 10⁻⁷]) and seven transcriptome-wide significant genes ( GINS2, SENP3, USP7, TUSC3, MAFA, METTL4, NDFIP1 [all with a p < 2.50 × 10⁻⁶]) associated with circulating AMH levels in Samoan women.

What is known already

Three prior GWASs of AMH levels identified eight loci in premenopausal women of European ancestry (AMH, MCM8, TEX41 , CHECK2, CDCA7 , EIF4EBP1, BMP4 and an uncharacterized non-coding RNA gene CTB-99A3.1 ), among which the MCM8 locus was shared among all three studies.

Study design size duration

We included a sample of 1,185 women from two independently recruited samples: a family study ( n = 212; [age: 18 to 40 years]) recruited in 2002-03 from Samoa and American Samoa; and the Soifua Manuia Study ( n = 973; age: 25 to 51 years), a crosssectional population-based study recruited in 2010 from Samoa.

Participants/materials setting methods

Serum AMH levels were measured using enzyme linked immunosorbent assays (ELISA). We performed GWASs in the two participant samples using a Cox mixed-effects model to account for AMH levels below detectable limits and adjusted for centered age, centered age², polity, and kinship via kinship matrix. The summary statistics were then meta-analyzed using a fixed-effect model. We annotated the variants with p < 1 × 10⁻⁵ and calculated posterior probability of causality for prioritization. We further annotated variants using FUMA and performed colocalization and transcriptome-wide association analysis. We also assessed whether any previously reported loci were replicated in our GWAS.

Main results and the role of chance

We identified eleven novel genome-wide suggestive loci ( p < 1 × 10⁻⁵) associated with AMH levels and replicated EIF4EBP1, a previously reported AMH locus, in the GWAS. The lead variant in ARID3A , 19-946163-G-C is in high linkage disequilibrium ( r ² = 0.79) with the known age-at-menopause variant 19-950694-G-A. Nearby KISS1R is a biologically plausibility causal gene in the region; kisspeptin regulates ovarian follicle development and has been linked to AMH levels. Further investigation of the ARID3A locus is warranted.

Limitations reasons for caution

The main limitations of our study are the small sample size for a GWAS and the use of the transcription model trained on mostly European samples from the Genotype Tissue Expression (GTEx) project, which may have led to reduced power to detect genotype-expression associations. Our findings need to be validated in larger Polynesian cohorts.

Wider implications of the findings

In addition to replicating one of the eight previously discovered AMH loci, we identified new suggestive associations. It is known that the inclusion of founder populations aids in the discovery of novel loci. These findings could enhance our understanding of AMH and AMH-related reproductive phenotypes (ovarian reserve, age at menopause, premature ovarian failure, and polycystic ovary syndrome) and help build a screening approach for women at risk for these phenotypes using genetically predicted AMH levels.

Study funding/competing interests

This work was funded by NIH grants R01-HL093093 (PI: S.T.M.), R01-HL133040 (PI: R.L.M.), and T90-DE030853 (PI: C.S. Sfeir). Molecular data for the Trans-Omics in Precision Medicine (TOPMed) Program was supported by the National Heart, Lung and Blood Institute (NHLBI). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Age-dependent effects of lockdown and post-lockdown periods on HbA1c during the COVID-19 pandemic: A 3-year longitudinal cohort study

The impact of COVID-19 lockdown on glycemic control in patients with diabetes mellitus (DM) remains unclear. This study aimed to investigate the effects of lockdown measures on the metabolic parameters of patients with DM, with particular emphasis on geriatric populations. In this retrospective, longitudinal cohort study, 1224 patients were analyzed. Three periods were identified to examine the effects of the lockdown: pre-lockdown, lockdown, and post-lockdown. Each period spanned 1-year. Within each 1-year period, at least 2 measurements were taken at least 3 months apart, and their arithmetic mean was calculated. Only patients who presented to the hospital for DM management during all 3 periods were included in the study. While HbA1c levels significantly increased in patients over 65 years old during the lockdown period (P = .017), we observed a significant decrease in HbA1c levels in patients under 65 years old (P = .014). Upon further stratification of patients over 65 by age groups, HbA1c levels increased the most among those aged 75 to 85 years, with a significant rise also observed in those aged 65 to 75 years during the lockdown. However, there was no change in HbA1c levels for patients over 85 years old during the lockdown. These findings highlight the need for careful monitoring of elderly patients with DM during lockdown periods, facilitated via home care or telehealth services. Structured diet and exercise programs should also be provided for at home adherence.

Effects of a Low-Protein Diet on Kidney Function in Patients With Chronic Kidney Disease: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Controlled Trials

CONTEXT

Chronic kidney disease (CKD) stands out as one of the most widespread diseases globally. Dietary interventions, such as adopting a low-protein diet (LPD), play a crucial role as a key approach in impeding the advancement of CKD.

OBJECTIVE

The objective of this umbrella review was to provide understanding into the effects of an LPD on kidney function among individuals with CKD, along with evaluating the certainty of the available evidence.

DATA SOURCES

Searches for relevant studies were conducted without limitations through databases such as PubMed, Scopus, Web of Science, and Google Scholar, encompassing findings up to June 2023.

DATA EXTRACTION

The effect sizes for each meta-analysis were recalibrated using a random-effects model. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

DATA ANALYSIS

Twenty-five meta-analyses including 47 randomized controlled trials were included in this study. Moderate certainty of the evidence suggests that LPDs may reduce glycated hemoglobin (HbA1c) and phosphorus levels, and the risk of progressing to end-stage renal disease in patients with CKD. Moreover, notable outcomes include increased glomerular filtration rate and decreased levels of serum albumin, blood urea nitrogen, and bicarbonate, although the certainty of evidence is low. In addition, LPDs can substantially decrease proteinuria, urine urea, and parathyroid hormone (PTH), although with very low certainty. The effects on serum creatinine, calcium, systolic blood pressure, and diastolic blood pressure are statistically nonsignificant, with the certainty of evidence ranging from low to moderate.

CONCLUSION

LPDs demonstrated beneficial effects on renal function in patients with CKD, which is supported by moderate to very low certainty evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023473647.

Association among diabetes, cardiovascular disease and mortality in patients hospitalised for COVID-19: an analysis of the American Heart Association COVID-19 CVD Registry

OBJECTIVE

To examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established heart failure (HF) or established atherosclerotic cardiovascular disease (ASCVD).

DESIGN

Observational study; longitudinal analysis of registry data.

SETTING

Hospitals in the USA reporting to the American Heart Association (AHA) COVID-19 Registry from January 2020 to May 2021.

PARTICIPANTS

20 796 individuals with diabetes (11 244 men; mean age 64.2) and 30 798 without diabetes (15 980 men; mean age 59.0) hospitalised for COVID-19 in the USA.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures were all-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilation. Secondary outcome measures included the association with diabetes and these outcomes among those with and without pre-existing ASCVD and HF and the association with insulin use and these outcomes in patients hospitalised for COVID-19.

RESULTS

After adjustment for relevant covariates diabetes increased the risk of mortality (HR 1.12, 95% CI: 1.03 to 1.21), MACE (HR 1.32, 95% CI: 1.17 to 1.48) and mechanical ventilation (HR 1.33, 95% CI: 1.26 to 1.42). Among patients with established ASCVD or HF, diabetes did not modify the risk of adverse outcomes. There was a significant difference in the risk of mortality between patients taking insulin compared with those who were not (HR 1.32, 95% CI: 1.01 to 1.26); however, there was no difference in the risk of MACE or mechanical ventilation.

CONCLUSIONS

Diabetes was associated with a higher risk of in-hospital all-cause mortality, MACE and need for mechanical ventilation in patients hospitalised for COVID-19. Diabetes was independently associated with adverse outcomes, particularly among those without pre-existing cardiovascular disease.

Computational studies for pre-evaluation of pharmacological profile of gut microbiota-produced gliclazide metabolites

Background

Gliclazide, a second-generation sulfonylurea derivative still widely used as a second-line treatment for type 2 diabetes mellitus, is well known to be subject to interindividual differences in bioavailability, leading to variations in therapeutic responses among patients. Distinct gut microbiota profiles among individuals are one of the most crucial yet commonly overlooked factors contributing to the variable bioavailability of numerous drugs. In light of the shift towards a more patient-centered approach in diabetes treatment, this study aimed to conduct a pharmacoinformatic analysis of gliclazide metabolites produced by gut microbiota and assess their docking potential with the SUR1 receptor to identify compounds with improved pharmacological profiles compared to the parent drug.

Methods

Ten potential gliclazide metabolites produced by the gut microbiota were screened for their pharmacological properties. Molecular docking analysis regarding SUR1 receptor was performed using Molegro Virtual Docker software. Drug-likeness properties were evaluated using DruLiTo software. Subsequently, the physicochemical and pharmacokinetic properties of gliclazide and its metabolites were determined by using VolSurf+ software package.

Results

All studied metabolites exhibited better intrinsic solubility than gliclazide, which is of interest, considering that solubility is a limiting factor for its bioavailability. Based on the values of investigated molecular descriptors, hydroxylated metabolites M1-M6 showed the most pronounced polar and hydrophilic properties, which could significantly contribute to their in vivo solubility. Additionally, docking analysis revealed that four hydroxyl-metabolites (M1, M3, M4, and M5), although having a slightly poorer permeability through the Caco-2 cells compared to gliclazide, showed the highest binding affinity to the SUR1 receptor and exhibited the most suitable pharmacological properties.

Conclusion

In silico study revealed that hydroxylated gut microbiota-produced gliclazide metabolites should be further investigated as potential drug candidates with improved characteristics compared to parent drug. Moreover, their part in the therapeutic effects of gliclazide should be additionally studied in vivo, in order to elucidate the role of gut microbiota in gliclazide pharmacology, namely from the perspective of personalized medicine.

Defining long COVID using a population-based SARS-CoV-2 survey in California

BACKGROUND

More than four years after the start of the COVID-19 pandemic, understanding of SARS-CoV-2 burden and post-acute sequela of COVID (PASC), or long COVID, continues to evolve. However, prevalence estimates are disparate and uncertain. Leveraging survey responses from a large serosurveillance study, we assess prevalence estimates using five different long COVID definitions among California residents.

METHODS

The California Department of Public Health (CDPH) conducted a cross-sectional survey that included questions about acute COVID-19 infection and recovery. A random selection of California households was invited to participate in a survey that included demographic information, clinical symptoms, and COVID-19 vaccination history. We assessed prevalence and predictors of long COVID among those previously testing positive for SARS-CoV-2 across different definitions using logistic regression.

FINDINGS

A total of 2883 participants were included in this analysis; the majority identified as female (62.5 %), and the median age was 39 years (interquartile range: 17-55 years). We found a significant difference in long COVID prevalence across definitions with the highest prevalence observed when participants were asked about incomplete recovery (20.9 %, 95 % confidence interval [CI]: 19.4-22.5) and the lowest prevalence was associated with severe long COVID affecting an estimated 4.9 % (95 % CI 4.1-5.7) of the participant population. Individuals that completed the primary vaccination series had significantly lower prevalence of long COVID compared to those that did not receive COVID vaccination.

INTERPRETATION

There were significant differences in the estimated prevalence of long COVID across different definitions. People who experience a severe initial COVID-19 infection should be considered at a higher probability for developing long COVID.

FUNDING

Centers for Disease Control and Prevention - Epidemiology and Laboratory Capacity.

A Narrative Review of the Role of Blood Biomarkers in the Risk Prediction of Cardiovascular Diseases

Cardiovascular disease (CVD) is a global health crisis and a leading cause of morbidities and mortalities. Biomarkers whose evaluation would allow the detection of CVD at an early stage of development are actively sought. Biomarkers are objectively measured as indicators of health, disease, or response to an exposure or intervention, including therapeutic interventions. Hence, this review aims to identify biomarkers that can help predict CVD risk in the healthy population. This helps with risk prediction and is crucial for advancing preventive cardiology and improving clinical outcomes in a wide range of patient populations. Biomarkers such as atherogenic lipoproteins, fibrinogen, homocysteine, and thyroid-stimulating hormone (TSH) have been linked to CVD risk factors, including dyslipidemia, hypertension, diabetes, and obesity. When combined with conventional biomarkers, inflammatory markers such as C-reactive protein (CRP) can enhance risk prediction. However, biomarkers such as high-sensitivity troponin T (hsTnT) and N-terminal proBNP (NT-proBNP) are widely used as diagnostic biomarkers for heart failure (HF) and cardiac dysfunction, as they are released only after one to two hours of cardiovascular event occurrence. Myeloperoxidase (MPO) and procalcitonin (PCT) have developed into promising new biomarkers for the early detection of systemic bacterial infections as inflammatory markers, which are better diagnostic tools than screening. Combining biomarkers can improve test accuracy, but the best combinations for diagnosis or prognosis must be identified.

Quality of life after prosthodontic rehabilitation in patients with bilateral total maxillectomy due to COVID-19-associated mucormycosis of the maxilla

BACKGROUND

Coronavirus disease 2019 (COVID-19)-associated mucormycosis of the maxilla emerged as a significant concern in India during the second wave of the pandemic, necessitating surgical interventions such as maxillectomy. This study investigated the quality of life following prosthodontic rehabilitation with interim obturators in patients who underwent bilateral total maxillectomy due to COVID-19-associated mucormycosis of the jaws.

METHODS

The study was conducted using questionnaire-based interviews administered by a single investigator employing the Oral Health Impact Profile-14 (OHIP-14) and Obturator Functioning Scale (OFS) questionnaires. Responses were evaluated on a Likert scale. All statistical analyses were performed using SPSS version 21.0 for Windows. A significance level of 5% was applied to all tests. The Wilcoxon signed-rank and chi-square tests were utilized to compare categorical and quantitative variables across groups. Responses to the questionnaires were recorded on numerical Likert scales ranging from 1 to 5 for OFS and 0 to 4 for OHIP-14. The mean OHIP-14 and OFS scores were compared between the pre-rehabilitation and post-rehabilitation stages.

RESULTS

A comparison between the pre-rehabilitation and post-rehabilitation scores from the OHIP-14 questionnaire revealed a significant difference (p= 0.001). The OFS results indicated significant improvements across all domains following the use of obturators.

CONCLUSION

Interim obturators play a vital role in improving speech, swallowing, and mastication during the recovery period for patients who have undergone bilateral total maxillectomy. Despite the altered anatomy resulting from the resection, patients adapted effectively and exhibited improvements in their social, psychological, and mental health.

Vitamin D: A key player in COVID-19 immunity and lessons from the pandemic to combat immune-evasive variants

As of the 7th of July 2024, 775,754,322 confirmed cases of COVID-19, including 7,053,902 deaths worldwide, had been reported to the WHO (World Health Organization). Nevertheless, untill the 15th of July 2024, a total of 13,578,710,228 vaccine doses had been administered, with almost no country spared from COVID-19 attacks. The pathophysiology of this virus is complicated, and several symptoms require a deep understanding of the actual mechanisms. It is unclear why some patients develop severe symptoms while others do not, although literature suggests a role for vitamin D. Vitamin D plays a crucial role in the infection or in ameliorating the severity of symptoms. The mechanism of action of vitamin D and vitamin D deficiency (VDD) is well understood. VDD is associated with increased hospitalization of severely ill patients and increased levels of COVID-19-caused mortality. Recent studies suggest that vitamin D levels and genetic variations in the vitamin D receptor (VDR) gene significantly impact the severity and outcomes of COVID-19, especially in the infections caused by Delta and Omicron variants. Furthermore, VDD causes immune system dysregulation upon infection with SARS-CoV-2, indicating that vitamin D sufficiency is crucial in fighting against COVID-19 infection. The therapeutic effect of vitamin D raises interest in its potential role as a prophylactic and treatment adjunct. We evaluate the immunomodulatory effects of vitamin D and its ability to enhance the efficacy of new antiviral drugs like molnupiravir and paxlovid against SARS-CoV-2. This review discusses the role of vitamin D sufficiency and VDD in COVID-19 initiation and progression, emphasizing the molecular mechanisms by which vitamin D exerts its actions as a proactive step for the next pandemic. However, there is still no clear evidence of vitamin D's impact on prevention and treatment, leading to contradictory findings. Therefore, large-scale randomized trials are required to reach a definitive conclusion. A bibliometric analysis of publications related to vitamin D, immunity, and COVID-19 revealed a significant increase in research activity in this area, particularly in 2020-2024, underscoring the growing recognition of vitamin D's potential role in the context of the pandemic.

The 5-HT-related gut-brain axis in obesity

AIMS

The incidence of obesity increases annually. It is closely related to the occurrence of cardiovascular diseases, malignant tumors, etc., and has become a major global health problem. 5-hydroxytryptamine (5-HT), a multifunctional monoamine neurotransmitter, is dispersed throughout the central nervous system and digestive tract. It is intimately related to the mechanism of obesity.

MATERIALS AND METHODS

PubMed, Web of Science and Embase were carefully searched. We collected articles that are closely related to 5-HT, the gut-brain axis, and obesity.

KEY FINGDINGS

The gut microbiota not only influences nutrient metabolism but also centrally meditates appetite and mood regulation. The gut-brain axis, a system connecting the gut and the brain, is known to participate in two-way communication between the gut flora and the central nervous system.

SIGNIFICANCE

There have been few reports on whether peripheral and central 5-HT interact bidirectionally via the gut-brain axis and jointly play a role in the pathogenesis of obesity. In this review, we summarize the rationale for the contribution of the 5-HT-related gut-brain axis to the development of obesity and explore feasible signaling pathways, which elucidates new targets for preventing and treating obesity.

Glucagon-like peptide agonists for weight management in antipsychotic-induced weight gain: A systematic review and meta-analysis

INTRODUCTION

Managing body weight in patients with antipsychotic-induced weight gain (AIWG) is challenging. Besides lifestyle interventions, pharmacological interventions may contribute to weight loss. This systematic review and meta-analysis evaluated the effect on weight loss and adverse effects of glucagon-like peptide-1 (GLP-1) agonists in patients with AIWG.

MATERIALS AND METHODS

Following PRISMA guidelines, we performed a meta-analysis of blinded and open-label randomised controlled trials (RCTs), non-randomised controlled trials and cohort studies that evaluated treatment with GLP-1 in patients with AIWG, regardless of psychiatric diagnosis. PubMed, Embase, PsycINFO and Cochrane Library databases were searched. Primary outcome measures were changes in body weight and BMI. Secondary outcomes were changes in adverse effects and severity of psychopathology due to GLP-1 agonists.

RESULTS

Only data for exenatide and liraglutide could be included, that is, five RCTs and one cohort study. For exenatide the mean weight loss was -2.48 kg (95% Confidence Interval (CI) -5.12 to +0.64; p = 0.07), for liraglutide the mean weight loss was -4.70 kg (95% CI -4.85 to -4.56; p < 0.001). The mean change in BMI was -0.82 (95% CI -1.56 to -0.09; p = 0.03) in the exenatide groups and -1.52 (95% CI -1.83 to -1.22; p < 0.001) in the liraglutide groups. Exenatide and liraglutide did not adversely affect psychopathology. The most common adverse events were nausea, vomiting, and diarrhoea.

CONCLUSION

The GLP-1 agonists exenatide and liraglutide are promising drugs for inducing weight loss in patients with AIWG. The adverse effects are acceptable, and the addition of GLP-1 does not increase the severity of psychopathology. However, more research is needed.

Structure based exploration of mitochondrial alpha carbonic anhydrase inhibitors as potential leads for anti-obesity drug development

BACKGROUND

Obesity has emerged as a major health challenge globally in the last two decades. Dysregulated fatty acid metabolism and de novo lipogenesis are prime causes for obesity development which ultimately trigger other co-morbid pathological conditions thereby risking life longevity. Fatty acid metabolism and de novo lipogenesis involve several biochemical steps both in cytosol and mitochondria. Reportedly, the high catalytically active mitochondrial carbonic anhydrases (CAVA/CAVB) regulate the intercellular depot of bicarbonate ions and catalyze the rapid carboxylation of pyruvate and acetyl-co-A to acetyl-co-A and malonate respectively, which are the precursors of fatty acid synthesis and lipogenesis. Several in vitro and in vivo investigations indicate inhibition of mitochondrial carbonic anhydrase isoforms interfere in the functioning of pyruvate, fatty acid and succinate pathways. Targeting of mitochondrial carbonic anhydrase isoforms (CAVA/CAVB) could thereby modulate gluconeogenetic as well as lipogenetic pathways and pave way for designing of novel leads in the development pipeline of anti-obesity medications.

METHODS

The present review unveils a diverse chemical space including synthetic sulphonamides, sulphamates, sulfamides and many natural bioactive molecules which selectively inhibit the mitochondrial isoform CAVA/CAVB with an emphasis on major state-of-art drug design strategies.

RESULTS

More than 60% similarity in the structural framework of the carbonic anhydrase isoforms has converged the drug design methods towards the development of isoform selective chemotypes. While the benzene sulphonamide derivatives selectively inhibit CAVA/CAVB in low nanomolar ranges depending on the substitutions on the phenyl ring, the sulpamates and sulpamides potently inhibit CAVB. The virtual screening and drug repurposing methods have also explored many non-sulphonamide chemical scaffolds which can potently inhibit CAVA.

CONCLUSION

The review could pave way for the development of novel and effective anti-obesity drugs which can modulate the energy metabolism.

Economic impact of COVID-19 on patients with type 2 diabetes in Kenya and Tanzania: a costing analysis

Introduction

COVID-19 affected healthcare access, utilisation and affordability, especially for patients suffering from chronic diseases, including type 2 diabetes (T2D). This study measured the occurrence and magnitude of changes in healthcare and broader societal costs among patients with T2D before and during COVID-19 in Kenya and Tanzania to understand whether and how COVID-19 affected T2D management in countries implementing different policies during the pandemic.

Methods

A cross-sectional study was conducted in Kenya and Tanzania in March-April 2022 among 500 patients with T2D in each country. We interviewed patients on direct healthcare costs (eg, inpatient and outpatient costs), societal costs (eg, productivity loss) and patients' characteristics before and during the COVID-19 pandemic. We estimated changes over time using the Generalised Linear Model in Kenya and a two-part model in Tanzania, adjusting for patient-level covariates.

Results

The overall costs of management of T2D in most categories increased in both countries during COVID-19, but some of the increase was not significant. Transport and testing costs increased significantly in Tanzania (I$0.33, p<0.01 and I$0.85, p<0.01) but not in Kenya (I$1.69, p=0.659 and I$0.10, p=0.603). Outpatient costs increased significantly in Tanzania (I$8.84, p<0.01) but there was no significant change in Kenya (I$8.09, p=0.432). T2D medication costs did not change in Tanzania (I$0.19, p=0.197), but decreased significantly in Kenya (I$18.48, p<0.01). Productivity losses increased significantly in both countries.

Conclusion

The COVID-19 pandemic is associated with increased direct costs but with a significant increase in many cost categories (transport, testing and outpatient) in Tanzania than in Kenya. A significant increase in productivity loss was observed in both countries. The minimal cost increases in Kenya may be due to the inaccessibility of services associated with lockdown measures and higher insurance coverage compared with Tanzania. Pandemic preparedness initiatives and interventions are needed to safeguard the welfare of patients with chronic conditions during pandemics.

Zinc pathogenic importance in correcting immunity and restoring public health in the post-COVID period: An overview

CONTEXT

The problem of correcting immune system function and compensating for co-morbidities becomes particularly clinically significant in the post-COVID period. There is evidence that certain trace elements in the human body, particularly zinc ions, play a critical role in restoring the function of the immune system and internal organs.

OBJECTIVE

To analyze the mechanisms of zinc action maintaining the body homeostasis in order to justify pathogenetically the inclusion of zinc drugs in the therapy of patients in the post-COVID period.

METHODS

Data from Elsevier, Global Health, PubMed-NCBI, Embase, MEDLINE, Scopus, Research gate, RSCI Scopus, Cochrane Library, Google Academy, e-LIBRARY.RU and CyberLeninka were used.

RESULTS

This review showed that the importance of zinc in maintaining body homeostasis in the post-COVID period is determined by its multifaceted effect on all parts of the immune system, its anti-inflammatory activity, antimicrobial properties and participation in the restoration of internal organ function. Elimination of zinc deficiency in the post-COVID period is essential to support immunity, compensate for comorbidities and reduce the risk of complications. The impossibility of synthesizing zinc in the body requires its constant intake in sufficient quantities. Zinc levels are significantly reduced after infectious diseases, as this element is specifically distributed to organs and tissues to maintain immunological and metabolic functions. The degree of zinc deficiency is associated with the severity of COVID-19 and the post-COVID period. It is pathogenetically justified to prescribe zinc drugs in the post-COVID period, the choice of which should take into account comorbidities and severity of hypozincemia.

CONCLUSION

Regularly administered therapy with zinc drugs in the post-COVID period will help correct the population immunity and restore public health.

Incretin-based therapy: a new horizon in diabetes management

Diabetes mellitus, a metabolic syndrome characterized by hyperglycemia and insulin dysfunction, often leads to serious complications such as neuropathy, nephropathy, retinopathy, and cardiovascular disease. Incretins, gut peptide hormones released post-nutrient intake, have shown promising therapeutic effects on these complications due to their wide-ranging biological impacts on various body systems. This review focuses on the role of incretin-based therapies, particularly Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, in managing diabetes and its complications. We also discuss the potential of novel agents like semaglutide, a recently approved oral compound, and dual/triple agonists targeting GLP-1/GIP, GLP-1/glucagon, and GLP-1/GIP/glucagon receptors, which are currently under investigation. The review aims to provide a comprehensive understanding of the beneficial impacts of natural incretins and the therapeutic potential of incretin-based therapies in diabetes management.

Lipids and apolipoproteins and the risk of vascular disease and mortality outcomes in women and men with type 2 diabetes in the ADVANCE study

AIM

Whether apolipoproteins (apolipoprotein A1, apolipoprotein B, apolipoprotein B/apolipoprotein A1 [ApoB/ApoA1] ratio) or very-low-density lipoprotein (VLDL) cholesterol are better risk predictors than established lipid risk markers, and whether there are sex differences, is uncertain, both in general populations and in patients with diabetes. The aim of this study was to assess the association between established risk markers, apolipoproteins and the risk of macro- and microvascular disease and death in a large study of women and men with diabetes and to assess the potential sex differences in the associations.

MATERIALS AND METHODS

Established lipid risk markers were studied in 11 140 individuals with type 2 diabetes from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial, and apolipoproteins (A1, B, ApoB/ApoA1 ratio) and VLDL cholesterol from nuclear magnetic resonance (NMR) lipid analyses in biobanked samples from 3586 individuals included in the ADVANCE case-cohort study (ADVANCE CC). Primary outcomes were major macro- and microvascular events and death. Cox proportional hazards models adjusted for confounders were used to quantify the associations (hazard ratio [HR] and 95% confidence intervals [CIs]) between established lipid risk markers and apolipoproteins with study outcomes. To address potential effect modification by sex, we investigated the association between the lipid risk markers and outcomes in subgroup analyses by sex.

RESULTS

There was a lower risk of macrovascular complications for high-density lipoprotein (HDL) cholesterol (HR [95%CI] 0.88 [0.82-0.95]), a higher risk for total cholesterol (1.10 [1.04-1.17]), low-density lipoprotein (LDL) cholesterol (1.15 [1.08-1.22]), non-HDL cholesterol (1.13 [1.07-1.20]) and the total cholesterol/HDL ratio (1.20 [1.14-1.27]) but no significant associations with triglycerides from ADVANCE. There was a higher risk of macrovascular complications for the ApoB/ApoA1 ratio (1.13 [1.03-1.24]) from the ADVANCE CC. Only the ApoB/ApoA1 ratio (1.19 [1.06-1.34]), but none of the established lipid risk markers, was associated with a higher risk of microvascular complications. There were no statistically significant sex differences for any of the established lipid risk markers or apolipoproteins with any outcome. Using C-statistics and net reclassification improvement (NRI) did not detect significant improvement in predicting all outcomes by adding lipids or apolipoproteins to the models with confounding factors only.

CONCLUSIONS/INTERPRETATION

All established lipid risk markers, except triglycerides, were predictors of macrovascular complications, but not microvascular complications, in patients with type 2 diabetes. The ApoB/ApoA1 ratio was associated with major macro- and microvascular complications, but there was no evidence that apolipoproteins are better than established lipid risk markers in predicting cardiovascular complications in patients with type 2 diabetes.