Therapeutic medications against diabetes: What we have and what we expect

Advancements in culture technology of adipose-derived stromal/stem cells: implications for diabetes and its complications

Stem cell-based therapies exhibit considerable promise in the treatment of diabetes and its complications. Extensive research has been dedicated to elucidate the characteristics and potential applications of adipose-derived stromal/stem cells (ASCs). Three-dimensional (3D) culture, characterized by rapid advancements, holds promise for efficacious treatment of diabetes and its complications. Notably, 3D cultured ASCs manifest enhanced cellular properties and functions compared to traditional monolayer-culture. In this review, the factors influencing the biological functions of ASCs during culture are summarized. Additionally, the effects of 3D cultured techniques on cellular properties compared to two-dimensional culture is described. Furthermore, the therapeutic potential of 3D cultured ASCs in diabetes and its complications are discussed to provide insights for future research.

Novel sulfonamide derivatives as multitarget antidiabetic agents: design, synthesis, and biological evaluation

A series of new sulfonamide derivatives connected through an imine linker to five or seven membered heterocycles were designed and synthesized. All synthesized derivatives were characterized using a variety of spectroscopic methods, including IR, 1HNMR, and 13CNMR. In vitro α-glucosidase and α-amylase inhibition activities, as well as glucose uptake were assessed for each of the synthesized compounds. Four sulfonamide derivatives namely 3a, 3b, 3h and 6 showed excellent inhibitory potential against α-glucosidase with IC50 values of 19.39, 25.12, 25.57 and 22.02 μM, respectively. They were 1.05- to 1.39-fold more potent than acarbose. Sulfonamide derivatives 3g, 3i and 7 (EC50 values of 1.29, 21.38 and 19.03 μM, respectively) exhibited significant glucose uptake activity that were 1.62- to 27-fold more potent than berberine. Both α-glucosidase protein (PDB: 2QMJ) and α-amylase (PDB: 1XCW) complexed with acarbose were adopted for docking investigations for the most active synthesized compounds. The docked compounds were able to inhabit the same space as the acarviosin ring of acarbose. The docking of the most active compounds showed an analogous binding with the active site of α-glucosidase as acarbose. The superior activity of the synthesized compounds against α-glucosidase enzyme than α-amylase enzyme can be rationalized by the weak interaction with the α-amylase. The physiochemical parameters of all synthesized compounds were aligned with Lipinski's rule of five.

TXNIP inhibition in the treatment of type 2 diabetes mellitus: design, synthesis, and biological evaluation of quinazoline derivatives

Thioredoxin interacting protein (TXNIP) is a potential drug target for type 2 diabetes mellitus (T2DM) treatment. A series of quinazoline derivatives were designed, synthesised, and evaluated to inhibit TXNIP expression and protect from palmitate (PA)-induced β cell injury. In vitro cell viability assay showed that compounds D-2 and C-1 could effectively protect β cell from PA-induced apoptosis, and subsequent results showed that these two compounds decreased TXNIP expression by accelerating its protein degradation. Mechanistically, compounds D-2 and C-1 reduced intracellular reactive oxygen species (ROS) production and modulated TXNIP-NLRP3 inflammasome signalling, and thus alleviating oxidative stress injury and inflammatory response under PA insult. Besides, these two compounds were predicted to possess better drug-likeness properties using SwissADME. The present study showed that compounds D-2 and C-1, especially compound D-2, were potent pancreatic β cell protective agents to inhibit TXNIP expression and might serve as promising lead candidates for the treatment of T2DM.

UPLC-Q-TOF/MS-based metabonomics reveals mechanisms for Holothuria leucospilota polysaccharides (HLP)-regulated serum metabolic changes in diabetic rats

This study aimed to use metabolomic methods to explore how Holothuria leucospilota polysaccharides (HLP) improved metabolism disorders in the liver of Goto-Kakizaki (GK) rats with spontaneous type 2 diabetes. The results showed that HLP effectively improved the metabolic disorder. Based on KEGG functional analysis, five key biomarkers associated with bile acid metabolism were detected and screened (P < 0.05). The results of serum total bile acid levels and liver damage in diabetic rats further showed the regulatory effects of HLP on bile acid metabolism. The results of bile acid-related gene expression in the liver showed that HLP inhibited liver farnesoid X Receptor - small heterodimer partner (FXR-SHP) signalling and increased the expression of bile acid synthesis genes (P < 0.05). Our results explored the underlying mechanisms by which HLP accelerated cholesterol consumption to anti-hypercholesterolemia and anti-diabetic by inhibiting liver FXR-SHP signaling. HLP's effect on bile acid regulation provides insights into treating T2DM.

Development of Long-Acting Dipeptidyl Peptidase-4 Inhibitors: Structural Evolution and Long-Acting Determinants

Considerable effort has been made to achieve less frequent dosing in the development of DPP-4 inhibitors. Enthusiasm for long-acting DPP-4 inhibitors is based on the promise that such agents with less frequent dosing regimens are associated with improved patient adherence, but the rational design of long-acting DPP-4 inhibitors remains a major challenge. In this Perspective, the development of long-acting DPP-4 inhibitors is comprehensively summarized to highlight the evolution of initial lead compounds on the path toward developing long-acting DPP-4 inhibitors over nearly three decades. The determinants for long duration of action are then examined, including the nature of the target, potency, binding kinetics, crystal structures, selectivity, and preclinical and clinical pharmacokinetic and pharmacodynamic profiles. More importantly, several possible approaches for the rational design of long-acting drugs are discussed. We hope that this information will facilitate the design and development of safer and more effective long-acting DPP-4 inhibitors and other oral drugs.

Comparative anti-Diabetic potential of phytocompounds from Dr. Duke's phytochemical and ethnobotanical database and standard antidiabetic drugs against diabetes hyperglycemic target proteins: an in silico validation

In the current investigation, the antidiabetic potential of 40 phytocompounds from Dr. Dukes phytochemical and ethanobotanical database and three antidiabetic pharmaceuticals from the market comparatively validated against hyperglycemic target proteins. Silymarin, proanthocyanidins, merremoside, rutin, mangiferin-7-O-beta-glucoside, and gymnemic acid exhibited good binding affinity toward protein targets of diabetes among the 40 phytocompounds from Dr.Dukes database over three chosen antidiabetic pharmaceutical compounds. Further these phytocompounds and sitagliptin are validated for its ADMET and bioactivity score to screen its pharmacological and pharmacokinetics properties. Silymarin, proanthocyanidins, rutin along with sitagliptin screened for DFT analysis found that phytocompounds have great Homo-Lumo orbital energies over commercial pharmaceutical sitagliptin. Finally, four complexes of alpha amylase-silymarin, alpha amylase-sitagliptin, aldose reductase-proanthocyanidins, and aldose reductase-sitagliptin screened for MD simulation and MMGBSA analysis, results shown that the phytocompounds silymarin and proanthocyanidins have strong affinities for binding to the binding pockets of alpha amylase and aldose reductase respectively over antidiabetic pharmaceuticals. Our current study proven proanthocyanidins and silymarin act as novel antidiabetic compounds toward diabetic target protein but it require clinical trial to evaluate its clinical pertinence toward diabetic target proteins.Communicated by Ramaswamy Sarma.

Potential Mechanism of Platelet-rich Plasma Treatment on Testicular Problems Related to Diabetes Mellitus

Diabetes mellitus is a condition of continuously increased blood glucose levels that causes hyperglycemia. This condition can result in disorders of various organs including testicular problems. The use of platelet-rich plasma (PRP) which is contained in several growth factors shows its potential in overcoming testicular problems. This literature review study was conducted to identify the potential of PRP in overcoming various testicular problems due to diabetic conditions.

Microbiota: A potential orchestrator of antidiabetic therapy

The gut microbiota, as a 'new organ' of humans, has been identified to affect many biological processes, including immunity, inflammatory response, gut-brain neural circuits, and energy metabolism. Profound dysbiosis of the gut microbiome could change the metabolic pattern, aggravate systemic inflammation and insulin resistance, and exacerbate metabolic disturbance and the progression of type 2 diabetes (T2D). The aim of this review is to focus on the potential roles and functional mechanisms of gut microbiota in the antidiabetic therapy. In general, antidiabetic drugs (α-glucosidase inhibitor, biguanides, incretin-based agents, and traditional Chinese medicine) induce the alteration of microbial diversity and composition, and the levels of bacterial component and derived metabolites, such as lipopolysaccharide (LPS), short chain fatty acids (SCFAs), bile acids and indoles. The altered microbial metabolites are involved in the regulation of gut barrier, inflammation response, insulin resistance and glucose homeostasis. Furthermore, we summarize the new strategies for antidiabetic treatment based on microbial regulation, such as pro/prebiotics administration and fecal microbiota transplantation, and discuss the need for more basic and clinical researches to evaluate the feasibility and efficacy of the new therapies for diabetes.

The possible protective and therapeutic effects of ginger and cinnamon on the testis and coda epididymis of streptozotocin-induced-diabetic rats: Histological and biochemical studies

Diabetes mellitus (DM) is a metabolic condition characterized by high blood sugar levels with serious system complications. Ginger (Zingiber officinale) and Cinnamon (Cinnamomum zeylanicum) have anti-diabetic activities. The goal of this study is to evaluate the possible protective and therapeutic effects of ginger and Cinnamon against histological, Ki67 Immunohistochemistry (IHC) and biochemical studies in testis and coda epididymis of Streptozotocin (STZ) induced diabetic rats. The experimental rats were divided into six groups: G1 was the control, G2 induced diabetic without treatment, G3 was treated with ginger before induction of DM (ginger protective), G4 were given ginger after DM induction (ginger therapeutic), G5 were given cinnamon before induction of DM (cinnamon protective) and G6 were given cinnamon after DM induction (cinnamon therapeutic). In diabetic rats' significant increases in fasting blood sugar and body weight were observed after three weeks. Ginger and cinnamon effectively decreased serum glucose levels. Histopathological evaluations of seminiferous tubules and coda epididymis sections from diabetic rats showed severe damage to them. Furthermore, the sections of seminiferous tubules and coda epididymis rats administered ginger and cinnamon extract showed normal structure, healthy lining epithelium and sperm contents compared to diabetic rats. The results of the study show that both Ginger and Cinnamon aqueous extracts are effective as both hypoglycemic natural supplements that can protect against diabetic-induced testicular damage as well as share in the reservation of the cauda epididymal structure and sperm contents.

Inhibitory effect of plant essential oils on α-glucosidase

Diabetes mellitus, associated with α-glucosidase, has been considered as a chronic metabolic disorder, seriously affecting human health. Thus, searching natural α-glucosidase inhibitors and investigating their inhibition mechanism are urgently important. In this study, sixty-two essential oils (EOs), derived from aromatic plants, were found to exert different inhibition on α-glucosidase. The further study revealed that the most potent EOs against α-glucosidase were chuan-xiong, fructus cnidii, sacha inchi, aloe, ganoderma lucidum spore and ginger with IC50 values of 3.02, 2.88, 7.37, 5.06, 5.32 and 7.40 μg/mL. Moreover, the inhibitory mechanism and kinetics studies found that chuan-xiong and sacha inchi were reversible and mixed-type inhibitors. Fructus cnidii, aloe, ganoderma lucidum spore and ginger were reversible and uncompetitive-type inhibitors. It is suggested that EOs, being of natural origin, would be promising anti-α-glucosidase agents.

Development of drug alone and carrier-based GLP-1 dry powder inhaler formulations

The study aimed to develop two types of dry powder inhaler (DPI) formulations containing glucagon-like peptide-1(7-36) amide (GLP-1): carrier-free (drug alone, no excipients) and carrier-based DPI formulations for pulmonary delivery of GLP-1. This is the first study focusing on the development of excipient free GLP-1 DPI formulations for inhaled therapy in Type 2 diabetes. The aerosolisation performance of both DPI formulations was studied using a next generation impactor and a DPI device (Handihaler®) at flow rate of 30 L min^-1. Carriers employed were either a 10% w/w glycine-mannitol prepared by spray freeze drying or commercial mannitol. Spray freeze dried (SFD) carrier was spherical and porous whereas commercial mannitol carrier exhibited elongated particles (non-porous). GLP-1 powder without excipients for inhalation was prepared using spray drying and characterised for morphology including size, thermal behaviour, and moisture content. Spray dried (SD) GLP-1 powders showed indented/dimpled particles in the particle size range of 1 to 5 µm (also mass median aerodynamic diameter, MMAD: <5 µm) suitable for pulmonary delivery. Across formulations investigated, carrier-free DPI formulation showed the highest fine particle fraction (FPF: 90.73% ± 1.76%, mean ± standard deviation) and the smallest MMAD (1.96 µm ± 0.07 µm), however, low GLP-1 delivered dose (32.88% ± 7.00%, total GLP-1 deposition on throat and all impactor stages). GLP-1 delivered dose was improved by the addition of SFD 10% glycine-mannitol carrier to the DPI formulation (32.88% ± 7.00% -> 45.92% ± 5.84%). The results suggest that engineered carrier-based DPI formulations could be a feasible approach to enhance the delivery efficiency of GLP-1. The feasibility of systemic pulmonary delivery of SD GLP-1 for Type 2 diabetes therapy can be further investigated in animal models.

The management of diabetes mellitus by mangiferin: advances and prospects

Diabetes mellitus has become one of the most challenging public health problems today. There are still various deficiencies that remain in existing therapeutic drugs. With increasing prevalence and mortality rates, more effective therapeutic agents are required for treatment clinically. As a kind of polyphenol and as a natural product, mangiferin has numerous pharmacological and excellent effects. In this review, the underlying mechanisms of mangiferin on diabetes mellitus and complications will be summarized. Moreover, mangiferin belongs to the BSC IV class and the clinical application and development of mangiferin are limited due to its poor aqueous solubility and fat solubility as well as low bioavailability. Our review also elaborated on improving the solubility of mangiferin by changing the dosage form and introduced the existing results, which hope to provide useful reference for mangiferin for further treating diabetes. In conclusion, mangiferin might be a potential adjuvant therapy for the treatment of diabetes mellitus and complications in the future.

Trehalose Ameliorates Diabetic Cardiomyopathy: Role of the PK2/PKR Pathway

Ample clinical case reports suggest a high incidence of cardiomyopathy in diabetes mellitus (DM). Recent evidence supports an essential role of trehalose (TLS) in cardiomyocyte survival signaling. Our previous study found that prokineticin2 (PK2) was involved in the process of diabetic cardiomyopathy (DCM). The present study examined the protective effects and mechanisms of TLS on DM-induced cardiomyocyte injury in mice and H9c2 cardiomyocytes. C57BL/6J mice were intraperitoneally injected with 50 mg·kg⁻¹·d⁻¹ streptozotocin for five consecutive days to establish an experimental diabetic model and then administered TLS (1 mg·g⁻¹·d⁻¹, i.p.) for two days every 4 weeks and given 2% TLS in drinking water for 24 weeks. Echocardiography, myocardial structure, apoptosis, pyroptosis, autophagy, and the PK2/PKR pathway were assessed. Cardiomyocytes exposed to high glucose (HG) were treated with TLS in the absence or presence of the PK2 antagonist PKRA7, and proteins involved in apoptosis, autophagy, and pyroptosis and the PK2/PKR pathways were evaluated using Western blot analysis. Diabetic mice demonstrated metabolic disorder, abnormal myocardial zymograms, and aberrant myocardial systolic and diastolic function, which were accompanied by pronounced apoptosis, pyroptosis, and dampened autophagy. TLS treatment relieved these effects. PK2 and receptor expressions were downregulated in diabetic mice, and TLS nullified this effect. PKRA7 eliminated the impact of TLS on cardiomyocytes. This evidence suggests that TLS rescues DM-induced myocardial function, pyroptosis, and apoptosis, likely via the PK2/PKR pathway.

Identification and structure-activity relationship exploration of uracil-based benzoic acid and ester derivatives as novel dipeptidyl Peptidase-4 inhibitors for the treatment of type 2 diabetes mellitus

Our previously reported carboxyl-containing DPP-4 inhibitors were highly potent but were poorly bioavailable. Esters of the carboxyl analogs exhibited a significant DPP-4 potency loss albeit with enhanced oral absorption. Herein, we described identification and structure-activity relationship (SAR) exploration of a novel series of benzoic acid and ester derivatives as low single-digit nanomolar DPP-4 inhibitors. Importantly, the esters displayed comparable activities to the acids counterparts. Molecular simulation revealed that ester adopts a similar binding mode to acid. Moreover, the selected esters and acids demonstrated high selectivity and low cytotoxicity, as well as good metabolic stability. And more importantly, the esters possessed excellent pharmacokinetic profiles for oral administration. The best compound ester 19b demonstrated long DPP-4 inhibition in vivo, and robustly improved the glucose tolerance in normal and db/db mice while ensuring glucose-lowering potency in chronic treatment. Our results supported that the compound 19b can be served as a potential candidate for the treatment of type 2 diabetes.

Secoiridoid dimers and their biogenetic precursors from the fruits of Cornus officinalis with potential therapeutic effects on type 2 diabetes

Cornusdiridoid A-F (1-6), six unusual cornuside-morroniside secoiridoid dimers, and their possible new biogenetic precursor, 3″,5″-dehydroxycornuside (7), together with four known secoiridoids (8-11), were obtained from the fruits of Cornus officinalis. Their structures were elucidated on the basis of various spectroscopic and chemical methods. A plausible biosynthetic pathway of compounds 1-11 was proposed. The α-glucosidase inhibitory, antioxidant and anti-inflammatory activities of these isolates were evaluated. Some of them emerged out as potent antidiabetic, anti-inflammatory and free radical scavenging agents. Molecular docking was also carried out for antidiabetic target α-glucosidase to investigate the possible binding modes of the most potent α-glucosidase inhibitor, vincosamide (9). These results revealed that the secoiridoids from C. officinalis fruits may be served as new potential antidiabetic agents to prevent and treat type 2 diabetes.

Fibronectin type III domain-containing 5 in cardiovascular and metabolic diseases: a promising biomarker and therapeutic target

Cardiovascular and metabolic diseases are the leading causes of death and disability worldwide and impose a tremendous socioeconomic burden on individuals as well as the healthcare system. Fibronectin type III domain-containing 5 (FNDC5) is a widely distributed transmembrane glycoprotein that can be proteolytically cleaved and secreted as irisin to regulate glycolipid metabolism and cardiovascular homeostasis. In this review, we present the current knowledge on the predictive and therapeutic role of FNDC5 in a variety of cardiovascular and metabolic diseases, such as hypertension, atherosclerosis, ischemic heart disease, arrhythmia, metabolic cardiomyopathy, cardiac remodeling, heart failure, diabetes mellitus, and obesity.

Targeting Small GTPases and Their Prenylation in Diabetes Mellitus

A fundamental role of pancreatic β-cells to maintain proper blood glucose level is controlled by the Ras superfamily of small GTPases that undergo post-translational modifications, including prenylation. This covalent attachment with either a farnesyl or a geranylgeranyl group controls their localization, activity, and protein–protein interactions. Small GTPases are critical in maintaining glucose homeostasis acting in the pancreas and metabolically active tissues such as skeletal muscles, liver, or adipocytes. Hyperglycemia-induced upregulation of small GTPases suggests that inhibition of these pathways deserves to be considered as a potential therapeutic approach in treating T2D. This Perspective presents how inhibition of various points in the mevalonate pathway might affect protein prenylation and functioning of diabetes-affected tissues and contribute to chronic inflammation involved in diabetes mellitus (T2D) development. We also demonstrate the currently available molecular tools to decipher the mechanisms linking the mevalonate pathway’s enzymes and GTPases with diabetes.

Catalytic effects of magnetic and conductive nanoparticles on immobilized glucose oxidase in skin sensors

Wearable skin sensors is a promising technology for real-time health care monitoring. They are of particular interest for monitoring glucose in diabetic patients. The concentration of glucose in sweat can be more than two orders of magnitude lower than in blood. In consequence, the scientific and technological efforts are focused in developing new concepts to enhance the sensitivity, decrease the limit of detection (LOD) and reduce the response time (RT) of glucose skin sensors. This work explores the effect of adsorbed superparamagnetic magnetite nanoparticles (MNPs) and conductive nanoparticles (CNPs) on carbon nanotube substrates (CNTs) used to immobilize glucose oxidase enzyme in the working electrode of skin sensors. MNPs and CNPs are made of magnetite and gold, respectively. The performance of the sensors was tested in standard buffer solution, artificial sweat, fresh sweat and on the skin of a healthy volunteer during an exercise session. In the case of artificial sweat, the presence of MNPs accelerated the RT from 7 to 5 s at the expense of increasing the LOD from 0.017 to 0.022 mM with slight increase of the sensitivity from 4.90 to 5.09μAm M^-1cm^-2. The presence of CNPs greatly accelerated the RT from 7 to 2 s and lowered the LOD from 0.017 to 0.014 mM at the expense of a great diminution of the sensitivity from 4.90 to 4.09μAm M^-1cm^-2. These effects were explained mechanistically by analyzing the changes in the concentration of free oxygen and electrons promoted by MNPs and CNPs in the CNTs and its consequences on the the glucose oxidation process.

Protective effect of fermented Diospyros lotus L. extracts against the high glucose-induced apoptosis of MIN6 cells

Date plum persimmon (Diospyros lotus L.) is a fruit crop from the Ebenaceae family. Its microorganism-fermented extract (DPEML) was shown to exhibit a hypoglycemic effect in our previous work. Here, we investigated the effects of DPEML fermented by Microbacterium flavum YM18-098 and Lactobacillus plantarum B7 on the high glucose-induced apoptosis of MIN6 cells and explored its potential cell protective mechanisms. DPEML ameliorated the apoptosis of MIN6 cells cultured under high glucose conditions, thereby improving cell viability. DPEML upregulated the Bcl-2/Bax mRNA ratio to obstruct an intrinsic apoptotic pathway and concomitantly downregulated the expression of the apoptosis-linked proteins, AIF, and Cyt-C, in high glucose-induced MIN6 cells. Furthermore, DPEML promoted the insulin secretion of MIN6 cells grown under chronically high-glucose conditions by upregulating Ins mRNA expression. In summary, our study suggested that DPEML is a promising functional food for the development of therapeutics for the treatment of Type 2 diabetes mellitus. PRACTICAL APPLICATIONS: We investigated the effects of DPEML fermented by Microbacterium flavum YM18-098 and Lactobacillus plantarum B7 on the high glucose-induced apoptosis of MIN6 cells and explored its potential cell protective mechanisms. DPEML ameliorated the apoptosis of MIN6 cells cultured under high glucose conditions, thereby improving cell viability. DPEML upregulated the Bcl-2/Bax mRNA ratio to obstruct an intrinsic apoptotic pathway and concomitantly downregulated the expression of the apoptosis-linked proteins, AIF and Cyt-C, in high glucose-induced MIN6 cells. Furthermore, DPEML promoted the insulin secretion of MIN6 cells grown under chronically high-glucose conditions by upregulating Ins mRNA expression. We suggested that DPEML is a promising functional food for the development of therapeutics for the treatment of Type 2 diabetes mellitus.

In silico analysis of a potential antidiabetic phytochemical erythrin against therapeutic targets of diabetes

Diabetes mellitus is a multifactorial disorder characterized by a chronic elevation in blood glucose levels. Currently, antidiabetic drugs are available to counteract the associated pathologies. Their concomitant effects necessitate the investigation for an effective and safe drug aimed to diminish blood glucose levels with fewer side effects. Several researchers are taking new initiatives to explore plant sources as they are known to contain a wide variety of active agents. Hence, the present study was undertaken to study the role of natural products using in silico interaction studies. Erythrin a compound present in lichens was selected as a potential anti-diabetic agent. Molecular docking studies were carried out with 14 target proteins to evaluate its antidiabetic potential. Molecular docking analysis resulted in favourable binding energy of interaction ranging as low as - 119.676 to - 92.9545 kcal/mol for erythrin, Analogue showed the highest interactions with 3C45 (- 119.676 kcal/mol) followed by 2Q5S (- 118.398 kcal/mol), 1XU7 (- 117.341 kcal/mol), 3K35 (- 114.267 kcal/mol). Erythrin was found to fare better than the three clinically used antidiabetic compounds, metformin, repaglinide and sitagliptin. Further, the molecular interactions between erythrin and the diabetes related target proteins was established by analysing the interactions with associated amino acids. In silico pharmacokinetics and toxicity profile of erythrin using admetSAR software predicted erythrin as non-carcinogenic and non-mutagenic. The drug-likeliness was calculated using molsoft software respecting Lipinski's rule of five. The compound was found to comply with Lipinksi rules violating only one filter criterion. The study suggested that erythrin could be a potential anti-diabetic agent.

Anti-inflammatory phytochemicals for the treatment of diabetes and its complications: Lessons learned and future promise

Diabetes mellitus (type 1 and type 2) and its various complications continue to place a huge burden on global medical resources, despite the availability of numerous drugs that successfully lower blood glucose levels. The major challenging issue in diabetes management is the prevention of various complications that remain the leading cause of diabetes-related mortality. Moreover, the limited long-term durability of monotherapy and undesirable side effects of currently used anti-diabetic drugs underlie the urgent need for novel therapeutic approaches. Phytochemicals represent a rich source of plant-derived molecules that are of pivotal importance to the identification of compounds with therapeutic potential. In this review, we aim to discuss recent advances in the identification of a large array of phytochemicals with immense potential in the management of diabetes and its complications. Given that metabolic inflammation has been established as a key pathophysiological event that drives the progression of diabetes, we focus on the protective effects of representative phytochemicals in metabolic inflammation. This paper also discusses the potential of phytochemicals in the development of new drugs that target the inflammation in the management of diabetes and its complications.

Nanotechnology in the Treatment of Diabetic Complications: A Comprehensive Narrative Review

In today's society, the prevention and treatment of diabetes mellitus and its subsequent complications have brought trouble to human beings. Complications caused by diabetes bring not only physical and mental pain to patients but also a heavy economic burden to families. And once diabetic complications occur, they are often irreversible and very difficult. At present, some studies suggest that nanotechnology can treat some diabetic complications. This paper reviews the application of nanotechnology in the repair of diabetic segmental bone injury, the healing of diabetic skin ulcers, the therapeutic effect, and improvement strategies and deficiencies of nanotechnology in diabetic complications.

Clinical and Prognostic Relevance of B7-H3 and Indicators of Glucose Metabolism in Colorectal Cancer

Objective

This study aimed to investigate the clinical and prognostic relevance of B7-H3 expression and indicators of glucose metabolism in patients with colorectal cancer (CRC).

Methods

Using immunohistochemistry, the expression of B7-H3 was detected in a total of 213 formalin-fixed paraffin-embedded CRC tissue specimens. Furthermore, levels of fasting blood glucose (FBG), lactic dehydrogenase (LDH), and fructosamine (FMN) as indicators of glucose metabolism were analyzed in CRC patients and stratified into high or low expression sub-groups based on Youden Index. The relationship between B7-H3, FBG, LDH, FMN expression, and clinicopathological characteristics were also evaluated to establish their prognostic significance in patients with CRC.

Results

B7-H3 was highly expressed in CRC tissue. The positive rates of B7-H3 expression was 63.8% (136/213). We found a linear correlation between B7-H3 and FBG in depth of tumor invasion (T3/4) (p = 0.037, r = 0.259), lymph node metastasis (N0) (p = 0.004, r = 0.259), and TNM stage (I/II) (p = 0.009, r = 0.242). High expression of FBG, LDH, FMN [hazard ratio (HR) = 1.916, 95% CI: 1.223–3.00, p = 0.005; HR = 1.801, 95% CI: 1.153–2.813, p = 0.010; HR = 2.154, 95% CI: 1.336–3.472, p = 0.002], respectively, was identified as a significant independent predictor of poor overall survival (OS). Although B7-H3 expression did not affect OS, CRC patients expressing both high B7-H3 and high FMN contributed to a significant decrease in OS (HR = 1.881, 95%CI: 1.059–3.339, p = 0.031). Moreover, with low expression of B7-H3, high expression of FBG, LDH and FMN were also recognized as predictors of inferior OS (HR = 3.393, 95% CI: 1.493-7.709, p = 0.004; HR = 7.107, 95% CI: 2.785–18.138, p = 0.000; HR = 2.800, 95% CI: 1.184–6.625, p = 0.019).

Conclusion

B7-H3 combined with FBG, LDH, or FMN, could reflect the clinical outcomes of patients with CRC.

Sex Differences in Kidney Stone Disease in Chinese Patients with Type 2 Diabetes Mellitus

Objectives

To investigate the characteristics of kidney stone disease (KSD) among the Chinese population with type 2 diabetes mellitus (T2DM) and identify sex-specific factors associated with KSD.

Methods

A single-center, cross-sectional analysis was performed among Chinese patients with T2DM. KSD was identified by ultrasonography or computed tomography results. Demographic data, physical measurements, laboratory measurements, comorbidities, and related medication data were collected and analyzed. Binary logistic regression was used to explore the associated factors.

Results

A total of 7,257 patients with T2DM were included in the study, of which 56.1% were male and 15.0% were diagnosed with KSD. The male-to-female ratio for KSD among T2DM patients was 1.35. Among all the T2DM patients, male gender, HOMA2-IR, uric acid, and renal cysts were independent risk factors for KSD development, whereas serum phosphorus and the use of angiotensin-converting enzyme inhibitors (ACEIs) were independent protective factors for KSD. Among male diabetic patients, triglycerides, HOMA2-IR, renal cysts, and urinary tract infections were all associated with a greater risk of KSD. In contrast, serum phosphorus was associated with a lower risk of KSD. Among female diabetic patients, systolic blood pressure and HOMA2-B were both contributing factors, and ACEIs acted as a protective factor for KSD.

Conclusion

Among Chinese patients with T2DM, approximately 1 in 7 patients was affected by KSD, and the prevalence was twice as high as that in the general Chinese population. The factors associated with KSD varied by sex among T2DM patients. Focusing on these factors is beneficial for reducing the risk of KSD and delaying kidney damage in diabetic patients.

Plant-Based Antidiabetic Nanoformulations: The Emerging Paradigm for Effective Therapy

Diabetes mellitus is a life-threatening metabolic syndrome. Over the past few decades, the incidence of diabetes has climbed exponentially. Several therapeutic approaches have been undertaken, but the occurrence and risk still remain unabated. Several plant-derived small molecules have been proposed to be effective against diabetes and associated vascular complications via acting on several therapeutic targets. In addition, the biocompatibility of these phytochemicals increasingly enhances the interest of exploiting them as therapeutic negotiators. However, poor pharmacokinetic and biopharmaceutical attributes of these phytochemicals largely restrict their clinical usefulness as therapeutic agents. Several pharmaceutical attempts have been undertaken to enhance their compliance and therapeutic efficacy. In this regard, the application of nanotechnology has been proven to be the best approach to improve the compliance and clinical efficacy by overturning the pharmacokinetic and biopharmaceutical obstacles associated with the plant-derived antidiabetic agents. This review gives a comprehensive and up-to-date overview of the nanoformulations of phytochemicals in the management of diabetes and associated complications. The effects of nanosizing on pharmacokinetic, biopharmaceutical and therapeutic profiles of plant-derived small molecules, such as curcumin, resveratrol, naringenin, quercetin, apigenin, baicalin, luteolin, rosmarinic acid, berberine, gymnemic acid, emodin, scutellarin, catechins, thymoquinone, ferulic acid, stevioside, and others have been discussed comprehensively in this review.

Dendrimer Based Nanoarchitectures in Diabetes Management: An Overview

Diabetes has turned out to be one of the biggest worldwide health and economic burdens, with its expanded predominance and high complexity proportion. The quantity of diabetic patients is expanding enormously around the world. Several reports have demonstrated the sharp increment in the sufferers. Stable and acceptable blood glucose control is fundamental to diminish diabetes-related complications. Consequently, ceaseless endeavors have been made in antidiabetic drugs, treatment strategies, and nanotechnology based products to accomplish better diabetes control. The nanocarriers pertaining hypoglycaemics provide improved diabetes management with minimum risk of associated side effects. Dendrimers have caught an incredible attention in the field of drug delivery and personalized medicines. Dendrimers are three-dimensional well-defined homogenous nanosized structures consisting tree-like branches. The present review highlights the different aspects of dendrimers including fabrication, surface engineering, toxicological profile as well as delivery of antidiabetic drugs for the effective cure of diabetes.