Global estimates of the prevalence of diabetes for 2010 and 2030

Impact of walnut consumption on glycemic control and anthropometric indices: a systematic review and meta-analysis of randomized controlled trials

Objectives

Previous studies have led to conflicting results regarding the effect of walnut consumption on glycemic control, and anthropometric indices. This study aimed to evaluate the efficacy of walnut consumption on serum levels of fasting blood sugar (FBS), fasting insulin, hemoglobin A1C (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), weight and body mass index (BMI) through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods

PubMed, Scopus, Web of Science, and the Cochrane databases were searched up to February 2023. Weighted mean difference (WMD) was analyzed using random effects models to assess the overall effect.

Results

A total of thirty-two RCTs were included in the systematic review and meta-analysis. Walnut supplementation was found to significantly reduce HOMA-IR (WMD = -0.29; 95% CI: -0.57, -0.01, P = 0.04), and body weight (WMD = -0.14 kg; 95% CI: -0.24, -0.04; P = 0.008). However, the meta-analysis showed that walnut supplementation did not have a significant effect on FBS (WMD = 0.62 mg/dL; 95% CI: -0.66, 1.91; P = 0.34), insulin levels (WMD = 1.27 mIU/ml; 95% CI: -0.59, 3.14; P = 0.18), HbA1C (WMD = 0.00%; 95% CI: -0.09, 0.10; P = 0.95), and BMI (WMD = -0.10 kg/m2; 95% CI: -0.40, 0.20; P = 0.50).

Conclusion

In conclusion, this study found a significant reduction in HOMA-IR levels and body weight with walnut supplementation, while other glycemic markers, and obesity-related indices did not change significantly. Future well-designed trials are needed to confirm these results.

Multifunctional dual-layer microneedles loaded with selenium-doped carbon quantum dots and Astilbin for ameliorating diabetic wound healing

Diabetic wounds (DW) represent a significant clinical challenge due to chronic inflammation, excessive oxidative stress, and impaired angiogenesis, all of which hinder effective tissue regeneration. Existing drug delivery systems often fail to achieve sustained and targeted therapeutic efficacy. In this study, we developed a novel dissolvable dual-layer methacrylated gelatin (GelMA) microneedle (MN) co-loading selenium-doped carbon quantum dots (Se-CQDs) and Astilbin (AST) for enhanced DW treatment. The outer layer, enriched with Se-CQDs, rapidly scavenges reactive oxygen species (ROS), effectively alleviating oxidative stress at the wound site. Sequentially, the inner layer releases AST, exerting potent anti-inflammatory and pro-angiogenic effects. Preliminary findings suggest these effects may involve the modulation of cytoskeletal dynamics and peroxisome function, contributing to endothelial cell migration and angiogenesis. This controlled, sequential release MN establishes a low-oxidative, anti-inflammatory microenvironment, thereby promoting angiogenesis and accelerating wound repair. The pioneering integration of selenium-doped quantum dots and AST-loaded hydrogels offers a synergistic therapeutic strategy, setting a new standard for advanced diabetic wound care with substantial clinical promise.

The causal association between cardiovascular proteins and diabetic nephropathy: a Mendelian randomization study

PURPOSE

To clarify the causal association between cardiovascular proteins and diabetic nephropathy (DN) in Europeans.

METHODS

The large genome-wide association study data of cardiovascular proteins and DN were used for this two-sample Mendelian randomization (MR) analysis. We took the Inverse variance weighted (IVW) as the primary method. Moreover, MR-Egger, weighted median, weighted mode, and simple mode were also performed as supplementary methods. Further, Cochrane's Q test, MR-Egger, and MR-PRESSO were conducted for sensitivity analysis.

RESULTS

According to the IVW method, the results indicated that Galanin peptide was a protective factor for DN (OR: 0.835, 95% CI 0.700, 0.996, P = 0.045) and seven cardiovascular proteins were identified as the risk factors for DN, including CX3CL1 (OR: 1.288, 95% CI 1.012, 1.639, P = 0.039), stem cell factor (OR: 1.228, 95%CI: 1.013, 1.489, P = 0.036), tumor necrosis factor receptor 2 (OR: 1.633, 95% CI 1.141, 2.338, P = 0.007), myeloperoxidase (OR: 1.412, 95% CI 1.103, 1.808, P = 0.006), galectin-3 (OR: 1.297, 95% CI 1.095, 1.537, P = 0.003), platelet-derived growth factor subunit B (OR: 1.338, 95% CI 1.020, 1.756, P = 0.035), and interleukin-27 (OR: 1.248, 95% CI 1.033, 1.509, P = 0.022). Moreover, the reverse MR study did not observe the causal effect of DN on cardiovascular proteins. The results of sensitivity analysis suggested no significant pleiotropy and heterogeneity.

CONCLUSION

This MR analysis first evaluated the causal relationship between cardiovascular protein and DN at the genetic level, which could be of great significance for the prevention and treatment of DN.

A review of the relationship between type 2 diabetes mellitus and different stages of hepatitis B infection (HCC, CHB, OBI)

A chronic condition known as diabetes develops when the pancreas does not generate insulin or the body cannot utilize the insulin it produces correctly. Viruses may drive metabolic disorders. Some research suggests that viral infections may play a role in developing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). If we want to know how viruses directly affect diabetes mellitus (DM), we need more long-term observational studies that began after viral outbreaks. For instance, more than one study has linked the hepatitis C virus (HCV) to an increased risk of T2DM. Furthermore, T2DM and hepatitis B virus (HBV) infection are major global health concerns. There may be a connection between the two illnesses, but researchers are unsure exactly what it is. Clinicians can develop more effective methods for preventing and treating T2DM and HBV infection if the possible roles of the two conditions are better understood. This article thoroughly examines T2DM and its correlation with the phases of hepatitis B infection (hepatocellular carcinoma, chronic HBV, occult hepatitis B infection). We also looked at the associations between T2DM and several viruses, including those that cause the disease and those associated with it, such as HBV, HCV, and HPV.

Glucagon-like peptide-1: a new potential regulator for mesenchymal stem cells in the treatment of type 2 diabetes mellitus and its complication

Glucagon-like peptide-1 is an enteric proinsulin hormone secreted by intestinal L-cells that orchestrates insulin secretion in a glucose-dependent manner. Renowned for preserving pancreatic β-cell mass, glucagon-like peptide-1 facilitates β-cell proliferation and inhibits apoptosis, while concurrently suppressing glucagon secretion from pancreatic α-cells, thereby exerting hypoglycemic effects.Recent in vitro and in vivo studies have clarified the benefits of combination therapy with glucagon-like peptide-1 and stem cells in Type 2 diabetes mellitus. Glucagon-like peptide-1 enhances the repair of type 2 diabetes mellitus-afflicted tissues and organs by modulating sourced mesenchymal stem cell differentiation, proliferation, apoptosis, and migration. Importantly, glucagon-like peptide-1 overcomes the detrimental effects of the diabetic microenvironment on transplanted mesenchymal stem cells by increasing the number of localized cells in stem cell therapy and the unstable efficacy of stem cell therapy.This review elucidates the molecular and cellular mechanisms through which glucagon-like peptide-1 regulates mesenchymal stem cells in the type 2 diabetes mellitus context and discuss its therapeutic prospects for type 2 diabetes mellitus and its associated complications, proposing a novel and comprehensive treatment paradigm.

Conundrum and chances of diabetes management in the Western Pacific Region: A narrative review

The prevalence of diabetes is increasing globally, and glucose management is essential for the treatment of diabetes. Most guidelines recommend early intensive therapy and individualized approaches. Although many countries have implemented various guidelines and educational programs to enhance glucose management, the target achievement rate still remains very low. Studies from several countries and regions have identified various factors that influence blood glucose management, either positively or negatively. These factors have been comprehensively incorporated into guidelines to assist people with diabetes and healthcare professionals in following them and/or developing additional guidelines through further research. We and others have suggested that diverse factors should be considered-including comorbidities, age, complications, life expectancy, and pathophysiologic characteristics, such as ethnic differences in insulin sensitivity and secretion. The Western Pacific (WP) region, comprising countries with significant cultural and racial diversity, necessitates customized programs and community-based management strategies. In this review, we present specific challenges and opportunities for diabetes management identified through a systematic review of the literature from the WP region, along with those common to other regions. To improve healthcare policy and management in the WP region, it is essential to address regional characteristics and the factors that act as either barriers or facilitators to develop strategies for early intensive and individualized therapeutic approaches. Moreover, additional studies on diabetes pathophysiology and management-including pharmacotherapy-are urgently needed.

Protective Effects of Isolated Curcumin From Curcuma longa on Key Enzymes Involved in the Insulin Signaling Pathway and Digestive and Metabolic Enzymes Associated With Obesity, Type 2 Diabetes, and Hypertension

This study explores the potential of curcumin (CUR), extracted from Curcuma longa, in combating obesity and Type 2 diabetes. Obesity and Type 2 diabetes were induced in rats through a high-fat and high-fructose diet (HFFD), and CUR, after purification and characterization by Fourier transform infrared spectroscopy (FTIR) and ultraviolet (UV) spectroscopy, was administered for 3 months via gastric gavage. The results show that CUR supplementation activates the insulin signaling pathway in a dose-dependent manner, leading to improved insulin sensitivity. Specifically, administering CUR at a daily dose of 100 mg/kg significantly reduces the activities of protein tyrosine phosphatase (PTP1B) and dipeptidyl peptidase-4 (DPP-4) by 43% and 45%, respectively, in obese and Type 2 diabetic rats compared to untreated obese rats. Furthermore, CUR effectively inhibits lipase and α-amylase activities at both the serum and intestinal levels. In obese rats, CUR administration reduces glycogen phosphorylase (GP) activity by 35% and enhances glycogen synthase (GS) activity by 78%, leading to a substantial increase in hepatic glycogen content. Additionally, CUR also led to a 21% reduction in food intake and a 12% decrease in water consumption. These changes contributed to significant reductions in the blood sugar and glycosylated hemoglobin (HbA1c) levels, with decreases of 59% and 53%, respectively. Additionally, administering CUR at a dose of 100 mg/kg body weight reduced thiobarbituric acid reactive substances (TBARSs), hydrogen peroxide (H2O2), and total oxidant status (TOS) in obese and diabetic rats, with reductions of 49%, 59%, and 58%, respectively. Furthermore, CUR demonstrates a strong regulatory effect on the levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (TC). Overall, these results underscore the CUR potential for treating and preventing diabetes and obesity.

GC-MS profiling and computational analysis of Balanites aegyptiaca phytoconstituents for antidiabetic activity: insights from network pharmacology and molecular docking

This study investigates the antidiabetic potential of the extracts and subsequent phytochemicals of Balanites aegyptiaca (BA). The approaches used were GC-MS for phytochemical characterization, network pharmacology for target identification, in vitro studies, and computational techniques for the antidiabetic activity. Network pharmacology revealed genes-associated disease targets, i.e., IL-6, PPARα, GCG, and GCK, and their signaling pathways that were modulated by the identified phytocompounds. In vitro assays demonstrated substantial antioxidant activity of n-hexane and ethyl acetate extracts and were found to be comparable to ascorbic acid. The anti-inflammatory potential using the egg albumin method was found to be best for n-hexane extract in comparison to aspirin. The in vitro antidiabetic activity using α-amylase inhibition method was most pronounced in the methanol extract and was found to be comparable to acarbose. Molecular docking and molecular dynamics simulations (100 ns) identified stable interactions between BA-derived compounds and target proteins. In silico pharmacokinetic investigations revealed that the heptadecanoic acid and ragaglitazar exhibited the LD50 of 900 and 1600 mg/kg, vouching for the substantial safety. Molecular dynamics simulations confirmed the greater stability of protein-ligand complexes and also inferred about the possible ligand-protein interactions. The BA phytocompounds inherit huge potential in the management of diabetes, with promising antioxidant, anti-inflammatory, and antidiabetic effects.

Polyphenol extract ameliorates diabetes-related atherosclerosis through HIF-1 signaling pathway in APOE-/- mice: Possible synergism with atorvastatin

BACKGROUND

Diabetes mellitus promotes atherosclerosis (AS), a major cause of cardiovascular disease. Statins, clinical drugs for AS treatment, may increase the risk of diabetes and induce hepatotoxicity. Polyphenols can alleviate AS by exerting anti-inflammatory and antioxidant effects, and play a role in liver protection. However, the effects of polyphenol extract (PE) on diabetic AS and whether PE can assist atorvastatin in managing diabetic AS with additional benefits remain poorly understood.

PURPOSE

This study aims to investigate the synergistic effects of a type of PE with atorvastatin on diabetic AS, as well as explore the anti-atherogenic mechanisms of PE.

METHODS

Polyphenol constituents in PE were identified using UPLC-MS/MS. Streptozocin -induced diabetic ApoE-/- mice were orally administered 350 and 700 mg/kg of PE, 10 mg/kg of atorvastatin, or 5 mg/kg of atorvastatin+700 mg/kg of PE for 10 weeks. Atherosclerotic lesions and plaque stability were evaluated using Oil Red O staining, Sirius red staining, and immunofluorescence. Inflammation and oxidative stress were determined using the corresponding markers. Hepatic pathological changes were assessed using hematoxylin and eosin staining. Network pharmacology prediction, molecular docking, microscale thermophoresis (MST) and western blotting were used to explore the anti-atherosclerotic mechanisms of PE.

RESULTS

The polyphenolic constituents of PE mainly consist of flavonoids and phenolic acids. PE treatment effectively mitigated atherosclerotic lesions in diabetic mice, particularly at high dose. Co-treatment with a half-dose of atorvastatin and PE did not restrain the anti-atherosclerotic effects of atorvastatin treatment, whereas the combination better relieved hyperglycemia, inflammation, oxidative stress, and liver damage in diabetic AS compared to that with atorvastatin alone. In addition, network pharmacology, molecular docking, MST and western blotting results indicated that PE ameliorated diabetic AS, possibly by targeting the AKT/mTOR/HIF-1 signaling pathway.

CONCLUSION

The PE demonstrated efficacy against diabetic AS and cooperated with atorvastatin for some additional benefits, especially in liver protection, indicating that PE has the potential to be developed as a supplement for the management of diabetes-related AS.

Diabetic Foot Ulcers: Pathophysiology, Immune Dysregulation, and Emerging Therapeutic Strategies

Diabetic foot ulcers (DFUs) are among the most common and debilitating complications of diabetes mellitus (DM), affecting approximately 15-25% of patients and contributing to over 85% of non-traumatic amputations. DFUs impose a substantial clinical and economic burden due to high recurrence rates, prolonged wound care, and frequent hospitalizations, accounting for billions in healthcare costs worldwide. The multifactorial pathophysiology of DFUs involves peripheral neuropathy, peripheral arterial disease, chronic inflammation, and impaired tissue regeneration. Recent studies underscore the importance of immune dysregulation-specifically macrophage polarization imbalance, regulatory T cell dysfunction, and neutrophil impairment-as central mechanisms in wound chronicity. These immune disruptions sustain a pro-inflammatory environment dominated by cytokines, such as TNF-α, IL-1β, and IL-6, which impair angiogenesis and delay repair. This review provides an updated synthesis of DFU pathogenesis, emphasizing immune dysfunction and its therapeutic implications. We examine emerging strategies in immunomodulation, regenerative medicine, and AI-based wound technologies, including SGLT2 inhibitors, biologics, stem cell therapies, and smart dressing systems. These approaches hold promise for accelerating healing, reducing amputation risk, and personalizing future DFU care.

Obesity: pathophysiology and therapeutic interventions

Over the past few decades, obesity has transitioned from a localized health concern to a pressing global public health crisis affecting over 650 million adults globally, as documented by WHO epidemiological surveys. As a chronic metabolic disorder characterized by pathological adipose tissue expansion, chronic inflammation, and neuroendocrine dysregulation that disrupts systemic homeostasis and impairs physiological functions, obesity is rarely an isolated condition; rather, it is frequently complicated by severe comorbidities that collectively elevate mortality risks. Despite advances in nutritional science and public health initiatives, sustained weight management success rates and prevention in obesity remain limited, underscoring its recognition as a multifactorial disease influenced by genetic, environmental, and behavioral determinants. Notably, the escalating prevalence of obesity and its earlier onset in younger populations have intensified the urgency to develop novel therapeutic agents that simultaneously ensure efficacy and safety. This review aims to elucidate the pathophysiological mechanisms underlying obesity, analyze its major complications-including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), non-alcoholic fatty liver disease (NAFLD), obesity-related respiratory disorders, obesity-related nephropathy (ORN), musculoskeletal impairments, malignancies, and psychological comorbidities-and critically evaluate current anti-obesity strategies. Particular emphasis is placed on emerging pharmacological interventions, exemplified by plant-derived natural compounds such as berberine (BBR), with a focus on their molecular mechanisms, clinical efficacy, and therapeutic advantages. By integrating mechanistic insights with clinical evidence, this review seeks to provide innovative perspectives for developing safe, accessible, and effective obesity treatments.

Real-world evidence on the association of novel antidiabetic medication use with cancer risk and protective effects: a systematic review and network meta-analysis

Background

Novel antidiabetic medications (SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 agonists) are commonly used worldwide; however, the available research lacks definitive conclusions on their protective effects or potential risks on cancer.

Objectives

Compared to other antidiabetics, our systematic review and network meta-analysis (NMA) aims to use real-world studies to assess the potential cancer risks or protective effects of these novel antidiabetics.

Methods

We comprehensively searched PubMed, CINAHL, and Web of Science from their inception until November 30, 2023. We included observational studies examining at least one novel antidiabetics in the systematic review. The novel antidiabetics include sodium-glucose cotransporter-2 inhibitors (SGLT-2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and glucagon-like peptide-1 agonists (GLP-1a).

Design

We focused on cohort studies that provided data on cancer incidence and sample size in the NMA. Using NetMetaXL®, the random effects model with informative priors was used in the NMA to estimate the pooled odds ratio (OR) with 95% credible intervals (CrI).

Results

The systematic review included 62 studies, of which 22 met the inclusion criteria for the NMA. SGLT-2i users had lower overall cancer risk compared to sulfonylureas (OR: 0.54; 95% CrI: 0.40-0.74, low certainty), GLP-1a (OR: 0.70; 95% CrI: 0.53-0.92, low certainty), and DPP-4i users (OR: 0.72; 95% CrI: 0.57-0.92, very low certainty). DPP-4i users also had a lower cancer risk than sulfonylureas users (OR: 0.76; 95% CrI: 0.60-0.96, low certainty). No other statistically significant ORs were found in other direct comparisons.

Conclusion

SGLT-2i users have a lower risk of developing cancers than sulfonylureas, GLP-1a, and DPP-4i users. These results may improve patient safety by guiding future clinical practice and medication choices. Future studies should investigate the mechanisms behind these observed associations.

Trial registration

This NMA was registered in PROSPERO (CRD42023469941).

Adhesive and Antioxidant Hydrogel with Glucose/ROS Dual-Responsive Drug Release for Diabetic Oral Mucosal Wound Healing

Diabetes mellitus is a global health threat, with chronic wounds, including oral mucosal wounds, being a severe complication. These wounds are characterized by delayed healing and increased inflammation due to hyperglycemia, affecting patients' quality of life. Current treatments for oral mucosal wounds cannot offer sustained management of these injuries in diabetic patients. Here, a glucose/ROS dual-responsive hydrogel incorporating sitagliptin was developed for the treatment of diabetic oral mucosal wounds. After chemical modification of tetra-armed poly(ethylene glycol) succinimidyl glutarate (tetra-PEG-SG) by dopamine (DA) and tetra-armed poly(ethylene glycol) amine (tetra-PEG-NH2) by phenylboronic acid (PBA), the resulting hydrogel was capable of rapid gelation, robust tissue adhesion, self-healing, antioxidant capacity, and dual response to glucose and reactive oxygen species (ROS), enabling the feasible injection and stable adherence in the moist oral environment while ensuring sustained therapeutic sitagliptin release. In vivo experiments on oral mucosal defects in diabetic mice revealed that the sitagliptin-loaded hydrogel could effectively reduce inflammation and promote wound healing. Collectively, this finding identifies a potential wound dressing as a therapeutic strategy for diabetic oral mucosal wounds.

GC-MS analysis, the in vitro and in vivo protective effect of Phlogacanthus thyrsiflorus Nees. on hyperglycaemia-induced diabetic mice model

Objective: This study investigates the in-vitro and in-vivo antioxidant capacities showed by Phlogacanthus thyrsiflorus Nees. (P. thyrsiflorus) in alloxan-administered diabetic mice.

Materials and Methods: The screening of phytochemical of methanolic flower extract (MFE), Gas Chromatography Mass Spectrometry (GC-MS) profiling was utilized to identify bioactive compounds. In-vitro antioxidant studies were performed. Acute toxicity was evaluated in mice. Glucose Transporter type 4 (GLUT4) protein expression and antioxidant enzyme activities were assessed. Histopathological examination of heart tissue was performed.

Results: GC-MS analysis revealed the presence of various bioactive compounds consisting of antioxidant, anti-inflammatory activities. The results also showed a noteworthy increase in in-vitro and in-vivo antioxidant enzymes activities. Moreover, MFE suppress hyperglycaemia by upregulating GLUT4 protein expression. In histological study MFE was found to restore cellular alterations in diabetic tissue.

Discussion and Conclusion: It is inferred from the study that MFE of P. thyrsiflorus can exert a protective effect by suppressing hyperglycaemia and modulating oxidative stress in alloxan-administered diabetic mice.

Prevalence and regional disparities of undiagnosed diabetes mellitus in Bangladesh: Results from the Bangladesh Demographic and Health Survey data

BACKGROUND

While undiagnosed diabetes mellitus (DM) presents a substantial global concern, there is a dearth of research examining its prevalence and characteristics specifically within the regional context of Bangladesh. The study focused on assessing the prevalence of undiagnosed diabetes mellitus in Bangladesh and examining regional disparities.

METHODS

The study analyzed data from the Bangladesh Demographic and Health Survey conducted between 2017 and 2018. The analysis focused on 11,911 participants aged 18 and above. Prevalence rates of both diagnosed and undiagnosed DM were calculated across various demographic and regional factors. To understand the impact of socio-demographic and regional variables on diagnosed and undiagnosed DM, the study employed multinomial regression analysis.

RESULTS

The study encompassed 11,911 participants with an average age of 39, of whom 57% were females. Among them, 333 individuals (2.8%) were diagnosed with diabetes mellitus (DM), while 667 participants (5.6%) had undiagnosed DM. The prevalence of both diagnosed and undiagnosed DM was notably higher in elderly, hypertensive, overweight or obese, and rural residents. Regression analysis indicated that individuals aged 70 and above faced 2.14 times more likely of diagnosed diabetes compared to those aged 30-39 (RRR = 2.20; 95% CI = 1.35-3.58). Regarding residential regions, individuals from the city exhibited significantly higher prevalence rates for both diagnosed DM (RRR: 1.83; 95% CI = 1.31-2.57) and undiagnosed DM (RRR: 1.52; 95% CI = 1.18-1.95) compared to those from the rural of Bangladesh.

CONCLUSION

The high prevalence of undiagnosed DM in city areas suggests potential shortcomings in routine diabetes screening practices. Prioritizing screening, particularly for high-risk groups like older adults, individuals with elevated BMI, hypertension, and urban residents from the central region of the country, is crucial. These groups have elevated diabetes risk and face higher complications without timely detection and treatment. To address this issue, collaborative efforts among the Bangladeshi government, healthcare providers, and community organizations are imperative.

Role of perceived organization support to promote diabetes treatment among workers

This study investigated association of Perceived Organization Support (POS) with diabetes treatment among workers. This prospective cohort study was conducted online, and parts of nations wide study stratified similarly with workers' characteristic in Japan. Samples were screened to those who had diabetes in the baseline years. Binary regression analysis and p for trend were used for statistical analysis. There were 1,203 participants with diabetes followed up regarding their treatment behavior. Higher POS were likely to seek appropriate diabetes treatment after adjustment with personal and occupational factors (p=0.032) but became marginally significant when adjusted with night shift status (p=0.051). Further analysis found that POS was only associated with diabetes treatment among workers with night shift. Higher POS was likely associated with proper diabetes treatment specifically among workers with night shift.

Rice with a healthier glycaemic profile: Unveiling the molecular mechanisms and breeding strategies for the future

Rice is a staple food crop consumed by billions globally. However, rice consumption is associated with a high glycaemic response, which has negative health implications. Identifying rice varieties with intrinsically lower glycaemic responses would benefit public health. Recent research has uncovered genomic loci in rice associated with glycaemic response in rice. However, diagnostic assays are needed to efficiently characterize these loci in rice germplasm and breeding populations. This review summarizes current knowledge on low glycaemic rice genetics and proposes strategies for diagnostic assay development. Specific loci implicated in modulating starch digestion and glycaemic response are highlighted. Developing robust, high-throughput molecular marker platform for low glycaemic rice loci will accelerate varietal improvement and enhance the nutritional qualities and health benefits of this essential crop. The review also explores the role of other grain components, such as lipids and proteins, and their interactions with starch in influencing the glycaemic index (GI).

Rising tide: the growing global burden and inequalities of early-onset type 2 diabetes among youths aged 15-34 years (1990-2021)

BACKGROUND

Type 2 diabetes mellitus (T2DM) is increasingly affecting people aged 15-34, posing a serious public health challenge due to its faster progression and higher complication risks. This study examines the global, regional, and national burden of early-onset T2DM from 1990 to 2021, emphasizing trends and disparities across different sociodemographic contexts.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) in people aged 15-34. Stratifications included age, sex, and the Socio-Demographic Index (SDI). Joinpoint regression significant temporal shifts, and decomposition analysis attributed changes in T2DM burden to factors such as prevalence, population growth, aging, and case fatality rates. Inequality was assessed with the Slope Index of Inequality and Concentration Index.

RESULTS

From 1990 to 2021, early-onset T2DM incidence and prevalence rose significantly worldwide, especially in high-SDI regions. Although global mortality and DALYs appeared relatively stable, low-SDI regions showed worrisome increases. Rising T2DM prevalence was the principal driver of mortality and DALYs, notably in low- and middle-SDI regions. Inequality analyses indicated widening disparities, with higher incidence and prevalence in high-SDI countries and more severe outcomes in low-SDI countries.

CONCLUSIONS

The global burden of early-onset T2DM among youths is escalating, with significant disparities across different sociodemographic levels. The findings underscore the urgent need for targeted public health interventions. Future research should focus on the underlying factors driving these trends and explore strategies for effective prevention and management of early-onset T2DM.

Neighborhood walkability and cardiometabolic disease in Texas

Cardiometabolic diseases (CMDs) affect significant numbers of adults in the United States, with 11% diagnosed with diabetes and 10% with cardiovascular diseases. Walking plays a crucial role in reducing health risks, particularly obesity and diabetes. We aim to explore the association between neighborhood walkability and CMD measures in Texas, while controlling for age, sex, racial/ethnic background, and family history of diabetes. We collected 1994 observations for the year 2019, merging data from the Texas Behavioral Risk Factor Surveillance System and the Environmental Protection Agency. We employed multilevel linear regression and multilevel logistic regression analyses to assess the association between CMD measures and neighborhood walkability. Our findings revealed that higher neighborhood walkability is significantly associated with a lower body mass index (BMI) (β = - 0.28, CI - 0.45 to - 0.10) and a reduced risk of diabetes (OR 0.93, CI 0.86-0.99), indicating that when walkability increases by one unit, an individual's BMI decreases by 0.28 kg/m2 and the odds of having diabetes decrease by 7%. We also found that African Americans living in communities with lower walkability scores compared to other racial/ethnic groups. Our findings highlight the need for urban planning policies promoting walkable neighborhoods, suggesting community-based approaches to health promotion.

Prevalence, Incidence, and Metabolic Characteristics of Young Adults with Type 2 Diabetes Mellitus in South Korea (2010-2020)

BACKGRUOUND

This study aimed to examine trends in the prevalence, incidence, metabolic characteristics, and management of type 2 diabetes mellitus (T2DM) among young adults in South Korea.

METHODS

Young adults with T2DM were defined as individuals aged 19 to 39 years who met the diagnostic criteria for T2DM. Data from the Korean National Health Insurance Service-Customized Database (2010-2020, n=225,497-372,726) were analyzed to evaluate trends in T2DM prevalence, incidence, metabolic profiles, comorbidities, and antidiabetic drug prescription. Additional analyses were performed using the Korea National Health and Nutrition Examination Survey.

RESULTS

The prevalence of T2DM in young adults significantly increased from 1.02% in 2010 to 2.02% in 2020 (P<0.001), corresponding to 372,726 patients in 2020. Over the same period, the incidence rate remained stable within the range of 0.36% to 0.45%. Prediabetes prevalence steadily increased from 15.53% to 20.92%, affecting 3.87 million individuals in 2020. The proportion of young adults with T2DM who were obese also increased, with 67.8% having a body mass index (BMI) ≥25 kg/m² and 31.6% having a BMI ≥30 kg/m² in 2020. The prevalence of hypertension, dyslipidemia, and fatty liver disease also increased, reaching 34.2%, 79.8%, and 78.9%, respectively, in 2020. Although the overall pharmacological treatment rate remained low, the prescription of antidiabetic medications with weight-reducing properties increased over the study period.

CONCLUSION

The prevalence of T2DM among young adults in South Korea nearly doubled over the past decade. The strong association with obesity and metabolic comorbidities emphasizes the urgent need for targeted prevention and management strategies tailored to this population.

Knowledge, Attitude, and Practices (KAP) Regarding Diabetic Foot Care in Al-Qassim, Saudi Arabia: A Cross-Sectional Study

INTRODUCTION

Diabetic foot care involves measures and practices aimed at maintaining foot health in individuals with diabetes and reducing the risk of severe, life-threatening complications. It is essential for diabetic patients to have the knowledge, attitudes, and skills necessary to enhance proper foot care, which can lead to better health outcomes and an improved quality of life.

METHODS

This cross-sectional study utilized data from a sample of 647 diabetic patients residing in the Al-Qassim region of the Kingdom of Saudi Arabia. Participants completed self-administered online questionnaires, ensuring their anonymity.

RESULTS

An overwhelming majority (604, 93.4%) of the patients had a positive attitude towards diabetic foot care, compared to only 43 (6.6%) with a poor attitude. Patients' age and duration of diabetes were significantly associated with their attitudes towards foot care (p=0.011*; p=0.005*), with those having a family history of diabetes showing a significantly more positive attitude towards diabetic foot care. Furthermore, nearly three-quarters (480, 74.2%) of diabetic patients had good knowledge about foot care, while about one-quarter (167, 25.8%) had poor knowledge. There was no statistically significant association between knowledge regarding diabetic foot care and patients' socio-demographic attributes.

CONCLUSION

The study revealed a high percentage of surveyed patients with good knowledge and a positive attitude towards diabetic foot care. However, significant gaps in diabetic education were evident, as a substantial proportion of patients had not received formal education on the subject. This highlights the need for educational programs aimed at improving both knowledge and attitudes, as well as promoting good routine practices by consistently reminding patients about health practices and the risks associated with diabetes-related complications.

Chemical Constituents, Antioxidant, and Enzyme Inhibitory Potentials Supported by In-Silico Studies of the n-Hexane Extract and Essential Oil of Platycladus Orientalis (L.) Franco Leaves

Platycladus orientalis leaves are widely used in traditional medicine to treat different ailments. In the present study, the volatile constituents were obtained by n-hexane extraction and hydrodistillation. Comprehensive metabolomic profiling was performed using GC-MS analysis. Furthermore, in vitro antioxidant potential and enzyme-inhibitory activity were assessed and supported by in silico profiling. Results revealed the predominance of monoterpene hydrocarbons in the hydrodistilled volatile oil (42.30 %) followed by oxygenated sesquiterpenes (32.10 %); with cedrol as the main component. Diterpenoids (49.70 %) and sesquiterpene hydrocarbons (13.43 %) were the major components of the n-hexane extract; with vulgarol A, a diterpene alcohol, as the major constituent. The volatile oil demonstrated significantly higher antioxidant potential across all assays, including ABTS and DDPH scavenging activity, CUPRAC, and FRAP assays. However, the n-hexane extract demonstrated broad inhibitory effects against butyrylcholinesterase, tyrosinase, α-amylase, and α-glucosidase enzymes, supported by molecular docking study and predictive ADME profiling. Therefore, it may be concluded that the n-hexane extract is a viable option for treating dysregulated enzyme conditions. In addition, the potential use of volatile oil in the pharmaceutical industries and management of oxidative stress can be inferred. These results warrant further studies to validate the therapeutic potential of the volatile oil and the n-hexane extract.

Population-based assessment of awareness of diabetes and diabetes related eye diseases in rural areas in Telangana, India - implications for eye health promotion

CLINICAL RELEVANCE

Understanding the awareness level of diabetes and diabetes-related eye diseases will help in developing better eye health education programmes and improve health-seeking behaviour in the community.

BACKGROUND

Diabetes and diabetes related eye diseases are increasing in numbers both in urban and rural areas in India. There are limited data on awareness of diabetes and diabetes-related eye disease in rural communities of India. This study reports on awareness of diabetes and diabetes-related eye diseases in people aged ≥40 years from two rural districts of Telangana, India.

METHODS

A structured questionnaire was used to determine the awareness of diabetes and diabetes-related eye diseases among participants aged ≥40 years in the Khammam and Warangal districts of Telangana, India. Social investigators visited the participant's households and conducted the interviews. A positive response to a question on having heard about diabetes was considered as 'awareness'. For those aware, follow-up questions were asked about the effect of diabetes on vision, frequency of eye examination and source of information. A positive response on a question that diabetes could cause loss of vision was considered as awareness of diabetic eye disease.

RESULTS

A total of 3273 participants were interviewed. Among them, 56.2% (n = 1840) were women, 60.6% (n = 1985) had no formal education, and 50.2% (n = 1645) were from the Khammam district. The mean age of the participants was 55.3 years (standard deviation: 11.7 years). Awareness of diabetes was 52.5% (n = 1719). Among them, 1056 participants (61.4%) were aware that diabetes could affect vision.

CONCLUSION

Only half of the participants were aware of diabetes and of this substantial proportion of individuals was unaware of potential vision loss due to diabetes. Improving awareness about diabetes and its impact on vision is recommended to prevent potential vision loss in this population.

Autonomous, Moisture-Driven Flexible Electrogenerative Dressing for Enhanced Wound Healing

Electrotherapy has shown considerable potential in treating chronic wounds, but conventional approaches relying on bulky external power supplies and mechanical force are limited in their clinical utility. This study introduces an autonomous, moisture-driven flexible electrogenerative dressing (AMFED) that overcomes these limitations. The AMFED integrates a moist-electric generator (MEG), an antibacterial hydrogel dressing, and concentric molybdenum (Mo) electrodes to provide a self-sustaining electrical supply and potent antibacterial activity against Staphylococcus aureus and Escherichia coli. The MEG harnesses chemical energy from moisture to produce a stable direct current of 0.61 V without external input, delivering this therapeutic electrical stimulation to the wound site through the Mo electrodes. The AMFED facilitates macrophage polarization toward reparative M2 phenotype and regulates inflammatory cytokines. Moreover, in vivo studies suggest that the AMFED group significantly enhances chronic wound healing, with an approximate 41% acceleration compared to the control group. Using a diabetic mouse wound model, the AMFED demonstrates its effectiveness in promoting nerve regulation, epithelial migration, and vasculogenesis. These findings present a novel and efficient platform for accelerating chronic wound healing.

Effects of Herbal Tea (Non-Camellia sinensis) on Glucose Homeostasis and Serum Lipids in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

CONTEXT

Hyperglycemia and hyperlipidemia increase the risk for diabetes and its complications, atherosclerosis, heart failure, and stroke. Identification of safe and cost-effective means to reduce risk factors is needed. Herbal teas may be a vehicle to deliver antioxidants and polyphenols for prevention of complications.

OBJECTIVE

This systematic review and meta-analysis were conducted to evaluate and summarize the impact of herbal tea (non-Camellia sinensis) on glucose homeostasis and serum lipids in individuals with type 2 diabetes (T2D).

DATA SOURCES

PubMed, FSTA, Web of Science, CINAHL, MEDLINE, and Cochrane Library databases were searched from inception through February 2023 using relevant keyword proxy terms for diabetes, serum lipids, and "non-Camellia sinensis" or "tea."

DATA EXTRACTION

Data from 14 randomized controlled trials, totaling 551 participants, were included in the meta-analysis of glycemic and serum lipid profile end points.

RESULTS

Meta-analysis suggested a significant association between drinking herbal tea (prepared with 2-20 g d-1 plant ingredients) and reduction in fasting blood glucose (FBG) (P = .0034) and glycated hemoglobin (HbA1c; P = .045). In subgroup analysis based on studies using water or placebo as the control, significant reductions were found in serum total cholesterol (TC; P = .024), low-density lipoprotein cholesterol (LDL-C; P = .037), and triglyceride (TG; P = .043) levels with a medium effect size. Meta-regression analysis suggested that study characteristics, including the ratio of male participants, trial duration, and region, were significant sources of FBG and HbA1c effect size heterogeneity; type of control intervention was a significant source of TC and LDL-C effect size heterogeneity.

CONCLUSIONS

Herbal tea consumption significantly affected glycemic profiles in individuals with T2D, lowering FBG levels and HbA1c. Significance was seen in improved lipid profiles (TC, TG, and LDL-C levels) through herbal tea treatments when water or placebo was the control. This suggests water or placebo may be a more suitable control when examining antidiabetic properties of beverages. Additional research is needed to corroborate these findings, given the limited number of studies.

Cellular crosstalk in organotypic vasculature: mechanisms of diabetic cardiorenal complications and SGLT2i responses

BACKGROUND

Diabetic panvascular disease (DPD) is the leading clinical complication of diabetes mellitus (DM), characterized by atherosclerosis across multiple organ vessels. It is a major cause of high disability and mortality rates in DM. However, the pathological mechanisms and key mediators of DPD remain unclear.

METHODS

This study constructed a single-cell organotypic atlas of the vasculature containing 321,358 cells by integrating 14 single-cell datasets from 8 major mouse organs and tissues. A total of 63 cell types were identified, including 9 vascular cell subtypes, whereas the cell-to-cell interaction (CCI) patterns of the organotypic vasculature were systematically analyzed.

RESULTS

Endothelial cells (ECs) were identified as the major cell type involved in CCI within the vasculature, with their ligands interacting with receptors of various cell types, which contribute to multiple biological processes such as stem cell differentiation and immune regulation. Notably, the study examined the cellular communication characteristics of different EC subtypes. Additionally, the inter-organ communication between the heart and kidney-key tissues in DPD-was analyzed. The BMP signaling pathway emerged as a critical communication pathway leading to cardiorenal complications in DM, with SGLT2i having a regulatory role in BMP6 modulation.

CONCLUSIONS

The study provides, for the first time, a single-cell analysis of the CCI patterns of the organotypic vasculature and highlights the central role of ECs. Moreover, the key role of BMP6 in diabetic cardiorenal complications is elucidated. These findings offer new insights into the mechanisms underlying DPD co-morbidities and provide a novel scientific basis for clinical prevention, treatment strategies for DPD, and the understanding of the action mechanism of SGLT2i.

Inhibition of repulsive guidance molecule A ameliorates diabetes-induced cognitive decline and hippocampal neurogenesis impairment in mice

Although diabetes mellitus is strongly associated with dementia, the mechanism underlying diabetes-induced cognitive dysfunction has not been clarified. Here, we demonstrate the vital role of repulsive guidance molecule A (RGMa) in the regulation of adult hippocampal neurogenesis and cognitive impairment under diabetic conditions. In type 2 diabetic db/db mice and streptozotocin-mediated type 1 diabetic mice, RGMa is upregulated in the granular cell layer of the dentate gyrus. Additionally, both neural stem cells (NSCs) and immature neurons express its receptor, neogenin. In vitro experiments revealed that high glucose-conditioned hippocampal neurons inhibited the differentiation of NSCs, and the application of an anti-RGMa antibody restored it. The treatment with an anti-RGMa antibody ameliorated diabetes-induced cognitive decline and impairment of hippocampal neurogenesis. These findings suggest that the RGMa negatively regulates hippocampal neurogenesis and is involved in diabetes mellitus-induced cognitive decline.

Stabilizing protein pharmaceuticals by imidazolium-type zwitterions

An imidazolium-carboxylate-type zwitterion, OE2imC3C, thermally stabilizes the structure in the vicinity of heme in cytochrome c. However, it remains unclear whether OE2imC3C can thermally stabilize protein pharmaceuticals, which are vulnerable to heating and shaking during production and transportation. In this study, we investigated the stabilization of the entire structure and function of insulin by OE2imC3C. Insulin in the 60 wt% OE2imC3C solution did not aggregate under shaking and heating (1000 rpm and 80 °C) and retained its folded structure. The shaked and heated insulin also exhibited normal function in cell proliferation. In contrast, the secondary structure of insulin in the 40 wt% OE2imC3C solution changed, and insulin in the 20 wt% OE2imC3C solution aggregated after shaking and heating. Therefore, the 60 wt% OE2imC3C solution has potential to stabilize protein pharmaceuticals.

Changes in insulin, adiponectin and lipid concentrations with age are associated with frailty and reduced quality of life in dogs

Declining metabolic function with aging is a conserved phenotype across many species. While aging-associated changes in metabolic status have been investigated rigorously in humans, less is known about metabolic aging in dogs. In this cross-sectional study, we aimed to examine changes in metabolic health with age, and any associations with frailty and quality of life, in a diverse population of companion dogs. This cross-sectional study enrolled 451 mature, adult companion dogs. Serum adiponectin, ALP, ALT, AST, cholesterol, insulin, IGF-1 and glucose levels were quantified. Additionally, plasma FFA, SFA, PA, OA and LA were quantified in a 61 dog subpopulation. All analytes were significantly associated with age, with the exception of AST. Elevated ALP, ALT, cholesterol, insulin, FFA, PA and OA were correlated with increased frailty scores, while higher levels of glucose and adiponectin were correlated with reduced frailty scores. The strength of these associations increased with age. Higher ALP, ALT and insulin were associated with lower HRQL scores after adjusting for covariates. Our findings establish novel associations between deleterious aging-associated metabolic changes and validated measures of clinical well-being in companion dogs. Future research should investigate the causality of these associations to inform therapeutic strategies targeting age-associated changes to frailty and quality of life.

Awareness and knowledge of diabetic retinopathy in diabetics and non-diabetics: A descriptive cross-sectional study

BACKGROUND AND AIMS

Early diagnosis and management of the ever-increasing global consequences of diabetes is of concern to all nations. The populations of developing countries in particular, account for about 75% of the estimated total number of those afflicted. The Middle East and North Africa Region have around 35.4 (24.3-47.4) million diabetics with a prevalence of around 10.5% in the Middle East. A high proportion of these are undiagnosed. The aim of this study was to assess the awareness of and knowledge about the ocular impacts of diabetes as diabetic retinopathy (DR) in Jordanians by comparing those with and those without diabetes.

METHODS

In this cross-sectional study, diabetic and non-diabetic patients attending different clinics at the National Center for Diabetes, Endocrinology and Genetics (NCDEG) were interviewed face-to-face using a questionnaire, to assess the level of knowledge about diabetic retinopathy (DR). The questionnaire was assessed beforehand by ophthalmologists from the School of Medicine, the University of Jordan, in Amman Results: A total of 214 subjects participated in this study (108 males:106 females). The mean age was 58.2 ± 10.6 years; (28 to 88 years) ~70% were diabetic. More than 98% were aware that diabetes can have ocular consequences. Only 17.3% however, had an adequate knowledge of DR. Around 40% did not know the treatment options although 75.7% of the diabetics carried out regular blood sugar checks in <6 months, and 73.4% had their last eye checkups in

CONCLUSIONS

The participants in this study had good awareness of DR but their knowledge of this ocular condition and treatment options is limited. Health-education programs and awareness campaigns should be initiated at health and eye care centers. Enrichment of social media and internet websites with evidence-based information by medical professionals are promising options for upgrading knowledge about this common global cause of blindness.

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Key Words

• Jordan
• awareness
• blindness
• complication
• diabetes
• diabetic retinopathy
• knowledge
• ocular consequences

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Affiliation(s)

Diala Walid Abu-Hassan Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, 11942 Jordan
Mona Freihat School of Medicine, The University of Jordan, Amman, 11942 Jordan Jordan University Hospital, Amman, 11942 Jordan
Ibraheem Saleh School of Medicine, The University of Jordan, Amman, 11942 Jordan Jordan University Hospital, Amman, 11942 Jordan
Iman Aolymat Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, Zarqa, 13133 Jordan
Manar Zraikat School of Medicine, The University of Jordan, Amman, 11942 Jordan
Muawyah Dawoud Al-Bdour School of Medicine, The University of Jordan, Amman, 11942 Jordan Jordan University Hospital, Amman, 11942 Jordan The National Centre for Diabetes, Endocrinology and Genetics, Amman, 11942 Jordan

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Physiological mechanisms of neuromuscular impairment in diabetes-related complications: Can physical exercise help prevent it?

Diabetes mellitus is a chronic disorder that progressively induces complications, compromising daily independence. Among these, diabetic neuropathy is particularly prevalent and contributes to substantial neuromuscular impairments in both types 1 and 2 diabetes. This condition leads to structural damage affecting both the central and peripheral nervous systems, resulting in a significant decline in sensorimotor functions. Alongside neuropathy, diabetic myopathy also contributes to muscle impairment and reduced motor performance, intensifying the neuromuscular decline. Diabetic neuropathy typically implicates neurogenic muscle atrophy, motoneuron loss and clustering of muscle fibres as a result of aberrant denervation-reinervation processes. These complications are associated with compromised neuromuscular junctions, where alterations occur in pre-synaptic vesicles, mitochondrial content and post-synaptic signalling. Neural damage is intensified by chronic hyperglycaemia and oxidative stress, exacerbating vascular dysfunction and reducing oxygen delivery. These complications imply a severe decline in neuromuscular performance, evidenced by reductions in maximal force and power output, rate of force development and muscle endurance. Furthermore, diabetes-related complications are compounded by age-related degenerative changes in long-term patients. Aerobic and resistance training offer promising approaches for managing blood glucose levels and neuromuscular function. Aerobic exercise promotes mitochondrial biogenesis and angiogenesis, supporting metabolic and cardiovascular health. Resistance training primarily enhances neural plasticity, muscle strength and hypertrophy, which are crucial factors for mitigating sarcopenia and preserving functional independence. This topical review examines current evidence on the physiological mechanisms underlying diabetic neuropathy and the potential impact of physical activity in counteracting this decline.

A Narrative Review of Moringa oleifera Lam., Moringaceae, Swietenia mahagoni L. Jacq., Meliaceae, and Momordica charantia L., Cucurbitaceae Plants Found in The Bahamas as Antidiabetes Phytomedicine

Moringa (Moringa oleifera Lam., Moringaceae), West Indian mahogany (Swietenia mahagoni [L.] Jacq., Meliaceae), and Cerasee (Momordica charantia L., Cucurbitaceae) are plants that are used for medicinal purposes in The Bahamas. They have various medicinal uses, including treating diabetes, anemia, inflammation, dermatological issues, backaches, cold, flu, and gastrointestinal problems. This review aims to summarize the current knowledge about natural products found in The Bahamas that can be used to treat diabetes mellitus. The search terms "Moringa oleifera Lam.," "Swietenia mahagoni (L.)," "Momordica charantia L.," "Tecoma stans," "Persea americana," "Psidium guajava," "Hamelia patens," and "Carica papaya L." in combination with "diabetes" were utilized to obtain pertinent data by searching PubMed and Google Scholar. Moringa oleifera Lam. significantly decreased fasting glucose levels in rodents after 3 months of consumption. The ethanolic extract of S. mahagoni seeds and the methanol extract of its bark can decrease blood glucose levels. Momordica charantia L. and H. patens Jacq. produce the same hypoglycemic effects as metformin. The plant extracts and compounds of T. stans (L.) Juss. ex Kunth, P. americana Mill., P. guajava L., and C. papaya L. showed diverse pharmacological activities such as reducing fasting glucose, lowering blood pressure and blood sugar, decreasing total triglycerides and total cholesterol, and improving structural damage of cardiac muscles caused by diabetes. Literature analysis reveals that the diverse pharmacological activities of various plants native to The Bahamas show promise as a medicinal food in the treatment of diabetes.

Ghrelin promotes chronic diabetic wound healing by regulating keratinocyte proliferation and migration through the ERK1/2 pathway

Delayed wound healing is a complication of diabetes mellitus and can lead to infection, sepsis, and amputation. Despite the currently available treatments, the global burden of diabetes-related wounds is growing; thus, more effective therapy for diabetic wounds is urgently needed. Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor, is a 28-amino acid peptide hormone. Some reports have confirmed the therapeutic effects of ghrelin on diabetes mellitus and its complications. However, the effects and corresponding mechanisms of ghrelin on chronic diabetic wounds remain unknown. In this study, we explored the effect of ghrelin on diabetic wound healing and investigated the associated mechanisms. We showed that ghrelin accelerated wound healing in diabetic rats by promoting the proliferation and migration of keratinocytes. Re-epithelialization was accelerated in ghrelin-treated wounds, thicker and longer newly formed epidermis and more dividing keratinocytes were observed. We further confirmed that ghrelin regulated keratinocytes by activating the ERK1/2 pathway through its receptor growth hormone secretagogue receptor 1a (GHSR1a). Ghrelin also significantly reduced the levels of pro-inflammatory cytokines and increased the deposition of collagen in diabetic wounds. Our data provides preclinical evidence for the potential application of ghrelin as a compound to promote diabetic wound healing and clarifies the molecular mechanism.

Serum 25-Hydroxyvitamin D Is Associated With Prediabetes, Type 2 Diabetes Mellitus, and Insulin Resistance in Children: A Systematic Review and Dose-Response Meta-analysis of Epidemiologic Studies

CONTEXT

Although several investigations have been conducted on the association between serum vitamin D levels and prediabetes and type 2 diabetes mellitus (T2DM) in children and adolescents, their findings are inconsistent.

OBJECTIVE

We conducted a systematic review and dose-response meta-analysis to summarize this subject.

DATA SOURCES

The electronic databases of ISI Web of Science, Scopus, PubMed, and motor engineering of Google Scholar were comprehensively searched up to May 2023.

DATA EXTRACTION

Epidemiologic studies that investigated the risk of hyperglycemia and insulin resistance in relation to serum 25-hydroxy vitamin D levels in children and adolescents were included.

DATA ANALYSIS

Twenty-two investigations, with a total of 38 622 participants, were systematically reviewed. Meta-analysis of 15 studies (n = 32 720 participants) showed that participants with the highest serum vitamin D levels had 42% lower risk of hyperglycemia, compared with those in the lowest category of serum vitamin D levels (relative risk [RR] = 0.58; 95%CI, 0.48, 0.71). Moreover, pooling 8 studies (n = 10 465 participants) illustrated that highest serum vitamin D level was associated with a 44% lower risk of insulin resistance compared with the lowest serum vitamin D level (RR = 0.56; 95%CI, 0.37, 0.83). Based on linear dose-response analysis, each 10 nmol/L increment in serum 25-hydroxy vitamin D was associated with a 6% decreased risk of hyperglycemia and insulin resistance in children. Furthermore, nonlinear dose-response analysis revealed that increasing serum vitamin D concentration from 40 nmol/L to sufficient values (>50 nmol/L) was associated with a decreasing trend in risk of hyperglycemia and insulin resistance.

CONCLUSION

This meta-analysis revealed inverse associations between serum vitamin D levels and hyperglycemia and insulin resistance in children and adolescents, in a dose-response manner. Increasing serum vitamin D concentration from 40 nmol/L to sufficient values (>50 nmol/L) was associated with a decreasing trend in hyperglycemia and insulin resistance risk. Systematic Review Registration: PROSPERO registration no. CRD42023458155.

Diabetes knowledge and behaviour: a cross-sectional study of Jordanian adults

AIMS/HYPOTHESIS

Diabetes mellitus is a significant global health concern that is projected to affect 7.7% of the global population by 2030. Understanding factors that influence diabetes knowledge and management adherence is crucial for effective diabetes mellitus management and prevention. This study investigates the relationships between demographic and clinical factors and their impact on diabetes knowledge and behaviour, as well as the potential influence of diabetes knowledge on management behaviours.

METHODS

The study comprised a cross-sectional survey of 1050 adults, collecting data on age, sex, marital status, education, employment, hypertension, dyslipidaemia (any lipid imbalance, such as high cholesterol, high LDL-cholesterol or low HDL-cholesterol), smoking and diabetes status. Two multiple linear regression models were used to identify factors associated with diabetes knowledge and behaviour, and a simple linear regression model was used to assess the relationship between knowledge and behaviour.

RESULTS

Significant associations were found between diabetes knowledge and the following factors: age (44.32 ± 9.53 for ≥50 years vs 39.73 ± 9.95 for 18 to <25 years; p<0.0001), sex (49.00 ± 12.35 for women vs 45.09 ± 13.27 for men; p<0.0001), marital status (50.92 ± 11.69 for married vs 45.39 ± 13.10 for single; p<0.0001), smoking status (45.78 ± 13.22 for smokers vs 48.22 ± 12.15 for non-smokers; p=0.003), hypertension (46.46 ± 13.11 for present vs 47.31 ± 12.87 for absent; p=0.007) and diabetes status (69.49 ± 17.35 for present vs 62.76 ± 16.88 for absent; p<0.001). Behaviour scores correlated similarly with these factors except for diabetes and smoking status. The adjusted simple linear regression model revealed that diabetes knowledge was significantly associated with better management behaviours (coefficient=0.0794, p<0.001) after adjusting for demographic and clinical factors.

CONCLUSIONS/INTERPRETATION

This study highlights the importance of demographic and clinical factors in the context of diabetes knowledge and behaviours, underscoring the need for targeted educational and preventive programmes to improve diabetes management, especially in vulnerable populations. Additionally, the strong association between diabetes knowledge and management behaviours supports a knowledge-attitude-behaviour (KAB) model of diabetes management.

Impaired hemodynamic forces assessed by routine CMR and its determinants in different duration T2DM patients with normal LV function and myocardial strain

Background

Early detection of subclinical myocardial dysfunction in asymptomatic patients with type 2 diabetes mellitus (T2DM) is essential before overt changes in left ventricular ejection fraction (LVEF) and myocardial strain occur. The objective of this study is to quantitatively assess hemodynamic forces (HDFs) using a rigorous mathematical model based on conventional cine cardiac magnetic resonance (CMR) images in patients with T2DM, and investigate their correlation with late gadolinium enhancement (LGE) and duration of diabetes.

Methods

We recruited 63 T2DM patients and 50 healthy volunteers to undergo contrast-enhanced CMR examinations. T2DM patients were divided into three groups according to the course of disease: early, middle and later stage (time <5 years, 5 ≤ time <10 years, time ≥10 years, respectively). LV deformation parameters, global circumferential strain (LVGCS), radial strain (LVGRS), longitudinal strain (LVGLS) and HDFs parameters such as longitudinal (apical-basal/A-B), transversal (lateral-septal/L-S) HDF strength (RMS) were measured and compared among the three groups.

Results

Compared with healthy volunteers, no significant differences in LV function and strains were observed (P > 0.05), while HDF Strength (RMS) L-S (%) were significantly higher in T2DM patients (p < 0.001). LVGLS was significantly decreased in late T2DM patients (p < 0.05), but HDF Strength (RMS) L-S (%) was significantly increased compared with early T2DM patients. Both HDF Strength (RMS) L-S (%) and HDF Strength (RMS) A-B (%) value were independently related to the extent of LGE (β = 0.435, p = 0.001; β = -0.329, p = 0.006, respectively). In addition, HDF Strength (RMS) L-S (%) was also independently correlated with insulin treatment(β = 0.291, p = 0.013).

Conclusions

HDF analysis can provide valuable insights into subclinical myocardial dysfunction prior to changes in ejection fraction and myocardial strain, suggesting that HDF analysis may be a potential early marker of subclinical myocardial dysfunction. LVGLS damage is gradually obvious with the prolongation of diabetes duration in T2DM patients. HDFs parameters are associated with the extent of LGE, and the transversal component of HDF increased with the duration of diabetes.

A comprehensive review on multifunctional bioactive properties of elm oyster mushroom Hypsizygus ulmarius (Bull.) Redhead (Agaricomycetes): Current research, challenges and future trends

Mushrooms have evolved as a nutritional powerhouse, harnessing a diverse spectrum of bioactive molecules to fortify human health. Hypsizygus ulmarius represents a pioneering species within the oyster mushrooms distinguished by its unique characteristics and potential abilities. It is characterized by its large fruiting bodies, which have a meaty flavor and excellent taste. Additionally, this mushroom has a high yield and biological efficiency. This mushroom also holds significant importance globally and is cultivated in China, Japan and other Asian nations due to its favorable growth conditions, exceptional nutritional value, and medicinal attributes. This review focuses on the nutrition and bioactive molecules present in this mushroom species and their further implications in medicine, agriculture, biotechnology for the development of new anti-bacterial agents and their potential industrial uses for human health. This review aims to provide more recent information on the above aspects. Hypsizygus ulmarius shows great potential as a valuable source of several nutrients and bioactive chemicals that may have therapeutic qualities. The immunomodulatory, anti-oxidant, anti-inflammatory and potential anti-cancer properties of this mushroom provide opportunities for further future research in the creation of beneficial functional foods, dietary supplements and pharmaceutical interventions to enhance human health.

Epidemiological status, development trends, and risk factors of disability-adjusted life years due to diabetic kidney disease: A systematic analysis of Global Burden of Disease Study 2021

BACKGROUND

Approximately 40% of individuals with diabetes worldwide are at risk of developing diabetic kidney disease (DKD), which is not only the leading cause of kidney failure, but also significantly increases the risk of cardiovascular disease, causing significant societal health and financial burdens. This study aimed to describe the burden of DKD and explore its cross-country epidemiological status, predict development trends, and assess its risk factors and sociodemographic transitions.

METHODS

Based on the Global Burden of Diseases (GBD) Study 2021, data on DKD due to type 1 diabetes (DKD-T1DM) and type 2 diabetes (DKD-T2DM) were analyzed by sex, age, year, and location. Numbers and age-standardized rates were used to compare the disease burden between DKD-T1DM and DKD-T2DM among locations. Decomposition analysis was used to assess the potential drivers. Locally weighted scatter plot smoothing and Frontier analysis were used to estimate sociodemographic transitions of DKD disability-adjusted life years (DALYs).

RESULTS

The DALYs due to DKD increased markedly from 1990 to 2021, with a 74.0% (from 2,228,000 to 3,876,000) and 173.6% (from 4,123,000 to 11,279,000) increase for DKD-T1DM and DKD-T2DM, respectively. In 2030, the estimated DALYs for DKD-T1DM surpassed 4.4 million, with that of DKD-T2DM exceeding 14.6 million. Notably, middle-sociodemographic index (SDI) quintile was responsible for the most significant DALYs. Decomposition analysis revealed that population growth and aging were major drivers for the increased DKD DALYs in most GBD regions. Interestingly, the most pronounced effect of positive DALYs change from 1990 to 2021 was presented in high-SDI quintile, while in low-SDI quintile, DALYs for DKD-T1DM and DKD-T2DM presented a decreasing trend over the past years. Frontiers analysis revealed that there was a negative association between SDI quintiles and age-standardized DALY rates (ASDRs) in DKD-T1DM and DKD-T2DM. Countries with middle-SDI shouldered disproportionately high DKD burden. Kidney dysfunction (nearly 100% for DKD-T1DM and DKD-T2DM), high fasting plasma glucose (70.8% for DKD-T1DM and 87.4% for DKD-T2DM), and non-optimal temperatures (low and high, 5.0% for DKD-T1DM and 5.1% for DKD-T2DM) were common risk factors for age-standardized DALYs in T1DM-DKD and T2DM-DKD. There were other specific risk factors for DKD-T2DM such as high body mass index (38.2%), high systolic blood pressure (10.2%), dietary risks (17.8%), low physical activity (6.2%), lead exposure (1.2%), and other environmental risks.

CONCLUSIONS

DKD markedly increased and varied significantly across regions, contributing to a substantial disease burden, especially in middle-SDI countries. The rise in DKD is primarily driven by population growth, aging, and key risk factors such as high fasting plasma glucose and kidney dysfunction, with projections suggesting continued escalation of the burden by 2030.

Age-related trends in trabecular bone scores and bone mineral density in Chinese men with type 2 diabetes mellitus: a cross-sectional study

Patients with Type 2 diabetes mellitus(T2DM) typically have an average or higher bone mineral density (BMD) but are at a significantly higher risk of fracture than patients without diabetes. Trabecular bone score (TBS) is a textural index derived from pixel gray-level variations in lumbar spine DXA image, which has been introduced as an indirect measure of bone quality. This study aimed to discuss the trends and annual rates of change in BMD and TBS with age in Chinese men with T2DM and men without diabetes mellitus. Lumbar spine(LS) TBS was significantly lower in males with T2DM compared to men without diabetes(1.279 ± 0.117 vs. 1.299 ± 0.090, P = 0.005). However, TBS in men with T2DM peaked around age 60, which occurred later and was lower than the peak observed in men without diabetes, who reached their peak TBS around age 50 (1.294 ± 0.126 vs. 1.328 ± 0.088). Femoral neck, total hip, and lumbar spine BMD in men with T2DM were not significantly different from those in men without diabetes. The results showed that both men with or without T2DM exhibited the lowest annual rates of change in TBS at 66-75 years of age, with values of -1.05%(P < 0.001) and - 0.90%(P < 0.001), respectively. Patients with great glycemic control demonstrated higher TBS and BMD. Men with T2DM have later and lower peak TBS and faster bone loss, suggesting that diabetes may negatively impact bone microarchitecture and mineralization.

Effect of diabetes and hyperglycaemia on the physical and mechanical properties of dentine: a systematic review

OBJECTIVES

The aim of this systematic review was to assess the effect of DM (Type 1 and Type 2 Diabetes) and hyperglycaemia on the physical and mechanical properties of dentine which is critical for successful endodontic treatment.

METHOD

An electronic search of the following databases: PubMed, MEDLINE, Web of Science and the grey literature was performed up until July 2024. In vitro and in vivo studies on the effect of DM or hyperglycaemia on the mechanical and physical properties of dentine were included. Non-English language literature was excluded.

RESULTS

Of the 234 articles identified, 15 met the inclusion criteria. Four studies evaluated how artificially induced glycation or natural glycation of dentine due to aging affects the mechanical properties of dentine. Five studies investigated the influence of Type 2 Diabetes (T2D) on dentine's mechanical properties, while two studies focused on the effects of Type 1 Diabetes (T1D). A further, four studies compared the effects of both T1D and T2D on the dentine. The studies were heterogeneous and a range of mechanical and physical properties were evaluated.

CONCLUSION

DM and AGEs negatively influence the physical and mechanical properties of dentine however, there remains a paucity of evidence and further studies are needed.

CLINICAL SIGNIFICANCE

Diabetes Mellitus (DM) is a chronic metabolic disease characterised by hyperglycaemia, an altered immune response and complications associated with collagen connective tissues. DM can influence bone metabolism and alter its physical and mechanical properties via glycation processes within collagen and changes to osteoblast activities. While bone and dentine share similarities, dentine is unique as it is intimately associated with the dental pulp. Inflammation within the pulp can induce calcification and tertiary dentine deposition and so exploring the influence of DM on the mechanical properties of dentine is warranted to understand the clinical significance.

Associations Between Diabetes Mellitus and Neurodegenerative Diseases

Diabetes mellitus (DM) and neurodegenerative diseases/disturbances are worldwide health problems. The most common chronic conditions diagnosed in persons 60 years and older are type 2 diabetes mellitus (T2DM) and cognitive impairment. It was found that diabetes mellitus is a major risk for cognitive decline, dementia, Parkinson's disease (PD), Alzheimer's disease (AD), Huntington's disease (HD), amyotrophic lateral sclerosis (ALS) and other neurodegenerative disorders. Different mechanisms of associations between these diseases and diabetes mellitus have been suggested. For example, it is postulated that an impaired intracellular insulin signaling pathway, together with hyperglycemia and hyperinsulinemia, may cause pathological changes, such as dysfunction of the mitochondria, oxidative stress inflammatory responses, etc. The association between diabetes mellitus and neurodegenerative diseases, as well as the mechanisms of these associations, needs further investigation. The aim of this review is to describe the associations between diabetes mellitus, especially type 1 (T1DM) and type 2 diabetes mellitus, and selected neurodegenerative diseases, i.e., Alzheimer's disease, Parkinson's disease, Huntington's disease and amyotrophic lateral sclerosis. Suggested mechanisms of these associations are also described.

Comparison of baseline clinical characteristics among people with type 2 diabetes on second-line therapy previously added with dapagliflozin or another oral glucose-lowering drug: AGORA study

INTRODUCTION

Type 2 diabetes mellitus (T2D) has acquired epidemic proportions worldwide. In recent years, new oral glucose-lowering drugs (OGLD) have emerged that improve the cardiovascular-kidney-metabolic control in T2D people.

OBJECTIVES

To compare the baseline clinical-biological characteristics among T2D people to whom had added-on dapagliflozin (DAPA group) or another OGLD (SOC group) second-line hypoglycaemic therapies among the AGORA study population.

METHODS

This is a multicentre cross-sectional observational study of the baseline characteristics of T2D people recruited through competitive sampling among 46 primary care health centres in Spain for the AGORA study. The inclusion and exclusion criteria of participants, and justification of the sample size are reported. After verifying the data necessary to be evaluated and informed consent, 317 subjects were included to the DAPA group and 288 to the SOC group. Both categorical and continuous variables were analysed and compared with the usual statistics. Cohen's d was used to assess the standardised difference in means.

RESULTS

Six hundred and five patients with T2D were assessed (mean age 63.5 [SD±8.1] years, 61.8% men), whom 17.4% were smokers, 47.6% had obesity, 74.8% hypertension, 87.3% dyslipidaemia, and 41.7% reported physical inactivity, with no significant differences between both comparison groups. The mean (SD) evolution time of T2D was 10.1 (5.6) years. Most baseline clinical-biological characteristics at recruitment were similar in both groups. However, DAPA group was younger (2.9 years), and had lower systolic blood pressure (SBP) (2.8mmHg), higher body weight (BW) (3.7kg), and higher glycated haemoglobin A1c (HbA1c) (0.3%) than SOC group. Only 11.5% of participants had poor glycaemic control (HbA1c>8%) at recruitment, 54.9% had good glycaemic control (HbA1c<7%), being significantly lower in the DAPA group (47.3%) than in the SOC group (63.4%). The percentage of T2D patients with high vascular risk (VR) was 46.3%, and 53.7% with very high VR, being significantly higher in the DAPA group (57.4%) than in the SOC group (49.6%).

CONCLUSIONS

Most baseline cardiovascular-kidney-metabolic characteristics were similar in T2D patients whom had added dapagliflozin on second-line hypoglycaemic therapy as those whom had added-on another OGLD. However, patients whom had added-on dapagliflozin had higher VR, lower SBP, higher BW, and slightly worse HbA1c control. Future research is necessary to explain the causes of these differences in cardiometabolic control.

GLP-1 mimetics and diabetic ketoacidosis: possible interactions and clinical consequences

Diabetic ketoacidosis is a serious diabetes-related consequence that occurs in type 1 diabetes and less commonly in type 2 diabetes and is a major cause of death. It results from the metabolic consequences due to a lack of insulin secretion or impaired insulin activity in diabetes leading to dysregulated pathophysiologic pathways resulting in excessive ketone body formation. While ketone bodies are physiologic molecules, their high levels reduce the physiological pH of the blood and induce ketoacidosis, leading to increasing metabolic dysfunction. Glucagon-like peptide-1 (GLP-1) mimetics are a class of recently developed diabetes therapy that do not lead to hypoglycemic, but some reports have suggested a relationship between GLP-1 mimetics and ketogenesis. To clarify the possible interactions between GLP-1 mimetics and ketogenesis in diabetes, this review was undertaken to collate and interpret the literature.

A Narrative Review of Signaling Pathway and Treatment Options for Diabetic Nephropathy

BACKGROUND

Diabetic nephropathy is a progressive kidney disease that frequently results in end-stage renal disorders and is characterized by proteinuria, albuminuria, decreased filtration, and renal fibrosis. Despite the fact that there are a number of therapeutic alternatives available, DN continues to be the main contributor to end-stage renal disease. Therefore, significant innovation is required to enhance outcomes in DN patients.

METHODS

Information was collected from online search engines like, Google Scholar, Web of Science, PubMed, Scopus, and Sci-Hub databases using keywords like diabetes, nephropathy, kidney disease, autophagy, etc. Results: Natural compounds have anti-inflammatory and antioxidant properties and impact various signaling pathways. They ameliorate kidney damage by decreasing oxidative stress, inflammatory process, and fibrosis and enhance the antioxidant system, most likely by activating and deactivating several signaling pathways. This review focuses on the role of metabolic memory and various signaling pathways involved in the pathogenesis of DN and therapeutic approaches available for the management of DN. Special attention is given to the various pathways modulated by the phytoconstituents.

The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

Transfemoral Compared to Transapical Transcatheter Aortic Valve Implantation in Chronic Dialysis-Dependent Patients

Introduction: Patients with end-stage kidney disease (ESRD) represent a high-risk population in terms of both development of and death by cardiovascular diseases. Outcome data of ESRD patients with severe aortic valve stenosis (AS) treated by transcatheter aortic valve implantation (AVI) are scarce. We aim to compare the outcome of ESRD patients undergoing transfemoral (TF) or transapical (TA) AVI. Methods: From June 2006 to December 2019, 176 consecutive patients with ESRD receiving chronic hemodialysis underwent TF- or TA-AVI at two German heart centers. The primary outcome measure was 1-year all-cause mortality. Other outcomes included VARC-3 defined device success and early safety. Results: The cohort comprised 61 (34.7%) patients receiving TA-AVI and 115 (65.3%) patients receiving TF-AVI. Perioperative risk, assessed using the EuroScore II, was not different between groups. VARC-3 defined device success (52.5% vs. 80.0%, p < 0.001) and early safety (27.9% vs. 45.2%, p = 0.025) were lower in TA-AVI patients compared to the TF-AVI group. The 30-day mortality was 4.7-fold higher in TA- compared TF-AVI patients (24.6% vs. 5.2%, p < 0.001). The 1-year mortality was higher in TA- compared with TF-AVI patients (57.3% vs. 27.8%, p < 0.001). By applying a Cox regression analysis, it was found that TA-AVI was the only independent factor associated with 1-year all-cause mortality (HRadj 2.65 (95%-CI 1.63-4.30), p < 0.001). Conclusions: In ESRD patients, TA-AVI was associated with worse early outcomes and increased mortality up to 1 year compared to the TF-AVI. Transfemoral access is recommended, when feasible, in ESRD patients undergoing TAVI.

β-blockers and metabolic modulation: unraveling the complex interplay with glucose metabolism, inflammation and oxidative stress

The growing burden of metabolic disorders manifested by hypertension, type 2 diabetes mellitus, hyperlipidemia, obesity and non-alcoholic fatty liver disease presents a significant global health challenge by contributing to cardiovascular diseases and high mortality rates. Β-blockers are among the most widely used drugs in the treatment of hypertension and acute cardiovascular events. In addition to blocking the receptor sites for catecholamines, third-generation β-blockers with associated vasodilating properties, such as carvedilol and nebivolol, provide a broad spectrum of metabolic effects, including anti-inflammatory and antioxidant properties and a favorable impact on glucose and lipid metabolism. This review aims to report the impact of β-blockers on metabolic modulation based on available literature data. We present an overview of β-blockers and their pleiotropic properties, discuss mechanisms by which these drugs affect cellular metabolism and outline the future perspectives. The influence of β-blockers on glucose metabolism, insulin sensitivity, inflammation and oxidative stress is complex and varies depending on the specific β-blocker used, patient population and underlying health conditions. Recent evidence particularly highlights the potential role of vasodilatory and nitric oxide-mediated properties of nebivolol and carvedilol in improving glycemic control, insulin sensitivity, and lipid metabolism and mitigating oxidative stress and inflammation. It suggests that these drugs may be potential therapeutic options for patients with metabolic disorders, extending beyond their primary role in cardiovascular management.

Role of urinary trace elements in diabetic kidney disease: a cross-sectional analysis

INTRODUCTION

The balance of trace elements plays an important role in diabetic kidney disease (DKD) patients. However, studies on the differences in urinary trace elements across different DKD stages are scarce. This study aimed to explore the associations between nine essential trace elements and DKD.

RESEARCH DESIGN AND METHODS

This cross-sectional analysis included 830 diabetic patients. Participants were classified into non-DKD (NDKD) and DKD, the latter was further grouped into mid and end DKD based on estimated glomerular filtration rate (eGFR), and the case and control were matched based on age and sex. The concentration of urinary trace elements was measured with inductively coupled plasma mass spectrometry.

RESULTS

Urinary concentrations of copper (Cu) and manganese (Mn) in DKD patients were significantly higher than that of NDKD patients, whereas that of iron (Fe), cobalt, selenium, and nickel (Ni) of DKD were lower. Positive correlations between urinary Mn/Cu and the risk of mid-stage and end-stage DKD were revealed by conditional logistic regression, while Fe and Ni were negatively associated with the risk of DKD. In mixed effect analyses, no significant trend was found for joint trace element exposure and risk of mid DKD, while negative associations between combined effects of trace elements and the risk of end DKD were observed.

CONCLUSIONS

This study revealed different associations between trace elements and the risk of mid and end DKD using both single and mixture effect modeling. The results suggested that the urinary trace element profile might be associated with the progression of DKD, which provides important insights for understanding the pathogenesis of DKD and developing individualized nutritive management strategies.