IDF diabetes Atlas: Global estimates of undiagnosed diabetes in adults for 2021

Depression among outpatients with diabetic peripheral neuropathy: prevalence and associated factors

AIM

This study aims to assess the prevalence of depression among patients with diabetic neuropathy and identify contributing factors.

METHODS

A cross-sectional descriptive design was used, recruiting 153 patients from outpatient clinics. Participants completed the Beck Depression Inventory II, Michigan Neuropathy Screening Instrument, and Douleur Neuropathique 4 questionnaires, with recent A1C results obtained from medical records.

RESULTS

The mean depression score was 16.5, with 98 patients (65%) reporting depression and 20 (13%) indicating moderate to severe depression. Approximately half of the sample experienced neuropathy and neuropathic pain. The mean Michigan Neuropathy Screening Instrument score was 5 (SD = 5), and the Douleur Neuropathique 4 score was 4 (SD = 3.5). Regression analyses showed significant demographic influences on depression. Higher Michigan Neuropathy Screening scores predicted greater depression severity, while DN4 scores did not significantly impact depression levels.

CONCLUSIONS

Depression in patients with diabetic neuropathy is influenced by the severity of neuropathy. Factors commonly associated with depression in diabetes, such as pain intensity and glycemic control, do not significantly affect depression in the context of neuropathy. These findings highlight the complexity of addressing depression in diabetes care, requiring comprehensive and ongoing approaches.

A comprehensive review on influence of millet processing on carbohydrate-digesting enzyme inhibitors and implications for diabetes management

Millets, often overlooked as food crops, have regained potential as promising stable food sources of bioactive compounds to regulate blood sugar levels in the diabetic populace. This comprehensive review delves into various millet varieties, processing methods, and extraction techniques aimed at isolating bioactive compounds. The review elucidates the inhibitory effects of millet-derived bioactive compounds on key enzymes involved in carbohydrate metabolism, such as α-amylase and α-glucosidase. It further explores the relationship between the antibacterial activity of phenols, flavonoids, and anthocyanins in millets and their role in amylase inhibition. In particular, phenols, flavonoids, and proteins found in millets play pivotal roles in inhibiting enzymes responsible for glucose digestion and absorption. However, processing methods can either enhance or reduce the bioactive compounds, thereby influencing enzyme inhibition capacity. Studies underscore the presence of phenolic compounds with notable inhibitory activity in: foxtail, finger, barnyard, and pearl millet varieties. Furthermore, extraction techniques, such as Soxhlet and ultrasonic-assisted extraction, emerge as efficient methods for isolating bioactive compounds, thus enhancing their therapeutic efficacy. This review highlights the challenges in preserving the inhibitory activity of millets during processing and optimizing processing methods to ensure better retention of bioactive compounds. It also emphasizes the utilization of millet as a natural dietary supplement or functional food to manage diabetes and promote overall well-being.

Vision transformer-based stratification of pre/diabetic and pre/hypertensive patients from retinal photographs for 3PM applications

Objective

Diabetes and hypertension pose significant health risks, especially when poorly managed. Retinal evaluation though fundus photography can provide non-invasive assessment of these diseases, yet prior studies focused on disease presence, overlooking control statuses. This study evaluated vision transformer (ViT)-based models for assessing the presence and control statuses of diabetes and hypertension from retinal images.

Methods

ViT-based models with ResNet-50 for patch projection were trained on images from the UK Biobank (n = 113,713) and Singapore Epidemiology of Eye Diseases study (n = 17,783), and externally validated on the Singapore Prospective Study Programme (n = 7,793) and the Beijing Eye Study (n = 6064). Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) for multiple tasks: detecting disease, identifying poorly controlled and well-controlled cases, distinguishing between poorly and well-controlled cases, and detecting pre-diabetes or pre-hypertension.

Results

The models demonstrated strong performance in detecting disease presence, with AUROC values of 0.820 for diabetes and 0.781 for hypertension in internal testing. External validation showed AUROCs ranging from 0.635 to 0.755 for diabetes, and 0.727 to 0.832 for hypertension. For identifying poorly controlled cases, the performance remained high with AUROCs of 0.871 (internal) and 0.655-0.851 (external) for diabetes, and 0.853 (internal) and 0.792-0.915 (external) for hypertension. Detection of well-controlled cases also yielded promising results for diabetes (0.802 [internal]; 0.675-0.838 [external]), and hypertension (0.740 [internal] and 0.675-0.807 [external]). In distinguishing between poorly and well-controlled disease, AUROCs were more modest with 0.630 (internal) and 0.512-0.547 (external) for diabetes, and 0.651 (internal) and 0.639-0.683 (external) for hypertension. For pre-disease detection, the models achieved AUROCs of 0.746 (internal) and 0.523-0.590 (external) for pre-diabetes, and 0.669 (internal) and 0.645-0.679 (external) for pre-hypertension.

Conclusion

ViT-based models show promise in classifying the presence and control statuses of diabetes and hypertension from retinal images. These findings support the potential of retinal imaging as a tool in primary care for opportunistic detection of diabetes and hypertension, risk stratification, and individualised treatment planning. Further validation in diverse clinical settings is warranted to confirm practical utility.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00412-9.

Overexpression of hsa-HLA-DRB1 may delay diabetic wound healing and angiogenesis by regulating miRNA_12118 and FLT-1

We investigated the role and mechanism of hsa-HLA-DRB1 in the development and progression of diabetic foot ulcers. High-throughput sequencing was performed on three normal foot trauma tissues and diabetic foot ulcer tissues. The circRNAs with significant differences were identified. The downstream miRNAs were predicted by miRanda and RNAhybrid databases, and the mRNAs were predicted by the TargetScan database. Validation was performed with CCK8, flow cytometry, trabecular scratch assay, tubule generation assay, Western blot, dual luciferase assay, and RT-qPCR. High-throughput sequencing identified 461 significantly different circRNAs, of which 260 were up-regulated and 201 down-regulated. Compared to normal tissue, hsa-HLA-DRB1 was highly expressed in diabetic foot ulcers. The hsa-HLA-DRB1/miRNA_12118/FLT-1 axis was constructed. In vitro, we found that HLA-DRB1 overexpression inhibited cell viability, wound healing, and tubule formation, promoted apoptosis, and enhanced FLT-1 expression in HUVECs. The upregulation of hsa-HLA-DRB1 may promote diabetic foot development The upregulation of hsa - HLA - DRB1 may inhibit the biological function of endothelial cells by targeting miRNA_12118 and acting on FLT - 1. by targeting miRNA_12118 and acting on FLT-1. Therefore, our study highlights the key role of the hsa-HLA-DRB1/miRNA_12118/FLT-1 axis in diabetic foot trauma.

Diabetes affects AD through plasma Aβ40: A Mendelian randomization study

Amyloid and tau proteins are important proteins in the pathological changes of Alzheimer's disease (AD), while Aβ pathology and tau pathology are the most critical factors contributing to the development of AD. Some studies have shown that there is a causal relationship between AD and diabetes mellitus, but there are no studies showing a causal relationship between diabetic traits and AD biomarkers, so further exploration is needed. We first summarized and analyzed the currently published literature on the link between diabetes and AD through a systematic review. Forest plots were used to observe whether there is an association between diabetes and AD. Then a two-sample Mendelian randomization (MR) analysis based on GWAS summary statistics was performed to verify the causal relationship between diabetic traits and AD biomarkers. Based on summary statistics from the GWAS, potential causal relationships between diabetic traits and AD biomarkers were explored separately. The results of the meta-analysis part showed that diabetes can increase the risk of AD. Meanwhile, our two-sample MR results showed a significant causal relationship between diabetes and plasma Aβ40. In addition, our two-sample MR results also showed a causal relationship between increased HbA1c and plasma APLP2. Other diabetic traits may have potential effects on different AD plasma markers.

Advances in biomaterials and regenerative medicine for diabetic foot ulcer therapy

Diabetic foot ulcer (DFU), a severe complication of diabetes mellitus, presents significant clinical challenges due to its rapid deterioration and high morbidity rates. While conventional therapies exist kinds of limitations, their clinical utility is frequently constrained. Recent advancements in biomedical engineering have introduced innovative therapeutic modalities, particularly nanomaterials and hydrogels. However, emerging technologies face translational barriers including immature manufacturing processes leading to elevated costs, and insufficient long-term safety data due to limited clinical validation periods. Current clinical studies remain constrained by small cohort sizes and preliminary-stage investigations. The purpose of this study was to review traditional primary treatment and simultaneously combine clinical data to increase the speed of innovative safety, cost, and effectiveness indicator testing.

How early can we detect diabetic retinopathy? A narrative review of imaging tools for structural assessment of the retina

Despite current screening models, enhanced imaging modalities, and treatment regimens, diabetic retinopathy (DR) remains one of the leading causes of vision loss in working age adults. DR can result in irreversible structural and functional retinal damage, leading to visual impairment and reduced quality of life. Given potentially irreversible photoreceptor damage, diagnosis and treatment at the earliest stages will provide the best opportunity to avoid visual disturbances or retinopathy progression. We will review herein the current structural imaging methods used for DR assessment and their capability of detecting DR in the first stages of disease. Imaging tools, such as fundus photography, optical coherence tomography, fundus fluorescein angiography, optical coherence tomography angiography and adaptive optics-assisted imaging will be reviewed. Finally, we describe the future of DR screening programmes and the introduction of artificial intelligence as an innovative approach to detecting subtle changes in the diabetic retina. CLINICAL TRIAL REGISTRATION NUMBER: N/A.

Deciphering the NLRP3 inflammasome in diabetic encephalopathy: Molecular insights and emerging therapeutic targets

Diabetic encephalopathy (DE) is a neurological complication characterized by neuroinflammation, cognitive impairment, and memory decline, with its pathogenesis closely linked to the activation of the NLRP3 inflammasome. As a central regulator of the innate immune system, the NLRP3 inflammasome plays a pivotal role in DE progression by mediating neuroinflammation, pyroptosis, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum (ER) stress, and microglial polarization. This review systematically explores the molecular mechanisms by which the NLRP3 inflammasome contributes to DE, focusing on its role in neuroinflammatory cascades and neuronal damage, as well as the diabetes-associated physiological changes that exacerbate DE pathogenesis. Furthermore, we summarize emerging therapeutic strategies targeting the NLRP3 inflammasome, including small-molecule inhibitors and bioactive compounds derived from traditional herbal medicine, highlighting their potential for DE treatment. These findings not only advance our understanding of DE but also provide a foundation for developing NLRP3-targeted pharmacological interventions.

Jejunoileal side-to-side anastomosis: New hope for patients with type 2 diabetes?

In this article, we comment on an article by Wang et al published in the World Journal of Diabetes. Existing treatments with oral medications can partially mitigate the toxicity of elevated blood glucose levels in patients with type 2 diabetes mellitus. However, these patients often require lifelong, costly medications, and many struggle with poor compliance. To address the limitations of pharmacological treatments, laparoscopic jejunal-ileal lateral anastomosis has become increasingly common in clinical practice and generally yields favorable outcomes. This procedure stimulates the secretion of larger amounts of glucagon-like peptide-1 by intestinal L cells, which in turn promotes pancreatic islet cell proliferation, reduces insulin resistance, and effectively controls glucose and lipid metabolism disorders. Nonetheless, further research is needed to fully explore its indications, contraindications, the enhancement of patients' quality of life and patients’ satisfaction with the subjective experience of treatment and long-term effects.

The Future Diabetes Mortality: Challenges in Meeting the 2030 Sustainable Development Goal of Reducing Premature Mortality from Diabetes

Objective: This study seeks to forecast the global burden of diabetes-related mortality by type, age group, WHO region, and income classification through 2030, and to assess progress toward Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality (among people age 30-70 years) from noncommunicable diseases (including diabetes) by one-third. Methods: We analyzed diabetes mortality data from the Institute for Health Metrics and Evaluation, Global Burden of Disease 2019, covering 30 years (1990-2019). Using this historical dataset, we generated 11-year prospective forecasts (2020-2030) globally and stratified by diabetes type (type 1, type 2), age groups, WHO regions, and World Bank income classifications. We employed multiple time series and epidemic modeling approaches to enhance predictive accuracy, including ARIMA, GAM, GLM, Facebook's Prophet, n-sub-epidemic, and spatial wave models. We compared model outputs to identify consistent patterns and trends. Results: Our forecasts indicate a substantial increase in global diabetes-related mortality, with type 2 diabetes driving the majority of deaths. By 2030, annual diabetes mortality is projected to reach 1.63 million deaths (95% PI: 1.48-1.91 million), reflecting a 10% increase compared to 2019. Particularly concerning is the projected rise in mortality among adults aged 15-49 and 50-69 years, especially in Southeast Asia and low- and middle-income countries. Mortality in upper-middle-income countries is also expected to increase significantly, exceeding a 50% rise compared to 2019. Conclusions: Diabetes-related deaths are rising globally, particularly in younger and middle-aged adults in resource-limited settings. These trends jeopardize the achievement of SDG 3.4. Urgent action is needed to strengthen prevention, early detection, and management strategies, especially in Southeast Asia and low-income regions. Our findings provide data-driven insights to inform global policy and target public health interventions.

Application of interpretable machine learning algorithms to predict macroangiopathy risk in Chinese patients with type 2 diabetes mellitus

Macrovascular complications are leading causes of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM), yet early diagnosis of cardiovascular disease (CVD) in this population remains clinically challenging. This study aims to develop a machine learning model that can accurately predict diabetic macroangiopathy in Chinese patients. A retrospective cross-sectional analytical study was conducted on 1566 hospitalized patients with T2DM. Feature selection was performed using recursive feature elimination (RFE) within the mlr3 framework. Model performance was benchmarked using 29 machine learning (ML) models, with the ranger model selected for its superior performance. Hyperparameters were optimized through grid search and 5-fold cross-validation. Model interpretability was enhanced using SHAP values and PDPs. An external validation set of 106 patients was used to test the model. Key predictive variables identified included the duration of T2DM, age, fibrinogen, and serum urea nitrogen. The predictive model for macroangiopathy was established and showed good discrimination performance with an accuracy of 0.716 and an AUC of 0.777 in the training set. Validation on the external dataset confirmed its robustness with an AUC of 0.745. This study establish an approach based on machine learning algorithm in features selection and the development of prediction tools for diabetic macroangiopathy.

Association of total cholesterol to high-density lipoprotein cholesterol ratio with diabetes risk: a retrospective study of Chinese individuals

A common complication of type 2 diabetes is hypercholesterolemia in many patients. It is still unclear, nevertheless, how high-density lipoprotein cholesterol ratio (TC/HDL-C), total cholesterol, and diabetes are related. The purpose of this study is to look at the prediction ability and causal relationship between TC/HDL-C and diabetes. This study included 117,268 subjects who were undergoing physical examinations. The subjects were grouped into four equal groups according to the TC/HDL-C quartiles; the main outcome was the occurrence of diabetes events. TC/HDL-C is calculated as total cholesterol divided by high-density lipoprotein cholesterol. In 3.1 years (± 0.95) of follow-up, 795 women (0.68%) and 1,894 men (1.62%) received new diabetes diagnoses. TC/HDL-C is an independent predictor of new-onset diabetes, according to multivariable Cox regression analysis (HR 1.27 per SD increase, 95% CI: 1.09-1.48, P for trend < 0.001). It turned out that a cutoff value of 3.55 (area under the curve 0.64, sensitivity 0.66, specificity 0.56), was ideal for TC/HDL-C in predicting new-onset diabetes. A subgroup analysis demonstrated that the younger population had a significantly higher risk of TC/HDL-C-related diabetes than the middle-aged group (interaction P < 0.05). After controlling for confounding variables, this Chinese cohort study reveals a direct correlation between TC/HDL-C and diabetes, with a stronger independent association observed in younger and middle-aged individuals.

Validation of artificial intelligence algorithm LuxIA for screening of diabetic retinopathy from a single 45° retinal colour fundus images: the CARDS study

OBJECTIVE

This study validated the artificial intelligence (AI)-based algorithm LuxIA for screening more-than-mild diabetic retinopathy (mtmDR) from a single 45° colour fundus image of patients with diabetes mellitus (DM, type 1 or type 2) in Spain. Secondary objectives included validating LuxIA according to the International Clinical Diabetic Retinopathy (ICDR) classification and comparing its performance between different devices.

METHODS

In this multicentre, cross-sectional study, retinal colour fundus images of adults (≥18 years) with DM were collected from five hospitals in Spain (December 2021-December 2022). 45° colour fundus photographs were captured using non-mydriatic Topcon and ZEISS cameras. The Discovery platform (RetinAI) was used to collect images. LuxIA output was an ordinal score (1-5), indicating a classification as mtmDR based on an ICDR severity score.

RESULTS

945 patients with DM were included; the mean (SD) age was 64.6 (13.5) years. The LuxIA algorithm detected mtmDR with a sensitivity and specificity of 97.1% and 94.8%, respectively. The area under the receiver-operating characteristic curve was 0.96, indicating a high test accuracy. The 95% CI data for overall accuracy (94.8% to 95.6%), sensitivity (96.8% to 98.2%) and specificity (94.3% to 95.1%) indicated robust estimations by LuxIA, which maintained a concordance of classification (N=829, kappa=0.837, p=0.001) when used to classify Topcon images. LuxIA validation on ZEISS-obtained images demonstrated high accuracy (90.6%), specificity (92.3%) and lower sensitivity (83.3%) as compared with Topcon-obtained images.

CONCLUSIONS

AI algorithms such as LuxIA are increasing testing feasibility for healthcare professionals in DR screening. This study validates the real-world utility of LuxIA for mtmDR screening.

Prevalence of diabetes mellitus among traumatic patients admitted to Aseer Central Hospital, Aseer Region, Abha, Saudi Arabia: cross-sectional study

BACKGROUND

Traumatic injuries among patients with diabetes mellitus (DM) are associated with extended hospital stays and higher mortality rates.

OBJECTIVES

This study aimed to estimate the prevalence of DM among traumatic patients admitted to Aseer Central Hospital, Aseer Region, Saudi Arabia.

METHODS

A cross-sectional design was conducted among trauma casualties aged 18 years and older admitted to the Trauma Center of Asser Central Hospital, Abha, Saudi Arabia, for six months from July 1 to December 31, 2024. Data were collected using an interviewer-administered questionnaire. The questionnaire covered various aspects, including demographic information, smoking status, presence of chronic diseases, previous diabetes diagnoses, details of any accidents, diabetes diagnosis during the accident, and self-care practices.

RESULTS

Three hundred and eleven trauma casualties were included with a mean age of 46.7 ± 12.9. Of them, 60.8% were men. The study found that the prevalence of diabetes among trauma casualties was 8.7%, with 48.2% incidentally discovered during the current trauma. Among diagnosed patients, 33.3% had glycated hemoglobin (HbA1c) levels between 7.51-8.5%, 11.1% between 8.51-9.5%, and 22.2% exceeded 9.5%. The predictors of diabetes diagnosis included smoking (OR = 6.39, 95% CI = 2.08-19.63), lower levels of education levels (OR = 0.75, 95% CI = 0.58-0.96), and a positive family history (OR = 24.9, CI = 7.96-78.36).

CONCLUSIONS

The study found an 8.7% prevalence of diabetes among trauma casualties, with nearly half discovered during the event. Factors like smoking, education, and family history of diabetes were associated with diagnosis. Routine diabetes screening is crucial for early detection and management. Targeted interventions, such as multidisciplinary care teams and telemedicine, can improve diabetes management. Further research is needed to address cultural and socioeconomic factors.

Mesenchymal Stem Cell-Derived Exosomes Hold Promise in the Treatment of Diabetic Foot Ulcers

Diabetic foot ulcers (DFU) represent one of the most common side effects of diabetes, significantly impacting patients' quality of life and imposing considerable financial burdens on families and society at large. Despite advancements in therapies targeting lower limb revascularization and various medications and dressings, outcomes for patients with severe lesions remain limited. A recent breakthrough in DFU treatment stems from the development of mesenchymal stem cells (MSCs). MSCs have shown promising results in treating various diseases and skin wounds due to their ability for multidirectional differentiation and immunomodulation. Recent studies highlight that MSCs primarily repair tissue through their paracrine activities, with exosomes playing a crucial role as the main biologically active components. These exosomes transport proteins, mRNA, DNA, and other substances, facilitating DFU treatment through immunomodulation, antioxidant effects, angiogenesis promotion, endothelial cell migration and proliferation, and collagen remodeling. Mesenchymal stem cell-derived exosomes (MSC-Exo) not only deliver comparable therapeutic effects to MSCs but also mitigate adverse reactions like immune rejection associated with MSCs transplantation. This article provides an overview of DFU pathophysiology and explores the mechanisms and research progress of MSC-Exo in DFU therapy.

The Effectiveness of a Custom AI Chatbot for Type 2 Diabetes Mellitus Health Literacy: Development and Evaluation Study

BACKGROUND

People living with chronic diseases are increasingly seeking health information online. For individuals with diabetes, traditional educational materials often lack reliability and fail to engage or empower them effectively. Innovative approaches such as retrieval-augmented generation (RAG) powered by large language models have the potential to enhance health literacy by delivering interactive, medically accurate, and user-focused resources based on trusted sources.

OBJECTIVE

This study aimed to evaluate the effectiveness of a custom RAG-based artificial intelligence chatbot designed to improve health literacy on type 2 diabetes mellitus (T2DM) by sourcing information from validated reference documents and attributing sources.

METHODS

A T2DM chatbot was developed using a fixed prompt and reference documents. Two evaluations were performed: (1) a curated set of 44 questions assessed by specialists for appropriateness (appropriate, partly appropriate, or inappropriate) and source attribution (matched, partly matched, unmatched, or general knowledge) and (2) a simulated consultation of 16 queries reflecting a typical patient's concerns.

RESULTS

Of the 44 evaluated questions, 32 (73%) responses cited reference documents, and 12 (27%) were attributed to general knowledge. Among the 32 sourced responses, 30 (94%) were deemed fully appropriate, with the remaining 2 (6%) being deemed partly appropriate. Of the 12 general knowledge responses, 1 (8%) was inappropriate. In the 16-question simulated consultation, all responses (100%) were fully appropriate and sourced from the reference documents.

CONCLUSIONS

A RAG-based large language model chatbot can deliver contextually appropriate, empathetic, and clinically credible responses to T2DM queries. By consistently citing trusted sources and notifying users when relying on general knowledge, this approach enhances transparency and trust. The findings have relevance for health educators, highlighting that patient-centric reference documents-structured to address frequent patient questions-are particularly effective. Moreover, instances in which the chatbot signals that it has drawn on general knowledge can provide opportunities for health educators to refine and expand their materials, ensuring that more future queries are answered from trusted sources. The findings suggest that such chatbots may support patient education, promote self-management, and be readily adapted to other health contexts.

Exploring the prevalence of hyperglycemia and the link to physical fitness in young Danish women with overweight - A cross-sectional study

BACKGROUND

Diagnosis of type 2 diabetes (T2D) at 20 years of age is associated with a reduction in life expectancy of 17.9 years. With an increasing prevalence of overweight among young people, we aimed to assess the prevalence of T2D and intermediate hyperglycaemia among young Danish women with overweight or obesity, who had not been previously diagnosed with T2D. Furthermore, we aimed to examine associations between markers of hyperglycaemia (glucose tolerance, fasting glucose, insulin, and HOMA-IR), body composition, physical fitness, and other lifestyle factors.

METHODS

In this multicentre, cross-sectional study, we included 111 women aged 18-30 years with BMI> 25 kg/m2 who engaged in little or no regular physical activity. Participants underwent an oral glucose tolerance test and fasting blood samples were obtained and analysed for fasting glucose, insulin, and lipids. Other outcomes included measurements of anthropometry and body composition (DXA), physical activity level (PAL), physical fitness (Aastrand's bike test), hand grip strength, and countermovement jump. Dietary intake was estimated through 4-day dietary records, and calcium intake was estimated through food frequency questionnaires.

RESULTS

Among women (24 ± 3 years) with a BMI of 30.9 ± 4.8 kg·m-2, 19.8 % were classified with intermediate hyperglycaemia and 2.7 % with T2D, despite no previous diabetes diagnosis. Markers of hyperglycaemia were inversely associated with PAL and physical fitness and positively associated with BMI and fat mass.

CONCLUSION

In a cohort of young women with overweight or obesity, not previously diagnosed with T2D, every fifth exhibited intermediate hyperglycaemia, which was linked to low physical fitness and high BMI.

Access to Blood Glucose Testing in Peru: Who Is Getting Tested?

BACKGROUND/OBJECTIVES

Significant disparities in access to diabetes screening persist, particularly among populations with limited healthcare access. We aimed to estimate the proportion of overweight-obese Peruvian adults who underwent blood glucose testing (BGT) in the past year and to analyse the socioeconomic and geographic inequalities associated with access to this preventive intervention.

METHODS

We conducted a cross-sectional study using data from the Demographic and Family Health Survey 2023. We included adults aged 35-70 years diagnosed with overweight or obesity, according to the United States Preventive Services Task Force screening recommendation. We used concentration curves (CC) and concentration indices (CI) to assess socioeconomic inequalities in BGT. BGT was ascertained using a self-reported question, while the wealth index was used as the variable to measure inequality. We also conducted a decomposition analysis to determine the relative contributions of covariates to socioeconomic inequalities in BGT.

RESULTS

A total of 9499 individuals were included in the analysis. A pro-rich concentration of BGT uptake was observed in CC and CI (0.2090; p < 0.001). Notably, a 27-point prevalence difference was reported between the lowest and highest wealth index. The decomposition analysis showed that higher education (+64%) and rural areas (+10.6%) were the main contributors to this pro-rich concentration. In contrast, secondary education (-4.7%) and female gender (-3.4%) reduced this pro-rich concentration.

CONCLUSIONS

The results underscore the need for targeted strategies, such as enhancing healthcare infrastructure and implementing localized screening initiatives, to close the gap and address the burden of undiagnosed diabetes in high-risk populations.

Anti-glycemic mechanism of dihydromyricetin from Ampelopsis grossedentata on α-glucosidase by multispectroscopic investigation and in silico molecular simulation

As a potential anti-glycemic candidate in Ampelopsis grossedentata, the binding behavior of dihydromyricetin (DMY) on α-glucosidase (α-GLA) was investigated by multispectral techniques and in silico molecular docking coupled with molecular dynamic simulation. The results revealed that DMY had potent inhibition on α-GLA with the IC50 of 38 ± 0.025 μM in a mixed competitive mode. It could attenuate the endogenous fluorescence of α-GLA through the static quenching manner. The thermodynamic analysis indicated hydrogen bonding and van der Waals forces were two major driving forces to maintain the stability of the complex, resulting in the decline of α-helix and β-turn and enhancement of β-sheet and random coil correspondingly, evidenced by Fourier transform infrared spectroscopy and circular dichroism approaches. Isothermal titration calorimetry directly measured the dissociation constant Kd for the bound α-GLA-DMY complex was 2.39 ± 0.034 μM with enthalpy change of -33.8 ± 2.85 kJ·mol-1 and entropy change of -24.1 ± 1.76 J·mol-1·K-1. As expected with the microenvironmental changes, the docking conformation followed by dynamic simulation within 200 ns further corroborated the surrounding catalytic sites of α-GLA was non-covalently bound by DMY, in which GLU411, ARG442, ARG315 and PRO312 as hydrogen bond acceptors were double-connected by -OH of DMY at C7 in the A ring and C5' in the B ring, and reinforced by the hydroxyl substitution at C3 due to the hydrogenation on C2C3 bond in C ring. Our findings would boost DMY as a spectacular α-GLA inhibitor for hypoglycemic foods application.

Evaluation of the toxicity potential of exercise and atorvastatin/metformin combination therapy on STZ-diabetic rats

Exercise is recommended for individuals with diabetes, and metformin and atorvastatin are commonly prescribed to diabetic patients. However, these two drugs have potential effects that may lead to toxicity in the skeletal muscle system. Therefore, the effects and potential interactions of combining these two drugs on skeletal muscle performance and structure were investigated in vivo in an experimental diabetes model. Male Wistar rats were divided into six groups: a sedentary control group (N) and five treatment groups-exercise (C), diabetes (D), diabetes with metformin (MET), diabetes with atorvastatin (ATO), and diabetes with metformin and atorvastatin (MET + ATO). In the diabetes model experimentally created with streptozotocin (STZ; 45 mg/kg, i.p.) and metformin (300 mg/kg/day), atorvastatin (10 mg/kg/day) was administered to drug groups by gavage during the 4-week study period. The rats were allowed to run (at moderate level) for 30 min, 5 days a week, on the treadmill. At the end of the study, blood samples and gastrocnemius muscle tissues of the rats were obtained under ketamine anesthesia (100 mg/kg; i.p). The effects of combining exercise and medication on skeletal muscle were assessed by examining the levels of significant biomarkers including PGC-1α, UCP-3, and MyHCs, as well as analyzing oxidative stress/antioxidant capacity parameters in muscle tissue samples. Additionally, relevant biochemical indicators were determined in serum samples. The quantity and morphology of mitochondria in muscle tissue were assessed using transmission electron microscopy. It was observed in the study that some toxic effects associated with the use of drugs alone were reduced by combination therapy. It is thought that this study will contribute to the literature in the evaluation of the effects of drugs and their combined use in Type 1 diabetes under exercise conditions.

Structural insights and therapeutic potential of plant-based pectin as novel therapeutic for type 2 diabetes mellitus: A review

Type 2 diabetes mellitus (T2DM) is a global health challenge with limited efficacy of current treatments, necessitating alternative therapies. Plant-derived pectin, composed of galacturonic acid and structural domains such as homogalacturonan, has shown promise as an anti-diabetic agent. Pectin exerts its therapeutic effects through multiple mechanisms, including enhancing β-cell function, regulating glucose metabolism, improving insulin sensitivity, inhibiting digestive enzymes, and restoring gut microbiota balance. Its bioactivity is influenced by physicochemical properties like molecular weight, degree of methylation, and structural complexity. This review explores the anti-diabetic potential of pectin, its structure-activity relationships, and mechanisms of action, providing insights for its development as a novel therapeutic agent in T2DM management.

Kidney function-related protection of polysaccharides from red kidney bean and small black soybean via urine metabolomics in type 2 diabetic rats

Diabetic nephropathy is a significant microvascular complication of diabetes mellitus. Crude polysaccharides extracted from red kidney beans and small black soybeans (RK, SB) have demonstrated promising antidiabetic effects in type 2 diabetic rats. This study evaluated the protective effects of RK and SB on kidney function in diabetic rats by examining kidney markers and urine metabolism. It also investigated the impact of pure polysaccharides (RKP, SBP) to pinpoint the active component of RK and SB. Findings indicated that RK and SB influenced kidney function by affecting the kidney index and key urine metabolites, like citric acid and cis-aconitic acid, linked to the TCA cycle and phenylalanine metabolism. Furthermore, a higher dose (400 mg/kg) of RKP and SBP was more effective in treating kidney damage in diabetic models than the optimal 200 mg/kg dose of RK and SB. This was shown by better regulation of urea nitrogen and uric acid levels, improved kidney tissue health seen in HE staining, and fewer red-stained lipid droplets in the kidney, as indicated by Oil Red O staining. Overall, this study provided additional evidence to support RKP and SBP as a functional ingredients production in the food industry.

Umbrella Review of Systematic Reviews and Meta-Analyses on Consumption of Different Food Groups and Risk of Type 2 Diabetes Mellitus and Metabolic Syndrome

Type 2 diabetes is a major contributor to the burden of chronic diseases globally. Most cases of type 2 diabetes are preventable through healthy lifestyle modifications in diet and physical activity. This systematic umbrella review presents a comprehensive overview of the evidence about the associations between risk of type 2 diabetes and metabolic syndrome with 13 food groups, including refined and whole grains, fruits, vegetables, nuts, legumes, fish and fish products, eggs, dairy/milk, sugar-sweetened beverages, processed meat, and unprocessed red and white meat. We present these relationships in per-serving and with high-versus-low comparisons. After doing a systematic search in MEDLINE, Embase, Web of Science, and Epistemonikos (registered with PROSPERO: CRD42024547606), we screened 5074 references published until May 15, 2024, and included 67 articles. This included 46 meta-analyses on risk of type 2 diabetes with half a million participants, 17 meta-analyses on risk of metabolic syndrome, and 4 meta-analyses on risk of diabetes-related mortality. Based on quality assessments using AMSTAR-2, 25 of the 67 studies were classified as high-quality studies, 8 as moderate, 12 as low, and 22 as critically low quality. Our results showed that a high intake of whole grains was associated with a lower risk of type 2 diabetes (metaevidence: moderate) and metabolic syndrome (metaevidence: low), with a similar tendency also for a high intake of fruits and vegetables (metaevidence: moderate). In contrast, the high intakes of processed meat (metaevidence: high), red meat (metaevidence: moderate), and sugar-sweetened beverages (metaevidence: moderate) were associated with a higher risk of type 2 diabetes. For the other food groups, the associations were generally neutral and not statistically significant. The heterogeneity was high for most food groups except fruits, indicating potential differences within each of the food groups in association with type 2 diabetes.

Heat shock-pretreated bone marrow mesenchymal stem cells accelerate wound healing in a diabetic foot ulcer rat model

BACKGROUND

Diabetic foot ulcers (DFUs) are the severe chronic complications of diabetes, amputation is required when ulcers cause severe loss of tissue or evoke a life-threatening infection. Mesenchymal stem cells (MSCs) have shown a good effect in helping DFU healing, though the efficiency needs to be improved. This study aimed to investigate the effects of heat shock pretreatment on the improvement of the therapeutic effects of MSCs.

METHODS

Primary rat bone marrow MSCs (BMSCs) were isolated and stimulated with heat shock pretreatment and then tested on a DFU rat model. Alkaline phosphatase, Alizarin Red S, and Oil Red O were stained to check the osteogenic differentiation ability of heat shock-pretreated BMSCs. The effect of heat shock pretreatment on the inflammatory response of macrophages was studied with the lipopolysaccharides stimulation model on a mouse macrophage cell line RAW264.7. The impact of heat shock-pretreated BMSCs on dermal fibroblasts was also checked. Last, heat shock-pretreated BMSCs were tested on a DFU rat model.

RESULTS

Heat shock-pretreated BMSCs were characterized by the expression of CD105 and CD44. Heat shock pre-stimulation did not affect cell viability when cultured up to 96 h. Heat shock pre-stimulated BMSCs inhibited the inflammatory response by reducing the pro-inflammatory cytokine production (IL-1β, IL-6, and TNF-α) and enhancing the anti-inflammatory cytokine production (IL-10) (at least all p < 0.01), as well as increasing the ratio of M2 polarization macrophages to M1 polarization in vitro (p < 0.001). Heat shock pre-stimulated BMSCs enhanced the growth and migration of dermal fibroblasts in vitro (p < 0.001). Heat shock-BMSCs promoted the M2 polarization level of macrophages in wound tissues in a DFU rat model.

CONCLUSION

Heat shock pretreatment could enhance the therapeutic effect of BMSCs on wound healing in a DFU rat model.

Uncoupling protein 1-mediated protective effects of β3-adrenergic receptor agonist on kidney fibrosis via promoting adipose tissue browning in diabetic mice

BACKGROUND

Diabetes mellitus (DM) is a global health concern. Diabetic kidney disease (DKD) is a prevalent severe complication of DM and therapy is urgently needed. Adipose tissue (AT) plays a crucial role in the energy mediation through glucolipid metabolism. Mirabegron is a specific β3-adrenergic receptor agonist, which can activate thermogenesis in adipocytes, improve energy consumption, and increase insulin sensitivity and glucose tolerance. Therefore, mirabegron may play a role in DKD pathogenesis. However, its effects and precise mechanisms remain unclear.

METHODS

A DKD mouse model based on type 2 DM (T2DM) was constructed and treated with mirabegron. Mice with AT surgically removed and mice with uncoupling protein 1 (Ucp1) knockout were used to confirm whether thermogenesis induced by mirabegron was the key process.

RESULTS

Mirabegron promoted AT browning in DKD mice. Mirabegron increased insulin sensitivity, promoted glucolipid metabolism, reduced inflammatory factor levels in kidney tissue, and improved renal function and fibrosis in DKD mice. Notably, all of these benefits disappeared in AT-removed DKD mice or in Ucp1 knockout DKD mice.

CONCLUSIONS

Mirabegron protects against kidney fibrosis in DM mice by activating AT thermogenesis via the UCP1 pathway. Thus, mirabegron may provide a promising potential option for DKD therapy.

Cross-cultural validation and psychometric testing of the Indonesian version of the Medical Outcomes Study Social Support Survey for people living with diabetes

Social support plays a crucial role in diabetes management. However, few valid tools are available for evaluating social support in Indonesia. Therefore, this study determined the psychometric properties of the Indonesian version of the Medical Outcomes Study Social Support Survey (IMOS-SSS) in people with diabetes. 539 Indonesian adults with diabetes completed the initial survey. In total, 142 participants completed two rounds of testing on the IMOS-SSS. The Cronbach's alpha of the IMOS-SSS was 0.938; with the interclass coefficient of correlation between the results for the first and second tests was 0.954 (p < 0.001). The IMOS-SSS was independently and significantly associated with the mental component of quality of life (β = 0.164, 95 % confidence interval = 0.079-0.217, p < 0.001) after adjustment for confounders. The IMOS-SSS was positively correlated with the Duke Social Support Index (r = 0.362, p < 0.001) and health-status (r = 0.099, p = 0.022) and was negatively correlated with loneliness (r = -0.186, p < 0.001) and depression (r = -0.087, p < 0.001). Factor loadings indicated adequate sampling (Kaiser-Meyer-Olkin = 0.941, Bartlett's test = 6839.87, p < 0.001). Four factors were retained; they explained approximately 69.75 % of the variance and model fit indices were satisfactory (NFI = 0.907, CFI = 0.928, RMSEA = 0.077, GFI = 0.888). These findings support the reliability and validity of the IMOS-SSS in adults with diabetes.

Connection between Impaired Fasting Glucose or Type 2 Diabetes Mellitus and Sepsis: A 10-Year Observational Data from the National Health Screening Cohort

BACKGRUOUND

The mortality of sepsis without direct drugs is high. The association between prediabetes, based on a single fasting glucose (FG), or long-term type 2 diabetes mellitus (T2DM) and sepsis remains unclear.

METHODS

Of the adults aged ≥20 years who were included in the National Health Screening Program (NHSP) in 2009, 40% were randomly sampled. After excluding patients with type 1 diabetes mellitus, with missing information, and who were diagnosed with sepsis during the wash-out (between 2001 and the NHSP) or 1-year lag period, a cohort comprised of 3,863,323 examinees. Body mass index (BMI) measurements, FG tests, and self-reported questionnaires on health-related behaviors were conducted. Individual information was followed up until 2020 and censored upon the first occurrence of sepsis or death. The incidence of sepsis was compared using a multivariable regression adjusted for age, sex, income, BMI, smoking, drinking, physical activity levels, and chronic diseases.

RESULTS

The cohort was divided into those with normal FG (n=2,675,476), impaired fasting glucose (IFG) (n=890,402, 23.0%), T2DM <5 years (n=212,391, 5.5%), or T2DM for ≥5 years (n=85,054, 2.2%). The groups with IFG (adjusted hazard ratio [aHR], 1.03; 95% confidence interval [CI], 1.01 to 1.05), T2DM <5 years (aHR, 1.43; 95% CI, 1.40 to 1.47), and T2DM for ≥5 years (aHR, 1.82; 95% CI, 1.77 to 1.87) exhibited significantly higher incidence of sepsis (P<0.001), with the greatest risk in patients with T2DM aged <40 years (aHR, 1.96; 95% CI, 1.71 to 2.25).

CONCLUSION

Patients with long-standing and young-onset T2DM show a substantially high risk of sepsis, emphasizing the need for infection prevention and vaccination.

Patient-centered care and satisfaction of patients with diabetes: insights from a survey among patients at primary healthcare centers in Saudi Arabia

BACKGROUND AND OBJECTIVE

Patient-centered care (PCC) and patient satisfaction are pivotal in healthcare provision for patients with diabetes. This study investigates the link between perceived PCC and satisfaction with care among patients with diabetes in Saudi Arabia.

METHODS

A cross-sectional study was conducted at 47 primary healthcare centers affiliated with general hospitals, including King Abdullah Medical Complex, King Abdulaziz Hospital, East Jeddah Hospital, King Fahd General Hospital, and Al Thagr General Hospital, operated by the Ministry of Health in Jeddah City, Saudi Arabia, between July and August 2023. Over 800 patients with diabetes were approached through a random sampling technique at the reception areas of these centers. These patients were directed to designated private rooms for further engagement, where they completed a face-to-face questionnaire administered by an interviewer. Data analysis was conducted using the software package SPSS version 28 and AMOS version 28.

RESULTS

Of the 594 patients who participated in the study (response rate 73.4%), the results indicated that the perceived level of PCC, including physical comfort (β = 0.200, p = 0.000), continuity in care transition (β = 0.114, p = 0.031), access to care (β = 0.203, p = 0.000), information and education (β = 0.169, p = 0.001), and family and friends involvement (β = 0.082, p = 0.023), were significantly related to patient satisfaction. However, other perceived PCC components, like patient preferences (β = 0.052, p = 0.233), care coordination (β = 0.078, p = 0.123), and emotional support (β=-0.080, p = 0.066), did not appear to have a significant relationship with patient satisfaction. Income and level of education substantially impacted the perception of PCC and satisfaction with care. One notable finding was that the perceived level of PCC had a strong positive relationship with patient satisfaction (β = 0.762, p = 0.002).

CONCLUSION

This study highlights the significant positive relationship between PCC and patient satisfaction in diabetes care in Saudi Arabia. It emphasizes the need for healthcare tailored to individual needs and demographic factors. This provide advocates the broader integration of PCC principles in health systems, particularly in Saudi Arabia, to improve patient experience and satisfaction. Policymakers should integrate patient-centered care into healthcare policies to improve service quality and health outcomes.

Association between diabetes phenotypes with hypertension and cardiovascular diseases, using single-sample confirmatory testing: a national study

AIM

To investigate, for the first time, the association between undiagnosed diabetes-using a single-sample confirmatory definition-and prevalent hypertension and cardiovascular diseases (CVD) in an Iranian national population. A few studies on this topic have been limited to Western populations.

METHODS

The study included 16328 adults aged ≥ 30 years. Diabetes phenotypes were classified as: 1-no diabetes: fasting plasma glucose (FPG) < 7 mmol/L (126 mg/dL) and glycated hemoglobin (HbA1c) < 6.5% (48 mmol/mol), as reference; 2-unconfirmed undiagnosed diabetes: having elevated levels of either FPG or HbA1c; 3-confirmed undiagnosed diabetes: having elevated levels of both tests; 4-known diabetes: self-reported history of glucose-lowering medications. Hypertension was defined using American Heart Association criteria. Self-reported history of CVD is defined as prevalent CVD. Multivariable logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between diabetes phenotypes with hypertension and CVD.

RESULTS

Prevalence of unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes was calculated as 2.70, 3.10, and 5.64%, respectively. Unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes were associated with hypertension with corresponding OR were, 1.30, 1.37, and 1.62; the related values for CVD were 1.80, 1.61, and 2.38; and for the coexistence of CVD and hypertension were 1.86, 1.79, and 2.80, respectively (all P values < 0.05). Furthermore, isolated HbA1c elevation was significantly associated with prevalent CVD [2.04 (1.20-3.45)], and coexistence of hypertension and CVD [1.89 (1.00-3.55)].

CONCLUSIONS

Both unconfirmed- and confirmed- undiagnosed -diabetes were significantly associated with hypertension and CVD, the issue that was mainly attributable to high HbA1c.

Psychometric Properties of the Spanish Version of the Caregiver Contribution to Self-Care of Diabetes Inventory (CC-SCODI)

Background: The Caregiver Contribution to Self-Care of Diabetes Inventory (CC-SCODI) is an instrument grounded in the middle-range theory of self-care of chronic illness. It is designed to measure how caregivers support individuals with diabetes mellitus in carrying out self-care activities. Effective tools are essential for clinicians and researchers to evaluate factors influencing self-care, including caregivers' contributions. This study aimed to assess the reliability and validity of the Spanish translation of the CC-SCODI. Methods: A total of 201 caregivers of individuals with Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) were recruited for participation in this cross-sectional study. Participants were selected through convenience sampling at a university hospital. Before administration, the survey questions were translated and culturally adapted to ensure appropriateness for both patients and caregivers. Confirmatory factor analysis (CFA) was performed on each of the CC-SCODI subscales using models fitted to the relevant indices. Results: The initial construction of the four-dimensional tool was verified. The internal consistency of the four subscales was assessed using Cronbach's α to measure the caregiver contribution to patients' self-care maintenance (α = 0.725), self-care monitoring (α = 0.728), self-care management (α = 0.729), and caregiver self-efficacy in contributing to patient self-care (α = 0.921). Model fit indices demonstrated a chi-square value of 1.028 with 773 degrees of freedom. CFA indicated an excellent model fit, confirming the reliability and validity of the proposed structure. Conclusions: The internal consistency and reliability of the Spanish version of the CC-SCODI were deemed adequate. Due to its strong psychometric properties, this instrument is considered appropriate for evaluating the contribution of caregivers to the self-care behaviors of Spanish-speaking individuals with diabetes.

Comparing umbilical cord arterial blood gas findings in pregnancies with and without gestational diabetes mellitus following elective cesarean section: a multicenter retrospective cohort study in Iran

BACKGROUND

Gestational diabetes mellitus (GDM) is linked to adverse fetal outcomes like macrosomia and neonatal hypoglycemia, with its global incidence increasing. While prior research indicates GDM may impair placental function and fetal oxygen delivery, direct evidence is limited. This study compares umbilical cord arterial blood gas measurements in pregnancies with and without GDM.

METHODS

This retrospective study analyzed medical records from four hospitals in Tehran, Rasht, Ahvaz, and Isfahan in Iran, focusing on term singleton pregnancies (gestational age ≥ 37 weeks) that underwent elective cesarean sections between January and July 2024. Exclusions included maternal age < 18 or > 45 years, pre-existing diabetes, thyroid, hypertensive, malignant, metabolic, or autoimmune disorders, intrauterine growth restriction, hypertensive disorders of pregnancy, and substance use during pregnancy. GDM was diagnosed using a 75-gram oral glucose tolerance test at 24-28 weeks. Primary outcomes included umbilical cord arterial blood gas measures (potential of hydrogen [pH], partial pressure of carbon dioxide [PCO2], partial pressure of oxygen [PO2], bicarbonate [HCO3], and base deficit). The neonatal outcomes were measured as secondary outcomes. Statistical analyses utilized Chi-square, Fisher's exact, and independent t-tests.

RESULTS

Data from 430 pregnancies, including 87 with GDM, were analyzed. Pregnancies with GDM showed significantly lower pH (7.33 ± 0.08 vs. 7.36 ± 0.06, P-value = 0.006) and greater base deficit (-1.82 ± 3.79 vs. -0.50 ± 2.74 mEq/L, P-value = 0.003). However, no significant between-group differences were observed in PCO2, PO2, or HCO3 (P-value > 0.05). Furthermore, we observed no significant differences in the mean birthweight, 1-minute, or 5-minute Apgar scores (P-values > 0.05), while neonates in the GDM group required more resuscitation (28.7% vs. 12.0%, P-value < 0.001) and neonatal intensive care unit admissions (34.5% vs. 16.9%, P-value < 0.001).

CONCLUSIONS

Pregnancies with GDM showed higher umbilical cord blood acidity, indicating impaired placental function and reduced fetal oxygenation. These findings underscore the need for enhanced monitoring, such as regular fetal surveillance and close glycemic control, along with timely interventions like early neonatal resuscitation protocols and preparedness for neonatal intensive care unit admissions, to mitigate impaired fetal oxygenation in GDM.

TRIAL REGISTRATION

Not applicable.

CD4+CD25- T-Cell-Secreted IFN-γ Promotes Corneal Nerve Degeneration in Diabetic Mice

Purpose

This study aimed to explore the relationship between corneal nerve degeneration and elevated dendritic cells (DCs) in diabetic keratopathy.

Methods

Corneas from diabetic and healthy mice were analyzed using single-cell RNA sequencing. Corneal nerve density and DC and T-cell infiltration were quantified through whole-mount corneal staining. Freshly isolated mouse trigeminal ganglion (TG) neurons were co-cultured with immature DCs, mature DCs, activated CD8+ T cells, and CD4+CD25- T cells. TG neurite outgrowth was assessed to identify potential effector cells driving corneal nerve degeneration. In addition, interferon-gamma (IFN-γ) and blocking antibodies were used to evaluate their effects on TG neurite outgrowth and corneal nerve degeneration in mice.

Results

Compared with age-matched healthy mice, diabetic mice exhibited a significant reduction in corneal nerve density and sensitivity, along with increased infiltration of DCs, CD4+ T cells, and CD8+ T cells. In vitro co-culture experiments revealed that CD4+CD25- T cells, rather than DCs and CD8+ T cells, significantly inhibited TG neurite outgrowth. Among cytokines, elevated IFN-γ in diabetic corneas impaired TG neurite outgrowth and induced corneal nerve degeneration, whereas IL-4 and IL-17 had no such effect. Blocking IFN-γ alleviated CD4+CD25- T-cell-induced inhibition of TG neurite outgrowth and corneal nerve degeneration in diabetic mice.

Conclusions

CD4+CD25- T cells, but not DCs or CD8+ T cells, contribute to corneal nerve degeneration in diabetic mice, a process partially mediated by IFN-γ.

ERK1/2 gene expression and hypomethylation of Alu and LINE1 elements in patients with type 2 diabetes with and without cataract: Impact of hyperglycemia-induced oxidative stress

AIMS

This study aimed to delineate the effect of hyperglycemia on the Alu/LINE-1 hypomethylation and in ERK1/2 genes expression in type 2 diabetes with and without cataract.

METHODS

This study included 58 diabetic patients without cataracts, 50 diabetic patients with cataracts, and 36 healthy controls. After DNA extraction and bisulfite treatment, LINE-1 and Alu methylation levels were assessed using Real-time MSP. ERK1/2 gene expression was analyzed through real-time PCR. Total antioxidant capacity (TAC), and fasting plasma glucose (FPG) were measured using colorimetric methods. Statistical analysis was performed with SPSS23, setting the significance level at P < 0.05.

RESULTS

The TAC levels were significantly lower for cataract and diabetic groups than controls (259.31 ± 122.99, 312.43 ± 145.46, 372.58 ± 132.95 nanomole of Trolox equivalent) with a significant correlation between FPG and TAC levels in both the cataract and diabetic groups (P < 0.05). Alu and LINE-1 sequences were found to be statistically hypomethylated in diabetic and cataract patients compared to controls. In these groups, TAC levels were directly correlated with Alu methylation (P < 0.05) but not LINE-1. ERK1/2 gene expression was significantly higher in diabetic and cataract patients, showing increases of 2.41-fold and 1.43-fold for ERK1, and 1.27-fold and 1.5 for ERK2, respectively. ERK1 expression correlated significantly with FPG levels. A reverse correlation was observed between TAC levels and ERK1/2 expression.

CONCLUSIONS

Our findings indicate that hyperglycemia-induced oxidative stress may alter ERK1/2 gene expression patterns and induce aberrant hypomethylation in Alu and LINE-1 sequences. These aberrant changes may play a contributing role in diabetic complications such as cataracts.

Exploring the Utility of Prunus mahaleb Extracts as a Source of Natural Bioactive Compounds for Functional Applications

Prunus mahaleb has garnered attention as a potent medicinal agent and functional component. We aimed to detect the chemical composition and biological activities of several parts (fruit, leaves, and twigs) of P. mahaleb. Biological activities were assessed for antioxidant properties, enzyme inhibition, mutagenic/antimutagenic effects, and antibacterial efficacy. Antioxidant capabilities were evaluated using various assays, including DPPH, ABTS, CUPRAC, FRAP, phosphomolybdenum, and metal chelating. The chemical constituents of the extracts were identified and quantified using the HPLC-ESI-MS/MS method. The effects of enzyme inhibition were examined on some enzymes, including AChE, BChE, tyrosinase, amylase, and glucosidase. The Ames test was used to evaluate the mutagenic and antimutagenic properties of the plant extracts. Furthermore, a broth microdilution assay was employed to evaluate the possible antibacterial effects of the extracts against microorganisms. The methanol extract of twigs showed superior antioxidant capabilities (DPPH: 388.39 mg TE/g; ABTS: 701.50 mg TE/g; CUPRAC: 459.05 mg TE/g; FRAP: 264.99 mg TE/g). The methanol extract of twigs demonstrated the highest tyrosinase inhibitory activity (61.91 mg KAE/g). A total of 40 metabolites, mainly flavonoids, were detected through HPLC-ESI-MS/MS analysis, revealing that ferulic acid, naringenin, and herniarin were the predominant compounds. In the Ames test, the tested extracts exhibited no mutagenic potential. The antimutagenicity assay demonstrated that methanol and ethyl acetate extracts from twigs and leaves were particularly efficient against frameshift and base pair substitution mutations induced by recognized mutagens. The metabolic activation system amplified these strong activities to inhibition rates ranging from 85% to 98%. The results from the antibacterial assay indicated antibacterial effectiveness at dosages between 6.25 and 0.195 mg/mL, particularly effective against Sarcina lutea, Bacillus cereus, Candida albicans, and Staphylococcus aureus. Our findings indicate that P. mahaleb can serve as a versatile raw material for the development of health-promoting applications, including medicines, cosmeceuticals, and nutraceuticals.

Cardiometabolic Biomarkers and Systemic Inflammation in US Adolescents and Young Adults With Latent Tuberculosis Infection: A Population-Based Cohort Study

Background

Mycobacterium tuberculosis (Mtb) infection in adults increases incident type 2 diabetes and atherosclerotic cardiovascular disease risk. It is unknown if this cardiometabolic detriment occurs in young people. We investigated whether young persons with latent tuberculosis infection (LTBI) have worse cardiometabolic health than their peers who are uninfected.

Methods

Peripubescent adolescents (12-15 years old) and older adolescents/young adults (16-30 years old) were assessed for LTBI by tuberculin skin testing (induration ≥10 mm). Outcomes included fasting plasma glucose, hemoglobin A1c, C-peptide, N-terminal prohormone of brain natriuretic peptide, high-sensitivity cardiac troponin T, C-reactive protein, ferritin, diabetes/prediabetes (fasting plasma glucose ≥5.6 mmol/L and/or hemoglobin A1c ≥5.7%), and homeostatic model of insulin resistance. LTBI cases were propensity score matched 1:4 with controls who were uninfected with tuberculosis (TB) on sociodemographics to estimate adjusted median, mean difference, and odds ratio of cardiometabolic indices.

Results

Seventy-five LTBI cases were matched to 300 peers who were TB uninfected. Among older participants, LTBI was associated with higher inflammation (adjusted median [IQR]: C-reactive protein, 0.22 mg/dL [0.05-0.34] vs 0.11 [0.04-0.35], P = .027; ferritin, 55.0 ng/mL [25.1-90.3] vs 41.1 [29.5-136.2], P = .047) but not among peripubescent adolescents. No meaningful differences were observed in fasting plasma glucose (adjusted mean difference [95% CI], -0.05 mmol/L [-.22 to .12]; P = .57), hemoglobin A1c (0.0% [-.17% to .17%], P = .98), diabetes/prediabetes prevalence (adjusted odds ratio [95% CI], 0.9 [.29-2.29]; P = .85), insulin secretion/resistance, N-terminal prohormone of brain natriuretic peptide, or high-sensitivity cardiac troponin T by LTBI status.

Conclusions

Older adolescents and young adults with LTBI had higher inflammation than those without LTBI, while cardiometabolic profiles were similar. Unlike that in adults, Mtb infection in young people may not be associated with cardiometabolic derangement, though the long-term consequences of chronic inflammation require further study.

Impact of pre-hospital delays on the prognosis of older patients with diabetic foot ulcers: a 10-year retrospective study

OBJECTIVE

This study aimed to evaluate the impact of pre-hospital delay on the prognosis of older patients with diabetic foot ulcers (DFUs).

METHOD

In this 10-year retrospective study, enrolled patients were divided into three groups based on the number of days before admission to hospital: <7 days (Group 1); 7-14 days (Group 2); and >14 days (Group 3). Electronic medical data were gathered, including: independent variables (such as age, sex, body mass index, education level and duration of diabetes); and dependent variables (such as number of surgeries, therapeutic regimen, Wagner grade, white blood cell counts, length of hospital stay (LoS), outcomes and treatment costs).

RESULTS

A total of 288 patients were included in the study, 192 of whom were male, and the median age was 65 years. Of the studied participants, 27 arrived at the hospital within seven days, while 223 arrived after >14 days since the onset of their DFU. Significant differences were observed in the distribution of age (p=0.03) among the three groups, with the age of Group 1 lower than that of Group 3 (p=0.02). Significant differences in the distribution of number of surgeries (p=0.01), LoS (p=0.04), outcomes (p=0.04) and costs (p=0.03) were also observed among the three groups. Analyses showed that Group 1 LoS was lower than that of Group 2 (p=0.02); the number of surgeries in Group 1 was lower than that of Group 2 (p<0.01) and Group 3 (p<0.01); and Group 1 costs were lower than those of Group 2 (p=0.03) and Group 3 (p=0.03). A positive relationship was observed between pre-hospital delay and Wagner grade (0.122; p=0.04), and a positive relationship was observed between Wagner grade and LoS (0.181; p<0.01), outcomes (0.294; p<0.01), and costs (0.289; p<0.01).

CONCLUSION

The findings of this study showed that longer pre-hospital delays adversely affected outcomes, such as extended hospital stays, increased numbers of surgeries and elevated hospitalisation expenses, in patients with DFUs. Age may be an underlying factor for this; further study with an increased sample size and comprehensive data is warranted.

"I Never Thought They Would Ever Take Off My Toes": A Qualitative Illness Trajectory Study in People With Diabetic Foot Syndrome

Diabetic foot syndrome (DFS) can be prevented, but due to various obstacles preventive measures can only be implemented inadequately. Person-centred care forms the foundation for effective support measures. However, the current lack of a longitudinal perspective on patients' Illness trajectory hinders the development and provision of tailored support. The aim was to describe the illness trajectory experienced by patients with DFS. To investigate the research question we used a qualitative design based on the 'Interpretive Description' and conducted a purposive sample of individual interviews in a university hospital's wound outpatient department. Data were analysed according to Braun and Clark's reflexive thematic analysis using the illness trajectory model as a theoretical framework. We included 12 patients with diabetic foot ulcers and recorded wound duration, number of ulceration recurrences and rate of amputation. We identified six illness trajectory-relevant phases: (1) silent or non-apparent diabetes mellitus (DM); (2) occurrence of the first wound: present DFS; (3) needing inpatient treatment; (4) from a mosquito emerges an elephant; (5) being in outpatient treatment and experiencing wound-free periods and (6) the occurrence of recurrences. Participants stated both self-management and care coordination behaviours regarding their treatment. However, due to knowledge gaps, misunderstandings or a desire for 'normalcy' and independence from the healthcare system as they juggled multiple comorbidity-related responsibilities, they often acted contrary to behavioural recommendations. 'Silent diabetes' is not always prioritised in disease management.

Novel sulfonyl hydrazide based β-carboline derivatives as potential α-glucosidase inhibitors: design, synthesis, and biological evaluation

A series of novel sulfonyl hydrazide based β-carboline derivatives (SX1-SX32) were designed and synthesized, and their structures were characterized on NMR and HRMS. Their α-glucosidase inhibitory screening results found that compounds (SX1-SX32) presented potential α-glucosidase inhibitory: IC50 values being 2.12 ± 0.33-19.37 ± 1.49 μM. Compound SX29 with a para-phenyl (IC50: 2.12 ± 0.33 μM) presented the strongest activity and was confirmed as a noncompetitive inhibitor. Fluorescence spectra, CD spectra and molecular docking were conducted to describe the inhibition mechanism of SX29 against α-glucosidase. Cells cytotoxicity indicated SX29 (0-32 μM) had no cytotoxicity on 293T cells. In particular, in vivo experiments revealed that oral administration of SX29 could regulate hyperglycemia and glucose tolerance of diabetic mice. These achieved findings indicated that sulfonyl hydrazide based β-carboline derivatives bore promising potential for discovering new α-glucosidase inhibitors with hypoglycemic activity.

Mechanism of Bile-Processed Coptidis Rhizoma in the Treatment of Type 2 Diabetes Mellitus in Rats Based on Dissolution Kinetics and Untargeted Metabolomics

Bile-processed Coptidis Rhizoma (BPCR) exhibits stronger efficacy in treating T2DM than Coptidis Rhizoma(CR) alone. However, the synergistic mechanism of its processing remains unknown. This study utilized HPLC to determine the content and dissolution characteristics of alkaloid components in BPCR before and after processing. The results indicated that the diffusion of the alkaloids in BPCR is stronger than that of CR, and their dissolution conforms to the Weibull equation. Additionally, BPCR significantly reduced fasting blood glucose (FBG) and serum insulin (FINS) levels in T2DM rats induced by a high-fat diet (HFD) and streptozotocin (STZ), improved glucose and lipid metabolism, and mitigated liver damage. Serum metabolomics analysis based on UPLC-Q-TOF-MS revealed that BPCR significantly regulates 27 endogenous differential biomarkers. The underlying mechanism may be related to glycerophospholipid metabolism, linoleic acid metabolism, steroid biosynthesis, and arachidonic acid metabolism pathways.

Possibilities of Optimizing Drug Therapy for Myocardial Infarction: a Consensus on the Use of Type 2 Sodium-Glucose Co-Transporter Inhibitors. Conciliation Document of the Expert Group

Ischemic heart disease, including previous myocardial infarction (MI), is one of the main causes for the development and progression of heart failure (HF). The presence of HF before MI or the development of HF in the setting of acute coronary catastrophe is an extremely unfavorable prognostic factor leading to a multiple increase in the risk of death and rehospitalization due to HF in the post-infarction period. In 2024, the results of two randomized clinical trials (RCTs) (DAPA-MI and EMPACT-MI) were published, which assessed the effect of sodium-glucose co-transporter type 2 inhibitors (SGLT2i) on clinical outcomes in patients with acute MI. In both studies, the predetermined primary composite endpoint was not achieved. At the same time, it was shown that SGLT2i significantly reduced the risk of hospitalization for HF (empagliflozin) and contributed to the improvement of metabolic outcomes (dapagliflozin). Also, the safety of early initiation of SGLT2i in the acute period of MI was demonstrated. Based on the available results of randomized and observational clinical studies, the working group has substantiated the need for implementing these RCT results into clinical practice and proposed an algorithm for administering SGLT2 to patients with acute MI. Thus, in the presence of compelling anamnestic criteria for the diagnosis or previously diagnosed type 2 diabetes mellitus, and/or chronic kidney disease, and/or HF, continuation or timely initiation of SGLT2i during the hospitalization for index MI is recommended to improve cardiovascular and renal outcomes. Based on the results of RCTs in patients with acute MI and taking into account individual risk factors for the development of HF, the initiation of SGLT2i before discharge may be considered in order to reduce the risk of hospitalization for HF.

Protective Effects of Polygonatum sibiricum Polysaccharides Against Type 2 Diabetic Mice Induced by High-Fat Diet and Low-Dose Streptozotocin

Polysaccharides possessing hypoglycemic effects have shown promising results in treating diabetes. Polygonatum sibiricum polysaccharide (PSP) is one of the most active ingredients in the Chinese medicine P. sibiricum Redoute with many biological activities. However, its efficacy in alleviating type 2 diabetes mellitus (T2DM) remains unexplored. Our aim is to evaluate the protective effect of PSP against T2DM by measuring body weight and serum biochemical indicators, examining the histopathological images of pancreatic and liver tissues, detecting fecal short-chain fatty acid (SCFA) content, and analyzing the intestinal flora diversity and the microbiota structure in T2DM mice. The findings indicated that PSP treatment in T2DM mice could obviously decrease the fasting blood glucose and fasting insulin levels, ameliorate glucose tolerance, insulin resistance, lipid, and inflammatory factor levels, attenuate pancreatic and liver damage, and increase the fecal SCFA content. In addition, PSP could modulate the composition of gut microbiota in T2DM mice, resulting in the relative abundance of Firmicutes decreasing and that of Bacteroidetes increasing, along with the abundance of beneficial flora significantly increasing, especially SCFA-producing bacteria. The findings indicate that PSP administration protected against diabetes by controlling disordered glucolipid metabolism and modulating the gut microbiota, which provides a valuable strategy for the utilization of PSP to treat T2DM.

Usefulness of the Córdoba Equation for Estimating Body Fat When Determining the Level of Risk of Developing Diabetes Type 2 or Prediabetes

Background and Objectives: Type 2 diabetes (T2D) and prediabetes represent major global health concerns, with obesity being a key risk factor. However, recent evidence suggests that the adipose tissue composition and distribution play a more critical role in metabolic dysfunction than the total body weight or body mass index (BMI). This study evaluates the predictive capacity of the Córdoba Equation for Estimating Body Fat (ECORE-BF) for identifying individuals at high risk of developing T2D and prediabetes. Materials and Methods: A cross-sectional study was carried out involving 418,343 Spanish workers. Body fat percentage was estimated using the ECORE-BF equation, and diabetes risk was assessed using validated predictive models, including the Finnish Diabetes Risk Score (FINDRISC), QDiabetes score (QD-score), and others. The discriminatory power of ECORE-BF in predicting T2D and prediabetes was assessed using receiver operating characteristic (ROC) curve analysis. Results: ECORE-BF showed a strong correlation with high-risk classifications across all diabetes risk scales. The area under the ROC curve (AUC) exceeded 0.95 for both men and women, demonstrating high predictive accuracy. Conclusions: Adipose tissue distribution, particularly visceral adiposity, is a central factor in metabolic dysfunction. ECORE-BF provides a cost-effective alternative for large-scale T2D and prediabetes risk assessment. Future research should explore the impact of visceral adipose tissue reduction on diabetes prevention and the integration of estimation scales into clinical and public health strategies.

Performance of fasting plasma glucose for community-based screening of undiagnosed diabetes and pre-diabetes in sub-Saharan Africa

Introduction

Early diabetes screening is critical in sub-Saharan Africa (SSA), where the prevalence is increasing, yet a large proportion of cases remain undiagnosed. This study aimed to evaluate the performance of fasting plasma glucose (FPG) in screening diabetes and/or prediabetes compared to the 2-hour plasma glucose (2-h PG)-level in SSA.

Methods

Data from a population-based, cross-sectional diabetes screening survey involving 1550 individuals in Butajira, Ethiopia, and Enugu state, Nigeria were analyzed. Fasting plasma glucose and a 2-hour 75-g oral glucose tolerance test (OGTT) were utilized for diabetes screening. In addition, we determined and plotted the receiver operating characteristic curve for FPG against the reference standard 2-h PG to evaluate the screening tool's sensitivity and specificity.

Results

The mean (SD) age of the study participants was 44.5 (± 16.43) years, with men comprising 50.4% of the cohort. Among 1550 individuals analyzed, 4.6% and 16.8% demonstrated diabetes and prediabetes, respectively, as identified by either FPG or 2-h PG. The agreement between FPG and 2-h PG in identifying diabetes and prediabetes was moderate, with kappa statistic of 0.56 (95% CI, 0.51 - 0.61; p<0.0001) for diabetes and 0.45 (95% CI, 0.40 - 0.50; p<0.0001) for prediabetes. FPG failed to detect 34.1% of all prediabetes and 44.4% of all diabetes cases. The sensitivity of FPG in identifying diabetes cases was 44.3% at a cut-off 126 mg/dL with a specificity of 99.3%. We identified the optimal FPG cut-off for detecting newly identified diabetes cases using 2-h PG to be 105 mg/dL associated with a sensitivity and specificity of 67.2% and 94.0%, respectively.

Conclusion

FPG was able to correctly identify 99.3% of individuals with no diabetes but a significant percentage of diabetes cases would have remained undiagnosed if only FPG had been utilized instead of the 2-h PG. The use of 2-h PG test is recommended to diagnose diabetes in older individuals, females and non-obese persons who would be missed if tested by only FPG. Lowering the cut-off value for FPG to 105 mg/dL substantially increases the identification of individuals with diabetes, thus improving the effectiveness of FPG as a screening test for type 2 diabetes.

Impact of Impaired Fasting Glucose on Musculoskeletal Pain Among Female-Dominated Healthcare Workers

Introduction: In 2021, 10.5% of people aged 20-79 had diabetes, projected to rise to 12.2% by 2045, causing early deaths and straining healthcare systems. Musculoskeletal (MS) pain is common, affecting many workers and the general population. Prediabetes, notably impaired fasting glucose (IFG), is linked to increased MS pain risk. Objective: This study aims to assess IFG's impact on MS pain and specific pain sites to aid prevention strategies. Methods: This cross-sectional study used the '2023 Employee Occupational Safety and Health Management Database' from a Taichung hospital. It included health checks, demographics, living and work data, and MS pain surveys. Out of 2369 staff members contacted, 1039 valid responses were analyzed, excluding incomplete data, diabetes history, or fasting blood glucose levels above 125 mg/dL. Data on sex, age, marital status, coffee and alcohol consumption, sleep duration, exercise habits, height, weight, chronic diseases, profession, work hours, shift work, and education level were collected. Fasting blood glucose was verified using American Diabetes Association criteria (100-125 mg/dL). The Nordic Musculoskeletal Questionnaire (NMQ) measured MS pain frequency and severity, creating a pain degree index. Results: Overall, 21.17% had IFG. Participants were mostly female (85.18%), averaging 37.50 years. Neck and shoulder pain risk was linked to sex, coffee and alcohol consumption, sleep, exercise, chronic diseases, work hours, and IFG. Ankle pain risk was linked to coffee and alcohol consumption. IFG, coffee, alcohol, sleep under 6 h, chronic diseases, and work hours were independent risk factors for neck and shoulder pain. IFG was a risk factor for those without overweight or obesity. A mediation model tested IFG's indirect effect on neck and shoulder pain among overweight or obese individuals, showing that IFG mediates the relationship between being overweight or obese and increased neck and shoulder pain risk. Conclusions: Among female-dominated healthcare workers, IFG, daily coffee, recent alcohol consumption, less than 6 h of sleep, chronic diseases (excluding diabetes), and longer work hours are independent risk factors for neck and shoulder pain. IFG mainly affects these areas, increasing pain risk regardless of body weight. Healthy blood glucose levels are associated with a lack of musculoskeletal pain, suggesting a novel prevention approach needing further study.

Effect of fecal microbiota transplantation on diabetic wound healing through the IL-17A-mTOR-HIF1α signaling axis

Diabetes is the third most common chronic disorder worldwide. Diabetic wounds are a severe complication that is costly and often results in non-traumatic lower limb amputation. Recent investigations have demonstrated that the gut microbiota as a "virtual organ" can regulate metabolic diseases like diabetes. Fecal microbiota transplantation (FMT) is an innovative therapeutic approach for promoting wound healing, but its function remains incompletely defined. A diabetes model was established by supplying mice with a high-fat diet and performing an intraperitoneal injection of streptozotocin. Diabetic wounds were then created, followed by bacterial transplantation. The relevant indexes of wound healing were evaluated to verify the promoting effect of FMT on the diabetic wounds. Human skin keratinocytes were also cultured, and cell scratch experiments were conducted to further investigate the underlying mechanism. The FMT regulated the levels of specific bacteria in the diabetic mice and helped restore the balance of intestinal microbes. This transplantation also enhanced wound healing in the diabetic mice by augmenting the closure rate, accelerating re-epithelialization, and boosting collagen deposition in skin wounds. Furthermore, FMT promoted the production of IL-17A, which significantly enhanced the growth and movement of human keratinocytes. Inhibiting molecules related to the IL-17A-mTOR-HIF1α signaling axis were shown to hinder wound re-epithelialization.This study clarifies the function of the IL-17A-mTOR-HIF1α signaling axis in the utilization of FMT in diabetic wound healing, providing a new therapeutic method and target for promoting the healing of diabetic wounds.

IMPORTANCE

The Intestinal microbiota, as the organ with the largest number of microorganisms in the body, plays a crucial role in the physiological functions of the human body. Normal microbiota can be involved in various functions such as energy absorption, metabolism, and immunity of the body, and microbiota imbalance is related to many diseases such as obesity and diabetes. Diabetes, as one of the world's three major chronic diseases, is a significant health issue that troubles more than a billion people globally. Diabetic wounds are a problem that all diabetic patients must confront when undergoing surgery, and it is an important cause of non-traumatic amputations. Exploring the role of intestinal microorganisms in the wound-healing process of diabetic mice can offer the possibility of using microorganisms as a therapeutic means to intervene in clinically related diseases.

Comparison of Effects of Glucagon-Like Peptide-1 Receptor Agonists Compared to Long-Acting Insulin, Added to Oral Anti-Diabetic Agents on Self-Management Behaviors, Anxiety, and Sleep Quality in Patients with Type 2 Diabetes

AIM

This study aimed to investigate the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on individuals with type 2 diabetes (T2DM) by comparing self-management behaviors, anxiety, and sleep quality in T2DM patients.

METHODS

This is a single-center prospective study. During the patients' hospitalization, we collected their clinical data, and three months after discharge, we conducted follow-up by phone to record weight changes, blood glucose levels, self-management behaviors, anxiety levels, and sleep quality.

RESULTS

A total of 271 patients were included in this study. Among them, 177 (65.31%) were classified into the oral drug combined with long-acting insulin group, and 94 (34.69%) were classified into the oral drug combined with GLP-1RAs group. No statistically significant differences were found between the two groups in age, duration of diabetes, comorbidities, complications, or types of oral medications (P> 0.05). However, significant differences were observed between the groups in postprandial blood glucose, glycated hemoglobin, dietary control, medication adherence, actual anxiety, and sleep time (P<0.05). Notably, the oral medication combined with GLP-1RAs group demonstrated improved dietary control, medication adherence, anxiety and actual sleep time compared to the oral medication combined with long-acting insulin group.

CONCLUSION

In this 3-month study, there were statistically significant differences in HbA1c, post-prandial glucose, weight, for self-management behaviors, for dietary control, medication adherence, anxiety, and actual sleep time in T2DM patients. The findings suggest that GLP-1 RA may contribute to the improvement of dietary behaviors, medication adherence, anxiety, and sleep quality in addition to weight and glycemic control in T2DM patients.

Dried Blood Spots to Assess Cardiovascular-Kidney-Metabolic Health

Dried blood spot sampling offers a scalable strategy to close diagnostic gaps and improve global surveillance for cardiovascular-kidney-metabolic syndrome. However, assay performance and the extent of validity vary widely between biomarkers used in cardiovascular-kidney-metabolic health assessment under different settings and have not been well described. To fill this gap, we conducted a systematic search of the literature and a narrative synthesis through April 2024 and included reports with laboratory or field validation measuring biomarkers that can be used in cardiovascular-kidney-metabolic health assessment. We categorized assays into categories based on laboratory validation: excellent performance (r>0.95 with gold standard methods and coefficients of variation <5%), very good performance (r>0.90 and coefficients of variation <10%), reasonable performance (r>0.80 and coefficients of variation <15%), and poor performance (r<0.80 or coefficients of variation >15%). The extent of validation was determined by the total number of field validation studies with strong agreement. Hemoglobin A1c has strong laboratory and field validation and should be considered for expansion into clinical testing in low-resource settings. Traditional lipid biomarkers showed poor performance in field validation studies, but apoB (apolipoprotein B), creatinine, cystatin C, and NT-proBNP (N-terminal prohormone of brain natriuretic peptide) showed promising initial laboratory validation results and deserve greater attention in field validation studies. High-sensitivity C-reactive protein has strong laboratory and field validation but has limited clinical utility. Dried blood spot assays have been developed for biomarkers that offer mechanistic insights including inflammatory and vascular injury markers, fatty acids, malondialdehyde, asymmetric dimethylarginine, trimethylamine N-oxide, carnitines, and omics.

Relationship between serum uric acid and ventricular diastolic dysfunction in type 2 diabetes mellitus patients

OBJECTIVE

To investigate the correlation of serum uric acid (SUA) levels with ventricular diastolic dysfunction (DD) in the diabetic population.

METHODS

Clinical data from 702 patients with type 2 diabetes mellitus (T2DM), including 394 males and 308 females, were retrospectively analyzed in this study. The data included demographic characteristics, biochemical test results, and echocardiography findings. Univariate and multivariate logistic regression analyses were performed to assess the association between SUA and DD. Additionally, the diagnostic efficacies of SUA and the multivariate logistic regression model (Logit P) for DD were evaluated using receiver operating characteristic (ROC) curves.

RESULTS

Compared to T2DM patients with normal diastolic function, those with DD had a higher prevalence of hypertension, older age, longer diabetes duration, elevated levels of low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), blood urea nitrogen (BUN), SUA, and hemoglobin A1c (HbA1c), as well as lower levels of 1,5-anhydroglucitol (1,5-AG) and estimated glomerular filtration rate (eGFR) (P<0.05). As indicated by the Logistic regression analysis, gender, age, and SUA were independent risk factors for DD (P<0.05). Women had a 47.8% lower risk of DD compared to men [95% CI (0.318-0.718)]. The risk of DD increased by 6.8% for each one-year rise in age [OR 1.068, 95% CI (1.051-1.085)] and by 0.5% for each 1 mmol/L increase in SUA [OR 1.005, 95% CI (1.003-1.007)]. The regression model incorporating sex, age, and SUA exhibited an area under the curve (AUC) of 0.753 (95% CI 0.712-0.794) for diagnosing DD, with a sensitivity of 65.65% and specificity of 78.65%.

CONCLUSIONS

Gender, age, and SUA were independent factors influencing the development of DD in T2DM patients. Among them, SUA is the only modifiable factor. Early and long-term control of SUA levels is essential to reduce the risk of DD in T2DM patients.

Empagliflozin ameliorates renal and metabolic derangements in obese type 2 diabetic mice by blocking advanced glycation end product-receptor axis

BACKGROUND

Although randomized clinical trials revealed that inhibitors of sodium-glucose cotransporter 2 (SGLT2) reduced the risk of cardiovascular and renal events in patients with type 2 diabetes, the underlying molecular mechanisms remain to be elucidated. Since there is accumulating evidence that AGEs and their receptor (RAGE) play a crucial role in diabetes-related complications, we examined here whether empagliflozin ameliorates renal and metabolic derangements in db/db mice, an obese type 2 diabetes animal by blocking the AGE-RAGE axis.

METHODS

Eight-week-old db/db mice were fed a 0.045% empagliflozin diet (db/db + Empa) or normal diet (db/db) for 13 weeks. The same week-old db/ + m mice were maintained on normal diet (db/ + m) used as a control. At baseline and 13 weeks after intervention, biochemical analyses in the serum and urine were performed, and kidneys and adipose tissues were obtained for morphological, immunohistochemical, and reverse transcription-polymerase chain reaction analyses.

RESULTS

Empagliflozin treatment for 13 weeks significantly reduced AGEs, Nε-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1), RAGE, NADPH oxidase-derived oxidative stress, inflammatory and fibrotic reactions in the kidneys of db/db mice of 21-week-old in association with attenuation of glomerular extracellular matrix accumulation, podocyte loss, proteinuria, and tubulointerstitial damage. Empagliflozin also reduced the AGE-RAGE-oxidative stress-induced inflammatory reactions in the adipose tissues of db/db mice, which was associated with restoration of adiponectin levels and decreased insulin resistance. Serum MG-H1 levels of control and db/db mice at 21 weeks of age were significantly associated with proteinuria, tubulointerstitial damage, tissue AGEs levels, and serum monocyte chemoattractant protein-1 and adiponectin (inversely) values.

CONCLUSIONS

Our present findings suggest that empagliflozin could ameliorate renal and metabolic derangements in type 2 diabetes animals by attenuating the AGE-RAGE axis.