IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045

IGFBP2 and IGFBP4 interact to activate complement pathway in diabetic kidney disease

BACKGROUND

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease globally. Recent research has identified insulin-like growth factor-binding proteins 2 (IGFBP2) and 4 (IGFBP4) as potential biomarkers for DKD. Overactivation of the complement pathway in DKD remains poorly understood.

METHODS

Blood samples were collected from patients for proteomic analysis, complemented by both in vitro and in vivo experiments to investigate the roles of IGFBP2, IGFBP4, and the complement pathway in DKD.

RESULTS

Elevated levels of IGFBP2 and IGFBP4 were observed in DKD patients. The levels of IGFBP2 and IGFBP4 increased in DKD mice, accompanied by the activation of the complement pathway, and a deterioration in renal function. High glucose and serum from DKD mice stimulated an increase in the levels of IGFBP2 and IGFBP4 in HK-2 cells. The supernatant from HK-2 cells was used to culture THP-1 cells, resulted in an increase in the M1 type of THP-1 cells, a decrease in the M2 type, and activation of the complement pathway. The supernatant from THP-1 cells affected the growth of primary human renal podocytes. The exogenous addition of IGFBP2 and IGFBP4 proteins to primary human renal podocytes did not affect their growth. However, when human renal podocytes were cultured with the supernatant from THP-1 cells, the growth of the podocytes was affected.

CONCLUSIONS

IGFBP2 and IGFBP4 interact to stimulate the activation of the complement pathway in macrophages, which induces podocyte apoptosis and subsequently promotes the development of DKD.

Comparison of the cardioprotective effects of liraglutide, dapagliflozin and their combination in a rat model of diabetes induced by streptozotocin

BACKGROUND

Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists positively affect diabetic cardiac complications.

AIM

To evaluate and compare the impact of liraglutide, dapagliflozin, and their combination on cardiac biomarkers of inflammation, oxidative stress, and fibrosis in a rat model of streptozotocin (STZ)-induced diabetes.

METHODS

Adult male Wistar rats were assigned into five groups (15-17 rats/group): control rats, diabetic rats (DM, single 50 mg/kg STZ intraperitoneally (IP)), diabetic rats treated with dapagliflozin (Dapa, 1 mg/kg by oral gavage), diabetic rats treated with liraglutide (Lira), 0.4 mg/kg subcutaneously (SC), and diabetic rats treated with both medications (Dapa+Lira) for 8 weeks. Cardiac biomarkers of inflammation, oxidative stress, and fibrosis were evaluated.

RESULTS

Dapagliflozin and/or liraglutide treatment lowered glucose levels, mostly in the combination group. Diabetes increased heart/body weight ratio, which was normalized by all treatments. DM increased cardiac inflammatory and oxidant markers, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), endothelin-1 (ET-1), myeloperoxidase (1), plasminogen activator inhibitor-2 (PAI-2), total nitrite, and thiobarbituric acid reactive substances (TBARS). Dapagliflozin normalized inflammatory markers levels, but combination with Lira added no benefit, except for PAI-2. Dapagliflozin normalized total nitrite and TBARS levels. Combining treatments further decreased nitrite and TBARS levels and normalized cardiac SOD activity. Both dapagliflozin and the combination normalized cardiac fibrosis and platelet-derived growth factor-BB (PDGF-BB) levels.

CONCLUSION

Dapagliflozin reduced cardiac fibrosis, and attenuated oxidative stress, and inflammation more effectively than liraglutide. Combining treatments improved oxidative status. Our findings support using dapagliflozin to prevent cardiovascular diseases more than liraglutide.

Antidiabetic constituents of Kaempferiae rhizoma: Previously undescribed O-linked diarylheptanoid dimers promoting GLP-1 secretion via PKA-CREB pathway

Glucagon-like peptide-1 (GLP-1) is a fascinating target for the treatment of diabetes to avoid hypoglycemia. Kaempferiae Rhizoma (KR), the dried rhizomes of Kaempferia galanga, is a famous pungent medicine used for activating Qi, warming interior, removing digestion and relieving pain in China. In order to characterize the antidiabetic effects of KR, 21 previously undescribed O-linked diarylheptanoid dimers, kaemgalangins A1-A4 (1-4), B1-B13 (5-17) and C1-C4 (18-21), were isolated from the ethyl acetate fraction. Their structures were determined by extensive spectroscopic analyses, quantum computation and chemical methods. All compounds were tested for their GLP-1 stimulating effects on NCI-H716 cells, most of which showed obvious activity representing a new type of antidiabetic constituents. Especially, compounds 1, 2 and 16 showed spectacular GLP-1 stimulation with promoting rates of 146.6 ± 31.1 %, 159.0 ± 16.6 % and 142.9 ± 2.7 %, more potent than the positive control. Mechanism study manifested that kaemgalangin A1 (1) promoted GLP-1 secretion through up-regulating the mRNA expression of Gcg and Pc1/3, and the phosphorylation of PKA and CREB, but independent on TGR5 and GPR119 receptors. Furthermore, network pharmacology analysis suggested that the GLP-1 secretion induced by 1 was closely related to MAPK and PI3K-Akt signaling pathways. This investigation first revealed that KR was rich in diarylheptanoid dimers with GLP-1 promoting effects, which provides scientific basis for the antidiabetic application of K. galanga.

Selenium-containing polyurethane nanofibers with MnO2 nanoparticles and gelsevirine promote diabetic wound healing by modulation of ROS and inflammation

Reactive oxygen species (ROS) and subsequent inflammatory cascades hinder the healing of diabetic wounds, which should be tackled simultaneously when designing wound dressings. In this study, ROS-responsive di‑selenium-containing polyurethane nanofibers (PUF) loaded with manganese dioxide nanoparticles (MnO2 NPs) and gelsevirine (GSV) with an average diameter of 0.6 ± 10 μm, were prepared to specifically target ROS and inflammation control, thereby enhancing healing in diabetic wounds. The resulting nanofibers exhibited a porous architecture and enhanced drug delivery capability. The MnO2/GSV/PUF dressing showed negligible cytotoxicity with cell viability over 80 %, effective ROS-scavenging ability of 87 %, and inhibition of pro-inflammatory cytokine expression. This dual mechanism of ROS-scavenging and inflammation modulation accelerated the healing of diabetic wounds up to 92 % in 14 d in a full-thickness diabetic wound model, as evidenced by reduced cytokine levels, enhanced epithelialization, and uniform collagen deposition with the highest percentage of 60 %.

Continuous glucose monitoring: Minimally and non-invasive technologies

This paper highlights technological advancements in non-invasive blood glucose monitoring against the backdrop of increasing global prevalence of diabetes. Traditional monitoring methods, primarily invasive methods face limitations in providing continuous glucose level data, which is essential for effective and timely diagnosis of disease stage and for determining the optimal therapeutic strategy. Recent non-invasive technologies encompass optical, acoustic, electromagnetic, and chemical approaches. These technologies exploit the intrinsic properties of glucose, such as its optical absorption coefficients, to offer promising avenues for less intrusive blood glucose monitoring. Despite these advancements, challenges in achieving high accuracy persist due to interference from substances like water and other blood components. This underlines the need for sophisticated algorithms and sensor designs for accurate glucose estimation. Further research is required to integrate various sensing techniques and advanced data processing to enhance accuracy and user-friendliness. In conclusion, while significant progress has been made, developing a reliable, convenient, and accessible method for non-invasive glucose monitoring is crucial for transforming diabetes management and improving patients' quality of life.

New perspectives on the treatment of diabetic nephropathy: Challenges and prospects of mesenchymal stem cell therapy

Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes mellitus. Traditional treatment methods have certain limitations and it is difficult to effectively delay the disease progression. Mesenchymal stem cells (MSCs), owing to their potential for self-renewal, multidirectional differentiation, and immunomodulatory abilities, can regulate the renal immune microenvironment and repair damaged tissues, providing a new strategy for the treatment of DN. However, MSCs face problems such as immune rejection, cell inactivation, challenges in directed differentiation, insufficient homing ability, and low cell retention rate after delivery. These issues limit their clinical application in patients with DN. This review aims to propose optimization strategies targeting DN pathological features to improve MSC effectiveness and reduce their side effects. Specifically, it involves optimizing cell culture systems and cryopreservation protocols, along with pre-transplantation pharmacological conditioning to boost the functionality and viability of MSCs. Additionally, the exploration of synergistic drug-MSC combination therapies was carried out, taking advantage of diverse mechanisms of action to improve therapeutic outcomes. The integration of biomaterials and gene editing technologies to significantly enhance cell survival, target specificity, and tissue engraftment was also pursued. Concurrently, the determination of optimal therapeutic dosages and administration routes remained crucial. These multifaceted strategies not only provide a theoretical framework for overcoming existing technical limitations but also lay a robust foundation for accelerating the clinical translation of MSC-based therapies.

Methylglyoxal-induced neuronal dysfunction: Linking diabetes to Alzheimer's disease through cytoskeletal disruption

This study investigates how methylglyoxal affects Alzheimer's disease, which is common in patients with diabetes mellitus. Using SH-SY5Y cells as a model of AD, we investigated the effects of MGO on cell viability, morphology, inflammation, and stress responses. Exposure to MGO induces cytotoxicity, inflammation and oxidative stress that contribute to AD in diabetic patients. We analyzed how MGO (150-900 μM) affects SH-SY5Y cells and its effects on cell survival, gene expression, cytoskeletal integrity, stress indicators, and Aβ42 accumulation (dose- and time-dependent). MGO dramatically affected cell viability depending on the dose and exposure time. Cell death occurred via intrinsic (BAX, CASP9) and extrinsic (FAS, FASLG) apoptotic pathways. Markers related to insulin signaling such as INSR, IRS1, IRS2, SLC2A4, etc. were downregulated, whereas markers of inflammation such as TNF-α, IL-6 and oxidative markers such as HMOX1, G6PD, etc. were upregulated with MGO (P < 0.001). Changes in MAP2 and TUBB3 expression were associated with cytoskeletal damage (P < 0.01). High levels of Aβ42 and low SOD activity confirmed that oxidative stress was induced. LPS treatment exacerbated these effects (P < 0.01). The results highlight the possible role of MGO in cognitive decline associated with diabetes and suggest the need for novel treatment against MGO-related neurotoxicity.

Coffee intake, plasma caffeine levels, and diabetic microvascular complications: A Mendelian randomization study

BACKGROUND AND AIM

Diabetic microvascular complications pose significant health challenges for individuals. The influence of modifiable lifestyle factors, such as coffee intake, on these complications has not been conclusively determined, highlighting the need for a causality assessment.

METHODS AND RESULTS

Utilizing Mendelian randomization (MR), this study explored the causal links between coffee intake, plasma caffeine levels, and diabetic microvascular complications using data from FinnGen. Single nucleotide polymorphisms associated with coffee intake and plasma caffeine levels were identified through genome-wide association study meta-analyses. The univariable MR analysis indicated a slightly increased risk for diabetic retinopathy (OR 1.006; 95 % CI: 1.002-1.010; P = 0.003) and a suggestively elevated risk for nephropathy (OR 1.011; 95 % CI: 1.001-1.022; P = 0.036) associated with genetically predicted higher coffee intake, while no significant effect on neuropathy was observed. Multivariable MR analysis, adjusted for smoking, revealed a significant protective effect of coffee intake on diabetic retinopathy (OR 0.895; 95 % CI: 0.856-0.936; P = 9.468 × 10-7) and a suggestive reduction in risk for diabetic nephropathy (OR 0.828; 95 % CI: 0.712-0.963; P = 0.014). Higher plasma caffeine levels were also suggestively protective against these complications.

CONCLUSIONS

Our findings suggest that genetically predicted higher coffee intake and plasma caffeine levels are protective for diabetic retinopathy and nephropathy. Further research is necessary to substantiate these findings and to investigate their potential impact on diabetes management strategies.

Fasting-mimicking diet in type 2 diabetes reduces myocardial triglyceride content: A 12-month randomised controlled trial

BACKGROUND AND AIMS

Type 2 diabetes is associated with a heightened risk of cardiovascular complications, including myocardial steatosis. Fasting-mimicking diets (FMDs) may mimic the metabolic benefits of fasting, while being less intensive than fasting. This study aims to investigate the effect of following an FMD program on myocardial triglyceride content (MTGC), as assessed by Magnetic Resonance Spectroscopy (MRS), in patients with type 2 diabetes.

METHODS AND RESULTS

100 patients with type 2 diabetes, who used metformin as the only glucose-lowering drug or no medication were randomly assigned to either an FMD group or a control group. The FMD group received the FMD program for 5 consecutive days a month alongside usual care, while the control group received usual care only. Both groups underwent baseline, 6-months and 12-months examinations, including single voxel cardiac 1H-MRS to assess MTGC. N = 13 participants of the FMD and n = 13 of the control group had complete data at baseline and twelve month follow-up. The FMD group exhibited a significant reduction in MTGC over the twelve month period (-0.235 % MTGC, p = 0.027), while the control group saw no significant change (0.143 % MTGC, p = 0.236). The decrease of MTGC in the FMD group was statistically different (p = 0.018) from control.

CONCLUSION

Following an FMD program reduces MTGC, which indicates a favorable effect on cardiac metabolism and thereby may be an effective strategy to reduce the cardiovascular risk in patients with type 2 diabetes.

CLINICAL TRIALS REGISTRATION NUMBER

NCT03811587.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT03811587, submitted January 13th, 2019.

Synthesis and profiling (in vitro and in silico) of the 6-methoxy/hydroxy substituted 7-acetyl-2-aryl-5-bromobenzofurans for antihyperglycemic, cytotoxic and antioxidant properties

A small library of the 7-acetyl-2-aryl-5-bromo-6-methoxybenzo[b]furans 2a-f was synthesized and transformed into the corresponding ortho-(hydroxyacetyl) substituted 2-arylbenzo[b]furan derivatives 3a-f. The structures of both series of compounds were characterized using a combination of spectroscopic techniques complemented with single crystal X-ray diffraction (XRD) analysis of a representative example from each category. Both series of compounds were evaluated through enzymatic assays in vitro for potential to inhibit α-glucosidase, α-amylase and/or protein tyrosine phosphatase 1 beta (PTP1B) all of which are associated with the pathogenesis and progression of type 2 diabetes mellitus (T2DM). The test compounds exhibited moderate to significant antigrowth effect against the breast cancer (MCF-7) cell line and reduced cytotoxicity against the human embryonic kidney derived (Hek293-T) cell line compared to the anticancer drug, doxorubicin. The anti-oxidation potential of the test compounds was evaluated spectrophotometrically using the nitric oxide (NO) radical scavenging assay. A cell-based antioxidant activity assay involving lipopolysaccharide (LPS) induced reactive oxygen species production in the MCF-7 and Hek293-T cells revealed their potential to mitigate against oxidative stress. Molecular docking analysis revealed hydrogen bonding, hydrophobic and π-π stacking interactions to play a significant role in the binding affinity and interactions of the test compounds with amino acid residues in the active sites of the test enzymes.

Construction of CeO2/Ti3C2Tx heterojunction with antibacterial and antioxidant capabilities for diabetic wound healing

Diabetic wounds are highly prone to persistent pathogenic infections due to the complex nature of their microenvironment, which significantly hinders the healing process under hyperglycemic conditions. In this study, we developed a bio-heterojunction enzyme system consisting of hollow CeO2/Ti3C2Tx MXene quantum dots (CeO2@MQD) integrated with glucose oxidase (GOx-CeO2@MQD). The GOx-CeO2@MQD system exhibits multifunctional enzymatic activities, including peroxidase (POD) and catalase (CAT)-like activity, resulting in the production of •OH and O2, alongside the consumption of glucose and glutathione (GSH). The incorporation of GOx effectively mitigates the hyperglycemic microenvironment by catalyzing glucose, leading to a significant increase in H2O2 production, which is subsequently converted into bactericidal •OH through POD activity. Furthermore, H2O2 can be catalyzed into H2O and O2 via the CAT pathway, thereby alleviating inflammation caused by the excessive accumulation of reactive oxygen species. In vitro antibacterial assays demonstrated that the GOx-CeO2@MQD system achieved remarkable bactericidal efficiencies of 99.99% against E. coli and S. aureus at concentrations of 12.5 ppm and 2.0 ppm, respectively. In vivo experiments further revealed that GOx-CeO2@MQD significantly promoted angiogenesis, accelerated wound epithelialization, and induced a strong anti-inflammatory response, thus facilitating the regeneration of infected diabetic skin. This study proposes a novel approach for diabetic wound treatment by harnessing the synergistic effects of multiple enzyme-like activities.

Immunomodulatory effect of allium sativum in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a metabolic disorder marked by chronic hyperglycemia and low-grade inflammation, contributing to various complications. Natural agents with immunomodulatory and antioxidant properties have gained attention as adjunct therapies. To review the effects of Allium sativum on inflammatory pathways and metabolic alterations associated with T2DM. A narrative review was performed using PubMed/MEDLINE, EMBASE, and Scielo databases. The search included terms such as “allium sativum”, “inflammation", “oxidative stress”, and “diabetes mellitus”. Studies in English and Spanish - ranging from clinical trials to meta-analyses - were selected based on relevance. Bioactive compounds such as allicin, S-allyl cysteine, and diallyl disulfide exhibit anti-inflammatory, antioxidant, hypoglycemic, and lipid-lowering actions. Preclinical studies show improved glucose metabolism, insulin sensitivity, and organ function. Moreover, clinical evidence supports reductions in fasting glucose, hemoglobin A1c, blood pressure, and oxidative stress, with good safety profiles. Allium sativum appears to be a promising adjuvant in T2DM management, offering metabolic and anti-inflammatory benefits. Nonetheless, further high-quality clinical trials are needed to confirm its long-term efficacy and standardize its therapeutic use.

Effects of a protein kinase C epsilon inhibitor on insulin signalling in lipid-treated HepG2 hepatocytes and glucose tolerance in fat-fed mice

AIMS

Protein kinase C epsilon (PKCε) plays a causative role in the development of glucose intolerance, and is a potential target for the treatment of type 2 diabetes. Here, we examined the effects of the PKCε inhibitor CIDD-0150612 (CP612) on insulin action in palmitate-treated HepG2 hepatocytes in vitro and on glucose homeostasis in fat-fed mice in vivo.

METHODS

HepG2 cells were treated with palmitate and CP612 and stimulated with insulin. Insulin signalling was examined by immunoblotting and glucose incorporation into glycogen was measured using glucose tracer. Mice were fed a high-fat diet and treated with CP612 prior to glucose tolerance tests and tissue harvest. Proteomic analysis of liver was carried out by mass spectrometry.

RESULTS

CP612 promoted Akt phosphorylation in a highly insulin-dependent manner and reversed the inhibition of insulin-stimulated Akt phosphorylation and glucose incorporation into glycogen by palmitate. Fat-fed mice treated with CP612 had reduced fat mass, but not lean mass, compared with vehicle-treated littermates. Mice treated acutely with CP612 exhibited elevated fasting blood glucose. However, mice studied 24h after the last dose had lower fasting glucose and improved glucose tolerance with a lower insulin excursion. Proteomic analysis of liver from CP612-treated fat-fed mice indicated a reduction in gluconeogenic gene expression and decreased phosphorylation of the transcription factor Foxk1.

CONCLUSIONS

The PKCε inhibitor CP612 had beneficial effects on insulin action in hepatocytes and on fat mass and glucose homeostasis in mice. Because certain effects were not previously observed in genetically PKCε-deficient mice, off-target effects may be partly responsible.

Mechanisms of Inonotus obliquus (Fr.) Pilát polysaccharides in ameliorating lipid-induced skeletal muscle insulin resistance via PI3K/AKT and AMPK/ACC1/CPT1 signaling pathways

ETHNOPHARMACOLOGICAL RELEVANCE

Inonotus obliquus (Fr.) Pilát, a traditional medicinal fungi, has been used to treat diabetes in China and Russia since the 16th century. Recent studies show Inonotus obliquus (Fr.) Pilát polysaccharides (IOP) have hypoglycemic and lipid-lowering effects in type 2 diabetes mellitus (T2DM) mice and can recover liver insulin resistance.

AIM OF THE STUDY

This study aims to assess the effect of IOP and its mechanisms in ameliorating insulin resistance and lipid metabolism disorders in T2DM.

MATERIALS AND METHODS

The potential targets of IOP for T2DM were identified by network pharmacology and molecular docking. In vitro, an insulin resistance model in C2C12 cells was induced, and IOP's effects on glucose uptake, glycogen, lipid content, and lipid metabolism-related mRNAs were assessed. In vivo, a T2DM mice model was established. Blood glucose, lipids, glucose tolerance, and insulin sensitivity were evaluated. Histopathology was used to assess morphological changes in mice skeletal muscle. Western blotting was utilized to evaluate the expression levels of PI3K/AKT and AMPK/ACC1/CPT1 signaling pathway proteins both in vivo and in vitro.

RESULTS

Network pharmacology results showed IOP and T2DM targets were enriched in PI3K/AKT, insulin resistance, and lipid metabolism pathways. Cell experiments showed IOP enhanced glucose uptake and glycogen content, reduced lipid content, and improved lipid deposition in insulin-resistant C2C12 cells. Animal experiments showed IOP improved hyperglycemia and hyperlipidemia, enhanced glucose tolerance and insulin sensitivity, and reduced insulin resistance in T2DM mice. Western blot showed IOP activated PI3K/AKT and AMPK/ACC1/CPT1 pathways, promoting GLUT4 expression and translocation, and GSK3β phosphorylation.

CONCLUSIONS

In summary, the results indicated that IOP was able to ameliorate lipid-induced skeletal muscle insulin resistance in T2DM. The mechanism may be related to the PI3K/AKT and AMPK/ACC1/CPT1 signaling pathways.

Cultural Influences, Experiences and Interventions Targeting Self-Management Behaviours for Prediabetes or Type 2 Diabetes in First-Generation Immigrants: A Scoping Review

AIM

To map the existing evidence and identify research gaps regarding the self-management of prediabetes or type 2 diabetes among first-generation immigrants ≥ 18 years.

DESIGN

A scoping review followed the JBI guidelines and was in accordance with the PRISMA extension for Scoping Reviews.

METHODS

A systematic search of CINAHL, Cochrane, EMBASE, MEDLINE, PsycINFO, ProQuest, SCOPUS and the Web of Science was conducted. Grey literature and reference lists of included studies were searched for additional citations. Articles published in English from the database inception to February 2023 were included.

RESULTS

We included 96 studies, of which 28.1% were published within the last 5 years. Most studies (71.9%) were conducted in the United States. Study participants were recruited mainly from community settings and English was their second language. The most common study methodologies used were cross-sectional surveys and phenomenological interviews. Only two studies specifically focussed on individuals with prediabetes. Multiple factors, such as age, gender, country of origin and other societal, linguistic, cultural and resource barriers or facilitators, as well as patient's cultural unique experiences, were of particular significance for self-management behaviours. Although several studies reported that culturally tailored interventions were feasible and acceptable among first-generation immigrants living with type 2 diabetes but not prediabetes, the duration and intensity of these interventions varied.

CONCLUSION

Health professionals should consider various demographic, societal, linguistic and cultural factors, such as participants' low English language proficiency, and provide appropriate support for this group to ensure better self-management behaviours. Tailoring interventions to individual and cultural preferences in collaboration with key stakeholders is crucial for adult immigrants with prediabetes and type 2 diabetes across diverse cultural and ethnic groups.

IMPACT

Developing and applying culturally tailored self-management interventions for the targeted population, particularly those with prediabetes, should be an important direction for future research. No Patient or Public Contribution.

Association of early-onset diabetes with socioeconomic, and health factors: a matched case-control study controlling for age, gender, and BMI

Objectives

This study examines the link between early-onset diabetes and health factors in South Korean young adults (20-39) using data from the Korea National Health and Nutrition Examination Survey (2010-2020).

Methods

A matched case-control study was conducted in 2022 with 103 patients with diabetes and 103 controls, matched by age, gender, and BMI. All data, including socioeconomic status (income, education, occupation), health behaviors (smoking, alcohol consumption, physical activity), and medical histories, were extracted from the KNHANES database. We analyzed socioeconomic status, health behaviors, and medical histories using descriptive statistics, chi-square tests, and binary logistic regression.

Results

The study revealed that educational attainment and economic status are substantial predictors of diabetes, with those holding only a high school diploma showing a nearly threefold increased risk compared to college graduates (OR = 2.986; 95% CI = 1.334-6.687). Additionally, participants with a higher number of chronic diseases (OR = 3.534; 95% CI: 1.547-8.073) and those who felt unwell in the past two weeks (OR = 4.010; 95% CI: 1.388-11.585) also demonstrated significantly increased odds of diabetes. And having a parent with diabetes was an exceptionally strong predictor, with these participants having a significantly increased risk of diabetes (OR = 47.022; 95% CI = 4.206-525.704).

Conclusion

The study emphasizes that improving educational and economic conditions, coupled with targeted screening programs for individuals with a family history of diabetes, may be effective in curbing the tide of early-onset diabetes in South Korea. These strategies may have profound implications for public health policies aimed at mitigating the risk in this increasingly vulnerable group.

Estimation of the population atributable fraction due a to excess body fat in primary care patients: IBERICAN study

The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.

MATERIAL AND METHODS

Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.

RESULTS

A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.

CONCLUSIONS

The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.

A bibliometric analysis of research trends on left ventricular dysfunction and exercise among individuals with type 2 diabetes mellitus

BACKGROUND

Diabetic cardiomyopathy (DCM) is a severe outcome of type 2 diabetes mellitus (T2DM) and a major global health concern. The overall impact of T2DM on the heart is demonstrated by echocardiographic measurements. Exercise helps reduce cardiovascular disease risk and improves glycemic management in T2DM. The objective of the present bibliometric study was to map the research trends on left ventricular dysfunction and exercise among T2DM.

MATERIALS AND METHODS

The comprehensive search was conducted in the SCOPUS database, with the keywords "type 2 diabetes", "diabetic cardiomyopathy", "exercise," and "left ventricular function", with BOOLEAN Operators AND, OR. The search period ranged from 1984 to November 2023. The data was exported to VOS Viewer(1.6.20) for analysis.

RESULTS

Sixty-nine documents were retrieved from the database search. A steady rise was observed in the number of documents per year, between 1 and 5. The following countries published the maximum number of documents: the USA, Italy, Australia, and the UK. 79.7% of documents were original articles, 18.8% were reviews, and 1.4% were editorials. Most studies belonged to categories, namely medicine(69.9%), biochemistry(15.1%), pharmacology (8.6%) and health professions (2.2%). The network analysis was performed to explore the association between the studies based on co-authorship, citation analysis, and co-occurrence.

CONCLUSION

The bibliometric analysis showed the maximum number of publications belonged to high-income countries, with smaller contributions from low-middle-income countries (LMICs), including the Indian subcontinent. There is a need to explore the area of exercise and left ventricular dysfunction in T2DM as exercise can act as a valuable tool in LMICs where the burden of T2DM is increasing.

Preoperative glycemic control and postoperative clinical outcomes in patients with type 2 diabetes mellitus undergoing bariatric surgery

BACKGROUND

The preoperative glycated hemoglobin (HbA1c) cutoff point for elective surgery in patients with type 2 diabetes mellitus (T2DM) remains unclear, as does its association with postoperative outcomes, especially in patients undergoing bariatric surgery.

METHODS

We conducted a retrospective cohort study including patients with T2DM and an electronic record of HbA1c within the four months prior to surgery who underwent Roux-en-Y gastric bypass (RYGB) from August 2010 to May 2019. The primary outcome was postoperative hospital length of stay (LOS), and secondary outcomes included need for intensive care, clinical outcomes (pulmonary, cardiovascular, septic), and surgical wound complications. These outcomes were assessed using an HbA1c cutoff value of 7 %. Comparisons were made using the Mann-Whitney U test and a general linear model adjusting the primary outcome for confounders and for differences in baseline characteristics between groups.

RESULTS

A total of 114 individuals were divided into two groups according to HbA1c: ≤7 % (N = 63) or > 7 % (N = 51). No differences were observed between the groups in terms of LOS (4 vs 5 days, p = 0.28) and clinical or operative wound complication rates. Alternative HbA1c cutoff points (7.5 %, 8 %, and 8.5 %) were also evaluated for LOS, with no change in results.

CONCLUSION

Bariatric surgery should not be postponed in patients with T2DM based on an HbA1c greater than 7 %, as LOS, clinical outcomes and operative wound complication rates are not worse in patients with poorer glucose control based on this criterion.

The association between dietary diversity score and food insecurity and novel cardiovascular risk factors in type 2 diabetes mellitus patients: a cross-sectional study

Objectives

An efficient approach to monitor the risks associated with chronic diseases is to use a dietary diversity score (DDS). To our knowledge, there has been no study conducted on the correlation between DDS and cardiovascular risk factors in individuals with diabetes. Hence, the objective of this study is to ascertain the correlation between these traits.

Methods

In this cross-sectional investigation, 490 individuals with type 2 diabetes were included. The patients' food consumption was assessed using a 168-item food frequency questionnaire (FFQ), and a dietary diversity score (DDS) was computed. Traditional CVD risk variables were used to evaluate cardiovascular risk factors, including Castelli risk index 1 and 2 (CRI-I and II), atherogenic index of plasma (AIP), lipid accumulation product (LAP), and cholesterol index (CI). We evaluated the anthropometric indicators that predict CVD, including the abdominal volume index (AVI), body roundness index (BRI), and body shape index (ABSI).

Results

In the final model adjusted for all the considered confounders, there was a significant association between DDS and LAP (OR: 1.33; 95% CI: 0.61, 0.82; p-trend = 0.03). Moreover, there was a significant association between DDS and AVI (OR: 1.99; 95% CI: 1.17,3.35; p-trend = 0.04). We could not find any association between food security and DDS among the participants of the current study.

Conclusions

In the present study, it was found that DDS may result in higher LAP and AVI which are markers of abdominal obesity and cardiovascular diseases. Therefore, despite the probable positive effect of having a diverse diet on cardiovascular health and wide recommendations for that, using healthier food groups should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01557-0.

Altered cerebellar activity and cognitive deficits in Type 2 diabetes: Insights from resting-state fMRI

OBJECTIVE

To investigate alterations in brain activity in patients with Type 2 Diabetes and explore the relationship between altered regions and neuropsychological performances.

METHODS

A total of 36 patients with Type 2 Diabetes and 40 age- and education-matched healthy controls were recruited for this case-control study. All participants underwent resting-state functional magnetic resonance imaging (Resting-state fMRI) and neuropsychological tests. The neuropsychological scales included the Auditory Verbal Learning Test (AVLT), Shape Trajectory Test B (STT-B), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Boston Naming Test (BNT), Symbol Digit Modality Test (SDMT), Regional homogeneity (ReHo) and the amplitude of low-frequency fluctuations (ALFF) were used to assess differences in spontaneous regional brain activity. For functional connectivity (FC) analyses, the differences identified among the groups were selected as seed regions. Then, the correlations between neuropsychological scale scores (AVLT, HAMA, HAMD, STT-B, BNT, and SDMT) and ALFF/ReHo values were specifically analyzed in the focal regions that exhibited significant alterations between the T2DM and control groups, as detailed in Tables 2 and 3.

RESULTS

Patients with Type 2 Diabetes exhibited significantly higher ALFF values in the superior lobe of the cerebellum, specifically in the left cerebellar crus I (Cerebellum_Crus I_L), left cerebellar lobule VI (Cerebellum_6_L), and left cerebellar lobule IV-V (Cerebellum_4_5_L). Additionally, they exhibited elevated ReHo values in the Cerebellum_Crus I_L and Cerebellum_6_L. The findings were statistically significant with a family-wise error-corrected, cluster-level p-value of less than 0.05. However, the FC analysis was not significant. AVLT scores were significantly lower in the diabetes group. The correlation analysis demonstrated a negative association between ALFF values of the Cerebellum_6_L and AVLT scores (R2 = 0.1375, P < 0.001). The ReHo values within the Cerebellum_6_L also exhibited a negative association with AVLT scores (R2 = 0.0937, P = 0.007).

CONCLUSION

Patients with Type 2 Diabetes showed abnormal neural activities in diverse cerebellar regions mainly related to cognitive functions. This provides supplementary information to deepen our insight into the neural mechanisms by which Type 2 Diabetes affects the functional activity of the brain's posterior circulation, as well as the potential association of these changes with cognitive impairment.

A simple and accessible diabetic retinopathy risk prediction model: Establishment and validation in a hospital-based cohort of type 2 diabetes patients

AIMS

Diabetic retinopathy (DR) is a leading cause of vision loss, with early detection challenging due to asymptomatic progression and limited predictive tools. To address this, we aimed to develop and validate a risk nomogram for DR prediction in type 2 diabetes patients.

METHODS

In this retrospective cohort study of 70,073 patients with type 2 diabetes admitted from 2013 to 2019, 2,585 patients were included after exclusions. Patients were randomly assigned to derivation (2/3) and validation (1/3) sets. The prediction model was derived using Cox proportional hazards regression. A nomogram was developed and evaluated for discriminatory capacity and calibration accuracy.

RESULTS

Among 2585 participants (mean age 59 years), 220 (8.5 %) developed retinopathy over a median follow-up of 34 months. We identified key predictors: glycated haemoglobin A1c, serum urea, and diabetes duration. Predictive models for 1-, 3-, and 5-year retinopathy-free survival were constructed and presented as a nomogram, demonstrating good discriminatory power (AUC: 0.941, 0.886, 0.594 in derivation; 0.747, 0.736, 0.670 in validation). Calibration plots further corroborated the improved fit for 3- and 5-year models.

CONCLUSIONS

The proposed model shows promise for guiding early interventions and improving outcomes. Further external validation is needed to confirm its applicability across diverse populations.

The PI3K/Akt pathway: a target for curcumin's therapeutic effects

Purpose

The purpose of this review study is to investigate the effect of curcumin on the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in various diseases. Curcumin, the main compound found in turmeric, has attracted a lot of attention for its diverse pharmacological properties. These properties have increased the therapeutic potential of curcumin in chronic diseases such as cardiovascular disease, Type 2 diabetes, obesity, non-alcoholic fatty liver disease, kidney disease, and neurodegenerative diseases. One of the main mechanisms of the effect of curcumin on health is its ability to modulate the PI3K/Akt signaling pathway. This pathway plays an important role in regulating vital cellular processes such as growth, cell survival, metabolism, and apoptosis. Disruption of the PI3K/Akt signaling pathway is associated with the incidence of several diseases.

Methods

Electronic databases including PubMed, Google Scholar, and Scopus were searched with the keywords "phosphoinositide 3-kinase" AND "protein kinase B "AND "curcumin" in the title/abstract. Also, following keywords "non-alcoholic fatty liver disease" AND "diabetes" AND "obesity" AND "kidney disease" and "neurodegenerative diseases" was searched in the whole text.

Results

Research indicates that curcumin offers potential benefits for several health conditions. Studies have shown it can help regulate blood sugar, reduce inflammation, and protect the heart, kidneys, and brain.

Conclusion

This protective effect is partially achieved by regulating the PI3K-Akt survival pathway, which helps improve metabolic disorders and oxidative stress. By examining how curcumin affects this vital cell pathway, researchers can discover new treatment strategies for a range of diseases.

The intervention effect of comprehensive precision nursing in elderly patients with type 2 diabetes

OBJECTIVE

This study evaluated the impact of precision nursing on blood sugar levels, psychological health and quality of life in ageing type 2 diabetes patients.

METHODS

A prospective cohort study involving 100 older patients was carried out at a tertiary hospital located in Sichuan Province, China. The patients were categorised into two groups: a control group that received standard nursing care and an observation group that received tailored nursing interventions.

RESULTS

The outcomes for the observation group were considerably more favourable, featuring decreased levels of fasting blood glucose (FPG), 2-h postprandial blood glucose (2hPG) and glycosylated haemoglobin (HbA1c). Additionally, this group reported lower levels of anxiety and depression, along with a better quality of life relative to the control group. Furthermore, the occurrence of hypoglycaemia was notably less in the observation group.

CONCLUSIONS

Precision nursing significantly improves glucose management, mental health and overall quality of life, while also lowering the risk of hypoglycaemia in older patients with type 2 diabetes. This research highlighted the efficacy of precision nursing in the care of ageing adults, promoting its integration as a common approach for managing chronic illnesses.

In silico and in vitro evidence on the anti-diabetic effect of grandidentatin from Salix acmophylla Boiss

Current pharmacological treatments against diabetes do not reach optimal results in many conditions, and the attention of medicinal chemists is currently dedicated to multi-target compounds with antioxidant, anti-inflammatory and anti-diabetic properties. In this connection, medicinal plants represent valuable sources. Grandidentatin is a phenolic glycoside isolated from the leaves of Salix acmophylla Boiss., and in the current study its anti-inflammatory activity was investigated in vitro through red blood cells membrane stabilization and protein denaturation assays, and it was comparable to that of the positive control diclofenac sodium. Additionally grandidentatin was effective in the glucose uptake assay, used to assess the blood sugar lowering action, in the same concentration range of metformin. Computational studies were also enrolled to investigate the physico-chemical properties and the mechanism of action, showing that the molecule possesses the features to be defined as a "drug-like" compound, and that it may target aldose reductase as observed by docking studies.

Exploration of novel dipeptidyl peptidase-IV inhibitory tetrapeptide from walnut (Juglans sigillata) protein and its effect on diabetes-like phenotypes induced by high-sugar diet in Drosophila melanogaster

Walnut protein was hydrolyzed by different enzymes, and bromelain protein hydrolysate (W-Bromelain) showed the highest dipeptidyl peptidase-IV (DPP-IV) inhibitory activity. W-Bromelain was fractionated, and three novel tetrapeptides (LPQF, LPSF, and VPFP) were identified. In vitro evaluation showed that LPQF exhibited the highest DPP-IV inhibitory activity with an IC50 value of 99.34 μM. Evaluation of the absorption, distribution, metabolism, excretion, and toxic properties of LPQF showed high absorption and nontoxicity. Molecular docking showed that LPQF could interact with the active residues of DPP-IV through seven hydrogen bonds and five hydrophobic interactions. Molecular dynamics simulation further confirmed the stability of the LPQF-DPP-IV complex. LPQF showed high stability in in vitro gastrointestinal digestion. LPQF ameliorated the type 2 diabetes mellitus-like phenotype and reduced the degree of oxidative stress and intestinal barrier damage in a Drosophila melanogaster model of insulin resistance. Furthermore, the RNA-seq analysis showed that LPQF may exert hypoglycemic effects by regulating the Wnt, MAPK, and FoxO pathways.

Artificial intelligence based predictive tools for identifying type 2 diabetes patients at high risk of treatment Non-adherence: A systematic review

AIMS

Several Artificial Intelligence (AI) based predictive tools have been developed to predict non-adherence among patients with type 2 diabetes (T2D). Hence, this study aimed to describe and evaluate the methodological quality of AI based predictive tools for identifying T2D patients at high risk of treatment non-adherence.

METHODS

A systematic search was conducted across multiple databases including, EMBASE, Cochrane Library, MedLine, and Google Scholar search. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to assess the quality of studies. The performances of tools were assessed by Area Under the Curve (AUC), precision, recall, C-index, accuracy, sensitivity, specificity or F1 score.

RESULTS

Most studies measured predictive ability using AUC (75 %), and some only reported precision (25 %), recall (12.5 %), C-index (12.5 %), accuracy (37.5), sensitivity (12.5 %), specificity (12.5 %) or F1 score (25 %). All tools had moderate to high predictive ability (AUC > 0.70). However, only one study conducted external validation. Demographic characteristics, HbA1c, glucose monitoring data, and treatment details were typical factors used in developing tools.

CONCLUSIONS

The existing AI based tools holds significant promise for improving diabetes care. However, future studies should focus on refining the existing tools, validating in other settings, and evaluating the cost-effectiveness of AI-supported interventions.

Relationship between glycaemic control and frailty in older Chinese patients: The mediating role of diabetes distress

PURPOSE

This study aimed to investigate the effects of glycaemic control and diabetes distress on frailty in older Chinese patients with diabetes, and to explore the mediating role of diabetes distress between glycaemic control and frailty.

DESIGN

This is a descriptive, cross-sectional study. A total of 209 older patients with diabetes were recruited from a teaching hospital in Zhejiang Province. Data were collected from February to September 2022.

METHODS

A self-designed questionnaire was used to collect demographic and disease-related data. The Fried Scale and Diabetes Distress Scale were employed to assess frailty and diabetes distress, respectively The bootstrap method was used to examine the mediating effects of diabetes distress on glycaemic control and frailty. The STROBE checklist was adhered to in the reporting of this study (see details in File S1).

RESULTS

The findings indicated a positive correlation between the level of glycaemic control and frailty, as well as between diabetes distress and frailty. Furthermore, diabetes distress was found to play a complete mediating role between glycaemic control and frailty.

CONCLUSIONS

The study findings highlight the relationship between glycaemic control, diabetes distress and frailty offering a valuable reference for enhancing the management of frailty in older patients with diabetes.

RELEVANCE TO CLINICAL PRACTICE

This study emphasizes the significance of managing glycaemic control and diabetes distress in older patients with diabetes to prevent frailty, and may contribute for healthcare professionals to developing effective measures to improve the frailty of older diabetic patients in clinical settings.

PATIENT OR PUBLIC CONTRIBUTION

This study was conducted with the participation of older patients with diabetes who contributed data by completing study questionnaires and undergoing physical assessments.

In vitro and in vivo antidiabetic evaluation of new Coumarin and Chromone derivatives: Design, synthesis and molecular modeling

Diabetes mellitus is a chronic metabolic disease characterized by an imbalance in glucose homeostasis, which raises blood glucose levels. α-glucosidase enzyme hydrolyzes polysaccharides to produce glucose and since glucose is one of the primary energy sources in eukaryotes, α-glucosidase is a target for postprandial hyperglycemia regulation. The design and synthesis of new oxadiazole coumarin (5a,b and 6a,b), acryloyl chromone (10a-c) and pyrazolyl chromone (11a-c) derivatives as naturally based scaffolds are presented in this work. The new compounds were assessed as antidiabetic agents targeting α-glucosidase enzyme. With an IC50 value of 119.7 ± 4.3 μM, compound 11c demonstrated the most promising α-glucosidase inhibitory activity, superior to the standard drug acarbose (IC50 = 300.9 ± 10.9 μM). Furthermore, compared to the group of diabetic rats, the in vivo investigations demonstrated that medium and high dosages of 11c ameliorated the expression of diabetic related genes (GCK, SYT11, SNAP-25 and Ins1). According to the molecular docking results, 11c possessed the best binding energy score (-9.1 kcal/mol) within the α-glucosidase active site, outperforming the rest of the derivatives and the reference inhibitor acarbose (-8.2 kcal/mol). Lastly, an in silico molecular dynamic simulation and a pharmacokinetic study were performed on compound 11c.

Diabetes Mellitus and Associated Vascular Disease: Pathogenesis, Complications, and Evolving Treatments

Diabetes mellitus is a metabolic disorder, characterized by elevated blood sugar levels (hyperglycemia) and insulin dysregulation. This disease is associated with morbidity and mortality, including significant potential vascular complications. High levels of hyperglycemia lead to not only elevated levels of reactive oxygen species but also advanced glycation end products, which are detrimental to the vascular endothelium and reduce protective compounds such as nitric oxide and prostacyclin. This damage contributes to the development of both macrovascular and microvascular complications. The present investigation explores the pathophysiological mechanisms of diabetic vascular complications and evaluates current management strategies, including lifestyle modifications, pharmacological treatments, and emerging therapies. The review underscores the importance of ongoing progress in diabetes management and patient education to lead to optimal patient-health outcomes and quality of life for individuals with diabetes mellitus.

Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears Yields Good Clinical Outcomes for Patients With and Without Diabetes Mellitus

PURPOSE

To compare the clinical outcomes after superior capsule reconstruction (SCR) for irreparable rotator cuff tears (RCTs) in patients with and without diabetes mellitus (DM).

METHODS

Patients who underwent SCR using fascia lata autograft for irreparable RCTs between 2012 and 2020 with a minimum 2-year follow-up were divided into non-DM and DM groups. Propensity score matching was used to select controls matched for patients' characteristics. Only patients with glycosylated hemoglobin <8% were eligible. The visual analog scale for shoulder pain, American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores, and acromiohumeral distance were evaluated preoperatively and at 2 years postoperatively. Shoulder active range of motion (ROM) was evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively. Graft integrity and postoperative complications that required additional surgery were evaluated. The Wilcoxon signed-rank test and Mann-Whitney U test were used to compare continuous variables. Pearson χ2 test and Fisher exact test were used for categorical variables. The interaction between the postoperative period and ROM was analyzed by the Friedman test and Wilcoxon rank-sum test with the Holm-Sidak post hoc test.

RESULTS

We studied 154 patients (non-DM, 130; DM, 24) who underwent SCR. After matching, 21 patients were selected in each group. All clinical outcomes significantly improved at 2 years (all P < .05) in both groups. We found no significant differences in clinical outcomes and rates of patients who achieved minimal clinically important differences in visual analog scale and American Shoulder and Elbow Surgeons scores between the groups (P = .10 to ≥.999). The rates of graft tear (both 9.5%) and complications (non-DM, 4.8%; DM, 0%) were not significantly different (both P ≥ .999).

CONCLUSIONS

SCR using fascia lata autograft for irreparable RCTs yields good clinical outcomes, including ROM, in patients with and without DM. No significant differences in postoperative outcomes were observed between the 2 groups.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Produce prescription to improve health among adults with type 2 diabetes in Australia: Protocol for a randomised controlled trial

BACKGROUND

'Food is medicine' programs such as Produce Prescription (PRx) aim to integrate food-based nutrition programs into healthcare, for the prevention, management and treatment of diet-related diseases, typically for those experiencing food insecurity. However, the impact of PRx on health indicators in Australia has never been tested in a randomised trial.

OBJECTIVES

To determine the effect of PRx on blood glucose control and other health indicators in adults with type 2 diabetes experiencing hyperglycaemia and food insecurity and/or financial hardship in Australia.

METHODS

Using a parallel design randomised controlled trial, n = 224 participants will be randomised (1:1) to PRx or usual care. Over 26 weeks, the intervention group will receive a weekly delivery of fruits, vegetables, wholegrains and nuts, and up to 3 sessions with an accredited dietitian. Controls will receive usual care. The primary outcome is change in mean HbA1c over 26 weeks, comparing the intervention and control group. Secondary outcomes include between-group differences at 26 weeks in change in blood pressure, body weight, blood lipids, food and nutrition insecurity, person-reported outcome measures, medication use, and diet quality. Implementation outcomes assessed will include feasibility, acceptability, scalability and cost effectiveness.

DISCUSSION

This Australia-first PRx trial will provide novel and rigorous data for an intervention that may be feasible to improve health and health equity as part of the Australian healthcare system. We anticipate PRx will lead to a clinically meaningful reduction in HbA1c, contribute to improved health equity and long-term health benefits for adults with type 2 diabetes and food insecurity.

HG043, a potent thienopyrimidine GPR119 agonist, demonstrates enhanced anti-diabetic and anti-obesity effects in preclinical models

GPR119 is a promising therapeutic target for type 2 diabetes because of its role in enhancing glucose-stimulated insulin secretion and GLP-1 release. We investigated the anti-diabetic and anti-obesity effects of HG043, a novel and potent thienopyrimidine-based GPR119 agonist, by comparing its pharmacological activities to those of MBX-2982 (a known GPR119 agonist) and sibutramine (an appetite suppressant) in both in vitro and in vivo models. HG043 exhibited potent agonistic activity for human GPR119 and demonstrated enhanced efficacy compared to MBX-2982 in stimulating incretin secretion in pancreatic β-cell lines. Single and long-term treatment with HG043 resulted in significant improvements in diabetic and obesity parameters compared to both MBX-2982 and sibutramine in both healthy and disease models. Furthermore, HG043 demonstrated synergistic glucose-lowering effects when combined with metformin or sitagliptin. These findings suggest that HG043 may serve as a promising therapeutic option for the treatment of type 2 diabetes with obesity patients.

DEXAMETHASONE INTRAVITREAL INJECTION IN DIABETIC PATIENTS UNDERGOING CATARACT SURGERY: An Updated Literature Review

PURPOSE

This literature review synthetizes current evidence on the timing and efficacy of dexamethasone intravitreal injections for diabetic macular edema in patients undergoing cataract surgery, particularly phacoemulsification, to determine the optimal timing for improved outcome.

METHODS

A systematic review of the literature was conducted across key databases to identify peer-reviewed studies, clinical trials, and meta-analyses addressing dexamethasone injections administered pre-, intra-, and postoperatively for diabetic macular edema in the context of cataract surgery. Studies were selected based on relevance to timing, visual outcomes, and inflammation control, with a focus on comparative efficacy.

RESULTS

The findings suggest that timely dexamethasone injections can substantially reduce inflammation and enhance visual recovery for patients with diabetic macular edema undergoing cataract surgery. Studies indicate that preoperative injections may effectively dampen the inflammatory response triggered by surgical trauma, potentially preserving retinal integrity, whereas intraoperative and postoperative administrations contribute to sustained anti-inflammatory effects during the recovery phase. Comparative studies also highlight dexamethasone's advantages over other anti-inflammatory treatments, such as NSAIDs, particularly in preventing cystoid macular edema. Notably, there was considerable variation in dosage and timing across studies, underscoring the need for standardized treatment protocols.

CONCLUSION

Dexamethasone intravitreal injections offer a valuable intervention for managing diabetic macular edema in diabetic patients undergoing cataract surgery, with optimal timing playing a crucial role in maximizing therapeutic benefits. Preoperative injections appear to be particularly beneficial in reducing the risk of postoperative inflammatory complications. Further research should focus on developing comprehensive guidelines for timing and dosage to standardize treatment and improve patient outcomes in this high-risk population.

Predictors of diabetes remission after bariatric surgery in patients with type 2 diabetes mellitus duration ≥ 10 years: A retrospective cohort study

OBJECTIVE

Patients with type 2 diabetes mellitus (T2DM) duration ≥ 10 years often have significant β-cell failure. This study aimed to explore predictors of diabetes remission after bariatric surgery in these patients.

METHODS

Patients with T2DM duration ≥ 10 years who underwent bariatric surgery were retrospective included and followed up. Remission of diabetes was defined as an HbA1c < 6.5 % (48 mmol/mol) at least 3 months after the discontinuation of hypoglycemic drugs. An intravenous glucose tolerance test (IVGTT) was performed in patients with diabetes remission.

RESULTS

203 patients with T2DM duration ≥ 10 years were included, 59.6 % were treated with insulin before bariatric surgery. One-, two- and three-year post-surgery remission rates were 65.6 %, 53.8 % and 41.9 %, respectively (∼10 % decrease/year). Cox regression analysis revealed that the odds of remission at one-year post-bariatric surgery were most strongly associated with β-cell function (HR 1.20, 95 % CI 1.03-1.40) and percentage of total weight loss (%TWL) (HR 1.04, 95 % CI 1.01-1.07). The first-phase insulin secretion peak was approximately 5-8 folds of the fasting insulin level in 50 patients with diabetes remission.

CONCLUSIONS

%TWL and β-cell function are significantly associated with diabetes remission after bariatric surgery in long-duration T2DM patients, with restored first-phase insulin secretion still observed.

Dynamic ALBI score and FIB-4 index trends to predict complications after resection of hepatocellular carcinoma: A K-means clustering approach

BACKGROUND

Severe postoperative complications still occur following hepatectomy among patients with hepatocellular carcinoma (HCC). There is a need to identify high-risk patients for severe complications to enhance patient safety. We sought to evaluate the combined impact of pre- and postoperative albumin-bilirubin (ALBI) score and Fibrosis-4 (FIB-4) index trends to predict severe complications after HCC resection.

METHOD

Patients with HCC undergoing curative-intent hepatectomy (2000-2023) were identified from an international, multi-institutional database. The cohort was divided into training (n = 439) and testing (n = 651) sets. ALBI score and FIB-4 index trends from preoperative to postoperative days 1, 3, and 5 were used for K-means clustering (K = 3). A logistic regression model was developed using the training set, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC) in both cohorts.

RESULTS

Severe complications (Clavien-Dindo Grade ≥ IIIa) occurred in 118 patients (10.8 %); 43 (9.8 %) in training and 75 (11.5 %) in testing set (p = 0.42). K-means clustering identified three groups: Cluster1 (low), Cluster2 (intermediate), and Cluster3 (high), which was associated with a progressively increasing risk of complications (p < 0.01). On multivariable logistic regression, patients in ALBI Cluster1 had 76 % decreased odds (odds ratio[OR] 0.24, 95 % CI 0.07-0.83, p = 0.02) of postoperative complications relative to Cluster3 patients. Individuals categorized into FIB-4 Cluster1 had 85 % decreased odds (OR 0.15, 95 % CI 0.02-1.24, p = 0.07) versus patients in FIB-4 Cluster3. A new prediction model incorporating ALBI and FIB-4 index clusters achieved an AUC of 0.71, outperforming models based on preoperative data. A tool was made available at https://nm49jf-miho-akabane.shinyapps.io/HCC_ALBI/.

CONCLUSION

A dynamic ALBI score and FIB-4 index trend tool improved risk stratification of patients undergoing resection of HCC relative to severe complications.

Psyllium husk powder enhances the management of type 2 diabetes by modulating gut microbiota and their metabolic products

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder characterized by hyperglycemia and insulin resistance. Plantain shell powder (PHP) serves as a high-quality source of dietary fiber, widely utilized in food additives and pharmaceutical applications. In this study, we investigated the hypoglycemic activity and underlying mechanisms of PHP by examining its effects on intestinal microbiota and metabolism in T2DM mice induced by a high-fat diet and streptozotocin (STZ). Our findings indicate that PHP significantly enhances blood glucose homeostasis and insulin sensitivity, reduces organ damage, and regulates blood lipid levels as well as short-chain fatty acid concentrations; notably, higher doses of PHP yielded optimal results. In addition, PHP can regulate the ratio of Bacteroidota to Firmicutes and increase the relative abundance of beneficial bacteria such as Bacteroidales, Muribaculaceae, and Parabacteroides. Furthermore, PHP enhances the enrichment of key metabolic pathways, including α-linolenic acid metabolism, monobactam biosynthesis, and PPAR signaling pathways, thereby promoting the production of beneficial metabolites. Complex interactions exist among these beneficial bacteria and metabolic pathways that are associated with improved metabolic function, regulation of glucose homeostasis, enhancement of insulin sensitivity, and reduction of inflammation. Our study demonstrates that PHP can ameliorate T2DM by reversing alterations in gut microbiota and metabolic profiles caused by T2DM while promoting the regulation of beneficial microbial populations.

A nomograph model for predicting the risk of diabetes nephropathy

OBJECTIVE

Using machine learning to construct a prediction model for the risk of diabetes kidney disease (DKD) in the American diabetes population and evaluate its effect.

METHODS

First, a dataset of five cycles from 2009 to 2018 was obtained from the National Health and Nutrition Examination Survey (NHANES) database, weighted and then standardized (with the study population in the United States), and the data were processed and randomly grouped using R software. Next, variable selection for DKD patients was conducted using Lasso regression, two-way stepwise iterative regression, and random forest methods. A nomogram model was constructed for the risk prediction of DKD. Finally, the predictive performance, predictive value, calibration, and clinical effectiveness of the model were evaluated through the receipt of ROC curves, Brier score values, calibration curves (CC), and decision curves (DCA). In addition, we will visualize it.

RESULTS

A total of 4371 participants were selected and included in this study. Patients were randomly divided into a training set (n = 3066 people) and a validation set (n = 1305 people) in a 7:3 ratio. Using machine learning algorithms and drawing Venn diagrams, five variables significantly correlated with DKD risk were identified, namely Age, Hba1c, ALB, Scr, and TP. The area under the ROC curve (AUC) of the training set evaluation index for this model is 0.735, the net benefit rate of DCA is 2%-90%, and the Brier score is 0.172. The area under the ROC curve of the validation set (AUC) is 0.717, and the DCA curve shows a good net benefit rate. The Brier score is 0.177, and the calibration curve results of the validation set and training set are almost consistent.

CONCLUSION

The DKD risk nomogram model constructed in this study has good predictive performance, which helps to evaluate the risk of DKD as early as possible in clinical practice and formulate relevant intervention and treatment measures. The visual result can be used by doctors or individuals to estimate the probability of DKD risk, as a reference to help make better treatment decisions.

Tea drinking effectively improves symptoms of diabetes and prevents hepatorenal damage in mice

Since type 2 diabetic patients often develop resistance to metformin as the progresses of diabetes, and almost all type 1 diabetic patients need receive insulin injection for hyperglycemia control. It is important to explore novel strategies with different mechanisms for diabetes management. Glucose-induced osmotic diuresis, known as polyuria, is the first clinical symptom in severe type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM). Drinking green tea or black tea effectively mitigates diabetic symptoms including polyuria, polydipsia, polyphagia and hyperglycemia in db/db mice via regulating renal aquaporin 2 and urine transporter A1 (UT-A1), in favor renal water reabsorption. This unique mechanism of action of tea could be useful for the treatment of diabetes in humans. In this study, we found that drinking Large-leaf yellow tea (LYT) for 5 weeks effectively ameliorated polyuria, polydipsia, polyphagia, hyperglycemia and excessive body weight gain, as well as upregulated renal water reabsorption associated proteins, including protein kinase C-alpha (PKC-α), membrane PKC-α and glycosylated UT-A1 in db/db mice. Four-days experiment were also confirmed the rapidly response of these proteins in favor renal water reabsorption and the amelioration of diabetic symptoms by LYT. We also found that green tea drinking effectively mitigated symptoms of diabetes in a mouse model for T1DM via upregulating these proteins. Moreover, green tea drinking prevented hepatorenal damage caused by hyperglycemia as suggested by the reduced levels of aspartate aminotransferase and creatinine in serum and the enhanced antioxidant defense system in liver and kidney. These results suggest the possible application of tea or tea constitutes in the clinical treatment of severe T2DM and T1DM, and the kidney is the target organ.

Green diabetes project: A comprehensive characterization of sustainable diabetes practices

INTRODUCTION

Technological advancements in diabetes mellitus (DM) management have empowered individuals for self-care. However, the widespread use of disposable devices has contributed to significant waste generation. This study aimed to assess patients' knowledge of sustainability in DM management and identify factors associated with varying levels of environmental concern.

MATERIALS AND METHODS

A cross-sectional observational study was conducted using a six-question survey to patients with DM under insulin therapy. Participants were categorized into three groups based on their level of concern for sustainability: absent, slight and high concern.

RESULTS

Among 285 participants, 11.2 %, 56.9 % and 31.9 % were respectively classified as having absent, slight and high concern. Most (62.1 %) had never discussed environmental sustainability with a healthcare professional, and 183 (64.3 %) reported improper disposal of sharps (general or plastic waste). No significant differences were found between sustainability concern and DM type, glycemic control, or age. Independent predictors of higher level of concern were female gender (p = 0.006) and prior discussion of sustainability during consultations (p < 0.001).

CONCLUSIONS

Waste from DM management poses a significant public health and environmental challenge. Despite widespread concern, awareness and proper disposal practices remain inadequate. Healthcare professionals play a pivotal role raising awareness about the issue.

Piperazine ferulate impact on diabetes-induced testicular dysfunction: unveiling genetic insights, MAPK/ERK/JNK pathways, and TGF-β signaling

Diabetic testicular dysfunction (DTD) poses a significant threat to male reproductive health. This study delves into the potential of piperazine ferulate (PF), a natural phenolic compound, in alleviating DTD and sheds light on its underlying mechanisms in rats. Animals were divided into the control, PF, diabetic, and diabetic plus PF groups. Diabetes was induced in rats with a single intraperitoneal (i.p.) injection of streptozotocin (STZ) at 50 mg/kg. PF was administered at 50 mg/kg/day via i.p. injection for four weeks. Significant changes in sexual behavior were observed in diabetic rats, which additionally revealed lower serum levels of testosterone, FSH, and LH. The abnormalities in sperm count, viability, motility, and morphology occurred along with the demonstrated suppression of genes and protein expression related to spermatogenesis. Atrophy of the seminiferous tubules and extensive degeneration and necrosis of the germ and Leydig cells were highlighted by histopathological examination. The testicular function of diabetic rats was significantly improved after PF administration, evidenced by normalized testicular histology, increased testosterone levels, and enhanced sperm quality. In addition to reducing inflammatory cytokines, COX2, and NF-κB expression, pf administration elevated the antioxidant levels and Nrf2/HO-1 expression. Furthermore, key signaling pathways involved in testicular degeneration are regulated by PF. It promoted cell survival and tissue repair by activating the protective TGF-β signaling pathway and attenuating the MAPK/ERK/JNK signaling cascade, which in turn reduced inflammation and apoptosis. PF suppressed the expression of INSL3, SPHK1, CD62E, ANGPTL2, and miR-148a-5p, while increasing the expression of testicular genes like HSD17B1, DAZL, and S1P, addressing DTD. This study highlights the potential of PF to restore testicular function and fertility in diabetic males by modulating genetic and signaling pathways.

Metabolomic network reveals novel biomarkers for type 2 diabetes mellitus in the UK Biobank study

AIMS

To identify hub metabolic biomarkers that constructively shape the type 2 diabetes mellitus (T2DM) risk network.

MATERIALS AND METHODS

We analysed data from 98 831 UK Biobank participants, confirming T2DM diagnoses via medical records and International Classification of Diseases codes. Totally 168 circulating metabolites were quantified by nuclear magnetic resonance at baseline. Metabolome-wide association studies with Cox proportional hazards models were performed to identify statistically significant metabolites. Network analysis was applied to compute topological attributes (degree, betweenness, closeness and eigencentrality) and to detect small-world features (high clustering, short path lengths). Identified metabolites were used with XGBoost models to assess risk prediction performance.

RESULTS

Over a median 12-year follow-up, 114 metabolites were significantly associated with T2DM risk and clustered into three distinct small-world modules. Total triglycerides and large high-density lipoprotein (HDL) cholesterol emerged as the pivotal biomarkers in the 'risk' and 'protective' modules, respectively, as evidenced by their high eigencentrality. Moreover, total branched-chain amino acids (BCAAs) exhibited small-world network characteristics exclusively in pre-T2DM individuals, suggesting them as a potent early indicators. GlycA demonstrated high closeness centrality in females, implying a female-specific risk biomarker.

CONCLUSIONS

By constructing a metabolic network that captures the complex interrelationships among circulating metabolites, our study identified total triglycerides and large HDL cholesterol as central hubs in the T2DM risk metabolome network. BCAA and GlycA emerged as alarm indicators for pre-T2DM individuals and females, respectively. Network analysis not only elucidates the topological functional roles of biomarkers but also addresses the limitations of false positives and collinearity in single-metabolite studies, offering insights for metabolic pathway research and precision interventions.

Genome-wide association study identifying novel risk variants associated with glycaemic traits in the continental African AWI-Gen cohort

AIMS/HYPOTHESIS

Glycaemic traits such as high fasting glucose levels and insulin resistance are positively associated with the risk of type 2 diabetes and other cardiometabolic diseases. Genetic association studies have identified hundreds of associations for each glycaemic trait, yet very few studies have involved continental African populations. We report the results of genome-wide association studies (GWASs) in a pan-African cohort for four glycaemic traits, namely fasting glucose, fasting insulin, insulin resistance (HOMA-IR) and beta cell function (HOMA-B), which are quantitative variables that affect the risk of developing type 2 diabetes.

METHODS

GWASs for the four traits were conducted in approximately 10,000 individuals from the Africa Wits-INDEPTH Partnership for Genomics Studies (AWI-Gen) cohort, with participants from Burkina Faso, Ghana, Kenya and South Africa. Association testing was performed using linear mixed models implemented in BOLT-LMM, with age, sex, BMI and principal components as covariates. Replication, fine mapping and functional annotation were performed using standard approaches.

RESULTS

We identified a novel signal (rs574173815) in the intron of the ankyrin repeat domain 33B (ANKRD33B) gene associated with fasting glucose, and a novel signal (rs114029796) in the intronic region of the WD repeat domain 7 (WDR7) gene associated with fasting insulin. SNPs in WDR7 have been shown to be associated with type 2 diabetes. A variant (rs74806991) in the intron of ADAM metallopeptidase with thrombospondin type 1 motif 16 (ADAMTS16) and another variant (rs6506934) in the β-1,4-galactosyltransferase 6 gene (B4GALT6) are associated with HOMA-IR. Both ADAMTS16 and B4GALT6 are implicated in the development of type 2 diabetes. In addition, our study replicated several well-established fasting glucose signals in the GCK-YTK6, SLC2A2 and THORLNC gene regions.

CONCLUSIONS/INTERPRETATION

Our findings highlight the importance of performing GWASs for glycaemic traits in under-represented populations, especially continental African populations, to discover novel associated variants and broaden our knowledge of the genetic aetiology of glycaemic traits. The limited replication of well-known signals in this study hints at the possibility of a unique genetic architecture of these traits in African populations.

DATA AVAILABILITY

The dataset used in this study is available in the European Genome-Phenome Archive (EGA) database ( https://ega-archive.org/ ) under study accession code EGAS00001002482. The phenotype dataset accession code is EGAD00001006425 and the genotype dataset accession code is EGAD00010001996. The availability of these datasets is subject to controlled access by the Data and Biospecimen Access Committee of the H3Africa Consortium. GWAS summary statistics are accessible through the NHGRI-EBI GWAS Catalog ( https://www.ebi.ac.uk/gwas/ ).

Diabetes care cascade in Bangladesh: Identifying gaps and social determinants

AIMS

Precise and up-to-date data regarding the care gaps is essential to prioritize interventions and guide efficient resource allocation for management of diabetes in Bangladesh. The aim of the present study was to evaluate the diabetes care cascade and identify the social determinants influencing retention at each stage of care in Bangladesh.

METHODS

Data was extracted from Bangladesh Demographic and Health Survey (BDHS), 2022. Type 2 diabetes mellitus (T2DM) was defined as fasting blood glucose ≥7.0 mmol/L or a diagnosis by a healthcare provider. The care cascade comprised three stages: (i) diagnosis, (ii) receiving treatment, and (iii) glycemic control. Logistic regression and Andersen's Behavioral Model were used in the study.

RESULTS

Among 2,403 individuals with T2DM, 33.5 % were diagnosed, 24.6 % received treatment, and 9.6 % achieved glycemic control. Losses occurred at diagnosis (66.5 %), treatment (9 %), and control (19.6 %). Women, individuals with higher education, and those in the wealthiest quintile had higher odds of diagnosis. Receiving treatment was significantly associated with wealth and body mass index.

CONCLUSIONS

Significant gaps were observed at all stages of diabetes care cascade, particularly diagnosis. Strengthening screening, ensuring access to affordable treatment, and improving adherence are essential to enhance glycemic control and mitigating the diabetes burden.

Efficient Screening of α-Glucosidase Inhibitory Peptides From Seahorse Through the Innovative Joint Technique: De Novo Sequencing and Parallel SPOT Synthesis

In this research, de novo sequencing was innovatively combined with parallel SPOT synthesis for the efficient screening of biological peptides from TCM or seafood: seahorse with synergistic antioxidant and α-glucosidase inhibitory activities, which is promising for postprandial hyperglycemia management. Gastrointestinal digestion mimic and de novo sequencing were sequentially carried out to predict new peptides from seahorse. After bioinformatic analysis using Peptide Ranker, 82 peptides were eventually synthesized by efficient parallel SPOT technique, and Ser-Val-Try-Leu-Gly-Gly-Ser-Leu-Leu (SVWLGGSLL) was screened out as the most efficient peptide with synergistic antioxidant (DPPH radical scavenging activity of 77%) and α-glucosidase inhibitory activity (IC50 = 0.36 mM). Molecular docking was further carried out to illustrate the favorable ligand-receptor interactions formed such as hydrogen bonding and van der Waals force with low binding free energy of -7.8 kcal/mol. Moreover, pharmacokinetic analysis indicated that SVWLGGSLL was unrelated to toxicity with the advantage of gastrointestinal stability.

Knowledge-Behavior Relationships and Technology Adoption Among Patients With Diabetes: A Mixed-Methods Analysis of Smart Foot Care Technology

BACKGROUND

Although recent systematic reviews indicate low adherence to foot care practices among patients with type 2 diabetes compared to other self-management behaviors, smart healthcare technologies offer potential solutions for improving foot care management. The smart diabetic foot screening system represents an innovative approach to diabetic foot care. However, the factors influencing its adoption, particularly the relationship between knowledge, behavior, and technology acceptance, remain poorly understood.

METHODS

A mixed-methods design was employed, integrating quantitative and qualitative data. Quantitative data were collected from 80 patients with type 2 diabetes using validated instruments: the foot care knowledge questionnaire, diabetic foot self-management behavior scale, and the unified theory of acceptance and use of technology questionnaire. Pearson correlation and regression analyses examined relationships between knowledge, behavior, and technology adoption intention. In-depth, semistructured interviews with 20 participants explored adoption factors. Thematic analysis was conducted on qualitative data.

RESULTS

Despite high levels of foot care knowledge (86.2% correct response rate), actual self-management behaviors remained suboptimal, with a modest correlation between knowledge and behavior (r = 0.31 and p < 0.01). Regression analysis identified attitude and facilitating conditions as significant predictors of smart system adoption intention, explaining 57% of the variance. Qualitative analysis revealed three main themes: technology acceptance perceptions, implementation support system, and self-management patterns, highlighting the complex interplay between knowledge, attitudes, and behavioral factors.

CONCLUSIONS

This study reveals that despite improved knowledge levels compared to previous decades, the knowledge-behavior gap in diabetic foot care persists. The findings suggest that successful implementations of smart healthcare technologies require addressing both attitudinal factors and facilitating conditions, rather than focusing solely on knowledge enhancement. These insights contribute to understanding technology adoption in chronic disease self-management and inform the development of more effective implementation strategies.