Type 2 diabetes: principles of pathogenesis and therapy

DPP-IV and FAS inhibitory peptides: therapeutic alternative against diabesity

Diabesity is a modern epidemic that indicates a strong association between obesity and diabetes. Key enzymes have been identified in the development and progression of both diseases, DPP-IV in glucose uptake and FAS in fatty acid synthesis. In both cases, the molecular mechanisms of how each one acts separately have been described, and which are the key inhibitory drugs and molecules for each one. However, although it is known that there is an association between both clinically and molecularly, the mechanism has not been elucidated; therefore, this review focuses on proposing a mechanism of convergence of DPP-IV and FAS in diabesity, and the possible mode of action in which bioactive peptides obtained from plant and animal sources can inhibit these two enzymes in a similar way as drugs do.

Impact of diabetes mellitus type two on incidence and progression of Parkinson's disease: a systematic review of longitudinal patient cohorts

Parkinson's disease (PD) is a chronic neurodegenerative disease of the elderly. Patients suffer from progressive motor and non-motor symptoms. Further, PD patients often present geriatric features like multimorbidity and polypharmacotherapy. A frequent comorbidity of PD patients is diabetes mellitus type two (T2DM). In the last decade growing evidence emerged on the impact of T2DM on PD. Of the present review was to analyze the impact of T2DM on PD incidence and progression in patient cohorts. A systematic review of the literature was performed via PubMed and Google Scholar. Studies on longitudinal PD patient cohorts with at least 10 patients per group were included. The diabetic state of the patient had to be determined. In total, 15 studies were analyzed for this review. According to most of the included studies T2DM increases the risk of developing PD significantly. Disease progression is augmented by T2DM both for motor and cognitive impairments. Some studies also point out a correlation of motor worsening and diabetic status measured by the serum HbA1c level. In relation to biomarkers, PD patients with diabetes have higher neurofilament light chain and Tau level but lower Amyloid beta level. T2DM seems to be a risk factor for the development and progression of PD. PD patients should be screened for T2DM and treatment should be initiated promptly. There is still a lack of knowledge about the molecular mechanisms leading to interactions of these diseases.

Patient-Reported Experience and Outcome Measures of Patients Living With Diabetes: Associations Among Different Factors

OBJECTIVES

This study aimed to explore the association between demographic characteristics and patient-reported experiences (PREs) and patient-reported outcomes (PROs) in individuals living with diabetes, using the Swedish National Diabetes Register questionnaire. The study sought to understand how baseline attributes such as age, gender, and education affect patients' experiences and management of diabetes.

METHODS

We used a cross-sectional survey approach with 544 patients diagnosed as having type 1 or type 2 diabetes mellitus at the University of Pécs. An exploratory factor analysis was conducted to identify the key dimensions of diabetes-related experiences, followed by a confirmatory factor analysis to validate these dimensions. Regression analysis was used to examine the impact of demographic variables on the derived factors.

RESULTS

The factor analysis revealed 5 key dimensions: diabetes-related obstacles, diabetes coping mechanisms, flexibility of healthcare providers, general well-being, and social support. Regression analysis indicated that older patients perceived fewer obstacles and demonstrated better coping mechanisms. Higher educational levels were significantly associated with greater satisfaction with healthcare provider flexibility. Females reported poorer overall well-being but better coping mechanisms than males.

CONCLUSIONS

The findings suggest that demographic characteristics significantly influence patient experiences and outcomes in diabetes care. Tailored interventions that address specific demographic needs can enhance patient-centered care and improve management strategies. These insights underscore the importance of considering patient diversity in developing healthcare interventions and underscore the utility of the Swedish National Diabetes Register questionnaire in assessing diverse patient experiences in diabetes management.

Association Among Vitamin D Receptor Gene Polymorphisms, Metabolic Control, and Inflammatory Markers in Type 2 Diabetes: A Systematic Review and Meta-Analysis

CONTEXT

Single-nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) contribute to inadequate metabolic profiles in individuals with type 2 diabetes mellitus (T2DM).

OBJECTIVE

We sought to elucidate the relationship among SNPs in the VDR and markers for glycemic control, lipid profile, and inflammation in individuals with T2DM.

DATA SOURCES

We performed a systematic search in the MEDLINE (via PubMed), EMBASE, and SCOPUS databases in July 2021 and updated the search in October 2023.

DATA EXTRACTION

6 observational studies were selected from the databases, and 1 study was included after checking the reference list. Two authors independently completed the selection and data extraction of studies and population characteristics, the prevalence of SNPs in the VDR, genotyping methods, and laboratory findings, and performed summary statistics of the results.

DATA ANALYSIS

The meta-analyses were performed on 5 studies including 1198 adults with T2DM. The duration of the diabetes diagnosis ranged from 5.0 to 14.7 years. A random-effects model was used to pool the results using a 2-tailed (P < .05). Effect sizes were reported as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Four SNPs in the VDR were identified (Fokl, BsmI, Taql, and Apal) by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The Fokl SNP was identified in 5 studies and associated with a higher percentage of glycated hemoglobin (HbA1c%) (SMD,  0.41 [95% CI, 0.15-0.67]). The Bsml in 4 studies was associated with higher triacylglycerol (SMD, 0.21 [95% CI, 0.03-0.38]). The Taql SNP was identified in 2 studies and did not show any associations, and the Apal SNP was identified in only 1 study and was not analysed in the meta-analysis.

CONCLUSIONS

Although the studies identified 4 SNPs in the VDR, the results of the meta-analysis allowed us to infer only the association of the SNPs Fokl and Bsml with increased %HbA1c and triacylglycerol levels, respectively, in individuals with T2DM.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021268152.

Mercuric Chloride Aggravates Hyperglycemia-Induced Anxiety and Depressive-Like Behaviors in Type 2 Diabetic Rats: Breakdown of the Antioxidant Defense System

Introduction Type 2 diabetes mellitus (T2DM) is a global health problem frequently associated with biochemical disturbance and also, with a range of mental health disorders including such as anxiety and depression. Whereas, mercury chloride (HgCl₂) is a common environmental pollutant, which is neurotoxic and induces oxidative stress, especially in metabolic disorders like diabetes. The purpose of this investigation is to evaluate the interaction between hyperglycemia-induced oxidative stress and HgCl₂ toxicity and to assess their far-reaching effect spotlighted on biochemical and behavioral disturbances. By analyzing key oxidative stress markers and anxiety- and depression-like behaviors. Experimental design was carried out as follow: control group, HgCl₂-treated group, diabetic group and diabetic HgCl₂-treated group. Type 2 diabetes was induced in a diabetic model via streptozotocin (STZ) and nicotinamide (NA) injections. For the HgCl₂-exposed groups, rats were administered 0.375 mg/kg/day of HgCl₂ orally for 45 consecutive days. Additionally, behavioral tests were performed to examine anxiety- and depression-like behaviors, and hematological, biochemical, oxidative stress markers were assessed to evaluate systemic and neurotoxic effects. The results showed significant increases in fasting blood glucose levels in diabetic and HgCl₂-treated diabetic groups compared to controls (p < 0.001). Body weight significantly decreased in all treated groups (p < 0.05), with the greatest reduction observed in the HgCl₂-treated diabetic group. Behavioral analysis revealed heightened anxiety and depression-like behaviors, particularly in the HgCl₂-treated diabetic group (p < 0.05). Biochemical assessments indicated significant disruptions in lipid profiles and hepatic and renal markers, with pronounced effects in HgCl₂-treated diabetic rats (p < 0.05). Oxidative stress markers demonstrated elevated malondialdehyde and nitric oxide levels in the liver, hippocampus, and prefrontal cortex, paired with diminished antioxidant defences, including catalase and superoxide dismutase activities (p < 0.05). These findings underscore the synergistic role of hyperglycemia and HgCl₂ exposure in amplifying oxidative damage and emotional disturbances, suggesting a critical interplay between metabolic and neurotoxic pathways.

TLR4 mediates lipotoxic β-cell dysfunction by inhibiting the TMEM24/PI3K/AKT pathway

Immune imbalance is the core pathophysiological mechanism of the deterioration of β-cell function driven by lipid metabolism disorders. Toll-like receptor 4 (TLR4) inflammatory signaling is a key pathway that mediates lipotoxic injury in β-cells, but the underlying mechanism needs to be further elucidated. Transmembrane protein 24 (TMEM24) is a key transporter that regulates pulsatile insulin secretion, but its pathophysiology in lipotoxicity remains unclear. In this study, we investigate whether TLR4-mediated lipotoxicity is affected by the inhibition of TMEM24 expression. The PPI network shows that TLR4 is associated with both insulin secretion and ER stress proteins in islets from obese rats. Using in vitro lipotoxic β-cell models, we found that TMEM24 is the target signal of palmitic acid (PA)-induced insulin secretion impairment in islet β-cells, and TLR4 plays a mediating role in this process. Mechanistically, TLR4 mediates lipotoxicity by binding to TMEM24 and downregulating its protein expression to suppress PI3K/AKT signaling, leading to β-cell dysfunction. TLR4 knockout ameliorates islet function impairment through TMEM24/PI3K/AKT signaling in HFD-induced obese rats. Taken together, our results show that TLR4 mediates lipotoxicity in islet β-cells by inhibiting the TMEM24/PI3K/AKT pathway, and the mechanism of TLR4-mediated lipotoxicity is elucidated from the perspective of insulin vesicular secretion.

Redox signaling in the pancreas in health and disease

This review addresses oxidative stress and redox signaling in the pancreas under healthy physiological conditions as well as in acute pancreatitis, chronic pancreatitis, pancreatic cancer, and diabetes. Physiological redox homeodynamics is maintained mainly by NRF2/KEAP1, NF-κB, protein tyrosine phosphatases, peroxisome proliferator-activated receptor-γ coactivator 1α (PGC1α), and normal autophagy. Depletion of reduced glutathione (GSH) in the pancreas is a hallmark of acute pancreatitis and is initially accompanied by disulfide stress, which is characterized by protein cysteinylation without increased glutathione oxidation. A cross talk between oxidative stress, MAPKs, and NF-κB amplifies the inflammatory cascade, with PP2A and PGC1α as key redox regulatory nodes. In acute pancreatitis, nitration of cystathionine-β synthase causes blockade of the transsulfuration pathway leading to increased homocysteine levels, whereas p53 triggers necroptosis in the pancreas through downregulation of sulfiredoxin, PGC1α, and peroxiredoxin 3. Chronic pancreatitis exhibits oxidative distress mediated by NADPH oxidase 1 and/or CYP2E1, which promotes cell death, fibrosis, and inflammation. Oxidative stress cooperates with mutant KRAS to initiate and promote pancreatic adenocarcinoma. Mutant KRAS increases mitochondrial reactive oxygen species (ROS), which trigger acinar-to-ductal metaplasia and progression to pancreatic intraepithelial neoplasia (PanIN). ROS are maintained at a sufficient level to promote cell proliferation, while avoiding cell death or senescence through formation of NADPH and GSH and activation of NRF2, HIF-1/2α, and CREB. Redox signaling also plays a fundamental role in differentiation, proliferation, and insulin secretion of β-cells. However, ROS overproduction promotes β-cell dysfunction and apoptosis in type 1 and type 2 diabetes.

Relationship between fasted insulin levels and mfERG implicit times in patients with type 2 diabetes and prediabetes

PURPOSE

It is established that the mfERG is altered in type 2 diabetes (T2DM). The P1 implicit time (IT) becomes delayed even before retinopathy is present. This has been associated with the duration of damage to retinal cells from hyperglycemia. However, patients withT2DM and prediabetes also have changes in insulin values. The impact of elevated or reduced blood insulin on retinal function using mfERG has not been explored. Here we evaluate the the relationship between blood insulin levels and mfERG parameters in patients with and without T2DM and prediabetes.

METHODS

66 subjects (age 50.4 ± 10.5) were included in this cross-sectional study. Subjects were asked if fasted upon presentation. HbA1c was taken and used to categorize subjects into groups as controls (< 5.7%), prediabetes (5.7-6.4%) or T2DM (> 6.4% or previously diagnosed). Insulin was collected from finger stick and was analyzed via ELISA. A mfERG (103 hexagons) was performed (VERIS 6.3) with 4-min m-sequence at near 100% contrast. Data was evaluated for ring hexagons, as well as averaged together for P1 IT. No subjects had retinopathy or were taking exogenous insulin. Data were evaluated through ANOVA for comparisons of groups and as well as with multivariate regression analysis.

RESULTS

There was a strong positive correlation between fasting blood glucose and mfERG IT (P < 0.002) in all subjects. There was also a negative relationship between averaged mfERG IT and fasted blood insulin concentration (P = 0.035) after age, T2DM duration and blood glucose were controlled for in a multivariate regression. There was a significant difference in mfERG IT between the groups (p = 0.008) with T2DM exhibiting the longest IT, but no difference between controls and prediabetes. There was no difference in insulin levels between groups, nor were there any significant relationships between insulin and mfERG IT for those who were not fasted.

CONCLUSIONS

Reduced blood insulin is associated with IT delays under overnight fasted conditions, which suggests a lack of insulin may impair retinal function. Future work should examine these associations of retinal function with insulin under well controlled and standardized postprandial conditions such as during oral glucose tolerance testing.

The role of endoplasmic reticulum stress in type 2 diabetes mellitus mechanisms and impact on islet function

Type 2 diabetes mellitus (T2DM) is a globally prevalent metabolic disorder characterized by insulin resistance and dysfunction of islet cells. Endoplasmic reticulum (ER) stress plays a crucial role in the pathogenesis and progression of T2DM, especially in the function and survival of β-cells. β-cells are particularly sensitive to ER stress because they require substantial insulin synthesis and secretion energy. In the early stages of T2DM, the increased demand for insulin exacerbates β-cell ER stress. Although the unfolded protein response (UPR) can temporarily alleviate this stress, prolonged or excessive stress leads to pancreatic cell dysfunction and apoptosis, resulting in insufficient insulin secretion. This review explores the mechanisms of ER stress in T2DM, particularly its impact on islet cells. We discuss how ER stress activates UPR signaling pathways to regulate protein folding and degradation, but when stress becomes excessive, these pathways may contribute to β-cell death. A deeper understanding of how ER stress impacts islet cells could lead to the development of novel T2DM treatment strategies aimed at improving islet function and slowing disease progression.

Plant Derived Exosome-Like Nanoparticles and Their Therapeutic Applications in Glucolipid Metabolism Diseases

Plant derived exosome-like nanoparticles (PELNs) are membrane structures isolated from different plants, which encapsulate many active substances such as proteins, lipids, and nucleic acids, which exert a substantial influence on many physiological processes such as plant growth and development, self-defense, and tissue repair. Compared with synthetic nanoparticles and mammalian cell derived exosomes (MDEs), PELNs have lower toxicity and immunogenicity and possess excellent biocompatibility. The intrinsic properties of PELNs establish a robust basis for their applications in the therapeutic management of a diverse array of pathologies. It is worth mentioning that PELNs have good biological targeting, which promotes them to load and deliver drugs to specific tissues, offering a superior development pathway for the construction of a new drug delivery system (DDS). Glucose and lipid metabolism is a vital life process for the body's energy and material supply. The maintenance of homeostatic balance provides a fundamental basis for the body's ability to adjust to modifications in both its internal and external environment. Conversely, homeostatic imbalance can lead to a range of severe metabolic disorders. This work provides a comprehensive overview of the extraction and representation methods of PELNs, their transportation and storage characteristics, and their applications as therapeutic agents for direct treatment and as delivery vehicles to enhance nutrition and health. Additionally, it examines the therapeutic efficacy and practical applications of PELNs in addressing abnormalities in glucose and lipid metabolism. Finally, combined with the above contents, the paper summarizes and provides a conceptual framework for the better application of PELNs in clinical disease treatment.

Heterogeneous effects of genetic variants and traits associated with fasting insulin on cardiometabolic outcomes

Elevated fasting insulin levels (FI), indicative of altered insulin secretion and sensitivity, may precede type 2 diabetes (T2D) and cardiovascular disease onset. In this study, we group FI-associated genetic variants based on their genetic and phenotypic similarities and identify seven clusters with distinct mechanisms contributing to elevated FI levels. Clusters fall into two types: "non-diabetogenic hyperinsulinemia," where clusters are not associated with increased T2D risk, and "diabetogenic hyperinsulinemia," where T2D associations are driven by body fat distribution, liver function, circulating lipids, or inflammation. In over 1.1 million multi-ancestry individuals, we demonstrated that diabetogenic hyperinsulinemia cluster-specific polygenic scores exhibit varying risks for cardiovascular conditions, including coronary artery disease, myocardial infarction (MI), and stroke. Notably, the visceral adiposity cluster shows sex-specific effects for MI risk in males without T2D. This study underscores processes that decouple elevated FI levels from T2D and cardiovascular risk, offering new avenues for investigating process-specific pathways of disease.

Non high density lipoprotein to high density lipoprotein cholesterol ratio and type 2 diabetes in Middle aged and Elderly Chinese

The aim of this study was to assess the potential association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and type 2 diabetes mellitus (T2DM) in a middle-aged and elderly Chinese population using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. Methods We used data from CHARLS 2011 as baseline data and follow-up data from 2015. NHHR was used as a continuous and categorical variable, and multivariate logistic regression modeling was used to explore its relationship with T2DM. Three models were developed to adjust for the possible effects of 14 factors on the outcomes. Restricted cubic spline was used to check for possible nonlinear associations, and subgroup and interaction analyses were used to assess differences between groups. Results A total of 7847 subjects were enrolled in the study, of whom 948 (12.1%) were diagnosed with T2DM. The last NHHR quartile group (Q4) presented the highest risk of T2DM (OR, 1.115, 95% CI, 1.088-1.141) after accounting for all covariates. Restricted cubic spline regression modeling revealed a nonlinear relationship between NHHR and T2DM (p for nonlinear = 0.001). The results of the subgroup analyses were consistent across the categories, indicating a significant positive correlation. Interaction analyses revealed significant interactions between NHHR and age, gender and marital status. Conclusion In the middle-aged and elderly population in China, there is a strong correlation between elevated NHHR and increased risk of T2DM onset. The relationship between NHHR and T2DM can be further investigated in the future to provide reference for the development of more accurate prediction models.

The research progress and future directions in the pathophysiological mechanisms of type 2 diabetes mellitus from the perspective of precision medicine

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder characterized by pathophysiological mechanisms such as insulin resistance and β-cell dysfunction. Recent advancements in T2DM research have unveiled intricate multi-level regulatory networks and contributing factors underlying this disease. The emergence of precision medicine has introduced new perspectives and methodologies for understanding T2DM pathophysiology. A recent study found that personalized treatment based on genetic, metabolic, and microbiome data can improve the management of T2DM by more than 30%. This perspective aims to summarize the progress in T2DM pathophysiological research from the past 5 years and to outline potential directions for future studies within the framework of precision medicine. T2DM develops through the interplay of factors such as gut microbiota, genetic and epigenetic modifications, metabolic processes, mitophagy, NK cell activity, and environmental influences. Future research should focus on understanding insulin resistance, β-cell dysfunction, interactions between gut microbiota and their metabolites, and the regulatory roles of miRNA and genes. By leveraging artificial intelligence and integrating data from genomics, epigenomics, metabolomics, and microbiomics, researchers can gain deeper insights into the pathophysiological mechanisms and heterogeneity of T2DM. Additionally, exploring the combined effects and interactions of these factors may pave the way for more effective prevention strategies and personalized treatments for T2DM.

Natural Saponins on Cholesterol-Related Diseases: Treatment and Mechanism

Saponins are compounds composed of lipophilic aglycones linked to hydrophilic sugars. Natural saponins are isolated from plants and some Marine organisms. As important cholesterol-lowering drugs, natural saponins have attracted wide attention for their therapeutic potential in a variety of cholesterol-related metabolic diseases. To review the effects of natural saponins on cholesterol-related metabolic diseases, and to deepen the understanding of the cholesterol-lowering mechanism of saponins. The literature related to saponins and cholesterol-lowering diseases was collected using keywords "saponins" and "cholesterol" from PubMed, Web of Science, and Google Scholar from January 2000 to May 2024. The total number of articles related to saponins and cholesterol-lowering diseases was 240 after excluding irrelevant articles. Natural saponins can regulate cholesterol to prevent and treat a variety of diseases, such as atherosclerosis, diabetes, liver disease, hyperlipidemia, cancer, and obesity. Mechanistically, natural saponins regulate cholesterol synthesis and uptake through the AMPK/SREBP2/3-hydroxy-3-methyl-glutaryl coenzyme A reductase pathway and PCSK9/LDLR pathway, and regulate cholesterol efflux and esterification targeting Liver X receptor/ABC pathway and ACAT family. Natural saponins have broad application prospects in regulating cholesterol metabolism, for the development of more cholesterol-lowering drugs provides a new train of thought. However, it is still necessary to further explore the molecular mechanism and expand clinical trials to provide more evidence.

The Magnetic Resonance Image-Arterial Spin Labeling Characteristic of Nonketotic Hyperglycemic Hemichorea in an Elderly Type 2 Diabetic Female Patient

Nonketotic hyperglycemia-induced hemichorea is a rare condition of type 2 diabetes. It is characterized by hyperglycemia with the symptom traced to the basal ganglion like hemichorea or hemiballism, with the hyperintensity within basal ganglion presented in computed tomography (CT) or hyper signal in T1-weighted magnetic resonance image (MRI). It was also confirmed with a relatively better prognosis in that the symptoms of these patients could be relieved after the alleviation of hyperglycemia. However, the exact pathophysiology or mechanism of this condition currently was unclear. Besides, the duration of improvement in tomography as far was varied. In the present study, we reported an elderly female patient who tested with nonketotic hyperglycemia (random blood glucose of fingertips was 19 mmol/L or 342 mg/dL, blood ketone was 0.1 mmol/L) with the symptoms of dysphoria and mild chorea of left low limb, the MRI and CT showed contralateral striatopathy. Her condition achieved alleviation after the normalization of blood glucose. We subsequently rechecked her MRI in arterial spin labeling sequence which showed the hypoperfusion in the right basal ganglion rather than the opposite. Therefore, we suppose the hyperglycemia could induce temporary hypoperfusion in the basal ganglion associated with motor dysfunction which is manifested by hemichorea or hemiballism.

The impact of bisphenol AF on skeletal muscle function and differentiation in vitro

Various environmental chemicals have been identified as contributors to metabolic diseases. Bisphenol AF (BPAF), a substitute for bisphenol A, has been associated with changes in glucose metabolism and incidence of type 2 diabetes mellitus in humans. However, its mode of action remains unclear. Considering that skeletal muscle is the primary tissue for glucose utilization and the development of insulin resistance, yet largely neglected in toxicological assessments, we investigated the impact of BPAF on skeletal muscle function and differentiation. We examined the effects of BPAF (0.01-10 μM) on glucose uptake, response to insulin, production of reactive oxygen species (ROS), intracellular calcium, and myocyte differentiation, during hyperglycemia, insulin stimulation, and muscle contraction. We used the rat myoblast cell line L6 differentiated into myotubes, and murine primary isolated muscle fibers. In myotubes and contracting adult fibers, BPAF increased mitochondrial ROS. Basal glucose uptake was increased in myotubes while cells' ability to respond to insulin was decreased. Additionally, in developing myotubes, differentiation markers were downregulated with BPAF, along with impaired formation of tube structures. These effects were primarily observed at 10 μM concentration, which is markedly higher than reported human exposure concentrations. The results provide an insight into potential hazards associated with BPAF in terms of metabolic disruption in skeletal muscle. The developed in vitro methods show promise for future usage in assessments of new chemicals and their mixtures.

Development of a sodium hyaluronate-enriched therapeutic formulation with stevia glycoside and mogroside V for the comprehensive management of diabetes and its complications

Diabetes prevalence continues to increase as a result of people's increasing sugar intake. Diabetes mellitus and its complications (dry skin, constipation, depression, and dental caries), as well as the prohibition of sweets ingestion, seriously affect patients' physical and mental health. Therefore, it is crucial to develop a long-term food for special medical purposes (FSMP) that aids in managing diabetes and its complications. To ensure effective biomedical function and taste, we developed a FSMP beverage formulation containing stevia glycoside, mogroside V, and sodium hyaluronate (SMH-B), each at a concentration of 0.1 mg/mL. Meanwhile, this study verified that SMH-B is an environmentally friendly and biocompatible formulation. Furthermore, both in vivo and in vitro studies have demonstrated that SMH-B significantly lowers blood glucose and lipid levels, enhances skin moisture and elasticity, prevents dental caries, alleviates constipation, reduces oxidative stress, and mitigates depressive symptoms. Notably, the SMH-B compound formula exhibits a more effective adjuvant therapeutic effect compared to single-ingredient formulation composed of stevia glycosides, mogroside V, and sodium hyaluronate. Moreover, SMH-B provides the sweetness desired by diabetic patients without affecting blood glucose levels, while also offering an auxiliary therapeutic role, making it a potential FSMP for diabetes management.

Loss of β-Cell KATP Reduces Ca2+ Sensitivity of Insulin Secretion and Trpm5 Expression

Loss-of-function mutations in ATP-sensitive potassium (KATP) channels cause hyperexcitability and insulin hypersecretion, resulting in congenital hyperinsulinism (CHI). Paradoxically, despite the initial insulin hypersecretion, many CHI cases, as well as KATP knockout (KO) animals, eventually "crossover" to undersecretion and even diabetes. Here, we confirm that Sur1 KO islets exhibit higher intracellular concentration of calcium ion ([Ca2+]i) at all concentrations of glucose but show decreased glucose-stimulated insulin secretion. However, when [Ca2+]i is artificially elevated by increasing extracellular [Ca2+], insulin secretion from Sur1 KO islets increases to the same levels as in wild-type (WT) islets. This indicates that a right-shift in [Ca2+]i dependence of insulin secretion, rather than loss of insulin content or intrinsic secretability, is the primary cause for the crossover. Chronic pharmacological inhibition of KATP channel activity by slow release of glibenclamide in pellet-implanted mice causes a very similar crossover to glucose intolerance and impaired insulin secretion seen in Sur1 KO animals. Whole-islet and single-cell transcriptomic analysis reveal markedly reduced Trpm5 in both conditions. Glibenclamide pellet-implanted Trpm5 KO mice also exhibited significant glucose intolerance. However, this was not as severe as in WT animals, which suggests decreased expression of Trpm5 may play a small role in the disruption of insulin secretion with KATP loss.

ARTICLE HIGHLIGHTS

Congenital hyperinsulinism caused by loss of ATP-sensitive potassium (KATP) channels crosses over to unexplained undersecretion. Why does loss of β-cell KATP channel activity result in undersecretion of insulin and glucose tolerance, despite elevated intracellular concentration of calcium ion ([Ca2+]i) levels? Superelevation of [Ca2+]i in supraphysiological extracellular [Ca2+] boosted secretion from Sur1 knockout (KO) islets to the same levels as WT, indicating a right-shift in [Ca2+]i dependence of secretion. Transcriptomic analysis revealed markedly reduced β-cell Trpm5 in the absence of KATP. KATP inhibition in Trpm5 KO mice still caused significant glucose intolerance, but slightly less severe than in WT animals. Right-shifted [Ca2+]i dependence of secretion explains crossover. Downregulation of Trpm5 may be involved.

Assessment of TyG Index and Modified TyG Indices in Type 2 Diabetes Mellitus: Evaluating Their Potential as Predictors of Glycemic Control

Introduction The triglyceride glucose (TyG) index and modified TyG-indices have been suggested as a reliable indication of insulin resistance. The present study aimed to investigate the predictive utility of TyG index and modified TyG indices (TyG-waist circumference, TyG-body mass index, TyG-waist-to-hip ratio, and TyG-waist-to-height ratio) for assessing glycemic control in type 2 diabetes mellitus (T2DM). Methods The present hospital-based cross-sectional study recruited 383 T2DM patients. On the basis of HbA1c levels, patients were grouped into poor glycemic control (n=168) and good glycemic control (n=215). Baseline and biochemical parameters including TyG and modified TyG indices were compared between the groups. We used a Spearman correlation analysis to look for an association between TyG and TyG-related indices and glycemic control. We conducted receiver operating characteristic curve analysis to evaluate the predictive capability of TyG-index and modified TyG indices in assessing poor glycemic control in T2DM. Results T2DM with poor glycemic control had significantly elevated TyG and modified TyG indices when compared to those with good glycemic control. The TyG index and modified TyG indices showed a strong correlation with glycemic control in individuals with T2DM. The TyG index exhibited greater predictive capacity for poor glycemic control as compared to the modified TyG indices. Conclusion Patients with T2DM who are treated in clinical settings with limited resources may benefit from using the TyG index to evaluate their glycemic control.

A Nonlinear Association of Body Mass Index and Fasting Blood Glucose: A Dose-Response Analysis From Fasa Adults Cohort Study (FACS)

Background and Aims

Obesity is associated with diabetes; however, the dose-response association between body mass index (BMI) and fasting blood glucose (FBG) remains unclear. This study aims to evaluate the dose-response relationship between BMI and the risk of prediabetes and diabetes among adults.

Methods

A total of 10,135 participants were enrolled in this study from the baseline profiles of the Fasa Adults Cohort Study (FACS) conducted between October 2014 and September 2016. Multivariable logistic regression model and restricted cubic spline (RCS) were applied to evaluate the dose-response relationship between BMI and the risk of prediabetes and ‎diabetes. Statistical ‎ analyses were performed using the software R (4.3.1), taking the significance level at 0.05.

Results

Findings indicated that after adjusting the confounding variables, the risk of diabetes was increased by increasing BMI (overweight: OR = 1.67, 95% CI = 1.36-2.06; obese: OR = 1.76, 95% CI = 1.37-2.26). The results of dose-response analysis displayed a nonlinear J-shaped association between BMI and the risk of diabetes (p trend < 0.001, nonlinear p < 0.001) and prediabetes (p trend < 0.001, nonlinear p < 0.049).

Conclusion

Based on our research, a higher BMI is a dose-dependent, independent risk factor for diabetes. As a result, prevention initiatives should think about emphasizing ongoing BMI modifications.

Natural Bioactive Compounds in the Management of Type 2 Diabetes and Metabolic (Dysfunction)-Associated Steatotic Liver Disease

Type 2 diabetes (T2D) and metabolic (dysfunction)-associated steatotic liver disease (MASLD) affect a growing number of individuals worldwide. T2D and MASLD often coexist and substantially elevate the risk of adverse hepatic and cardiovascular clinical outcomes. Several common pathogenetic mechanisms are responsible for T2D and MASLD onset and progression, including insulin resistance, oxidative stress, and low-grade inflammation, among others. The latter can also be induced by gut microbiota and its derived metabolites. Natural bioactive compounds (NBCs) have been reported for their therapeutic potential in both T2D and MASLD. A large amount of evidence obtained from clinical trials suggests that compounds like berberine, curcumin, soluble fibers, and omega-3 fatty acids exhibit significant hypoglycemic, hypolipidemic, and hepatoprotective activity in humans and may be employed as adjunct therapy in T2D and MASLD management. In this review, the role of the most studied NBCs in the management of T2D and MASLD is discussed, emphasizing recent clinical evidence supporting these compounds' efficacy and safety. Also, prebiotics that act against metabolic dysfunction by modulating gut microbiota are evaluated.

Disease Awareness in Patients With Type 2 Diabetes: Analysis of Baseline Data From the SMART-Finder Observational Study

Background

Chronic kidney disease (CKD) is a common comorbidity of type 2 diabetes mellitus (T2DM). Data on the determination of CKD-related biomarkers among patients with T2DM in a real-life setting within Germany are limited.

Objective

We aimed to determine the prevalence of CKD and risk factors, availability of urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) values, treatment satisfaction, and quality of life among patients with T2DM in Germany.

Methods

SMART-Finder is a retrospective and prospective, observational, digital, patient-centered cohort study being performed as part of the routine use of an adherence-supporting app. This baseline analysis' observation period was from August to November 2023. Patients with T2DM in Germany who actively used the MyTherapy app; allowed push notifications; and documented use of diabetes medications, renin-angiotensin system inhibitors, finerenone, and/or blood glucose test strips were eligible for inclusion. Study materials (background information, electronic consent form, and laboratory and electronic questionnaires) were provided to eligible patients via app push notifications. Participants completed an electronic case report form that included questions on their blood pressure; their most recent UACR, eGFR, and glycated hemoglobin (HbA1c) values in the past 12 months; the EQ-5D-5L; and the Diabetes Treatment Satisfaction Questionnaire. The primary outcome was the proportion of patients with a UACR of ≥30 mg/g.

Results

Of 9527 invited eligible patients, 101 completed the electronic case report form (male: n=61; female: n=40; age: mean 54.2, SD 11.4 y). Of these, 1 female patient and 5 male patients reported their UACR values; 3 (all male) had a UACR of ≥30 mg/g. The remaining 95 patients reported that their health care professionals had not provided UACR measurements. Only 9 (8.9%) patients were aware of their latest eGFR values (3 patients: 15-44 mL/min/1.73 m2; 6 patients: 45-89 mL/min/1.73 m2), 90 provided HbA1c values (80 patients: ≥6.0%), 46 had a systolic blood pressure of ≥130 mm Hg, and 83 reported former or current nephrotoxic medication intake. The mean EQ-5D-5L index score was 0.7 (SD 0.3; range -0.1 to 1.0; 50 patients). The mean Diabetes Treatment Satisfaction Questionnaire score was 28.8 (SD 6.8; range 9.0-36.0; 49 patients).

Conclusions

Patients with T2DM who were using an adherence-supporting app in Germany lacked awareness of CKD-related biomarkers but had high knowledge of self-manageable biomarkers (eg, blood pressure, serum fasting glucose, and HbA1c values). Our results suggest that treating physicians either do not test for UACRs and eGFRs or do not inform patients about the results. Nonadherence to diagnostic testing guidelines and a lack of physician-patient communication put patients at risk. Another reason for this health literacy imbalance may be the focus on HbA1c instead of kidney comorbidity in patient education material. Future goals for diabetes management must include guideline-compliant testing of CKD-related biomarkers and open physician-patient communication.

Bioprinting of bespoke islet-specific niches to promote maturation of stem cell-derived islets

Pancreatic islets are densely packed cellular aggregates containing various hormonal cell types essential for blood glucose regulation. Interactions among these cells markedly affect the glucoregulatory functions of islets along with the surrounding niche and pancreatic tissue-specific geometrical organization. However, stem cell (SC)-derived islets generated in vitro often lack the three-dimensional extracellular microenvironment and peri-vasculature, which leads to the immaturity of SC-derived islets, reducing their ability to detect glucose fluctuations and insulin release. Here, we bioengineer the in vivo-like pancreatic niches by optimizing the combination of pancreatic tissue-specific extracellular matrix and basement membrane proteins and utilizing bioprinting-based geometrical guidance to recreate the spatial pattern of islet peripheries. The bioprinted islet-specific niche promotes coordinated interactions between islets and vasculature, supporting structural and functional features resembling native islets. Our strategy not only improves SC-derived islet functionality but also offers significant potential for advancing research on islet development, maturation, and diabetic disease modeling, with future implications for translational applications.

Sub-Clinical Regional Macular Changes in Self-Reported Diabetic Subjects: Vascular and Retinal Layer Analysis Using Swept-Source OCT

Aim

To assess and compare subclinical alterations in superficial capillary plexus vessel density (SCPVD) and retinal layers thickness in the macular region between individuals with type 2 diabetes mellitus (DM) and healthy controls.

Methods

Swept-source OCT images were obtained from 29 control subjects and 24 diabetic subjects. Macular thickness (MT), retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer (GCL) thickness were measured in the central macula and four quadrants of macular region using a 6.0 × 6.0 mm radial macular scan centered on the fovea. OCTA acquisition included a 3.0 × 3.0 mm macular scan for the foveal avascular zone (FAZ) and a 4.5 × 4.5 mm macular scan for SCPVD. The FAZ was manually mapped at the SCP on OCTA images.

Results

In diabetic subjects, the superficial capillary plexus vessel density (SCPVD) was significantly lower in both the central (P = 0.04) and inferior (P = 0.01) regions compared to the control group. Additionally, diabetic patients showed a significant reduction in temporal macular thickness (MT) and thinning of the ganglion cell layer (GCL) in all three quadrants except in the central and inferior macula (P < 0.05). There was also significant thinning of the superior macular retinal nerve fiber layer (RNFL) in diabetics compared to controls (P = 0.02). While the foveal avascular zone (FAZ) was larger in diabetic subjects, this difference was not statistically significant (P = 0.78). Duration of diabetes has shown a significantly high positive correlation (r = 0.77, P < 0.01) with superior macular VD.

Conclusion

The findings of this study suggest that the diabetic macula experiences significant ganglion cell layer (GCL) thinning and reduced superficial capillary plexus (SCP) vascular density even before the onset of clinical retinopathy. Swept-source OCT proves to be an essential tool for detecting these early changes in diabetic patients.

A novel bombesin-related peptide modulates glucose tolerance and insulin secretion in non-obese and hypothalamic-obese rats

This study investigated the effects of a novel bombesin-related peptide (BR-b), derived from the skin of the Chaco tree frog (Boana raniceps), on glucose homeostasis in non-obese and hypothalamic-obese male rats. Hypothalamic obesity was induced in neonatal rats through high-dose administration of monosodium glutamate (MSG; 4 g/kg), while control animals (CTL) received an equimolar saline solution. At 70 days of age, both MSG and CTL groups underwent an oral glucose tolerance test (OGTT; 2 g/kg) with or without prior intraperitoneal administration of BR-b at doses of 0.5 or 1.0 mg/kg, delivered 5 min before the glucose challenge. At 75 days of age, pancreatic islets were isolated and exposed to glucose in the presence or absence of BR-b (1.0 or 5.0 μM). MSG-treated rats developed obesity, hyperinsulinemia, and insulin resistance. BR-b administration exacerbated glucose intolerance during the OGTT, particularly at the 1.0 mg/kg dose, with more pronounced effects observed in the CTL group. Insulin secretion from pancreatic islets was influenced by both obesity status and glucose concentration. In islets from CTL rats, BR-b (5 μM) reduced insulin release under non-stimulatory glucose conditions but enhanced insulin secretion at stimulatory glucose levels. Conversely, in islets from MSG-obese rats, BR-b exhibited an inhibitory effect on insulin release at basal glucose concentrations, while the insulinotropic response to high glucose was abolished. In summary, BR-b administration shortly before the OGTT impaired glucose tolerance and modulated insulin secretion from pancreatic islets in a glucose-dependent manner in non-obese rats. These effects were attenuated or absent in MSG-obese rats, indicating that hypothalamic obesity alters the metabolic responses to bombesin-related peptides.

Insights Into Genetic Variations of the OCT1 Gene in Metformin Poor Responders Among Bangladeshi Type 2 Diabetic Patients

Metformin is the most widely prescribed drug for the treatment of Type 2 diabetes mellitus (T2DM), but its response varies from person to person. This study aims to analyze the complete mutation spectrum of the OCT1 gene in metformin poor responders and to explore the potential pathogenic effects of the identified mutations. Clinical features of 56 Bangladeshi T2DM patients (who showed altered response to metformin) were analyzed, and genomic DNA was extracted from their blood samples. Subsequently, the entire exons (1-11), along with flanking introns of the OCT1 gene were amplified and sequenced. Molecular consequences of the identified mutations on OCT1 protein activity were determined through in silico analyses. In this study, 29 mutations of the OCT1 gene were identified; among which 5 mutations (c.412-86G>T, c.970G>C, c.1386-3088_1386-3083delGAATCA, c.1498+66G>T, and c.1653C>A) were novel. It was found that nsSNPs c.181C>T, c.1022C>T, c.493G>T, c.1207A>G, and c.970G>C (novel) as well as frameshift deletions have potential deleterious effects on OCT1 protein stability and function. Some of these mutations also cause alternative splicing, as per the HSF tool. In addition, alteration of interatomic bonding in the OCT1 protein due to two high-risk mutations (c.181C>T and c.1022C>T) was found from web-based analysis. The mutations, as mentioned earlier, are the most probable causative factor of decreased metformin effectiveness and adverse side effects in T2DM patients who are poor responders. Understanding the OCT1 gene variations of patients can help tailor treatment strategies for optimal metformin response or identify alternative medications.

Type 2 Diabetes Mellitus: New Pathogenetic Mechanisms, Treatment and the Most Important Complications

Type 2 diabetes mellitus (T2DM), a prevalent chronic disease affecting over 400 million people globally, is driven by genetic and environmental factors. The pathogenesis involves insulin resistance and β-cell dysfunction, mediated by mechanisms such as the dedifferentiation of β-cells, mitochondrial dysfunction, and oxidative stress. Treatment should be based on non-pharmacological therapy. Strategies such as increased physical activity, dietary modifications, cognitive-behavioral therapy are important in maintaining normal glycemia. Advanced therapies, including SGLT2 inhibitors and GLP-1 receptor agonists, complement these treatments and offer solid glycemic control, weight control, and reduced cardiovascular risk. Complications of T2DM, such as diabetic kidney disease, retinopathy, and neuropathy, underscore the need for early diagnosis and comprehensive management to improve patient outcomes and quality of life.

Caragana jubata ethanol extract ameliorates the symptoms of STZ-HFD-induced T2DM mice by PKC/GLUT4 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Caragana jubata (Pall.) Poir., a traditional Tibetan medicinal plant in China, is renowned in Tibetan medicine for its hypoglycemic properties and long-standing use in treating diabetes. Despite its extensive clinical use, the mechanisms underlying its blood sugar-lowering effects still need to be explored. Our investigation contributes a new understanding of the hypoglycemic mechanism of C. jubata, validating its traditional medicinal application by demonstrating its ability to increase GLUT4 expression and glucose uptake, crucial elements in treating type 2 diabetes mellitus (T2DM).

AIM OF THE STUDY

This study investigated the potential anti-diabetic effects of C. jubata ethanol extract (CJEE) by upregulating GLUT4 expression and promoting its integration into the plasma membrane in L6 skeletal muscle cells and diabetic mice. Additionally, the research aimed to uncover the mechanisms involved, particularly focusing on the involvement of the PKC signaling pathway and Ca2⁺ release.

MATERIALS AND METHODS

The chemical composition of CJEE was evaluated using UPLC-Q-TOF/MS. Glucose uptake, GLUT4 expression, and plasma membrane fusion in L6 cells were assessed through a glucose oxidase kit, Western blotting, and laser confocal microscopy, respectively. The modulation of GLUT4 by Akt, AMPK, and PKC signaling pathways was investigated utilizing specific inhibitors. The impact of CJEE on intracellular Ca2⁺ concentration was determined with Fluo-4 dye. Additionally, an in vivo study was conducted on high-fat diet (HFD) and streptozotocin (STZ)-induced type 2 diabetic mice to evaluate the effects of CJEE on blood glucose levels, insulin resistance, lipid metabolism, and pancreatic function.

RESULTS

Chemical analysis of CJEE revealed 18 major constituents, primarily flavonoids. In L6 cells, CJEE was found to significantly enhance glucose uptake, increase GLUT4 expression, and facilitate its fusion with the plasma membrane. The study illustrated that CJEE predominantly activates the PKC pathway, with minimal involvement of the Akt pathway, emphasizing the critical role of Ca2⁺ release in GLUT4 regulation. Diabetic mice treated with CJEE exhibited decreased fasting blood glucose levels, enhanced oral glucose tolerance, reduced insulin resistance, and ameliorated lipid metabolism disorders. Additionally, CJEE elevated GLUT4 expression in insulin-sensitive tissues and alleviated pancreatic and hepatic lesions.

CONCLUSIONS

Our results demonstrated that the activation of the PKC pathway and release of Ca2⁺ by CJEE induce GLUT4 expression, promoting its fusion with the plasma membrane. Consequently, this process boosts glucose uptake and enhances insulin sensitivity, underscoring CJEE as a promising option for managing T2DM.

Antin-diabetic cognitive dysfunction effects and underpinning mechanisms of phytogenic bioactive peptides: a review

Diabetic cognitive dysfunction is one of the important comorbidities and complications of diabetes, which is mainly manifested by loss of learning ability and memory, behavioural disorders, and may even develop into dementia. While traditional anti-diabetic medications are effective in improving cognition and memory, long-term use of these medications can be accompanied by undesirable side effects. Therefore, there is an urgent need to find safe and effective alternative therapies. Accumulating evidence suggests that phytogenic bioactive peptides play an important role in the regulation of cognitive dysfunction in diabetes. In this review, we explored the relationship between diabetes mellitus and cognitive dysfunction, and the potential and underlying mechanisms of plant-derived bioactive peptides to improve diabetic cognitive dysfunction. We found that plant-derived active peptides alleviate diabetic cognitive impairment by inhibiting key enzymes (e.g., α-glucosidase, α-amylase) to improve blood glucose levels and increase antioxidant activity, modulate inflammatory mediators, and address intestinal dysbiosis. In conclusion, plant-derived active peptides show strong potential to improve diabetic cognitive impairment.

Association of dietary decanoic acid intake with diabetes or prediabetes: an analysis from NHANES 2005-2016

Background

With the increasing prevalence of prediabetes and diabetes, exploring dietary factors associated with prediabetes and diabetes has become a global health research priority. This study aimed to assess the relationship between dietary decanoic acid (DDA) intake and the risk of diabetes and prediabetes.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 included 11,477 adult participants. DDA intake was assessed through two 24-h dietary recalls and participants were grouped according to the diagnostic criteria for diabetes and prediabetes. Multivariate regression models were applied to analyze the relationship between DDA intake and diabetes and prediabetes, with subgroup analyses conducted to explore potential interactions.

Results

Dietary decanoic acid intake was significantly negatively associated with the risk of diabetes. In the fully adjusted model, each 1 g/day increase in DDA intake was associated with a 19% reduction in the odds of developing diabetes from prediabetes (OR = 0.81, 95% CI: 0.68-0.96, p = 0.015) and this negative association was more pronounced in individuals with higher education level (P for interaction = 0.006). Compared with the DDA intake ≤0.18 g/day, DDA intake >0.58 g/day is related to reduced risk of progression to diabetes in prediabetic patients. However, the relationship between DDA intake and the risk of prediabetes was not statistically significant in the fully adjusted model (OR = 0.95, 95% CI: 0.84-1.07, p = 0.404).

Conclusion

This study found that higher DDA intake may be associated with lower prevalence of diabetes among prediabetic population, and high education level strengthen this relationship.

Marital status and risk of type 2 diabetes among middle-aged and elderly population: a systematic review and meta-analysis

Background

Marital status is among the factors influencing type 2 diabetes mellitus (T2DM). However, the precise relationship remains incompletely understood. This meta-analysis aims to evaluate the association between marital status and the incidence of T2DM.

Methods

A review and meta-analysis of observational studies were conducted to investigate the relationship between marital status and diabetes incidence. We searched three databases, including PubMed, Google Scholar, and Scopus, for relevant studies published up to August 16th, 2023. In our initial search, we identified a total of 358 articles. After a demanding screening process involving evaluating titles, abstracts, and full-text content, we ultimately included six studies for our meta-analysis.

Result

Comprising a total of 1,440,904 participants, our study found that in comparison to married individuals, unmarried participants exhibited a higher likelihood of developing diabetes [odds ratio (OR): 1.47, 95% confidence interval (CI): 0.88-2.45, I 2: 91%, p-value = 0.14]. Divorced participants had a reduced likelihood of developing diabetes compared to married participants (OR: 0.84, 95% CI: 0.77-0.91, I 2: 17%, p < 0.001). Similarly, widowed participants showed a lower risk of developing diabetes compared to divorced participants (OR: 0.35, 95% CI: 0.26-0.46, I 2: 83%, p < 0.00001).

Conclusion

This study provides strong evidence of links between marital status and type 2 diabetes risk. Unmarried individuals are more susceptible to T2DM, divorced individuals have a lower risk, and widowed individuals exhibit reduced T2DM risk. Further research should investigate underlying mechanisms and confounding factors.

Type 2 diabetes prediction method based on dual-teacher knowledge distillation and feature enhancement

Diabetes prediction is an important topic in the field of medical health. Accurate prediction can help early intervention and reduce patients' health risks and medical costs. This paper proposes a data preprocessing method, including removing outliers, filling missing values, and using sparse autoencoder (SAE) feature enhancement. This study proposes a new method for type 2 diabetes classification using a dual Convolutional Neural Network (CNN) teacher-student distillation model (DCTSD-Model), aiming to improve the accuracy and reliability of diabetes prediction. The variables of the original data are expanded by SAE to enhance the expressive power of the features. The proposed CNN and DCTSD-Model models are evaluated on the feature enhancement dataset using 10-fold cross validation. The experimental results show that after data preprocessing, DCTSD-Model adopts the dual teacher model knowledge distillation method to help the student model learn rich category information by generating soft labels, and uses weighted random samplers to learn samples of different categories, which solves the category imbalance problem and achieves excellent classification performance. The accuracy of DCTSD-Model on the classification task reached 98.57%, which is significantly higher than other models, showing higher classification ability and reliability. This method provides an effective solution for diabetes prediction and lays a solid foundation for further research and application.

Association of BMI and WC for insulin resistance and type 2 diabetes among Brazilian adolescents

OBJECTIVE

To investigate how body mass index (BMI) and waist circumference (WC) may be associated with insulin resistance and type 2 diabetes (T2DM) in Brazilian adolescents.

METHODS

Cross-sectional study using data from the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA) including adolescents aged 12-17 years. The relationship between adiposity and T2DM was investigated using ordinal logistic regression models. To study the association between adiposity categories and the occurrence of insulin resistance, linear regression models were used.

RESULTS

The prevalence of T2DM for the same BMI category did not increase with the presence of high WC. Regarding insulin resistance, for the same BMI categories, having a high WC resulted in a higher prevalence of insulin resistance (HOMA-IR). The only groups significantly associated with prediabetes and T2DM were those with obesity by BMI with elevated WC (POR 1.68, 95 % CI 1.45; 1.94) and obesity with normal WC (POR 1.58, 95 % CI 1.01; 2.46). Similar findings were observed concerning insulin resistance, where the increased WC had its greatest effect when associated with obesity by BMI (β Coefficient 2.20, 95 % CI 1.89; 2.50).

CONCLUSION

The combination of BMI and WC is better for assessing adolescents at risk of developing T2DM.

Association Between Nontraditional Lipid Profiles and the Risk of Type 2 Diabetes Mellitus in Chinese Adults With Hypertension: Findings From the China Hypertension Registry Study

The relationship between nontraditional lipid profiles and type 2 diabetes mellitus (T2DM) remains ambiguous within the hypertension population. The objective of this study is to examine the association between nontraditional lipid profiles and T2DM in Chinese adults with hypertension. The current investigation encompassed 13 728 participants with hypertension from the China Hypertension Registry Study. Logistic regression analysis and smooth curve fitting were employed to evaluate the association between nontraditional lipid profiles and T2DM. The prevalence of T2DM was found to be 17.8%. In the fully adjusted model, atherogenic index of plasma (AIP) exhibited the highest odds ratios (ORs) for T2DM (OR: 2.71, 95% confidence interval [CI]: 2.26-3.26). Conversely, the fully adjusted ORs (95% CI) for total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)/HDL-C, and non-high-density lipoprotein cholesterol (Non-HDL-C) were 1.33 (1.25-1.41), 1.40 (1.29-1.51), and 1.41 (1.34-1.49), respectively. Additionally, the study demonstrated that AIP had a superior ability to identify T2DM. Subgroup analyses indicated that the relationship between AIP and Non-HDL-C with T2DM was more significant in the lighter weight population. In addition, the association of TC/HDL-C with LDL-C/HDL-C with T2DM was stronger in the lower homocysteine level population. Among the southern Chinese population with hypertension, all nontraditional lipid indices positively correlated with the risk of T2DM. Among these lipid indices, AIP exhibited superior discriminatory power in identifying T2DM compared to TC/HDL-C, LDL-C/HDL-C. Trial Registration: ChiCTR1800017274.

Diabetes in China: epidemiology, pathophysiology and multi-omics

Although diabetes is now a global epidemic, China has the highest number of affected people, presenting profound public health and socioeconomic challenges. In China, rapid ecological and lifestyle shifts have dramatically altered diabetes epidemiology and risk factors. In this Review, we summarize the epidemiological trends and the impact of traditional and emerging risk factors on Chinese diabetes prevalence. We also explore recent genetic, metagenomic and metabolomic studies of diabetes in Chinese, highlighting their role in pathogenesis and clinical management. Although heterogeneity across these multidimensional areas poses major analytic challenges in classifying patterns or features, they have also provided an opportunity to increase the accuracy and specificity of diagnosis for personalized treatment and prevention. National strategies and ongoing research are essential for improving diabetes detection, prevention and control, and for personalizing care to alleviate societal impacts and maintain quality of life.

Association between reduced hemoglobin-to-red cell distribution width ratio and elevated cardiovascular mortality in patients with diabetes: Insights from the National Health and Nutrition Examination Study, 1999-2018

OBJECTIVE

The purpose of this research was to examine the relationship between the hemoglobin-to-red blood cell distribution width ratio (HRR) and cardiovascular disease (CVD)-related mortality in people who have diabetes.

METHODS

Data derived from the National Health and Nutrition Examination Survey (NHANES), between the years 1999 to 2018, were meticulously analyzed. Mortality data, encompassing events until December 31, 2019, were systematically collected. A comprehensive group comprising of 8,732 participants were subjected to scrutiny, and subsequently, classified into four distinct groups predicated upon quartiles of baseline HRR levels: Q1 (n = 2,183), Q2 (n = 2,181), Q3 (n = 2,185), and Q4 (n = 2,183). The correlation between HRR and CVD-related mortality was examined through the use of survival curves and Cox proportional hazard regression models, the latter incorporating weights as advised by NHANES.

RESULTS

Among the 8,732 participants in the study cohort, CVD-related mortality was identified in 710 cases. The Kaplan-Meier analysis demonstrated a significant association, indicating that a decreased HRR was correlated with a reduction in survival in cases with CVD. Both univariate and multivariable Cox proportional hazard regression analyses consistently indicated that patients exhibiting a lower HRR exhibited a markedly elevated risk of CVD-related mortality in comparison to those with higher HRR. Notably, the correlation between HRR and decreasing CVD-related mortality was discerned to be non-linear.

CONCLUSION

In patients with diabetes, a decreased HRR was associated with an increased risk of CVD-related mortality.

Vascular volume changes in radiological patterns of usual interstitial pneumonia in patients with type 2 diabetes

OBJECTIVE

This research primarily focuses on exploring the changes in intrapulmonary vascular volume (IPVV) in radiological patterns of usual interstitial pneumonia (UIP) associated with Type 2 Diabetes Mellitus (T2DM), thereby inferring the possible mechanisms of the co-occurrence of diabetes and UIP patterns.

METHODS

Thin-layer data were post-processed on the basis of high-resolution computed tomography (HRCT) and quantitatively assessed for IPVV. Changes in IPVV were compared between T2DM combined with UIP modality and T2DM non-UIP modality. Correlations between UIP patterns and various markers and confounders, including IPVV, were determined via logistic regression analysis. In this study, the potential of IPVV as a predictor for UIP presence was analysed through the application of subject operating characteristic curve analysis.

RESULTS

In patients with T2DM, the IPVV demonstrated smaller size in those with combined UIP patterns compared to T2DM patients without UIP patterns (164.4 ± 68.7 vs 202.9 ± 76.3 mL, P = 0.005). We detected a positive correlation between IPVV levels and several variables, including fasting plasma glucose (FPG) (r = 0.404, P < 0.0001), glycated hemoglobin (HbA1c) (r = 0.225, P = 0.022), serum uric acid (SUA) (r = 0.332, P = 0.0007) and HRCT scores (r = 0.288, P = 0.024). Conversely, negative correlations were noted with total cholesterol (TC) (r = -0.220, P = 0.028) and cystatin-C (Cys-C) (r = -0.215, P = 0.038). Multivariate logistic regression analysis identified independent associations between the presence of UIP and several factors: IPVV, age, smoking history, and FPG. In assessing the combined UIP pattern among T2DM patients, IPVV levels exhibited a sensitivity of 70.5% and a specificity of 58.5%, generating an AUC of 0.645.

CONCLUSION

In individuals diagnosed with T2DM alongside UIP, a substantial decline in IPVV was documented. This diminution correlates with the presence of UIP, suggesting that IPVV may serve as a potent biomarker for detecting UIP patterns in individuals with T2DM. This may suggest that the mechanism behind the co-occurrence of T2DM with UIP patterns is attributed to alterations in the pulmonary microvasculature, potentially representing one of the vascular complications associated with diabetes.

Discovery of the selective and nanomolar inhibitor of DPP-4 more potent than sitagliptin by structure-guided rational design

Various therapeutic targets and approaches are commonly employed in the management of Type 2 Diabetes. These encompass diverse groups of drugs that target different mechanisms involved in glucose regulation. Inhibition of the DPP-4 enzyme has been proven an excellent target for antidiabetic drug design. Our previous work on discovering multitarget antidiabetic drugs led to the identification of a gallic acid-thiazolidinedione hybrid as a potent DPP4 inhibitor (IC50 = 36 nM). In current research, our efforts resulted in a new dihydropyrimidine-based scaffold with enhanced DPP4 inhibition potential. After virtual evaluation, the designed molecules with excellent interaction patterns and binding energy values were synthesized in the wet laboratory. The inhibition potential of synthesized compounds was assessed against the DPP-4 enzyme. Compound 46 with single digit IC50 value 2 nM exhibited 4-fold and 18-fold higher activity than Sitagliptin and our previously reported hybrid respectively. Moreover, compounds 46, 47 and 50 have shown manyfold selectivity against DPP8 and DPP9. Further pretreatment with compounds 43, 45-47 and 50 (at doses of 10 and 20 mg/kg) in OGTT conducted on rats resulted in a significant decrease in the serum glucose levels compared to the control group. In the long-term STZ-induced diabetic rats, tested compound 50 performed similarly to the reference drug. Molecular dynamics simulations and in-silico molecular docking studies were employed to elucidate the time-dependent interactions of inhibitors within the active sites of DPP4. The compounds examined in this work might serve as a possible lead in the development of effective diabetic mellitus treatments.

TRPV1: A novel target for the therapy of diabetes and diabetic complications

BACKGROUND

Diabetes mellitus is a chronic metabolic disease characterized by abnormally elevated blood glucose levels. Type II diabetes accounts for approximately 90% of all cases. Several drugs are available for hyperglycemia treatment. However, the current therapies for managing high blood glucose do not prevent or reverse the disease progression, which may result in complications and adverse effects, including diabetic neuropathy, retinopathy, and nephropathy. Hence, developing safer and more effective methods for lowering blood glucose levels is imperative. Transient receptor potential vanilloid-1 (TRPV1) is a significant member of the transient receptor potential family. It is present in numerous body tissues and organs and performs vital physiological functions.

PURPOSE

This review aimed to develop new targeted TRPV1 hypoglycemic drugs by systematically summarizing the mechanism of action of the TRPV1-based signaling pathway in preventing and treating diabetes and its complications.

METHODS

Literature searches were performed in the PubMed, Web of Science, Google Scholar, Medline, and Scopus databases for 10 years from 2013 to 2023. The search terms included "diabetes," "TRPV1," "diabetic complications," and "capsaicin."

RESULTS

TRPV1 is an essential potential target for treating diabetes mellitus and its complications. It reduces hepatic glucose production and food intake and promotes thermogenesis, metabolism, and insulin secretion. Activation of TRPV1 ameliorates diabetic nephropathy, retinopathy, myocardial infarction, vascular endothelial dysfunction, gastroparesis, and bladder dysfunction. Suppression of TRPV1 improves diabetes-related osteoporosis. However, the therapeutic effects of activating or suppressing TRPV1 may vary when treating diabetic neuropathy and periodontitis.

CONCLUSION

This review demonstrates that TRPV1 is a potential therapeutic target for diabetes and its complications. Additionally, it provides a theoretical basis for developing new hypoglycemic drugs that target TRPV1.

Work Around the Clock: How Work Hours Induce Social Jetlag and Sleep Deficiency

A growing body of evidence has placed an increasing emphasis on how sleep affects health. Not only does insufficient sleep make one subjectively feel worse, but is associated with chronic diseases that are considered epidemics in industrialized nations. This is partly caused by the growing need for prolonged work and social schedules, exemplified by shift work, late-night weekends, and early morning work/school start times (social jetlag). Here, we consider fundamental relationships between the circadian clock and biologic processes and discuss how common practices, such as shift work and social jetlag, contribute to sleep disruption, circadian misalignment, and adverse health outcomes.

Glucagon Stimulation Test and Insulin Secretory Capacity in the Clinical Assessment of Incretin-Based Therapy for Diabetes

Evaluation of insulin secretory capacity is essential to understand the pathophysiologic condition of individuals with diabetes and assess the efficacy of drugs used in the treatment of this disease. The 1-mg i.v. glucagon stimulation test (GST) is widely used to evaluate residual β-cell function; we previously reported that GST assessment of insulin secretory capacity is useful in assessing the efficacy of glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs). However, recent reports have indicated that pharmacologic concentrations of glucagon stimulate insulin secretion through GLP-1 receptors, confounding the issue. The current studies were undertaken to reassess the reliability of the GST for evaluation of insulin secretory capacity under GLP-1RAs and dipeptidyl peptidase 4 inhibitors (DPP-4is). Our first study included individuals receiving GLP-1RA treatment, evaluated by the GST before and after treatment. Although the fasting C-peptide response (CPR) levels were elevated after treatment, the induction of insulin secretion by glucagon was significantly reduced. Our second study compared glucagon-induced insulin secretion between DPP-4i users and nonusers, assessed by the GST after propensity score matching. Although the fasting CPR levels were similar in the two investigations, glucagon-induced insulin secretion was significantly lower with DPP-4i use. These results suggest that the GST might underestimate insulin secretory capacity under incretin-based therapy.

ARTICLE HIGHLIGHTS

Evidence of traditional Chinese medicine for treating type 2 diabetes mellitus: from molecular mechanisms to clinical efficacy

CONTEXT

The global prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades. Despite numerous studies and systematic reviews, there is a gap in comprehensive and up-to-date evaluations in this rapidly evolving field.

OBJECTIVE

This review provides a comprehensive and current overview of the efficacy of Traditional Chinese Medicine (TCM) in treating T2DM.

METHODS

A systematic review was conducted using PubMed, Web of Science, Wanfang Data, CNKI, and Medline databases, with a search timeframe extending up to November 2023. The search strategy involved a combination of subject terms and free words in English, including 'Diabetes,' 'Traditional Chinese Medicine,' 'TCM,' 'Hypoglycemic Effect,' 'Clinical Trial,' and 'Randomized Controlled Trial.' The studies were rigorously screened by two investigators, with a third investigator reviewing and approving the final selection based on inclusion and exclusion criteria.

RESULTS

A total of 108 relevant papers were systematically reviewed. The findings suggest that TCMs not only demonstrate clinical efficacy comparable to existing Western medications in managing hypoglycemia but also offer fewer adverse effects and a multitarget therapeutic approach. Five main biological mechanisms through which TCM treats diabetes were identified: improving glucose transport and utilization, improving glycogen metabolism, promoting GLP-1 release, protecting pancreatic islets from damage, and improving intestinal flora.

CONCLUSIONS

TCM has demonstrated significant protective effects against diabetes and presents a viable option for the prevention and treatment of T2DM. These findings support the further exploration and integration of TCM into broader diabetes management strategies.

FNDC5/Irisin mitigates high glucose-induced neurotoxicity in HT22 cell via ferroptosis

Diabetes-induced neuropathy represents a major etiology of dementia, highlighting an urgent need for the development of effective therapeutic interventions. In this study, we explored the role of fibronectin type III domain containing 5 (FNDC5)/Irisin in mitigating hyperglycemia-induced neurotoxicity in HT22 cells and investigated the underlying mechanisms. Our findings reveal that high glucose conditions are neurotoxic, leading to reduced viability of HT22 cells and increased apoptosis. Furthermore, the elevated expression of the intracellular ferroptosis marker Acyl-CoA Synthetase Long Chain Family Member 4 (ACSL4), along with increased levels of ferrous ions and malondialdehyde (MDA), suggests that high glucose conditions may induce ferroptosis in HT22 cells. FNDC5/Irisin treatment effectively mitigates high glucose-induced neurotoxicity and ferroptosis in HT22 cells. Mechanistically, FNDC5/Irisin enhances cellular antioxidant capacity, regulates ACSL4 expression, and improves intracellular redox status, thereby inhibiting ferroptosis and increasing HT22 cell survival under high-glucose conditions. These results highlight the neuroprotective potential of FNDC5/Irisin in high glucose environments, offering a promising avenue for developing treatments for diabetes-related neurodegenerative diseases.

Long-Term Clinical Outcomes of Polymer-Free Sirolimus-Eluting Stent and Polymer-Coated Sirolimus-Eluting Stent in Patients with Type 2 Diabetes

Introduction

Polymer-free sirolimus-eluting stent (PF-SES) possess multiple properties improving targeted drug elution and in-stent reendothelialization without the presence of polymers. The long-term clinical performance comparison between PF-SES and the latest generation polymer-coated sirolimus-eluting stents (SES), particularly regarding intravascular imaging assessment and in the type 2 diabetes mellitus (DM) population, remains unexplored.

Methods

We conducted a retrospective study involving 2646 diabetes patients meeting coronary artery disease (CAD) criteria underwent coronary stents in the real-world. All patients were divided into the PF-SES group and the SES group. Optical coherence tomography (OCT) was used to evaluate the imaging characteristics of in-stent reendothelialization. Patient information between the two groups was systematically compared in hospital and at 5-year follow-up.

Results

In terms of basic characteristics, the proportion of current smoker and stable angina patients in the PF-SES group was significantly higher than that in the SES group. The PF-SES group exhibited significantly higher rate of left anterior descending (LAD) lesion and more stents per patients compared to the SES group. The value of minimum lumen area (MLA), neointimal area (NA) and neointimal thickness (NT) were higher in the PF-SES group. Additionally, the occurrence rates of heterogeneous, lipid layer, intimal tears, thrombi, and micro-vessels were notably lower in the PF-SES group compared to the SES group. A higher all-cause mortality was observed in the SES cohort.

Discussion

PF-SES could effectively improve in-stent reendothelialization in patients with type 2 DM, with positive effects on survival rate and may, therefore, be considered as an alternative treatment option for improving clinical long-term outcomes.

SOCS3 Methylation Partially Mediated the Association of Exposure to Triclosan but Not Triclocarban with Type 2 Diabetes Mellitus: A Case-Control Study

This study aimed to evaluate the association of TCs (triclosan (TCS) and triclocarban) exposure with T2DM and glucose metabolism-related indicators and the mediating effect of SOCS3 methylation on their associations. A total of 956 participants (330 T2DM and 626 controls) were included in this case-control study. Logistic regression and generalized linear models were used to assess the effect of TCs on T2DM and glucose metabolism-related indicators. The dose-response relationship between TCs and T2DM was analyzed by restricted cubic spline. Finally, after evaluating the association between TCs and SOCS3 methylation levels, the mediating effect of SOCS3 methylation on the TC-associated T2DM was estimated. Each 1-unit increase in TCS levels was associated with a 13.2% increase in the risk of T2DM (OR = 1.132, 95% CI: 1.062, 1.207). A linear dose-response relationship was found between TCS and T2DM. TCS was negatively associated with Chr17:76356190 methylation. Moreover, mediation analysis revealed that Chr17:76356190 methylation mediated 14.54% of the relationship between TCS exposure and T2DM. Exposure to TCS was associated with a higher prevalence of T2DM. SOCS3 methylation partially mediated the association of TCS with T2DM. Our findings may provide new insights into the treatment of T2DM, and the study of the biological mechanisms of T2DM.

Integrating transcriptomics and proteomics to understand the molecular mechanisms underlying the pathogenesis of type 2 diabetes mellitus

The liver plays an important role in glucose regulation, and their dysfunction is closely associated with the development of type 2 diabetes mellitus (T2DM), and insulin resistance (IR) in hepatocyte mediate the pathogenesis of diabetes mellitus. In T2DM rats and their correlated control, we investigated various genes expression at transcriptional and translational level by utilizing transcriptomic using RNA sequencing (RNA-seq) and proteomics using isobaric tags for relative and absolute quantification (iTRAQ) to disclose potential candidates for Type 2 diabetes diagnosis and therapy. We found the lecithin retinol acyltransferase (Lrat) gene regulate hepatocyte IR in T2DM. Furthermore, BRL-3A cells, rat liver cells, worked as the IR model in vitro study. Hence, Lrat gene was overexpressed in BRL-3A cells to explore the role of Lrat gene in IR by measuring the cellular glucose consumption, TCHO, and LDL-C levels. Finally, we found that Lrat gene can improve the level of glycolipid metabolism in BRL-3A cells and reduce the degree of IR in BRL-3A cells. Therefore, further exploration of Lrat gene related molecular mechanism is meaningful.

Evaluation of Bayesian Linear Regression models for gene set prioritization in complex diseases

Genome-wide association studies (GWAS) provide valuable insights into the genetic architecture of complex traits, yet interpreting their results remains challenging due to the polygenic nature of most traits. Gene set analysis offers a solution by aggregating genetic variants into biologically relevant pathways, enhancing the detection of coordinated effects across multiple genes. In this study, we present and evaluate a gene set prioritization approach utilizing Bayesian Linear Regression (BLR) models to uncover shared genetic components among different phenotypes and facilitate biological interpretation. Through extensive simulations and analyses of real traits, we demonstrate the efficacy of the BLR model in prioritizing pathways for complex traits. Simulation studies reveal insights into the model's performance under various scenarios, highlighting the impact of factors such as the number of causal genes, proportions of causal variants, heritability, and disease prevalence. Comparative analyses with MAGMA (Multi-marker Analysis of GenoMic Annotation) demonstrate BLR's superior performance, especially in highly overlapped gene sets. Application of both single-trait and multi-trait BLR models to real data, specifically GWAS summary data for type 2 diabetes (T2D) and related phenotypes, identifies significant associations with T2D-related pathways. Furthermore, comparison between single- and multi-trait BLR analyses highlights the superior performance of the multi-trait approach in identifying associated pathways, showcasing increased statistical power when analyzing multiple traits jointly. Additionally, enrichment analysis with integrated data from various public resources supports our results, confirming significant enrichment of diabetes-related genes within the top T2D pathways resulting from the multi-trait analysis. The BLR model's ability to handle diverse genomic features, perform regularization, conduct variable selection, and integrate information from multiple traits, genders, and ancestries demonstrates its utility in understanding the genetic architecture of complex traits. Our study provides insights into the potential of the BLR model to prioritize gene sets, offering a flexible framework applicable to various datasets. This model presents opportunities for advancing personalized medicine by exploring the genetic underpinnings of multifactorial traits.

Computed tomography-based body composition indicative of diabetes after hypertriglyceridemic acute pancreatitis

BACKGROUND

Post‑acute pancreatitis prediabetes/diabetes mellitus (PPDM‑A) is one of the common sequelae of acute pancreatitis (AP). The aim of our study was to build a machine learning (ML)-based prediction model for PPDM-A in hypertriglyceridemic acute pancreatitis (HTGP).

METHODS

We retrospectively enrolled 165 patients for our study. Demographic and laboratory data and body composition were collected. Multivariate logistic regression was applied to select features for ML. Support vector machine (SVM), linear discriminant analysis (LDA), and logistic regression (LR) were used to develop prediction models for PPDM-A.

RESULTS

65 patients were diagnosed with PPDM-A, and 100 patients were diagnosed with non-PPDM-A. Of the 84 body composition-related parameters, 15 were significant in discriminating between the PPDM-A and non-PPDM-A groups. Using clinical indicators and body composition parameters to develop ML models, we found that the SVM model presented the best predictive ability, obtaining the best AUC=0.796 in the training cohort, and the LDA and LR model showing an AUC of 0.783 and 0.745, respectively.

CONCLUSIONS

The association between body composition and PPDM-A provides insight into the potential pathogenesis of PPDM-A. Our model is feasible for reliably predicting PPDM-A in the early stages of AP and enables early intervention in patients with potential PPDM-A.

Uncovering the hidden burden: A mixed methods study on the implementation of depression screening among persons with type 2 diabetes mellitus seeking health care in an urban primary health center of South India

BACKGROUND

Diabetes is linked with depression, but screening rates for depression are low, indicating a need for periodic assessments among those with diabetes. The study aimed to determine depression prevalence and associated factors in persons with type 2 diabetes mellitus (T2DM) in an urban primary care setting of Karnataka, as well as implementation challenges in depression screening for persons with T2DM as perceived by healthcare providers.

MATERIAL AND METHODS

A mixed-methods study was performed for 6 months in 2022-2023 at an Urban Primary Health Centre (UPHC) in Bengaluru. The sample size was calculated to be 110, and convenience sampling was applied to select persons with T2DM. The participants were screened for depression using Patient Health Questionnaire-9. Key informant interviews were performed among various health care providers of the UPHC. Data were captured using EpiCollect Version 5.0. Univariate logistic regression was performed to find the factors associated with depression.

RESULT

Of the 110 participants, 60 (54.5%) screened positive for depression. Men had 0.474 (95% Confidence Intervals-CI: 0.126, 1.782) lesser odds of depression when compared with women (P = 0.269). Those with comorbidities had 1.975 more odds (95% CI: 0.538, 7.252) when compared with absence of comorbidities (P = 0.305). Statistically significant associations were not found with any of the factors. Key facilitators for screening were willingness to implement screening, empathetic attitude, and awareness of mental health, whereas the challenges included lack of training in mental health assessment and patient reluctance to adhere to treatment due to stigma.

CONCLUSION

The study found that 54.5% of persons with T2DM seeking heath care at the UPHC screened positive for depression. Several challenges in implementing depression screening for T2DM in primary care settings were noted.