Diabetes and Hypertension: Epidemiology of the Relationship and Pathophysiology of Factors Associated With These Comorbid Conditions

Unveiling the twin epidemics of hypertension and diabetes: a cross-sectional analysis of sex-specific prevalence, risk, and hotspots in India's epidemiological transition zones

BACKGROUND

The prevalence of hypertension and diabetes, which often coexist and significantly contribute to the burden of noncommunicable diseases (NCDs), is increasing in India. This study examines the sex-stratified prevalence, coexistence, and bidirectional risks of hypertension and diabetes across states with varying epidemiological transition levels (ETLs) and identifies high-burden hotspots.

METHODS

This study analysed data from the fifth round of the National Family Health Survey, covering 614,426 women and 556,199 men aged 30 years and above, with biomarker information on both diabetes and hypertension. The age-standardized prevalence was estimated, and adjusted risk ratios (ARRs) were obtained on multivariate logit scale. Bivariate maps, spatial autocorrelation and hotspot analyses were conducted using ArcGIS Pro to identify geographic clusters associated with twin epidemics.

RESULTS

Individuals diagnosed with hypertension or diabetes were, on average, nearly a decade older than those without. Hypertension prevalence was 30.3% (95%CI:30.14-30.48) among men and 28.6% (95%CI:28.47-28.79) among women, whereas diabetes prevalence was at 19.7% (95%CI:19.58-19.88) in men and 17.4% (95%CI:17.22-17.50) in women. Among individuals with diabetes, 43.1% (95%CI:42.67-43.53) of men and 43.9% (95%CI:43.48-44.36) of women had hypertension, whereas 28.1% (95%CI:27.75-28.37) of hypertensive men and 26.6% (95%CI:26.33-26.93) of hypertensive women were diabetic. Hotspots for twin epidemics were identified in coastal regions, including the southern states with high ETLs, as well as the northern states with high-ETLs and the country's northeastern region. ARR estimates revealed that the risk of hypertension among individuals with diabetes was 39% higher (95%CI:1.38-1.40) in men and 41% higher (95%CI:1.39-1.42) in women than in individuals without diabetes. Similarly, the risk of diabetes among individuals with hypertension was 51% higher (95%CI:1.49-1.52) in men and 55% higher (95%CI:1.53-1.57) in women than in individuals without hypertension.

CONCLUSION

Our findings highlight the progressive nature of the twin epidemics of diabetes and hypertension, with an increased risk of onset associated with advanced age. The presence of one condition substantially elevates the likelihood of developing the other, highlighting their bidirectional relationship. Achieving Sustainable Development Goal target 3.4 requires addressing these intersecting epidemics as a unified entity for effective management. Targeted interventions should prioritise high-burden hotspots for integrated care strategies to mitigate the twin epidemics of diabetes and hypertension.

Pilot-Scale Production of Sericin-Derived Oligopeptides (SDOs) from Yellow Silk Cocoons: Peptide Characterization and Specifications

Our previous research demonstrated the health benefits of sericin-derived oligopeptides (SDOs) from yellow silk cocoons, particularly their hypoglycemic and antihypertensive properties. This study aims to produce SDOs at a pilot scale, preparing them for large commercial production as a novel food ingredient, and investigates the impact of scale-up on their characteristics and specifications. We compared the productivity of SDOs generated from 25 L and 300 L batches via the hydrolysis of sericin using 5% Neutrase (E/S) at 50 °C for 4 h. The 300 L production scale outperformed the 25 L scale, achieving a hydrolysis degree (DH) of 8.63%, a solid recovery rate of 94.35%, and enhanced inhibitory actions for dipeptidyl peptidase IV (DPP-IV) and angiotensin-converting enzyme (ACE). The characterization of peptides was carried out in ultrafiltered SDOs. Peptides < 3 kDa demonstrated optimal enzyme inhibition and were then fractionated by size exclusion chromatography into nine distinct fractions. Of the nine fractions, F1, F8, and F9 had significant enzyme inhibitory activity. LC-MS/MS analysis revealed 32 unique peptide sequences, with YPDLPYH exhibiting significant dual inhibitory effects on both DPP-IV (IC50 1.35 mM) and ACE (IC50 18.10 μM). The maximum residue limit (MRL) for trace metals, pesticide residues, and microbiological contamination in SDOs complies with food regulations. SDOs exhibited stability at 4, 25, and 45 °C for six months, based on their physical characteristics and biological activity. Considering their investigated characteristics, SDOs could be manufactured at a pilot capacity and used as a functional food component in commercial applications designed to improve metabolic health.

Inhibitory Mechanism of Camellianin A against α-Glucosidase: In Vitro and Molecular Simulation Studies

α-Glucosidase is an important target for type II diabetes treatment, and the search for natural α-glucosidase inhibitors is currently a hot topic in functional food research. Camellianin A is the main flavonoid in the leaves of Adinandra nitida, but research on its inhibition of α-glucosidase is rarely reported. In view of this, the present study systematically investigated the inhibitory impact of camellianin A on α-glucosidase, combining the fluorescence method and molecular docking to explore their interaction, aiming to reveal the relevant inhibitory mechanism. The results indicated that camellianin A possessed excellent α-glucosidase inhibitory activity (IC50, 27.57 ± 0.59 μg/mL), and van der Waals force and hydrogen bonding dominated the binding process between camellianin A and α-glucosidase, with a binding-site number of 1. A molecular docking experiment suggested that camellianin A formed hydrogen bonding with Glu771, Trp391, Trp710, Gly566, Asp568, and Phe444 of α-glucosidase, consistent with the thermodynamic result. Our result can provide a reference for the development of natural α-glucosidase inhibitors.

Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus

PURPOSE

This study aimed to analyze the clinical characteristics, pathogen distribution, drug sensitivity, and antibiotic treatment strategies of patients with neck abscesses with or without diabetes.

METHODS

A retrospective analysis was conducted on 2194 patients who underwent neck abscess surgery at our hospital over the past 13 years. Patients were grouped as NAwithDM (neck abscess with diabetes mellitus) or NAwithoutDM (neck abscess without diabetes mellitus). Clinical features, pathogen distribution, and antibiotic sensitivity were compared between the groups. Venn diagrams were used to illustrate the antibiotics effective against all three predominant pathogens.

RESULTS

A total of 2194 patients with neck abscesses were included in this study, with 579 patients (26.43%) in the NAwithDM group and 1612 patients (73.51%) in the NAwithoutDM group. There were no significant differences in sex or age distribution between the two groups (all P > 0.05). However, there were significant differences in BMI, length of hospital stays, occurrence of laryngeal obstruction, hypertension, and hypoalbuminemia between the two groups (all P < 0.05). In the NAwithoutDM group, the top three pathogens were Streptococcus constellatus, Klebsiella pneumoniae, and Staphylococcus aureus. The antibiotics that were simultaneously effective against all three pathogens were ceftriaxone, moxifloxacin, and ampicillin/sulbactam. In the NAwithDM group, the top three pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus constellatus. The antibiotics that were simultaneously effective against all three pathogens were compound sulfamethoxazole, cefuroxime, levofloxacin, ciprofloxacin, vancomycin, and imipenem.

CONCLUSION

Neck abscess patients with diabetes have distinct clinical features. Therefore, it is crucial to pay attention to these clinical features and manage them accordingly during the treatment process. Empirical antibiotic treatment should be tailored to individual patient groups. Sulfamethoxazole-methoxazole is recommended for neck abscess patients with diabetes, while ceftriaxone or moxifloxacin is recommended for those without diabetes.

Diabetes management, dietary supplements use and the effect of coronavirus pandemic on diabetes patients in Serbia: a cross-sectional study

OBJECTIVES

Diabetes mellitus (DM) is a significant public health challenge in Serbia, mirroring the situation in other European middle-income countries. The aims of this study were to examine the disease-related characteristics and management of diabetes, as well as the prevalence of use of dietary supplements (DS) among diabetes patients in Serbia, and to analyze the effects of the coronavirus pandemic on DM patients in Serbia.

METHODS

The study was carried out as an online, observational, cross-sectional study involving 422 adult diabetes type 1 (DM1) and type 2 (DM2) patients residing in Serbia.

RESULTS

DM1 patients were more likely than DM2 patients to self-control glucose levels (p < 0.001). Almost one-third of DM2 patients (31.4%) did not know their HbA1c value. Polypharmacy has been reported by 9.7% of DM1 patients and 23.5% of DM2 patients. During the coronavirus pandemic increased anxiety levels for one-third of respondents was noticed. The prevalence of DS use among DM patients was very high (95.3%), with vitamin C, zinc, vitamin D and magnesium being the most commonly used. Women were more likely to use vitamin D (p = 0.001) and magnesium DS (p = 0.005) than men. Most patients (76.9%) faced limited access to healthcare services during the coronavirus pandemic with, sometimes, detrimental consequences. A significant portion of respondents (41.2%) consulted a pharmacist more often in 2021 than in previous years.

CONCLUSIONS

Special caution is needed regarding the potential interactions of DS with chronic therapy. To enhance diabetes care, Serbia needs more accessible mental health support, improved diabetes education, expanded CGM availability, and carefully planned emergency healthcare measures for chronic patients.

A Retrospective Cohort Study of the Association Between Calcium Serum Level and Hypertension in Older Adults

INTRODUCTION

 One of the major global risk factors for cardiovascular morbidity and death is hypertension. Earlier research has been conducted on the connection between calcium consumption and blood pressure.

OBJECTIVE

This study aims to investigate the association between calcium serum levels and hypertension in older hypertensive adults.

METHODS

 A retrospective cohort study of 121 of hypertension patients was conducted in Prince Faisal Bin Khalid Cardiac Center. The data of all patients were collected by records, including lab, pathology, and medical review, in order to determine the effects on patients, providers, and institutions. Statistical analyses were performed using SPSS Statistics version 26.0. A p-value of <0.05 was considered statistically significant.

RESULTS

 The study included 121 adult hypertensive patients with a mean of age 60.29 ± 13.92. The majority of included patients were male (81%). More than one-third of patients were obese (39.7%), about one-third (33.9%) were overweight, and 26.4% of patients were in normal weight. The majority of patients had co-morbidities (68.3%); about one-half of them had diabetes mellitus (52.1%). The calcium level mean was 5.07 ± 1.26. The creatine kinase (CK) (initial day) mean ± SD was 813.22 ± 1146.37 became 221.4 ± 330.67 on the last day. The CK-myocardial band (CK-MB) (initial day) was 65.43 ± 118.9 and became 24.38 ± 23.26 on the last day. Additionally, the troponin (initial day) mean was 23.49 ± 104.26 and became 1.65 ± 2.66 on the last day. The most common discharge medications were anti-platelets (95%), beta-blockers (78.5%), statins (70.2%), and proton-pump inhibitors (PPI) (64.5%). The hospital stay days ranged from 1 to 20 days with a mean of 4.83 ± 3.38. The ICU stay days ranged from 1 to 15 days with a mean of 3.57 ± 2.72. Most of the patients (90.9%) improved.

CONCLUSION

There is no significant correlation between calcium levels in hypertensive patients and the demographic characteristics of patients, home or current medications, ECHO findings, or procedures done. However, there is a significant correlation between the calcium level and CK level among patients with hypertension. Further investigations are required to verify the relationship between CK and calcium levels in hypertensive patients.

Evaluation of the multifunctional dipeptidyl-peptidase IV and angiotensin converting enzyme inhibitory properties of a casein hydrolysate using cell-free and cell-based assays

The objective of the study was the evaluation of the potential pleiotropic effect of a commercial casein hydrolysate (CH). After an analysis of the composition, the BIOPEP-UWM database suggested that these peptides contained numerous sequences with potential inhibitory activities on angiotensin converting enzyme (ACE) and dipeptidyl-peptidase IV (DPP-IV). The anti-diabetic and anti-hypertensive effects of these peptides were thus assessed using either cell-free or cell-based assays. In the cell-free system, CH displayed inhibitory properties against DPP-IV (IC₅₀ value equal to 0.38 ± 0.01 mg/mL) and ACE (IC₅₀ value equal to 0.39 ± 0.01 mg/mL). Further, CH reduced the DPP-IV and ACE activities expressed by human intestinal Caco-2 cells by 61.10 ± 1.70% and 76.90 ± 4.47%, respectively, versus untreated cells, after 6 h of treatment at the concentration of 5 mg/mL. This first demonstration of the multifunctional behavior of this material suggests that it may become an anti-diabetic and/or anti-hypertensive ingredient to be included in the formulation of different functional food or nutraceutics.

Exogenous H2S Attenuates Hypertension by Regulating Renin Exocytosis under Hyperglycaemic and Hyperlipidaemic Conditions

Obesity, along with type 2 diabetes mellitus (T2DM), is a major contributor to hypertension. The renin-angiotensin-aldosterone system is involved in the occurrence of diabetes and hypertension. However, the mechanism by which obesity is related to T2DM induced hypertension is unclear. In this study, we observed that blood pressure and serum renin content were increased in patients with diabetes and hypertension. Hydrogen sulfide (H₂S), as an endogenous bioactive molecule, has been shown to be a vasodilator. Db/db mice, characterized by obesity and T2DM, and juxtaglomerular (JG) cells, which line the afferent arterioles at the entrance of the glomeruli to produce renin, treated with glucose, palmitic acid (PA) and oleic acid (OA), were used as animal and cellular models. NaHS, the H₂S donor, was administered to db/db mice through intraperitoneal injection. NaHS significantly alleviated blood pressure in db/db mice, decreased the renin content in the serum of db/db mice and reduced renin secretion from JG cells. NaHS modulated renin release via cAMP and soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs), including synaptosome-associated protein 23 (SNAP23) and vesicle-associated membrane protein 2 (VAMP2), which mediate renin exocytosis. Furthermore, NaHS increased the levels of autophagy-related proteins and colocalization with EGFP-LC3 puncta with renin-containing granules and VAMP2 to consume excessive renin to maintain intracellular homeostasis. Therefore, exogenous H₂S attenuates renin release and promotes renin-vesicular autophagy to relieve diabetes-induced hypertension.

Evaluation of Morphological Changes in Retinal Vessels in Type 1 Diabetes Mellitus Patients with the Use of Adaptive Optics

Introduction. Diabetes mellitus contributes to the development of microvascular complications in the eye. Moreover, it affects multiple end organs, including brain damage, leading to premature death. The use of adaptive optics technique allows to perform non-invasive in vivo assessment of retinal vessels and to identify changes in arterioles about 100 μm in diameter. The retinal vasculature may be a model of the cerebral vessels both morphologically and functionally. Aim. To evaluate morphological parameters of retinal arterioles in patients with type 1 diabetes mellitus (DM1). Material and methods. The study included 22 DM1 patients (13 females) aged 43.00 ± 9.45 years with a mean diabetes duration of 22.55 ± 10.05 years, and 23 healthy volunteers (10 females) aged 41.09 ± 10.99 years. Blood pressure, BMI, waist circumference, and metabolic control markers of diabetes were measured in both groups. Vascular examinations were performed using an rtx1 adaptive optics retinal camera (Imagine Eyes, Orsay, France); the vessel wall thickness (WT), lumen diameter (LD), wall-to-lumen ratio (WLR), and vascular wall cross-sectional area (WCSA) were assessed. Statistical analysis was performed with the application of IMB SPSS version 23 software. Results. The DM1 group did not differ significantly in age, BMI, waist circumference, blood pressure, or axial length of the eye compared to the control group. Intraocular pressure (IOP) in both groups was normal, but in the DM1 group it was significantly higher. The DM1 group had significantly higher WT, WLR, and WCSA. These parameters correlated significantly with the duration of diabetes, but not with IOP. Conclusions. The presented study demonstrates the presence of significant morphological changes in retinal vessels in DM1 patients without previously diagnosed diabetic retinopathy. Similar changes may occur in the brain and may be early indicators of cardiovascular risk, but further investigation is required to confirm that.

Trends in the prevalence and associated factors of prediabetes and diabetes in Bangladesh: Evidence from population-based cross-sectional surveys

AIMS

Diabetes is a major health problem in Bangladesh, but nationally representative studies on its trends and associated factors are scarce to guide policy formulation. Therefore, the study aims to determine trends in the prevalence and associated factors of prediabetes and diabetes in Bangladesh.

METHODS

The study included two population-based cross-sectional surveys from Bangladesh Demographic and Health Survey (n = 7,505 in 2011 and n = 11,959 in 2017-18). Chi-square association tests were performed to determine the associated factors. Logistic regression models (univariate and multivariable) were used to estimate unadjusted and adjusted relative risks of having diabetes, reported with odds ratios. Age-adjusted prevalence was also reported for both surveys.

RESULTS

The overall age-adjusted prevalence of prediabetes and diabetes decreased from 52.77% (95% CI: 52.61-52.92) and 10.43% (95% CI: 10.33-10.53) in 2011 to 34.10% (95% CI: 33.43-34.78) and 8.50% (95% CI: 8.11-8.90) in 2017-18. Compared to males, females had a higher odds of diabetes in 2011, but in 2017-18 a significant inverse result was observed. In both surveys, the odds of prediabetes and diabetes increased with advancing age, obesity, better wealth status, and hypertension.

CONCLUSION

The study shows that the prevalence of prediabetes and diabetes is high in Bangladesh despite decreasing trends. Therefore, the study recommends promoting healthy lifestyles and regular screening for non-communicable diseases.

Glycemic status, non-traditional risk and left ventricular structure and function in the Jackson Heart Study

BACKGROUND

Left ventricular structure and function abnormalities may be an early marker of cardiomyopathy among African Americans with diabetes (DM) even in the absence of coronary artery disease (CAD), arrhythmia, valvular heart disease and end-stage renal disease (ESRD). This study examined the association of prediabetes (PDM), DM and HbA1c with left ventricular structure and function among Jackson Heart Study (JHS) participants without traditional risk factors.

METHODS

Retrospective cross-sectional analyses of the association of PDM, DM and HbA1c with, left ventricular ejection fraction (LV EF), fractional shortening (LV FS), stroke volume index (SVI), cardiac index (CI), left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), relative wall thickness (RWT), myocardial contraction fraction (MCF) and left ventricular mass index (LVMI). The study was conducted in 2234 adult JHS participants without preexisting CAD, arrhythmia, valvular heart disease or ESRD. Statistical analyses included descriptive, univariate and covariate adjusted linear regression analyses. Sensitivity analyses to explore the impact of hypertension on study outcomes were also carried out.

RESULTS

DM compared with no DM was associated with lower, SVI (- 0.96 ml/m2, p = 0.029), LVEDVI (- 1.44 ml/m2 p = 0.015), and MCF (- 1.90% p = 0.007) but higher CI (0.14 L/min/m2, p < 0.001), RWT (0.01 cm, p = 0.002) and LVMI (2.29 g/m2, p = 0.009). After further control for DM duration, only CI remaining significantly higher for DM compared with no DM participants (0.12 L/min/m2, p = 0.009). PDM compared with no PDM was associated with lower, SVI (- 0.87 ml/m2, P = 0.024), LVEDVI (- 1.15 ml/m2 p = 0.003) and LVESVI (- 0.62 ml/m2 p = 0.025). HbA1c ≥ 8.0% compared with HbA1c < 5.7% was associated with lower SVI (- 2.09 ml/m2, p = 0.004), LVEDVI (- 2.11 ml/m2 p = 0.032) and MCF (- 2.94% p = 0.011) but higher CI (0.11 L/min/m2, p = 0.043) and RWT (0.01 cm, p = 0.035).

CONCLUSIONS

Glycemic status is associated with important left ventricular structure and function changes among African Americans without prior CAD, arrhythmia, valvular heart disease and ESRD. Longitudinal studies may further elucidate these relationships.

How Perturbated Metabolites in Diabetes Mellitus Affect the Pathogenesis of Hypertension?

The presence of hypertension (HTN) in type 2 diabetes mellitus (DM) is a common phenomenon in more than half of the diabetic patients. Since HTN constitutes a predictor of vascular complications and cardiovascular disease in type 2 DM patients, it is of significance to understand the molecular and cellular mechanisms of type 2 DM binding to HTN. This review attempts to understand the mechanism via the perspective of the metabolites. It reviewed the metabolic perturbations, the biological function of perturbated metabolites in two diseases, and the mechanism underlying metabolic perturbation that contributed to the connection of type 2 DM and HTN. DM-associated metabolic perturbations may be involved in the pathogenesis of HTN potentially in insulin, angiotensin II, sympathetic nervous system, and the energy reprogramming to address how perturbated metabolites in type 2 DM affect the pathogenesis of HTN. The recent integration of the metabolism field with microbiology and immunology may provide a wider perspective. Metabolism affects immune function and supports immune cell differentiation by the switch of energy. The diverse metabolites produced by bacteria modified the biological process in the inflammatory response of chronic metabolic diseases either. The rapidly evolving metabolomics has enabled to have a better understanding of the process of diseases, which is an important tool for providing some insight into the investigation of diseases mechanism. Metabolites served as direct modulators of biological processes were believed to assess the pathological mechanisms involved in diseases.

Profile of diabetes patients' chronic illness care in India and its role in their adherence

BACKGROUND AND AIMS

Negligence of illness care in terms of non-adherence may give rise to serious health outcomes in patients with type 2 diabetes mellitus. Considering the importance of both chronic illness care and adherence, the primary purpose of the study is to explore the profile of diabetic patients' chronic illness care and examine its role in their clinical adherence. In addition to this, we have also investigated the major confounding variables in understanding the chronic illness care of diabetic patients.

METHODS

We have conducted this study using a simple retrospective design with one group involving the patients primarily diagnosed with type 2 diabetes (N = 200) in India.

RESULTS

The cluster analysis (k-Means) has yielded three clusters on the basis of five domains of chronic illness care-patient activation, delivery system design, goal setting, problem solving, and follow-up/coordination. The findings further reveal that the profile of chronic illness care plays a significant role in deciding the clinical adherence of patients with type 2 diabetes. The three clusters of diabetes patients, however, are confounded by health risk behaviour.

CONCLUSIONS

These initial findings are suggestive of an association between chronic illness care, clinical adherence, and health risk behaviour of patients with type 2 diabetes. More research on this topic, however, needs to be undertaken involving other important dimensions of health care system like patient-provider relationship and quality of life during hospitalisation. The implications and shortcomings are discussed.

Social Anxiety Symptoms and Quality of Life of Secondary School Students of Abha, Saudi Arabia

Interest in social anxiety disorder has grown substantially over the past few decades. Most of the available data from United States and European countries emphasized its high prevalence, comorbidity and morbidity and its association with occupational, educational, social affairs, stress, depression and substance use disorder contributing to poor quality of life. Present study was aimed to assess the social anxiety symptoms and to explore its impact on quality of life of secondary school students. Present study included male (n = 200) and female (n = 200) students enrolled at government secondary schools, Abha, Saudi Arabia. Arabic version of Social Phobia Inventory (SPIN) and World Health Organization Quality of Life Questionnaire (WHOQOL) were implemented to assess the social anxiety symptoms and quality of life of the students. Results revealed that 45% of the students showed social anxiety symptoms. Associated factors were younger age, chronic diseases, parent's status, parent's occupation and income. Quality of life was found significantly lower in students with social anxiety symptoms as compared to the students without symptoms. We suggest that the school health program should include routine screening of students for social anxiety disorder. Students diagnosed with social anxiety symptoms should be promptly managed and their quality of life should be improved.

In Silico and In Vitro Assessment of Portuguese Oyster (Crassostrea angulata) Proteins as Precursor of Bioactive Peptides

In this study, the potential bioactivities of Portuguese oyster (Crassostrea angulata) proteins were predicted through in silico analyses and confirmed by in vitro tests. C. angulata proteins were characterized by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and identified by proteomics techniques. Hydrolysis simulation by BIOPEP-UWM database revealed that pepsin (pH > 2) can theoretically release greatest amount of bioactive peptides from C. angulata proteins, predominantly angiotensin I-converting enzyme (ACE) and dipeptidyl peptidase IV (DPP-IV) inhibitory peptides, followed by stem bromelain and papain. Hydrolysates produced by pepsin, bromelain and papain have shown ACE and DPP-IV inhibitory activities in vitro, with pepsin hydrolysate (PEH) having the strongest activity of 78.18% and 44.34% at 2 mg/mL, respectively. Bioactivity assays of PEH fractions showed that low molecular weight (MW) fractions possessed stronger inhibitory activity than crude hydrolysate. Overall, in vitro analysis results corresponded with in silico predictions. Current findings suggest that in silico analysis is a rapid method to predict bioactive peptides in food proteins and determine suitable enzymes for hydrolysis. Moreover, C. angulata proteins can be a potential source of peptides with pharmaceutical and nutraceutical application.

Angiotensin-converting enzyme inhibitors attenuated advanced glycation end products-induced renal tubular hypertrophy via enhancing nitric oxide signaling

Advanced glycation end products (AGE) and angiotensin II were closely correlated with the progression of diabetic nephopathy (DN). Nitric oxide (NO) is a protective mediator of renal tubular hypertrophy in DN. Here, we examined the molecular mechanisms of angiotensin-converting enzyme inhibitor (ACEI) and NO signaling responsible for diminishing AGE-induced renal tubular hypertrophy. In human renal proximal tubular cells, AGE decreased NO production, inducible NOS activity, guanosine 3',5'-cyclic monophosphate (cGMP) synthesis, and cGMP-dependent protein kinase (PKG) activation. All theses effects of AGE were reversed by treatment with ACEIs (captopril and enalapril), the NO donor S-nitroso-N-acetylpenicillamine (SNAP), and the PKG activator 8-para-chlorophenylthio-cGMPs (8-pCPT-cGMPs). In addition, AGE-enhanced activation of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 mitogen-activated protein kinase (MAPK) were clearly reduced by captopril, enalapril, SNAP, and 8-pCPT-cGMPs. The abilities of ACEIs and NO/PKG activation to inhibit AGE-induced hypertrophic growth were verified by the observation that captopril, enalapril, SNAP, and 8-pCPT-cGMPs decreased protein levels of fibronectin, p21 ^Waf1/Cip1 , and receptor for AGE. The results of the present study suggest that ACEIs significantly reduced AGE-increased ERK/JNK/p38 MAPK activation and renal tubular hypertrophy partly through enhancement of the NO/PKG pathway.

Mortality and Macrovascular Risk in Elderly With Hypertension and Diabetes: Effect of Intensive Drug Therapy

BACKGROUND

This study identifies the effect of intensive drug therapy (IDT) in individuals age 65+ with diabetes (type 2 diabetes mellitus (T2D)) and hypertension on all-cause death, congestive heart failure (CHF), hospitalization for myocardial infarction (MI), and stroke or transient ischemic attack (TIA).

METHODS

Individuals from the Medicare 5% dataset with hypertension and T2D undergoing IDT for these conditions were propensity score matched to a nonintensive drug-therapy group. Hazard ratios (HRs) were obtained using the Cox proportional hazard model.

RESULTS

IDT was associated with increased risk of CHF (HR 2.32; 95% confidence interval (CI) 2.32-2.38), MI (HR 4.27; 95% CI 4.05-4.52), and stroke or TIA (HR 1.80; 95% CI 1.70-1.89) but decreased risk of death (HR 0.95; 95% CI 0.93-0.97). Risk for CHF (HR 0.73; 95% CI 0.71-0.73), MI (HR 0.64; 95% CI 0.62-0.67), stroke or TIA (HR 0.82; 95% CI 0.78-0.86), and death (HR 0.29; 95% CI 0.28-0.29) was decreased by adherence to diabetes management guidelines.

CONCLUSIONS

Use of IDT in a high-risk population delays death but not severe macrovascular outcomes. Protective effects of IDT in high-risk patients likely outweigh polypharmacy-related health concerns.

Annual Total Medical Expenditures Associated with Hypertension by Diabetes Status in U.S. Adults

INTRODUCTION

Hypertension and diabetes, both independent risk factors for cardiovascular disease, often coexist. The hypertension-increased medical expenditures by diabetes status is unclear, however. This study estimated annual total medical expenditures in U.S. adults by hypertension and diabetes status.

METHODS

The study population consisted of 40,746 civilian, non-institutionalized adults aged ≥18 years who participated in the 2013 or 2014 Medical Expenditure Panel Survey. The authors separately estimated hypertension-increased medical expenditures using two-part econometric and generalized linear models for the total; diabetes (n=4,396); and non-diabetes (n=36,250) populations and adjusted the results into 2014 U.S. dollars. Data were analyzed in 2017 and estimated the hypertension-increased medical expenditures by type of medical service and payment source.

RESULTS

The prevalence of hypertension was 34.9%, 78.3%, and 30.1% for the total, diabetes, and non-diabetes populations, respectively. The respective mean unadjusted annual per capita medical expenditures were $5,225, $12,715, and $4,390. After controlling for potential confounders, hypertension-increased expenditures were $2,565, $4,434, and $2,276 for total, diabetes, and non-diabetes populations, respectively (all p<0.001). The hypertension-increased expenditure was highest for inpatient stays among the diabetes population ($1,730, p<0.001), and highest for medication among the non-diabetes population ($687, p<0.001). By payment source, Medicare ranked first in hypertension-increased expenditures for the diabetes ($2,753) and second for the non-diabetes ($669) populations (both p<0.001).

CONCLUSIONS

Hypertension-increased medical expenditures were substantial and varied by medical service type and payment sources. These findings may be useful as inputs for cost- effectiveness evaluations of hypertension interventions by diabetes status.

Prevalence and determinants of comorbid diabetes and hypertension: Evidence from non communicable disease risk factor STEPS survey, India

PROBLEM STATEMENT

Comorbidity of non-communicable diseases carries a significant risk of cardiovascular events and mortality. With the rising burden of diabetes, hypertension and other risk factors, and ageing population in India, this is likely to pose a major threat to the health system. It is therefore essential to understand this high risk group. This article reports prevalence of comorbid diabetes and hypertension and its associated risk factors in the North Indian state of Punjab.

METHODS

A household NCD STEPS survey was done in Punjab, India in a multistage stratified sample of 5127 individuals. All the subjects were administered the WHO STEPS questionnaire, anthropometric and blood pressure measurements. Every alternate respondent in the sample (n=2499) were assayed for blood glucose and lipid parameters.

RESULTS

The prevalence of comorbid DM and HTN was 4.5% in the general adult population. DM, HTN and dyslipidemia co-existed in 1.8% of the population. Obesity and dyslipidemia are the most common comorbidities among persons with DM and HTN alone and comorbid DM and HTN. Factors strongly associated with comorbid DM and HTN include elderly age group, dyslipidemia, obesity and family history of DM.

CONCLUSIONS

The study reported high burden of comorbid diabetes and hypertension among the elderly, strongly associated with obesity and dyslipidemia. This emphasizes the role of nonpharmacological intervention such as weight reduction, physical activity, and dietary modification.

Glycaemic control and excess risk of major coronary events in persons with type 1 diabetes

OBJECTIVE

The excess risk of major coronary events (acute myocardial infarction (AMI) or death from coronary heart disease (CHD)) in individuals with type 1 diabetes (T1D) in relation to glycaemic control and renal complications is not known.

METHODS

Individuals with T1D in the Swedish National Diabetes Registry after 1 January 1998, without a previous MI (n=33 170) and 1 64 698 controls matched on age, sex and county were followed with respect to non-fatal AMI or death from CHD. Data were censored at death due to any cause until 31 December 2011.

RESULTS

During median follow-up of 8.3 and 8.9 years for individuals with T1D and controls, respectively, 1500 (4.5%) and 1925 (1.2%), experienced non-fatal AMI or died from CHD, adjusted HR 4.07 (95% CI 3.79 to 4.36). This excess risk increased with younger age, female sex, worse glycaemic control and severity of renal complications.The adjusted HR in men with T1D with updated mean haemoglobin A1c (HbA1c) <6.9% (52 mmol/mol) and normoalbuminuria was 1.30 (95% CI 0.90 to 1.88) and in women 3.16 (95% CI 2.14 to 4.65). HRs increased to 10.7 (95% CI 8.0 to 14.3) and 31.8 (95% CI 23.6 to 42.8) in men and women, respectively, with HbA1c >9.7% and renal complications.

CONCLUSIONS

The excess risk of AMI in T1D is substantially lower with good glycaemic control, absence of renal complications and men compared with women. In women, the excess risk of AMI or CHD death persists even among patients with good glycaemic control and no renal complications.

Bioactive peptides from Atlantic salmon (Salmo salar) with angiotensin converting enzyme and dipeptidyl peptidase IV inhibitory, and antioxidant activities

The pH shift method was utilised for the recovery of proteins from salmon trimmings (ST), yielding 93% (w/w) protein. ST protein (STP) hydrolysates were generated with different enzyme preparations. STP incubated with Corolase PP for 1h (STP-C1) had the most potent angiotensin converting enzyme (ACE) and dipeptidyl peptidase IV (DPP-IV) inhibitory and oxygen radical absorbance capacity (ORAC) activities. Analysis of fractions of STP-C1 using UPLC-MS/MS identified sixteen peptides/amino acids. Tyr-Pro had the highest ACE inhibitory activity (ACE IC₅₀=5.21±0.94μM). The highest DPP-IV inhibitory activity was found with the amino acid Tyr (DPP-IV IC₅₀=75.15±0.84μM). Val-Pro had the highest ORAC activity (19.45±2.15μmol of TEg^-1). To our knowledge, the peptides Gly-Pro-Ala-Val, Val-Cys, and Phe-Phe have not been previously identified to have the activities tested in this study. These results indicate that STP hydrolysates are potential sources of bioactive peptides.

Association between renin and atherosclerotic burden in subjects with and without type 2 diabetes

Background

Activation of the renin-angiotensin-aldosterone-system (RAAS) has been proposed to contribute to development of vascular complications in type 2 diabetes (T2D). The aim of the present study was to determine if plasma renin levels are associated with the severity of vascular changes in subjects with and without T2D.

Methods

Renin was analyzed by the Proximity Extension Assay in subjects with (n = 985) and without (n = 515) T2D participating in the SUMMIT (SUrrogate markers for Micro- and Macro-vascular hard endpoints for Innovative diabetes Tools) study and in 205 carotid endarterectomy patients. Vascular changes were assessed by determining ankle-brachial pressure index (ABPI), carotid intima-media thickness (IMT), carotid plaque area, pulse wave velocity (PWV) and the reactivity hyperemia index (RHI).

Results

Plasma renin was elevated in subjects with T2D and demonstrated risk factor-independent association with prevalent cardiovascular disease both in subjects with and without T2D. Renin levels increased with age, body mass index, HbA1c and correlated inversely with HDL. Subjects with T2D had more severe carotid disease, increased arterial stiffness, and impaired endothelial function. Risk factor-independent associations between renin and APBI, bulb IMT, carotid plaque area were observed in both T2D and non-T2D subjects. These associations were independent of treatment with RAAS inhibitors. Only weak associations existed between plasma renin and the expression of pro-inflammatory and fibrous components in plaques from 205 endarterectomy patients.

Conclusions

Our findings provide clinical evidence for associations between systemic RAAS activation and atherosclerotic burden and suggest that this association is of particular importance in T2D.

Evaluation of Glycemic Control, Lifestyle and Clinical Characteristics in Patients with Type 2 Diabetes Treated at King Abdullah University Hospital in Jordan

OBJECTIVES

The study aimed to assess glycemic control in a Jordanian population with type 2 diabetes and to explore the sociodemographic, clinical and medication-related factors as well as the anthropometric indexes and laboratory values associated with and possibly contributing to unsatisfactory glycemic control.

METHODS

We included 237 patients previously diagnosed as having type 2 diabetes. Data were collected through direct interviews. Sociodemographic and clinical details were collected using a questionnaire designed for the purpose of the study, anthropometric measurements were obtained at the time of the interviews, and laboratory data were extracted from the medical records of King Abdullah University Hospital.

RESULTS

Of the participants, 60.8% were found to have unsatisfactory glycemic control (glycated hemoglobin levels ≥7%). Unsatisfactory glycemic control was associated with younger ages at diabetes diagnosis, higher mean weights and higher prevalences of diabetic neuropathy. No relationships were found among glycemic control and body mass index, waist circumference or central obesity. Patients with adequate control were more likely to have health insurance and to have hypothyroidism as a comorbidity. Insulin use and medication plans containing insulin were associated with unsatisfactory control. Patients with unsatisfactory control had higher mean levels of low-density lipoproteins and triglycerides and lower mean levels of high-density lipoproteins. Moreover, elevated triglycerides (≥150 mg/dL) and dyslipidemia were associated with unsatisfactory glycemic control.

CONCLUSIONS

More than half of the participants had unsatisfactory glycemic control, highlighting the need for a change in the approach and strategies used for patients with diabetes in Jordan. Factors associated with glycemic control that were found in this study should be further studied and used in the prevention and management of diabetes.

Interlinkage among cardio-metabolic disease markers in an urban poor setting in Nairobi, Kenya

Introduction

The main cardio-metabolic diseases – mostly cardiovascular diseases such as stroke and ischemic heart disease – share common clinical markers such as raised blood pressure and blood glucose. The pathways of development of many of these conditions are also interlinked. In this regard, a higher level of co-occurrence of the main cardio-metabolic disease markers is expected. Evidence about the patterns of occurrence of cardio-metabolic markers and their interlinkage in the sub-Saharan African setting is inadequate.

Objective

The goal of the study was to describe the interlinkage among common cardio-metabolic disease markers in an African setting.

Design

We used data collected in a cross-sectional study from 5,190 study participants as part of cardiovascular disease risk assessment in the urban slums of Nairobi, Kenya. Five commonly used clinical markers of cardio-metabolic conditions were considered in this analysis. These markers were waist circumference, blood pressure, random blood glucose, total blood cholesterol, and triglyceride levels. Patterns of these markers were described using means, standard deviations, and proportions. The associations between the markers were determined using odds ratios.

Results

The weighted prevalence of central obesity, hypertension, hyperglycemia, hypercholesterolemia, and hypertriglyceridemia were 12.3%, 7.0%, 2.5%, 10.3%, and 17.3%, respectively. Women had a higher prevalence of central obesity and hypercholesterolemia as compared to men. Blood glucose was strongly associated with central obesity, blood pressure, and triglyceride levels, whereas the association between blood glucose and total blood cholesterol was not statistically significant.

Conclusions

This study shows that most of the common cardio-metabolic markers are interlinked, suggesting a higher probability of comorbidity due to cardio-metabolic conditions and thus the need for integrated approaches.

Hypomagnesemia in Type 2 Diabetes: A Vicious Circle?

Over the past decades, hypomagnesemia (serum Mg(2+) <0.7 mmol/L) has been strongly associated with type 2 diabetes mellitus (T2DM). Patients with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. Clinical studies demonstrate that T2DM patients with hypomagnesemia have reduced pancreatic β-cell activity and are more insulin resistant. Moreover, dietary Mg(2+) supplementation for patients with T2DM improves glucose metabolism and insulin sensitivity. Intracellular Mg(2+) regulates glucokinase, KATP channels, and L-type Ca(2+) channels in pancreatic β-cells, preceding insulin secretion. Moreover, insulin receptor autophosphorylation is dependent on intracellular Mg(2+) concentrations, making Mg(2+) a direct factor in the development of insulin resistance. Conversely, insulin is an important regulator of Mg(2+) homeostasis. In the kidney, insulin activates the renal Mg(2+) channel transient receptor potential melastatin type 6 that determines the final urinary Mg(2+) excretion. Consequently, patients with T2DM and hypomagnesemia enter a vicious circle in which hypomagnesemia causes insulin resistance and insulin resistance reduces serum Mg(2+) concentrations. This Perspective provides a systematic overview of the molecular mechanisms underlying the effects of Mg(2+) on insulin secretion and insulin signaling. In addition to providing a review of current knowledge, we provide novel directions for future research and identify previously neglected contributors to hypomagnesemia in T2DM.

Association of branched and aromatic amino acids levels with metabolic syndrome and impaired fasting glucose in hypertensive patients

BACKGROUND

The three branched amino acids (valine, leucine, and isoleucine) and two aromatic amino acids (tyrosine and phenylalanine) have been associated with many adverse metabolic pathways, including diabetes. However, these associations have been identified primarily in otherwise healthy Caucasian populations. We aimed to investigate the association of this five-amino-acid signature with metabolic syndrome and impaired fasting glucose (IFG) in a hypertensive cohort of Caucasian and African Americans.

METHODS

We analyzed data from the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) studies PEAR and PEAR2 conducted between 2005 and 2014. Subjects were enrolled at the University of Florida (Gainesville, FL), Emory University (Atlanta, GA), and Mayo Clinic (Rochester, MN). A total of 898 patients with essential hypertension were included in this study. Presence of metabolic syndrome and IFG at baseline were determined on the basis of measurements of demographic and biochemical data. Levels of the five amino acids were quantified by liquid chromatography-tandem mass spectroscopy (LC-MS/MS).

RESULTS

With a multiple logistic regression model, we found that all five amino acids were significantly associated with metabolic syndrome in both Caucasian and African Americans. IFG and the five amino acids were associated in the Caucasian Americans. Only valine was significantly associated with IFG in African Americans.

CONCLUSION

In both Caucasian and African Americans with uncomplicated hypertension, plasma levels of the five-amino-acid signature are associated with metabolic syndrome. Additionally, in Caucasians we have confirmed the five-amino-acid signature was associated with IFG.

Gymnemasylvestre derived compounds inhibit GSH depletion and increase cGMP and nitric oxide to attenuate advanced glycation end products induced hypertrophic growth in renal tubular epithelial cells

The accumulation of advanced glycation end products (AGE) plays significant role in developing tubular hypertrophy during diabetic nephropathy (DN). Reactive oxygen species and nitric oxide (NO) are directly involved in the progression of DN. We have studied the effect of standardized Gymnemasylvestre organic extract (GE) on AGE induced cellular hypertrophy using rat renal tubular epithelial cells (NRK 52E). AGE (400 μg/ml) induced cytotoxicity to NRK 52E cells as determined by MTT assay at 0–72 h. We report cellular hypertrophy mediated cytotoxicity by AGE which was the result of significant reduction in the cellular nitric oxide and cGMP levels associated with increased lipid peroxidation and antioxidant depletion (P < 0.05). Upon treatment with GE the cell viability was increased with reduced cellular hypertrophy by 1.7 folds when compared to AGE treated group. GE could significantly increase NO by 1.9 folds and cGMP by 2.8 folds and inhibited GSH depletion by 50% during AGE induced toxicity. The antioxidant enzyme activity of catalase was increased by 50% while, glutathione peroxidase and superoxide dismutase enzyme activities were significantly increased by 42% and 67% with decreased lipid peroxidation (49%) upon GE treatment. Thus, GE attenuates AGE induced hypertrophic growth by inhibiting GSH depletion and partly through increased NO/cGMP signaling.

Variations in 7-day/24-h circadian pattern of ambulatory blood pressure and heart rate of type 2 diabetes patients

AIMS/INTRODUCTION

Diabetes has profound consequences on the cardiovascular system leading to cardiovascular morbidity and mortality in diabetic patients. Blood pressure (BP) has a characteristic and reproducible circadian pattern, with high values during the day and low values at night. A 7-day timed analysis of BP through ambulatory blood pressure monitoring has been used not only to diagnose day and night dipping patterns of blood pressure, but also to measure day-to-day variability and the circadian hyper-amplitude-tension, a condition in which excessive circadian BP amplitude precedes the chronic established hypertension. Our objective was to assess the 7-day/24-h circadian pattern of BP and heart rate in diabetic patients, as it could be helpful in the diagnosis and prevention of cardiovascular morbidity.

MATERIALS AND METHODS

A total of 50 diabetic patients with type 2 diabetes and 50 non-diabetic participants were recruited for the study. General health records were individually maintained, and 7-day/24-h ambulatory blood pressure monitoring using an ambulatory blood pressure monitor was carried out.

RESULTS

The rhythmic parameters of systolic and diastolic BP, heart rate, double amplitude, acrophase and 3-h fractionated hyperbaric index were found to be significantly high in diabetic patients. A total of 12 participants were diagnosed with circadian hyper-amplitude-tension. These data suggest that diabetic patients have certain variations in the circadian pattern of blood pressure and heart rate, which can result in disturbed vascular events, and thus are at greater risk of cardiovascular morbidity.

CONCLUSION

Seven-day/24-h monitoring might be useful as an early predictive tool in assessing future cardiovascular risk, guiding treatment and management of these patients.

Cerebral white matter and retinal arterial health in hypertension and type 2 diabetes mellitus

We examined 33 hypertensive (22 with comorbid type 2 diabetes mellitus (T2DM)) and 29 normotensive (8 with T2DM) middle-aged and elderly adults, comparable in age and education. Relative to normotensive participants, those with hypertension, in addition to a higher prevalence of periventricular white matter (WM) lesions, had significantly lower WM microstructural integrity of major fiber tracts as seen with MRI-based diffusion tensor imaging. Among participants with hypertension, those with co-morbid T2DM (n = 22) had more widespread WM pathology than those without T2DM (n = 11). Furthermore and consistent with previous research, both hypertension and T2DM were related to decreased retinal arterial diameter. Further exploratory analysis demonstrated that the observed retinal arteriolar narrowing among individual with hypertension was associated with widespread subclinical losses in WM microstructural integrity and these associations were present predominantly in the frontal lobe. We found that T2DM adds to the damaging effects of hypertension on cerebral WM, and notably these effects were independent of age and body mass index. Given that the decrease in retinal arteriolar diameter may be a biomarker for parallel pathology in cerebral arterioles, our data suggest that the frontal lobe may be particularly vulnerable to microvascular damage in the presence of hypertension and T2DM.

Delayed diagnosis of hypertension in diabetic patients monitored in primary care

INTRODUCTION AND OBJECTIVES

Delayed diagnosis of hypertension may result in inadequate blood pressure control and increased cardiovascular risk. The aim of this study was to estimate the delay in hypertension diagnosis in patients with type 2 diabetes and the likelihood of a diagnosis within a suitable period (first 6 months), and to analyze the patient and physician characteristics associated with delayed diagnosis.

METHODS

Retrospective dynamic cohort study, with a 7-year follow-up in primary care, of 8074 adult patients with diabetes who met the diagnostic criteria for hypertension. Two thresholds were considered: 140/90mmHg and 130/80mmHg. The time elapsed between meeting these criteria and recording the diagnosis was estimated; the time course of the likelihood of a missed diagnosis and the variables associated with correct diagnosis were assessed by Kaplan-Meier survival analysis and logistic regression analysis, respectively.

RESULTS

The mean diagnostic delay was 8.9 (15.4) months in patients with blood pressure≥140/90mmHg compared to 15.2 (19.6) months for those with <140/90mmHg (P<.001). The main variables associated with correct diagnosis were baseline blood pressure≥140/90mmHg (odds ratio=2.77; 95% confidence interval, 2.44-3.15), no history of acute myocardial infarction (odds ratio=2.23; 95% confidence interval, 1.67-2.99), obesity (odds ratio=1.70; 95% confidence interval, 1.44-1.99), absence of depression (odds ratio=1.63; 95% confidence interval, 1.27-2.08), female sex (odds ratio=1.29; 95% confidence interval, 1.14-1.46), older age, and taking more intensive antidiabetic therapy. There was an inverse relationship with the age of physicians and a direct relationship with their professional stability.

CONCLUSIONS

The mean diagnostic delay in hypertension among diabetic patients was greater than 6 months and varied according to the diagnostic threshold used. Patients with baseline blood pressure≥140/90mmHg were more likely to receive a timely diagnosis.

Treatment with marine collagen peptides modulates glucose and lipid metabolism in Chinese patients with type 2 diabetes mellitus

This study was aimed at examining the therapeutic effects of marine collagen peptides (MCPs) from fish hydrolysate in Chinese patients with type 2 diabetes mellitus (T2DM). A total of 100 diabetic patients and 50 healthy controls were recruited. Diabetic patients were randomized into treatment and control groups. The patients in the treatment group received an additional 13 g of MCPs daily for 3 months. Their blood samples were collected before, and 1.5 and 3 months after, treatment to evaluate glucose and lipid metabolism. The levels of serum high-sensitivity C-reactive protein (hs-CRP), nitric oxide (NO), bradykinin, prostacyclin (PGI2), and adipokines were determined. Significantly reduced levels of fasting blood glucose, human glycated hemoglobin A1c (GHbA1c), fasting blood insulin, total triglycerides, total cholesterol, low-density lipoprotein, and free-fatty acids, but increased levels of insulin sensitivity index and HDL were observed in T2DM patients following treatment with MCPs for 1.5 and 3 months. The values of these measures were significantly lower or higher than those of patient controls (p < 0.01), respectively. Interestingly, significantly decreased levels of hs-CRP and NO, but increased levels of bradykinin, PGI2, and adiponectin were detected in MCP-treated T2DM patients (p < 0.01), as compared with their basal values or the levels in patient controls. MCP treatment improved glucose and lipid metabolism in diabetic patients.

Therapeutic effects of marine collagen peptides on Chinese patients with type 2 diabetes mellitus and primary hypertension

INTRODUCTION

Marine collagen peptides (MCPs) from deep sea fish are shown to ameliorate hyperlipidemia in animal models. The study aimed at examining the effects of MCPs on glucose and lipid metabolism in Chinese patients with type 2 diabetes mellitus (T2DM) and primary hypertension.

METHODS

One hundred patients with T2DM and primary hypertension and 50 healthy subjects (normal controls) were recruited for a randomized double blind study. The patients were randomized into MCPs treatment or patient control groups (n = 50 per group). Both patient controls and normal controls were given carboxymethylcellulose twice daily whereas the MCPs treatment group was given MCPs twice daily for 3 months. Blood pressure, glucose and lipid metabolism, serum high-sensitivity C-reactive protein, cytochrome P450, nitric oxide, bradykinin, prostacyclin, creatinine, uric acid and adipokines were measured at baseline, 1.5 and 3 months after treatment. All patients received regular medicines for control of hyperglycemia and hypertension.

RESULTS

Compared with patient controls, significantly reduced levels of fasting blood glucose, HbA1c, diastolic blood pressure, mean arterial pressure and creatinine but increased levels of Insulin Sensitivity Index and Insulin Secretion Index were observed in patients receiving MCPs treatment. Furthermore, significantly reduced levels of serum triglycerides, total cholesterol, low-density lipoprotein, free fatty acids, cytochrome P450, nitric oxide and prostacyclin but increased levels of high-density lipoprotein, bradykinin and adiponectin were detected in patients taking MCPs.

CONCLUSIONS

MCPs supplement may benefit glucose and lipid metabolism, insulin sensitivity, renal function and hypertension management in Chinese patients with T2DM and hypertension.

Effect of Lactobacillus reuteri GMNL-263 treatment on renal fibrosis in diabetic rats

Hyperglycemia is the most important factor in the progression of renal fibrosis in diabetic kidney. Prevention and treatment of renal fibrosis may improve diabetic nephropathy. To explore whether probiotic Lactobacillus reuteri GMNL-263 treatment was linked to altered hyperglycemia-mediated renal fibrosis in diabetic kidney, the mechanisms of L. reuteri GMNL-263 treatment responsible for the inhibition of renal fibrosis in streptozotocin (STZ)-induced diabetic rats were examined. Diabetic rats were induced by intraperitoneal injection of STZ (50 mg/kg). Induction of diabetes was confirmed by measurement of the blood glucose using the glucose oxidase method, and hyperglycemic rats with levels >16 mmol/L were used. We found that L. reuteri GMNL-263 treatment caused reduction of glycated hemoglobin and blood glucose levels in STZ-induced diabetic rats for 28 days (all p<0.05). Treatment with L. reuteri GMNL-263 increased body weight but decreased kidney weight in diabetic rats as compared to diabetic control (p<0.05). In diabetic renal cortex, the Janus kinase 2/signal transducers and activators of transcription 1 (but not extracellular signal-regulated kinase/c-Jun N-terminal kinase/p38 mitogen-activated protein kinase) activation was markedly blocked by L. reuteri GMNL-263 treatment. The ability of L. reuteri GMNL-263 treatment to inhibit renal fibrosis was verified by the observation that it significantly decreased protein levels of plasminogen activator inhibitor-1, p21(Waf1/Cip1), α-smooth muscle actin, and fibronectin in diabetic renal cortex. The results obtained in this study indicate that L. reuteri GMNL-263 treatment may protect STZ-induced diabetic rats from hyperglycemia-enhanced renal fibrosis.

Role of heme oxygenase in inflammation, insulin-signalling, diabetes and obesity

Diabetes and obesity are chronic conditions associated with elevated oxidative/inflammatory activities with a continuum of tissue insults leading to more severe cardiometabolic and renal complications including myocardial infarction and end-stage-renal damage. A common denominator of these chronic conditions is the enhanced the levels of cytokines like tumour necrosis factor-alpha (TNF-α), interleukin (IL-6), IL-1β and resistin, which in turn activates the c-Jun-N-terminal kinase (JNK) and NF-κB pathways, creating a vicious cycle that exacerbates insulin resistance, type-2 diabetes and related complications. Emerging evidence indicates that heme oxygenase (HO) inducers are endowed with potent anti-diabetic and insulin sensitizing effects besides their ability to suppress immune/inflammatory response. Importantly, the HO system abates inflammation through several mechanisms including the suppression of macrophage-infiltration and abrogation of oxidative/inflammatory transcription factors like NF-κB, JNK and activating protein-1. This review highlights the mechanisms by which the HO system potentiates insulin signalling, with particular emphasis on HO-mediated suppression of oxidative and inflammatory insults. The HO system could be explored in the search for novel remedies against cardiometabolic diseases and their complications.

Association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan

BACKGROUND

The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

METHODS

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from diabetic Out Patient Department (OPD) of Civil Hospital, Karachi. They were matched on age and sex with controls (n = 296), who were attendants sitting in the medical out patient department of the same hospital, recruited on the basis of absence of classical symptoms of polyuria and polydipsia along with random blood glucose level of <200 mg/dl measured by a glucometer. Depression was identified by the Siddiqui Shah Depression Scale. Conditional logistic regression was applied to examine the association of depression and other independent variables with newly diagnosed type 2 diabetes at 95% C.I. and P < 0.05.

RESULTS

The study comprised of 592 subjects with 432(73%) males and 160(27%) females. Depression was significantly associated with newly diagnosed type 2 diabetes having mild level (mOR: 3.86; 95%CI: 2.22,6.71) and moderate to severe level (mOR: 3.41; 95%CI: 2.07,5.61). History of (h/o) gestational diabetes (mOR: 2.83; 95%CI: 1.05,7.64), family h/o diabetes (mOR: 1.59; 95%CI: 1.04,2.43), nuclear family (mOR: 1.75; 95%CI: 1.14,2.69), BMI (mOR: 1.62; 95%CI: 1.01,2.60 for obese and mOR: 2.12; 95%CI: 1.19,3.79 for overweight vs healthy to underweight) were also significantly associated with outcome, adjusting for age, sex, marital status, h/o smoking and h/o high BP.

CONCLUSIONS

Diabetics should be screened simultaneously for depression and concomitant preventive strategies for gestational diabetes, nuclear family and high BMI should also be used to prevent mortality/morbidity among patients between 25 to 60 years of age.

Cinnamaldehyde impairs high glucose-induced hypertrophy in renal interstitial fibroblasts

Cinnamaldehyde is a major and a bioactive compound isolated from the leaves of Cinnamomum osmophloeum kaneh. To explore whether cinnamaldehyde was linked to altered high glucose (HG)-mediated renal tubulointerstitial fibrosis in diabetic nephropathy (DN), the molecular mechanisms of cinnamaldehyde responsible for inhibition of HG-induced hypertrophy in renal interstitial fibroblasts were examined. We found that cinnamaldehyde caused inhibition of HG-induced cellular mitogenesis rather than cell death by either necrosis or apoptosis. There were no changes in caspase 3 activity, cleaved poly(ADP-ribose) polymerase (PARP) protein expression, and mitochondrial cytochrome c release in HG or cinnamaldehyde treatments in these cells. HG-induced extracellular signal-regulated kinase (ERK)/c-Jun N-terminal kinase (JNK)/p38 mitogen-activated protein kinase (MAPK) (but not the Janus kinase 2/signal transducers and activators of transcription) activation was markedly blocked by cinnamaldehyde. The ability of cinnamaldehyde to inhibit HG-induced hypertrophy was verified by the observation that it significantly decreased cell size, cellular hypertrophy index, and protein levels of collagen IV, fibronectin, and alpha-smooth muscle actin (alpha-SMA). The results obtained in this study suggest that cinnamaldehyde treatment of renal interstitial fibroblasts that have been stimulated by HG reduces their ability to proliferate and hypertrophy through mechanisms that may be dependent on inactivation of the ERK/JNK/p38 MAPK pathway.

Impact of hypertension on health-related quality of life in a population-based study in Shanghai, China

OBJECTIVES

The purpose of this study was to examine the relationship between hypertension and health-related quality of life (HRQL) in a general representative Chinese population, and to explore the impacts of comorbidity on people with hypertension.

STUDY DESIGN

Population-based cross-sectional survey.

METHODS

A self-administered questionnaire survey including demographic questions and the Mandarin version of 36-item Short Form (SF-36) was conducted in a general population in Shanghai, China. In total, 1034 subjects participated. The SF-36 dimension scores of hypertensive subjects were compared with those of normotensive subjects. Independent association of hypertension with each quality-of-life domain was analysed using a multiple linear regression model, so were the effects of comorbidity on the HRQL of hypertensive subjects.

RESULTS

Nine hundred and nineteen respondents were included in the analysis, and 16.97% reported hypertension. Respondents with hypertension scored lower than those without hypertension in at least five SF-36 dimensions. The dimension of role limitations due to physical problems was the most affected, whereas the mental health dimension was the least affected. Hypertensive subjects with comorbidity experienced lower SF-36 scores than hypertensive subjects without comorbidity.

CONCLUSIONS

Hypertension markedly impairs quality of life in terms of both physical and mental health. Comorbidity further deteriorates HRQL among people with hypertension. The findings suggest that people with hypertension represent a vulnerable population, and it is important to prevent and treat comorbidity of hypertension.

Effects of nitric oxide and antioxidants on advanced glycation end products-induced hypertrophic growth in human renal tubular cells

The accumulation of advanced glycation end products (AGE) is a key mediator of renal tubular hypertrophy in diabetic nephropathy (DN). Reactive oxygen species and nitric oxide (NO) were involved in the progression of DN. In this study, the molecular mechanisms of NO and antioxidants responsible for inhibition of AGE-induced renal tubular hypertrophy were examined. We found that AGE (but not nonglycated bovine serum albumin) significantly suppressed the NO/cGMP/PKG signaling in human renal proximal tubular cells. NO donors S-nitroso-N-acetylpenicillamine (SNAP)/sodium nitroprusside (SNP) and antioxidants N-acetylcysteine (NAC)/taurine treatments significantly attenuated AGE-inhibited NO production, cGMP synthesis, and inducible NO synthase/cGMP-dependent protein kinase (PKG) activation. Moreover, AGE-induced extracellular signal-regulated kinase/c-Jun N-terminal kinase/p38 mitogen-activated protein kinase activation was markedly blocked by antireceptor for AGE (RAGE), SNAP, SNP, NAC, and taurine. The abilities of NO and antioxidants to inhibit AGE/RAGE-induced hypertrophic growth were verified by the observation that SNAP, SNP, NAC, and taurine inhibited fibronectin, p21(Waf1/Cip1), and RAGE expression. Therefore, antioxidants significantly attenuated AGE/RAGE-enhanced cellular hypertrophy partly through induction of the NO/cGMP/PKG signaling.

Hypertension among 1000 patients with type 2 diabetes attending a national diabetes center in Jordan

BACKGROUND AND OBJECTIVES

In Jordan, there is a paucity of research on hypertension and its risk factors among patients with type 2 diabetes mellitus. This study was designed to assess the prevalence of hypertension, risk factors, and the level of awareness and control of hypertension among outpatients with type 2 diabetes.

SUBJECTS AND METHODS

A cross-sectional study was carried out on a sample of 1000 patients with type 2 diabetes who were attending the National Center for Diabetes, Endocrine and Genetic Diseases for follow-up during the period of June to December 2006. Data were collected from medical records and through a structured interview questionnaire. Logistic regression analysis was used to assess the independent effect of variables on hypertension.

RESULTS

The prevalence of hypertension (BP >130/80 or on medication for high blood pressure) was 72.4% (70.9% of males and 73.9% of females). The logistic regression indicated that hypertension was positively associated with age (P=.001), body mass index (P=.001), and duration of diabetes (P=.001). About one-half of patients who were aware of having hypertension failed to keep their blood pressure under control.

CONCLUSION

Hypertension is a common co-morbidity among diabetic patients. Despite a high rate of awareness of hypertension among study subjects (93%), hypertension was not controlled to the recommended levels of blood pressure in about one-half (50.4%) of patients.

The role of renin-angiotensin-aldosterone system-based therapy in diabetes prevention and cardiovascular and renal protection

Hypertension increases the risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease. In addition to lowering blood pressure, blockade of the renin-angiotensin-aldosterone system (RAAS) reduces the risk of new-onset T2DM and offers renal protection. Using a MEDLINE search, we identified multiple trials that reported the incidence of T2DM in patients taking inhibitors of RAAS. In this review, we will discuss the RAAS as a potential target in diabetes prevention and the mechanisms through which inhibitors of this system achieve such an important effect. We will also shed light on the beneficial cardiovascular and renal effects of RAAS blockade. Although multiple studies have demonstrated that inhibitors of RAAS, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, can reduce the incidence of T2DM, randomized controlled studies are still needed to further elucidate their exact role in diabetes prevention.