Strategies for preventing type 2 diabetes: an update for clinicians

Alteration of Sweet and Bitter Taste Sensitivity with Development of Glucose Intolerance in Non-insulin-Dependent Diabetes Mellitus Model OLETF Rats

Patients with diabetes exhibit altered taste sensitivity, but its details have not been clarified yet. Here, we examined alteration of sweet taste sensitivity with development of glucose intolerance in Otsuka Long-Evans Tokushima Fatty (OLETF) rats as a model of non-insulin-dependent diabetes mellitus. Compared to the cases of Long Evans Tokushima Otsuka (LETO) rats as a control, glucose tolerance of OLETF rats decreased with aging, resulting in development of diabetes at 36-weeks-old. In brief-access tests with a mixture of sucrose and quinine hydrochloride, OLETF rats at 25 or more-weeks-old seemed to exhibit lower sweet taste sensitivity than age-matched LETO ones, but the lick ratios of LETO, but not OLETF, rats for the mixture and quinine hydrochloride solutions decreased and increased, respectively, aging-dependently. Expression of sweet taste receptors, T1R2 and T1R3, in circumvallate papillae (CP) was almost the same in LETO and OLETF rats at 10- and 40-weeks-old, while expression levels of a bitter taste receptor, T2R16, were greater in 40-weeks-old rats than in 10-weeks-old ones in both strains. There was no apparent morphological alteration in taste buds in CP between 10- and 40-weeks-old LETO and OLETF rats. Metagenomic analysis of gut microbiota revealed strain- and aging-dependent alteration of mucus layer-regulatory microbiota. Collectively, we concluded that the apparent higher sweet taste sensitivity in 25 or more-weeks-old OLETF rats than in age-matched LETO rats was due to the aging-dependent increase of bitter taste sensitivity in LETO rats with alteration of the gut microbiota.

A retrospective comparison between intensive and nonintensive insulin regimens in type 2 diabetes mellitus

BACKGROUND

This study compared the outcomes between intensive and nonintensive insulin regimens and assessed the predictive factors for failing to achieve the glycated hemoglobin (A1C) goals in type-2-diabetes-mellitus (T2DM) patients requiring insulin therapy.

METHODS

A single-center, retrospective assessment of the medical records of 125 T2DM patients undergoing intensive (46 patients) and nonintensive insulin therapy (79 patients) were conducted.

RESULTS

No significant differences were found when the intensive and nonintensive insulin therapy groups were compared in terms of the percentage decreases of glucose and A1C levels. The mean A1C levels of the nonintensive and intensive groups declined from 11.15% and 11.30% to 7.97% and 8.06%, respectively.

CONCLUSIONS

Both intensive and nonintensive insulin therapies improved the baseline glycemic parameters but being overweight or obese and/or being reluctant to dietary recommendations led to treatment failures regardless of the insulin regimen.

Peer support facilitator and peer perspectives of an inner-regional Australian diabetes prevention and self-management peer support program

Peer support programmes have been shown to facilitate diabetes prevention and improvements in diabetes self-management. Worldwide, few studies have qualitatively evaluated peer support programs in inner-regional (semi-rural) areas, and none involving mixtures of people with and without diabetes. This study researched an inner-regional peer support programme underway over 2 years in Australia. Fifteen participants, including ten peers and five peer support facilitators (PSFs) were interviewed using semi-structured focus group and one-to-one interviews with the aim of understanding their perceptions and experiences of the programme, barriers, and ways of overcoming barriers. Participants were those with and without diabetes. The main themes identified were; benefits of the programme, factors affecting recruitment and retention, challenges and barriers to programme participation, PSF reflections on peer support training, and recommendations to improve the programme. Participants identified increased knowledge of diet, diabetes and complications as key benefits, with greater social support and well-being the main reasons for initial participation. The main challenges for the programme were the lack of wide community engagement before setting up the peer groups, difficulty with peer recruitment and personal difficulties in maintaining a healthy lifestyle. The peer support programme was well received within an inner-regional area and was perceived as useful in providing support and motivation to make lifestyle behavioural changes from shared experiences with peers. Whilst considered beneficial to those with and without diabetes, ways of overcoming identified challenges are required.

Beneficial effects of carvedilol modulating potassium channels on the control of glucose

The increased prevalence of hypertensive patients with type 2 diabetes mellitus (T2DM) is evident worldwide, leading to a higher risk of cardiovascular disease onset, which is substantially associated with disabilities and mortality in the clinic. In order to achieve the satisfyingly clinical outcomes and prognosis, the comprehensive therapies have been conducted with a beneficial effect on both blood pressure and glucose homeostasis, and clinical trials reveal that some kind of antihypertensive drugs such as angiotensin converting enzyme inhibitors (ACE-I) may, at least in part, meet the dual requirement during the disease management. As a nonselective β-blocker, carvedilol is employed for treating many cardiovascular diseases in clinical practice, including hypertension, angina pectoris and heart failure, and also exhibit the effectiveness for glycemic control and insulin resistance. Apart from alleviating sympathetic nervous system activity, several causes, such as lowering oxygen reactive species, may contribute to the effects of carvedilol on controlling plasma glucose levels, suggesting a feature of this drug having multiple targets. Interestingly, numerous distinct K⁺ channels expressed in pancreatic β-cells and peripheral insulin-sensitive tissues, which play a sentential role in glucose metabolism, are subjected to extensive modulation of carvdilol, establishing a linkage between K⁺ channels and drug's effects on the control of glucose. A variety of evidence shows that the impact of carvedilol on different K⁺ channels, including Kv, K_Ach, K_ATP and K_2 P, can lead to positive influences for glucose homeostasis, contributing to its clinical beneficial effectiveness in treatment of hypertensive patients with T2DM. This review focus on the control of plasma glucose conferred by carvedilol modulation on K⁺ channels, providing the novel mechanistic explanation for drug's actions.

Identification of Pre-Diabetic Biomarkers in the Progression of Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a major global health issue. The development of T2DM is gradual and preceded by the pre-diabetes mellitus (pre-DM) stage, which often remains undiagnosed. This study aimed to identify novel pre-DM biomarkers in a high-fat diet (HFD)-induced pre-DM mouse model. Male C57BL/6J mice were fed either a chow diet or HFD for 12 weeks. Serum and liver samples were isolated in a time-dependent manner. Semi-quantitative assessment of secretory cytokines was performed by cytokine array analysis, and 13 cytokines were selected for further analysis based on the changes in expression levels in the pre-DM and T2DM stages. HFD-fed mice gained body weight and exhibited high serum lipid, liver enzyme, glucose, and insulin levels during the progression of pre-DM to T2DM. The mRNA expression of inflammatory and lipogenic genes was elevated in HFD-fed mice The mRNA expression of Fc receptor, IgG, low affinity Iib, lectin, galactose binding, soluble 1, vascular cell adhesion molecule 1, insulin-like growth factor binding protein 5, and growth arrest specific 6 was elevated in the pre-DM, which was confirmed by measuring protein levels. Our study identified novel pre-DM biomarkers that may help to delay or prevent the progression of T2DM.

Obesity and risk of age-related eye diseases: a systematic review of prospective population-based studies

BACKGROUND

Obesity is a public health challenge worldwide. The relationship between obesity and age-related eye diseases including cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR) have remained elusive.

DESIGN AND METHODS

We conducted a systematic review of three electronic databases for longitudinal population-based studies that described associations between measures of obesity including body mass index (BMI), waist-circumference (WC), and waist-to-hip ratio (WHR), and age-related eye diseases.

RESULTS

Our search yielded 1731 articles, of which 14, 10, 16 and 8 articles met our eligibility criteria for cataract, glaucoma, AMD and DR, respectively. BMI-defined obesity was positively associated with incident cataract, incident AMD and incident DR in Western populations, but in Asian populations associations for incident AMD were not significant and associations for incident DR were inverse. WC-defined obesity was associated with incident glaucoma in non-Western populations. WHR-defined obesity but not BMI-defined obesity was associated with the incidence or progression of AMD in two Western studies.

CONCLUSIONS

Overall, we found strong evidence supporting associations between obesity and age-related eye diseases. Further research on the association of abdominal obesity and effect of weight loss and physical activity on age-related eye diseases is warranted to support clinical and public health recommendations.

Antihyperglycemic and Antidyslipidemic Activities of the Aqueous Salvia hispanica Extract in Diabetic Rat

AIMS

The study targeted to evaluate the antihyperglycemic activity of Salvia hispanica.

BACKGROUND

Salvia hispanica L. (Lamiaceae) is a medicinal plant with many beneficial properties on human health.

OBJECTIVE

This objective of the study was to investigate the antihyperglycemic effect of the aqueous extract of Salvia hispanica (S. hispanica) seeds and its capacity to improve lipid profile in normal and STZ-induced diabetic rats.

MATERIAL AND METHODS

The seed aqueous extract of S. hispanica (SHSAE) at a dose of 100 mg/kg was administered orally in normal and diabetic rats. The effect of oral SHSAE treatment on blood glucose and lipid levels during 15 days was assessed in normal and streptozotocin-induced diabetic rats. The oral glucose tolerance test (OGTT) was carried out. The antioxidant activity of SHSAE was also examined.

RESULTS

The decrease of glycemia in rats following the administration of the plant extract suggested that the studied extract possesses antidiabetic effect. The extract of S. hispanica produced hypolipidemic effect with a significant lowering effect on plasma total cholesterol levels and increase on HDL-cholesterol levels. SHSAE was also able to enhance glucose tolerance using OGTT. Moreover, SHSAE possess a potential antioxidant effect in vitro.

CONCLUSION

In conclusion, this study demonstrates the antihyperglycemic and antilipidemic effects of SHSAE in rats.

The High-Resolution Three-Dimensional Magnetic Detector System 3D-Magma Accurately Measures Gastric and Small Bowel Motility in People with Type 2 Diabetes with Neuropathy

Gastroparesis is an important complication of diabetes. Motility disorders are underdiagnosed and can lead to unexplained hypoglycemia. Currently diagnostic options are limited. All established methods harbor certain disadvantages. The 3D-MAGMA system is capable of reliably measuring gastric and small intestinal motility. The aim of the current study was to determine if 3D-MAGMA is able to detect changes in intestinal motility in people with type 2 diabetes. 18 healthy volunteers and 19 people with type 2 diabetes underwent motility testing by 3D-MAGMA. In the control group the retention time in the stomach was 33.0 [min] compared to 75.3 [min] in the diabetes group. The median time in the duodenum was 12.7 [min] compared to 8.1 [min]. The time for the first 50 cm of the jejunum was 29.9 [min] compared to 28.2 [min]. Discussion and conclusion: 3D-MAGMA is able to detect changes in intestinal motility. Its clinical value might be useful in patients with fluctuating blood glucose levels and unexplained hypoglycemic episodes.

Antihyperglycemic and Antihyperlipidemic Effects of Lippia citriodora in Rats

AIM

The study was conducted to assess the antidiabetic and antihyperlipidemic effects of Lippia citriodora.

BACKGROUND

Lippia citriodora Kunth (Verbenaceae) is a medicinal plant with many traditional uses.

OBJECTIVE

The goal of this study was to investigate the antidiabetic activity of aqueous extract of Lippia citriodora and its capacity to improve the lipid profile in diabetic rats.

METHODS

Normal and diabetic rats were treated orally for 15 days by the leaves aqueous extract of Lippia citriodora (LCLAE) (100 mg/kg). The whole glucose utilization and liver architecture were also evaluated. The in vitro antioxidant activity of LCLAE was also assessed.

RESULTS

LCLAE lowered blood glucose and lipid levels in all groups. Moreover, LCLAE ameliorated the liver structure and exhibited antioxidant activity.

CONCLUSION

In conclusion, this study demonstrates the hypoglycemic and antihyperlipidemic effects of LCLAE in rats.

Effect of Steviol Glycosides on Human Health with Emphasis on Type 2 Diabetic Biomarkers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The natural sweetener from Stevia rebaudiana Bertoni, steviol glycoside (SG), has been proposed to exhibit a range of antidiabetic properties. The objective of this systematic review was to critically evaluate evidence for the effectiveness of SGs on human health, particularly type 2 diabetic (T2D) biomarkers, collecting data from randomized controlled trials (RCTs). Electronic searches were performed in PubMed and EMBASE and the bibliography of retrieved full-texts was hand searched. Using the Cochrane criteria, the reporting quality of included studies was assessed. Seven studies, nine RCTs, including a total of 462 participants were included. A meta-analysis was performed to assess the effect of SGs on following outcomes: BMI, blood pressure (BP), fasting blood glucose (FBG), lipids, and glycated hemoglobin (HbA1c). The meta-analysis revealed an overall significant reduction in systolic BP in favour of SGs between SG and placebo, mean difference (MD): -6.32 mm Hg (-7.69 to 0.46). The overall effect of BMI, diastolic BP, FBG, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) was a non-significant reduction in favour of SGs, and a non-significant increase in low-density lipoprotein cholesterol and triglyceride, while no significant effect of HbA1c was found. Heterogeneity was significant for several analyses. More studies investigating the effect of SGs on human health, particularly T2D biomarkers, are warranted.

Patterns of changes in overtime working hours over 3 years and the risk for progression to type 2 diabetes in adults with pre-diabetes

No information exists regarding the effects of working hours on glucose metabolism in adults with pre-diabetes, a high-risk group for developing diabetes. Further, longitudinal patterns in working hours and their effects on glucose metabolism have not been described previously. We investigated the association between changes in overtime working hours over 3 years and the risk for progression to type 2 diabetes among adults with pre-diabetes. We analyzed patterns of overtime working hours from 2008 to 2011 among 18,172 workers in Japan (16,474 men, aged 30 to 64 years) with pre-diabetes in 2011 (baseline) using the sub-cohort data from the Japan Epidemiology Collaboration on Occupational Health Study. Participants were followed up to March 2016. Overtime working hours per month were self-reported annually in 2008-2011 and trajectory patterns were identified using group-based trajectory modeling. Type 2 diabetes was diagnosed by fasting or random plasma glucose test, hemoglobin A1c, and history of diabetes. Multivariable-adjusted hazard ratios of incident diabetes were calculated using Cox regression. We identified 3 distinct trajectories of overtime work: persistently short, long-to-short, and persistently long. During a mean follow-up of 3.5 years, 1613 participants (8.9%) developed diabetes. Compared with persistently short overtime working hours, no material increase in diabetes risk was observed for either long-to-short working hours or persistently long working hours. After adjustment for potential confounders, this association was materially unchanged. The results suggest that among individuals with pre-diabetes, persistently long working hours over 3 years were not associated with an increased risk of developing type 2 diabetes.

Potential antidiabetic effect of ethanolic and aqueous-ethanolic extracts of Ricinus communis leaves on streptozotocin-induced diabetes in rats

Recently, herbal drugs and their bioactive compounds have gained popularity in the management of diabetes mellitus (DM), which has become an epidemic disease all over the world and is especially prevalent in the Kingdom of Saudi Arabia (KSA). This study aimed to investigate the antidiabetic effect of ethanolic and aqueous-ethanolic extracts of wild Ricinus communis (R. communis) leaves in streptozotocin (STZ) induced diabetic rats. Diabetic rats were administered orally with the mentioned extracts at doses of 300 and 600 mg/kg/BW for 14 days, and the obtained results of different biochemical parameters were compared with normal control, diabetic control and standard drug glibenclamide (5 mg/kg/BW). The obtained results revealed a remarkable and significantly (P < 0.05) reverse effect of the body weight loss, observed when diabetic rats were treated with ethanol and aqueous-ethanol extracts at 300 mg/kg/BW. Administration of the ethanol extract at 600 mg/kg/BW significantly (P < 0.05) reduced the blood glucose level. A significant increase in the AST, ALT and ALP levels (P < 0.05) was observed in the diabetic control and in the experimental groups with glibenclamide which was also significantly (P < 0.05) lowered after treatment with extracts at special doses. Total proteins, albumin, total bilirubin, direct bilirubin, creatinine and urea were also investigated and compared to the corresponding controls. We showed that administration of R. communis extract generally significantly (P < 0.05) ameliorated the biochemical parameters of diabetic rats. Also, the changes in serum electrolyte profile were assessed and the results demonstrate that administration of extracts at concentration of 600 mg/kg/BW generally inhibits the alteration maintain their levels. The obtained data imply the hypoglycemic effects of this plant, which may be used as a good alternative for managing DM and therefore validating its traditional usage in KSA.

High prevalence of prediabetes among the family members of individuals with diabetes. Findings from targeted screening program from south India

AIM

We aimed to screen for prediabetes, diabetes and other cardiovascular risk factors among family members of people with diabetes registered for care in a primary health centre in South India.

METHODS

During 2017-2018, we screened eligible family members of individuals with diabetes at their homes. We measured fasting capillary blood glucose (FCBG); for those with FCBG≥126 mg/dl, we confirmed the diagnosis of diabetes with fasting plasma glucose (FPG). We defined prediabetes as FCBG between 100 and 125 mg/dl; diabetes as both FCBG and FPG ≥126 mg/dl. We assessed non-communicable disease risk factors using WHO STEPS questionnaire.

RESULTS

Of total 884 participants, 873 (99%) underwent screening; 280 (32%) had prediabetes, and 19 (2.2%) were confirmed with diabetes. Of newly diagnosed, 17 (90%) were initiated on treatment. Of 873 participants, 180 (20.6%) were newly diagnosed with hypertension. Of the total, 7.3%, 5.2% and 16% reported tobacco use, alcohol use and high salt intake respectively. Nearly half (48%) had overweight.

CONCLUSION

Though the yield for diabetes is modest (3%), the house to house approach was able to screen 99% of eligible population. High prevalence of prediabetes and undiagnosed hypertension emphasize the need for screening and life style modifications.

The Association Between Prediabetes and Dyslipidemia Among Attendants of Primary Care Health Centers in Jeddah, Saudi Arabia

INTRODUCTION

Early detection and treatment of dysglycemia including diabetes and prediabetes is demonstrated to improve disease outcomes and prevent complications.

OBJECTIVE

To assess the association of prediabetes with lipid metabolism disorders to clarify whether systematic screening for prediabetes should be proposed for individuals with dyslipidemia.

MATERIAL AND METHODS

A cross-sectional study design, employing a stratified two-stage cluster sampling method recruited non-diabetic adults (age ≥18 years) from attendees of Primary Health Care (PHC) centers in Jeddah. Anthropomorphic measurements, demographic and clinical information were taken, and blood pressure was measured. Fasting blood sample was obtained for the measurement of plasma glucose (FPG), glycated hemoglobin (HbA1C), and lipid profile. Plasma glucose was estimated 1 hr after the ingestion of 50 g glucose (1h-OGTT). Prediabetes and dyslipidemia were defined according to international guidelines. Demographic and clinical factors of subjects with prediabetes, and those with normoglycemia were compared. Multiple logistic regression analysis was used to adjust for confounding factors.

RESULTS

A total of 613 individuals were included with a mean age (±SD) of 32±11.8years, and 54.8% being female. Prediabetes was detected in 28.7%, and dyslipidemia in 54.2% of participants. After adjusting for age, an association was found for high low-density lipoprotein-cholesterol (LDL-C) and prediabetes based on any definition. After adjustment for body mass index (BMI), the association was retained for any type of dyslipidemia and in particular high LDL-C. After adjusting for both age and BMI, a significant association was found only between high LDL-C and prediabetes based on any definition (OR, 95% CI=1.50,1.02-2.19, P= 0.037).

CONCLUSION

Even though high LDL-C is associated with an increased probability of prediabetes, a recommendation for universal screening of dyslipidemic patients requires further cohort studies.

Body Weight Considerations in the Management of Type 2 Diabetes

Obesity is one of the main risk factors for type 2 diabetes (T2D), representing a major worldwide health crisis. Modest weight-loss (≥ 5% but < 10%) can minimize and reduce diabetes-associated complications, and significant weight-loss can potentially resolve disease. Treatment guidelines recommend that intensive lifestyle interventions, pharmacologic therapy, and/or metabolic surgery be considered as options for patients with T2D and obesity. The benefits and risks of such interventions should be evaluated in the context of their weight-loss potential, ability to sustain weight change, side effect profile, and costs. Antihyperglycemia therapies have considerable effects on patient weight, prompting careful consideration of weight-loss or weight-neutral therapies for patients with T2D who also have obesity. Metformin, sodium glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), α-glucosidase inhibitors, and amylin mimetics promote weight-loss. Dipeptidyl peptidase-4 inhibitors and fixed-ratio insulin/GLP-1 RA combination therapies (IDegLira, iGlarLixi) appear to be weight-neutral. Thiazolidinediones, insulin secretagogues (sulfonylureas, meglitinides), and insulins are associated with weight gain. Sulfonylureas are additionally associated with a higher risk of serious hypoglycemia from hyperinsulinemia, making them less suitable for the treatment of patients who are overweight or have obesity. Patients are often overtitrated on basal insulin, resulting in an increased risk of hypoglycemia and weight gain without achieving glycemic goals. Given these observations, the effects of antihyperglycemia agents on weight should be considered when individualizing T2D therapy.Funding: Sanofi US, Inc.

Prevention of type 2 diabetes: what is the right target population?

INTRODUCTION

Prevention of type 2 diabetes (T2D) is important to reduce suffering and health care costs. A precursor to T2D is impaired glucose regulation (IGR), a condition of elevated plasma glucose that is associated with insulin resistance and increased risk of cardiovascular disease. Prevention of T2D is determined by preservation of pancreatic β cell function which can be achieved by the use of anti-hyperglycemic medications or intensive lifestyle interventions (ILIs) to modify dietary and physical activity habits that induce modest weight loss (≥5%). Both interventions have beneficial effects on normal glucose regulation (NGR), but ILI is preferred due to its safety, efficacy, and cost.

AREAS COVERED

Traditional approaches to the prevention of T2D have used a variety of screening methods to identify those who are at high risk for developing T2D (prediabetes). People designated with prediabetes are then treated with ILI. An alternative approach for preventing T2D is to offer ILI to all overweight/obese adults who volunteer for weight loss treatment.

EXPERT COMMENTARY

This new alternative has several potential advantages: more rapid recruitment of participants with lower burden of care and early, aggressive treatment of potential β cell dysfunction. Cost-effectiveness studies of this alternative approach are needed.

Determining the optimal screening interval for type 2 diabetes mellitus using a risk prediction model

Background

Progression to diabetes mellitus (DM) is variable and the screening time interval not well defined. The American Diabetes Association and US Preventive Services Task Force suggest screening every 3 years, but evidence is limited.

The objective of the study was to develop a model to predict the probability of developing DM and suggest a risk-based screening interval.

Methods

We included non-diabetic adult patients screened for DM in the Cleveland Clinic Health System if they had at least two measurements of glycated hemoglobin (HbA1c), an initial one less than 6.5% (48 mmol/mol) in 2008, and another between January, 2009 and December, 2013. Cox proportional hazards models were created.

The primary outcome was DM defined as HbA1C greater than 6.4% (46 mmol/mol). The optimal rescreening interval was chosen based on the predicted probability of developing DM.

Results

Of 5084 participants, 100 (4.4%) of the 2281 patients with normal HbA1c and 772 (27.5%) of the 2803 patients with prediabetes developed DM within 5 years. Factors associated with developing DM included HbA1c (HR per 0.1 units increase 1.20; 95%CI, 1.13–1.27), family history (HR 1.31; 95%CI, 1.13–1.51), smoking (HR 1.18; 95%CI, 1.03–1.35), triglycerides (HR 1.01; 95%CI, 1.00–1.03), alanine aminotransferase (HR 1.07; 95%CI, 1.03–1.11), body mass index (HR 1.06; 95%CI, 1.01–1.11), age (HR 0.95; 95%CI, 0.91–0.99) and high-density lipoproteins (HR 0.93; 95% CI, 0.90–0.95). Five percent of patients in the highest risk tertile developed DM within 8 months, while it took 35 months for 5% of the middle tertile to develop DM. Only 2.4% percent of the patients in the lowest tertile developed DM within 5 years.

Conclusion

A risk prediction model employing commonly available data can be used to guide screening intervals. Based on equal intervals for equal risk, patients in the highest risk category could be rescreened after 8 months, while those in the intermediate and lowest risk categories could be rescreened after 3 and 5 years respectively.

The prevalence of impaired fasting glucose and undiagnosed diabetes mellitus and associated risk factors among adults living in a rural Koladiba town, northwest Ethiopia

Background

Diabetes mellitus is becoming a big public health challenge, particularly in developing countries like Ethiopia. It is a manageable disease if early screening and follow up is made. However, as studies in Ethiopia are limited and unorganized, determining the magnitude of prediabetes and diabetes and identifying associated risk factors is quite essential.

Methods

A community-based, cross-sectional study was conducted from February to April 2015 among adults (aged ≥20 years) in a rural Koladiba town. A multistage sampling technique was used to select a total of 392 study participants. Data were collected after a fully informed written consent was obtained from each participant. Demographic, behavioral, and clinical data were collected using a well-structured questionnaire. Multivariable logistic regression models were fitted to control the effect of confounders. Adjusted odds ratios (AOR) with their 95% confidence intervals (95% CI) were computed to measure associations. A p value of <0.05 was considered as statistically significant.

Results

The prevalence of impaired fasting glucose and undiagnosed diabetes mellitus were 12% (95% CI 9–16) and 2.3% (95% CI 1.1–4), respectively, in Koladiba. Overweight (AOR: 4.257, 95% CI 1.345–13.476), obesity (AOR: 5.26, 95% CI 1.138–24.316), hypertriglyceridemia (AOR: 2.83, 95% CI 1.451–5.521), and systolic hypertension (AOR: 3.858, 95% CI 1.62–9.189) were found to be independently associated with impaired fasting glucose. Positive family history of diabetes also showed a marginal association with impaired fasting glucose (p = 0.057). Male sex (p = 0.012) and hypertriglyceridemia (p = 0.030) were associated with undiagnosed diabetes mellitus.

Conclusions

The prevalence of impaired fasting glucose and undiagnosed diabetes mellitus are found to be significant. Obesity, hypertriglyceridemia, and systolic hypertension are independently associated with impaired fasting glucose among adults. We recommend that the community be aware of healthy life style, early screening, and maintain continuous follow up.

Effects of Obex in Overweight and Obese Subjects With or Without Impaired Fasting Glucose: A Pilot Study

Obex is a dietary supplement to help weight loss. The purpose of this study was to evaluate the effect of Obex in overweight/obese participants with or without impaired fasting glucose. This was an open-label pilot study conducted with 40 overweight and obese subjects, 23-60 years old with a body mass index of 25-44 kg/m² (20 participants with impaired fasting glucose [IFG] and 20 with normal glucose levels). Participants received Obex at a dose of one sachet before the two main meals of each day for 3 months. In addition to anthropometric measures and blood pressure (BP), fasting plasma glucose, lipid profile, insulin, creatinine, and uric acid were determined. Insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) were assessed. Three indirect indices were used to calculate insulin sensitivity. Compared to baseline, Obex significantly reduced body weight, body mass index, waist circumference, waist/hip ratio, and waist/height ratio in both groups of participants (p <.05). In individuals without IFG, Obex improved HDL-c (high-density lipoprotein cholesterol) (p <.0001) and lowered BP (p <.05). After 3 months of Obex, subjects with IFG showed a reduction in fasting glucose concentrations (p <.0001). Compared to baseline, this group also showed improved insulin sensitivity and HDL-c (p <.05). In conclusion, the consumption of Obex contributed to weight reduction, improved glucose tolerance and insulin sensitivity, as well as HDL-c, and appears to be safe in overweight/obese adults with impaired fasting glucose. Obex may be beneficial for weight loss, indicating that further studies are required.

Evaluation of lorcaserin on progression of prediabetes to type 2 diabetes and reversion to euglycemia

OBJECTIVES

Lorcaserin is a selective 5-HT2C (5-hydroxytryptamine 2C) receptor agonist indicated for weight management. Here, we assess the impact of lorcaserin on progression from prediabetes to type 2 diabetes (T2D) and on reversion from prediabetes to euglycemia.

METHODS

This is a post hoc analysis of pooled data from two Phase 3 studies, BLOOM and BLOSSOM (N = 6136), evaluating the impact of lorcaserin on weight and glycemic parameters over 52 weeks in the subpopulation of obese/overweight subjects with prediabetes, alternately defined by fasting plasma glucose (FPG) 100-125 mg/dl or glycated hemoglobin (HbA1c) 5.7-6.4% at baseline.

RESULTS

At Week 52, in the subpopulation with prediabetes, nearly twice as many lorcaserin-treated subjects achieved ≥5% weight loss versus placebo (HbA1c: 55.6% vs. 27.5%, p < 0.001; FPG: 52.8% vs. 28.8%, p < 0.001), and a significantly lower percentage of lorcaserin-treated subjects progressed to T2D versus placebo based on HbA1c (lorcaserin 3.2%, placebo 5.0%, p = 0.032) but not FPG (lorcaserin 1.6%, placebo 2.6%, p = 0.227). A significantly greater proportion of lorcaserin-treated subjects versus placebo also reverted to euglycemia based on both HbA1c (lorcaserin 40%, placebo 29.5%, p < 0.001) and FPG (lorcaserin 52.4%, placebo 46.5%, p = 0.047).

CONCLUSION

In subjects with prediabetes, lorcaserin may contribute to weight loss and improve glycemic parameters, and thus may help with preventing progression to T2D and promoting reversion to euglycemia.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov identifiers are NCT00395135 (BLOOM) and NCT00603902 (BLOSSOM).

Chemical and Biological Aspects of Extracts from Medicinal Plants with Antidiabetic Effects

Diabetes mellitus is a chronic disease and a leading cause of death in western countries. Despite advancements in the clinical management of the disease, it is not possible to control the late complications of diabetes. The main characteristic feature of diabetes is hyperglycemia, which reflects the deterioration in the use of glucose due to a faulty or poor response to insulin secretion. Alloxan and streptozotocin (STZ) are the chemical tools that are most commonly used to study the disease in rodents. Many plant species have been used in ethnopharmacology or to treat experimentally symptoms of this disease. When evaluated pharmacologically, most of the plants employed as antidiabetic substances have been shown to exhibit hypoglycemic and antihyperglycemic activities, and to contain chemical constituents that may be used as new antidiabetic agents. There are many substances extracted from plants that offer antidiabetic potential, whereas others may result in hypoglycemia as a side effect due to their toxicity, particularly their hepatotoxicity. In this article we present an updated overview of the studies on extracts from medicinal plants, relating the mechanisms of action by which these substances act and the natural principles of antidiabetic activity.

Conceptualizing type 2 diabetes and its management

Type 2 diabetes is growing worldwide due to population growth, increased rates of obesity, unhealthy diet, and physical inactivity. Risk assessment methods can effectively evaluate the risk of diabetes, and a healthy lifestyle can significantly reduce risk or prevent complications of type 2 diabetes. However, risk assessment alone has not significantly improved poor adherence to recommended medical interventions and lifestyle changes. This paper focuses on the challenge of nonadherence and posits that improving adherence requires tailoring interventions that explicitly consider the social determinants of health.

Older Age, Higher Body Mass Index and Inflammation Increase the Risk for New-Onset Diabetes and Impaired Glucose Tolerance in Patients on Peritoneal Dialysis

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OBJECTIVES

To identify predictors of new-onset diabetes and impaired glucose tolerance (IGT) events in patients undergoing peritoneal dialysis (PD) based on baseline and time-dependent covariates, respectively. ♦

METHODS

In this prospective, single center-based cohort, all non-diabetic incident PD patients between August 2003 and August 2011 were included. All demographic and laboratory data were recorded at baseline. Repeated measurements for laboratory, dialysis prescription, and nutrition parameters were recorded at regular intervals. Multivariable Cox regression models built from baseline and time-dependent variables respectively were used to calculate the hazard ratio (HR) of potential predictors for new-onset diabetes and IGT (NODI). ♦

RESULTS

Of the 612 PD patients, 25 (4.1%) and 7 (1.1%) patients were identified with NODI, respectively, during a mean follow-up period of 32.4 (12.9 - 60.8) months. Using multivariable Cox regression analysis, age and body mass index (BMI) at baseline were significantly associated with NODI after adjustment for potential confounders. During follow-up, time-dependent BMI and serum high-sensitive C-reactive protein (HS-CRP) independently predicted the risk for NODI. Patients with NODI had significantly elevated plasma glucose concentrations and BMI from the start of PD therapy, with serum HS-CRP maintained at high levels. Dietary/dialysate energy intake and other laboratory parameters were not correlated with NODI risk either as baseline or time-dependent variables. ♦

CONCLUSIONS

Traditional and uremic-related risk factors, such as older age, higher BMI, and inflammation, contribute to new-onset diabetes and impaired glucose tolerance in PD patients.

Prevention of type 2 diabetes through lifestyle modification: is there a role for higher-protein diets?

Type 2 diabetes (T2D) incidence is increasing worldwide, driven by a rapidly changing environment and lifestyle and increasing rates of overweight and obesity. Prevention of diabetes is key and is most likely achieved through prevention of weight gain and/or successful long-term weight loss maintenance. Weight loss is readily achievable but there is considerable challenge in maintaining that weight loss over the long term. Lower-fat carbohydrate-based diets are widely used for T2D prevention. This is supported primarily by 3 successful long-term interventions, the US Diabetes Prevention Program, the Finnish Diabetes Prevention Study, and the Chinese Da Qing Study, but evidence is building in support of novel higher-protein (>20% of energy) diets for successful weight loss maintenance and prevention of T2D. Higher-protein diets have the advantage of having relatively low energy density, aiding longer-term appetite suppression, and preserving lean body mass, all central to successful weight loss and prevention of weight regain. Here, we review the carbohydrate-based intervention trials and present mechanistic evidence in support of increased dietary protein for weight loss maintenance and a possible novel role in prevention of dysglycemia and T2D.

Tissue biomarkers of drug efficacy: case studies using a MALDI-MSI workflow

MALDI MS imaging (MALDI-MSI) offers a capability to not only evaluate the distribution, localization and metabolism of drugs within tissues but also allow correlative tissue measurement of the effect of the drug on biomolecules in the targeted pathway. Particularly for MALDI-MSI, lipid molecules are readily detectable within tissues. Case study examples are provided for two different drugs targeting the sphingosine-1-phosphate/ceramide nexus in tumor xenograft tissues. A workflow combining high-resolution MALDI-MSI with on-tissue confirmation of targeted compounds using a structural library and on-tissue enzymatic digestion strategy is described. Representative images of drug metabolite distribution that correlate to an increase or decrease in sphingosine-1-phosphate or ceramide species are provided.

A systematic review of the role of renin angiotensin aldosterone system genes in diabetes mellitus, diabetic retinopathy and diabetic neuropathy

BACKGROUND

The renin angiotensin aldosterone system (RAAS) plays a vital role in regulating glucose metabolism and blood pressure, electrolyte and fluid homeostasis. The aim of this systematic review is to assess the association of the RAAS genes with diabetes mellitus (DM) and its complications of retinopathy, neuropathy and cardiovascular disease (CVD).

MATERIALS AND METHODS

The relevant English-language studies were identified using the key words of DM, type 1 diabetes mellitus (T1DM), T2DM, renin angiotensin aldosterone polymorphisms or genotypes and RAAS from the search engines of MEDLINE/PubMed, and Scopus from January 1, 1995 to July 30, 2014. Inclusion criteria for selecting relevant studies were reporting the role of RAAS gene variants in the pathogenesis of T1DM or T2DM, diabetic retinopathy (DR), diabetic neuropathy and cardiovascular complication of DM.

RESULTS

The reviewers identified 204 studies of which 73 were eligible for inclusion in the present systematic review. The review indicates the angiotensinogen (AGT) M235T polymorphism might not affect the risk of DM. The role of angiotensin converting enzyme insertion/deletion (ACE I/D) and angiotensin II type 1 receptor gene (AT1R) A1166C polymorphisms in the pathogenesis of DM could not be established. Studies indicate the absence of an association between three polymorphisms of AGT M235T, ACE I/D and AT1R A1166C and DR in DM patients. A protective role for ACE II genotype against diabetic peripheral neuropathy has been suggested. Also, the ACE I/D polymorphism might be associated with the risk of CVD in DM patients.

CONCLUSION

More studies with adequate sample size that investigate the influence of all RAAS gene variants together on the risk of DM and its complications are necessary to provide a more clear picture of the RAAS genes polymorphisms involvement in the pathogenesis of DM and its complications.

Novel treatment approaches in hypertensive type 2 diabetic patients

Type 2 diabetes mellitus (T2DM) and hypertension represent two common conditions worldwide. Their frequent association with cardiovascular diseases makes management of hypertensive patients with T2DM an important clinical priority. Carvedilol and renal denervation are two promising choices to reduce plasma glucose levels and blood pressure in hypertensive patients with T2DM to reduce future complications and improve clinical outcomes and prognosis. Pathophysiological mechanisms of both options are under investigation, but one of the most accepted is an attenuation in sympathetic nervous system activity which lowers blood pressure and improves insulin sensitivity. Choice of these therapeutic approaches should be individualized based on specific characteristics of each patient. Further investigations are needed to determine when to consider their use in clinical practice.

Sweet taste sensitivity in pre-diabetics, diabetics and normoglycemic controls: a comparative cross sectional study

BACKGROUND

Increasing prevalence of pre-diabetes is an emerging public health problem. Decrease in sweet taste sensitivity which can lead to an increase in sugar intake might be a factor driving them to overt diabetes. The aim of the present study was to assess the sweet taste sensitivity in pre-diabetics in comparison with diabetics and with normoglycemic controls.

METHODS

Forty pre-diabetics, 40 diabetics and 34 normoglycemic controls were studied. The three groups were matched for age, sex and BMI. The division into groups was based on their glycated hemoglobin levels. The detection and recognition thresholds were determined by the multiple forced-choice method using sucrose solutions prepared in ¼ log dilutions. The intensities of perceived sensations for a series of suprathreshold concentrations of sucrose solutions prepared in ½ log dilution were determined by rating on a visual analogue scale. Statistical analyses were performed by SPSS version 21.

RESULTS

The mean (SD) detection thresholds of diabetic, pre-diabetic and normoglycemic groups were 0.025 (0.01), 0.018 (0.01) and 0.015 (0.01) respectively with a significant increase in diabetic group compared to normoglycemic group (p = 0.03). The mean recognition thresholds were not different among the three groups. When the intensity ratings for suprathreshold concentrations of sucrose were compared between the three groups, for all suprathreshold concentrations tested, significant differences were observed across the four concentrations (p < 0.001) and between groups in suprathreshold ratings (p < 0.05). Further analysis showed that the diabetic group had significantly lower suprathreshold ratings than the normoglycemic group (p < 0.001). Although all mean suprathreshold intensity ratings of the pre-diabetic group were between the normoglycemic and diabetic groups, the differences were not significant.

CONCLUSIONS

This is the first study to demonstrate the sweet taste sensitivity in pre-diabetics. The findings of the present study do not support the hypothesis of decreased sweet taste sensitivity of pre-diabetics. However, the results confirm the previous findings of blunted taste response in diabetics. The observation of pre-diabetics having intermediate values for all taste thresholds and suprathreshold ratings warrants a future investigation with a larger pre-diabetic sample recruited with more specific screening criteria to test this hypothesis further.

Antidiabetic plants improving insulin sensitivity

BACKGROUND

Globally, the prevalence of diabetes mellitus is increasing at an alarming rate. This chronic pathology gravely troubled the human health and quality of life. Both insulin deficiency and insulin resistance are involved in the pathophysiology of diabetes mellitus. Moreover, insulin resistance is being diagnosed nowadays in a growing population of diabetic and obese patients, especially in industrialized societies. There are lots of conventional agents available to control and to treat diabetes, but total recovery from this disorder has not been reported up to this date. Plants provided a potential source of hypoglycemic drugs and are widely used in several traditional systems of medicine to prevent diabetes. A few reviews with less attention paid to mechanisms of action have been published on antidiabetic plants.

OBJECTIVES

The present review focuses on the various plants that have been reported to be effective in improving insulin sensitivity associated with diabetes.

KEY FINDINGS

In this work, an updated systematic review of the published literature has been conducted to review the antidiabetic plants improving insulin sensitivity and 111 medicinal plants have been reported to have a beneficial effect on insulin sensitivity using several in-vitro and in-vivo animal models of diabetes.

CONCLUSION

The different metabolic and cellular effects of the antidiabetic plants improving insulin sensitivity are reported indicating the important role of medicinal plants as potential alternative or complementary use in controlling insulin resistance associated with diabetes mellitus.

Sulforaphane attenuation of type 2 diabetes-induced aortic damage was associated with the upregulation of Nrf2 expression and function

Type 2 diabetes mellitus (T2DM) significantly increases risk for vascular complications. Diabetes-induced aorta pathological changes are predominantly attributed to oxidative stress. Nuclear factor E2-related factor-2 (Nrf2) is a transcription factor orchestrating antioxidant and cytoprotective responses to oxidative stress. Sulforaphane protects against oxidative damage by increasing Nrf2 expression and its downstream target genes. Here we explored the protective effect of sulforaphane on T2DM-induced aortic pathogenic changes in C57BL/6J mice which were fed with high-fat diet for 3 months, followed by a treatment with streptozotocin at 100 mg/kg body weight. Diabetic and nondiabetic mice were randomly divided into groups with and without 4-month sulforaphane treatment. Aorta of T2DM mice exhibited significant increases in the wall thickness and structural derangement, along with significant increases in fibrosis (connective tissue growth factor and transforming growth factor), inflammation (tumor necrosis factor-α and vascular cell adhesion molecule 1), oxidative/nitrative stress (3-nitrotyrosine and 4-hydroxy-2-nonenal), apoptosis, and cell proliferation. However, these pathological changes were significantly attenuated by sulforaphane treatment that was associated with a significant upregulation of Nrf2 expression and function. These results suggest that sulforaphane is able to upregulate aortic Nrf2 expression and function and to protect the aorta from T2DM-induced pathological changes.

Body mass index: a risk factor for retinopathy in type 2 diabetic patients

The aim of the study was to investigate whether body mass index (BMI) independently or in correlation with other risk factors is associated with diabetic retinopathy (DR) progression. The study included 545 patients with type 2 diabetes. According to DR status, they were divided into three groups: group 1 (no retinopathy; n = 296), group 2 (mild/moderate nonproliferative DR; n = 118), and group 3 (severe/very severe NPDR or proliferative DR; n = 131). Patients without DR were younger than those with signs of retinopathy at time of diabetes onset whilst diabetes duration was longer in groups with severe NPDR and PDR. DR progression was correlated with diabetes duration, BMI, HbA₁c, hypertension, and cholesterol. Statistical analyses showed that the progression of retinopathy increased significantly with higher BMI (gr. 1: 26.50 ± 2.70, gr. 2: 28.11 ± 3.00, gr. 3: 28.69 ± 2.50; P < 0.01). We observed a significant deterioration of HbA₁c and a significant increase in cholesterol and hypertension with an increase in BMI. Correlation between BMI and triglycerides was not significant. Thus, BMI in correlation with HbA₁c cholesterol and hypertension appears to be associated with the progression of DR in type 2 diabetes and may serve as a predictive factor for the development of this important cause of visual loss in developed countries.