Diabetes mellitus and electrolyte disorders

Integrated analysis of long non‑coding RNA megacluster, microRNA‑132 and microRNA‑133a and their implications for cardiovascular risk and kidney failure progression in diabetic patients

Inefficient control of elevated blood sugar levels can lead to certain health complications such as diabetic nephropathy (DN) and cardiovascular disease (CVD). The identification of effective biomarkers for monitoring diabetes was performed in the present study. The present study aimed to investigate the implications of long non-coding RNA megacluster (lnc-MGC), microRNA (miR)-132 and miR-133a, and their correlation with lactate dehydrogenase (LDH) activity and glycated hemoglobin (HbA1C) levels to identify biomarkers for the early diagnosis of diabetes mellitus, induced DN and CVD. The present study included a total of 200 patients with type 2 diabetes, as well as 40 healthy subjects as controls. The diabetic patients were classified into six groups based on their estimated HbA1c level, glomerular filtration rate and LDH activity, while the healthy controls constituted the seventh group. Diabetic patients exhibited significant increases in parameters related to diabetes as fasting blood sugar, HbA1c levels, cardiac injury and kidney failure. Furthermore, the expression levels of TNF-α were significantly increased in the diabetic groups compared with healthy controls. Diabetic patients with cardiovascular dysfunction showed significantly increased expression levels of miR-132, miR-133a and lnc-MGC, compared with the healthy group. The expression of circulating miR-132 in blood was low in the groups of diabetic patients compared with the healthy controls, and demonstrated a negative correlation with LDH and HbA1C levels. Expression levels of miR-132, miR-133a and lnc-MGC, along with their correlations with LDH and HbA1C levels, could be used to distinguish diabetic patients with reduced CVD from those at early stage diabetes, which indicated their potential as biomarkers for CV complications associated with diabetes mellitus in the future.

Hyponatremia Associated with the Use of Common Antidepressants in the All of Us Research Program

Selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), and norepinephrine-dopamine reuptake inhibitor (NRI) antidepressants can cause hyponatremia through syndrome of inappropriate antidiuretic hormone secretion (SIADH). This study assesses the differential risks of hyponatremia associated with commonly prescribed SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram), SNRIs (duloxetine, venlafaxine) and NRI (bupropion), as well as omeprazole as a reference, with a retrospective observational cohort study in the All of Us Research Program, a national multicenter research cohort containing de-identified electronic health records (EHR). Participants who had been prescribed monotherapy with any of eight common antidepressants were included, with each drug considered as a separate arm indexed with a start date. Events were defined as the first occurrence of a low plasma sodium measurement or a clinical diagnosis recorded for either hyponatremia or SIADH. Those who did not have events were censored at their last plasma sodium measurement. A total of 17,439 individuals were exposed to one of the eight antidepressants as monotherapy. The overall incidences for hyponatremia were 0.87% in the first 30 days and 10.5% in the first 3 years in the antidepressant arms. Compared to sertraline, duloxetine (hazard ratio [HR] = 1.37 [1.19-1.58]) and escitalopram (HR = 1.16 [1.01-1.33]) were associated with the highest overall risk of hyponatremia, and bupropion (HR = 0.83 [0.73-0.94]) and paroxetine (HR = 0.78 [0.65-0.93]) were associated with the lowest risk. The risks were unchanged after adjusting for comorbidity and polypharmacy. Such information could help guide providers in managing patients and their risks of hyponatremia when on common antidepressants.

Association of initial serum sodium change and clinical outcome in patients with diabetes receiving sodium-glucose cotransporter-2 inhibitor therapy: A multicentre database analysis in Taiwan

AIM

The study aimed to assess the impact of varying degrees of initial serum sodium change among patients with type 2 diabetes (T2D) starting sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy and their subsequent clinical outcome.

METHODS

We used medical data from a multicentre health care provider in Taiwan and recruited 4400 patients with T2D with baseline normal serum sodium (135-145 mmol/L) and follow-up serum sodium measures available after 3 months of SGLT2i treatment from 1 June 2016 to 31 December 2021.

RESULTS

After a median of 2.9 (2.4, 3.4) months of SGLT2i treatment, overall, there was a minimal change in serum sodium levels (from 139.6 ± 2.4 to 139.5 ± 3.7 mmol/L). Most patients (87.8%) maintained normal sodium levels, while 8.6% (n = 378) experienced hyponatraemia (<135 mmol/L) and 3.6% (n = 158) hypernatraemia (>145 mmol/L). Factors independently associated with hyponatraemia included cancer history, chronic lung disease, insulin use, higher glycated haemoglobin, impaired liver function, lower baseline sodium and greater initial decline in kidney function. Conversely, factors linked to hypernatraemia included older age, absence of cancer history, loop diuretic and non-steroidal anti-inflammatory drug use, higher baseline sodium and a lesser initial decline in kidney function. Over a median of 26.0 months of follow-up, hyponatraemia shortly after starting SGLT2i therapy was associated with significantly increased risks of major adverse cardiovascular events [hazard ratio (HR): 2.52; 95% confidence interval (CI): 1.83-3.48], heart failure for hospitalization (HR: 1.66; 95% CI: 1.16-2.37), major adverse renal events (HR: 2.27; 95% CI: 1.73-2.96) and all-cause death (HR: 2.98; 95% CI: 2.17-4.11) after adjusting for clinically relevant factors. Non-linear analysis indicated that a more pronounced initial decline in serum sodium levels correlated steeply with higher risks of these adverse events.

CONCLUSION

While most patients with T2D maintain stable serum sodium homeostasis on SGLT2i therapy, a subset may experience dysnatraemic events with potential worse clinical consequences. Physicians should be vigilant about monitoring sodium levels and considering the associated risks when initiating SGLT2i therapy in patients with risk.

Acute and sub-acute toxicity study of aqueous and methanol root extract of Tetracera alnifolia in male albino rats

The aim of this study was to assess the acute and sub-acute toxicity of aqueous and methanol extracts of the root of Tetracera alnifolia as well as the effects on some biochemical parameters in albino rats as many plants used in traditional medicine lack scientific and clinical evidence to support a better understanding of their safety and efficacy. Phytochemical screening and proximate analysis of the pulverised root of Tetracera alnifolia was carried out using previously reported protocol. Sub-acute toxicity study of each extract was done for 28 days followed by organs function tests and histopathology studies of the liver, kidney and heart. Evaluation of lipid profile and oxidative stress marker to ascertain the effect of each extract on lipid peroxidation and their antioxidant property was done after administration of 200 mg/Kg body weight of each extract for a period of thirty-five days. Acute toxicity study of each extract gave oral LD50 (rat) of greater than 5000 mg/kg body weight with no signs of toxicity. Sub-acute toxicity study showed both extracts were non-toxic to the liver, kidney, heart and blood at doses between 200 and 3000 mg/Kg body weight assessed by the respective organ function tests, hematological parameters, and histopathology study. However, higher doses seem toxic to the liver particularly at 5000 mg/kg B. W due to increase in plasma AST, ALT and ALP activities accompanied with reduced protein and albumin concentrations. Effects of each extracts at 200 mg/Kg body weight on some biochemical parameters revealed no significant difference in lipid profile parameters and no lipid peroxidation. Each extract may possess antioxidant property due to increase in catalase activity. The result from this research may help validate the safety of the oral use of this plant in traditional medicine.

Major electrolyte disorder and associated factors among patients with chronic disease in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Alterations in electrolytes are associated with a number of clinical problems and prompt diagnosis of electrolyte disorder and treatment are crucial in the management of patients with chronic illness. Even though, major electrolyte disorders are common among patients with chronic diseases, the problem were not received enough attention. Thus, the aim of this review was to determine the pooled prevalence and associated factors of major electrolyte disorder among patients with chronic diseases.

METHODS

The PubMed, Cochrane Library, Science Direct, African Journals Online, and Google Scholar databases were searched by two authors (WCT and YAF) from January 15/2024 to January 22/2024 to identify articles reporting the prevalence of electrolyte disorders in patients with chronic disease in Ethiopia. A random-effects model was used to estimate the pooled prevalence of electrolyte disorder. Important data were extracted with Microsoft Excel and then exported to STATA software version 11 (STATA Corp LLC, TX, USA) for analysis. Cochran's Q test at a significance level of less than 0.05 and the I2 index were used to examine the statistical heterogeneity among the included studies. A random-effects model was used to estimate the pooled prevalence of major electrolyte disorder due to the presence of heterogeneity.

RESULTS

The finding of this review showed that, the pooled estimate of electrolyte disorder among patients with chronic diseases in Ethiopia was found to be 56.66% (95% CI: 44.54, 68.79, P < 0.001). Having no formal education (POR = 7.06, 95% CI = 1.35, 36.98), taking diuretic (POR = 4.41, 95% CI = 1.78, 10.91), patients with anti-diabetic medication (POR = 10.11, 95% CI = 3.45, 29.66), having a body mass index ≥ 30 kg/m2 (POR = 6.99, 95% CI = 2.01, 5.93) and having uncontrolled blood glucose [POR: 7.09, 95% CI = 5.10-9.80) were factors associated with electrolyte disorders among patients with chronic diseases.

CONCLUSION

This systematic review and meta-analysis revealed that the pooled electrolyte disorders among patients with chronic disease was significant in Ethiopia. Patients who had no formal education, taking diuretic, taking anti-diabetic medication, body mass index ≥ 30 kg/m2, alcohol consumption and having high uncontrolled blood glucose were significantly associated with electrolyte disorders. Special emphasis on the status of serum electrolytes should be given for patients with chronic disease in those taking diuretic and anti-diabetic treatments and who are overweight.

TRIAL REGISTRATION

Prospero registration: CRD42024579411.

Challenges of Glycemic Control in People With Diabetes and Advanced Kidney Disease and the Potential of Automated Insulin Delivery

Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease in the world. It is known that maintaining optimal glycemic control can slow the progression of CKD. However, the failing kidney impacts glucose and insulin metabolism and contributes to increased glucose variability. Conventional methods of insulin delivery are not well equipped to adapt to this increased glycemic lability. Automated insulin delivery (AID) has been established as an effective treatment in patients with type 1 diabetes mellitus, and there is emerging evidence for their use in type 2 diabetes mellitus. However, few studies have examined their role in diabetes with concurrent advanced CKD. We discuss the potential benefits and challenges of AID use in patients with diabetes and advanced CKD, including those on dialysis.

Hypoglycemic Assessment of Aqueous Leaf Extract of Moringa oleifera on Diabetic Wistar Rats

Background: Moringa oleifera leaf is used for diabetes due to its pharmacologic effects. Patients with hyperglycemia experience beta cell destruction. However, no research on risk awareness has been done to ascertain its safety. The present study describes the antidiabetic effect of Moringa oleifera leaf, such as the protection of pancreatic beta cells and the induction of glycogen synthesis, before addressing the secondary effects of diabetes, such as hepatic and renal toxicity. Methods: Forty-five Wistar rats weighed 160 ± 10 g were divided into nine groups. All animal operations complied with the National Institute of Health (NIH) guidelines for the care and use of laboratory animals as approved by the Animal Ethical Committee, University of Jos. Group I was normal control and Group II was diabetic animals induced with alloxan. Insulin and extract doses of 200, 400, and 800 mg/kg were given to diabetic Groups III-VI. Normal animals in Groups VII-IX were given extract at doses of 200, 400, and 800 mg/kg for 28 days. Tissues were retrieved for biochemical and histological investigations using standard techniques. Results: There was decrease relative body weight of diabetic animals (95.50 ± 5.50) when compared to normal control (142.75 ± 20.08) with increased levels of urea (control 6.13 ± 0.523 and diabetes 29.23 ± 1.267) and creatinine (control 0.70 ± 0.057 and diabetes 2.13 ± 0.185). Histology of the liver and pancreas also points to organ damage due to hyperglycemia. However, oral administration of extract showed antidiabetic effect with protection of pancreatic beta cells and the induction of glycogen synthesis, no glycogen was deposited in the liver, addressing the secondary effects of diabetes, such as hepatic and renal toxicity. Further discovery revealed that extract elevated antioxidant enzyme expression. Conclusion: Leaf extract from Moringa oleifera reduces blood sugar and lessens the damage caused by hyperglycemia in the pancreas and liver.

Prevalence and Predictors of Adverse Events Associated With Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in Type 2 Diabetic Patients: A Cross-sectional Study

Background

Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic agents widely prescribed in India despite safety concerns. However, studies focused on their safety profile are scarce, especially in South India.

Objective

To evaluate the prevalence and predictors of adverse events (AEs) with DPP-4 inhibitors in patients with type 2 diabetes mellitus (T2DM).

Research design and methods

This retrospective cross-sectional study analyzed data from medical records of T2DM patients prescribed DPP-4 inhibitors admitted to the medicine department from 2019 to 2021 at a South Indian tertiary care hospital. The causality of AEs was assessed using the WHO-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo scale, and severity using the Modified Hartwig and Seigel scale. We applied a Generalized model with a binary response and logit-link function to understand the factors that best explain the AE. The best-fit models were chosen based on least Akaike's information criterion and highest PseudoR 2 and presented the odds ratio (OR) with a 95% confidence interval. The analyses were performed in R software version 4.2.1.

Results

Among the 796 patients included in the study, 26% experienced AEs. A total of 212 AEs were observed, and Saxagliptin-associated AEs were the most prevalent (66.6%). Hepatic AEs were predominant (37.7%), followed by gastrointestinal events (16.5%) and electrolyte imbalances (12.3%). Most AEs were possible based on WHO-UMC criteria (78.7%) and the Naranjo scale (86.7%), with 58% being of moderate severity and 42% mild. In the multivariate analysis, aspartate transaminase [OR: 1.013 (0.006-1.020)], alkaline phosphatase [OR: 1.004 (1.001-1.007)] and patients already on DPP-4 inhibitors [OR 1.191(1.012-1.366)] were significant predictors for AEs with DPP-4 inhibitors.

Conclusion

The study highlighted a high prevalence of AEs with DPP-4 inhibitors and identified significant predictors of these AEs. These findings underscore the necessity of vigilant monitoring and risk assessment while prescribing DPP-4 inhibitors to the Indian population.

Impact of Hyponatremia on COVID-19-Related Outcomes: A Retrospective Analysis

BACKGROUND

Sodium disturbances are observed in one-third of patients with COVID-19 and result from multifaceted mechanisms. Notably, hyponatremia is associated with disease progression and mortality.

AIM

We aimed to analyze the impact of hyponatremia on COVID-19 outcomes and its correlation with clinical and laboratory parameters during the first wave.

METHODS

We evaluated the sodium levels of 558 patients with COVID-19 between 21 March 2020, and 31 July 2020, at a single center. We performed linear regression analyses to explore the correlation of sodium levels with COVID-19-related outcomes, demographic data, signs and symptoms, and laboratory parameters. Next, we conducted Pearson correlation analyses. A p-value < 0.05 was considered significant.

RESULTS

Hyponatremia was found in 35.3% of hospitalized patients with COVID-19. This was associated with the need for intensive care transfer (B = -1.210, p = 0.009) and invasive mechanical ventilation (B = -1.063, p = 0.032). Hyponatremia was frequently found in oncologic patients (p = 0.002) and solid organ transplant recipients (p < 0.001). Sodium was positively associated with diastolic blood pressure (p = 0.041) and productive cough (p = 0.022) and negatively associated with dry cough (p = 0.032), anorexia (p = 0.004), and nausea/vomiting (p = 0.007). Regarding the correlation of sodium levels with other laboratory parameters, we observed a positive correlation with hematocrit (p = 0.011), lymphocytes (p = 0.010), pCO2 (p < 0.0001), bicarbonate (p = 0.0001), and base excess (p = 0.008) and a negative correlation with the neutrophil-to-lymphocyte ratio (p = 0.009), the platelet-to-lymphocyte ratio (p = 0.033), and arterial blood glucose (p = 0.016).

CONCLUSIONS

Hyponatremia is a risk factor for adverse outcomes in COVID-19 patients. It is associated with demographic data and clinical and laboratory parameters. Therefore, hyponatremia is an important tool for risk stratification in COVID-19 patients.

Prevalence of hyponatremia among medically hospitalized patients and associated outcomes: a retrospective cohort study

BACKGROUND

Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes.

OBJECTIVES

Study the prevalence of hyponatremia among medically admitted patients and the outcomes associated with hyponatremia.

DESIGN

Retrospective cohort.

SETTING

Medical ward at tertiary hospital setting.

PATIENTS AND METHODS

The study included adult (≥18 years) hospitalized patients in general medical wards. Three readings of serum sodium level were taken (initial sodium level, nadir during admission, and before discharge).

SAMPLE SIZE AND BASIS

The sample size of 350 was determined based on a presumed 35% incidence of hyponatremia among hospitalized patients, with a 5% error margin.

MAIN OUTCOME MEASURES

The prevalence of hyponatremia among medically hospitalized patients and association with health outcomes including length of hospital stay, inpatient mortality, 90-days readmission and 1-year mortality.

RESULTS

In this study, 736 patients met the inclusion criteria. Of these, 377 (51.2%) had hyponatremia on admission, increasing to 562 (76.35%) during hospitalization. Mild hyponatremia was observed in 49.6% (n=365), moderate in 13.6% (n=100), and severe in 13.2% (n=97). Severe hyponatremia patients were significantly older (P<.01), predominantly female (P=.014), and had lower serum magnesium and albumin levels (P<.01). Hypertension, ischemic heart disease, heart failure, and diabetes were more prevalent in severe hyponatremia cases (P<.01, P<.01, P=.045, P<.01, respectively). Hospital stays were significantly shorter for patients with normal sodium levels (P<.01). Patients with severe hyponatremia had a shorter time for first hospital readmission (HR=0.80, P<.01 [95% CI; 0.69-0.94]).

CONCLUSION

Hyponatremia was prevalent among medically hospitalized patients and more common among old patients, women, and patients with comorbidities. Hyponatremia was associated with increased length of stay in hospital and increased risk of 90-day re-admission.

LIMITATIONS

Single-centre design and retrospective nature.

Correlation of Serum Electrolyte Imbalances With Diabetic Duration and Medication Use: A Cross-Sectional Comparative Study

BACKGROUND

Certain anti-diabetic medications may exacerbate electrolyte imbalances, potentially complicating glycemic control in diabetic patients. The present study aimed to correlate the serum electrolyte imbalances such as Na+, K+, Ca+2, Cl-, and Mg+2 with the duration of disease, glycemic control, and medication regimens.

METHOD

In this cross-sectional study, 31 patients with type 2 diabetes mellitus (T2DM) and 30 healthy controls, with mean ages of 52.06 and 48.5 years, respectively, were recruited based on eligibility criteria. Data on demographic information, medication history, and duration of diabetes were collected. Fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1C), and serum electrolytes were measured. The data were statistically analyzed. The mean differences in serum electrolytes between T2DM patients and non-diabetic participants were compared using the Mann-Whitney U test, and correlation analysis was performed. A p-value of <0.05 was considered statistically significant.

RESULT

Around 9.6% of participants had diabetes duration of less than one year, while the majority (45%) fell within the 1-5-year duration range. Most diabetic patients (61.2%) exhibited poor glycemic control. Statistically significant differences were observed between the mean FBS, PPBS, and HbA1C levels of T2DM (150, 249, and 8.82, respectively) and control group (95, 114, and 5.52, respectively). Analysis of serum electrolytes showed statistically significant differences with regard to Na+, K+, and Cl- between the diabetic and control groups. Mean sodium and chloride levels were lower and potassium levels were higher in diabetic patients compared to the control group. Negative correlations were observed between sodium and chloride levels and duration of diabetes and HbA1C levels.

CONCLUSION

The study reveals significant electrolyte imbalances in patients with T2DM, characterized by reduced sodium and chloride levels and elevated potassium levels compared to healthy controls. These alterations are closely associated with poor glycemic control and longer disease duration, emphasizing the importance of regular electrolyte monitoring in T2DM management to mitigate potential complications.

Hyponatremia in geriatric patients

Hyponatremia is the most frequent electrolyte imbalance in geriatric medicine. Causes of hyponatremia were retrospectively analyzed in all in-patients treated in 2016 (N = 2267, 1564 women, 703 men, mean age ± standard deviation 81.9 ± 7.6 years). Any form of hyponatremia on admission, during the stay or on discharge was noted in 308 patients (13.6%, 231 women, 77 men; mean age ± standard deviation 83.1 ± 7.3 years, p = 0.009 vs. age of all patients). Women had a higher probability of developing hyponatremia compared to men (p = 0.019), 131 patients were hypovolemic, and dyspnea as an indicator of hypervolemia was noted in 71 patients.Only 12 patients suffering from hyponatremia (3.9%) did not receive any of the potentially sodium-lowering drugs assessed (diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, antidepressants, neuroleptics, nonsteroidal antirheumatics, carbamazepine, oxcarbazepine). The median number of drugs per patient potentially lowering the plasma sodium level was 3 and the maximum number was 7.Hypovolemic hyponatremia and the syndrome of inadequate antidiuretic hormone secretion were the most important causes of hyponatremia. Adverse drug effects were the main origins of both conditions. In patients with hyponatremia the drug load influencing plasma sodium level should be minimized, thiazide diuretics should be avoided and older individuals should receive a diet with sufficient salt content.

Impact of electrolyte abnormalities and adverse outcomes in persons with eating disorders: A systematic review protocol

BACKGROUND

Electrolytes (sodium, potassium, calcium, magnesium, chloride, phosphate) are required in specific amounts for proper functioning of the human body. Although the body has different organ systems, such as the kidneys, that regulate electrolyte levels in the blood, electrolyte abnormalities occur frequently in people with eating disorders. The objective of this review will be to examine the association between electrolyte imbalances and adverse outcomes in people with eating disorders.

METHODS

A systematic review of studies on eating and electrolyte disorders shall be conducted. Electronic searches shall be done in the Ovid MEDLINE, EMBASE, and PsycINFO databases. Selected studies shall include randomized control trials (RCTs), non-randomized controlled trials, and cross-sectional studies published in English or French. Quality appraisal of studies and a narrative synthesis of extracted data shall be conducted.

DISCUSSION

This review will synthesize existing evidence on electrolyte abnormalities in people with eating disorders. It will identify the type of electrolyte imbalances, their impact, and outcomes in people with eating disorders. We anticipate that information that will be useful to policy makers and clinicians in designing better policies to prevent eating disorders and or manage people with eating disorders shall be elucidated in this study.

DISSEMINATION

The final manuscript will be submitted for publication in a journal.

REVIEW REGISTRATION

This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number CRD42023477497.

Unmeasured Osmoles: The Hidden Solutes Obscuring a Hyponatremia Evaluation

Hyponatremia is defined as serum sodium less than 135 mEq/L and is principally a result of water excess relative to total body sodium content. The evaluation of hyponatremia is incomplete without a careful assessment of the patient's volume status, history, and acquisition of both serum and urine osmolality and sodium studies. Many of these studies can be affected by various clinical factors, and these nuances should be considered while interpreting the results. This is because these results guide the etiologic diagnosis of hyponatremia and consequently its management. In this report, we describe a 50-year-old male being evaluated for hyponatremia found to have unusual serum/urine osmolality studies but ultimately found to have an unmeasured serum osmole (ethanol) interfering with the interpretation of these results. Clinical scenarios that interfere with serum and urine studies commonly obtained in a hyponatremia evaluation are reviewed and an equation to correct for ethanol's osmotic contribution is described.

Global prevalence of hypomagnesemia in type 2 diabetes mellitus - a comprehensive systematic review and meta-analysis of observational studies

PURPOSE

Hypomagnesemia, characterized by low magnesium levels, has been implicated in the pathophysiology of Type 2 Diabetes Mellitus (T2DM). This meta-analysis aims to provide a comprehensive assessment of hypomagnesemia prevalence in individuals with T2DM as well as its potential implications for diabetes management and complications.

METHODS

We conducted a comprehensive systematic review and meta-analysis using databases like PubMed, Google Scholar, Science Direct, and Research Gate to identify relevant studies between January 2008 and August 2023. We focused on observational studies related to serum magnesium levels and Type 2 Diabetes in individuals aged 19 and older. Newcastle Ottawa tool was used for quality assessment. A random effect meta-analysis was performed to calculate the prevalence of hypomagnesemia in T2DM.

RESULTS

We identified a total of 671 studies, and after screening 383 abstracts and full texts by two independent reviewers, we identified 19 eligible studies encompassing 4192 patients diagnosed with T2DM. The mean age was 55.4 (SD, 4.39) years with a mean HbA1C level of 8.01. The pooled prevalence of hypomagnesemia in T2DM was 32% (95% CI: 22-36%) out of 4192 cases. On subgroup analysis, the prevalence of hypomagnesemia in male and female were 19.8% and 20.1%, respectively. Geographically, Asia had the highest prevalence of hypomagnesemia with 31.9% (95% CI: 24-41.1%).

CONCLUSION

This meta-analysis highlights a significant prevalence of hypomagnesemia in individuals with T2DM, emphasizing the need for further investigation due to the intricate nature of the association between serum magnesium levels and T2DM.

Weight loss treatment for COVID-19 in patients with NCDs: a pilot prospective clinical trial

COVID-19 comorbid with noncommunicable chronic diseases (NCDs) complicates the diagnosis, treatment, and prognosis, and increases the mortality rate. The aim is to evaluate the effects of a restricted diet on clinical/laboratory inflammation and metabolic profile, reactive oxygen species (ROS), and body composition in patients with COVID-19 comorbid with NCDs. We conducted a 6-week open, pilot prospective controlled clinical trial. The study included 70 adult patients with COVID-19 comorbid with type 2 diabetes (T2D), hypertension, or nonalcoholic steatohepatitis (NASH).

INTERVENTIONS

a restricted diet including calorie restriction, hot water drinking, walking, and sexual self-restraint.

PRIMARY ENDPOINTS

COVID-19 diagnosis by detecting SARS-CoV-2 genome by RT-PCR; weight loss in Main group; body temperature; C-reactive protein. Secondary endpoints: the number of white blood cells; erythrocyte sedimentation rate; adverse effects during treatment; fasting blood glucose, glycosylated hemoglobin A1c (HbA1c), systolic/diastolic blood pressure (BP); blood lipids; ALT/AST, chest CT-scan. In Main group, patients with overweight lost weight from baseline (- 12.4%; P < 0.0001); 2.9% in Main group and 7.2% in Controls were positive for COVID-19 (RR: 0.41, CI: 0.04-4.31; P = 0.22) on the 14th day of treatment. Body temperature and C-reactive protein decreased significantly in Main group compared to Controls on day 14th of treatment (P < 0.025). Systolic/diastolic BP normalized (P < 0.025), glucose/lipids metabolism (P < 0.025); ALT/AST normalized (P < 0.025), platelets increased from baseline (P < 0.025), chest CT (P < 0.025) in Main group at 14 day of treatment. The previous antidiabetic, antihypertensive, anti-inflammatory, hepatoprotective, and other symptomatic medications were adequately decreased to completely stop during the weight loss treatment. Thus, the fast weight loss treatment may be beneficial for the COVID-19 patients with comorbid T2D, hypertension, and NASH over traditional medical treatment because, it improved clinical and laboratory/instrumental data on inflammation; glucose/lipid metabolism, systolic/diastolic BPs, and NASH biochemical outcomes, reactive oxygen species; and allowed patients to stop taking medications.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05635539 (02/12/2022): https://clinicaltrials.gov/ct2/show/NCT05635539?term=NCT05635539&draw=2&rank=1 .

Dosage-effect of selenium supplementation on blood glucose and oxidative stress in type 2 diabetes mellitus and normal mice

BACKGROUND

The effectiveness of selenium (Se) supplementation on glycemic control is disparate.

OBJECTIVE

This study aims to evaluate the effects of different dosages of Se diets on the blood glucose in type 2 diabetes mellitus (T2DM, db/db) and normal (db/m) mice.

METHODS

The db/db and db/m mice were fed with different dosages of Se supplemented diets (0, 0.1, 0.3, 0.9, 2.7 mg/kg) for 12 weeks, respectively. Se concentrations of tissues, physical and biochemical characteristics, oxidative stress indexes and gene expression related to glucose, lipid metabolism and Se transporters of liver were detected.

RESULTS

The Se concentrations in tissues were related to the dosages of Se supplementation in db/db (blood: slope=11.69, r = 0.924; skeletal muscle: slope=0.36, r = 0.505; liver: slope=22.12, r = 0.828; kidney: slope=11.81, r = 0.736) and db/m mice (blood: slope=19.89, r = 0.876; skeletal muscle: slope=2.80, r = 0.883; liver: slope=44.75, r = 0.717; kidney: slope=60.15, r = 0.960). Compared with Se2.7 group, the fasting blood glucose (FBG) levels of Se0.1 and Se0.3 group were decreased at week3 in db/db mice. Compared with control (Se0) group, the FBG levels of Se2.7 group were increased from week6 to week12 in db/m mice. The oral glucose tolerance test (OGTT) showed that the area under the curve (AUC) of Se0.3 group was lower than that of Se0.9 and Se2.7 group in db/m mice. Furthermore, compared with control group, the malondialdehyde (MDA) level in skeletal muscle of Se0.1 group was decreased, while that of Se2.7 group was increased in db/db mice; the glutathione peroxidase (GPx) activity in skeletal muscle of Se0.3, Se0.9 and Se2.7 group was increased both in db/db and db/m mice. For db/db mice, glucose-6-phosphatase catalytic (G6pc) expression of other groups were lower and fatty acid synthase (Fasn) expression of Se0.9 group were lower compared with Se0.3 group. For db/m mice, compared with Se0.3 group, (peroxisome proliferative activated receptor gamma coactivator 1 alpha) Pgc-1α expression of control and Se0.9 group were higher; (phosphoenolpyruvate carboxykinase 1) Pck1 expression of Se0.1, Se0.9, and Se2.7 group were higher.

CONCLUSION

Low dosages (0.1 and 0.3 mg/kg) of Se supplementation exerted beneficial effects on FBG levels and glucose tolerance through regulating hepatic glycolysis and gluconeogenesis and inhibit the oxidative stress while high dosages of Se (0.9 and 2.7 mg/kg) supplementation enhanced FBG levels, impaired glucose tolerance and aggravate oxidative stress.

Cumulative effect of chronic dehydration and age on postoperative complications after total shoulder arthroplasty

Background

Dehydration is a modifiable risk factor that should be optimized prior to all surgical procedures. The aim of this study was to determine the effects of dehydration on postoperative complications following total shoulder arthroplasty (TSA).

Methods

The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019 and a total of 16,993 patients were included in this study. The study population was subsequently classified into 3 categories: 8498 (50.0%) nondehydrated patients with blood urea nitrogen/creatinine (BUN/Cr) < 20, 4908 (28.9%) moderately dehydrated patients with 20 ≤ BUN/Cr ≤ 25, and 3587 (21.1%) severely dehydrated patients with 25 < BUN/Cr. A subgroup analysis involving only elderly patients aged > 65 years and normalized gender-adjusted Cr values was also performed. Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to explore the correlation between dehydration and postoperative complications.

Results

Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P < .05). The moderately dehydrated cohort had a greater risk of wound dehiscence (P = .044). Among the elderly, severely dehydrated patients had a greater risk of cardiac complications, postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P < .05). Finally, the elderly moderately dehydrated cohort had a greater risk of postoperative transfusion and nonhome discharge (all P < .05).

Conclusion

BUN/Cr ratio is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning.