Complications of the Type 2 Diabetes Mellitus

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence of diabetes mellitus and dialysis risk based on annual health checkup frequency among National Health Insurance citizens in Japan

BACKGROUND

In Japan, type 2 diabetes mellitus (T2DM) is a major health concern due to its increasing prevalence and associated complications, including diabetic nephropathy and dialysis. Although the positive relationship between annual health checkups and health outcomes is well-documented, the impact of skipping health checkups on T2DM and its progression to dialysis remains unclear. This study aimed to explore the association between the frequency of annual health checkups and DM-related indices and the potential impact of early intervention in preventing dialysis.

METHODS

The study included citizens aged ≥ 40 years from Nobeoka City, Japan (n = 22,094). Health checkup data from 2021 were analyzed, and participants were categorized into four groups based on their health checkup attendance between 2018 and 2020. Logistic regression analyses evaluated the association between health checkup frequency and DM-related indices, such as hemoglobin A1c and estimated glomerular filtration rate. These indices are used to diagnose DM and evaluate its severity. The time to dialysis for citizens without health checkups was estimated under untreated and treated scenarios using a previously published model.

RESULTS

Among the 3,472 participants who underwent health checkups in 2021, 2,098 (60.4%) were women, and 1,374 (39.6%) were men. Citizens who missed health checkups for 3 consecutive years had a higher risk of T2DM than those who had annual checkups (odds ratio = 4.69, 95% confidence interval: 2.78-7.94). No significant difference was observed in T2DM rates between those who attended once or twice and those who attended annually. Simulations for high-risk citizens showed that 32 of 39 individuals may require dialysis during their lifetime; however, early intervention could prevent dialysis in 31 of them.

CONCLUSIONS

Citizens who skipped health checkups for 3 consecutive years or longer had a higher risk of T2DM, highlighting the need for targeted public interventions to prevent DM in this population.

Hypothalamus and brainstem circuits in the regulation of glucose homeostasis

The central nervous system (CNS) senses and integrates blood glucose status, regulating its levels through communication with peripheral organs. Since traditional wisdom holds that the hypothalamus primarily controls glucose homeostasis, the brainstem, although less studied, has been emerging as a key player in blood glucose metabolism. Although the brainstem is reciprocally wired with the hypothalamus, their interactions are crucial for glucose control. Here, we focus on classic discoveries and recent advancements of hypothalamic and brainstem nodes that regulate glucose homeostasis. Based on the current progress and development for central regulation of blood sugar, we propose that the circuitry and cellular mechanisms for how hypothalamus and brainstem coordinate in blood sugar regulation are crucial; hence, a deeper understanding of both nuclei could shed light on a future cure for diabetes.

Liraglutide Treatment Improves Glycaemic Dysregulation, Body Composition, Cardiometabolic Variables and Uncontrolled Eating Behaviour in Adolescents with Severe Obesity

Objective

Childhood obesity is associated with long-term health complications. Liraglutide is approved for use in adolescents for weight loss and has shown beneficial outcomes in clinical trials. Continuous glucose monitoring (CGM) is widely used in type 1 diabetes mellitus. To look at the effect of liraglutide treatment on cardiometabolic variables, glycaemic control (as assessed by CGM), body composition, quality-of-life and satiety levels in adolescents with severe obesity.

Methods

Patients aged 12 to 17.9 years were commenced on liraglutide in addition to lifestyle support. Pediatric Quality of Life 4.0 generic scale and Three-factor Eating Questionnaire R18 were completed at baseline and after 3-months.

Results

Twenty-four subjects (10 male: 14 female) took part. Significant improvements in weight, body mass index (BMI), BMI standard deviation scores, percentage body fat and fat mass following liraglutide treatment. A significant reduction in glycated haemoglobin, triglyceride and cholesterol levels, as well as a reduction in uncontrolled eating behaviour were observed. The time spent within normal glucose range (3.9-7.8 mmol/L; 70.2-140.4 mg/dL) was lower than in healthy peers (91.76% vs. 97.00%) at baseline but improved after liraglutide treatment. The cohort reported lower health-related quality-of-life scores and exhibited more uncontrolled eating and emotional eating behaviours, compared to the healthy population.

Conclusion

We report, for the first time, the role of CGM in identifying glycaemic dysregulation in children and young people with obesity before and after liraglutide treatment. The results have shown significant potential for liraglutide treatment in improving outcomes. Earlier identification of glycaemic dysregulation and targeted therapy could potentially reduce the long-term risk of developing type 2 diabetes mellitus.

Glucagon-Like Peptide-1 Receptor Agonists and Risk for Depression in Older Adults With Type 2 Diabetes : A Target Trial Emulation Study

BACKGROUND

Although glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown potential antidepressant effects, population studies yield inconsistent results.

OBJECTIVE

To compare the risk for depression in older adults with type 2 diabetes (T2D) initiating treatment with GLP-1RAs versus sodium-glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is).

DESIGN

Target trial emulation study.

SETTING

U.S. National Medicare administrative data from January 2014 to December 2020.

PATIENTS

Adults aged 66 years or older with T2D initiating treatment with a GLP-1RA were matched 1:1 on propensity score with those initiating treatment with either an SGLT2i or a DPP4i.

MEASUREMENTS

The primary end point was incident depression. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) with 95% CI within matched groups.

RESULTS

A total of 14 665 matched pairs of older adults were included in the cohort for GLP-1RAs versus SGLT2is; the rate difference of depression between GLP-1RA users and SGLT2i users was 3.48 (95% CI, -0.81 to 7.78) per 1000 person-years, with an HR of 1.07 (CI, 0.98 to 1.18). In the cohort for GLP-1RAs versus DPP4is (13 711 matched pairs), the rate difference was -5.78 (CI, -10.49 to -1.07) per 1000 person-years, with an HR of 0.90 (CI, 0.82 to 0.98).

LIMITATION

Unmeasured confounders (such as hemoglobin A1c levels and body mass index), outcome misclassification, and limited generalizability to all GLP-1RA users (for example, younger populations or those without T2D receiving the drug for obesity treatment).

CONCLUSION

Among older adults with T2D, the incidence of depression was relatively low. Use of GLP-1RAs was associated with a modestly lower risk for depression compared with use of DPP4is, but not SGLT2is.

PRIMARY FUNDING SOURCE

National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.

Dulaglutide accelerates diabetic wound healing by suppressing Nrf2-dependent ferroptosis in diabetic mice

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are frequently utilized to treat type 2 diabetes mellitus (T2DM). Several GLP-1RAs (Exendin-4 and liraglutide) have been shown to accelerate diabetic wound healing. The major aim of the study was to investigate the roles of dulaglutide in wound healing in diabetic mice and identify the underlying mechanism involved. Round-shape, full-thickness wounds were created on the backs of db/db diabetic mice. Subsequently, dulaglutide was delivered via subcutaneous injections surrounding the wound's perimeter, and the wound closure rates were monitored. In vitro, keratinocytes were treated with dulaglutide under high glucose (HG) conditions, and cell viability was assessed by cell counting kit-8 (CCK-8) and EdU assays. The roles of dulaglutide in ferroptosis were assessed by measuring the levels of Fe2 + and oxidative stress, as well as the expression of ferroptosis markers. The results demonstrated that dulaglutide treatment increased the expression of vascular endothelial growth factor (VEGF) and the proliferation marker Ki67, thereby accelerating wound healing in diabetic mice. In vitro, dulaglutide promoted HaCaT cell proliferation and migration under HG conditions. Exposure of HaCaT cells to HG resulted in ferroptosis in vivo and in vitro, as evidenced by the significant increase in Fe2+, reactive oxygen species (ROS), and malondialdehyde (MDA) levels and the decrease in glutathione (GSH) and superoxide dismutase (SOD) levels. All these effects were reversed by dulaglutide. Mechanistically, dulaglutide activated NFE2-related factor 2 (Nrf2) signaling under HG conditions, which increased glutathione peroxidase (Gpx4) and solute carrier family 7-member 11 (Slc7a11) expression, thereby inhibiting ferroptosis. In summary, these results demonstrate dulaglutide as a promising agent for treating diabetic wounds by regulating Nrf2-dependent ferroptosis.

Determination diabetes mellitus disease markers in tear fluid by photothermal AFM-IR analysis

The tear fluids from three healthy individuals and three patients with diabetes mellitus were examined using atomic force microscopy-infrared spectroscopy (AFM-IR) and Fourier transform infrared spectroscopy (FTIR). The dried tear samples showed different surface morphologies: the control sample had a dense network of heart-shaped dendrites, while the diabetic sample had fern-shaped dendrites. By using the AFM-IR technique we identified spatial distribution of constituents, indicating how diabetes affects the structural characteristics of dried tears. FTIR showed that the dendritic structures gradually disappeared over time due to glucose-induced lysozyme damage. The tear fluid from diabetes mellitus patients has a higher concentration of glucose, which accelerates the breakdown of lysozyme and, as a result, the quick loss of the dendritic structure. Our study shows that analysis of dry tear fluid can be promising technique for the detection of glycated proteins that reveal long lasting hyperglycemia and diabetes mellitus.

In-silico study and in-vitro validations for an affinity of mangiferin with aldose reductase: Investigating potential in tackling diabetic retinopathy

Type II Diabetes mellitus (T2DM) and associated complications primarily diabetic retinopathy cases are rising with an alarming rate. Prolong hyperglycemia along with the aldose reductase (AR) activity play a pivotal role in the development of oxidative stress in the aqueous humor and diabetic retinopathy. AR catalyzes conversion of glucose into sorbitol and or fructose get diffuse into lens leading to impaired electrolyte balance and cataract formation. Here in the study, affinity of mangiferin was evaluated first using in silico approaches (Docking studies) and then validated via isothermal titration calorimetry. Here in the present study aim was to check the does mangiferin do have affinity with AR, does mangiferin inhibit the AR and polyol pathway as key pathway involve in the diabetic retinopathy. Both in silico and laboratory investigations were carried out to explore the affinity of mangiferin with the aldose reductase. Swiss target prediction study showed that the AR is prime target of mangiferin in the human proteome. The molecular docking study and affinity searches were performed to seek the bonding pattern and forces involved. Docking (affinity 34.37 kcal/mol) for AR pose 1 was reported superior over the AR pose 2 (affinity -35.46 kcal/mol) against mangiferin. Mangiferin showed significant AR inhibition where IC50 reported 67.711 µg/ml and highest inhibition was reported at 300 µg/ml i.e. 86.44 %. On the contrary, Quercetin showed much higher inhibition of aldose reductase at similar concentration i.e. 94.47 % at 300 µg/ml with IC50 59.6014 µg/ml. Here, AR pose 1 showed higher affinity with the mangiferin and confirmed via Isothermal Titration Calorimetry clearly showed higher binding affinity parameters. Binding affinity of AR pose 1 with the mangiferin was higher as showed with affinity parameter determined via ITC i.e. floating association constant (Ka) reported 6.47×106, binding enthalpy (ΔH) -46.11 kJ/mol and higher binding sites (n) i.e. 1.84. Findings demonstrates that the mangiferin is promising AR inhibitor with the ADME prediction (CLR 1.119 ml/min and t1/2 1.162 h).

Computational Exploration of Phenolic Compounds from Endophytic Fungi as α-Glucosidase Inhibitors for Diabetes Management

Diabetes has become a global epidemic, affecting even the younger people on an alarming scale. Inhibiting intestinal α-glucosidase is one of the key approaches to managing type 2 diabetes (T2D). In the present study, phenolic compounds (PCs) produced by endophytic fungi as potential α-glucosidase inhibitors (AGIs) are explored through ADMET profiling, molecular docking, and molecular dynamics (MD) Simulations. After 150 PCs were screened for their drug-likeness and toxicity properties, 45 molecules were selected. These were subjected to molecular docking studies against human N-terminal maltase-glucoamylase (NtMGAM). Based on binding energy and IC50 values, the best five PCs from different chemical classes (depsidones, phenolic acids, butenolides, furanones, and polyketides) were studied for their binding dynamics with NtMGAM employing all-atom MD simulations. Among the five ligands analyzed, the methybutyrolactone III (BUT)-NtMGAM complex exhibited significantly higher active site flexibility, indicating a conformational change in response to ligand binding. BUT interacted specifically with both key residues, Asp443 and Phe575, critical for enzyme-inhibitor stability. These interactions, coupled with increased flexibility, suggest enhanced stabilization of BUT in the active site pocket. BUT also exhibited one of the most favorable toxicity profiles among molecules analyzed using ProTox 3.0. Molecular mechanics Poisson-Boltzmann surface area calculations confirmed that BUT had the highest binding energy (-35.01 kcal/mol) driven by substantial van der Waals and electrostatic interactions. Another butenolide derivative, aspernolide (ALD) ranked second in the binding energy score (-31.13 kcal/mol). These findings suggest that PCs possessing butenolide scaffolds, like BUT and ALD, hold great promise as potential AGIs for managing T2D. These findings, however, need to be further validated through in vivo experimentation.

Protective Role of Dietary Polyphenols in the Management and Treatment of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM), a serious metabolic disorder, is a worldwide health problem due to the alarming rise in prevalence and elevated morbidity and mortality. Chronic hyperglycemia, insulin resistance, and ineffective insulin effect and secretion are hallmarks of T2DM, leading to many serious secondary complications. These include, in particular, cardiovascular disorders, diabetic neuropathy, nephropathy and retinopathy, diabetic foot, osteoporosis, liver damage, susceptibility to infections and some cancers. Polyphenols such as flavonoids, phenolic acids, stilbenes, tannins, and lignans constitute an extensive and heterogeneous group of phytochemicals in fresh fruits, vegetables and their products. Various in vitro studies, animal model studies and available clinical trials revealed that flavonoids (e.g., quercetin, kaempferol, rutin, epicatechin, genistein, daidzein, anthocyanins), phenolic acids (e.g., chlorogenic, caffeic, ellagic, gallic acids, curcumin), stilbenes (e.g., resveratrol), tannins (e.g., procyanidin B2, seaweed phlorotannins), lignans (e.g., pinoresinol) have the ability to lower hyperglycemia, enhance insulin sensitivity and improve insulin secretion, scavenge reactive oxygen species, reduce chronic inflammation, modulate gut microbiota, and alleviate secondary complications of T2DM. The interaction between polyphenols and conventional antidiabetic drugs offers a promising strategy in the management and treatment of T2DM, especially in advanced disease stages. Synergistic effects of polyphenols with antidiabetic drugs have been documented, but also antagonistic interactions that may impair drug efficacy. Therefore, additional research is required to clarify mutual interactions in order to use the knowledge in clinical applications. Nevertheless, dietary polyphenols can be successfully applied as part of supportive treatment for T2DM, as they reduce both obvious clinical symptoms and secondary complications.

Pleiotropic effect of teneligliptin versus glimepiride add-on therapy on hs-CRP and cardiorenal parameters in Indian type 2 diabetes patients: An open-labeled randomized controlled trial

Objective

The objective of the study was to estimate the pleiotropic effect of teneligliptin on high-sensitivity C-reactive protein (hs-CRP) levels and some cardiorenal parameters in comparison to glimepiride, both as add-on therapy to metformin.

Methodology

This 12-week open-label, parallel-group, randomized controlled trial was conducted among Indian people with type 2 diabetes mellitus and on metformin monotherapy with poor glycemic control (glycated hemoglobin >7% or 53 mmol/mol). The endpoints were mean change in hs-CRP levels, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine, blood urea, estimated glomerular filtration rate (eGFR), and change in cardiovascular (CV) risk categories from baseline to end of 12 weeks.

Results

Seventy participants were randomized (1:1) to receive either teneligliptin 20 mg once daily (n = 35) or glimepiride 1 mg twice daily (BD) (n = 35) as an add-on to metformin 500 mg BD. The mean age of the participants was 50.65 and 50.7 years in arms 1 and 2, respectively. At 12-weeks end, teneligliptin add-on caused a statistically significant reduction in hs-CRP compared to glimepiride in both per-protocol (PP) and intention-to-treat (ITT) sets. No significant difference was observed for changes in SBP and DBP, creatinine, urea, eGFR levels, and CV risk category in both PP and ITT sets.

Conclusion

Teneligliptin add-on resulted in favorable effects on hs-CRP levels and comparable effects on cardiorenal parameters compared to glimepiride add-on therapy at 12-weeks end.This trial has been prospectively registered in CTRI (Clinical Trials Registry of India). Registration number: CTRI/2021/08/035342.

The Role of Dietary Anthocyanins for Managing Diabetes Mellitus-Associated Complications

Diabetes mellitus (DM) is an intricate metabolic disorder marked by persistent hyperglycemia, arising from disruptions in glucose metabolism, with two main forms, type 1 and type 2, involving distinct etiologies affecting β-cell destruction or insulin levels and sensitivity. The islets of Langerhans, particularly β-cells and α-cells, play a pivotal role in glucose regulation, and both DM types lead to severe complications, including retinopathy, nephropathy, and neuropathy. Plant-derived anthocyanins, rich in anti-inflammatory and antioxidant properties, show promise in mitigating DM-related complications, providing a potential avenue for prevention and treatment. Medicinal herbs, fruits, and vegetables, abundant in bioactive compounds like phenolics, offer diverse benefits, including glucose regulation and anti-inflammatory, antioxidant, anticancer, anti-mutagenic, and neuroprotective properties. Anthocyanins, a subgroup of polyphenols, exhibit diverse isoforms and biosynthesis involving glycosylation, making them potential natural replacements for synthetic food colorants. Clinical trials demonstrate the efficacy and safety of anthocyanins in controlling glucose, reducing oxidative stress, and enhancing insulin sensitivity in diabetic patients, emphasizing their therapeutic potential. Preclinical studies revealed their multifaceted mechanisms, positioning anthocyanins as promising bioactive compounds for managing diabetes and its associated complications, including retinopathy, nephropathy, and neuropathy.

Unlocking the Potential of Carrier Mediated Nano-biomedicine in Management of Diabetes Mellitus: A Review

Diabetes is a medical condition that belongs to the group of chronic diseases that affect how the body processes glucose, the primary source of energy for cells. Glucose comes indirectly from the consumed food and is carried by bloodstream to various cells in the body. Insulin, a hormone synthesized by the pancreas plays a vital role in the conversion of glucose to energy. Managing diabetes involves regular monitoring of blood sugar levels, adopting a healthy diet, engaging in regular physical activity, and taking medications or insulin as prescribed by a healthcare provider. Proper management of diabetes may lead to the prevention or delay of diabetic complications may further sever other diseases associated impediment. Drug delivery in the management of diabetes is designed to administer insulin or other diabetes medications in a controlled and convenient manner. Recently nanotechnology has emerged as a transformative approach in the management of diabetic complications, particularly through carrier-mediated nano-biomedicine. Several natural products have been studied and reported for their potential role in managing diabetes. While they may not replace standard medical treatments, some of these natural products could complement existing therapies and support overall diabetes management. Therefore, this review explores the potential of nanocarriers to enhance drug delivery systems for diabetes mellitus treatment, addressing the limitations of conventional therapies that often suffer from poor bioavailability and frequent dosing requirements. Studies have demonstrated that bridging these bioactive compounds significantly enhance the therapeutic efficacy in the management of diabetes. Challenges remain in translating these technologies from laboratory settings to clinical applications; however, the potential benefits for improving glycemic control and overall quality of life for diabetic patients are substantial. Future research should focus on optimizing these nano-biomedicine strategies to realize their full therapeutic potential in diabetes management.

Modern-Day Management of the Dysglycemic Continuum: An Expert Viewpoint from the Arabian Gulf

Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes. Additionally, a large base of clinical evidence supports the use of metformin in preventing or delaying the transition from prediabetes to clinical type 2 diabetes, for some people with prediabetes. For many years, guidelines for the management of type 2 diabetes focused on lowering blood glucose, with metformin prescribed first for those without contraindications. More recently, guidelines have shifted towards prevention of diabetes complications as the primary goal, with increased use of GLP-1 receptor agonists (or multi-agonist incretin peptides) or SGLT-2 inhibitors for patients with existing atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. Access to these medications often remains challenging. Metformin remains a suitable option for initial pharmacologic intervention to manage glycemia for many people with prediabetes or type 2 diabetes along with other therapy to maintain control of blood glucose or to address specific comorbidities as the patient progresses along the diabetes continuum.

Ethyl gallate ameliorates diabetes-induced Alzheimer's disease-like phenotype in rats via activation of α7 nicotinic receptors and mitigation of oxidative stress

Cognitive decline, an important comorbidity of type 2 diabetes (T2D), is attributed to oxidative stress and impaired cholinergic signaling in the brain. The α7 nicotinic acetylcholine receptor (α7nAChR) is densely distributed in the hippocampus and cortex, and exerts neuroprotective and procognitive actions. Ethyl gallate (EG), a natural phenolic antioxidant compound, showed high in-silico binding affinity towards α7nAChR and brain penetrability. Therefore, the present study aimed to evaluate the involvement of α7nAChR in the potential of EG to ameliorate T2D-induced Alzheimer's disease-like condition. T2D was induced by intraperitoneal (i.p.) injection of streptozotocin (35 mg/kg) in rats on high-fat diet. Diabetic animals were treated with EG (10 and 20 mg/kg, i.p.) for four weeks, and their learning and memory performance was evaluated by the Morris water maze (MWM). Further, the brains were subjected to biochemical analysis of antioxidants like glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT), and oxidative stress marker malonaldehyde (MDA). While diabetic rats showed a significant decline in cognitive performance in the MWM, a substantial improvement was noticed following EG treatment. Further, the diabetes-associated reductions in GSH, SOD, and CAT levels, along with increased MDA contents in the brain, were effectively restored by EG. Interestingly, pre-treatment with α7nAChR antagonist methyllycaconitine (1 mg/kg, i.p.) attenuated the effects of EG on behavioral and biochemical parameters. The results suggest that EG may augment cholinergic signaling in the brain via α7nAChR to mitigate oxidative stress, consequently alleviating T2D-associated dementia. Therefore, EG could be a potential candidate for addressing cognitive impairment comorbid with T2D.

In Silico Hydrolysis of Lupin (Lupinus angustifolius L.) Conglutins with Plant Proteases Releases Antihypertensive and Antidiabetic Peptides That Are Bioavailable, Non-Toxic, and Gastrointestinal Digestion Stable

Lupin (Lupinus angustifolius L.) proteins are potential sources of bioactive peptides (LBPs) that can inhibit dipeptidyl peptidase IV (DPP-IV) and angiotensin I-converting enzyme (ACE-I) activity. However, the capacity of different enzymes to release LBPs, the pharmacokinetic and bioactivities of the peptides released, and their binding affinities with the active sites of DPP-IV and ECA-I are topics scarcely addressed. Therefore, we used in silico hydrolysis (BIOPEP-UWM platform) with various enzymes to predict the release of LBPs. Among the bioactive peptides identified in lupin proteins (n = 4813), 2062 and 1558 had DPP-IV and ACE-I inhibitory activity, respectively. Ficin, bromelain, and papain released the highest proportion of ACE-I (n = 433, 411, and 379, respectively) and DPP-IV (n = 556, 544, and 596, respectively) inhibitory peptides. LBPs with favorable pharmacokinetics and gastrointestinal stability tightly interacted with the active sites of ACE-I (-5.6 to -8.9 kcal/mol) and DPP-IV (-5.4 to -7.6 kcal/mol). Papain generated the most bioavailable LBPs (n = 459) with ACE-I (n = 223) and DPP-IV (n = 412) inhibitory activity. These peptides were non-toxic and gastrointestinal digestion stable. Notably, papain-based hydrolysis released some LBPs (n = 270) that inhibited both ACE-I and DPP-IV. Plant protease-based hydrolysis is a promising approach for producing lupin hydrolysates with ACE-I and DPP-IV inhibitory activities.

Optimal cutoff score of the circular tandem walk test for determining the risk of falls in older community-dwelling individuals with type 2 diabetes

Patients with chronic diabetes may have a physical performance decline, which significantly increases the risk of falling. The study aimed to assess the validity of the Circular Tandem Walk Test (CTWT) in determining fall risk among older community-dwelling Thais with type 2 diabetes mellitus (T2DM). This is a cross-sectional diagnostic study of 71 older participants with T2DM from various communities. The participants were divided into "faller" (who had experienced one or more fall events) and "non-faller" groups based on 6-month fall history data. They were then interviewed about their fear of falling (FOF) using a single question and the Falls Efficacy Scale International (FES-I), followed by the CTWT. Thirty-five participants reported having fallen in the past six months. Significant differences were in the fallers and non-fallers CTWT, FOF, and FES-I scores (p < 0.001). CTWT results were significantly correlated with FOF (rpb = 0.605, p < 0.001), FES-I (rho = 0.837, p < 0.001), and number of falls (rho = 0.736, p < 0.001). The study suggested that the cutoff score for CTWT is 15.2 s, with a sensitivity = 80.00, specificity = 86.11, and AUC = 0.915. This study demonstrated the validity of the CTWT for determining the risk of falls in older community-dwelling individuals with T2DM. Implementing this tool in a community setting would be helpful in the initial screening and referral of data by concerned healthcare professionals. However, further studies may be needed to explore the reliability of CTWT and ensure the appropriate clinical use of CTWT by healthcare professionals.

Tirzepatide: unveiling a new dawn in dual-targeted diabetes and obesity management

INTRODUCTION

Incretin-based therapies have emerged as effective treatments for type 2 diabetes (T2D) and obesity. However, not all patients achieve optimal outcomes with existing treatments, highlighting the need for more effective solutions.

AREAS COVERED

We present a comprehensive evaluation of Tirzepatide (TZP), a novel dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GIP/GLP-1) receptor agonist, for managing obesity and T2D. We conducted a systematic search of Cochrane, PubMed, Scopus, and Web of Science databases from inception to April 2024. The focus of the review is on the development and therapeutic potential of TZP, with detailed exploration on pharmacodynamics, pharmacokinetics, clinical efficacy, and safety. Furthermore, it reviews TZP's impacts on glycemic control, weight management, and its potential cardiovascular (CV) benefits.

EXPERT OPINION

TZP represents a significant advancement in the dual-targeted approach to treating T2D and obesity. Its unique mechanism of action offers superior efficacy in reducing glycemic levels and body weight compared to existing therapies. New data suggesting improvements in CV outcomes indicate that TZP could set a new standard in the treatment paradigm. While long-term data on efficacy and safety are still forthcoming, current evidence positions TZP as a promising option for patients who have not reached their therapeutic goals with existing treatments.

Mapping the evolution and impact of ketogenic diet research on diabetes management: a comprehensive bibliometric analysis from 2005 to 2024

Objective

The ketogenic diet (KD) has been explored for diabetes management; however, a quantitative synthesis of its specific effects on diabetes has not yet been conducted. This study aims to examine the current status and research hotspots of KD in diabetes management from 2005 to 2024, providing a reference for future research.

Methods

We retrieved articles published between 2005 and 2024 from the Web of Science database and analyzed them using R software, VOSviewer, and CiteSpace.

Results

This study includes 432 relevant publications. From 2005 to 2024, the volume of literature in this field has shown a steady upward trend, with a notable increase from 2017 to 2021, and a slight decline observed from 2021 to 2023. The United States is the leading country in terms of the number of publications, followed by China, Australia, and Canada. The United States not only leads in publication volume but also maintains a broader international collaboration network. Nutrients and the American Journal of Clinical Nutrition are the most frequently published and cited journals. Current research hotspots primarily focus on the impact of KD on blood glucose control, insulin resistance, and lipid metabolism in diabetic patients. Mechanistic studies on KD in diabetes management concentrate on aspects such as the "regulation of genes by β-hydroxybutyrate," "anti-inflammatory effects," and "oxidative stress." The role of the gut microbiome is also emerging as an important research area. Currently, exploring the application of KD in managing different age groups and types of diabetes has become a significant research trend.

Conclusion

As an emerging dietary intervention, KD is gradually attracting widespread attention from researchers around the world and is expected to become a major research focus in the future for diabetes management and control. This paper provides a systematic review and analysis of the current research status and hotspots of KD in diabetes management, offering important references and insights for future research in related fields.

Beyond Blood Sugar: Low Awareness of Kidney Disease among Type 2 Diabetes Mellitus Patients in Dalmatia-Insights from the First Open Public Call

Background and Objectives: Kidney disease (KD) is a common complication of diabetes mellitus (DM) associated with adverse outcomes of renal failure, cardiovascular disease, and mortality. The aim of this study was to determine the prevalence and awareness of the KD among the DM type 2 (T2DM) patients. Materials and Methods: This cross-sectional study was conducted at the University Hospital of Split between November and December of 2023 during an open call for DM patients. For each participant, blood and urine samples, along with relevant medical information, were collected, and adherence to the Mediterranean diet (MeDi) was assessed using the Mediterranean Diet Service Score (MDSS). Furthermore, blood pressure was measured, along with body composition and anthropometric parameters. Results: Of 252 T2DM patients with a median age of 67 years (IQR: 60-73), 130 (51.6%) were women. The median duration of T2DM was 10 years (IQR: 6-20). Despite the fact that 80.95% of total participants reported receiving dietary guidelines from any source, only 53.2% reported adhering to the suggested instructions, while according to the MDSS, only 7.2% adhered to the MeDi. The median body mass index was 27.6 kg/m2 (24.2-31), with 70.1% of participants overweight or obese. Only 6% of participants believed they had KD, but after blood and urine sample analysis, 31% were found to have KD. Conclusions: This study highlights a significant gap in awareness of KD, low adherence to MeDi, and a high prevalence of obesity among T2DM patients. Due to the increasing number of T2DM patients, it is crucial to improve healthy lifestyle education and make modifications within this group, as well as perform regular screening for KD and medical check-ups.

Experiences of occupational nurses regarding non-adherent mineworkers with chronic illnesses

Background

Occupational nurses continue to provide service to mineworkers diagnosed with chronic illnesses, however, non-adherence to medication is prevalent, cause overcrowding, long queues and admission at hospitals as they become sick.

Aim

This study aimed to describe the experience of occupational nurses (ONs) regarding non-adherence to medication among mineworkers diagnosed with chronic illnesses.

Setting

The study was conducted at a selected mine in Gauteng province, South Africa.

Methods

A qualitative, exploratory, descriptive design that is contextual in nature, was used with a phenomenological approach. Thirteen ONs were purposively sampled and individual face-to-face interviews were conducted until data saturation was reached. Thematic analysis using ATLAS.ti 24 software was applied to analyse the data collected. The researcher and the independent coder held a consensus discussion and agreed on the themes and the sub-themes.

Results

Two themes and various sub-themes emerged along with Care-related challenges linked to the mineworkers and challenges related to the provision of service to mineworkers. Data analysed indicated that the ONs had varying but often similar perspectives regarding non-adherence to medication among mineworkers diagnosed with chronic illnesses.

Conclusion

Non-adherence to medication is prevalent among mineworkers diagnosed with chronic illnesses and improving the mineworkers' outcomes requires addressing the issue of non-adherence to primary medication.

Contribution

This study highlights the importance of adhering to prescribed medication among mineworkers diagnosed with chronic illnesses to ensure quality of life.

Comparative Efficacy of Low-Carbohydrate and Ketogenic Diets on Diabetic Retinopathy and Oxidative Stress in High-Fat Diet-Induced Diabetic Rats

This study examined the effect of a low-carbohydrate diet (LCD) and a low-carbohydrate ketogenic diet (LCKD) on diabetic retinopathy in high-fat diet-induced diabetes mellitus in rats and studied the mechanisms of action. Rats were divided into four groups: the Control group, which was fed a normal diet for 16 weeks; the HFD group, which was fed a high-fat diet (HFD) for the first 8 weeks and then switched to a normal diet for 8 weeks; the HFD+LCD group, fed a HFD for 8 weeks followed by an LCD for 8 weeks, and the HFD+LCKD group, which was fed a HFD for 8 weeks followed by an LCKD for 8 more weeks. Both the LCD and the LCKD effectively reduced the final body and total fat weights and decreased fasting serum levels of glucose, insulin, hemoglobin A1 (HbA1C), triglycerides, cholesterol, and LDL-c. They also reduced the levels of malondialdehyde (MDA), tumor necrosis factor-α, vascular endothelial factor, caspapse-3, and bax. In the HFD rats, we found increased serum levels of β-Hydroxybutyrate and upregulated expression of Bcl2, glutathione, superoxide dismutase, and hemeoxygenase-1. Moreover, the LCD and LCKD significantly reduced mRNA levels of Kelch-like ECH-associated protein 1 (Keap1) and enhanced mRNA and nuclear concentrations of nuclear factor erythroid factor 2 (Nrf2). All these effects were associated with improved layers of the retina in the HFD - LCD and HFD + LCKD rats but not in HFD animals. The impact of the LCKD was always more profound on all measured parameters and on improving the structure of the retina compared to the LCD. In conclusion, the LCKD is superior to the LCD in preventing diabetic retinopathy in HFD-fed rats. Mechanistically, our results suggest that the hypoglycemic and hypolipidemic conditions and the Nrf2-dependent antioxidant and anti-inflammatory effects may be involved in the preventative effects of the LCD and LCKD.

Design, Synthesis of 3-(Aryl)-1-(2-p-tolylthiazol-4-yl)prop-2-en-1-ones as Alpha(α)-Amylase Inhibitors

α-Amylase inhibition is vital in controlling diabetic complications. Herein, we have synthesized a hybrid scaffold based on thiazole-chalcone to access α-amylase inhbition. The proposed structures were verified with spectroscopic techniques (UV-Vis., FT-IR, 1H-, 13C-NMR, and elemental analysis). The synthesized compounds were evaluated for their α-amylase and antioxidant potential. In vitro hemolytic assay was performed to test biocompatibility of all compounds. Among tested compounds, 4 c (IC50=3.8 μM), 4 g (IC50=14.5 μM), and 4 f (IC50=17.1 μM) were found excellent α-amylase inhibitors. However, none of the tested compounds exhibited significant antioxidant activity. All compounds showed less lysis than Triton X-100, but compounds 4 f and 4 h had the least lysis at all tested concentrations and were found to be safe for human erythrocytes. Molecular docking study was performed to evaluate the binding interactions of ligands with human pancreatic α-amylase (HPA). The binding score -8.09 to -8.507 kcal/mol revealed strong binding interactions in the ligand-protein complex. The docking results supplemented the observed α-amylase inhibition and hence augment the scaffold to serve as leads for the antidiabetic drug development.

The Other Side of the Perfect Cup: Coffee-Derived Non-Polyphenols and Their Roles in Mitigating Factors Affecting the Pathogenesis of Type 2 Diabetes

The global prevalence of type 2 diabetes (T2D) is 10.5% among adults in the age range of 20-79 years. The primary marker of T2D is persistent fasting hyperglycemia, resulting from insulin resistance and β-cell dysfunction. Multiple factors can promote the development of T2D, including obesity, inflammation, and oxidative stress. In contrast, dietary choices have been shown to prevent the onset of T2D. Oatmeal, lean proteins, fruits, and non-starchy vegetables have all been reported to decrease the likelihood of T2D onset. One of the most widely consumed beverages in the world, coffee, has also demonstrated an impressive ability to reduce T2D risk. Coffee contains a diverse array of bioactive molecules. The antidiabetic effects of coffee-derived polyphenols have been thoroughly described and recently reviewed; however, several non-polyphenolic molecules are less prominent but still elicit potent physiological actions. This review summarizes the effects of select coffee-derived non-polyphenols on various aspects of T2D pathogenesis.

The interplay between vitamin D status, subclinical inflammation, and prediabetes

Vitamin D's role extends beyond classical calcium and phosphate homeostasis to encompass a pivotal influence on immune modulation and metabolic health. The mechanisms by which vitamin D exerts these effects involve its conversion to hormonally active calcitriol, which binds intracellular vitamin D receptors, initiating various downstream cascades. In this review, we tease out the evidence showing the relationship between vitamin D deficiency and prediabetes within the context of subclinical inflammation, with a special focus on the novel monocyte-to-HDL ratio (MHR), a novel inflammatory marker reflecting subclinical inflammation. This was based on a thorough literature review using reputable databases covering the period from 1980 to 2024. In light of this, we discuss calcitriol's anti-inflammatory effects and consequently link vitamin D deficiency to both overt and subclinical inflammation. Additionally, the utility of several biomarkers, notably MHR, in investigating this association is also discussed. We further reviewed the role of vitamin D deficiency in precipitating prediabetes and type 2 diabetes mellitus (T2DM) via insulin resistance, decreased insulin synthesis and secretion, and subclinical inflammation. Taken together, this mini review highlights that vitamin D deficiency is significantly associated with subclinical inflammation, playing a critical role in the development of prediabetes and the progression to T2DM. Addressing vitamin D deficiency through appropriate interventions may serve as a preventative measure against the development of prediabetes and T2DM.

Audiological profile of patients with type 2 diabetes mellitus

BACKGROUND

 South Africa shows a high prevalence of type 2 diabetes with reported association with auditory dysfunction.

OBJECTIVES

 To describe the audiological profile of adults with this metabolic condition.

METHOD

 Employing a descriptive research design, 35 individuals with type 2 diabetes, selected through purposive sampling, underwent a basic audiological assessment in addition to extended high-frequency (EHF) audiometry, distortion product otoacoustic emissions (DPOAE) testing and neurological auditory brainstem response (ABR) test.

RESULTS

 This study revealed a 31.4% prevalence of hearing loss with 81.8% being sensorineural in nature. Poor hearing thresholds were observed at 16 kHz (n = 19; 54.3%), 18 kHz (n = 24; 68.6%) and 20 kHz (n = 30; 85.7%) in the right ear and at 16 kHz (n = 20; 57.1%), 18 kHz (n = 24; 68.6%) and 20 kHz (n = 30; 85.7%) in the left ear. Absent DPOAEs were observed at 6 kHz (n = 20; 51.7%) and 8 kHz (n = 24; 68.6%) in the right ear and at 6 kHz (n = 17; 48.6%) and 8 kHz (n = 29; 82.9%) in the left ear, possibly indicating that type 2 diabetes specifically targets higher frequency hearing. The ABR results revealed a delayed absolute latency of wave III bilaterally (right ear -69%; left ear - 51%), suggesting an impact of this metabolic disease on retro-cochlear pathways.

CONCLUSION

 Hearing loss should be recognised as a comorbidity accompanying type 2 diabetes, which indicates the need for routine comprehensive audiological assessments to facilitate early detection and intervention.Contribution: The present findings have implications for audiology clinical protocols; diabetes related health policies and patient education.

Pharmacotherapeutic Considerations on Telomere Biology: The Positive Effect of Pharmacologically Active Substances on Telomere Length

Telomeres are part of chromatin structures containing repeated DNA sequences, which function as protective caps at the ends of chromosomes and prevent DNA degradation and recombination, thus ensuring the integrity of the genome. While telomere length (TL) can be genetically inherited, TL shortening has been associated with ageing and multiple xenobiotics and bioactive substances. TL has been characterised as a reliable biomarker for the predisposition to developing chronic pathologies and their progression. This narrative review aims to provide arguments in favour of including TL measurements in a complex prognostic and diagnostic panel of chronic pathologies and the importance of assessing the effect of different pharmacologically active molecules on the biology of telomeres. Medicines used in the management of cardiovascular diseases, diabetes, schizophrenia, hormone replacement therapy at menopause, danazol, melatonin, and probiotics have been studied for their positive protective effects against TL shortening. All these classes of drugs are analysed in the present review, with a particular focus on the molecular mechanisms involved.

Okinawa-Based Nordic Diet Decreases Plasma Levels of IAPP and IgA against IAPP Oligomers in Type 2 Diabetes Patients

Pancreas-derived islet amyloid polypeptide (IAPP) aggregates and deposits in the pancreas and periphery of Type 2 Diabetes (T2D) patients, contributing to diabetic complications. The excess IAPP can be removed by autoantibodies, and increased levels of immunoglobulin (Ig) G against IAPP have been reported in T2D patients. However, whether other Ig classes are also affected and if the levels can be managed is less known. This pre-post study examines IgA levels against IAPP oligomers (IAPPO-IgA) in T2D patients and assesses the impact of the Okinawa-based Nordic (O-BN) diet-a low-carbohydrate, high-fiber diet-on these levels after following the diet for 3 months. IAPP, IAPPO-IgA, and total IgA levels were measured in plasma and fecal samples from n = 30 T2D patients collected at baseline, after 3 months of diet, and after additional 4 months of unrestricted diets (a clinical follow-up). The IAPP and IAPPO-IgA levels were significantly lower after 3 months, with the latter also being significantly reduced at the clinical follow-up. The reduction in plasma IAPP and IAPPO-IgA levels correlated with reductions in plasma levels of metabolic and inflammatory markers. Hence, following the O-BN diet for at least 3 months is sufficient to reduce circulating IAPP and IAPPO-IgA levels, which may be principal in managing T2D.

Tauroursodeoxycholic Acid (TUDCA) Relieves Streptozotocin (STZ)-Induced Diabetic Rat Model via Modulation of Lipotoxicity, Oxidative Stress, Inflammation, and Apoptosis

Tauroursodeoxycholic acid (TUDCA) is approved for the treatment of liver diseases. However, the antihyperglycemic effects/mechanisms of TUDCA are still less clear. The present study aimed to evaluate the antidiabetic action of TUDCA in streptozotocin (STZ)-induced type 2 diabetes mellitus (T2DM) in rats. Fifteen adult Wistar albino male rats were randomly divided into three groups (n = five in each): control, diabetic (STZ), and STZ+TUDCA. The results showed that TUDCA treatment significantly reduced blood glucose, HbA1c%, and HOMA-IR as well as elevated the insulin levels in diabetic rats. TUDCA therapy increased the incretin GLP-1 concentrations, decreased serum ceramide synthase (CS), improved the serum lipid profile, and restored the glycogen content in the liver and skeletal muscles. Furthermore, serum inflammatory parameters (such as TNF-α, IL-6, IL-1ß, and PGE-2) were substantially reduced with TUDCA treatment. In the pancreas, STZ+TUDCA-treated rats underwent an obvious enhancement of enzymatic (CAT and SOD) and non-enzymatic (GSH) antioxidant defense systems and a marked decrease in markers of the lipid peroxidation rate (MDA) and nitrosative stress (NO) compared to STZ-alone. At the molecular level, TUDCA decreased the pancreatic mRNA levels of iNOS and apoptotic-related factors (p53 and caspase-3). In conclusion, TUDCA may be useful for diabetes management and could be able to counteract diabetic disorders via anti-hyperlipidemic, antioxidant, anti-inflammatory, and anti-apoptotic actions.

Anti-obesity Medications: Ethical, Policy, and Public Health Concerns

New anti-obesity medications (AOMs) have received widespread acclaim in medical journals and the media, but they also raise critical ethical, public health, and public policy concerns that have largely been ignored. AOMs are very costly, need to be taken by a patient in perpetuity (since significant rebound weight gain otherwise occurs), and threaten to shift resources and focus away from other crucial efforts at obesity treatment and prevention. Many people may feel less motivated to exercise or reduce their caloric consumption, if they assume that obesity is now medically treatable. Policy-makers may similarly come to feel that the solution to the obesity pandemic is simply to prescribe medications and that prevention efforts are far less necessary. These drugs raise concerns about justice (since AOMs will disproportionately benefit the wealthy), medicalization, and marketing. Policy-makers, clinicians, and others need to engage in multipronged educational and policy efforts to address these challenges.

Behind the Hospital Ward: In-Hospital Mortality of Type 2 Diabetes Mellitus Patients in Indonesia (Analysis of National Health Insurance Claim Sample Data)

The rising global prevalence of diabetes mellitus, a chronic metabolic disorder, poses significant challenges to healthcare systems worldwide. This study examined in-hospital mortality among patients diagnosed with non-insulin-dependent diabetes mellitus (NIDDM) of ICD-10, or Type 2 Diabetes Mellitus (T2DM), in Indonesia, utilizing hospital claims data spanning from 2017 to 2022 obtained from the Indonesia Health Social Security Agency or Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. The analysis, which included 610,809 hospitalized T2DM patients, revealed an in-hospital mortality rate of 6.6%. Factors contributing to an elevated risk of mortality included advanced age, the presence of comorbidities, and severe complications. Additionally, patients receiving health subsidies and those treated in government hospitals were found to have higher mortality risks. Geographic disparities were observed, highlighting variations in healthcare outcomes across different regions. Notably, the complication of ketoacidosis emerged as the most significant risk factor for in-hospital mortality, with an odds ratio (OR) of 10.86, underscoring the critical need for prompt intervention and thorough management of complications to improve patient outcomes.

Risk factors for chronic kidney disease in middle eastern patients with type 2 diabetes mellitus: A cross-sectional study using the KDIGO classification

AIMS

Chronic kidney disease (CKD) is prevalent in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate risk factors for CKD progression across the kidney disease-Improving Global Outcomes (KDIGO)categories in a Middle Eastern population beyond hyperglycemia as emphasized by KDIGO guidelines which classifying CKD by cause and severity.

METHODS

This cross-sectional study targeted 1603 patients with T2DM. Risk factors for CKD progression were determined using odds ratios (ORs) and 95 % confidence intervals (CIs).

RESULTS

Overall, 35.5 %, 31.7 %, and 32.8 % of patients were classified as low-risk, moderate-risk, and high-/very high-/highest-risk, respectively. Several factors were associated with high/very high/highest risk categorization, including being aged >45 years (OR: 1.85, 95 % CI: 1.36-2.49; P < 0.001), male gender (OR: 1.87, 95 % CI: 1.38-2.54; P < 0.001), hypertension (OR: 3.66, 95 % CI: 2.32-5.78; P < 0.001), and T2DM duration of ≥15 years (OR: 3.2, 95 % CI: 2.27-4.5; P < 0.001). Patients with more concurrent risk factors were notably represented in the high/very high/highest risk category.

CONCLUSIONS

Male patients, older patients, and those with comorbid hypertension, longstanding T2DM, and additional concurrent risk factors have a significantly higher risk of advanced CKD. Such findings should be considered when planning management approaches for patients with CKD.

Associations of Angiopoietin 2 and Vascular Endothelial Growth Factor-A Concentrations with Clinical End Points

BACKGROUND

Angiopoietin 2 regulates endothelial function partially mediated by vascular endothelial growth factor-A (VEGF-A) and may play a role in diabetic kidney disease (DKD). We assessed the association of angiopoietin 2 and VEGF-A with cardiorenal outcomes and investigated the effect of canagliflozin on angiopoietin 2 and VEGF-A concentrations.

METHODS

Two thousand five hundred sixty-five study participants with DKD and available plasma samples treated with canagliflozin or placebo in the Canagliflozin and Kidney Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial were included. Angiopoietin 2 and VEGF-A concentrations were measured at baseline, year 1, and year 3. The primary composite end point of the trial was a composite of kidney failure, doubling of the serum creatinine level, and kidney or cardiovascular death.

RESULTS

Patients with the highest baseline quartile of angiopoietin 2, but not VEGF-A, concentration had the highest risk clinical profile. Treatment with canagliflozin significantly lowered concentrations of angiopoietin 2 (adjusted geometric mean ratio: 0.94; 95% confidence interval, 0.92 to 0.95; P < 0.001), but not VEGF-A. In multivariable-adjusted modeling, each 50% increment in log baseline angiopoietin 2 concentrations was associated with a higher risk of primary composite outcome (hazard ratio, 1.27; 95% confidence interval, 1.13 to 1.43). Angiopoietin 2 change at year 1 compared with baseline explained 10% of the effect of canagliflozin on the primary composite outcome. VEGF-A concentrations were not associated with outcomes, alone or in combination with angiopoietin 2.

CONCLUSIONS

Higher angiopoietin 2 levels were associated with cardiorenal risk among individuals with DKD independent of VEGF-A. Canagliflozin lowered angiopoietin 2 concentrations.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER

Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy, NCT02065791 .

Impact of calcium channel blockers and angiotensin receptor blockers on hematological parameters in type 2 diabetic patients

Antihypertensive medications have been associated with a reduction in hemoglobin (Hb) levels, leading to clinically significant anemia. We aimed to provide valuable insights into the impact of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) on hematological parameters by measuring the levels of erythropoietin (EPO), ferritin, and complete blood count (CBC) in individuals with type 2 diabetes mellitus (T2DM), particularly considering the duration of the antihypertensives use. In addition to comparing their effects on blood pressure, glycemic status, and renal function, a retrospective cohort study was conducted at the consultation unit of Alsalam Teaching Hospital, Mosul, Nineveh Province, between October 2022 and February 2023. A total of 160 participants were enrolled after being fully examined by the consultants to detect their eligibility for inclusion in the study and to rule out any abnormality. They consisted of 40 healthy controls, 30 T2DM patients (T2DM group), 30 T2DM patients with newly diagnosed hypertension (HT) (T2DM+HT group), 30 type 2 diabetic-hypertensives on ARBs (T2DM+HT+ARBs group), and 30 type 2 diabetic-hypertensives on CCBs (T2DM+HT+CCBs group). Five milliliters of blood was drawn from a vein and divided into two parts. Two milliliters was transferred into an anticoagulant tube for the measurement of HbA1c and complete blood picture. Serum was obtained from the remaining blood and used for assessment of ferritin, EPO, FSG, creatinine, urea, and uric acid. Significantly reduced FSG and HbA1c levels were observed in T2DM+HT+CCBs and T2DM+HT+ARBs groups vs T2DM+HT group (p < 0.05). The T2DM+HT+CCBs group had statistically higher urea levels than the T2DM group (p < 0.05). Both CCBs and ARBs use resulted in reduced creatinine clearance (CrCl). T2DM+HT+CCBs group exhibited slightly higher uric acid levels compared to controls (p < 0.05). Prolonged use of CCBs and ARBs led to disturbances in hematological parameters, with CCBs users showing the lowest levels of hemoglobin (Hb), RBCs, and hematocrit (Hct) among the groups. ARBs users displayed the lowest values of EPO and ferritin compared to other patient groups, along with reduced levels of Hb, RBCs, and Hct, albeit slightly higher than CCBs users. Our study highlights the importance of a balanced approach in prescribing ARBs and CCBs to patients with T2DM, given their potential to induce blood abnormalities, particularly with prolonged usage.

β-caryophyllene attenuates oxidative stress and hepatocellular mitochondrial dysfunction in type-2 diabetic rats induced with high fat and fructose diets

Objective

Hyperglycemia, hyperlipidemia, and systemic resistance to insulin are typical manifestations of type 2 diabetes mellitus. One of the main pathophysiological alterations in insulin-sensitive organs is mitochondrial malfunction associated with oxidative stress and diminished fuel utilization. β-Caryophyllene (BCP) has qualities that are anti-inflammatory, anti-tumor, antioxidant, hypolipidemic, and hypoglycemic. In this work, rats suffering from type 2 diabetes were given a diet high in fat and sugar with the aim of examining the ameliorative effects of BCP on oxidative stress-mediated hepatic mitochondrial dysfunction.

Methods

The diabetic condition was experimentally induced by feeding rats a high-calorie diet. The rats were then administered the recommended doses of BCP and metformin (MET) once every day for 30 days at 200 mg and 50 mg concentrations per kg of body weight, respectively, to prove the hypothesis of the study that BCP ameliorates mitochondrial dysfunction induced by oxidative stress in diabetic rats. Mitochondrial dysfunction can be identified by indicators such as oxidative stress, cardiolipin dienes, membrane phospholipid concentration, and mitochondrial enzymes.

Results

The mitochondria in the liver of rats with diabetes exhibit elevated redox imbalance-related parameters and malfunctioning mitochondria with peroxided cardiolipin, while their amounts of glutathione and phospholipids are lowered. Oxidative stress indices, ameliorated mitochondrial activities, and peroxided cardiolipin were drastically decreased in rats with diabetes treated with BCP or MET.

Conclusions

The present research demonstrated that BCP improved the vital role of mitochondria by reducing free radical dominance in type 2 diabetic experimental rats fed high-fat and high-sugar diets.

Synthetic GPR40/FFAR1 agonists: An exhaustive survey on the most recent chemical classes and their structure-activity relationships

Free fatty acid receptor 1 (FFAR1 or GPR40) is a potential target for treating type 2 diabetes mellitus (T2DM) and related disorders that have been extensively researched for many years. GPR40/FFAR1 is a promising anti-diabetic target because it can activate insulin, promoting glucose metabolism. It controls T2DM by regulating glucose levels in the body through two separate mechanisms: glucose-stimulated insulin secretion and incretin production. In the last few years, various synthetic GPR40/FFAR1 agonists have been discovered that fall under several chemical classes, viz. phenylpropionic acid, phenoxyacetic acid, and dihydrobenzofuran acetic acid. However, only a few synthetic agonists have entered clinical trials due to various shortcomings like poor efficacy, low lipophilicity and toxicity issues. As a result, pharmaceutical firms and research institutions are interested in developing synthetic GPR40/FFAR1 agonists with superior effectiveness, lipophilicity, and safety profiles. This review encompasses the most recent research on synthetic GPR40/FFAR1 agonists, including their chemical classes, design strategies and structure-activity relationships. Additionally, we have emphasised the structural characteristics of the most potent GPR40/FFAR1 agonists from each chemical class of synthetic derivatives and analysed their chemico-biological interactions. This work will hopefully pave the way for developing more potent and selective synthetic GPR40/FFAR1 agonists for treating T2DM and related disorders.

A Systematic Review of Economic Evaluations of Insulin for the Management of Type 2 Diabetes

Diabetes is a chronic, metabolic disease characterized by hyperglycemia, which occurs as a result of inadequate production or utilization of insulin. Type 2 diabetes (T2D) is the most common type of diabetes with estimates projecting a prevalence of more than 1 billion people living with T2DM by 2050. Hence, it was decided to conduct a systematic literature review of health economic evaluations of insulin, the most common medication used for the treatment of the disease, to inform policy. Pharmacoeconomic analyses, written in English and published after 2016, were considered for inclusion. PubMed/Medline, Global Health, Embase and Health Management Consortium were searched separately between 5 July 2023 and 17 July 2023. Grey literature articles were searched on ISPOR and the Cost-Effectiveness Analysis Registry during the same period. After the exclusion criteria were applied, 21 studies were included. Using the BMJ checklist, a quality appraisal was performed on all included studies. Data extraction was performed manually. Regarding evidence synthesis, data were heterogenous and are presented based on study type. The results showed a variety of treatment combinations being available for the treatment of diabetes, with insulin degludec/DegLira and semaglutide being cost-effective despite their high cost, due to the effectiveness of managing the disease. Research around the cost-effectiveness or cost-utility of insulin has potential to progress further, to ensure informed policy-making in the future.