From Pre-Diabetes to Diabetes: Diagnosis, Treatments and Translational Research

Diabetic wounds and short-chain fatty acids

Diabetes mellitus is a debilitating and worrisome chronic disease with many complications such as cardiovascular disease, kidney damage, blindness and diabetic wounds. Despite advances in the treatment of diabetic wounds, there are still concerns regarding the management of diabetic wound healing, particularly the inflammatory phase. In addition to many treatments with successful effects on wound healing in diabetic patients, short-chain fatty acids (SCFA) acetate, propionate, butyrate, valproate and valerate and their by-products have recently been proposed as new treatments for wound healing in diabetic patients. We provide an overview of the most recent studies on the effectiveness of the above-mentioned SCFAs in the treatment of diabetic wounds as well as possible effects on cytokines in this area of ​​study.

Arterial Spin Labeling (ASL) MRI in Evaluating Pancreatic Blood Perfusion in Subjects With Different Glucose Tolerances

BACKGROUND

The pancreas plays a central role in type 2 diabetes mellitus (T2DM), and its blood flow is usually associated with insulin release demand.

PURPOSE

To noninvasively assess pancreatic blood flow (PBF) changes and modulation in people with different glucose tolerance following a glucose challenge using ASL MRI.

STUDY TYPE

Prospective.

SUBJECTS

Fourteen prediabetes, 22 T2DM, and 40 normal.

FIELD STRENGTH/SEQUENCE

Pseudo-continuous ASL with a turbo gradient spin echo sequence at 3.0 T.

ASSESSMENT

All normal and subjects (diagnosed by oral glucose tolerance test) underwent ASL after fasting for at least 6 hours. The normal and prediabetes groups additionally had ASL scans at 5, 10, 15, 20, and 25 minutes following oral glucose (50 mL, 5%). PBF maps were generated from the ASL data and measured at body and tail. The ability of baseline PBF (BL-PBF) of body, tail (BL-PBFtail), and their average to determine abnormal glucose tolerance and stage was assessed.

STATISTICAL TESTS

ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, paired sample t-test, intra-class correlation coefficient, repeated measures ANOVA, correlation analysis, receiver operating characteristic analysis, and logistic regression analysis. A P value <0.05 was considered significant.

RESULTS

There were significant differences in BL-PBF among the three groups. The prediabetes group exhibited significantly lower PBF than the normal group at all time points; Both groups showed similar changing trends in PBF (peaking at the 15th minute and subsequently declining). The BL-PBFtail had the highest diagnostic performance when evaluating abnormal glucose tolerance or stage (area under the curves = 0.800, 0.584, respectively) and was an independent risk factor for glucose tolerance status.

DATA CONCLUSION

ASL can noninvasively assess changes in PBF among individuals with varying glucose tolerance and in response to glucose challenge, which could be linked to insulin release demand and might help characterize changes in pancreatic endocrine function.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 1.

Grifola frondosa Polysaccharide F2 Ameliorates Disordered Glucose and Lipid Metabolism in Prediabetic Mice by Modulating Bile Acids

Prediabetes (pre-DM) is the buffer period before developing overt type 2 diabetes (T2DM), and the search for novel food agents to protect against pre-DM is in high demand. Our team previously reported that the Grifola frondosa (maitake mushroom) polysaccharide F2 reduced insulin resistance in T2DM rats induced by streptozocin (STZ) combined with a high-fat diet (HFD). This study aimed to evaluate the effects of G. frondosa polysaccharide F2 on disordered lipid and glucose metabolism and to investigate its mechanisms in pre-DM mice. F2 (30 and 60 mg/kg/d) was administered (i.g.) for 5 weeks to pre-DM mice. The results showed that F2 decreased the fasting blood glucose and lipid profile index of pre-DM mice (p < 0.05 or 0.0001). An untargeted metabolomics analysis of feces from pre-DM mice showed that F2 reduced the content of conjugated bile acids, including taurochenodeoxycholic acid and taurocholic acid, and increased the free bile acids of lithocholic acid. The results of 16S rDNA sequencing of feces from pre-DM mice showed that bile salt hydrolase (BSH)-producing bacteria, including Bacillus, Bifidobacterium, and Lactococcus, may be the therapy targets of F2 in pre-DM mice. Through the integrated analysis of untargeted metabolomics and 16S rDNA sequencing, it was found that F2 may ameliorate glucose and lipid metabolism disorders by promoting bile acid metabolism while regulating the abundance of BSH-producing bacteria (Lactococcus spp.), suggesting its potential as a functional food ingredient for the prevention of T2DM.

Changes in expression of inflammatory cytokines and ocular indicators in pre-diabetic patients with cataract

Pre-diabetes is the preceding condition of diabetes, and in some cases, fundus changes have been seen in pre-diabetes. The inflammatory response is widely recognized as being involved in the pathophysiologic process of diabetic eye disease. Therefore, we aimed to acquire understanding of the role of early altered blood glucose levels in the development and etiology of diabetic ocular disorders from the perspective of inflammation. In this study, serum, tear, aqueous humor and vitreous fluid samples were collected from patients undergoing cataract surgery. VEGF, IL-6, TNF-a, MCP-1, APOA-1, ICAM-1, VCAM-1, PEDF, TSP-1 were measured by ELISA. The quantity of hyperreflective retinal spots (HRS) was counted by optical coherence tomography OCT images. We found that the levels of inflammatory cytokines are already altered in pre-diabetes. Levels of pro-inflammatory cytokine expression and quantity of HRS can reflect the disease process to some extent.

New Markers for the Assessment of Microvascular Complications in Patients with Metabolic Syndrome

Background: Metabolic syndrome is a complex disorder characterized by the coexistence of multiple risk factors, including dysglycemia, hypertension, dyslipidemia, and visceral obesity. Both metabolic syndrome and diabetes mellitus are closely associated with the onset of microvascular complications such as retinopathy, polyneuropathy, and nephropathy. Methods: This narrative review analyzed 137 studies published up to 2025, retrieved from PubMed and Crossref databases. The objective was to identify and evaluate potential biomarkers that could facilitate the early detection of microvascular complications in patients with metabolic syndrome. Results: Several biomarkers demonstrated a strong correlation with microvascular complications in individuals with metabolic syndrome. These findings suggest their potential role in early diagnosis and risk assessment. Conclusions: The identification of reliable biomarkers may enhance early detection and targeted interventions for microvascular complications in metabolic syndrome. Further research is essential to validate these markers and establish their clinical applicability in routine medical practice.

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

Background and Aims

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

Methods

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

Results

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

Conclusion

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

The Role of the Planetary Diet in Managing Metabolic Syndrome and Cardiovascular Disease: A Narrative Review

Introduction: The planetary health diet, introduced by the EAT-Lancet Commission, aims to address global health and sustainability challenges by promoting a plant-based diet with reduced consumption of animal-sourced foods. This diet not only contributes to environmental sustainability but also offers significant health benefits, including prevention and management of abdominal obesity, carbohydrate metabolism disorders, dyslipidemia, and elevated blood pressure. These metabolic disorders are components of metabolic syndrome, a cluster of risk factors for cardiovascular disease. Objectives: This narrative review aims to gather the most recent findings on the impact of the planetary diet on individual components of metabolic syndrome and on the prevention and treatment of cardiovascular disease. Methods: The available research on the topic was identified via searches in PubMed, Scopus, and Google Scholar. Results: Abdominal obesity, a major risk factor for a range of chronic diseases, can be effectively mitigated by adhering to plant-based dietary patterns, which have been shown to reduce waist circumference and improve overall cardiometabolic health. Furthermore, the planetary diet plays a crucial role in reducing the risk of type-2 diabetes and improving glycemic control, with specific dietary components such as whole grains and fiber, demonstrating positive effects on blood glucose levels. This diet is additionally associated with favorable lipid profiles, including lower levels of LDL cholesterol and total cholesterol, which are critical in the prevention of atherosclerosis and cardiovascular diseases. Conclusions: These multiple benefits highlight that the planetary diet may be an effective strategy for managing and preventing metabolic syndrome and cardiovascular disease. However, further research is needed to confirm its long-term efficacy and applicability across diverse populations.

Exploring the Role of Hypoxia and HIF-1α in the Intersection of Type 2 Diabetes Mellitus and Endometrial Cancer

Diabetes and Cancer are the most complex chronic diseases, accounting for significant global mortality and morbidity. The association between Type 2 DM (T2DM) and endometrial cancer (EC) is multifaced, sharing numerous risk factors, including insulin resistance, obesity, hypoxia, and oxidative stress. Hypoxia plays a vital role in T2DM pathogenesis by altering the insulin level and pancreatic β-cell failure through an imbalance between antioxidant enzymes and cellular oxidative levels, while chronic inflammation contributes to EC malignancy. HIF-1α is a potent transcription factor involved in modulating cellular responses to hypoxia within the disease environment. Targeting the HIF-1α signaling cascade, a major metabolic regulator may contribute to advanced therapeutic advances. This review focuses on the association between T2DM and EC, especially focusing on hypoxia and HIF signaling pathways. These intersect with key pathways involved in T2DM and EC pathology, such as insulin signaling, PI3K/AKT, mTOR pathway, MUC1/HIF-1α pathway, and hormonal imbalance. Understanding this complex relationship paves the way for future researchers to develop HIF-1α-targeted therapies that could lead to novel combination therapies to treat these comorbid conditions.

Green approach for the synthesis of zinc oxide nanoparticles from methanolic stem extract of Andrographis paniculata and evaluation of antidiabetic activity: In silico GSK-3β analysis

In this study, zinc oxide nanoparticles (ZnO-NPs) were biosynthesized from methanolic stem extract of Andrographis paniculata (MEAP) and characterized physicochemically. ZnO-NPs were evaluated biologically for anti-diabetic and anti-nephropathy activities. A diabetic rat model generated by streptozotocin was used to test the anti-diabetic properties of ZnO-NPs. In diabetic rats, oral doses of MEAP and ZnO-NPs generated from MEAP were given once daily for 30 days at 100, 200, 300, 400, 600, and 1,200 mg·kg−1, respectively. Metformin, a common antidiabetic drug, was utilized as a control at a dosage of 250 mg·kg−1. The NPs mediated by MEAP were homogenous, stable, spherical, and tiny. MEAP-derived ZnO-NPs prevented weight loss while significantly (p < 0.05) lowering blood glucose levels in comparison to MEAP and, to a lesser extent, metformin. Furthermore, MEAP-mediated ZnO-NPs were found to have favorable effects on the lipid profile and diabetic nephropathy. The histopathological evaluation demonstrated the safety, non-toxicity, and biocompatibility of synthesized ZnO-NPs produced from MEAP. The hypoglycemic response to MEAP-derived ZnO-NPs was greater at 400 mg·kg−1·day−1 than it was at 200 and 100 mg·kg−1·day−1. Therefore, ZnO-NPs biosynthesized from MEAP exhibit more anti-diabetic and anti-nephropathy action than MEAP in this first experimental setting reported.

Comparative analysis of retinal vascular structural parameters in populations with different glucose metabolism status based on color fundus photography and artificial intelligence

Objective

Measure and analyze retinal vascular parameters in individuals with varying glucose metabolism, explore preclinical retinal microstructure changes related to diabetic retinopathy (DR), and assess glucose metabolism's impact on retinal structure.

Methods

The study employed a cross-sectional design encompassing a 4-year period from 2020 to 2024. Fundus photographs from 320 individuals (2020-2024) were categorized into non-diabetes, pre-diabetes, type 2 diabetes mellitus (T2DM) without DR, and T2DM with mild-to-moderate non-proliferative DR (NPDR) groups. An artificial intelligence (AI)-based automatic measurement system was used to quantify retinal blood vessels in the fundus color photographic images, enabling inter-group parameter comparison and analysis of significant differences.

Results

Between January 2020 and June 2024, fundus color photographs were collected from 320 individuals and categorized into four groups: non-diabetes (n = 54), pre-diabetes (n = 71), T2DM without overt DR (n = 144), and T2DM with mild-to-moderate NPDR (n = 51). In pairwise comparisons among individuals with pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly different (P < 0.05). Within the T2DM population, FBG, HbA1c, age, SBP, and DBP were significant predictors for mild-to-moderate NPDR (P < 0.05). Average venous branching number (branch_avg_v) was significantly different among pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR groups. In patients with T2DM with mild-to-moderate NPDR, Average length of arteries (length_avg_a) and average length of veins (length_avg_v) increased, whereas branch_avg_v, average venous branching angle (angle_avg_v), average venous branching asymmetry (asymmetry_avg_v),overall length density (vessel_length_density), and vessel area density (vessel_density) decreased significantly (P < 0.05). Logistic regression analysis identified length_avg_a, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density as independent predictors of mild-to-moderate NPDR in patients with T2DM. Receiver Operating Characteristic (ROC) curve analysis demonstrated that length_avg_a, length_avg_v, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density had diagnostic value for mild-to-moderate NPDR (P < 0.05).

Conclusion

In individuals diagnosed with T2DM, specific retinal vascular parameters, such as branch_avg_v and vessel_density, demonstrate a significant correlation with mild-to-moderate NPDR. These parameters hold promise as preclinical biomarkers for detecting vascular abnormalities associated with DR.

Plasma high-sensitivity C-reactive protein measured prior to transplant is related to prediabetes in first-year kidney transplant recipients: A single-center cross-sectional study in Vietnam

AIM

To determine the rate of prediabetes among and the pre-transplant plasma high-sensitivity C-reactive protein (hs-CRP) value predictive of prediabetes in patients during their first year post-living donor kidney transplant.

METHODS

A total of 538 patients underwent living donor kidney transplantation between January 2018 and December 2020, 413 of whom met the inclusion criteria for this study. All patients underwent oral glucose tolerance tests (OGTTs) with 75 g glucose/200 mL solution, starting 3 months post-transplant and repeating the test every 3 months for the first year. Clinical and paraclinical indicators and plasma hs-CRP concentrations were quantified the day prior to the transplant. Prediabetes was diagnosed according to the American Diabetes Association 2018 criteria as a 2-h OGTT result between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L).

RESULTS

The rate of prediabetes among the study subjects was 38.3 % (158/413). Body mass index (BMI) and pre-transplant plasma triglycerides, high-density lipoprotein cholesterol (HDLC), and hs-CRP levels were related factors predictive of prediabetes in patients within the first year post-kidney transplant based on multivariate logistic regression and receiver operative characteristic curve models. Hs-CRP was the factor with the best predictive value (area under the curve = 0.89; p < 0.001).

CONCLUSIONS

Pre-transplant plasma hs-CRP levels were a good predictor of prediabetes in the first year post-living donor kidney transplant.

Pancreatic beta cell function and insulin resistance profiles in first-degree relatives of patients with prediabetes and type 2 diabetes

AIMS

To evaluate insulin secretion and insulin resistance profiles in individuals with family history of prediabetes and type 2 diabetes.

METHODS

This was a cross-sectional study to evaluate clinical and metabolic profiles between individuals with type 2 diabetes, prediabetes and their relatives. There were 911 subjects divided into five groups: (i) normoglycemic (NG), (ii) type 2 diabetes, (iii) prediabetes, (iv) first-degree relatives of patients with type 2 diabetes (famT2D), and (v) first-degree relatives of patients with prediabetes (famPD); anthropometrical, biochemical and nutritional evaluation, as well as insulin resistance and pancreatic beta cell function measurement was performed by oral glucose tolerance to compare between groups.

RESULTS

The most prevalent type 2 diabetes risk factors were dyslipidemia (81%), family history of type 2 diabetes (76%), central obesity (73%), male sex (63%), and sedentary lifestyle (60%), and most of them were progressively associated to prediabetes and type 2 diabetes groups. Insulin sensitivity was lower in famT2D groups in comparison to NG group (p < 0.0001). FamPD and famT2D had a 10% lower pancreatic beta cell function (DI) than the NG group (NG group 2.78 ± 1.0, famPD 2.5 ± 0.85, famT2D 2.4 ± 0.75, p˂0.001).

CONCLUSIONS

FamPD and famT2D patients had lower pancreatic beta cell function than NG patients, highlighting that defects in insulin secretion and insulin sensitivity appear long time before the development of hyperglycemia in patients genetically predisposed.

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

Background

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

Methods

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

Results

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

Conclusion

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

Alopecia Areata Is Associated with an Increased Risk for Prediabetes and Obesity: A Nationwide Case-Control Study

Background and Aims: Alopecia areata (AA) is a non-scarring inflammatory hair loss condition associated with various immune-mediated comorbidities. Prediabetes, characterized by elevated blood glucose levels not yet high enough to be classified as diabetes, significantly increases the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular complications. The associations between AA obesity and prediabetes have long been investigated in an attempt to identify preventable risk factors, yet the literature is relatively scarce and inconclusive. This study aimed to explore the association between AA, prediabetes, obesity, and T2DM in a large population cohort. Methods: All patients diagnosed with AA between 2005 and 2019 within Maccabi Healthcare Services (MHS) in Israel were compared with age-matched and gender-matched healthy controls for prediabetes, T2DM and obesity, using logistic regression models for all analyses. A total of 33,401 patients with AA and 66,802 controls were included in the analysis. Results: The prevalence of prediabetes was significantly higher in AA patients (26.3%) compared to controls (18.1%), with an odds ratio (OR) of 1.62. Obesity prevalence was also higher in AA patients (17.2% vs. 13.3%, OR 1.35). T2DM prevalence was similar between groups. Prediabetes prevalence notably increased with age in AA patients, especially in those aged 40 and older (OR 2.02). Discussion: The study highlights a significant association between prediabetes and alopecia areata, with prediabetes risk emerging prominently in AA patients. Obesity also showed a strong link with AA. These findings suggest the need for regular screening and early management of prediabetes and obesity in patients with AA to potentially mitigate associated health risks.

"Hyperglycemic Memory": Observational Evidence to Experimental Inference

Several epidemiological studies have appreciated the impact of "duration" and "level" of hyperglycemia on the initiation and development of chronic complications of diabetes. However, glycemic profiles could not fully explain the presence/absence and severity of diabetic complications. Genetic issues and concepts of "hyperglycemic memory" have been introduced as additional influential factors involved in the pathobiology of late complications of diabetes. In the extended phase of significant diabetes randomized, controlled clinical trials, including DCCT/EDIC and UKPDS, studies have concluded that the quality of glycemic or metabolic control at the early time around the diabetes onset could maintain its protective or detrimental impact throughout the following diabetes course. There is no reliable indication of the mechanism by which the transient exposure to a given glucose concentration level could evoke a consistent cellular response at target tissues at the molecular levels. Some biological phenomena, such as the production and the concentration of advanced glycation end products (AGEs), reactive oxygen species (ROS) and protein kinase C (PKC) pathway activations, epigenetic changes, and finally, the miRNAs-mediated pathways, may be accountable for the development of hyperglycemic memory. This work summarizes evidence from previous experiments that may substantiate the hyperglycemic memory soundness by its justification in molecular terms.

Efficacy and safety of red ginseng extract powder (KGC05pg) in achieving glycemic control in prediabetic Korean adults: A 12-week, single-center, randomized, double-blind, parallel-group, placebo-controlled study

BACKGROUND

This study was conducted to assess the efficacy and safety of Red Ginseng Extract Powder (RGEP) (KGC05pg; Korea Ginseng Corporation, Daejeon, Korea) in achieving glycemic control in prediabetic Korean adults.

METHODS

The patients of the RGEP group (n = 49) and those of the placebo group (n = 49) were orally given 2 tablets of RGEP and its matching placebo, respectively, at a dose of 500 mg/day twice daily in the morning and the evening within 30 min after meal during a 12-week treatment period. The patients were assessed for glycemic control parameters, such as fasting blood glucose levels, 30-, 60-, 90-, and 120-min blood glucose levels on an oral glucose tolerance test, Hb1Ac levels and glucose area under the curve, insulin resistance parameters, such as homeostasis model assessment of insulin resistance, c-peptide and insulinogenic index, and hormone parameters, such as glucagon, adiponectin and glucagon-like peptide-1. Moreover, the patients were also assessed for time-dependent changes in dipeptidyl peptidase-4 levels. Finally, the patients were also assessed for incidences of treatment-emergent adverse events and serious adverse events.

RESULTS

There were significant differences in changes in fasting blood glucose and 30-, 60-, 90-, and 120-min blood glucose levels on an oral glucose tolerance test, Hb1Ac levels, glucose area under the curve, homeostasis model assessment of insulin resistance, c-peptide levels and insulinogenic index, glucagon, adiponectin, and glucagon-like peptide-1 levels at 12 weeks from baseline between the 2 groups (P < .05). There was a significant time-dependent decrease in dipeptidyl peptidase-4 levels in the RGEP group (P = .001). There were no cases of treatment-emergent adverse events and serious adverse events in each treatment arm.

CONCLUSION

RGEP might be effective in achieving glycemic control in prediabetic Korean adults.

Molecular hybridization, synthesis, in vitro α-glucosidase inhibition, in vivo antidiabetic activity and computational studies of isatin based compounds

In the pursuit of novel antidiabetic agents, a series of isatin-thiazole derivatives (7a-7j) were synthesized and characterized using a range of spectroscopic techniques. The enzyme inhibitory activities of the target analogues were assessed using both in vitro and in vivo assays. The tested compounds 7a-7j demonstrated In vitro inhibitory potential against α-glucosidase, as indicated by their IC50 values ranging from 28.47 to 46.61 µg/ml as compared to standard drug acarbose IC50 value of 27.22 ± 2.30 µg/ml. Additionally, compounds 7d and 7i were chosen for in vivo evaluation of their antidiabetic efficacy in streptozotocin-induced diabetic Wistar rats. These compounds exhibited significant antidiabetic activity both in vitro and in vivo, compound 7d produces therapeutic effects compared to standard pioglitazone by decreasing glycaemia and triglyceride levels in diabetic animals. Furthermore, a molecular docking study was conducted to elucidate the binding interactions of the compounds within the α-glucosidase enzyme binding pocket (PDB ID 3A47) and stability was confirmed by dynamics simulation trajectories. Thus, from the above findings, it may demonstrate that isatin-thiazole hybrids constitute promising candidates in the pursuit of developing newer oral antidiabetic agents.

Ellagic acid as potential therapeutic compound for diabetes and its complications: a systematic review from bench to bed

Diabetes mellitus (DM) is a worldwide-concerning disease with a rising prevalence. There are many ongoing studies aimed at finding new and effective treatments. Ellagic acid (EA) is a natural polyphenolic compound abundant in certain fruits and vegetables. It is the objective of this investigation to assess the effectiveness and preventive mechanisms of EA on DM and associated complications. This systematic review used PubMed, Scopus, and Google Scholar as search databases using a predetermined protocol from inception to June 2024. We assessed all related English studies, including in vitro, in vivo, and clinical trials. EA counteracted DM and its complications by diminishing inflammation, oxidative stress, hyperglycemia, apoptosis, insulin resistance, obesity, lipid profile, and histopathological alterations. Several mechanisms contributed to the anti-diabetic effect of EA, the most significant being the upregulation of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), peroxisome proliferator-activated receptor gamma (PPAR-γ), protein kinase B, and downregulation of nuclear factor-kappa-B (NF-κB) gene expression. EA also revealed protective effects against diabetes complications, such as diabetic-induced hepatic damage, testicular damage, endothelial dysfunction, muscle dysfunction, retinopathy, nephropathy, cardiomyopathy, neuropathy, and behavioral deficit. Administration of EA could have various protective effects in preventing, treating, and alleviating DM and its complications. Although it could be considered a cost-effective, safe, and accessible treatment, to fully establish the effectiveness of EA as a medication for DM, it is crucial to conduct further well-designed studies.

Targeting the Gut Microbiota for Prevention and Management of Type 2 Diabetes

Type 2 diabetes (T2D) is a chronic metabolic disorder with a heterogeneous etiology encompassing societal and behavioral risk factors in addition to genetic and environmental susceptibility. The cardiovascular consequences of diabetes account for more than two-thirds of mortality among people with T2D. Not only does T2D shorten life expectancy, but it also lowers quality of life and is associated with extremely high health expenditures since diabetic complications raise both direct and indirect healthcare costs. An increasing body of research indicates a connection between T2D and gut microbial traits, as numerous alterations in the intestinal microorganisms have been noted in pre-diabetic and diabetic individuals. These include pro-inflammatory bacterial patterns, increased intestinal permeability, endotoxemia, and hyperglycemia-favoring conditions, such as the alteration of glucagon-like peptide-1 (GLP-1) secretion. Restoring microbial homeostasis can be very beneficial for preventing and co-treating T2D and improving antidiabetic therapy outcomes. This review summarizes the characteristics of a "diabetic" microbiota and the metabolites produced by microbial species that can worsen or ameliorate T2D risk and progression, suggesting gut microbiota-targeted strategies to restore eubiosis and regulate blood glucose. Nutritional supplementation, diet, and physical exercise are known to play important roles in T2D, and here their effects on the gut microbiota are discussed, suggesting non-pharmacological approaches that can greatly help in diabetes management and highlighting the importance of tailoring treatments to individual needs.

Trends in Children's Dietary Inflammatory Index and association with prediabetes in U.S. adolescents

BACKGROUND AND OBJECTIVES

Prediabetes is a high-risk state for diabetes. We aimed to illustrate secular trends in the Children's Dietary Inflammation Index (C-DII) among U.S. adolescents and assess its association with prediabetes.

METHODS

Adolescents aged 12-18 years were collected from the National Health and Nutrition Examination Survey, 2001-2018. Prediabetes was defined based on Hemoglobin A1c, fasting glucose, and glucose tolerance levels. Risk was quantified by odds ratio (OR) and 95% confidence interval (CI).

RESULTS

A total of 13,684 adolescents were analyzed, representing a weighted total population of 33,351,181. C-DII scores declined significantly from 2001 to 2012 and increased from 2013 to 2018. The relationship between C-DII and prediabetes was roughly linear. When assigning the low C-DII scores as the reference, adolescents with medium and high C-DII scores were 1.22 (adjusted 95% CI: 1.04-1.44) and 1.25 (0.99-1.60) times more likely to have prediabetes. In subgroup analyses, the risk for prediabetes was significantly enhanced in boys (adjusted OR = 1.26 and 1.45 for medium and high C-DII scores, 95% CI: 1.05-1.51 and 1.09-1.92), and in adolescents living in poor families for medium (1.34 and 1.44, 1.08-1.67 and 1.07-1.95).

CONCLUSIONS

Our findings indicate a V-shaped secular trend in C-DII scores from 2001 to 2018 in U.S. adolescents, with the nadir in 2011-2012, and the risk for prediabetes was significantly increased by over 20% in adolescents possessing medium or high C-DII scores.

Corneal subepithelial nerve fibers in type 2 diabetes: potential biomarker of diabetic neuropathy

AIM

To observe the changes in corneal subepithelial nerve fibers (CNFs) and Langerhans cells (LCs) in patients with type 2 diabetes using corneal laser confocal microscopy (CLCM).

METHODS

A total of 60 patients (64 eyes), including 40 patients with type 2 diabetes (DM group) and 20 subjects without diabetes (control group) were included with CLCM. Neuron J plugin of Image J software were used for quantitative analysis of CNF length (CNFL), CNF density (CNFD), corneal nerve branch fiber density (CNBD), main branch length density, branch length density, corneal nerve fiber tortuosity (NT) score, and LCs density. An independent samples t-test to analyze the variability between the two groups was performed, and Pearson correlation analysis was used to analyze the relationships between CNF and multiple biochemical indicators in the DM group. The predictive power of CNF for type 2 diabetes was assessed using the receiver operating characteristic (ROC) curve.

RESULTS

There were significant differences in the CNFL, CNFD, and main branch length density between two groups. The results of Pearson correlation analysis showed a significant negative correlation between CNFD and the duration of diabetes as well as triglyceride levels and total cholesterol, and a significant positive correlation between CNFD and serum albumin. In addition, the NT score showed a positive correlation and urea nitrogen, similar to the positive correlation observed between LC density and glycosylated hemoglobin (HbA1c) levels. CNFD showed the highest area under the curve (AUC of ROC) value, followed by main branch length density and CNFL. The AUC of the ROC curve under the logistic regression model also demonstrated good predictive values. The cut-off values of CNFD, CNFL, and main branch length density for diabetes showed 31.25, 18.85, and 12.56, respectively.

CONCLUSION

In patients with type 2 diabetes, there is a notable reduction in both CNFL and CNFD. These measurements can be influenced by various blood biochemical factors. However, the compromised nerve fibers can serve as valuable indicators for predicting the onset of type 2 diabetes and also as biomarkers for detecting diabetic neuropathy and its related complications.

Beyond the 9-to-5 grind: workaholism and its potential influence on human health and disease

Workaholism is often considered a conventional word in the general population to portray those individuals who continuously work and find it challenging not to work. It is usually described as a work addiction and operationalized as a compulsive need to work excessively hard. However, the concept of workaholism remains poorly understood. The first objective of this review is to define workaholism, followed by its related concepts, and how it is assessed. Notably, we distinguish workaholism from work addiction and work engagement. Next, we review the current research literature, largely from the last two decades, to suggest that workaholism contributes toward a wide range of health outcomes, ranging from sleep to stress. In particular, we focus on evidence suggesting that workaholism may be associated with differing risk factors for cardiovascular diseases and potentially other related metabolic abnormalities. Finally, we discuss potential limitations of the existing literature on workaholism, and we provide future directions for this emerging field. Specifically, we underscore the need to link workaholism with more biomarkers of metabolic diseases, such as those related to inflammation, the gut microbiome, and glucose homeostasis. In addition, we highlight the importance of establishing causality between workaholism and poor health outcomes, such as cardiovascular diseases and type 2 diabetes.

Elevated Plasma High Sensitive C-Reactive Protein and Triglyceride/High-Density Lipoprotein Cholesterol Ratio are Risks Factors of Diabetes Progression in Prediabetes Patients After Kidney Transplant: A 3-Year Single-Center Study in Vietnam

Purpose

Determination the rate of developing post-transplant diabetes mellitus (PTDM) in prediabetic patients and the relationship with plasma hs-CRP levels and TG/HDL-C ratio in patients after kidney transplantation from living donors followed for 3 years.

Subjects and Methods

A total of 206 post-transplant patients diagnosed with prediabetes by oral glucose tolerance test (OGTT) were included in the study. At the time of diagnosis of prediabetes, all patients were clinically examined, paraclinical tests were performed, plasma hs-CRP was quantified, and the TG/HDL-C ratio was determined. Patients are individualized and given a reasonable diet and exercise regimen. Patients had their fasting blood glucose measured monthly or had an OGTT every 3 months. Patients meeting the criteria for diagnosis of PTDM according to the American Diabetes Association (ADA)-2018 were collected during 3 years of follow-up.

Results

The study group had an average age of 39.46 ± 10.26 years old, including 74.8% males and 25.2% females. The rate of patients who had a development of PTDM from prediabetes was 29.6% (61/206 patients). BMI, plasma TG, HDL-C, hs-CRP, and TG/HDL-C ratio at the time of prediabetes diagnosis were factors related to the progression of PTDM, in which hs-CRP and TG/HDL-C ratio were good predictors (with AUC = 0.85 and 0.874, respectively; p < 0.001).

Conclusion

After 3 years of follow-up, nearly one-third of prediabetic patients developed PTDM post-living donor kidney transplantation. BMI, plasma TG, HDL-C, hs-CRP, and the TG/HDL-C ratio were linked to DM progression, with hs-CRP and TG/HDL-C being the strongest predictors.

An enhanced machine learning algorithm for type 2 diabetes prognosis with a detailed examination of Key correlates

This study aimed to construct a high-performance prediction and diagnosis model for type 2 diabetic retinopathy (DR) and identify key correlates of DR. This study utilized a cross-sectional dataset of 3,000 patients from the People's Liberation Army General Hospital in 2021. Logistic regression was used as the baseline model to compare the prediction performance of the machine learning model and the related factors. The recursive feature elimination cross-validation (RFECV) algorithm was used to select features. Four machine learning models, support vector machine (SVM), decision tree (DT), random forest (RF), and gradient boost decision tree (GBDT), were developed to predict DR. The models were optimized using grid search to determine hyperparameters, and the model with superior performance was selected. Shapley-additive explanations (SHAP) were used to analyze the important correlation factors of DR. Among the four machine learning models, the optimal model was GBDT, with predicted accuracy, precision, recall, F1-measure, and AUC values of 0.7883, 0.8299, 0.7539, 0.7901, and 0.8672, respectively. Six key correlates of DR were identified, including rapid micronutrient protein/creatinine measurement, 24-h micronutrient protein, fasting C-peptide, glycosylated hemoglobin, blood urea, and creatinine. The logistic model had 27 risk factors, with an AUC value of 0.8341. A superior prediction model was constructed that identified easily explainable key factors. The number of correlation factors was significantly lower compared to traditional statistical methods, leading to a more accurate prediction performance than the latter.

Retrotransposon SINEs in age-related diseases: Mechanisms and therapeutic implications

Retrotransposons are self-replicating genomic elements that move from one genomic location to another using a "copy-and-paste" method involving RNA intermediaries. One family of retrotransposon that has garnered considerable attention for its association with age-related diseases and anti-aging interventions is the short interspersed nuclear elements (SINEs). This review summarizes current knowledge on the roles of SINEs in aging processes and therapies. To underscore the significant research on the involvement of SINEs in aging-related diseases, we commence by outlining compelling evidence on the classification and mechanism, highlighting implications in age-related phenomena. The intricate relationship between SINEs and diseases such as neurodegenerative disorders, heart failure, high blood pressure, atherosclerosis, type 2 diabetes mellitus, osteoporosis, visual system dysfunctions, and cancer is explored, emphasizing their roles in various age-related diseases. Recent investigations into the anti-aging potential of SINE-targeted treatments are examined, with particular attention to how SINE antisense RNA mitigate age-related alterations at the cellular and molecular levels, offering insights into potential therapeutic targets for age-related pathologies. This review aims to compile the most recent advances on the multifaceted roles of SINE retrotransposons in age-related diseases and anti-aging interventions, providing valuable insights into underlying mechanisms and therapeutic avenues for promoting healthy aging.

Intestinal-level anti-inflammatory bioactivities of whole wheat: Rationale, design, and methods of a randomized, controlled, crossover dietary trial in adults with prediabetes

Randomized controlled trials (RCT) demonstrate that whole wheat consumption improves glycemia. However, substantial inter-individual variation is often observed, highlighting that dietary whole grain recommendations may not support the health of all persons. The objective of this report is to describe the rationale and design of a planned RCT aimed at establishing the gut microbiota and metabolome signatures that predict whole wheat-mediated improvements in glucose tolerance in adults with prediabetes. It is hypothesized that a controlled diet containing wheat bread (WHEAT; 160 g/day) compared with refined bread (WHITE) will improve glucose tolerance in a gut microbiota-mediated manner. Biospecimens will be collected before and after each 2-week study arm. Testing for oral glucose tolerance and gastrointestinal permeability will be performed post-intervention. Assessments will include oral glucose tolerance (primary outcome) and secondary outcomes including gut microbiota, targeted and untargeted metabolomics of fecal and plasma samples, intestinal and host inflammatory responses, and intestinal permeability. WHEAT is predicted to alleviate glucose intolerance by shifting microbiota composition to increase short-chain fatty acid-producing bacteria while reducing populations implicated in intestinal inflammation, barrier dysfunction, and systemic endotoxemia. Further, benefits from WHEAT are anticipated to correlate with gut-level and systemic metabolomic responses that can help to explain the expected inter-individual variability in glucose tolerance. Thus, knowledge gained from integrating multi-omic responses associating with glucose tolerance could help to establish a precision nutrition-based framework that can alleviate cardiometabolic risk. This framework could inform novel dietary whole grain recommendations by enhancing our understanding of inter-individual responsiveness to whole grain consumption.

Glucagon-Like Peptide-1 Receptor Agonist Use Is Not Associated With Increased Complications After Total Hip Arthroplasty in Patients Who Have Type 2 Diabetes

BACKGROUND

Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, their effects on outcomes following total hip arthroplasty (THA) are not well known. This study aimed to compare the risk of complications in patients who had type 2 diabetes mellitus (DM) who were on GLP-1 agonists with those who were not on these medications.

METHODS

In total, 14,065 patients who had type 2 DM undergoing primary THA between 2016 and 2021 were retrospectively reviewed using a national database. Propensity score matching was employed at a 1:4 ratio to match patients who used GLP-1 agonists (n = 812) to those who did not (n = 3,248). Patients were matched on age, sex, insulin status, presence of other diabetic medications, comorbidities, and smoking status. Multivariable logistic regressions were performed to examine 90-day and 1-year THA outcomes between groups.

RESULTS

Patients who were not on GLP-1 agonists exhibited increased rates of extended hospital stays (≥3 days) (odds ratio 1.25, P = 0.01). Patients who were on GLP-1 agonists exhibited no significant differences in surgical or medical complication rates at 90 days compared to those not on GLP-1 agonists. There were also no significant differences in rates of all-cause revision THA, aseptic revision THA, or periprosthetic joint infection during the 1-year postoperative period.

CONCLUSIONS

This study demonstrated that GLP-1 agonists were not associated with increased risks for medical or surgical complications in patients who had DM undergoing THA and were associated with lower rates of extended hospital stays after surgery. This study provides additional evidence regarding the association of GLP-1 agonist use before THA with postoperative outcomes. Given the potential for increased glycemic control and weight loss, more data are needed to delineate the role of GLP-1 agonists in the optimization of patients who have DM before THA to minimize postoperative complications.

LEVEL OF EVIDENCE

Level III, retrospective cohort.

Association Between Gallstones and Depressive Symptoms: Results from NHANES and Mendelian Randomization Study

Purpose

Prior research has suggested a correlation between gallstones and depressive symptoms, yet the specifics of this relationship remain unclear. This study aims to explore the association between gallstones and depressive symptoms among adults.

Patients and Methods

Initially, we conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017 - March 2020. After propensity score matching (PSM) for participants with gallstones and those without gallstones, multivariate logistic regression analysis was used to explore the potential association between gallstones and depressive symptoms. This was followed by Mendelian randomization (MR) analysis to further elucidate the causal relationship between them. Using the genome-wide association study database, we extracted instrumental variables and performed bidirectional univariate and multivariate MR analyses.

Results

In the cross-sectional study of NHANES 2017 - March 2020, 835 pairs of participants with comparable characteristics, both with and without gallstones, were identified after PSM. The multivariate adjusted logistic regression analyses revealed a significant association between gallstones and depressive symptoms [fully adjusted model: OR=1.821 (95% CI, 1.181-2.808), P=0.007]. Subsequent MR analyses further clarified the causal relationship, indicating that genetically determined gallstones significantly increase the risk of developing depressive symptoms [forward univariate MR analysis: OR=1.04 (95% CI, 1.01-1.06), P=0.002; multivariate MR analysis: OR=1.03 (95% CI, 1.01-1.05), P=0.009], with no evidence of reverse causation [inverse univariate MR analysis: OR=1.28 (95% CI, 0.90-1.83), P=0.17].

Conclusion

Gallstones are a risk factor for depressive symptoms among adults. Hence, we recommend timely depression screening for patients diagnosed with gallstones, facilitating early detection and effective treatment of depressive symptoms, thus alleviating its impact on both individuals and society.

Working young adults' engagement with public and workplace health promotion efforts in Singapore: A qualitative study

Young adults entering the workforce are at increased risk of becoming overweight or obese. Yet, internationally, young adults are rarely targeted in health campaigns, and little is known on how to improve their interest and participation in health promotion efforts. Through 33 semi-structured interviews with young adults working in Singapore, we explored their engagement with existing public and workplace health promotion efforts that encouraged healthy eating and increased physical activity, and their subjective health in the context of their daily lives. Interviews were coded and thematically analysed, taking an inductive and deductive approach. Despite some interest in health messaging, participating working young adults rarely adopted health-promoting activities such as meeting daily recommended servings of fruits and vegetables and exercising regularly. Participants reported that the health promotion campaigns they were aware of, suggested actions that they couldn't incorporate in their lives as they did not address the barriers that they are facing from socio-environmental contributors such as long working hours, personal and social commitments, and the food environment. Furthermore, some considered their health to be good enough and therefore had little reason to change existing practices. Affordable and accessible health screenings were an objective way for young adults to re-evaluate their perceptions of their own health which motivated some to favourably change their behaviours. Our findings suggest that future health promotion campaigns would benefit from more fully addressing some of the existing barriers that young working adults face, in tandem with policy changes to directly tackle the socio-environmental conditions for young workers.

Poly (ADP-Ribose) Polymerase-1 (PARP-1) Inhibitors in Diabetic Retinopathy: An Attractive but Elusive Choice for Drug Development

Owing to its promiscuous roles, poly (ADP-ribose) polymerase-1 (PARP-1) is involved in various neurological disorders including several retinal pathologies. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus affecting the retina. In the present review, we highlight the importance of PARP-1 participation in pathophysiology of DR and discuss promising potential inhibitors for treatment. A high glucose level enhances PARP-1 expression; PARP inhibitors have gained attention due to their potential therapeutic effects in DR. They target different checkpoints (blocking nuclear transcription factor (NF-κB) activation; oxidative stress protection, influence on vascular endothelial growth factor (VEGF) expression, impacting neovascularization). Nowadays, there are several improved clinical PARP-1 inhibitors with different allosteric effects. Combining PARP-1 inhibitors with other compounds is another promising option in DR treatments. Besides pharmacological inhibition, genetic disruption of the PARP-1 gene is another approach in PARP-1-initiated therapies. In terms of future treatments, the limitations of single-target approaches shift the focus onto combined therapies. We emphasize the importance of multi-targeted therapies, which could be effective not only in DR, but also in other ischemic conditions.

Modulation of glycolipid metabolism in T2DM rats by Rubus irritans Focke extract: Insights from metabolic profiling and ERK/IRS-1 signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

The extracellular regulated protein kinase (ERK) plays a crucial role in the mitogen-activated protein kinase (MAPK) family, influencing apoptosis, proliferation, and differentiation. It connection to the insulin (INS) signaling cascade and the development of type 2 diabetes mellitus (T2DM) has been established. Rubus irritans Focke, an indispensable herb in Chinese Tibetan medicine for diabetes mellitus treatment, lacks a comprehensive understanding of its effects and pharmacological mechanisms in T2DM.

AIM OF THE STUDY

This study aimed to elucidate the effects of Rubus irritans Focke extract (Rife) on a T2DM rat model, exploring its impact on glycemic and lipid metabolism, histopathological changes, and its potential targeting of the extracellular regulated protein kinase/insulin receptor substrate-1 (ERK/IRS-1) signaling pathway.

MATERIALS AND METHODS

A T2DM rat model was induced by streptozotocin (STZ) injection (40 mg/kg) in high-fat diet-fed (HFD) male Wistar rats. Rife and metformin (Met) were administered for 4 weeks, and glycemic, lipid metabolism indices, and histopathological changes were assessed. Protein expression of ERK, IRS-1 in rat liver tissues was examined to evaluate the impact on the ERK/IRS-1 pathway.

RESULTS

Rife reducing hepatic ERK and IRS-1 protein expression in T2DM rats. Untargeted metabolomics identified 13 potential biomarkers and 4 differential metabolic pathways related to glycolipid metabolism disorders.

CONCLUSIONS

Rife demonstrated improved glycolipid metabolism in T2DM rats by inhibiting the ERK/IRS-1 related signaling pathway and influencing multiple metabolic pathways. This study provides valuable insights into the potential therapeutic mechanisms of Rife in the context of T2DM.

Renewable regeneration optic fiber glucose sensor based on succinylaminobenzenoboronic acid modified excessively tilted fiber grating

BACKGROUND

Optical fiber sensors have been used to detect glucose owing to advantages such as low cost, small size, and ease of operation etc. phenylboronic acid is one of the commonly used receptors for glucose detection, however phenylboronic acid based regenerative optical fiber sensors are commonly cumulative regeneration, renewable regeneration sensor has been missing from the literature.

RESULTS

In this work, instead of using phenylboronic acid, we synthesized succinylaminobenzenoboronic acid molecule (BPOA) by introducing a short chain containing carboxyl group at the other end of phenylboronic acid then covalently bonded BPOA on the surface of excessively tilted fiber grating (Ex-TFG). This provides a very stable platform for renewable regeneration and the regenerative buffer was also optimized. The proposed renewable regeneration method exhibited higher linearity and sensitivity (R2 = 0.9992, 8 pm/mM) in relative to the conventional cumulative regeneration method (R2 = 0.9718, 4.9 pm/mM). The binding affinity between BPOA and glucose was found to be almost constant over 140 bind/release cycles with a variation of less than 0.3 % relative standard deviation.

SIGNIFICANCE

The regenerative and label-free sensing capacity of the proposed device provides a theoretical foundation for label-free saccharide detection and the development of wearable glucose monitoring devices based on fiber optic sensors.

One anastomosis gastric bypass ameliorates diabetic nephropathy via regulating the GLP-1-mediated Sirt1/AMPK/PGC1α pathway

BACKGROUND

Diabetic nephropathy (DN), a complication of diabetes, is the most leading cause of end-stage renal disease. Bariatric surgery functions on the remission of diabetes and diabetes-related complications. One anastomosis gastric bypass (OAGB), one of popular bariatric surgery, can improve diabetes and its complications by regulating the glucagon-like peptide-1 (GLP-1) level. Meanwhile, GLP-1 can alleviate renal damage in high-fat-diet-induced obese rats. However, the effect of OAGB on renal injury remains uncertain in DN.

METHODS

A diabetes model was elicited in rats via HFD feeding and STZ injection. The role and mechanism of OAGB were addressed in DN rats by the body and kidney weight and blood glucose supervision, oral glucose tolerance test (OGTT), enzyme-linked immunosorbent assay (ELISA), biochemistry detection, histopathological analysis, and western blot assays.

RESULTS

OAGB surgery reversed the increase in body weight and glucose tolerance indicators in diabetes rats. Also, OAGB operation neutralized the DN-induced average kidney weight, kidney weight/body weight, and renal injury indexes accompanied with reduced glomerular hypertrophy, alleviated mesangial dilation and decreased tubular and periglomerular collagen deposition. In addition, OAGB introduction reduced the DN-induced renal triglyceride and renal cholesterol with the regulation of fatty acids-related proteins expression. Mechanically, OAGB administration rescued the DN-induced expression of Sirt1/AMPK/PGC1α pathway mediated by GLP-1. Pharmacological block of GLP-1 receptor inverted the effect of OAGB operation on body weight, glucose tolerance, renal tissue damage, and fibrosis and lipids accumulation in DN rats.

CONCLUSION

OAGB improved renal damage and fibrosis and lipids accumulation in DN rats by GLP-1-mediated Sirt1/AMPK/PGC1α pathway.

Nonlinear relationship between triglyceride-glucose index and the risk of prediabetes and diabetes: a secondary retrospective cohort study

BACKGROUND

The triglyceride-glucose (TyG) index, recognized for its cost-efficiency and simplicity, serves as an accessible indicator of insulin resistance. Yet, its correlation with the risk of prediabetes and diabetes (Pre-DM/DM) in the Chinese demographic remains uncertain. Consequently, our study explored the association between the TyG index and the development of Pre-DM/DM within the Chinese population.

METHODS

The retrospective cohort study was carried out utilizing data from a health screening initiative. The study included 179541 adults over 20 who underwent medical examinations at the Rich Healthcare Group over a period spanning from 2010 to 2016. The correlation between the TyG index and Pre-DM/DM risk was investigated using Cox regression analysis. Furthermore, Cox proportional hazards regression with cubic spline functions and smooth curve fitting was incorporated to explore their non-linear connection.

RESULTS

The mean age of study participants was 41.18 ± 12.20 years old, and 95255 (53.05%) were male. During a median follow-up of 3.01 years, 21281 (11.85%) participants were diagnosed with Pre-DM/DM. After adjusting the potential confounding factors, the results showed that the TyG index was positively correlated with incident Pre-DM/DM (HR: 1.67, 95%CI: 1.62-1.71, P< 0.001). Additionally, a non-linear association was observed between the TyG index and the onset of Pre-DM/DM, with an inflection point identified at 8.73. Hazard ratios (HR) to the left and right of this inflection point were 1.95 (95%CI: 1.86-2.04) and 1.34 (95%CI: 1.27-1.42), respectively. Furthermore, sensitivity analyses confirmed the stability of these findings.

CONCLUSION

The TyG index exhibited a non-linear positive relationship with the risk of Pre-DM/DM. These findings imply that maintaining the TyG index at a lower, specified threshold may be beneficial in mitigating the onset of Pre-DM/DM.

Factors associated with development of retinopathy in patients with type 2 diabetes mellitus at onset and within three years after diagnosis

OBJECTIVE

To investigate the prevalence of diabetes retinopathy and evaluate the factors influencing its occurrence both at the onset of type 2 diabetes (T2D) and three years into its duration.

DESIGN

Retrospective population-based study.

SETTING

Data was retrieved from Regional Healthcare Information Platform in Region Halland 2016-2020.

SUBJECTS

Patients 35-75 years old in Region Halland receiving first-time diabetes diagnosis according to ICD-code E11-14 in 2016-17. The total cohort consisted of 1659 patients.

MAIN OUTCOME MEASURES

The main outcome measure of the study was the occurrence of diabetes retinopathy at onset and within three years from the diabetes diagnosis. Multivariate logistic regression analysis was conducted for diabetes retinopathy at onset and within three years, adjusted for age, gender, comorbidities, levels of HbA1c, cholesterol, kidney functional and blood pressure.

RESULTS

At onset, there were 12% with diabetes retinopathy and after three years, 32% of the patients had developed diabetes retinopathy. In the study cohort, 71 of patients who were examined with fundus photography within three years after onset, and 8% had had dietary recommendation without pharmacotherapy. High HbA1c levels, blood pressure values and impaired renal function already at onset were associated with development of diabetes retinopathy at onset and this association persisted after three years. The odds ratio for diabetes retinopathy was increased adjusted for HbA1c elevations, renal impairment, and increased blood pressure at index and when adjusted for these variables three years from index.

CONCLUSION

These findings indicate that the risk of developing diabetes retinopathy is present early on at onset and within the first three years of diabetes diagnosis. This highlights the importance of promptly regulating glucose- and blood-pressure levels and follow up kidney dysfunction to mitigate the risk of diabetes retinopathy.

A roadmap for empowering cardiovascular disease patients: a 5P-Medicine approach and technological integration

This article explores the multifaceted concept of cardiovascular disease (CVD) patients' empowerment, emphasizing a shift from compliance-oriented models to active patient participation. In recognizing that cardiovascular disease is a paramount global health challenge, this study illuminates the pressing need for empowering patients, underscoring their role as active participants in their healthcare journey. Grounded in 5P-Medicine principles-Predictive, Preventive, Participatory, Personalized, and Precision Medicine-the importance of empowering CVD patients through analytics, prevention, participatory decision making, and personalized treatments is highlighted. Incorporating a comprehensive overview of patient empowerment strategies, including self-management, health literacy, patient involvement, and shared decision making, the article advocates for tailored approaches aligned with individual needs, cultural contexts, and healthcare systems. Technological integration is examined to enhance patient engagement and personalized healthcare experiences. The critical role of patient-centered design in integrating digital tools for CVD management is emphasized, ensuring successful adoption and meaningful impact on healthcare outcomes. The conclusion proposes vital research questions addressing challenges and opportunities in CVD patient empowerment. These questions stress the importance of medical community research, understanding user expectations, evaluating existing technologies, defining ideal empowerment scenarios, and conducting a literature review for informed advancements. This article lays the foundation for future research, contributing to ongoing patient-centered healthcare evolution, especially in empowering individuals with a 5P-Medicine approach to cardiovascular diseases.

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.

Arylphthalide Delays Diabetic Retinopathy via Immunomodulating the Early Inflammatory Response in an Animal Model of Type 1 Diabetes Mellitus

Diabetic retinopathy (DR) is one of the most prevalent secondary complications associated with diabetes. Specifically, Type 1 Diabetes Mellitus (T1D) has an immune component that may determine the evolution of DR by compromising the immune response of the retina, which is mediated by microglia. In the early stages of DR, the permeabilization of the blood-retinal barrier allows immune cells from the peripheral system to interact with the retinal immune system. The use of new bioactive molecules, such as 3-(2,4-dihydroxyphenyl)phthalide (M9), with powerful anti-inflammatory activity, might represent an advance in the treatment of diseases like DR by targeting the immune systems responsible for its onset and progression. Our research aimed to investigate the molecular mechanisms involved in the interaction of specific cells of the innate immune system during the progression of DR and the reduction in inflammatory processes contributing to the pathology. In vitro studies were conducted exposing Bv.2 microglial and Raw264.7 macrophage cells to proinflammatory stimuli for 24 h, in the presence or absence of M9. Ex vivo and in vivo approaches were performed in BB rats, an animal model for T1D. Retinal explants from BB rats were cultured with M9. Retinas from BB rats treated for 15 days with M9 via intraperitoneal injection were analyzed to determine survival, cellular signaling, and inflammatory markers using qPCR, Western blot, or immunofluorescence approaches. Retinal structure images were acquired via Spectral-Domain-Optical Coherence Tomography (SD-OCT). Our results show that the treatment with M9 significantly reduces inflammatory processes in in vitro, ex vivo, and in vivo models of DR. M9 works by inhibiting the proinflammatory responses during DR progression mainly affecting immune cell responses. It also induces an anti-inflammatory response, primarily mediated by microglial cells, leading to the synthesis of Arginase-1 and Hemeoxygenase-1(HO-1). Ultimately, in vivo administration of M9 preserves the retinal integrity from the degeneration associated with DR progression. Our findings demonstrate a specific interaction between both retinal and systemic immune cells in the progression of DR, with a differential response to treatment, mainly driven by microglia in the anti-inflammatory action. In vivo treatment with M9 induces a switch in immune cell phenotypes and functions that contributes to delaying the DR progression, positioning microglial cells as a new and specific therapeutic target in DR.

Preparation, Characterization and In vitro Evaluation of Insulin-PHBV Nanoparticles/Alginate Hydrogel Composite System for Prolonged Delivery of Insulin

PURPOSE

In the present study, biodegradable poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanoparticles (NPs) containing insulin were loaded in sodium alginate/jeffamine (ALG/jeff) hydrogel for prolonged delivery of insulin. The main aim of this work was to fabricate an efficient insulin delivery system to improve patient adherence by decreasing the repetition of injections.

METHODS

Swelling and morphological properties and crosslinking efficiency of ALG/jeff hydrogel were assessed. The composite hydrogel was prepared by adding PHBV NPs to ALG/jeff hydrogel concurrently with crosslinking process. The morphology and loading capacity of composite hydrogel were analyzed.

RESULTS

Circular dichroism measurement demonstrated that insulin remains stable following fabrication process. The release profile exhibited 54.6 % insulin release from composite hydrogel within 31 days with minor initial burst release equated to nanoparticles and hydrogels. MTT cell viability analysis was performed by applying L-929 cell line and no cytotoxic effect was observed.

CONCLUSIONS

Favorable results clearly introduced fabricated composite hydrogel as an excellent candidate for drug delivery systems and also paves the route for prolonged delivery systems of other proteins.

A fluorescence probe for imaging lipid droplet and visualization of diabetes-related polarity variations

Diabetes mellitus is a disorder that affects lipid metabolism. Abnormalities in the lipid droplets (LDs) can lead to disturbances in lipid metabolism, which is a significant feature of diabetic patients. Nevertheless, the correlation between diabetes and the polarity of LDs has received little attention in the scientific literature. In order to detect LDs polarity changes in diabetes illness models, we created a new fluorescence probe LD-DCM. This probe has a stable structure, high selectivity, and minimal cytotoxicity. The probe formed a typical D-π-A molecular configuration with triphenylamine (TPA) and dicyanomethylene-4H-pyran (DCM) as electron donor and acceptor parts. The LD-DCM molecule has an immense solvatochromic effect (λem = 544-624 nm), fluorescence enhancement of around 150 times, and a high sensitivity to polarity changes within the linear range of Δf = 0.28 to 0.32, all due to its distinctive intramolecular charge transfer effect (ICT). In addition, LD-DCM was able to monitor the accumulation of LDs and the reduction of LDs polarity in living cells when stimulated by oleic acid, lipopolysaccharide, and high glucose. More importantly, LD-DCM has also been used effectively to detect polarity differences in organs from diabetic, drug-treated, and normal mice. The results showed that the liver polarity of diabetic mice was lower than that of normal mice, while the liver polarity of drug-treated mice was higher than that of diabetic mice. We believe that LD-DCM has the potential to serve as an efficient instrument for the diagnosis of disorders that are associated with the polarity of LDs.

Natural Compounds for Preventing Age-Related Diseases and Cancers

Aging is a multifaceted process influenced by hereditary factors, lifestyle, and environmental elements. As time progresses, the human body experiences degenerative changes in major functions. The external and internal signs of aging manifest in various ways, including skin dryness, wrinkles, musculoskeletal disorders, cardiovascular diseases, diabetes, neurodegenerative disorders, and cancer. Additionally, cancer, like aging, is a complex disease that arises from the accumulation of various genetic and epigenetic alterations. Circadian clock dysregulation has recently been identified as an important risk factor for aging and cancer development. Natural compounds and herbal medicines have gained significant attention for their potential in preventing age-related diseases and inhibiting cancer progression. These compounds demonstrate antioxidant, anti-inflammatory, anti-proliferative, pro-apoptotic, anti-metastatic, and anti-angiogenic effects as well as circadian clock regulation. This review explores age-related diseases, cancers, and the potential of specific natural compounds in targeting the key features of these conditions.

Associations between Diabetes Mellitus and Selected Cancers

Cancer is one of the major causes of mortality and is the second leading cause of death. Diabetes mellitus is a serious and growing problem worldwide, and its prevalence continues to grow; it is the 12th leading cause of death. An association between diabetes mellitus and cancer has been suggested for more than 100 years. Diabetes is a common disease diagnosed among patients with cancer, and evidence indicates that approximately 8-18% of patients with cancer have diabetes, with investigations suggesting an association between diabetes and some particular cancers, increasing the risk for developing cancers such as pancreatic, liver, colon, breast, stomach, and a few others. Breast and colorectal cancers have increased from 20% to 30% and there is a 97% increased risk of intrahepatic cholangiocarcinoma or endometrial cancer. On the other hand, a number of cancers and cancer therapies increase the risk of diabetes mellitus. Complications due to diabetes in patients with cancer may influence the choice of cancer therapy. Unfortunately, the mechanisms of the associations between diabetes mellitus and cancer are still unknown. The aim of this review is to summarize the association of diabetes mellitus with selected cancers and update the evidence on the underlying mechanisms of this association.

Uric acid is associated with type 2 diabetes: data mining approaches

Background

Several blood biomarkers have been related to the risk of type 2 diabetes mellitus (T2D); however, their predictive value has seldom been assessed using data mining algorithms.

Methods

This cohort study was conducted on 9704 participants recruited from the Mashhad Stroke and Heart Atherosclerotic disorders (MASHAD) study from 2010 to 2020. Individuals who were not between the ages of 35 and 65 were excluded. Serum levels of biochemical factors such as creatinine (Cr), high-sensitivity C reactive protein (hs-CRP), Uric acid, alanine aminotransferase (ALT), aspartate aminotransferase (AST), direct and total bilirubin (BIL.D, BIL.T), lipid profile, besides body mass index (BMI), waist circumference (WC), blood pressure, and age were evaluated through Logistic Regression (LR) and Decision Tree (DT) methods to develop a predicting model for T2D.

Results

The comparison between diabetic and non-diabetic participants represented higher levels of triglyceride (TG), LDL, cholesterol, ALT, BIL.D, and Uric acid in diabetic cases (p-value < 0.05). The LR model indicated a significant association between TG, Uric acid, and hs-CRP, besides age, sex, WC, and blood pressure, hypertension and dyslipidemia history with T2D development. DT algorithm demonstrated dyslipidemia history as the most determining factor in T2D prediction, followed by age, hypertension history, Uric acid, and TG.

Conclusion

There was a significant association between hypertension and dyslipidemia history, TG, Uric acid, and hs-CRP with T2D development, along with age, WC, and blood pressure through the LR and DT methods.

Graphical abstract

Bitter yet beneficial: The dual role of dietary alkaloids in managing diabetes and enhancing cognitive function

With the rising prevalence of diabetes and its association with cognitive impairment, interest in the use of dietary alkaloids and other natural products has grown significantly. Understanding how these compounds manage diabetic cognitive dysfunction (DCD) is crucial. This comprehensive review explores the etiology of DCD and the effects of alkaloids in foods and dietary supplements that have been investigated as DCD therapies. Data on how dietary alkaloids like berberine, trigonelline, caffeine, capsaicin, 1-deoxynojirimycin, nuciferine, neferine, aegeline, tetramethylpyrazine, piperine, and others regulate cognition in diabetic disorders were collected from PubMed, Research Gate, Web of Science, Science Direct, and other relevant databases. Dietary alkaloids could improve memory in behavioral models and modulate the mechanisms underlying the cognitive benefits of these compounds, including their effects on glucose metabolism, gut microbiota, vasculopathy, neuroinflammation, and oxidative stress. Evidence suggests that dietary alkaloids hold promise for improving cognition in diabetic patients and could open exciting avenues for future research in diabetes management.

Metabolomic approaches to dissect dysregulated metabolism in the progression of pre-diabetes to T2DM

Many individuals with pre-diabetes eventually develop diabetes. Therefore, profiling of prediabetic metabolic disorders may be an effective targeted preventive measure. We aimed to elucidate the metabolic mechanism of progression of pre-diabetes to type 2 diabetes mellitus (T2DM) from a metabolic perspective. Four sets of plasma samples (20 subjects per group) collected according to fasting blood glucose (FBG) concentration were subjected to metabolomic analysis. An integrative approach of metabolome and WGCNA was employed to explore candidate metabolites. Compared with the healthy group (FBG < 5.6 mmol L-1), 113 metabolites were differentially expressed in the early stage of pre-diabetes (5.6 mmol L-1 ⩽ FBG < 6.1 mmol L-1), 237 in the late stage of pre-diabetes (6.1 mmol L-1 ⩽ FBG < 7.0 mmol L-1), and 245 in the T2DM group (FBG ⩾ 7.0 mmol L-1). A total of 27 differentially expressed metabolites (DEMs) were shared in all comparisons. Among them, L-norleucine was downregulated, whereas ethionamide, oxidized glutathione, 5-methylcytosine, and alpha-D-glucopyranoside beta-D-fructofuranosyl were increased with the rising levels of FBG. Surprisingly, 15 (11 lyso-phosphatidylcholines, L-norleucine, oxidized glutathione, arachidonic acid, and 5-oxoproline) of the 27 DEMs were ferroptosis-associated metabolites. WGCNA clustered all metabolites into 8 modules and the pathway enrichment analysis of DEMs showed a significant annotation to the insulin resistance-related pathway. Integrated analysis of DEMs, ROC and WGCNA modules determined 12 potential biomarkers for pre-diabetes and T2DM, including L-norleucine, 8 of which were L-arginine or its metabolites. L-Norleucine and L-arginine could serve as biomarkers for pre-diabetes. The inventory of metabolites provided by our plasma metabolome offers insights into T2DM physiology metabolism.

Research trends between diabetes mellitus and bariatric surgery researches: Bibliometric analysis and visualization from 1998 to 2023

This study conducted a bibliometric analysis using the Web of Science Core Collection (WOSCC) to explore the relationship between diabetes mellitus and bariatric surgery (BS) from January 1985 to August 2023. No publications were found between 1985 and 1998. However, from 1998 to 2023, a total of 9,496 English articles were identified, accumulating 291,289 citations (241,563 excluding self-citations) and achieving an H-Index of 197. Leading contributors to the field were the United States, China, and Italy. Noteworthy authors in this area of research included Philip R. Schauer, Wei-Jei Lee, and Carel W. le Roux. The major journals that featured this research were 'Obesity Surgery,' 'Diabetes Care,' and 'Surgery for Obesity and Related Diseases.' The most highly cited article focused on lifestyle, diabetes, and cardiovascular risks 10 years after BS, emphasizing the significant attention given to the nutritional, cardiac, and general internal medicine impacts of diabetes and BS. The increase in research output during the review period indicates a growing interest in the relationship between diabetes and BS, providing a valuable reference for future studies in this evolving field.

Sortilin-Mediated Inhibition of TREK1/2 Channels in Primary Sensory Neurons Promotes Prediabetic Neuropathic Pain

Neuropathic pain can occur during the prediabetic stage, even in the absence of hyperglycemia. The presence of prediabetic neuropathic pain (PDNP) poses challenges to the management of individuals with prediabetes. However, the mechanisms underlying this pain remain unclear. This study aims to investigate the underlying mechanism and identify potential therapeutic targets of PDNP. A prediabetic animal model induced by a high-energy diet exhibits both mechanical allodynia and thermal hyperalgesia. Furthermore, hyperexcitability and decreased potassium currents are observed in the dorsal root ganglion (DRG) neurons of these rats. TREK1 and TREK2 channels, which belong to the two-pore-domain K+ channel (K2P) family and play an important role in controlling cellular excitability, are downregulated in DRG neurons. Moreover, this alteration is modulated by Sortilin, a molecular partner that modulates the expression of TREK1. The overexpression of Sortilin negatively affects the expression of TREK1 and TREK2, leading to increased neuronal excitability in the DRG and enhanced peripheral pain sensitivity in rats. Moreover, the downregulation of Sortilin or activation of TREK1 and TREK2 channels by genetic or pharmacological approaches can alleviate PDNP. Therefore, targeting the Sortilin-mediated TREK1/2 pathway may provide a therapeutic approach for ameliorating PDNP.

Immunomodulatory effects of Kaempferol on microglial and Macrophage cells during the progression of diabetic retinopathy

BACKGROUND

Diabetic retinopathy (DR) stands as a prevalent secondary complication of diabetes, notably Type 1 Diabetes Mellitus (T1D), characterized by immune system involvement potentially impacting the retinal immune response mediated by microglia. Early stages of DR witness blood-retinal barrier permeabilization, facilitating peripheral immune cell interaction with the retinal immune system. Kaempferol (Kae), known for its potent anti-inflammatory activity, presents a promising avenue in DR treatment by targeting the immune mechanisms underlying its onset and progression. Our investigation delves into the molecular intricacies of innate immune cell interaction during DR progression and the attenuation of inflammatory processes pivotal to its pathology.

METHODS

Employing in vitro studies, we exposed HAPI microglial and J774.A1 macrophage cells to pro-inflammatory stimuli in the presence or absence of Kae. Ex vivo and in vivo experiments utilized BB rats, a T1D animal model. Retinal explants from BB rats were cultured with Kae, while intraperitoneal Kae injections were administered to BB rats for 15 days. Quantitative PCR, Western blotting, immunofluorescence, and Spectral Domain - Optical Coherence Tomography (SD-OCT) facilitated survival assessment, cellular signaling analysis, and inflammatory marker determination.

RESULTS

Results demonstrate Kae significantly mitigates inflammatory processes across in vitro, ex vivo, and in vivo DR models, primarily targeting immune cell responses. Kae administration notably inhibits proinflammatory responses during DR progression while promoting an anti-inflammatory milieu, chiefly through microglia-mediated synthesis of Arginase-1 and Hemeoxygenase-1(HO-1). In vivo, Kae administration effectively preserves retinal integrity amid DR progression.

CONCLUSIONS

Our findings elucidate the interplay between retinal and systemic immune cells in DR progression, underscoring a differential treatment response predominantly orchestrated by microglia's anti-inflammatory action. Kae treatment induces a phenotypic and functional shift in immune cells, delaying DR progression, thereby spotlighting microglial cells as a promising therapeutic target in DR management.