Type 1 Diabetes Mellitus

Design and development of chromene-3-carboxylate derivatives as antidiabetic agents: Exploring the antidiabetic potential via dual inhibition of angiotensin II type 1 receptor and neprilysin enzyme

Diabetes mellitus, particularly type II diabetes mellitus, is a metabolic condition that has a substantial impact on the health of individuals. The implication of diabetes with increased risk of cardiovascular diseases (CVD) and, consequently, myocardial infarction is well established. However, developing new antidiabetic drugs with an established efficacy on cardiovascular health is an underdeveloped area of research. To address this, in the present study, a new series of chromene-3-carboxylate derivatives (1B1-1B22) as dual inhibitors of Angiotensin II Type 1 Receptor (AT1R) and Neprilysin (NEP), which are recognized targets in diabetes with CVD, is reported. The compounds were rationally designed and synthesized, considering the pharmacophoric features of these two targets. The evaluation was performed via glucose uptake, α-amylase, AT1R, and NEP inhibition assay. The derivatives were found to increase glucose uptake and inhibit all three targets, of which compound 1B15 was the most active. The most active compound, 1B15, reduced the oxidative stress and restored the mitochondrial membrane potential. The biological findings were further corroborated by in silico studies, which included molecular modelling and dynamics. It was deduced that 1B15 remains unionized in acidic to weak basic pH and may be passively absorbed. Further, the molecule was found to undergo hydroxylation as a means of Phase I metabolism and glucuronic conjugation in Phase II. The wet lab experiments on 1B15 further validated the in-silico absorption and metabolism prediction. The compounds, particularly 1B15, could be explored further as a lead for its utility as an antidiabetic with profound implications on cardiovascular health.

Two-pronged approach: Therapeutic effect of biological scaffold combined with immune intervention and β-cell replacement on type 1 diabetic mice

AIMS

Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by β-cell damage and absolute insulin deficiency. We consider combining immune intervention and β-cell replacement by biological scaffold to treat T1DM. Zinc transporter 8 (ZnT8) is known to be a pancreatic islet-specific autoantigen. Studies have shown that ZnT8(107-115)/HLA-A2 dimers can be used as antigen-specific immunosuppressants for T1DM. Mesenchymal stem cells (MSCs) can be induced to differentiate into insulin-producing cells (IPCs) under certain conditions in vitro. In recent years, the development of biomaterials has provided a more suitable three-dimensional microenvironment for cell transplantation. Our research group previously prepared gelatin/polylactic acid (PLLA/G) nanofiber scaffold by electrospinning technology, fixed GLP-1 analogues on the scaffold by surface modification with polydopamine (pDA) and confirmed the scaffold can promote bone mesenchymal stem cells (BMSCs) proliferation and improve cell survival rate. In addition, the scaffold can promote the differentiation of BMSCs into IPCs. Subsequently, ZnT8(107-115)/HLA-A2 dimer was constructed and loaded on the scaffold and confirmed the scaffold loaded with immunosuppressants can inhibit the proliferation and cytotoxicity of specific CD8+ T cells in vitro. This study used the above scaffold to co-load ZnT8(107-115)/HLA-A2 dimer and IPCs and implanted the scaffold into T1DM mice to study the blood glucose control and immunomodulatory effects on T1DM.

MATERIALS AND METHODS

First, the PLLA/G scaffold was modified with pDA and fixed with Liraglutide (LIR) to obtain the PLLA/G-pDA-LIR scaffold. Rat BMSCs were loaded on the scaffold and the 'three-step induction method' was used to induce differentiation in vitro. The insulin expression of IPCs was detected by Dithizone (DTZ) staining, glucose stimulate insulin secretion (GSIS) in vitro and intraperitoneal glucose tolerance test (IPGTT) in vivo. Then, non obese diabetes mice were modelled with T1DM and randomly divided into 5 groups. Blank control group was not treated; negative control group underwent sham surgery; positive control group was injected with IPCs through tail vein; single load scaffold group was subcutaneously transplanted with PLLA/G-pDA-LIR scaffold loaded with IPCs; double load scaffold group was subcutaneously transplanted with PLLA/G-pDA-LIR scaffold loaded with IPCs and ZnT8(107-115)/HLA-A2 dimer. Blood glucose and body weight were measured weekly before and after transplantation. At 2, 4 and 6 W after transplantation, some mice were taken from each group to detect serum insulin and C-peptide, spleen lymphocyte subsets and Tregs and pancreatic Th1/Th2 cell inflammatory factors.

RESULTS

The results of insulin expression in induced differentiated IPCs show that cells with insulin expression can be obtained through the "three-step induction method", and transplanting IPCs can effectively reduce blood glucose and improve glucose tolerance. Compared with non-scaffold induced IPCs, fixing Liraglutide scaffolds can improve the insulin expression level of IPCs and promote the induction of differentiation. The results after scaffold transplantation showed that compared with the positive control group and the single load scaffold group, the blood glucose was significantly reduced, and the serum insulin and C-peptide were significantly increased and lasted longer. In addition, the pathogenic T cells and inflammatory factors in the double load scaffold group were significantly reduced, and Tregs and anti-inflammatory factors were significantly increased.

CONCLUSIONS

The results show that the biological scaffold with IPCs and ZnT8(107-115)/HLA-A2 dimers has the dual functions of controlling blood glucose and regulating immunity, and may effectively treat T1DM.

The Role of Diabetes and SGLT2 Inhibitors in Cerebrovascular Diseases

PURPOSE OF REVIEW

Diabetes is a well-established risk factor for stroke. Understanding the pathophysiology of this connection is crucial to implementing appropriate prevention strategies. Lately, there has been a paradigm shift in the care of individuals with diabetes toward the use of glucose-lowering medications with potential cardiovascular, cerebrovascular or cardiorenal benefits. The aim of this article is to provide a critical analysis of the role of diabetes in cerebrovascular disease and current evidence and recommendations for the use of glucose-lowering medication with particular focus on the sodium glucose cotransporter-2 inhibitor (SGLT2i) class.

RECENT FINDINGS

Intensive glycemic control in individuals with diabetes reduces the risk of microvascular complications, but there is less clear evidence for decreasing risk of macrovascular events (e.g., stroke). A multifaceted management of diabetes addressing healthy lifestyle practices, glycemic control, and optimization of other cardiovascular risk factors is highly recommended. SGLT2i are the latest class of antihyperglycemic agents available for diabetes management. Canagliflozin and empagliflozin are associated with reduction in major adverse cardiovascular events (MACE). Dapagliflozin did not reduce the rate of MACE but is associated with reduction in heart-failure related death and hospitalization and has the potential to decrease dementia risk. Ertugliflozin decreases rates of hospitalization related to heart failure however it was non-inferior to placebo in reducing MACE. There is increasing evidence that the use of SGLT2i may reduce the risk of stroke, particularly hemorrhagic stroke, in individuals with type 2 diabetes and a high risk of cardiovascular events, and that SGLT2i may also be beneficial for brain health by decreasing risk of cognitive decline and dementia. Antihyperglycemic therapy should be tailored to patients' circumstances. SGLT2i treatment should be considered in patients with type 2 diabetes and established or high-risk cardiovascular disease, heart failure, or chronic kidney disease, to reduce the overall cerebro-cardiovascular and renal risks.

Research Progress of Traditional Chinese Medicine in Adjuvant Treatment of Type 1 Diabetes

Type 1 diabetes (T1DM) is one of the most common chronic metabolic diseases in the world. Insulin replacement therapy and drug adjuvant therapy are the main means of modern medical treatment of T1DM; still, there are adverse reactions such as drug resistance, which seriously hinder the therapeutic effect. As a unique medical method in China, traditional Chinese medicine (TCM) has a significant effect on the treatment of T1DM. TCM therapy can reduce the symptoms of T1DM, prevent complications, improve insulin resistance, and promote insulin secretion. In recent years, the research field of TCM in the treatment of T1DM has made considerable progress. The research on the treatment of T1DM by Chinese herbal medicine, TCM prescription, acupuncture, and moxibustion shows good anti-T1DM effect and significantly improves the survival rate of patients. This article aims to summarize the methods of TCM in the treatment of T1DM, expounds on the mechanism of action in the treatment of T1DM, and discusses the limitations and opportunities of TCM in the treatment of T1DM.

Validity and reliability of the Turkish version of the type 1 diabetes distress scale

AIMS

This study aimed to examine the psychometric properties of the Turkish version of the Type 1 Diabetes Distress Scale METHODS: This methodological, descriptive, and correlational study was conducted with 292 individuals diagnosed with Type 1 diabetes. Data were collected between January 2024 and August 2024 using the "Information Form for Individuals with Diabetes," the "Type 1 Diabetes Distress Scale," and the "Patient Health Questionnaire." The linguistic validity and content validity of the scale were evaluated, with content validity assessed using the Davis technique. The psychometric properties of the scale were analyzed through exploratory and confirmatory factor analyses, internal consistency reliability, test-retest reliability, and parallel-form reliability.

RESULTS

The Turkish version of the Type 1 Diabetes Distress Scale consists of 21 items and two subdimensions (Factor 1: Concerns About Diabetes Management; Factor 2: Social Diabetes Perception and Pressure). The two-factor structure explained 66 % of the total variance. The overall Cronbach's alpha coefficient for the scale was 0.96. Test-retest reliability analysis revealed a high, positive, and statistically significant correlation (r = 0.995, p < 0.05).

CONCLUSIONS

The questionnaire was demonstrated to be a valid and reliable instrument for evaluating diabetes distress in patients with type 1 diabetes.

Harnessing Machine Learning, a Subset of Artificial Intelligence, for Early Detection and Diagnosis of Type 1 Diabetes: A Systematic Review

Type 1 diabetes (T1D) is an autoimmune condition characterized by the destruction of insulin-producing pancreatic beta cells, leading to lifelong insulin dependence and significant complications. Early detection of T1D is essential to delay disease onset and improve outcomes. Recent advancements in artificial intelligence (AI) and machine learning (ML) have provided powerful tools for predicting and diagnosing T1D. This systematic review evaluates the current landscape of AI/ML-based approaches for early T1D detection. A comprehensive search across PubMed, EMBASE, Science Direct, and Scopus identified 1447 studies, of which 10 met the inclusion criteria for narrative synthesis after screening and full-text review. The studies utilized diverse ML models, including logistic regression, support vector machines, random forests, and artificial neural networks. The datasets encompassed clinical parameters, genetic risk markers, continuous glucose monitoring (CGM) data, and proteomic and metabolomic biomarkers. The included studies involved a total of 49,172 participants and employed case-control, retrospective cohort, and prospective cohort designs. Models integrating multimodal data achieved the highest predictive accuracy, with area under the curve (AUC) values reaching up to 0.993 in sex-specific models. CGM data and plasma biomarkers, such as CXCL10 and IL-1RA, also emerged as valuable tools for identifying at-risk individuals. While the results highlight the potential of AI/ML in revolutionizing T1D risk stratification and diagnosis, challenges remain. Data heterogeneity and limited model generalizability present barriers to widespread implementation. Future research should prioritize the development of universal frameworks and real-world validation to enhance the reliability and clinical integration of these tools. Ultimately, AI/ML technologies hold transformative potential for clinical practice by enabling earlier diagnosis, guiding targeted interventions, and improving long-term patient outcomes. These advancements could support clinicians in making more informed, timely decisions, thus reducing diagnostic delays and paving the way for personalized prevention strategies in both pediatric and adult populations.

Effectiveness of Telemedicine-Delivered Carbohydrate-Counting Interventions in Patients With Type 1 Diabetes: Systematic Review and Meta-Analysis

BACKGROUND

Type 1 diabetes mellitus (T1DM) significantly affects patients' quality of life and can be life-threatening, necessitating improved monitoring strategies. Telemedicine, which leverages telecommunications technologies to deliver health care services and expertise, has the potential to enhance T1DM management. However, its effectiveness remains to be fully established.

OBJECTIVE

This study aims to evaluate the effectiveness of various telemedicine-based carbohydrate-counting (CC) interventions in patients with T1DM.

METHODS

This systematic review and meta-analysis searched 5 databases-PubMed, Web of Science, CINAHL, Embase, and Cochrane-as well as reference lists of retrieved articles on September 26, 2024, for randomized controlled trials (RCTs) assessing the effectiveness of telemedicine-based CC interventions in reducing glycated hemoglobin A1c (HbA1c) levels in patients with T1DM.

RESULTS

From 3612 citations, we identified 18 eligible RCTs (n=1627) from 14 regions for inclusion in the meta-analysis. Participants in the telemedicine intervention group experienced a 0.35% reduction in HbA1c levels (95% CI -0.54 to -0.16) compared with the control group. A total of 13 studies used smartphone apps, 4 used connected and wearable glucometers, and 3 delivered the intervention through web-based systems. Significant reductions in HbA1c were observed across smartphone apps (-0.36%, 95% CI -0.63% to -0.09%), connected and wearable glucometers (-0.35%, 95% CI -0.56% to -0.14%), and web-based systems (-0.36%, 95% CI -0.71% to -0.02%). Considerable heterogeneity was noted (I2=81%, P<.001). Telemedicine-based CC interventions also increased time in range by 9.59% (95% CI 6.50%-12.67%). However, evidence regarding treatment satisfaction, total daily insulin dose, and hypoglycemia remains inconclusive. Subgroup analysis showed that telemedicine platform variety did not significantly contribute to heterogeneity, while meta-regression indicated that the impact on HbA1c was most pronounced in trials conducted in Asia.

CONCLUSIONS

Compared with usual care, telemedicine-delivered CC interventions improved HbA1c and time in range but did not significantly impact other clinically relevant outcomes in patients with T1DM. High-quality, large-scale RCTs are needed to draw definitive conclusions. These findings provide health care professionals with updated evidence on the role of telemedicine in glycemic control for patients with T1DM.

TRIAL REGISTRATION

PROSPERO CRD42024523025; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024523025.

Causal relationship between type I diabetes mellitus and atrial fibrillation: A Mendelian randomization study

Background

Patients with type 1 diabetes mellitus have been at heightened risk for developing atrial fibrillation. We aimed to investigate whether this association is causal using Mendelian randomization.

Methods

Using publicly available genome-wide association studies data, we selected single nucleotide polymorphisms significantly associated with type 1 diabetes mellitus as instrumental variables. We employed inverse variance-weighted, weighted median, MR-Egger regression, simple mode, and weighted mode methods within a two-sample Mendelian randomization framework to assess the causal relationship between type 1 diabetes mellitus and atrial fibrillation. We evaluated the pleiotropy and heterogeneity levels of the included genetic instruments using MR-PRESSO, MR-Egger intercept test, Cochran's Q test, funnel plots, and leave-one-out plots.

Results

Causal impact of type 1 diabetes mellitus on atrial fibrillation: Inverse variance weighted (odds ratio [OR] = 0.996, 95 % confidence interval [CI]: 0.985-1.007, P = 0.498). MR-Egger (OR = 1.000, 95 % CI: 0.985-1.016, P = 0.963). Weighted median (OR = 0.985, 95 % CI: 0.973-0.998, P = 0.022). Simple mode (OR = 1.007, 95 % CI: 0.974-1.040, P = 0.698). Weighted mode (OR = 0.995, 95 % CI: 0.984-1.005, P = 0.298). MR-Egger intercept test (P = 0.437). There was no evidence of pleiotropy among the genetic instrumental variables included in the analysis.

Conclusions

In Mendelian randomization analysis, we did not find evidence of a causal relationship between genetically determined type 1 diabetes mellitus in European ancestry populations and atrial fibrillation.

Differential risk of autoimmune disorders in non-traumatic osteonecrosis: clue to pathogenesis

INTRODUCTION

Non-traumatic osteonecrosis is a frequent complication in patients with autoimmune disorders, though its prevalence varies markedly depending upon the type of disorder. Understanding the causes of this difference can help uncover the underlying pathophysiology of osteonecrosis and guide the development of effective preventive and therapeutic strategies.

AREAS COVERED

In this perspective study, we reviewed available databases, including PubMed, Cochrane Library, Scopus, and Web of Science, to explore why the risk of osteonecrosis varies among different autoimmune disorders. Is this variation primarily due to the disease's pathophysiology, the use of medications such as corticosteroids, or a combination of both? If both factors are involved, what is the extent of each contribution in this context?

EXPERT OPINION

Non-traumatic osteonecrosis is often induced by an interaction between disease pathophysiology and corticosteroid use. In patients with different autoimmune disorders but an identical history of corticosteroid use, the risk of osteonecrosis is influenced by how the underlying pathophysiology compromises bone health. In autoimmune disorders with multiple adverse effects on bone, such as SLE (systemic lupus erythematosus), there is a much higher risk of osteonecrosis compared to disorders with minimal impact on bone health, such as celiac disease and MS (multiple sclerosis).

Tregs in pregnancy with type 1 diabetes mellitus: pilot study

OBJECTIVE

Pregnancy in women with type 1 diabetes mellitus has been associated with adverse outcomes due to persistent hyperglycemia and impaired maternal-fetal interactions. Regulatory T cells seem to exert a critical role in this process. Pregnancy can change the profile of Treg cells and affect the outcome of pregnancy; therefore, our purpose was to characterize the profile of regulatory T cells in the peripheral blood of pregnant and nonpregnant (controls) women with type 1 diabetes mellitus.

METHODS

This prospective case-control study recruited 36 women with type 1 diabetes mellitus, 16 pregnant and 20 nonpregnant. Peripheral blood samples were collected in the three trimesters of pregnancy and only once in the control group. Flow cytometry was used to assess peripheral blood T subpopulations: CD3+, CD4+, CD8+, CD4+ Treg (CD4+CD25+CD127-FOXP3+), and CD8+ Treg (CD8+CD25+FOXP3). In addition, the expression of CD4+CD25high and CD4+CD25low was analyzed.

RESULTS

Compared to controls, the pregnant women (regardless of the trimester) presented a lower percentage of TCD4+CD25high, TCD4+CD25low, and CD8 Treg (CD8+CD25+FOXP3+). Moreover, a higher percentage of total TCD8+ lymphocytes was observed in pregnant women than in controls.

CONCLUSION

This study reported changes in the circulating Treg cell profile that seem to be associated with pregnancy in type 1 diabetes mellitus patients and pregnancy outcomes.

Specialized pro-resolving lipid mediators: a key player in resolving inflammation in autoimmune diseases

Uncontrolled hyperactivation of the immune system is the central mechanism underlying the pathogenesis of autoimmune diseases. Timely control of the inflammatory response is essential to prevent inflammation progression and organ damage. Specialized pro-resolving lipid mediators (SPMs) are autacoid molecules derived from essential polyunsaturated fatty acids during acute inflammatory responses. They promote the resolution of inflammation and orchestrate endogenous reparative responses. The SPM superfamily includes lipoxins, resolvins, protectins, and maresins, as well as novel conjugates involved in tissue regeneration. Much work has been done focusing on the actions of SPMs in autoimmunity and has identified their deficiencies and therapeutic effects in autoimmune diseases. In this review, we provide a brief introduction of SPMs, summarize their effects on key cells involved in innate and adaptive immunity, and highlight their role and therapeutic potential in autoimmune diseases.

ZHX2 inhibits diabetes-induced liver injury and ferroptosis by epigenetic silence of YTHDF2

OBJECTIVE

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common complication of type 2 diabetes mellitus (DM). The transcription factor zinc fingers and homeoboxes 2 (ZHX2) has been implicated in the pathogenesis of chronic liver diseases, yet its precise role and underlying mechanism in DM-induced hepatic injury remain poorly elucidated.

METHODS

To investigate this, we used a high-fat diet (HFD) and streptozotocin (STZ) administration to create a DM model in mice, while high glucose (HG) exposure was used to simulate DM in vitro. Through various experiments such as luciferase reporter assay, chromatin immunoprecipitation, RNA immunoprecipitation, and rescue experiments, we aimed to uncover the mechanisms involving ZHX2.

RESULTS

Our findings revealed that ZHX2 was lower and YTHDF2 was higher in the livers of DM mice and HG-induced Huh7 cells. ZHX2 overexpression rescued DM-induced liver injury. ZHX2 overexpression also reversed DM-induced hepatic ferroptosis in vivo and in vitro. Mechanistically, YTHDF2 recognized m6A-modified ZHX2 mRNA and promoted its degradation. In turn, ZHX2 inhibited the transcription of YTHDF2 by binding to its promoter region. Knockdown of ZHX2 led to increased ferroptosis in Huh7 cells through activating YTHDF2-induced GPX4 and SLC7A11 degradation.

CONCLUSION

These findings highlight the involvement of the ZHX2-YTHDF2-ferroptosis pathway in DM-induced liver injury and suggest that targeting this pathway may hold therapeutic potential for improving such injuries.

Advances in the Pathogenesis and Treatment Strategies for Type 1 Diabetes Mellitus

Type 1 diabetes (T1D) is a complex autoimmune disorder distinguished by the infiltration of immune cells into pancreatic islets, primarily resulting in damage to pancreatic β-cells. Despite extensive research, the precise pathogenesis of T1D remains elusive, with its etiology linked to a complex interplay of genetic, immune, and environmental factors. While genetic predispositions, such as HLA and other susceptibility genes, are necessary, they do not fully account for disease development. Environmental influences such as viral infections and dietary factors may contribute to the disease by affecting the immune system and epigenetic modifications. Additionally, endogenous retroviruses (ERVs) might play a role in T1D pathogenesis. Current therapeutic approaches, including insulin replacement therapy, immune omodulatory therapy, autoantigen immunotherapy, organ transplantation, and genetic modification, offer potential to alter disease progression but are still constrained by limitations. This review presents updated knowledge on T1D, with a focus on risk factors, predisposing hypotheses, and recent advancements in therapeutic strategies.

Ramadan fasting among adolescents with type 1 diabetes: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis assess the effects of Ramadan fasting in adolescents with type 1 diabetes mellitus (T1DM), on blood sugar factors such as hemoglobin A1C and problems caused by its lack of control such as hypoglycemia and DKA, and metabolic outcomes.

METHODS

Electronic databases including MEDLINE, Embase, and SINOMED were searched up to February 13, 2024, without language, region, or publication time restrictions. The outcomes were Acute complications, changes in Hemoglobin A1c (HbA1c) and weight changes. Meta-analyses used random-effects models to compute weighted Relative risk (RR) and standard mean differences (SMD). And to check the risk of bias of included studies, the Newcastle-Ottawa scale was used.

RESULTS

Nine studies were included, comprising 458 participants, with studies varying in quality from high to low. Meta-analysis showed no significant reduction in HbA1c levels post-Ramadan (SMD: -0.12; 95% CI: -0.38 to 0.14), indicating minimal impact on long-term glycemic control. The incidence of hypoglycemia was notably high (50.79 events per 100 observations), with hyperglycemia and diabetic ketoacidosis (DKA) also reported but less frequently. The variability in complication rates among studies was significant, reflecting the high heterogeneity across the data. Weight changes during Ramadan were minimal and not statistically significant, suggesting fasting's negligible effect on body weight among participants.

CONCLUSIONS

Ramadan fasting among adolescents with T1DM does not significantly alter HbA1c levels, suggesting potential feasibility under careful monitoring and management. However, the high incidence of hypoglycemia underscores the need for vigilant glucose monitoring and tailored adjustments to diabetes management plans during fasting periods.

Unveiling the Therapeutic Potential of the Second-Generation Incretin Analogs Semaglutide and Tirzepatide in Type 1 Diabetes and Latent Autoimmune Diabetes in Adults

Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic beta cells, resulting in the lifelong need for exogenous insulin. Over the last few years, overweight and obesity have recently emerged as growing health issues also afflicting patients with T1D. In this context, the term "double diabetes" has been coined to indicate patients with T1D who have a family history of type 2 diabetes mellitus (T2D) and/or patients with T1D who are affected by insulin resistance and/or overweight/obesity and/or metabolic syndrome. At the same time, the use of second-generation incretin analogs semaglutide and tirzepatide has substantially increased on a global scale over the last few years, given the remarkable clinical benefits of these drugs (in terms of glucose control and weight loss) in patients with T2D and/or overweight/obesity. Although the glucagon-like peptide-1 (GLP-1) receptor agonists and the novel dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 receptor agonist tirzepatide are currently not approved for the treatment of T1D, a growing body of evidence over the last few years has shown that these medications may serve as valid add-on treatments to insulin with substantial efficacy in improving glucose control, promoting weight loss, preserving residual beta-cell function and providing other beneficial metabolic effects in patients with T1D, double diabetes and latent autoimmune diabetes in adults (LADA). This manuscript aims to comprehensively review the currently available literature (mostly consisting of real-world studies) regarding the safety and therapeutic use (for different purposes) of semaglutide and tirzepatide in patients with T1D (at different stages of the disease), double diabetes and LADA.

Targeting ferroptosis: opportunities and challenges of mesenchymal stem cell therapy for type 1 diabetes mellitus

Type 1 diabetes mellitus (T1DM) is characterized by progressive β-cell death, leading to β-cell loss and insufficient insulin secretion. Mesenchymal stem cells (MSCs) transplantation is currently one of the most promising methods for β-cell replacement therapy. However, recent studies have shown that ferroptosis is not only one of the key mechanisms of β-cell death, but also one of the reasons for extensive cell death within a short period of time after MSCs transplantation. Ferroptosis is a new type of regulated cell death (RCD) characterized by iron-dependent accumulation of lipid peroxides. Due to the weak antioxidant capacity of β-cells, they are susceptible to cytotoxic stimuli such as oxidative stress (OS), and are therefore susceptible to ferroptosis. Transplanted MSCs are also extremely susceptible to perturbations in their microenvironment, especially OS, which can weaken their antioxidant capacity and induce MSCs death through ferroptosis. In the pathophysiological process of T1DM, a large amount of reactive oxygen species (ROS) are produced, causing OS. Therefore, targeting ferroptosis may be a key way to protect β-cells and improve the therapeutic effect of MSCs transplantation. This review reviews the research related to ferroptosis of β-cells and MSCs, and summarizes the currently developed strategies that help inhibit cell ferroptosis. This study aims to help understand the ferroptosis mechanism of β-cell death and MSCs death after transplantation, emphasize the importance of targeting ferroptosis for protecting β-cells and improving the survival and function of transplanted MSCs, and provide a new research direction for stem cells transplantation therapy of T1DM in the future.

Pharmacotherapy of type 1 diabetes - part 1: yesterday

INTRODUCTION

Type 1 diabetes is a unique autoimmune attack on the β cell of the pancreatic islet resulting in progressive destruction of these cells and as a result the ability of the body to maintain insulin production. The consequences of insulin deficiency are very severe, and the disease was fatal prior to the ability to extract insulin from animal pancreas in 1921. We review progress in the treatment of childhood type 1 diabetes over the past 100 years.

AREAS COVERED

We used PubMed and standard search engines to search for the evolution of diagnosis and treatment of type 1 diabetes.

EXPERT OPINION

Insulin replacement proved lifesaving for children afflicted with type 1 diabetes. However, it was observed that these children suffered from microvascular and large vessel disease. The Diabetes Control and Complications Trial (DCCT) with its extension Epidemiology of Diabetes Interventions and Complications Trial (EDIC) proved that control of blood glucose as close to normal as possible could prevent these diabetes-related conditions. Many formuations of insulin with varying onset and duration of action have been developed; yet normalization of glucose levels is difficult due to hypoglycemic events. There is continued progress toward that goal.

Lymphocyte-C-reactive protein ratio upon admission to predict disease progression and ICU admission in adult patients with diabetic ketoacidosis

This study aimed to investigate whether lymphocyte-C-reactive protein ratio (LCR) upon admission can predict disease progression and intensive care unit (ICU) admission in adult patients with diabetic ketoacidosis (DKA). A single-center retrospective study was conducted, including adult DKA patients admitted to the First Affiliated Hospital of Harbin Medical University between March 2018 and March 2023. Multiple demographic and clinical data were collected from the medical records upon admission and during hospitalization. Subsequently, sequential organ failure assessment (SOFA) score and LCR were calculated based on relevant clinical parameters within 24 h of admission. These indicators were compared among different disease severity groups, and factors related to severe DKA, concurrent acute kidney injury (AKI), and ICU admission were further analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity, specificity, area under the ROC curve (AUC), and cut-off value of LCR. A total of 271 adult DKA patients were enrolled and categorized into three groups: mild group (n = 42), moderate group (n = 64), and severe group (n = 165). Significant differences in demographic and clinical data were observed among these groups. Glasgow coma scale (GCS) score, LCR, pH, and bicarbonate (HCO3-) were identified as protective factors for severe DKA. Conversely, SOFA score, neutrophil count (NEUT), serum creatinine (SCr), and glucose (GLU) were risk factors for concurrent AKI. Concurrent AKI and SOFA score were risk factors for ICU admission, while pH was a protective factor. The areas under the ROC curve (AUC) of LCR to classify adult DKA patients into mild group, severe group, and ICU admission were 0.679, 0.718, and 0.621, respectively, with cut-off value of 212.80, 96.16, and 63.35, sensitivity of 54.8%, 76.4%, and 78.9%, and specificity of 76.0%, 62.4%, and 46.3%. LCR upon admission provides great potential to predict disease progression and ICU admission in adult patients with DKA.

Effect of trace elements and nutrients on 21 autoimmune diseases: a Mendelian randomization study

Background

Numerous clinical studies have observed a close relationship between serum trace elements, nutrients, and autoimmune diseases. However, whether there is a genetic causal effect between serum trace elements, nutrients, and autoimmune diseases remains unclear.

Objective

This study aims to investigate the causal effects of serum trace elements and nutrients on 21 autoimmune diseases using Mendelian randomization (MR).

Methods

Single nucleotide polymorphisms for the exposure factors (serum trace elements and vitamins) were obtained from the published UK Biobank database and genome-wide association study (GWAS) public databases. Outcome GWAS data were derived from the FinnGen database. MR was employed to explore the causal relationships between 9 trace elements and 6 vitamins and autoimmune diseases. Causal inference was performed using inverse variance weighted methods, MR Egger, and weighted median methods. Subsequently, heterogeneity tests, horizontal pleiotropy tests, MR-PRESSO tests, and leave-one-out analyses were conducted for sensitivity analysis to evaluate the robustness of the study results. Finally, trace elements and vitamins that were statistically significant in the IVW method and had consistent effect sizes and odds ratios across five methods were selected as exposure factors with a causal relationship to diabetes and its complications. Additionally, multivariable Mendelian randomization was employed to assess the combined effects of multiple exposure factors on autoimmune diseases.

Results

MR analysis indicated that elevated levels of the trace element copper were associated with an increased risk of systemic lupus erythematosus (SLE) and a decreased risk of ulcerative colitis. Carotene was found to have a negative causal relationship with adult-onset Still's disease (AOSD). Elevated levels of copper and selenium were associated with an increased risk of autoimmune hyperthyroidism. Calcium levels showed a negative causal relationship with the risk of polyarteritis nodosa. MVMR results demonstrated that selenium could independently affect the risk of autoimmune hyperthyroidism, separate from copper.

Conclusion

The findings from both univariable and multivariable Mendelian randomization studies support a causal relationship between trace elements, nutrients, and autoimmune diseases. These results have significant clinical implications for developing targeted prevention and treatment strategies for autoimmune diseases.

Weight stigma in pediatric type 1 diabetes: An associated risk for disordered eating?

Adolescents with type 1 diabetes (T1D) have elevated eating disorder risk. No studies have examined weight stigma as a potential factor associated with disordered eating. This study investigated cross-sectional associations among weight-based victimization, weight bias internalization, and disordered eating in adolescents with T1D. Adolescents (12-17 years; N = 166) self-reported experiences of weight-based victimization from peers, family members, and healthcare professionals. The Weight Bias Internalization Scale (WBIS) and Diabetes Eating Problems Survey (DEPS-R) assessed internalized weight bias and disordered eating, respectively. In a series of multiple hierarchical linear regression analyses (controlling for zBMI, diabetes duration, HbA1c, sex), weight bias internalization, weight-based victimization, and frequency of weight-based victimization by peers, family, and healthcare professionals were all positively associated with disordered eating. Weight stigma is an understudied but potentially important factor to address in adolescents with T1D. Reducing weight stigma may be a promising, novel target for eating disorder prevention in this population.

Enhanced Electrochemiluminescence from Ruthenium-Tagged Immune Complex at Flexible Chains for Sensitive Analysis of Glutamate Decarboxylase Antibody

Herein, a sensitive electrochemiluminescence (ECL) immunosensor is designed by immobilizing ruthenium-tagged immune complexes at flexible poly-ethylene-glycol (PEG) chains on the electrode surface, which offers more freedom for the collision of the ruthenium complex at the electrode during the initial ECL reaction. The electrochemical characterizations confirm the loose structure of the assembled layer with the immune complex, providing an increase in the current and the resultant enhanced ECL emissions. Comparing the sensors with the rigid structure, a 34-fold increase in the maximal ECL emission is recorded when PEG3400 is used as a linker. Using the optimized protocol, the prepared immunosensor exhibits a wide-ranging linear response to the model antibody (glutamate decarboxylase antibody) ranging from 10 pg/mL to 10 ng/mL. The detection limit is almost two orders lower than the value using the classic enzyme-linked immunosorbent assay, which offers a new design to enhance ECL emissions and the resultant analytical performance.

The protective roles of eugenol on type 1 diabetes mellitus through NRF2-mediated oxidative stress pathway

Type 1 diabetes mellitus (T1DM), known as insulin-dependent diabetes mellitus, is characterized by persistent hyperglycemia resulting from damage to the pancreatic β cells and an absolute deficiency of insulin, leading to multi-organ involvement and a poor prognosis. The progression of T1DM is significantly influenced by oxidative stress and apoptosis. The natural compound eugenol (EUG) possesses anti-inflammatory, anti-oxidant, and anti-apoptotic properties. However, the potential effects of EUG on T1DM had not been investigated. In this study, we established the streptozotocin (STZ)-induced T1DM mouse model in vivo and STZ-induced pancreatic β cell MIN6 cell model in vitro to investigate the protective effects of EUG on T1DM, and tried to elucidate its potential mechanism. Our findings demonstrated that the intervention of EUG could effectively induce the activation of nuclear factor E2-related factor 2 (NRF2), leading to an up-regulation in the expressions of downstream proteins NQO1 and HMOX1, which are regulated by NRF2. Moreover, this intervention exhibited a significant amelioration in pancreatic β cell damage associated with T1DM, accompanied by an elevation in insulin secretion and a reduction in the expression levels of apoptosis and oxidative stress-related markers. Furthermore, ML385, an NRF2 inhibitor, reversed these effects of EUG. The present study suggested that EUG exerted protective effects on pancreatic β cells in T1DM by attenuating apoptosis and oxidative stress through the activation of the NRF2 signaling pathway. Consequently, EUG holds great promise as a potential therapeutic candidate for T1DM.

Oxidative stress in diabetes mellitus and its complications: From pathophysiology to therapeutic strategies

ABSTRACT

Oxidative stress due to aberrant metabolism is considered as a crucial contributor to diabetes and its complications. Hyperglycemia and hyperlipemia boost excessive reactive oxygen species generation by elevated mitochondrial respiration, increased nicotinamide adenine dinucleotide phosphate oxidase activity, and enhanced pro-oxidative processes, including protein kinase C pathways, hexosamine, polyol, and advanced glycation endproducts, which exacerbate oxidative stress. Oxidative stress plays a significant role in the onset of diabetes and its associated complications by impairing insulin production, increasing insulin resistance, maintaining hyperglycemic memory, and inducing systemic inflammation. A more profound comprehension of the molecular processes that link oxidative stress to diabetes is crucial to new preventive and therapeutic strategies. Therefore, this review discusses the mechanisms underlying how oxidative stress contributes to diabetes mellitus and its complications. We also summarize the current approaches for prevention and treatment by targeting the oxidative stress pathways in diabetes.

The relevance of the heme oxygenase system in alleviating diabetes-related hormonal and metabolic disorders

Heme oxygenase (HO) is an enzyme that catalyzes heme degradation. HO dysfunction is linked to various pathological conditions, including diabetes. Results of animal studies indicate that HO expression and activity are downregulated in experimentally induced diabetes. This is associated with severe hormonal and metabolic disturbances. However, these pathological changes have been shown to be reversed by therapy with HO activators. In animals with experimentally induced diabetes, HO was upregulated by genetic manipulation or by pharmacological activators such as hemin and cobalt protoporphyrin. Induction of HO alleviated elevated blood glucose levels and improved insulin action, among other effects. This effect resulted from beneficial changes in the main insulin-sensitive tissues, i.e., the skeletal muscle, the liver, and the adipose tissue. The action of HO activators was due to positive alterations in pivotal signaling molecules and regulatory enzymes. Furthermore, diabetes-related oxidative and inflammatory stress was reduced due to HO induction. HO upregulation was effective in various animal models of type 1 and type 2 diabetes. These data suggest the possibility of testing HO activators as a potential tool for alleviating hormonal and metabolic disorders in people with diabetes.

Harnessing cellular therapeutics for type 1 diabetes mellitus: progress, challenges, and the road ahead

Type 1 diabetes mellitus (T1DM) is a growing global health concern that affects approximately 8.5 million individuals worldwide. T1DM is characterized by an autoimmune destruction of pancreatic β cells, leading to a disruption in glucose homeostasis. Therapeutic intervention for T1DM requires a complex regimen of glycaemic monitoring and the administration of exogenous insulin to regulate blood glucose levels. Advances in continuous glucose monitoring and algorithm-driven insulin delivery devices have improved the quality of life of patients. Despite this, mimicking islet function and complex physiological feedback remains challenging. Pancreatic islet transplantation represents a potential functional cure for T1DM but is hindered by donor scarcity, variability in harvested cells, aggressive immunosuppressive regimens and suboptimal clinical outcomes. Current research is directed towards generating alternative cell sources, improving transplantation methods, and enhancing cell survival without chronic immunosuppression. This Review maps the progress in cell replacement therapies for T1DM and outlines the remaining challenges and future directions. We explore the state-of-the-art strategies for generating replenishable β cells, cell delivery technologies and local targeted immune modulation. Finally, we highlight relevant animal models and the regulatory aspects for advancing these technologies towards clinical deployment.

3D evaluation of the extracellular matrix of hypoxic pancreatic islets using light sheet fluorescence microscopy

Pancreatic islet transplantation is a promising treatment for type 1 diabetes, but the survival and function of transplanted islets are hindered by the loss of extracellular matrix (ECM) during islet isolation and by low oxygenation upon implantation. This study aimed to evaluate the impact of hypoxia on ECM using a cutting-edge imaging approach based on tissue clearing and 3D microscopy. Human and rat islets were cultured under normoxic (O2 21%) or hypoxic (O2 1%) conditions. Immunofluorescence staining targeting insulin, glucagon, CA9 (a hypoxia marker), ECM proteins (collagen 4, fibronectin, laminin), and E-cadherin (intercellular adhesion protein) was performed on fixed whole islets. The cleared islets were imaged using Light Sheet Fluorescence Microscopy (LSFM) and digitally analyzed. The volumetric analysis of target proteins did not show significant differences in abundance between the experimental groups. However, 3D projections revealed distinct morphological features that differentiated normoxic and hypoxic islets. Under normoxic conditions, ECM could be found throughout the islets. Hypoxic islets exhibited areas of scattered nuclei and central clusters of ECM proteins, indicating central necrosis. E-cadherin was absent in these areas. Our results, demonstrating a diminution of islets' functional mass in hypoxia, align with the functional decline observed in transplanted islets experiencing low oxygenation after grafting. This study provides a methodology combining tissue clearing, multiplex immunofluorescence, Light Sheet Fluorescence Microscopy, and digital image analysis to investigate pancreatic islet morphology. This 3D approach allowed us to highlight ECM organizational changes during hypoxia from a morphological perspective.

[Gly14]-Humanin ameliorates high glucose-induced endothelial senescence via SIRT6

High glucose (HG) induced endothelial senescence is related to endothelial dysfunction and cardiovascular complications in diabetic patients. Humanin, a member of mitochondrial derived peptides (MDPs), is thought to contribute to aging-related cardiovascular protection. The goal of the study is to explore the pathogenesis of HG-induced endothelial senescence and potential anti-senescent effects of Humanin. Human umbilical vein endothelial cells (HUVECs) were exposed to glucose to induce senescence, determined by β-galactosidase staining and the expressions of p21, p53, and p16. A clinically relevant dose of HG (15 mM, HG) induced endothelial senescence after 72 h incubation without elevated apoptosis. HG-induced senescence was attributed to the induction of reactive oxygen species (ROS) caused by SIRT6 downregulation, as ROS inhibitor N-acetyl cysteine blocked HG-induced senescence, while inactivation of SIRT6 increased ROS levels and promoted senescence. Strikingly. pretreatment with [Gly14]-Humanin (HNG) antagonized the downregulation of SIRT6 in response to HG and alleviated ROS production and cell senescence. HG-induced reduction of SIRT6 results in ROS overproduction and endothelial senescence. Humanin protects against HG-induced endothelial senescence via SIRT6. This study provides new directions for biological products related to Humanin to be a potential candidate for the prevention of vascular aging in diabetes.

TRPV1: A novel target for the therapy of diabetes and diabetic complications

BACKGROUND

Diabetes mellitus is a chronic metabolic disease characterized by abnormally elevated blood glucose levels. Type II diabetes accounts for approximately 90% of all cases. Several drugs are available for hyperglycemia treatment. However, the current therapies for managing high blood glucose do not prevent or reverse the disease progression, which may result in complications and adverse effects, including diabetic neuropathy, retinopathy, and nephropathy. Hence, developing safer and more effective methods for lowering blood glucose levels is imperative. Transient receptor potential vanilloid-1 (TRPV1) is a significant member of the transient receptor potential family. It is present in numerous body tissues and organs and performs vital physiological functions.

PURPOSE

This review aimed to develop new targeted TRPV1 hypoglycemic drugs by systematically summarizing the mechanism of action of the TRPV1-based signaling pathway in preventing and treating diabetes and its complications.

METHODS

Literature searches were performed in the PubMed, Web of Science, Google Scholar, Medline, and Scopus databases for 10 years from 2013 to 2023. The search terms included "diabetes," "TRPV1," "diabetic complications," and "capsaicin."

RESULTS

TRPV1 is an essential potential target for treating diabetes mellitus and its complications. It reduces hepatic glucose production and food intake and promotes thermogenesis, metabolism, and insulin secretion. Activation of TRPV1 ameliorates diabetic nephropathy, retinopathy, myocardial infarction, vascular endothelial dysfunction, gastroparesis, and bladder dysfunction. Suppression of TRPV1 improves diabetes-related osteoporosis. However, the therapeutic effects of activating or suppressing TRPV1 may vary when treating diabetic neuropathy and periodontitis.

CONCLUSION

This review demonstrates that TRPV1 is a potential therapeutic target for diabetes and its complications. Additionally, it provides a theoretical basis for developing new hypoglycemic drugs that target TRPV1.

Antioxidant effects of a novel pioglitazone analogue (PA9) in a rat model of diabetes: Modulation of redox homeostasis and preservation of tissue architecture

Oxygen-free radicals have been implicated in the initiation of diabetic complications. Thiazolidinediones (TZDs), known for their antidiabetic properties, also demonstrate notable antioxidant and anti-inflammatory effects. Although a recently developed imidazolyl analogue of pioglitazone (PA9) has exhibited superior glucose-lowering efficacy compared to pioglitazone, its antioxidant effects remain unexplored. Thus, the objective of this study is to evaluate the antioxidant properties of PA9 in animal models with diabetes. Rats were randomly separated into the following four groups: control, diabetic, and two groups treated orally with pioglitazone as a standard drug and PA9 for ten days. Upon completion of the experiment, tissues from the liver, heart, brain, pancreas, spleen, and kidneys were collected to assess oxidant/antioxidant markers and histological alterations. The administration of PA9 resulted in a noteworthy reduction in malondialdehyde (MDA) levels compared to the diabetic group (p < 0.05). The group receiving PA9 displayed elevated levels of three antioxidant markers, catalase (CAT), superoxide dismutase (SOD), and total thiol, in pancreatic tissue compared to diabetic rats (p < 0.05). Furthermore, increased content of CAT was evident in the heart (p < 0.05), spleen (p < 0.001), brain, and kidney tissues in the PA9-treated group, along with augmented thiol content in the spleen compared to the diabetic group. Remarkably, no significant histological changes were observed in the liver, pancreas, heart, brain, spleen, and kidneys of the PA9-treated groups relative to diabetic rats. PA9 effectively mitigates oxidative stress, modulates redox homeostasis, and shows promise in preventing diabetic complications. The proven safety profile of this analogue underscores its potential, warranting comprehensive clinical evaluation to thoroughly understand its therapeutic scope and efficacy in the management of diabetes.

An Evidence-Based Measure to Assess Self-Efficacy Among Adolescents With Type 1 Diabetes Mellitus in Jordan

PURPOSE

The purpose of the study was to assess self-efficacy among adolescents with type 1 diabetes mellitus and to identify its contributing factors using a new measure based on the International Society for Pediatric and Adolescent Diabetes Guidelines: the Type 1 Diabetes Mellitus Self-Efficacy Scale (T1DM-SES).

METHOD

A descriptive, cross-sectional design was used to collect data from 161 adolescents ages between 12 and 18 via an online questionnaire survey, including demographic and management-related variables and the 21 items of T1DM-SES.

RESULTS

Results demonstrated that adolescents had high self-efficacy levels regarding the basic needs to manage their diabetes and relatively moderate and low levels regarding more sophisticated needs, such as adjusting insulin dose to correct fluctuated glucose levels, covering carbohydrates, and managing ketoacidosis at home. Adolescent females and adolescents who have working mothers or caregivers demonstrated higher levels of self-efficacy, whereas adolescents who have another family member with T1DM reported lower levels.

CONCLUSION

Assessing adolescents' self-efficacy using evidence-based measures is crucial for informing health education plans. There should be a greater focus on acquiring the advanced knowledge and skills necessary for adolescents to manage the constantly evolving challenges of diabetes management. Access to health care and sufficient health insurance coverage that encompasses modern technology are fundamental for the effective management of T1DM.

Adolescents' Diabetes Self-Management Regimens and Outcomes During the COVID-19 Pandemic: A Scoping Review

Adolescents with diabetes mellitus (DM) experience poorer glycemic outcomes and lower adherence to self-management regimens compared to other age groups. The coronavirus 2019 (COVID-19) pandemic posed new barriers to DM self-management, including social distancing measures and additional stressors. We conducted a scoping review of peer-reviewed literature to examine self-management regimens and outcomes among adolescents aged 10-17 years with type 1 and type 2 DM during the pandemic. Our scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched three online databases, screened articles through a rigorous process, and assessed bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. The findings from the included articles were categorized into six thematic areas: glycemic control/monitoring, insulin administration/regimens, weight/lifestyle behaviors, inpatient care/acute complications, outpatient care/telemedicine utilization, and psychosocial well-being. The findings from the included articles (n = 32) varied. Adolescents who used continuous glucose monitoring (CGM), regularly adjusted insulin doses, and utilized telemedicine generally maintained or improved glycemic control during the pandemic. However, many adolescents gained weight, reduced their physical activities, worsened their diet and sleep habits, and experienced increased stress, all of which negatively impacted glycemic control. Rates of acute complications and hospitalizations varied among adolescents. Telemedicine was widely used and viewed positively by adolescents with DM. Adolescents with DM faced various physical, behavioral, and psychosocial challenges during the COVID-19 pandemic. Further research is needed to assess the long-term impacts of the pandemic on this population. Multilevel interventions and preparedness efforts are required to improve and sustain adolescents' DM self-management outcomes during public health emergencies, particularly focused on promoting CGM use, increasing physical activity levels, improving dietary habits, and reducing stress.

Single-Cell RNA Sequencing Uncovers Pathological Processes and Crucial Targets for Vascular Endothelial Injury in Diabetic Hearts

Cardiovascular disease remains the leading cause of high mortality in individuals with diabetes mellitus. Endothelial injury is a major contributing factor for vascular dysfunction in diabetes. However, the precise mechanisms underlying endothelial cell injury and their heterogeneity in diabetes remains elusive. In this study, single-cell sequencing is performed in heart tissues from leptin receptor knock-out (db/db) diabetic mice at various pathological stages. Through cell cluster identification, differential gene analysis, intercellular communication analysis, pseudo time analysis, and transcription factor analysis, a novel mechanism of cardiac vascular endothelial damage in diabetes is identified. Specifically, a single-cell transcription map of cardiac vascular endothelial cells is presented in db/db mice. Diverse cellular clusters are found to play vital roles under diabetes-induced damage, highlighting crucial transcription factors involved in their regulation. In addition, the essential transcription factor Ets1 is found to protect against vascular endothelial injury in db/db mice. In summary, the work provides a comprehensive understanding of the development of diabetic cardiac vascular endothelial damage and the heterogeneity of the cells involved. These findings offer valuable insights into potential treatments and assessments of diabetic cardiovascular endothelial damage.

Mendelian randomization study of inflammatory bowel disease and type 1 diabetes

PURPOSE

Our purpose was to investigate and test the causal relationship between type 1 diabetes (T1D) and inflammatory bowel disease (IBD) and its major phenotypes, including ulcerative colitis (UC) and Crohn's disease (CD), in two large datasets.

METHODS

We obtained IBD samples from the largest publicly available genome-wide association study (GWAS), as well as the FinnGen database and the publicly accessible IEU GWAS database of T1D. We employed a two-sample Mendelian randomization approach to assess bidirectional causality using the inverse variance weighting (IVW) method as the primary outcome.

RESULTS

Genetic predisposition to T1D was associated with reduced risk of IBD (IVW: odds ratio (OR), 0.867; 95% confidence interval (CI), [0.852, 0.883]; P < 0.001), UC (OR = 0.879 [0.823, 0.939], P < 0.001), and CD (OR = 0.925 [0.872, 0.981], P = 0.009). The republication results found IBD genetically possessed negative association with T1D (OR = 0.781 [0.684, 0.891], P < 0.001). Additionally, a meta-analysis of results was conducted to prove the strong evidence between T1D and CD (OR = 0.95 [0.91, 0.98]; p = 0.01).

CONCLUSIONS

This study first demonstrated a causal effect of TID on the reduced risk of CD in the mendelian randomization study.

Decoding the Significance of Alpha Cell Function in the Pathophysiology of Type 1 Diabetes

Alpha cells in the pancreas, traditionally known for their role in secreting glucagon to regulate blood glucose levels, are gaining recognition for their involvement in the pathophysiology of type 1 diabetes (T1D). In T1D, autoimmune destruction of beta cells results in insulin deficiency, which in turn may dysregulate alpha cell function, leading to elevated glucagon levels and impaired glucose homeostasis. This dysfunction is characterized by inappropriate glucagon secretion, augmenting the risk of life-threatening hypoglycemia. Moreover, insulin deficiency and autoimmunity alter alpha cell physiological responses, further exacerbating T1D pathophysiology. Recent studies suggest that alpha cells undergo transdifferentiation and interact with beta cells through mechanisms involving gamma-aminobutyric acid (GABA) signaling. Despite these advances, the exact pathways and interactions remain poorly understood and are often debated. Understanding the precise role of alpha cells in T1D is crucial, as it opens up avenues for developing new therapeutic strategies for T1D. Potential strategies include targeting alpha cells to normalize glucagon secretion, utilizing glucagon receptor antagonists, enhancing GABA signaling, and employing glucagon-like peptide-1 (GLP-1) receptor agonists. These approaches aim to improve glycemic control and reduce the risk of hypoglycemic events in individuals with T1D. This review provides an overview of alpha cell function in T1D, highlighting the emerging focus on alpha cell dysfunction in the context of historically well-developed beta cell research.

IL-22, a vital cytokine in autoimmune diseases

Interleukin-22 (IL-22) is a vital cytokine that is dysregulated in various autoimmune conditions including rheumatoid arthritis (RA), multiple sclerosis (MS), and Alzheimer's disease (AD). As the starting point for the activation of numerous signaling pathways, IL-22 plays an important role in the initiation and development of autoimmune diseases. Specifically, imbalances in IL-22 signaling can interfere with other signaling pathways, causing cross-regulation of target genes which ultimately leads to the development of immune disorders. This review delineates the various connections between the IL-22 signaling pathway and autoimmune disease, focusing on the latest understanding of the cellular sources of IL-22 and its effects on various cell types. We further explore progress with pharmacological interventions related to targeting IL-22, describing how such therapeutic strategies promise to usher in a new era in the treatment of autoimmune disease.

Association between diabetes mellitus and miscarriage, recurrent miscarriage: A meta-study

BACKGROUND

Previous studies provided inconsistent associations between diabetes mellitus (DM) and miscarriage, recurrent miscarriage (RM). Therefore, this study aims to evaluate the association between DM and miscarriage, specifically RM, through a meta-analysis approach.

METHODS

We searched for articles published before July 2023 in PubMed and Web of Science databases. STATA 12.0 software was used to compute all the results collected from included studies.

RESULTS

DM was associated with a higher risk of miscarriage, RM (miscarriage: odds ratio [OR]/relative risk [RR] = 1.23, 95% confidence interval [CI] 1.13 to 1.34; RM: OR/RR = 1.73, 95% CI 1.55 to 1.94). T1DM was associated with a higher risk of miscarriage (OR/RR = 1.16, 95% CI 1.07 to 1.26). Similarly, T2DM showed a higher risk of miscarriage (OR/RR = 1.44, 95% CI 1.23 to 1.68). Miscarriage, RM were associated with a higher risk of DM (miscarriage: OR/RR = 1.14, 95% CI 1.08 to 1.19; RM: OR/RR = 1.14, 95% CI 1.08 to 1.20). Furthermore, miscarriage was found to be associated with a higher risk of T2DM (OR/RR = 1.08, 95% CI 1.05 to 1.11).

CONCLUSION

In conclusion, our meta-analysis findings indicate a significant association between DM and miscarriages as well as RM. As a result, women with a history of miscarriage should consider regular monitoring of their metabolic health as a potential benefit. Nevertheless, it is important to note that further research is needed to validate the results of our study and shed light on the biological mechanisms underlying these associations.

The relationship of short-term exposure to meteorological factors on diabetes mellitus mortality risk in Hefei, China: a time series analysis

OBJECTIVES

The study aims to explore whether short-term exposure to meteorological factors has a potential association with the risk of diabetes mellitus (DM) mortality.

METHODS

During the period 2015-2018, we collected daily data on meteorological factors and deaths of diabetic patients in Hefei. A total of 1101 diabetic deaths were recorded. We used structural equation modeling to initially explore the relationships among air pollutants, meteorological variables, and mortality, and generalized additive modeling (GAM) and distributional lag nonlinear modeling (DLNM) to explore the relationship between meteorological factors and the mortality risk of DM patients. We also stratified by age and gender. The mortality risk in diabetic patients was expressed by relative risks (RR) and 95% confidence intervals (CI) for both single and cumulative days.

RESULTS

Single-day lagged results showed a high relative humidity (RH) (75th percentile, 83.71%), a fairly high average temperature (T mean) (95th percentile, 30.32 °C), and an extremely low diurnal temperature range (DTR) (5th percentile, 3.13 °C) were positively related to the mortality risk of DM. Stratified results showed that high and very high levels of T mean were significantly positively linked to the mortality risk of DM among females and the elderly, while very high levels of DTR were linked to the mortality risk in men and younger populations.

CONCLUSION

In conclusion, this study found that short-duration exposure to quite high T mean, high RH, and very low DTR were significantly positively related to the mortality risk of DM patients. For women and older individuals, exposure to high and very high T mean environments should be minimized. Men and young adults should be aware of daily temperature changes.

Screening of Diabetes-Associated Autoantigens and Serum Antibody Profiles Using a Phage Display System

Aims/Introduction: Phage display method is a crucial tool to find novel clinically valuable diabetes-associated autoantigens and identify known autoantigen epitopes that are associated with diabetes and could provide scientific support and guidance for the artificial construction and synthesis of Type I diabetes mellitus (T1DM) novel biomarkers. Materials and Methods: The phage display system was used for the "biopanning" of T1DM serum. Following the sequencing of the phage DNAs, the homologous sequences of the above fusion heptapeptide were further investigated by BLAST to track the origin of the polypeptide sequences. The antibody spectrum revealed new T1DM-associated epitopes and antibodies. Results: A total of 1200 phage DNA were sequenced and 9 conserved polypeptide sequences were collected. It was confirmed that the zinc transporter and islet amyloid protease were among them. The conserved polypeptide sequence 8 and another three distinctive polypeptide sequences derived from Proteus were discovered. Furthermore, we expressed recombinant proteins with homologous polypeptide sequences for the human islet amyloid polypeptide (IAPP) and polypeptide precursor human zinc transporter 8 (ZNT8). Through clinical sample detection for the serum from T1DM (n = 100) and T2DM (n = 200) patients, results demonstrate the importance and relevance of these polypeptides in the recognition and classification of various forms of diabetes. Conclusion: Human pancreatic and concurrent bacterial-derived protein antigens and their epitopes were identified in this research by the phage display system, which is crucial for distinguishing different types of diabetes.

Management of a Patient with Cardiovascular Disease Should Include Assessment of Primary and Secondary Immunodeficiencies: Part 2-Secondary Immunodeficiencies

BACKGROUND

Cardiovascular diseases are among the most common chronic diseases, generating high social and economic costs. Secondary immunodeficiencies occur more often than primary ones and may result from the co-occurrence of specific diseases, treatment, nutrient deficiencies and non-nutritive bio-active compounds that result from the industrial nutrient practices.

OBJECTIVES

The aim of this article is to present selected secondary immunodeficiencies and their impact on the cardiovascular system.

RESULTS

The treatment of a patient with cardiovascular disease should include an assess-ment for immunodeficiencies, because the immune and cardiovascular systems are closely linked.

CONCLUSIONS

Immune system dysfunctions can significantly affect the course of cardiovascular diseases and their treatment. For this reason, comprehensive care for a patient with cardiovascular disease requires taking into account potential immunodeficiencies, which can have a significant impact on the patient's health.

Protective effects of puerarin on metabolic diseases: Emphasis on the therapeutical effects and the underlying molecular mechanisms

Metabolic diseases (MetD) such as diabetes mellitus, obesity, and hyperlipidemia have become global health challenges. As a naturally occurring plant component, puerarin has been verified to possess a wide range of pharmacological effects including lowering blood glucose, improving insulin resistance, and regulating lipid metabolism, which has attracted extensive attention in recent years, and its potential in the treatment of MetD has been highly acclaimed. In addition, puerarin has exhibited antioxidant, anti-inflammatory, and cardiovascular protective effects, which are of great significance in the prevention and treatment of MetD. This article comprehensively summarizes the research progress of puerarin in the treatment of MetD and explores its pharmacological mechanisms, clinical applications, and future perspectives. More importantly, this review provided a list of the involved molecular mechanims in treating MetD of puerarin. Taking into account these conclusions, it may provide a strong foundation for the optimized use of puerarin in the treatment of patients suffering from MetD.

N-acetylcysteine combined with insulin therapy can reduce myocardial injury induced by type 1 diabetes through the endoplasmic reticulum pathway

With the development of Type 1 diabetes mellitus (T1DM), various complications can be caused. Hyperglycemia affects the microenvironment of cardiomyocytes, changes endoplasmic reticulum homeostasis, triggers unfolding protein response and eventually promotes myocardial apoptosis. However, insulin therapy alone cannot effectively combat the complications caused by T1DM. Forty adult beagles were randomly divided into five groups: control group, diabetes mellitus group, insulin group, insulin combined with NAC group, and NAC group. 24-hour blood glucose, 120-day blood glucose, 120-day body weight, and serum FMN content were observed, furthermore, hematoxylin-eosin staining, Periodic acid Schiff reagent staining, and Sirius red staining of the myocardium were evaluated. The protein expressions of GRP78, ATF6, IRE1, PERK, JNK, CHOP, caspase 3, Bcl2, and Bax were detected. Results of the pathological section of myocardial tissue indicated that insulin combined with NAC therapy could improve myocardial pathological injury and glycogen deposition. Additionally, insulin combined with NAC therapy down-regulates the expression of GRP78, ATF6, IRE1, PERK, JNK, CHOP, caspase3, and Bax. These findings suggest that NAC has a phylactic effect on myocardial injury in beagles with T1DM, and the mechanism may be related to the improvement of endoplasmic reticulum stress-induced apoptosis.

Unveiling the influence of circulating immune cells count on type 1 diabetes: Insight from bidirectional Mendelian randomization

Observational studies have demonstrated an association between circulating immune cell and type 1 diabetes (T1D) risk. However, it is unknown whether this relationship is causal. Herein, we adopted a 2-sample bidirectional Mendelian randomization study to figure out whether circulating immune cell profiles causally impact T1D liability. Summary statistical data were obtained from genome-wide association study (GWAS) to investigate the causal relationship between white cell (WBC) count, 5 specific WBC count, and lymphocyte subtypes cell count and T1D risk. After false discovery rate (FDR) correction, the results indicated that lower lymphocyte cell count (odds ratio [OR] per 1 standard deviation [SD] decrease = 0.746, 95% confidence interval (CI): 0.673-0.828, PFDR = 0.036), and basophil cell count (OR per 1 SD decrease = 0.808, 95% CI: 0.700-0.932, PFDR = 0.010) were causally associated with T1D susceptibility. However, the absolute count of WBC, monocyte, neutrophil, eosinophil, and lymphocyte subtypes cell had no statistically significant effect on T1D risk. Taken together, this study indicates suggestive association between circulating immune cell count and T1D. Moreover, lower numbers of circulating lymphocyte and basophil cell were associated with the increased risk of T1D, which confirmed the immunity predisposition for T1D.

Evaluation of the relationship between self-care agency and quality of life in adolescents with type 1 diabetes mellitus during COVID-19 pandemic

PURPOSE

This study aims to explore the relationship between self-care agency and quality of life among adolescents with Type 1 Diabetes Mellitus (T1DM) during the pandemic.

DESIGN AND METHODS

The study was conducted with 186 adolescents aged 13-16 who have T1DM and attended a pediatric endocrinology clinic at a Training and Research Hospital in the capital city of Turkey between January 1, 2022, and December 31, 2022. Data from 118 adolescents who met the inclusion criteria and fully completed the survey were used in the analysis. Data were collected using the 'Participant Information Form', 'Self-Care Agency Scale', and 'Kiddo-KINDL Quality of Life Scale'.

RESULTS

The study found that adolescents with higher self-care agency reported significantly better quality of life. Additionally, significant correlations were observed between self-care agency and adherence to pandemic measures, dietary adjustments, hygiene practices, diabetes management challenges, family communication, sleep duration, dietary patterns, and exercise difficulties (p < 0.05).

CONCLUSION

During the COVID-19 pandemic, it was evident that the self-care agency and quality of life of adolescents with T1DM were impacted, with those possessing higher self-care agency experiencing better and more meaningful quality of life.

APPLICATION TO PRACTICE

T1DM affects all aspects of life, and quality of life is considered a critical outcome of diabetes care. It is essential for adolescents to adhere to practices such as regular nutrition, physical activity, blood sugar monitoring, and appropriate insulin intake to achieve optimal glycemic levels and the best possible quality of life. Adolescents should be trained on these issues by pediatric nurses.

The Predictive Potential of C-Peptide in Differentiating Type 1 Diabetes From Type 2 Diabetes in an Outpatient Population in Abu Dhabi

PURPOSE

We aimed to investigate the predictive potential of plasma connecting peptide (C-peptide) in differentiating type 1 diabetes (T1D) from type 2 diabetes (T2D) and to inform evidence-based diabetes classification criteria.

METHODS

A retrospective review was performed of all the patients with diabetes visiting an outpatient diabetology, endocrinology, general practice and family medicine tertiary health care center between January 2016 and December 2021.

FINDINGS

Two hundred twelve individuals with diabetes were included, 85 (44.8%) with T1D and 127 (55.2%) with T2D. Mean (SD) age at diagnosis was 35.9 (15.1) years, and 112 (52.8%) men. Median (interquartile range [IQR]) duration of diabetes was 3.8 (3.0-4.5) years (T1D, 3.9 [3.5-4.6]; T2D, 3.4 [2.4-4.4]; P = 0.001). Body mass index was <18.5 kg/m2 in 5 (2.5%) individuals (T1D, 5; T2D, none), 18.5 to <25 kg/m2 in 57 (28.5%) (T1D, 32; T2D, 25), 25 to <30 kg/m2 in 58 (29%) (T1D, 28; T2D, 30), and >30 kg/m2 in 80 (40.0%) (T1D, 20; T2D, 60). Median (IQR) glycosylated hemoglobin was 7.4% (6.7%-8.5%) (T1D, 8.3% [7.2%-9.9%]; T2D, 7% [6.3%-7.6%]; P = 0.0001). Median (IQR) C-peptide concentration was 0.59 nmol/L (0.01-1.14 nmol/L) (T1D, 0.01 nmol/L [0.003-0.05 nmol/L]; T2D, 1.03 nmol/L [0.70-1.44 nmol/L]; P = 0.0001). C-peptide concentration of ≤0.16 nmol/L showed 92.9% sensitivity, 1-specificity of 2.4%, and AUC of 97.2% (CI, 94.7%-99.6%; P = 0.0001) in differentiating T1D from T2D.

IMPLICATIONS

To our knowledge, this is the first study in the Middle East and North Africa region highlighting the role of C-peptide in diabetes classification. The estimated cutoff point for C-peptide concentration (≤0.16 nmol/L) will certainly help in accurately classifying the T1D and will rule out the routine clinical judgmental approaches in the region, especially in those scenarios and periods where it is always difficult to diagnose the diabetes type. Quantifying the cutoff for C-peptide is among the vital strengths of this study that will provide a better treatment plan in diabetes care management. Also, we evaluated concomitant glucose levels to rule out the phenomenon of falsely low C-peptide values in the setting of hypoglycemia or severe glucose toxicity. Based on our findings, C-peptide testing could be included in postulating an evidence-based guideline that differentiates T1D from T2D. Despite this, our study has some limitations, including the selection bias due to the retrospective design and low C-peptide levels could be indicative of low pancreatic reserves due to other causes or long-standing T2D, and quantifying these reasons requires additional resources and time.

Tailoring of apoptotic bodies for diagnostic and therapeutic applications:advances, challenges, and prospects

Apoptotic bodies (ABs) are extracellular vesicles released during apoptosis and possess diverse biological activities. Initially, ABs were regarded as garbage bags with the main function of apoptotic cell clearance. Recent research has found that ABs carry and deliver various biological agents and are taken by surrounding and distant cells, affecting cell functions and behavior. ABs-mediated intercellular communications are involved in various physiological processes including anti-inflammation and tissue regeneration as well as the pathogenesis of a variety of diseases including cancer, cardiovascular diseases, neurodegeneration, and inflammatory diseases. ABs in biological fluids can be used as a window of altered cellular and tissue states which can be applied in the diagnosis and prognosis of various diseases. The structural and constituent versatility of ABs provides flexibility for tailoring ABs according to disease diagnostic and therapeutic needs. An in-depth understanding of ABs' constituents and biological functions is mandatory for the effective tailoring of ABs including modification of bio membrane and cargo constituents. ABs' tailoring approaches including physical, chemical, biological, and genetic have been proposed for bench-to-bed translation in disease diagnosis, prognosis, and therapy. This review summarizes the updates on ABs tailoring approaches, discusses the existing challenges, and speculates the prospects for effective diagnostic and therapeutic applications.

Auto-immuno-deficiency syndromes

Autoimmune diseases constitute a broad, heterogenous group with many diverse and often overlapping symptoms. Even so, they are traditionally classified as either systemic, rheumatic diseases or organ-directed diseases. Several theories exist about autoimmune diseases, including defective self-recognition, altered self, molecular mimicry, bystander activation and epitope spreading. While there is no consensus about these theories, it is generally accepted that genetic, pre-disposing factors in combination with environmental factors can result in autoimmune disease. The relative contribution of genetic and environmental factors varies between diseases, as does the significance of individual contributing factors within related diseases. Among the genetic factors, molecules involved in antigen (Ag) recognition, processing, and presentation stand out (e.g., MHC I and II) together with molecules involved in immune signaling and regulation of cellular interactions (i.e., immuno-phenotypes). Also, various immuno-deficiencies have been linked to development of autoimmune diseases. Among the environmental factors, infections (e.g., viruses) have attracted most attention, but factors modulating the immune system have also been the subject of much research (e.g., sunlight and vitamin D). Multiple sclerosis currently stands out due to a very strong and proven association with Epstein-Barr virus infection, notably in cases of late infection and in cases of EBV-associated mononucleosis. Thus, a common picture is emerging that both systemic and organ-directed autoimmune diseases may appropriately be described as auto-immuno-deficiency syndromes (AIdeSs), a concept that emphasizes and integrates existing knowledge on the role of immuno-deficiencies and chronic infections with development of overlapping disease syndromes with variable frequencies of autoantibodies and/or autoreactive T cells. This review integrates and exemplifies current knowledge on the interplay of genetically determined immuno-phenotypes and chronic infections in the development of AIdeSs.

A temperature-responsive dual-hormone foam nanoengine improves rectal absorptivity of insulin-pramlintide for diabetes treatment

Despite the therapeutic benefits of insulin-pramlintide dual-hormone therapy in diabetes, its application potential has been limited due to a lack of efficient delivery routes. Here, we developed a temperature-responsive dual-hormone foam nanoengine (HormFoam) and combined it with a customized spraying device to further construct an in situ foam-generating system for improving the rectal bioavailability of dual-hormone therapy. To support rapid clinical translation, a continuous microfluidic preparation for HormFoam was proposed, including the power unit of perfluorocarbon nanodroplets and the pharmaceutical components Pluronic F127-functionalized liposomal insulin and pramlintide. We found that HormFoam could consistently generate foams to drive drugs forward after rectal administration, which enhanced intestinal distribution and mucosa absorption, leading to systemic codelivery of insulin-pramlintide. HormFoam reproduced the physiology of endocrine pancreas for glycemic control and induced body weight loss while reversing metabolic disorders in diabetic mice with good biosafety. Therefore, HormFoam represents a state-of-the-art dual-hormone regimen with the potential to address unmet needs in diabetes management.

Unveiling therapeutic potential: Adipose tissue-derived mesenchymal stem cells and their exosomes in the management of diabetes mellitus, wound healing, and chronic ulcers

Diabetes mellitus (DM) is a pervasive global health issue with substantial morbidity and mortality, often resulting in secondary complications, including diabetic wounds (DWs). These wounds, arising from hyperglycemia, diabetic neuropathy, anemia, and ischemia, afflict approximately 15% of diabetic patients, with a considerable 25% at risk of lower limb amputations. The conventional approaches for chronic and diabetic wounds management involves utilizing various therapeutic substances and techniques, encompassing growth factors, skin substitutes and wound dressings. In parallel, emerging cell therapy approaches, notably involving adipose tissue-derived mesenchymal stem cells (ADMSCs), have demonstrated significant promise in addressing diabetes mellitus and its complications. ADMSCs play a pivotal role in wound repair, and their derived exosomes have garnered attention for their therapeutic potential. This review aimed to unravel the potential mechanisms and provide an updated overview of the role of ADMSCs and their exosomes in diabetes mellitus and its associated complications, with a specific focus on wound healing.

The cellular and molecular targets of natural products against metabolic disorders: a translational approach to reach the bedside

Metabolic disorders, including obesity, dyslipidemia, diabetes, nonalcoholic fatty liver disease, and metabolic syndrome, are characterized by insulin resistance, abnormalities in circulating cholesterol and lipid profiles, and hypertension. The most common pathophysiologies of metabolic disorders are glucose/lipid metabolism dysregulation, insulin resistance, inflammatory response, and oxidative stress. Although several agents have been approved for the treatment of metabolic disorders, there is still a strong demand for more efficacious drugs with less side effects. Natural products have been critical sources of drug research and discovery for decades. However, the usefulness of bioactive natural products is often limited by incomplete understanding of their direct cellular targets. In this review, we highlight the current understanding of the established and emerging molecular mechanisms of metabolic disorders. We further summarize the therapeutic effects and underlying mechanisms of natural products on metabolic disorders, with highlights on their direct cellular targets, which are mainly implicated in the regulation of glucose/lipid metabolism, insulin resistance, metabolic inflammation, and oxidative stress. Finally, this review also covers the clinical studies of natural products in metabolic disorders. These progresses are expected to facilitate the application of these natural products and their derivatives in the development of novel drugs against metabolic disorders.

Increase in the Expression of Glucose Transporter 2 (GLUT2) on the Peripheral Blood Insulin-Producing Cells (PB-IPC) in Type 1 Diabetic Patients after Receiving Stem Cell Educator Therapy

Multicenter international clinical trials demonstrated the clinical safety and efficacy by using stem cell educator therapy to treat type 1 diabetes (T1D) and other autoimmune diseases. Previous studies characterized the peripheral blood insulin-producing cells (PB-IPC) from healthy donors with high potential to give rise to insulin-producing cells. PB-IPC displayed the molecular marker glucose transporter 2 (GLUT2), contributing to the glucose transport and sensing. To improve the clinical efficacy of stem cell educator therapy in the restoration of islet β-cell function, we explored the GLUT2 expression on PB-IPC in recent onset and longstanding T1D patients. In the Food and Drug Administration (FDA)-approved phase 2 clinical studies, patients received one treatment with the stem cell educator therapy. Peripheral blood mononuclear cells (PBMC) were isolated for flow cytometry analysis of PB-IPC and other immune markers before and after the treatment with stem cell educator therapy. Flow cytometry revealed that both recent onset and longstanding T1D patients displayed very low levels of GLUT2 on PB-IPC. After the treatment with stem cell educator therapy, the percentages of GLUT2+CD45RO+ PB-IPC were markedly increased in these T1D subjects. Notably, we found that T1D patients shared common clinical features with patients with other autoimmune and inflammation-associated diseases, such as displaying low or no expression of GLUT2 on PB-IPC at baseline and exhibiting a high profile of the inflammatory cytokine interleukin (IL)-1β. Flow cytometry demonstrated that their GLUT2 expressions on PB-IPC were also markedly upregulated, and the levels of IL-1β-positive cells were significantly downregulated after the treatment with stem cell educator therapy. Stem cell educator therapy could upregulate the GLUT2 expression on PB-IPC and restore their function in T1D patients, leading to the improvement of clinical outcomes. The clinical data advances current understanding about the molecular mechanisms underlying the stem cell educator therapy, which can be expanded to treat patients with other autoimmune and inflammation-associated diseases.