[Type 2 Diabetes and Vascular Endothelial Dysfunction]

Risk Factors of Catheter-Related Thrombosis in Elderly Patients with Lung Cancer Based on Thromboelastography: A Retrospective, Case-Control Study

Catheter-related thrombosis (CRT) poses serious risks for cancer patients. Identifying risk factors and implementing targeted interventions can prevent CRT. To explore thromboelastogram parameters and clinical risk factors for CRT in elderly lung cancer patients. A total of 663 elderly lung cancer patients were selected from three hospitals in Hunan, Hainan, and Qinghai provinces in China from January 1, 2022, to June 30, 2024. The patients were divided into two groups: a CRT group (221 patients) and a non-CRT group (442 patients), with a ratio of 1:2. A between-group comparison and binary logistic regression were used to analyze risk factors for CRT in elderly lung cancer patients. Binary logistic regression analysis showed that decreased R (odds ratio [OR]: 0.849, 95% confidence interval [CI]: 0.763-0.945, p = 0.003), decreased K (0.571, 95% CI: 0.404-0.807, p = 0.001), advanced age (OR: 1.073, 95% CI: 1.033-1.113, p < 0.001), elevated platelet count (OR: 1.006, 95% CI: 1.004-1.009, p < 0.001), increased hemoglobin level (OR: 1.020, 95% CI: 1.009-1.031, p < 0.001), shortened PT (OR: 0.904, 95% CI: 0.830-0.985, p = 0.022), surgery ≤ 1 month (OR: 2.258, 95% CI: 1.420-3.590, p = 0.001), male sex (OR: 4.534, 95% CI: 2.815-7.304, p < 0.001), diabetes (OR: 2.478, 95% CI: 1.373-4.472, p = 0.003), hypertension (OR: 2.386, 95% CI: 1.505-3.784, p < 0.001), physical activity disorders (OR: 9.038, 95% CI: 4.462-18.309, p < 0.001) were independent risk factors for CRT in elderly lung cancer patients. Independent risk factors for CRT in elderly lung cancer patients include decreased K-values and decreased R-values, shortened PT, advanced age, elevated platelet count, increased hemoglobin level, surgery ≤ 1 month, male sex, diabetes, hypertension, and physical activity disorders.

Comprehensive treatment of diabetic endothelial dysfunction based on pathophysiological mechanism

Vascular endothelium is integral to the regulation of vascular homeostasis and maintenance of normal arterial function in healthy individuals. Endothelial dysfunction is a significant contributor to the advancement of atherosclerosis, which can precipitate cardiovascular complications. A notable correlation exists between diabetes and endothelial dysfunction, wherein chronic hyperglycemia and acute fluctuations in glucose levels exacerbate oxidative stress. This results in diminished nitric oxide synthesis and heightened production of endothelin-1, ultimately leading to endothelial impairment. In clinical settings, it is imperative to implement appropriate therapeutic strategies aimed at enhancing endothelial function to prevent and manage diabetes-associated vascular complications. Various antidiabetic agents, including insulin, GLP-1 receptor agonists, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, α-glucosidase inhibitors, thiazolidinediones (TZDs), and metformin, are effective in mitigating blood glucose variability and improving insulin sensitivity by lowering postprandial glucose levels. Additionally, traditional Chinese medicinal compounds, such as turmeric extract, resveratrol, matrine alkaloids, tanshinone, puerarin, tanshinol, paeonol, astragaloside, berberine, and quercetin, exhibit hypoglycemic properties and enhance vascular function through diverse mechanisms. Consequently, larger randomized controlled trials involving both pharmacological and herbal interventions are essential to elucidate their impact on endothelial dysfunction in patients with diabetes. This article aims to explore a comprehensive approach to the treatment of diabetic endothelial dysfunction based on an understanding of its pathophysiology.

Is a 12-week home-based functional teletraining for individuals with type 2 diabetes an alternative for blood glucose control?

BACKGROUND

Virtual or Tele-exercise programs have emerged due to safety concerns of COVID-19 contamination for at-risk groups. However, blood glucose (BG) comparisons concerning in-person and virtual exercise programs need to be scientifically researched. Understanding and monitoring home-based teletraining effects on glycemia is vital for safe management of people with type-2 diabetes (T2DM).

PURPOSE

To verify a 12-week functional teletraining on the capillary BG and compare it with in-person exercise before the COVID-19 pandemic in people with T2DM.

METHODS

T2DM participants underwent tele-exercise during the COVID-19 pandemic. It consisted of functional training (functional resistance training (FRT) for 12 weeks, 2 times a week, ∼60 min). Capillary BG was performed before and after (pre-post) each exercise session. The pre-post ΔBG for each session was considered for statistical analysis. Friedman's test with repetitive measures over time was performed to compare the ΔBG of the teletraining and the results of these participants before the pandemic. The minimum detectable difference was performed to verify clinical ΔBG for each session over the weeks.

RESULTS

Similar responses were seen over time without a statistical time effect after the programs (p = 0.177). A noticeable minimum difference of 24.5 mg/dL was observed in the in-person group post-session in all sessions. The virtual group showed a minimum detectable difference of 21.1 mg/dL post-session with clinical relevance over the 12 weeks.

CONCLUSION

Despite the teletraining being twice weekly and the in-person program thrice weekly, both exhibited similar outcomes over time, with the virtual program showing significant clinical improvements in BG after each session.

N6-methylation of RNA-bound adenosine regulator HNRNPC promotes vascular endothelial dysfunction in type 2 diabetes mellitus by activating the PSEN1-mediated Notch pathway

AIM

The regulatory mechanism of m6A regulators in vascular endothelial function of type 2 diabetes mellitus (T2DM) remains largely unknown. We addressed this issue based on the data retrieved Gene Expression Omnibus (GEO) database and experimental validations.

METHODS

Expression of m6A methylation regulators was evaluated in T2DM samples of GSE76894 dataset and GSE156341 dataset. Further analysis of candidate m6A methylation regulators was conducted in the thoracic aorta of db/db mice and high glucose (HG)-induced human umbilical vein endothelial cells (HUVECs). Ectopic expression and depletion experiments were conducted to detect effects of m6A methylation regulators on vascular endothelial function in T2DM.

RESULTS

It emerged that three m6A methylation regulators (HNRNPC, RBM15B, and ZC3H13) were highly expressed in T2DM, which were related to vascular EC function, showing diagnostic values for T2DM. HNRNPC expression in the thoracic aorta of db/db mice was higher than that in heterozygous db mice, and HNRNPC expression in HG-induced HUVECs was upregulated when compared with normal glucose-exposed HUVECs. Furthermore, HNRNPC activated PSEN1-dependent Notch pathway to induce eNOS inactivation and NO production decrease, thereby causing vascular endothelial dysfunction in T2DM.

CONCLUSIONS

HNRNPC impaired vascular endothelial function to enhance the development of vascular complications in T2DM through PSEN1-mediated Notch signaling pathway.

Effects of sphingolipid metabolism disorders on endothelial cells

Many cardiovascular disorders, including atherosclerosis, hypertension, coronary heart disease, diabetes, etc., are characterized by endothelial cell dysfunction. Endothelial cell function is closely related to sphingolipid metabolism, and normal sphingolipid metabolism is critical for maintaining endothelial cell homeostasis. Sphingolipid metabolites or key enzymes in abnormal situation, including sphingosine, ceramide (Cer), sphingosine-1-phosphate (S1P), serine, sphingosine kinase (SPHK), ceramide kinase (Cerk), sphingosine-1-phosphate lyase (S1PL) etc., may have a protective or damaging effect on the function of endothelial cells. This review summarizes the effects of sphingolipid metabolites and key enzymes disordering in sphingolipid metabolism on endothelial cells, offering some insights into further research on the pathogenesis of cardiovascular diseases and corresponding therapeutic targets.

Risk Factors for Gastric Cancer-Associated Thrombotic Diseases in a Han Chinese Population

The aim of the present work was to investigate the risk factors for gastric cancer- (GC-) associated thrombotic diseases in a Han Chinese population. A total of 333 patients diagnosed with GC, 68 with thrombotic diseases included in the case group and the remaining 265 in the control group, were enrolled. The relevant data for the participants, including general information (gender, age, smoking, and drinking), comorbidities (diabetes, hypertension, and anemia), tumor-related data (tumor site, histology, degree of differentiation, and clinical stage), and treatment-related data (surgery, chemotherapy, hormones, transfusion, and peripherally inserted central venous catheter (PICC)), were collected. Statistically significant factors derived from univariate analyses were then subjected to multivariate logistic regression analyses. The results demonstrate a statistically significant difference in age, diabetes, hypertension, histology, surgery, chemotherapy, and PICC (P < 0.05), compared with control. Age, diabetes, surgery, and PICC serve as independent risk factors for GC-associated thrombotic diseases (P < 0.05). The present work demonstrates that GC-associated thrombotic diseases are significantly associated with age, diabetes, surgery, and PICC, suggesting a potential target for early detection and preventive strategy for GC patients with thrombophilia.

Changes in endothelial function during educational hospitalization and the contributor to improvement of endothelial function in type 2 diabetes mellitus

Only a few reports have examined vascular endothelial function before and after educational hospitalization and the factors that affect it in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to assess vascular endothelial function before and after educational hospitalization and identify factors that affect it. In 65 patients with T2DM who underwent peripheral arterial tonometry (EndoPAT) before and after hospitalization, vascular endothelial function (reactive hyperemia index [RHI]), glucose metabolism, lipid metabolism, and blood pressure were assessed before and after hospitalization. The primary endpoint was hospitalization-induced changes in vascular endothelial function. Educational hospitalization significantly improved the natural logarithmically scaled RHI (L_RHI) from 0.555 ± 0.212 to 0.625 ± 0.245 (p = 0.012). Multivariable logistic regression analysis identified hypoglycemia during hospitalization as the single factor that significantly altered vascular endothelial function (p = 0.019). The odds of achieving normal vascular endothelial function were 0.08 times lower (95% confidence interval, 0.01-0.67) for each episode of hypoglycemia. Furthermore, multivariable analysis identified hypoglycemia during hospitalization as the single factor that worsened L_RHI. Our study showed that educational hospitalization of patients with T2DM improved vascular endothelial function, and that the development of hypoglycemic episodes had a significant negative impact on normalization of vascular endothelial function.

The role of diabetes in the onset and development of endothelial dysfunction

The vascular endothelium performs many functions. It is a key regulator of vascular homeostasis, maintains a balance between vasodilation and vasoconstriction, inhibition and stimulation of smooth muscle cell migration and proliferation, fibrinolysis and thrombosis, and is involved to regulation of platelet adhesion and aggregation. Endothelial dysfunction (ED) plays the critical role in pathogenesis of diabetes mellitus (DM) vascular complications. The purpose of this review was to consider the mechanisms leading to the occurrence of ED in DM. The paper discusses current literature data concerning the role of hyperglycemia, oxidative stress, advanced glycation end products in endothelial alteration. A separate section is devoted to the particularities of the functioning of the antioxidant system and their significance in the development of ED in DM. The analysis of the literature allows to conclude that pathological activation of glucose utilization pathways causes damage of endothelial cells, which is accompanied by disorders of all their basic functions. Metabolic disorders in DM cause a pronounced imbalance of free radical processes and antioxidant defense, accompanied by oxidative stress of endotheliocytes, which contributes to the progression of ED and the development of vascular complications. Many aspects of multicomponent regulatory reactions in the pathogenesis of the development of ED in DM have not been sufficiently studied.

Biochemical and Molecular Mechanisms of Glucose Uptake Stimulated by Physical Exercise in Insulin Resistance State: Role of Inflammation

Obesity associated with systemic inflammation induces insulin resistance (IR), with consequent chronic hyperglycemia. A series of reactions are involved in this process, including increased release of proinflammatory cytokines, and activation of c-Jun N-terminal kinase (JNK), nuclear factor-kappa B (NF-κB) and toll-like receptor 4 (TLR4) receptors. Among the therapeutic tools available nowadays, physical exercise (PE) has a known hypoglycemic effect explained by complex molecular mechanisms, including an increase in insulin receptor phosphorylation, in AMP-activated protein kinase (AMPK) activity, in the Ca2+/calmodulin-dependent protein kinase kinase (CaMKK) pathway, with subsequent activation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), Rac1, TBC1 domain family member 1 and 4 (TBC1D1 and TBC1D4), in addition to a variety of signaling molecules, such as GTPases, Rab and soluble N-ethylmaleimide-sensitive factor attached protein receptor (SNARE) proteins. These pathways promote greater translocation of GLUT4 and consequent glucose uptake by the skeletal muscle. Phosphoinositide-dependent kinase (PDK), atypical protein kinase C (aPKC) and some of its isoforms, such as PKC-iota/lambda also seem to play a fundamental role in the transport of glucose. In this sense, the association between autophagy and exercise has also demonstrated a relevant role in the uptake of muscle glucose. Insulin, in turn, uses a phosphoinositide 3-kinase (PI3K)-dependent mechanism, while exercise signal may be triggered by the release of calcium from the sarcoplasmic reticulum. The objective of this review is to describe the main molecular mechanisms of IR and the relationship between PE and glucose uptake.

MicroRNA and mRNA analysis of angiotensin II-induced renal artery endothelial cell dysfunction

Continuous activation of angiotensin II (Ang II) induces renal vascular endothelial dysfunction, inflammation and oxidative stress, all of which may contribute to renal damage. MicroRNAs (miRs/miRNAs) play a crucial regulatory role in the pathogenesis of hypertensive nephropathy (HN). The present study aimed to assess the differential expression profiles of potential candidate genes involved in Ang II-induced rat renal artery endothelial cell (RRAEC) dysfunction and explore their possible functions. In the present study, the changes in energy metabolism and autophagy function in RRAECs were evaluated using the Seahorse XF Glycolysis Stress Test and dansylcadaverine/transmission electron microscopy following exposure to Ang II. Subsequently, mRNA-miRNA sequencing experiments were performed to determine the differential expression profiles of mRNAs and miRNAs. Integrated bioinformatics analysis was applied to further explore the molecular mechanisms of Ang II on endothelial injury induced by Ang II. The present data supported the notion that Ang II upregulated glycolysis levels and promoted autophagy activation in RRAECs. The sequencing data demonstrated that 443 mRNAs and 58 miRNAs were differentially expressed (DE) in response to Ang II exposure, where 66 mRNAs and 55 miRNAs were upregulated, while 377 mRNAs and 3 miRNAs were downregulated (fold change >1.5 or <0.67; P<0.05). Functional analysis indicated that DE mRNA and DE miRNA target genes were mainly associated with cell metabolism (metabolic pathways), differentiation (Th1 and Th2 cell differentiation), autophagy (autophagy-animal and autophagy-other) and repair (RNA-repair). To the best of the authors' knowledge, this is the first report on mRNA-miRNA integrated profiles of Ang II-induced RRAECs. The present results provided evidence suggesting that the miRNA-mediated effect on the ‘mTOR signaling pathway’ might play a role in Ang II-induced RRAEC injury by driving glycolysis and autophagy activation. Targeting miRNAs and their associated pathways may provide valuable insight into the clinical management of HN and may improve patient outcome.

Anti‑glycolipid disorder effect of epigallocatechin‑3‑gallate on high‑fat diet and STZ‑induced T2DM in mice

Epigallocatechin-3-gallate (EGCG) is beneficial for inhibiting dyslipidemia and reducing hyperlipidemic risk. The purpose of the present study was to investigate the glycolipid regulatory effects and potential mechanisms of EGCG in a high-fat diet and streptozotocin-induced type 2 diabetes mellitus (T2DM) mouse model. The results demonstrated that EGCG can decrease blood glucose levels and increase insulin resistance in T2DM mice. In addition, EGCG can regulate serum lipid levels, including those of total cholesterol, triglyceride and low-density lipoprotein receptor (LDL-r), and reduce lipid deposition in vascular endothelial cells in a dose-dependent manner. In addition, the gene and protein expression of related scavenger receptors, including cluster of differentiation 36, sterol regulatory element binding protein 2 (SREBP), SREBP cleavage-activating protein and LDL-r, were downregulated in a dose-dependent manner. The present study noted that EGCG possesses potential as a natural product for preventing and treating metabolic hyperlipidemia syndrome, probably by reducing the blood lipid levels, alleviating vascular endothelial cell damage, maintaining normal lipid metabolism in blood vessels and ameliorating glycolipid disorders.

Endothelial dysfunction: from the particular to the general. Return to the «Old Paradigm»?

The vascular endothelium is a heterogeneous structure with diverse functions, being an active metabolic system. Endothelial cells mediate inflammatory and immune processes, regulate leukocyte adhesion, permeability and vascular tone, participate in the hemostasis system, stimulate the processes of angiogenesis. Endothelial dysfunction can initiate individual disorders, but more often it is a universal link in the pathogenesis of many diseases. Currently, endothelial dysfunction is presented as an imbalance between the production of vasodilating, angioprotective, antiproliferative factors, on the one hand, and vasoconstrictive, prothrombotic, proliferative factors, on the other hand. The manifestations of endothelial dysfunction, the direction and severity of these changes may vary depending on the disease. The review provides examples of combined endothelial disorders in the most studied and common diseases (essential hypertension, type 2 diabetes, systemic diseases of the connective tissue, atherosclerosis, and malignant tumors). Despite the presence of rare cases of isolated endothelial dysfunction, it can be argued that in the absolute majority of diseases, endothelial dysfunction has combined type of violations. The allocation of individual endothelial disorder spectra, typical for a specific disease, is problematic, due to the universality and nonspecificity of the manifestations of endothelial dysfunction. These conclusions allow us to return to the origins of this problem, considering endothelial dysfunction as a holistic concept, not limited to a certain range of its disorders.

Life satisfaction and other determinants of eating behaviours among women aged 40-65 years with type 2 diabetes from the Krakow population

Introduction

A rational dietary model is one of the key aspects in the treatment of type 2 diabetes.

Aim of the study

The study aimed to analyse the frequency of consuming selected groups of food products among women aged 40-65 years with type 2 diabetes, depending on age, BMI, duration of disease, and level of life satisfaction.

Material and methods

The study was carried out among 276 women using the author’s specially designed questionnaire (metric data, duration of diabetes) and the Satisfaction with Life Scale (SWLS). We assessed BMI values on the basis of measurements of somatic indicators (body mass and height). Statistical analysis was performed using Pearson’s r and Spearman’s R correlation coefficients via the SPSS programme (significance level of α = 0.05).

Results

Among the women with type 2 diabetes we observed nutritional deficiencies, in particular a low frequency of consuming the recommended product groups (vegetables, fruit, legume seeds, whole-grain cereals, dairy products with reduced fat content, and nuts). The scale of rational dietary choices among women increased along with age and perceived life satisfaction. As the time from diagnosis passed, this scale decreased. A decrease was also noted along with the increase in BMI.

Conclusions

The frequency of consuming some product groups shows a significant relationship with age, BMI, duration of disease, and the level of life satisfaction among women aged 40-65 years with type 2 diabetes.

The Effects of Exenatide and Metformin on Endothelial Function in Newly Diagnosed Type 2 Diabetes Mellitus Patients: A Case-Control Study

INTRODUCTION

Exenatide is a new antidiabetic glucagon-like peptide-1 receptor agonist. In addition to its hypoglycemic effect, exenatide may have a potential protective benefit on vascular endothelial function. This study attempted to compare the effects of exenatide and traditional antidiabetic drug metformin treatment on endothelial function in overweight patients with type 2 diabetes.

METHODS

Ninety overweight patients with newly diagnosed type 2 diabetes were recruited; 45 patients received exenatide (Exe) treatment and 45 patients received metformin (Met) treatment for 12 weeks. The control groups included 37 overweight and 24 non-overweight individuals. The parameters of glucose and lipid metabolism and endothelial function were measured before and after treatment. Vascular endothelial dysfunction was measured by reactive hyperemia index.

RESULTS

Newly diagnosed patients with type 2 diabetes had more serious vascular endothelial dysfunction than both overweight and normal-weight control groups. The levels of body mass index, glucose, HbA1c, homeostasis model assessment insulin resistance, and homeostasis model assessment β-cell function were improved significantly by both exenatide and metformin treatment. Both exenatide and metformin treatment can improve vascular endothelial function (Exe group: 1.67 ± 0.52 vs 1.98 ± 0.67, P < 0.05; Met group: 1.68 ± 0.29 vs 1.82 ± 0.24, P < 0.05). Exenatide treatment was no less effective than metformin in improving endothelial function (0.31 ± 0.70 vs 0.13 ± 0.24, P > 0.05).

CONCLUSIONS

Newly diagnosed patients with type 2 diabetes may have vascular endothelial dysfunction. Both exenatide and metformin treatment can improve vascular endothelial dysfunction, and exenatide was no less effective than metformin treatment.