IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship between glycaemic control and frailty in older Chinese patients: The mediating role of diabetes distress

PURPOSE

This study aimed to investigate the effects of glycaemic control and diabetes distress on frailty in older Chinese patients with diabetes, and to explore the mediating role of diabetes distress between glycaemic control and frailty.

DESIGN

This is a descriptive, cross-sectional study. A total of 209 older patients with diabetes were recruited from a teaching hospital in Zhejiang Province. Data were collected from February to September 2022.

METHODS

A self-designed questionnaire was used to collect demographic and disease-related data. The Fried Scale and Diabetes Distress Scale were employed to assess frailty and diabetes distress, respectively The bootstrap method was used to examine the mediating effects of diabetes distress on glycaemic control and frailty. The STROBE checklist was adhered to in the reporting of this study (see details in File S1).

RESULTS

The findings indicated a positive correlation between the level of glycaemic control and frailty, as well as between diabetes distress and frailty. Furthermore, diabetes distress was found to play a complete mediating role between glycaemic control and frailty.

CONCLUSIONS

The study findings highlight the relationship between glycaemic control, diabetes distress and frailty offering a valuable reference for enhancing the management of frailty in older patients with diabetes.

RELEVANCE TO CLINICAL PRACTICE

This study emphasizes the significance of managing glycaemic control and diabetes distress in older patients with diabetes to prevent frailty, and may contribute for healthcare professionals to developing effective measures to improve the frailty of older diabetic patients in clinical settings.

PATIENT OR PUBLIC CONTRIBUTION

This study was conducted with the participation of older patients with diabetes who contributed data by completing study questionnaires and undergoing physical assessments.

Exploration of novel dipeptidyl peptidase-IV inhibitory tetrapeptide from walnut (Juglans sigillata) protein and its effect on diabetes-like phenotypes induced by high-sugar diet in Drosophila melanogaster

Walnut protein was hydrolyzed by different enzymes, and bromelain protein hydrolysate (W-Bromelain) showed the highest dipeptidyl peptidase-IV (DPP-IV) inhibitory activity. W-Bromelain was fractionated, and three novel tetrapeptides (LPQF, LPSF, and VPFP) were identified. In vitro evaluation showed that LPQF exhibited the highest DPP-IV inhibitory activity with an IC50 value of 99.34 μM. Evaluation of the absorption, distribution, metabolism, excretion, and toxic properties of LPQF showed high absorption and nontoxicity. Molecular docking showed that LPQF could interact with the active residues of DPP-IV through seven hydrogen bonds and five hydrophobic interactions. Molecular dynamics simulation further confirmed the stability of the LPQF-DPP-IV complex. LPQF showed high stability in in vitro gastrointestinal digestion. LPQF ameliorated the type 2 diabetes mellitus-like phenotype and reduced the degree of oxidative stress and intestinal barrier damage in a Drosophila melanogaster model of insulin resistance. Furthermore, the RNA-seq analysis showed that LPQF may exert hypoglycemic effects by regulating the Wnt, MAPK, and FoxO pathways.

Diabetes Mellitus and Associated Vascular Disease: Pathogenesis, Complications, and Evolving Treatments

Diabetes mellitus is a metabolic disorder, characterized by elevated blood sugar levels (hyperglycemia) and insulin dysregulation. This disease is associated with morbidity and mortality, including significant potential vascular complications. High levels of hyperglycemia lead to not only elevated levels of reactive oxygen species but also advanced glycation end products, which are detrimental to the vascular endothelium and reduce protective compounds such as nitric oxide and prostacyclin. This damage contributes to the development of both macrovascular and microvascular complications. The present investigation explores the pathophysiological mechanisms of diabetic vascular complications and evaluates current management strategies, including lifestyle modifications, pharmacological treatments, and emerging therapies. The review underscores the importance of ongoing progress in diabetes management and patient education to lead to optimal patient-health outcomes and quality of life for individuals with diabetes mellitus.

Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears Yields Good Clinical Outcomes for Patients With and Without Diabetes Mellitus

PURPOSE

To compare the clinical outcomes after superior capsule reconstruction (SCR) for irreparable rotator cuff tears (RCTs) in patients with and without diabetes mellitus (DM).

METHODS

Patients who underwent SCR using fascia lata autograft for irreparable RCTs between 2012 and 2020 with a minimum 2-year follow-up were divided into non-DM and DM groups. Propensity score matching was used to select controls matched for patients' characteristics. Only patients with glycosylated hemoglobin <8% were eligible. The visual analog scale for shoulder pain, American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores, and acromiohumeral distance were evaluated preoperatively and at 2 years postoperatively. Shoulder active range of motion (ROM) was evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively. Graft integrity and postoperative complications that required additional surgery were evaluated. The Wilcoxon signed-rank test and Mann-Whitney U test were used to compare continuous variables. Pearson χ2 test and Fisher exact test were used for categorical variables. The interaction between the postoperative period and ROM was analyzed by the Friedman test and Wilcoxon rank-sum test with the Holm-Sidak post hoc test.

RESULTS

We studied 154 patients (non-DM, 130; DM, 24) who underwent SCR. After matching, 21 patients were selected in each group. All clinical outcomes significantly improved at 2 years (all P < .05) in both groups. We found no significant differences in clinical outcomes and rates of patients who achieved minimal clinically important differences in visual analog scale and American Shoulder and Elbow Surgeons scores between the groups (P = .10 to ≥.999). The rates of graft tear (both 9.5%) and complications (non-DM, 4.8%; DM, 0%) were not significantly different (both P ≥ .999).

CONCLUSIONS

SCR using fascia lata autograft for irreparable RCTs yields good clinical outcomes, including ROM, in patients with and without DM. No significant differences in postoperative outcomes were observed between the 2 groups.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Produce prescription to improve health among adults with type 2 diabetes in Australia: Protocol for a randomised controlled trial

BACKGROUND

'Food is medicine' programs such as Produce Prescription (PRx) aim to integrate food-based nutrition programs into healthcare, for the prevention, management and treatment of diet-related diseases, typically for those experiencing food insecurity. However, the impact of PRx on health indicators in Australia has never been tested in a randomised trial.

OBJECTIVES

To determine the effect of PRx on blood glucose control and other health indicators in adults with type 2 diabetes experiencing hyperglycaemia and food insecurity and/or financial hardship in Australia.

METHODS

Using a parallel design randomised controlled trial, n = 224 participants will be randomised (1:1) to PRx or usual care. Over 26 weeks, the intervention group will receive a weekly delivery of fruits, vegetables, wholegrains and nuts, and up to 3 sessions with an accredited dietitian. Controls will receive usual care. The primary outcome is change in mean HbA1c over 26 weeks, comparing the intervention and control group. Secondary outcomes include between-group differences at 26 weeks in change in blood pressure, body weight, blood lipids, food and nutrition insecurity, person-reported outcome measures, medication use, and diet quality. Implementation outcomes assessed will include feasibility, acceptability, scalability and cost effectiveness.

DISCUSSION

This Australia-first PRx trial will provide novel and rigorous data for an intervention that may be feasible to improve health and health equity as part of the Australian healthcare system. We anticipate PRx will lead to a clinically meaningful reduction in HbA1c, contribute to improved health equity and long-term health benefits for adults with type 2 diabetes and food insecurity.

HG043, a potent thienopyrimidine GPR119 agonist, demonstrates enhanced anti-diabetic and anti-obesity effects in preclinical models

GPR119 is a promising therapeutic target for type 2 diabetes because of its role in enhancing glucose-stimulated insulin secretion and GLP-1 release. We investigated the anti-diabetic and anti-obesity effects of HG043, a novel and potent thienopyrimidine-based GPR119 agonist, by comparing its pharmacological activities to those of MBX-2982 (a known GPR119 agonist) and sibutramine (an appetite suppressant) in both in vitro and in vivo models. HG043 exhibited potent agonistic activity for human GPR119 and demonstrated enhanced efficacy compared to MBX-2982 in stimulating incretin secretion in pancreatic β-cell lines. Single and long-term treatment with HG043 resulted in significant improvements in diabetic and obesity parameters compared to both MBX-2982 and sibutramine in both healthy and disease models. Furthermore, HG043 demonstrated synergistic glucose-lowering effects when combined with metformin or sitagliptin. These findings suggest that HG043 may serve as a promising therapeutic option for the treatment of type 2 diabetes with obesity patients.

DEXAMETHASONE INTRAVITREAL INJECTION IN DIABETIC PATIENTS UNDERGOING CATARACT SURGERY: An Updated Literature Review

PURPOSE

This literature review synthetizes current evidence on the timing and efficacy of dexamethasone intravitreal injections for diabetic macular edema in patients undergoing cataract surgery, particularly phacoemulsification, to determine the optimal timing for improved outcome.

METHODS

A systematic review of the literature was conducted across key databases to identify peer-reviewed studies, clinical trials, and meta-analyses addressing dexamethasone injections administered pre-, intra-, and postoperatively for diabetic macular edema in the context of cataract surgery. Studies were selected based on relevance to timing, visual outcomes, and inflammation control, with a focus on comparative efficacy.

RESULTS

The findings suggest that timely dexamethasone injections can substantially reduce inflammation and enhance visual recovery for patients with diabetic macular edema undergoing cataract surgery. Studies indicate that preoperative injections may effectively dampen the inflammatory response triggered by surgical trauma, potentially preserving retinal integrity, whereas intraoperative and postoperative administrations contribute to sustained anti-inflammatory effects during the recovery phase. Comparative studies also highlight dexamethasone's advantages over other anti-inflammatory treatments, such as NSAIDs, particularly in preventing cystoid macular edema. Notably, there was considerable variation in dosage and timing across studies, underscoring the need for standardized treatment protocols.

CONCLUSION

Dexamethasone intravitreal injections offer a valuable intervention for managing diabetic macular edema in diabetic patients undergoing cataract surgery, with optimal timing playing a crucial role in maximizing therapeutic benefits. Preoperative injections appear to be particularly beneficial in reducing the risk of postoperative inflammatory complications. Further research should focus on developing comprehensive guidelines for timing and dosage to standardize treatment and improve patient outcomes in this high-risk population.

In vitro and in vivo antidiabetic evaluation of new Coumarin and Chromone derivatives: Design, synthesis and molecular modeling

Diabetes mellitus is a chronic metabolic disease characterized by an imbalance in glucose homeostasis, which raises blood glucose levels. α-glucosidase enzyme hydrolyzes polysaccharides to produce glucose and since glucose is one of the primary energy sources in eukaryotes, α-glucosidase is a target for postprandial hyperglycemia regulation. The design and synthesis of new oxadiazole coumarin (5a,b and 6a,b), acryloyl chromone (10a-c) and pyrazolyl chromone (11a-c) derivatives as naturally based scaffolds are presented in this work. The new compounds were assessed as antidiabetic agents targeting α-glucosidase enzyme. With an IC50 value of 119.7 ± 4.3 μM, compound 11c demonstrated the most promising α-glucosidase inhibitory activity, superior to the standard drug acarbose (IC50 = 300.9 ± 10.9 μM). Furthermore, compared to the group of diabetic rats, the in vivo investigations demonstrated that medium and high dosages of 11c ameliorated the expression of diabetic related genes (GCK, SYT11, SNAP-25 and Ins1). According to the molecular docking results, 11c possessed the best binding energy score (-9.1 kcal/mol) within the α-glucosidase active site, outperforming the rest of the derivatives and the reference inhibitor acarbose (-8.2 kcal/mol). Lastly, an in silico molecular dynamic simulation and a pharmacokinetic study were performed on compound 11c.

Predictors of diabetes remission after bariatric surgery in patients with type 2 diabetes mellitus duration ≥ 10 years: A retrospective cohort study

OBJECTIVE

Patients with type 2 diabetes mellitus (T2DM) duration ≥ 10 years often have significant β-cell failure. This study aimed to explore predictors of diabetes remission after bariatric surgery in these patients.

METHODS

Patients with T2DM duration ≥ 10 years who underwent bariatric surgery were retrospective included and followed up. Remission of diabetes was defined as an HbA1c < 6.5 % (48 mmol/mol) at least 3 months after the discontinuation of hypoglycemic drugs. An intravenous glucose tolerance test (IVGTT) was performed in patients with diabetes remission.

RESULTS

203 patients with T2DM duration ≥ 10 years were included, 59.6 % were treated with insulin before bariatric surgery. One-, two- and three-year post-surgery remission rates were 65.6 %, 53.8 % and 41.9 %, respectively (∼10 % decrease/year). Cox regression analysis revealed that the odds of remission at one-year post-bariatric surgery were most strongly associated with β-cell function (HR 1.20, 95 % CI 1.03-1.40) and percentage of total weight loss (%TWL) (HR 1.04, 95 % CI 1.01-1.07). The first-phase insulin secretion peak was approximately 5-8 folds of the fasting insulin level in 50 patients with diabetes remission.

CONCLUSIONS

%TWL and β-cell function are significantly associated with diabetes remission after bariatric surgery in long-duration T2DM patients, with restored first-phase insulin secretion still observed.

Dynamic ALBI score and FIB-4 index trends to predict complications after resection of hepatocellular carcinoma: A K-means clustering approach

BACKGROUND

Severe postoperative complications still occur following hepatectomy among patients with hepatocellular carcinoma (HCC). There is a need to identify high-risk patients for severe complications to enhance patient safety. We sought to evaluate the combined impact of pre- and postoperative albumin-bilirubin (ALBI) score and Fibrosis-4 (FIB-4) index trends to predict severe complications after HCC resection.

METHOD

Patients with HCC undergoing curative-intent hepatectomy (2000-2023) were identified from an international, multi-institutional database. The cohort was divided into training (n = 439) and testing (n = 651) sets. ALBI score and FIB-4 index trends from preoperative to postoperative days 1, 3, and 5 were used for K-means clustering (K = 3). A logistic regression model was developed using the training set, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC) in both cohorts.

RESULTS

Severe complications (Clavien-Dindo Grade ≥ IIIa) occurred in 118 patients (10.8 %); 43 (9.8 %) in training and 75 (11.5 %) in testing set (p = 0.42). K-means clustering identified three groups: Cluster1 (low), Cluster2 (intermediate), and Cluster3 (high), which was associated with a progressively increasing risk of complications (p < 0.01). On multivariable logistic regression, patients in ALBI Cluster1 had 76 % decreased odds (odds ratio[OR] 0.24, 95 % CI 0.07-0.83, p = 0.02) of postoperative complications relative to Cluster3 patients. Individuals categorized into FIB-4 Cluster1 had 85 % decreased odds (OR 0.15, 95 % CI 0.02-1.24, p = 0.07) versus patients in FIB-4 Cluster3. A new prediction model incorporating ALBI and FIB-4 index clusters achieved an AUC of 0.71, outperforming models based on preoperative data. A tool was made available at https://nm49jf-miho-akabane.shinyapps.io/HCC_ALBI/.

CONCLUSION

A dynamic ALBI score and FIB-4 index trend tool improved risk stratification of patients undergoing resection of HCC relative to severe complications.

Dendrobium nobile Lindl. Polysaccharides ameliorate the inflammatory microenvironment in the retina of diabetic rats: a multi-omics study of the gut-blood-retina axis

The global epidemic of type 2 diabetes (T2D) and its complications threaten human health and lives. Dendrobium nobile Lindl., a traditional Chinese medicinal herb, demonstrates anti-hyperglycemic and anti-hyperlipidemic effects. However, its protective role and mechanisms against diabetes-induced retinopathy remain unclear. This study aimed to investigate the impact of Dendrobium nobile Lindl. Polysaccharides (DNP) on the gut microbiota-metabolite-retinal inflammatory microenvironment in T2D rats. The results demonstrated that DNP could significantly ameliorate hyperglycemia, restore gut microbiota, and improve related microbial metabolites. Interestingly, DNP restored the damaged gut barrier and improved the metabolic profiles of circulating amino and organic acids. Specifically, DNP decreased the Firmicutes/Bacteroidota (F/B) ratio, restored gut morphology and the expression of ZO-1 and claudin-1, reduced serum lipopolysaccharides (LPS) levels, decreased gut and circulating branched-chain amino acids (BCAA) metabolism, increased gut and circulating hippurate metabolism, inhibited the TLR4/NF-κB signaling pathway, and ultimately ameliorated the inflammatory microenvironment of the retina. This comprehensive multi-omics study provides the first systematic evaluation of the therapeutic effects of DNP on T2D and its associated retinal inflammatory microenvironment, proposing the "gut-blood-retina" axis as a key mechanistic pathway. Consequently, DNP treatment emerges as a promising preventive or therapeutic strategy for mitigating these pathophysiological processes.

Psyllium husk powder enhances the management of type 2 diabetes by modulating gut microbiota and their metabolic products

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder characterized by hyperglycemia and insulin resistance. Plantain shell powder (PHP) serves as a high-quality source of dietary fiber, widely utilized in food additives and pharmaceutical applications. In this study, we investigated the hypoglycemic activity and underlying mechanisms of PHP by examining its effects on intestinal microbiota and metabolism in T2DM mice induced by a high-fat diet and streptozotocin (STZ). Our findings indicate that PHP significantly enhances blood glucose homeostasis and insulin sensitivity, reduces organ damage, and regulates blood lipid levels as well as short-chain fatty acid concentrations; notably, higher doses of PHP yielded optimal results. In addition, PHP can regulate the ratio of Bacteroidota to Firmicutes and increase the relative abundance of beneficial bacteria such as Bacteroidales, Muribaculaceae, and Parabacteroides. Furthermore, PHP enhances the enrichment of key metabolic pathways, including α-linolenic acid metabolism, monobactam biosynthesis, and PPAR signaling pathways, thereby promoting the production of beneficial metabolites. Complex interactions exist among these beneficial bacteria and metabolic pathways that are associated with improved metabolic function, regulation of glucose homeostasis, enhancement of insulin sensitivity, and reduction of inflammation. Our study demonstrates that PHP can ameliorate T2DM by reversing alterations in gut microbiota and metabolic profiles caused by T2DM while promoting the regulation of beneficial microbial populations.

A nomograph model for predicting the risk of diabetes nephropathy

OBJECTIVE

Using machine learning to construct a prediction model for the risk of diabetes kidney disease (DKD) in the American diabetes population and evaluate its effect.

METHODS

First, a dataset of five cycles from 2009 to 2018 was obtained from the National Health and Nutrition Examination Survey (NHANES) database, weighted and then standardized (with the study population in the United States), and the data were processed and randomly grouped using R software. Next, variable selection for DKD patients was conducted using Lasso regression, two-way stepwise iterative regression, and random forest methods. A nomogram model was constructed for the risk prediction of DKD. Finally, the predictive performance, predictive value, calibration, and clinical effectiveness of the model were evaluated through the receipt of ROC curves, Brier score values, calibration curves (CC), and decision curves (DCA). In addition, we will visualize it.

RESULTS

A total of 4371 participants were selected and included in this study. Patients were randomly divided into a training set (n = 3066 people) and a validation set (n = 1305 people) in a 7:3 ratio. Using machine learning algorithms and drawing Venn diagrams, five variables significantly correlated with DKD risk were identified, namely Age, Hba1c, ALB, Scr, and TP. The area under the ROC curve (AUC) of the training set evaluation index for this model is 0.735, the net benefit rate of DCA is 2%-90%, and the Brier score is 0.172. The area under the ROC curve of the validation set (AUC) is 0.717, and the DCA curve shows a good net benefit rate. The Brier score is 0.177, and the calibration curve results of the validation set and training set are almost consistent.

CONCLUSION

The DKD risk nomogram model constructed in this study has good predictive performance, which helps to evaluate the risk of DKD as early as possible in clinical practice and formulate relevant intervention and treatment measures. The visual result can be used by doctors or individuals to estimate the probability of DKD risk, as a reference to help make better treatment decisions.

Tea drinking effectively improves symptoms of diabetes and prevents hepatorenal damage in mice

Since type 2 diabetic patients often develop resistance to metformin as the progresses of diabetes, and almost all type 1 diabetic patients need receive insulin injection for hyperglycemia control. It is important to explore novel strategies with different mechanisms for diabetes management. Glucose-induced osmotic diuresis, known as polyuria, is the first clinical symptom in severe type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM). Drinking green tea or black tea effectively mitigates diabetic symptoms including polyuria, polydipsia, polyphagia and hyperglycemia in db/db mice via regulating renal aquaporin 2 and urine transporter A1 (UT-A1), in favor renal water reabsorption. This unique mechanism of action of tea could be useful for the treatment of diabetes in humans. In this study, we found that drinking Large-leaf yellow tea (LYT) for 5 weeks effectively ameliorated polyuria, polydipsia, polyphagia, hyperglycemia and excessive body weight gain, as well as upregulated renal water reabsorption associated proteins, including protein kinase C-alpha (PKC-α), membrane PKC-α and glycosylated UT-A1 in db/db mice. Four-days experiment were also confirmed the rapidly response of these proteins in favor renal water reabsorption and the amelioration of diabetic symptoms by LYT. We also found that green tea drinking effectively mitigated symptoms of diabetes in a mouse model for T1DM via upregulating these proteins. Moreover, green tea drinking prevented hepatorenal damage caused by hyperglycemia as suggested by the reduced levels of aspartate aminotransferase and creatinine in serum and the enhanced antioxidant defense system in liver and kidney. These results suggest the possible application of tea or tea constitutes in the clinical treatment of severe T2DM and T1DM, and the kidney is the target organ.

Green diabetes project: A comprehensive characterization of sustainable diabetes practices

INTRODUCTION

Technological advancements in diabetes mellitus (DM) management have empowered individuals for self-care. However, the widespread use of disposable devices has contributed to significant waste generation. This study aimed to assess patients' knowledge of sustainability in DM management and identify factors associated with varying levels of environmental concern.

MATERIALS AND METHODS

A cross-sectional observational study was conducted using a six-question survey to patients with DM under insulin therapy. Participants were categorized into three groups based on their level of concern for sustainability: absent, slight and high concern.

RESULTS

Among 285 participants, 11.2 %, 56.9 % and 31.9 % were respectively classified as having absent, slight and high concern. Most (62.1 %) had never discussed environmental sustainability with a healthcare professional, and 183 (64.3 %) reported improper disposal of sharps (general or plastic waste). No significant differences were found between sustainability concern and DM type, glycemic control, or age. Independent predictors of higher level of concern were female gender (p = 0.006) and prior discussion of sustainability during consultations (p < 0.001).

CONCLUSIONS

Waste from DM management poses a significant public health and environmental challenge. Despite widespread concern, awareness and proper disposal practices remain inadequate. Healthcare professionals play a pivotal role raising awareness about the issue.

Piperazine ferulate impact on diabetes-induced testicular dysfunction: unveiling genetic insights, MAPK/ERK/JNK pathways, and TGF-β signaling

Diabetic testicular dysfunction (DTD) poses a significant threat to male reproductive health. This study delves into the potential of piperazine ferulate (PF), a natural phenolic compound, in alleviating DTD and sheds light on its underlying mechanisms in rats. Animals were divided into the control, PF, diabetic, and diabetic plus PF groups. Diabetes was induced in rats with a single intraperitoneal (i.p.) injection of streptozotocin (STZ) at 50 mg/kg. PF was administered at 50 mg/kg/day via i.p. injection for four weeks. Significant changes in sexual behavior were observed in diabetic rats, which additionally revealed lower serum levels of testosterone, FSH, and LH. The abnormalities in sperm count, viability, motility, and morphology occurred along with the demonstrated suppression of genes and protein expression related to spermatogenesis. Atrophy of the seminiferous tubules and extensive degeneration and necrosis of the germ and Leydig cells were highlighted by histopathological examination. The testicular function of diabetic rats was significantly improved after PF administration, evidenced by normalized testicular histology, increased testosterone levels, and enhanced sperm quality. In addition to reducing inflammatory cytokines, COX2, and NF-κB expression, pf administration elevated the antioxidant levels and Nrf2/HO-1 expression. Furthermore, key signaling pathways involved in testicular degeneration are regulated by PF. It promoted cell survival and tissue repair by activating the protective TGF-β signaling pathway and attenuating the MAPK/ERK/JNK signaling cascade, which in turn reduced inflammation and apoptosis. PF suppressed the expression of INSL3, SPHK1, CD62E, ANGPTL2, and miR-148a-5p, while increasing the expression of testicular genes like HSD17B1, DAZL, and S1P, addressing DTD. This study highlights the potential of PF to restore testicular function and fertility in diabetic males by modulating genetic and signaling pathways.

Metabolomic network reveals novel biomarkers for type 2 diabetes mellitus in the UK Biobank study

AIMS

To identify hub metabolic biomarkers that constructively shape the type 2 diabetes mellitus (T2DM) risk network.

MATERIALS AND METHODS

We analysed data from 98 831 UK Biobank participants, confirming T2DM diagnoses via medical records and International Classification of Diseases codes. Totally 168 circulating metabolites were quantified by nuclear magnetic resonance at baseline. Metabolome-wide association studies with Cox proportional hazards models were performed to identify statistically significant metabolites. Network analysis was applied to compute topological attributes (degree, betweenness, closeness and eigencentrality) and to detect small-world features (high clustering, short path lengths). Identified metabolites were used with XGBoost models to assess risk prediction performance.

RESULTS

Over a median 12-year follow-up, 114 metabolites were significantly associated with T2DM risk and clustered into three distinct small-world modules. Total triglycerides and large high-density lipoprotein (HDL) cholesterol emerged as the pivotal biomarkers in the 'risk' and 'protective' modules, respectively, as evidenced by their high eigencentrality. Moreover, total branched-chain amino acids (BCAAs) exhibited small-world network characteristics exclusively in pre-T2DM individuals, suggesting them as a potent early indicators. GlycA demonstrated high closeness centrality in females, implying a female-specific risk biomarker.

CONCLUSIONS

By constructing a metabolic network that captures the complex interrelationships among circulating metabolites, our study identified total triglycerides and large HDL cholesterol as central hubs in the T2DM risk metabolome network. BCAA and GlycA emerged as alarm indicators for pre-T2DM individuals and females, respectively. Network analysis not only elucidates the topological functional roles of biomarkers but also addresses the limitations of false positives and collinearity in single-metabolite studies, offering insights for metabolic pathway research and precision interventions.

Genome-wide association study identifying novel risk variants associated with glycaemic traits in the continental African AWI-Gen cohort

AIMS/HYPOTHESIS

Glycaemic traits such as high fasting glucose levels and insulin resistance are positively associated with the risk of type 2 diabetes and other cardiometabolic diseases. Genetic association studies have identified hundreds of associations for each glycaemic trait, yet very few studies have involved continental African populations. We report the results of genome-wide association studies (GWASs) in a pan-African cohort for four glycaemic traits, namely fasting glucose, fasting insulin, insulin resistance (HOMA-IR) and beta cell function (HOMA-B), which are quantitative variables that affect the risk of developing type 2 diabetes.

METHODS

GWASs for the four traits were conducted in approximately 10,000 individuals from the Africa Wits-INDEPTH Partnership for Genomics Studies (AWI-Gen) cohort, with participants from Burkina Faso, Ghana, Kenya and South Africa. Association testing was performed using linear mixed models implemented in BOLT-LMM, with age, sex, BMI and principal components as covariates. Replication, fine mapping and functional annotation were performed using standard approaches.

RESULTS

We identified a novel signal (rs574173815) in the intron of the ankyrin repeat domain 33B (ANKRD33B) gene associated with fasting glucose, and a novel signal (rs114029796) in the intronic region of the WD repeat domain 7 (WDR7) gene associated with fasting insulin. SNPs in WDR7 have been shown to be associated with type 2 diabetes. A variant (rs74806991) in the intron of ADAM metallopeptidase with thrombospondin type 1 motif 16 (ADAMTS16) and another variant (rs6506934) in the β-1,4-galactosyltransferase 6 gene (B4GALT6) are associated with HOMA-IR. Both ADAMTS16 and B4GALT6 are implicated in the development of type 2 diabetes. In addition, our study replicated several well-established fasting glucose signals in the GCK-YTK6, SLC2A2 and THORLNC gene regions.

CONCLUSIONS/INTERPRETATION

Our findings highlight the importance of performing GWASs for glycaemic traits in under-represented populations, especially continental African populations, to discover novel associated variants and broaden our knowledge of the genetic aetiology of glycaemic traits. The limited replication of well-known signals in this study hints at the possibility of a unique genetic architecture of these traits in African populations.

DATA AVAILABILITY

The dataset used in this study is available in the European Genome-Phenome Archive (EGA) database ( https://ega-archive.org/ ) under study accession code EGAS00001002482. The phenotype dataset accession code is EGAD00001006425 and the genotype dataset accession code is EGAD00010001996. The availability of these datasets is subject to controlled access by the Data and Biospecimen Access Committee of the H3Africa Consortium. GWAS summary statistics are accessible through the NHGRI-EBI GWAS Catalog ( https://www.ebi.ac.uk/gwas/ ).

Diabetes care cascade in Bangladesh: Identifying gaps and social determinants

AIMS

Precise and up-to-date data regarding the care gaps is essential to prioritize interventions and guide efficient resource allocation for management of diabetes in Bangladesh. The aim of the present study was to evaluate the diabetes care cascade and identify the social determinants influencing retention at each stage of care in Bangladesh.

METHODS

Data was extracted from Bangladesh Demographic and Health Survey (BDHS), 2022. Type 2 diabetes mellitus (T2DM) was defined as fasting blood glucose ≥7.0 mmol/L or a diagnosis by a healthcare provider. The care cascade comprised three stages: (i) diagnosis, (ii) receiving treatment, and (iii) glycemic control. Logistic regression and Andersen's Behavioral Model were used in the study.

RESULTS

Among 2,403 individuals with T2DM, 33.5 % were diagnosed, 24.6 % received treatment, and 9.6 % achieved glycemic control. Losses occurred at diagnosis (66.5 %), treatment (9 %), and control (19.6 %). Women, individuals with higher education, and those in the wealthiest quintile had higher odds of diagnosis. Receiving treatment was significantly associated with wealth and body mass index.

CONCLUSIONS

Significant gaps were observed at all stages of diabetes care cascade, particularly diagnosis. Strengthening screening, ensuring access to affordable treatment, and improving adherence are essential to enhance glycemic control and mitigating the diabetes burden.

Efficient Screening of α-Glucosidase Inhibitory Peptides From Seahorse Through the Innovative Joint Technique: De Novo Sequencing and Parallel SPOT Synthesis

In this research, de novo sequencing was innovatively combined with parallel SPOT synthesis for the efficient screening of biological peptides from TCM or seafood: seahorse with synergistic antioxidant and α-glucosidase inhibitory activities, which is promising for postprandial hyperglycemia management. Gastrointestinal digestion mimic and de novo sequencing were sequentially carried out to predict new peptides from seahorse. After bioinformatic analysis using Peptide Ranker, 82 peptides were eventually synthesized by efficient parallel SPOT technique, and Ser-Val-Try-Leu-Gly-Gly-Ser-Leu-Leu (SVWLGGSLL) was screened out as the most efficient peptide with synergistic antioxidant (DPPH radical scavenging activity of 77%) and α-glucosidase inhibitory activity (IC50 = 0.36 mM). Molecular docking was further carried out to illustrate the favorable ligand-receptor interactions formed such as hydrogen bonding and van der Waals force with low binding free energy of -7.8 kcal/mol. Moreover, pharmacokinetic analysis indicated that SVWLGGSLL was unrelated to toxicity with the advantage of gastrointestinal stability.

Knowledge-Behavior Relationships and Technology Adoption Among Patients With Diabetes: A Mixed-Methods Analysis of Smart Foot Care Technology

BACKGROUND

Although recent systematic reviews indicate low adherence to foot care practices among patients with type 2 diabetes compared to other self-management behaviors, smart healthcare technologies offer potential solutions for improving foot care management. The smart diabetic foot screening system represents an innovative approach to diabetic foot care. However, the factors influencing its adoption, particularly the relationship between knowledge, behavior, and technology acceptance, remain poorly understood.

METHODS

A mixed-methods design was employed, integrating quantitative and qualitative data. Quantitative data were collected from 80 patients with type 2 diabetes using validated instruments: the foot care knowledge questionnaire, diabetic foot self-management behavior scale, and the unified theory of acceptance and use of technology questionnaire. Pearson correlation and regression analyses examined relationships between knowledge, behavior, and technology adoption intention. In-depth, semistructured interviews with 20 participants explored adoption factors. Thematic analysis was conducted on qualitative data.

RESULTS

Despite high levels of foot care knowledge (86.2% correct response rate), actual self-management behaviors remained suboptimal, with a modest correlation between knowledge and behavior (r = 0.31 and p < 0.01). Regression analysis identified attitude and facilitating conditions as significant predictors of smart system adoption intention, explaining 57% of the variance. Qualitative analysis revealed three main themes: technology acceptance perceptions, implementation support system, and self-management patterns, highlighting the complex interplay between knowledge, attitudes, and behavioral factors.

CONCLUSIONS

This study reveals that despite improved knowledge levels compared to previous decades, the knowledge-behavior gap in diabetic foot care persists. The findings suggest that successful implementations of smart healthcare technologies require addressing both attitudinal factors and facilitating conditions, rather than focusing solely on knowledge enhancement. These insights contribute to understanding technology adoption in chronic disease self-management and inform the development of more effective implementation strategies.

Alterations of the gut microbiota in patients with diabetic nephropathy and its association with the renin-angiotensin system

Objective

Type 2 Diabetes Mellitus (T2DM) is a global health concern, with complications such as diabetic nephropathy (DN) affecting 16.6% of patients and contributing to end-stage renal failure. Emerging research suggests that gut microbial communities may influence DN progression, potentially through mechanisms involving the renin-angiotensin system (RAS). This study aimed to evaluate changes in specific microbial genera in individuals with T2DM, both with and without DN, and to explore their associations with renal function markers and RAS activation.

Methods

A total of 120 participants were categorized into three groups: healthy controls, T2DM without DN, and T2DM with DN. Microbial abundances of genera including Escherichia, Prevotella, Bifidobacterium, Lactobacillus, Roseburia, Bacteroides, Faecalibacterium, and Akkermansia were quantified using qPCR targeting the bacterial 16 S rRNA gene. Gene expression levels of RAS-associated markers (ACE, AGT1R, AT2R, and Ang II) and inflammation-related genes (TNF-α, TLR4) were analyzed in peripheral blood mononuclear cells via qPCR.

Results

The study identified significant alterations in microbial composition. Genera such as Faecalibacterium, Akkermansia, Roseburia (butyrate producers), and Bifidobacterium (a potential probiotic) were markedly reduced in T2DM and DN groups compared to controls. Increased mRNA expression of RAS-related genes, including ACE, AGT1R, and Ang II, was observed in these groups. We also foun correlations between altered microbial genera, RAS gene expression, and clinical markers of renal dysfunction.

Conclusion

The findings suggest that specific microbial genera may influence the pathogenesis of DN through RAS activation and inflammatory pathways. These insights highlight potential therapeutic targets for mitigating DN progression in T2DM patients.

Association between sleep duration and obesity in patients with type 2 diabetes: A longitudinal study

BACKGROUND

Obesity is prevalent in patients with type 2 diabetes (T2D) and negatively impacts diabetes outcomes. While studies in the general population have established a link between sleep duration and obesity, this relationship in T2D remains unclear.

OBJECTIVES

To assess the association between sleep duration and adiposity in patients with T2D.

METHODS

This prospective study of adults enrolled in the SLEEP T2D study from 13 UK NHS Trusts. Sleep duration was self-reported using the Pittsburgh Sleep Quality Index (PSQI) and categorized as short (≤ 6 h/ night), long (> 9 h/night) or (normal > 6-9 h/night). Adiposity was assessed using body mass index (BMI) and waist circumference.

RESULTS

Among 229 patients (61% male, mean age 61.2 (± 11.7) years, 63.7% with BMI ≥ 30 kg/m2). At baseline, sleep duration negatively correlated with BMI (r = -0.27, p < 0.001) and waist circumference (r = -0.25, p = 0.001). After adjusting for potential confounders in different models, short sleep duration was associated with higher BMI (β = -1.01; p = 0.006) and waist circumference (β = -1.91; p = 0.01). Following a median follow-up of 26.5 months, short sleep at baseline was associated with a 5% or more gain in BMI (adjusted OR 10.03; 95% CI 1.55-64.84; p = 0.01).

CONCLUSION

Short sleep duration is associated with higher adiposity measures (BMI and waist circumference) and weight gain in patients with T2D. Addressing sleep duration may reduce the burden of obesity in T2D, and future studies in this area are warranted.

Incorporating sedentary behaviour for identifying risk of type 2 diabetes: Implications for primary care

INTRODUCTION

Type 2 diabetes mellitus (DM2) is one of the main public health threats of the 21st century. Half of the people with DM2 worldwide are not diagnosed. The high prevalence, underdiagnosis and complications of diabetes highlight the need for identifying people at risk. Sedentary behaviour (SB) or prolonged sitting is a major predisposing risk factor for the increasing prevalence of DM2. Incorporating SB measures into clinical practice systems for identifying individuals more likely to have DM2 should be considered.

OBJECTIVE

To develop a mathematical model for clinical practice that allows early identification of office employees at risk of DM2 based on objective data on SB.

METHODS

A cross-sectional study with a cross-validation procedure was conducted. Anthropometric variables (sex, age and body mass index, BMI), sleep time (hours; measured by ActivPAL3M devices), and SB patterns (sedentary breaks and time spent in sedentary bouts of four different lengths; measured by ActivPAL3M devices) of two groups of office employees (adults with and without diabetes) were compared. Eighty-one participants had DM2 and 132 had normal glucose metabolism (NGM). The risk of having DM2 was modelled using generalized linear models (GLM), particularly a logistic regression model.

RESULTS

Five non-invasive clinical variables that were significantly correlated to DM2 with no collinearity were included in the mathematical model: sex, age, BMI, sleep time (hours) and sedentary breaks < 20 minutes (number/day). The validated model correctly classified 94.58 % of the participants with DM2 and 97.99 % of participants with NGM. The sensitivity was 94.58 % and the specificity 97.99 %. Additionally, the model allowed the design of a preventive tool to recommend changes in the SB pattern based on the participant's anthropometric profile, aiming to reduce the risk of developing DM2 in office employees.

CONCLUSION

This study highlights the importance of incorporating SB measures in primary care clinical practice. Our mathematical model suggests that including SB could enhance the early identification of adults at risk of DM2. Further research is needed to validate these findings and assess the practical application of the mathematical model in clinical practice.

Elevated neutrophil-monocyte-to-lymphocyte ratio increases risk of adverse outcomes in patients with chronic kidney disease and type 2 diabetes

BACKGROUND

The relationship between the neutrophil-monocyte-to-lymphocyte ratio (NMLR) and adverse outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes remains unclear. This study explored the association between NMLR, adverse cardiovascular events, and CKD progression.

METHODS

This single-center retrospective study included patients with CKD and type 2 diabetes between November 2016 and December 2023. Patients were divided into tertiles according to NMLR values. The primary outcome was major adverse cardiovascular events (MACEs), while the secondary outcome was CKD progression. Restricted cubic splines (RCS) were used to describe the association between elevated NMLR and the risk of adverse outcomes. Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis. Nomograms were developed to predict event-free survival, with their performance validated using the area under the curve (AUC).

RESULTS

A total of 586 patients were included in this study. Over a median follow-up period of 23 months, at least one adverse event occurred in 225 patients (38.4%). The risk of MACEs, CKD progression, or both gradually increased across the NMLR tertiles (21.9% vs. 22.1% vs. 35.4%, p for trend = 0.001; 18.4% vs. 23.6% vs. 30.8%, p for trend = 0.004; and 31.6% vs. 35.9% vs. 47.7%, p for trend = 0.001, respectively). RCS showed an elevated risk of MACEs, CKD progression, or both with increasing NMLR (HR = 1.43, 95% CI [1.20, 1.70]; HR = 1.41, 95% CI [1.23, 1.61]; HR = 1.38, 95% CI [1.23, 1.55], respectively; all p < 0.001).

CONCLUSIONS

Increased NMLR was positively correlated with a higher risk of adverse cardiovascular events and CKD progression in patients with CKD and type 2 diabetes, and routine assessment of NMLR, particularly in those above 1.6, may aid in effective risk stratification and early intervention.

Gendered experience of people living with type 2 diabetes in rural and urban Mexico: an ethnographic study

OBJECTIVE

To analyse the gendered experience of women and men living with type 2 diabetes mellitus (T2D) related to diagnosis, treatment, and control in rural and urban contexts of Mexico.

METHODOLOGY

Qualitative ethnographic study. Thirty-six adults (21 women and 15 men) with a confirmed diagnosis of T2D for more than five years residing in urban and rural localities in Baja California and Morelos participated in this qualitative study between November 2022 and February 2023. A semi-structured interview guide was used to explore lifestyle changes, social and community networks, work and living conditions, experience with the disease, health services and associated economic burden. The analysis was guided by four conceptual domains of gender influence: identity, norms and roles, relationships and institutionalised gender.

RESULTS

Women were more likely to report difficulty in accepting the diagnosis of T2D and stress in coping with the disease and related lifestyle changes. Men were more likely to report impact of T2D on their job and role as household providers, and their inability to contribute to the care of other family members. Women were more likely to report leaving their jobs, taking on caregiving responsibilities for family members, experiencing difficulty in accessing healthcare, and prioritizing their health in comparison to men. Men reported receiving more support from their partners, faced fewer financial barriers to care access, and had more freedom to pay for their medications and seek treatment in private care. However, they were also less adherent to treatment and disease care measures.

CONCLUSIONS

Gender appears to substantially influence experience of living with T2D. Women were more likely to provide family support and less likely to receive it and reported greater financial barriers to care access in comparison to men. Men were more likely to experience stress in relation to their employment as primary providers for their family, and less likely to adhere to prescribed medical management of their condition. These findings should be considered in more targeted health policy interventions to promote greater gender equity in the care of those with T2D in Mexico.

Mechanism of Ginsenosides in the Treatment of Diabetes Mellitus Based on Network Pharmacology and Molecular Docking

Diabetes mellitus (DM) is a multifactorial metabolic disorder characterized by chronic hyperglycemia and systemic metabolic dysregulation. Although ginsenosides, the primary bioactive components of Panax ginseng Meyer, exhibit regulatory effects on glucose and lipid metabolism, their precise mechanisms and key targets in DM remain incompletely understood. Unlike previous studies focusing solely on crude extracts or individual ginsenosides, this study integrates network pharmacology, molecular docking, and molecular dynamics (MD) simulations to systematically elucidate the multi-target mechanisms of ginsenosides, with experimental validation using the ginsenoside derivative AD-1. Network pharmacology identified 134 potential targets, with protein-protein interaction (PPI) analysis revealing 25 core targets (such as NFKB1, HDAC1, ESR1, and EP300). Molecular docking and MD simulations showed that ginsenosides have stable binding conformations with these targets and exhibit excellent dynamic stability. Notably, in vivo experiments using AD-1 in streptozotocin-induced type 1 diabetic mice confirmed its therapeutic efficacy, significantly downregulating key diabetic markers (e.g., NFKB1 and HDAC1) in pancreatic tissues-a finding unreported in prior studies. This study not only revealed the multitarget pharmacological mechanism of ginsenosides but also highlighted the therapeutic potential of AD-1. These findings provide a foundation for further mechanistic studies and suggest new strategies for the application of novel ginsenoside derivatives in diabetes therapy.

HDAC4: an emerging target in diabetes mellitus and diabetic complications

Diabetes mellitus (DM) is a metabolic disease with complex pathogenic mechanisms. Histone deacetylase 4 (HDAC4) is a member of an important family of epigenetic modifications. An increasing amount of research indicates that HDAC4 may control DM by modulating the epigenetic and post-translational expression of numerous transcription factors and taking part in different signaling cascades. In this review, HDAC4 was reported to control the differentiation, growth, and function of pancreatic β-cells. Furthermore, HDAC4 regulates glucose metabolism by targeting GLUT4 and FOXO1 and further modulates insulin signaling pathways through cytoplasmic-nuclear shuttling. Moreover, HDAC4 has also been implicated in the regulation of diabetic nephropathy, diabetic cardiomyopathy, diabetes osteoporosis, diabetic wounds, and diabetic encephalopathy. Therefore, HDAC4 is consider to be a viable therapeutic target for the treatment of DM and its complications. HDAC inhibitors and other targeted inhibitions of HDAC4 provide us with new ideas for developing novel intervention strategies. This article reviews the role of HDAC4 in diabetes mellitus and its complications.

Empowering Pharmacists in Type 2 Diabetes Care: Opportunities for Prevention, Counseling, and Therapeutic Optimization

Diabetes is a growing chronic disease with complications that impose a significant burden on healthcare systems worldwide. Pharmacists are readily accessible for diabetes management beyond simply dispensing medications. Consequently, they are involved in disease prevention and detection, therapy management, and patient monitoring. However, with the current escalating impact of diabetes, pharmacists must upgrade their strategies by integrating guidelines from sources like the American Diabetes Association (ADA) 2024 with pharmacy expertise. This perspective serves as a guide for pharmacists, identifying key foundations involved in diabetes management, highlighting five crucial steps for optimal disease control, ranging from prevention strategies to pharmacist-led counseling interventions. We employed PubMed, CDC, WHO guidelines, and key reference texts. Searches were performed using combinations of terms such as "pharmacist", "type 2 diabetes", "diabetes prevention", "pharmacist intervention", and "diabetes management", covering publications from January 2010 to March 2025. Studies were included if they focused on pharmacist-led prevention, intervention, or management strategies related to type 2 diabetes (T2D) and were published in English. Studies focusing exclusively on type 1 diabetes were excluded. Generative artificial intelligence was employed to order and structure information as described in the acknowledgments. Conflicting evidence was resolved by giving relevance to recent systematic reviews, randomized trials, and major guidelines. Additional insights were gained through consultations with PharmD professionals experienced in diabetes care. Evidence from selected studies suggests that pharmacist-led care models may enhance and promote the early detection of T2D, improve therapy adherence, enhance glycemic control, and increase overall treatment efficiency. This work suggests that pharmacists must play a key role in diagnosing, preventing, managing, and mitigating the consequences associated with T2D. They must contribute to early treatments with appropriate training and involvement to improve therapeutic outcomes and reduce diabetes-related complications.

Pharmacological and physiological activation of TGR5 in the NTS lowers food intake by enhancing leptin-STAT3 signaling

Feeding increases plasma bile acid levels while the nucleus of the solitary tract (NTS) and area postrema (AP) of the brain detect changes in hormones to regulate feeding. However, whether an increase in bile acids activates Takeda G protein-coupled receptor 5 (TGR5) in the NTS and/or AP to lower feeding through a negative feedback pathway is unknown. Here, we discover that infusion of TGR5 agonist CCDC in the NTS of male rats lowered food intake without causing conditional taste avoidance in short-term high fat (HF) fed male rats in association with HF-induced increase in TGR5 expression in the NTS. In contrast, CCDC infusion into the AP failed to lower food intake in HF rats with a reduction in TGR5 expression in the AP. CCDC infusion in the NTS activates TGR5 to reverse HF-induced leptin resistance by enhancing a leptin-leptin receptor-STAT3 signaling axis selectively in the NTS to lower feeding. Finally, metabolomic analysis indicated that HF impaired a refeeding-induced rise of endogenous TGR5 ligand deoxycholic acid in the plasma and subsequently in the NTS in association with hyperphagia, while direct infusion of deoxycholic acid in the NTS of HF rats activated TGR5 to lower feeding and enhanced leptin-STAT3 signaling, thereby altogether demonstrating physiological and pharmacological activation of TGR5 in the NTS regulates food intake. In summary, we discover that an activation of TGR5 in the NTS enhances leptin-STAT3 signaling to lower food intake. Our findings highlight the potential of targeting TGR5 to reverse leptin resistance in the NTS.

The efficacy of PRECEDE-PROCEED model-based interventions on HbA1c and self-management in type 2 diabetes patients: a systematic review and meta-analysis

BACKGROUND

Type 2 diabetes is a global public health challenge characterized by high prevalence and poor self-management outcomes. The PRECEDE-PROCEED model is a well-known conceptual widely used to promote health in chronic diseases. This meta-analysis evaluated the efficacy of interventions based on PRECEDE-PROCEED model in reducing Glycated Hemoglobin A1c (HbA1c) and enhancing self-management in patients with type 2 diabetes.

METHODS

Nine online databases-PubMed, Cochrane Library, Embase, PsycINFO, Scopus, CINAHL, Web of Science, CNKI, and WANFANG-were searched from inception to June 2024. Randomized controlled trials (RCTs) and quasi-experimental studies (QESs) were identified using keywords related to the PRECEDE-PROCEED model, type 2 diabetes, and self-management. Review Manager 5.4 was used for meta-analysis and the 95% confidence intervals (CIs) was calculated for standardized mean differences (SMDs) or weighted mean differences (WMDs).

RESULTS

Fourteen studies (11 RCTs and 3 QESs) involving 2,478 patients met the eligibility criteria. Interventions significantly reduced HbA1c, with progressive improvements over time: WMD = -0.41 (95% CI: -0.58 to -0.24) at 1 month, -0.50 (95% CI: -0.67 to -0.33) at 3 months, and -0.63 (95% CI: -0.93 to -0.33) at 6 months. Significant improvements were also observed in total self-management scores (SMD = 2.53; 95% CI: 1.14to 3.91) and in key PRECEDE-PROCEED model variables, including knowledge, attitudes, self-efficacy, reinforcing, and enabling factors, though high heterogeneity was noted.

CONCLUSIONS

The PRECEDE-PROCEED model is an effective framework for reducing HbA1c and enhancing self-management among patients with type 2 diabetes. Future research should focus on standardizing intervention protocols and developing unified outcome measures to improve reproducibility and cross-study comparability.

TRIAL REGISTRATION

The PROSPERO registration ID is CRD42024600814.

tRNA fragments in diabetes mellitus

This review summarizes the research progress on tRNA-derived small RNAs (tsRNAs) in diabetes mellitus and its complications. tsRNAs, categorized into tRNA-derived stress-induced RNAs (tiRNAs) and tRNA-derived fragments (tRFs), are involved in gene expression, protein translation, apoptosis, and intercellular communication. As a class of regulatory non-coding RNAs, tsRNAs exhibit significant roles in diabetes mellitus. Specifically, tRF-1:31-Glu-CTC-1-M2 shows early diagnostic value in gestational diabetes mellitus (GDM), while 5'ValCAC combined with miR-23b-3p distinguishes maternally inherited diabetes from type 2 diabetes mellitus (T2DM) (AUC = 1.00). tsRNAs demonstrate specific expression in complications: tRF-3001a and tRF-30 are elevated in diabetic retinopathy (DR) vitreous samples and tRF-Gly-CCC-039 exacerbates diabetic foot ulcer (DFU) progression. Furthermore, specific fragments like 5'tiRNA-His-GTG and tiRNA-Val are implicated in neurovascular dysfunction during DR progression. These findings present novel insights into the precise diagnosis and therapeutic management of diabetes mellitus and diabetic complications, underscoring the considerable translational potential of tsRNAs in clinical applications.

The association between the visceral obesity indices and the future diabetes mellitus risk: A prospective cohort study

AIM

As abnormal visceral fat accumulation is the core pathophysiology of diabetes mellitus (DM), this study evaluated five novel visceral obesity indices to provide optimized clinical metabolic risk assessment tools.

MATERIALS AND METHODS

This study included 6575 participants aged ≥40 years without baseline diabetes. Waist-to-height ratio (WHtR), body roundness index (BRI), visceral adipose index (VAI), lipid accumulation product (LAP) and abdominal body shape index (ABSI) were exposure variables. Multivariable-adjusted Cox proportional hazards models analysed associations with diabetes onset; restricted cubic splines (RCS) explored dose-response relationships, stratified analyses and receiver operating characteristic (ROC) curve assessed model stability and predictive efficacy.

RESULTS

During an average follow-up period of 3.19 years, 752 (11.4%) of participants developed diabetes. Multivariable Cox regression showed that each visceral obesity index independently predicted the risk of diabetes (all P for trend <0.05), with LAP showing the strongest association (HR = 2.93, 95% CI = 2.27-4.01). The RCS model revealed the characteristics of a nonlinear dose-response relationship. Stratified analysis and sensitivity analysis confirmed the high stability of the association between LAP and the risk of diabetes. ROC curve analysis indicated that LAP had the optimal predictive efficacy (AUC = 0.752).

CONCLUSIONS

Visceral obesity indices are closely linked to the risk of diabetes onset, highlighting the potential benefits of reducing visceral fat accumulation. Among these indices, LAP emerges as the most robust clinical indicator for predicting DM risk.

Screening and Validation: AI-Aided Discovery of Dipeptidyl Peptidase-4 Inhibitory Peptides from Hydrolyzed Rice Proteins

Dipeptidyl peptidase-4 (DPP-4) inhibitors play a critical role in the management of type 2 diabetes; however, some synthetic drugs may cause adverse effects. Natural peptides derived from rice offer a promising alternative due to their favorable biocompatibility and development potential. In this study, an AI-assisted virtual screening pipeline integrating machine learning, molecular docking, and molecular dynamics (MD) simulations was established to identify and evaluate rice-derived DPP-4 inhibitory peptides. A random forest classification model achieved 85.37% accuracy in predicting inhibitory activity. Peptides generated by simulated enzymatic hydrolysis were screened based on machine learning and docking scores, and four proline-rich peptides (PPPPPPPPA, PPPSPPPV, PPPPPY, and CPPPPAAY) were selected for MD analysis. The simulation results showed that PPPSPPPV formed a stable complex with the DPP-4 catalytic triad (Ser592-Asp670-His702) through electrostatic and hydrophobic interactions, with low structural fluctuation (RMSF < 1.75 Å). In vitro assays revealed that PPPPPY exhibited the strongest DPP-4 inhibitory activity (IC50 = 153.2 ± 5.7 μM), followed by PPPPPPPPA (177.0 ± 6.0 μM) and PPPSPPPV (216.3 ± 4.5 μM). This study presents an efficient approach combining virtual screening and experimental validation, offering a structural and mechanistic foundation for the development of natural DPP-4 inhibitory peptides as candidates for functional foods or adjunct diabetes therapies.

Effects of Cereal-Derived Proteins and Peptides on Blood Glucose Levels

Some cereal proteins and their digestive peptides exhibit the potential to regulate blood glucose levels, which is important for the management of diabetes and its complications. Proteins in common grains, such as wheat and buckwheat, and in legumes, such as kidney beans and soybeans, contain proteinaceous α-amylase inhibitors (α-AIs) that inhibit the breakdown of starch into reducing sugars, thereby mitigating postprandial glucose spikes. Indigestible cereal proteins function similarly to dietary fibers by adsorbing glucose and facilitating its excretion and stabilizing blood glucose levels. Moreover, peptides derived from these proteins can suppress glucose transporter expression in the intestine, thereby reducing glucose absorption. They also promote insulin secretion by inhibiting dipeptidyl peptidase-IV (DPP-IV), an enzyme that breaks down incretin hormones. Collectively, these properties highlight the potential of cereal proteins and peptides in functional foods for blood glucose management.

Absorption and metabolic transformation mechanisms of the interaction between salvianolic acids and tanshinones in DKD rats

ETHNOPHARMACOLOGICAL RELEVANCE

Salviae Miltiorrhizae Radix Et Rhizoma (SM) (The plant name has been checked with http://www.theplantlist.org) mainly contains water-soluble salvianolic acids and fat-soluble tanshinone components, which are often used to treat diabetic kidney disease (DKD) in clinical settings.

AIM OF THE STUDY

To investigate the absorption and metabolism regulation of salvianolic acid B and tanshinone IIA combination (Comb1) along with fraction of salvianolic acids and tanshinones combination (Comb2) in DKD rats.

METHODS

Plasma concentrations of 11 salvianolic acids and tanshinone compounds of Comb2 were determined using ultra-performance liquid chromatography in rats with DKD. The Caco-2 cell monolayer model was used to study the transmembrane transport of salvianolic acids and tanshinones and compatibility of the two compounds. Finally, we assessed the effects of cytochrome P450 (CYP450) enzyme on the metabolism of salvianolic acids and tanshinones as well as the compatibility of their components in normal and DKD rats using in vitro incubation of liver microsomes.

RESULTS

The results showed that danshensu, protocatechualdehyde, dihydrotanshinone I, cryptotanshinone, tanshinone I, and tanshinone IIA were well-absorbed in vivo. Salvianolic acid B and salvianolic acids promoted the absorption of tanshinone IIA, whereas tanshinones promoted the absorption of danshensu and inhibited the absorption of protocatechualdehyde. In vitro incubation of liver microsomes showed that salvianolic acids may not undergo phase I metabolism. The pathological status of DKD affected the metabolic rates of tanshinones not the content of total CYP450 enzymes.

CONCLUSION

The molecular compatibility of salvianolic acid B and tanshinone IIA as well as of salvianolic acids and tanshinones act synergistically to improve DKD by affecting drug absorption and metabolism. This study provides an experimental basis for research and development of new drugs related to salvianolic acids and tanshinones.

Qing'e Pill rectifies bone homeostasis imbalance in diabetic osteoporosis via the AGE/RAGE pathway: A network pharmacology analysis and multi-omics validation

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetic osteoporosis (DOP), a metabolic disorder arising from diabetes mellitus, results in a hyperglycemic state that impairs bone microstructure, strength, and quality, thereby increasing the risk of fractures and complicating treatment and rehabilitation. Qing'e Pill(QEP), first recorded in the Song Dynasty's Heji Ju Fang, is renowned as an effective formula for tonifying the kidneys and strengthening bones. Its potential therapeutic mechanisms for treating DOP remain to be explored.

AIM OF THE STUDY

This study aimed to elucidate the therapeutic mechanism of QEP, a Chinese herbal medicine compound, in the treatment of DOP by integrating network pharmacology and laboratory analyses.

MATERIALS AND METHODS

Gene targets associated with DOP were identified utilizing gene databases (GeneCards, TTD, OMIM). The active ingredients of QEP were characterized via HPLC analysis. The therapeutic potential of QEP was assessed in a rat model of DOP by monitoring blood glucose levels, employing Micro-CT imaging, and conducting histological staining. In vitro experiments were performed to confirm QEP's ability to promote bone formation. Additionally, its angiogenic potential was evaluated using scratch, migration, and tube formation assays.

RESULTS

QEP was observed to stimulate osteogenesis and angiogenesis in vitro, modulate the AGE/RAGE signaling pathway, and foster anti-inflammatory osteogenesis. Micro-CT analysis demonstrated significant enhancements in bone density and microstructure following QEP treatment.

CONCLUSION

QEP enhance osteogenesis and angiogenesis via the AGE/RAGE signaling pathway, offering anti-inflammatory, hypoglycemic, and anti-osteoporotic effects. These results support the potential clinical application of QEP in managing diabetic osteoporosis.

Icariin alleviates cardiomyocyte pyroptosis through AMPK-NLRP3 pathway to ameliorates diabetic cardiomyopathy

Among the multitude of pressing global health concerns, diabetes mellitus stands out as a significant issue. An alarming consequence of this condition is diabetic cardiomyopathy (DCM), which represents a critical contributor to mortality in individuals with diabetes. Recently, research has unveiled the pivotal role that pyroptosis plays in the progression of myocardial fibrosis associated with DCM. An epimedial flavonoid monomer, Icariin (ICA), primarily sourced from Epimedium genus plants, has shown a safeguarding influence on cardiac health through various means, encompassing anti-inflammatory actions and its capacity against oxidative stress. Our research endeavor focuses on elucidating the beneficial impacts alongside the underlying physiological processes triggered by ICA within the context of DCM. An animal model representative of DCM was developed through intraperitoneal administration of streptozotocin (STZ). In parallel, in vitro experiments utilized H9C2 cardiomyocytes to mimic hyperglycemic environments relevant to disease states. In vivo experiments found that ICA improved cardiac function, alleviated myocardial fibrosis, and reduced NLRP3-mediated pyroptosis in heart tissue of DCM mice. Under in vitro settings characterized by elevated glucose concentrations, there was a notable elevation in both NLRP3 pyroptosis-associated proteins and oxidative stress markers within the heart muscle cells. ICA treatment attenuated pyroptosis and oxidative stress caused by high glucose in cardiomyocytes. Further studies revealed that when treated with an AMPK inhibitor, the shielding benefits conferred by ICA on cardiomyocytes were negated, suggesting that the regulatory effects of ICA on cardiomyocyte pyroptosis may be achieved through the AMPK-NLRP3 pathway. In conclusion, ICA exerts protective effects in DCM by inhibiting cardiomyocyte pyroptosis, alleviating myocardial fibrosis, and improving cardiac function via the AMPK-NLRP3 pathway.

Factors influencing health-related quality of life among people with uncontrolled type II diabetes mellitus in Wenzhou, China: A cross-sectional study

Background

China has a high prevalence of Type 2 Diabetes Mellitus (T2DM), and more than half of the population has uncontrolled blood sugar levels. As a result, this leads to a reduction in health-related quality of life (HRQOL). Therefore, identifying the factors that influence HRQOL in individuals with uncontrolled T2DM is a clinical priority.

Objectives

This study aimed to describe the level of HRQOL among people with uncontrolled T2DM in Wenzhou, China, and to examine the predictive factors, including social support, diabetes distress, self-efficacy, and health literacy, in relation to HRQOL among these individuals.

Methods

This predictive correlational study used a simple random sampling technique to recruit 107 adults with uncontrolled T2DM from the Endocrinology outpatient department at the First Affiliated Hospital of Wenzhou Medical University in Wenzhou, China, between August and September 2024. Data were collected through questionnaires and standardized tools to assess the correlation between HRQOL, social support, health literacy, self-efficacy, and diabetes distress. Data were analyzed using descriptive statistics and multiple regression analysis.

Results

The HRQOL in this study was moderate (Mean = 3.34, SD = 0.31). Significant factors associated with HRQOL were health literacy (r = 0.819, p <0.01), self-efficacy (r = 0.825, p <0.01), and social support (r = 0.477, p <0.01). All predictor variables in the regression model collectively explained 79.8% of the variance in HRQOL among individuals with uncontrolled T2DM. Furthermore, health literacy (β = 0.426, p <0.001), self-efficacy (β = 0.463, p <0.001), and social support (β = 0.130, p = 0.009) were significant predictors of HRQOL.

Conclusion

Enhancing health literacy, self-efficacy, and social support is crucial for improving HRQOL. Healthcare professionals and nurses should develop and implement intervention programs that help individuals and families enhance their critical thinking abilities and adopt lifestyles that support disease management and improve HRQOL.

Spontaneous brain activity in patients with type 2 diabetes: linking serum neuroproteins to cognitive ability

BACKGROUND

Cognitive impairment is a complication of type 2 diabetes with high prevalence and serious harm. This study aims to identify serum and imaging biomarkers of type 2 diabetes with mild cognitive impairment (MCI) and to study whether spontaneous brain activities evaluated by functional MRI mediate the relationships between these serum neuroprotein biomarkers and cognitive ability.

METHODS

According to Montreal Cognitive Assessment (MoCA) scores, 38 patients with MCI and 32 patients with normal cognition in type 2 diabetes were recruited. Serum neuroproteins were determined with Olink Proteomics. Brain activities were evaluated by functional MRI. Logistic regression were performed to determine the biomarkers of type 2 diabetes with MCI. Mediation analysis were performed to examine the potential causal chain between the neuroproteins and cognitive ability.

RESULTS

The levels of Epiregulin (EREG), Abhydrolase domain containing 14B (ABHD14B) and Inositol monophosphatase 1 (IMPA1) decreased, while the level of Cysteine-rich intestinal protein 2 (CRIP2) increased in type 2 diabetic patients with MCI (FDR p < 0.05). Combination of EREG and CRIP2, a ROC curve was generated with an AUC of 0.85 and an accuracy of 70.0%, and a sensitivity of 86.7% for diagnosing type 2 diabetes with MCI. Brain activities in bilateral superior parietal gyrus, bilateral postcentral gyrus, left inferior frontal gyrus, right cerebellum 6, left cerebellum crus1 decreased, while increased in right hippocampus and left middle frontal gyrus in type 2 diabetic patients with MCI (FDR p < 0.05). The mALFF values in the left cerebellum crus-1 mediated 29.1% of the association between the EREG and MoCA scores (p < 0.001). The mALFF values in the right cerebellum-6, left cerebellum crus-1, right hippocampus, right superior parietal gyrus and right postcentral gyrus all significantly and partially mediated the association between ABHD14B levels and MoCA scores, with mediating effects of 21.7%, 27.1%, 25.8%, 20.7% and 19.2%, respectively (all p values < 0.001).

CONCLUSIONS

Type 2 diabetic patients with MCI exhibit specific serum neuroprotein and functional MRI characteristics. The relationships between these neuroproteins and cognitive ability were mediated by spontaneous brain activities.

Association between cerebral lesions and the severity of diabetic cardiovascular disease, retinopathy, and nephropathy-new lessons to learn from neuroimaging

Diabetes is associated with cerebrovascular lesions detectable through neuroimaging. Neuroimaging is traditionally valued for its insights into the structure of the central nervous system. However, the brain is connected with other organs. The vascular system, hormones, and peripheral nerve system connect the brain to other sections of the body bidirectionaly. This interaction between the brain and other parts encourages us to look at the total body, not just its different parts separately. Growing evidence has shown the link between brain injuries and cardiac, retinal, and kidney disorders, suggesting that neuroimaging has the potential to provide valuable information about peripheral organs This is particularly crucial for a systemic disease like diabetes, which affects the entire body. In this review, we aim to first discuss the data that neuroimaging can reveal about the severity of diabetic retinopathy, nephropathy, and cardiovascular disease in diabetic patients. This interdisciplinary approach could guide the design of new randomized controlled trials, screening programs, and an integrated clinical practice. This study explores the mechanisms underlying the association between the brain and other organs in the context of diabetes. Then we will consider their implications for future research and clinical practice.

Synergistically enhanced Ni-MOF/CNTs nanocomposite as an electrochemical platform for ultrasensitive determination of sotagliflozin in various matrices, with whiteness and blueness assessments

An electrochemical sensing platform based on a nickel metal-organic framework/carbon nanotubes (Ni-MOF/CNTs) nanocomposite has been developed for the determination of sotagliflozin, the first dual sodium-glucose co-transporter inhibitor recently approved by the FDA. The nanocomposite was synthesized using a simple one-pot solvothermal method and characterized by Raman spectroscopy, Fourier-transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), scanning electron microscope (SEM), and electrochemical impedance spectroscopy (EIS). The Ni-MOF/CNTs nanocomposite demonstrates superior electrochemical properties compared with its monocomponent counterparts, due to the synergistic combination of the advantages of both materials. The electrochemical behavior and the oxidation mechanism of sotagliflozin at the electrode surface were investigated using cyclic voltammetry (CV). Under optimal conditions, the sensor exhibits wide linearity across two concentration ranges: 8.0 × 10-10 to 6.0 × 10-7 M and 6.0 × 10-7 to 8.0 × 10-5 M, using differential pulse voltammetry (DPV) with a detection limit of 2.65 × 10-10 M. Good recoveries (96.60-102.83%) were achieved in human plasma, urine, and tablets. The whiteness assessment confirms the method's sustainability, while the blueness assessment demonstrates its applicability. The sensor's outstanding performance addresses the unmet need for a simple and accurate tool for sotagliflozin determination in biological and pharmaceutical samples, as no existing analytical methods are available for its determination in different matrices. This makes it a valuable tool for sotagliflozin therapeutic drug monitoring, point-of-care diagnostics, and quality control.

Efficacy and safety of Pueraria lobata radix as an adjuvant therapy for type 2 diabetes mellitus: rationale, design and protocol for a randomised controlled trial

INTRODUCTION

The current pharmacological management of type 2 diabetes mellitus (T2DM) faces challenges such as low rates of optimal glycaemic control, high incidences of adverse drug reactions and suboptimal treatment compliance. Pueraria lobata radix (PLR), a medicinal and edible herb, has shown hypoglycaemic effects in animal models. However, existing clinical studies have only assessed the hypoglycaemic effect of PLR-containing herb formulas or PLR extract preparations. The aim of this study is to investigate the efficacy and safety of using PLR solely as an adjuvant therapy for T2DM.

METHODS AND ANALYSIS

This study is a multicentre, randomised, double-blind, placebo-controlled trial. 200 patients with T2DM will be randomly allocated to either the PLR group or the placebo group for a consecutive 12-week intervention. Regular visits will be conducted at weeks 4, 8 and 12, following the initiation of the study to evaluate the efficacy and safety of PLR. The primary outcome is the change in haemoglobin A1c (HbA1c) from baseline at week 12. Secondary outcomes include changes in HbA1c from baseline at weeks 4 and 8; the HbA1c response rate (< 7%), changes in fasting blood glucose, 2-hour blood glucose, fasting C-peptide, body mass index, severity of diabetes symptoms, quality of life from baseline at weeks 4, 8 and 12; and changes in blood lipid indicators at week 12. Safety outcomes include the incidences of total adverse events (AEs), serious AEs and PLR-related AEs.

ETHICS AND DISSEMINATION

The protocol has been approved by the Ethics Committees of the First Affiliated Hospital of Nanchang University (approval number: IIT[2024]LLS No.303) and the Affiliated Hospital of Jiangxi University of Chinese Medicine (approval number: JZFYLL2024006200087). We will disseminate the study findings through publications in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT06494683.

Young-onset type 2 diabetes-Epidemiology, pathophysiology, and management

The prevalence and incidence of young-onset type 2 diabetes is increasing globally, especially in low- and middle-income countries, and predominantly affects non-White ethnic and racial populations. Young-onset type 2 is heterogeneous in terms of the genetic and environmental contributions to its underlying pathophysiology, which poses challenges for glycemic management. Young at-risk individuals remain underrepresented in clinical trials, including diabetes prevention studies, and there is still an insufficient evidence base to inform practice for this age group. Improvements in diabetes care delivery have not reached young people who will progress to have disabling complications at an age when they are most productive. This review summarizes recent studies on the epidemiology of young-onset type 2 diabetes and its complications. We discuss the genetic and environmental risk factors that act in concert to promote glycemic dysregulation and early onset of type 2 diabetes. We provide perspectives on diabetes prevention and management, and propose strategies to address the unique medical and psychosocial issues associated with young-onset type 2 diabetes. The Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes Randomized Controlled Trial (PRISM-RCT) is the first large-scale clinical trial designed to evaluate the effect of a structured care model that integrates biogenetic markers with communication and information technology on attaining strict metabolic targets and improving clinical outcomes in individuals with young-onset type 2 diabetes. The results of this study will inform the scientific community about the impact of multifactorial intervention and precision care in young patients, for whom the legacy effect is particularly significant.

Diabetes affects AD through plasma Aβ40: A Mendelian randomization study

Amyloid and tau proteins are important proteins in the pathological changes of Alzheimer's disease (AD), while Aβ pathology and tau pathology are the most critical factors contributing to the development of AD. Some studies have shown that there is a causal relationship between AD and diabetes mellitus, but there are no studies showing a causal relationship between diabetic traits and AD biomarkers, so further exploration is needed. We first summarized and analyzed the currently published literature on the link between diabetes and AD through a systematic review. Forest plots were used to observe whether there is an association between diabetes and AD. Then a two-sample Mendelian randomization (MR) analysis based on GWAS summary statistics was performed to verify the causal relationship between diabetic traits and AD biomarkers. Based on summary statistics from the GWAS, potential causal relationships between diabetic traits and AD biomarkers were explored separately. The results of the meta-analysis part showed that diabetes can increase the risk of AD. Meanwhile, our two-sample MR results showed a significant causal relationship between diabetes and plasma Aβ40. In addition, our two-sample MR results also showed a causal relationship between increased HbA1c and plasma APLP2. Other diabetic traits may have potential effects on different AD plasma markers.

Acupoint injection increases the efficacy of vitamin B12 for diabetic neuropathy: a meta-analysis and trial sequential analysis

This study aims to systematically evaluate the efficacy and safety of vitamin B12 acupoint injections compared to other administration routes in treating diabetic neuropathy (DN). We included 20 randomized controlled trials published before March 1, 2024, sourced from eight public databases, involving 1688 participants. Subsequently, we recorded their basic data, investigated their risk of bias, and then carried out a meta-analysis and trial sequential analysis (TSA). The meta-analysis revealed that compared to other administration routes of vitamin B12, acupoint injection significantly improved the clinical effectiveness proportion by 28% (risk ratio [RR] 1.28, 95% confidence interval [CI] 1.22-1.35), peroneal nerve motor nerve conduction velocity (MNCV) by 4.43 m/s (MD 4.43, 95% CI 2.83-6.03), peroneal nerve sensory nerve conduction velocity (SNCV) by 3.82 m/s (MD 3.82, 95% CI 3.23-4.41), median nerve MNCV by 5.48 m/s (MD 5.48, 95% CI 4.71-6.24), and median nerve SNCV by 4.62 m/s (MD 4.62, 95% CI 3.84-5.39) in patients with DN, while having no significant impact on fasting blood glucose (FBG) (MD -0.18, 95% CI -0.44 to 0.08), 2-h postprandial blood glucose (2h-PBG) (MD -0.02, 95% CI -0.36 to 0.33), and the adverse event incidence (RR 1.44, 95% CI 0.44-4.70). TSA indicated that except for FBG, 2h-PBG, and adverse event incidence, the remaining meta-analysis results were conclusive. These findings indicate that compared to other administration routes of vitamin B12, acupoint injection improves neurological function in patients with DN without increasing adverse events and economic burden, suggesting that it may be the optimal administration route for vitamin B12.