Does obesity cause type 2 diabetes mellitus (T2DM)? Or is it the opposite?

Longitudinal genotype-phenotype analysis in 86 patients with PAX6-related aniridia

Aniridia is most commonly caused by haploinsufficiency of the PAX6 gene, characterized by variable iris and foveal hypoplasia, nystagmus, cataracts, glaucoma, and aniridia-related keratopathy (ARK). Genotype-phenotype correlations have previously been described; however, detailed longitudinal studies of aniridia are less commonly reported. We identified 86 patients from 62 unrelated families with molecularly confirmed heterozygous PAX6 variants from a UK-based single-center ocular genetics service. They were categorized into mutation groups, and a retrospective review of clinical characteristics (ocular and systemic) from baseline to most recent was recorded. One hundred and seventy-two eyes were evaluated, with a mean follow-up period of 16.3 ± 12.7 years. Nystagmus was recorded in 87.2% of the eyes, and foveal hypoplasia was found in 75%. Cataracts were diagnosed in 70.3%, glaucoma in 20.6%, and ARK in 68.6% of eyes. Prevalence, age of diagnosis and surgical intervention, and need for surgical intervention varied among mutation groups. Overall, the missense mutation subgroup had the mildest phenotype, and surgically naive eyes maintained better visual acuity. Systemic evaluation identified type 2 diabetes in 12.8% of the study group, which is twice the UK prevalence. This is the largest longitudinal study of aniridia in the UK, and as such, it can provide insights into prognostic indicators for patients and guiding clinical management of both ocular and systemic features.

Obesity in people with diabetes in COVID-19 times: Important considerations and precautions to be taken

At the end of 2019, a new disease with pandemic potential appeared in China. It was a novel coronavirus called coronavirus disease 2019 (COVID-19). Later, in the first quarter of 2020, the World Health Organization declared the outbreak of this disease a pandemic. Elderly people, people with comorbidities, and health care professionals are more vulnerable to COVID-19. Obesity has been growing exponentially worldwide, affecting several age groups. It is a morbidity that is associated with genetic, epigenetic, environment factors and/or interaction between them. Obesity is associated with the development of several diseases including diabetes mellitus, mainly type 2. Diabetes affects a significant portion of the global population. Obesity and diabetes are among the main risk factors for the development of severe symptoms of COVID-19, and individuals with these conditions constitute a risk group. Based on a literature review on obesity in people with diabetes in the framework of the COVID-19 pandemic, this study presents updated important considerations and care to be taken with this population.

Association of a composite score of relative grip strength and timed up and go test with incident type 2 diabetes mellitus: Guangzhou Biobank Cohort Study

Background: We investigated association of a score incorporating relative grip strength (RGS) and timed up and go (TUG) test with incident type 2 diabetes mellitus (T2DM) in older Chinese.

Methods: Both RGS and TUG scores were classified into tertiles (0~2 points) and summed to yield RGS-TUG score, ranging from 0 to 4 points, with higher points indicating better physical function. Cox proportional hazards regression was used to analyze association of RGS-TUG score with incident T2DM.

Results: 3,892 participants without T2DM were followed up for an average of 3.6 years with 240 developing T2DM. After adjustment, those with the lowest RGS-TUG score, versus the highest, had higher fasting glucose, two-hour post-load glucose and glycosylated hemoglobin A1c, with β (95% confidence interval (CI)) being 0.21 (0.08, 0.33), 1.06 (0.69, 1.43) and 0.16 (0.06, 0.27), respectively. In participants with BMI of ≥25 kg/m2, those with the lowest RGS-TUG score showed a higher risk of T2DM (adjusted hazard ratio 3.01, 95% CI 1.04–8.69). No association was found for BMI of 18.5~<25 kg/m2 (P for interaction < 0.05).

Conclusions: This is the first study showing lower RGS-TUG score was associated with increased glycemia and incident T2DM in older people with overweight/obesity. The underlying mechanisms warrant further investigation.

Ectopic Overexpression of PPARγ2 in the Heart Determines Differences in Hypertrophic Cardiomyopathy After Treatment With Different Thiazolidinediones in a Mouse Model of Diabetes

The clinical controversy of rosiglitazone as a hypoglycemic agent is potentially associated with heart failure, mainly due to its potent activation of peroxisome proliferator-activated receptor γ (PPARγ). PPARγ partial agonists showed superior pharmacological profiles to rosiglitazone. This study compared differences in cardiac morphology and function of the PPARγ partial agonist CMHX008 with rosiglitazone. High-fat diet (HFD) induced obese mice, ob/ob mice and cardiomyocytes overexpressing PPARγ2 were treated with CMHX008 or rosiglitazone. Heart function, myocardial morphology, and hypertrophy-related gene expression were examined. Clinical information from patients with type 2 diabetes mellitus (T2DM) who had taken rosiglitazone and undergone Doppler echocardiography was collected. HFD and ob/ob mice significantly developed cardiac contractile dysfunction, with upregulated PPARγ2 protein levels in heart tissues. Cardiomyocytes of HFD and ob/ob mice were disorderly arranged, the cell areas expanded, and collagen accumulated. In vitro cardiomyocytes overexpressing PPARγ2 displayed obvious structural abnormalities and high mRNA levels of ANP and BNP, critical cardiac hypertrophy-related genes. HFD-fed mice treated with rosiglitazone or CMHX008 had significantly improved cardiac function, but rosiglitazone induced higher expression of ANP and βMHC and hypertrophic cardiomyopathy, while CMHX008 did not. Patients with T2DM taking rosiglitazone exhibited increased thickness of the posterior wall and the ventricular septum, suggesting cardiac hypertrophy. Our findings show that diabetic cardiomyopathy was associated with ectopic overexpression of PPARγ2. The full agonist rosiglitazone prevents cardiac dysfunction at the expense of compensatory hypertrophy, while the partial agonist CMHX008 shared a comparable protective effect without altering the structure of cardiomyocytes.

Prevalence and clinical characteristics of prediabetes and diabetes mellitus in young patients with ST-segment elevation myocardial infarction

BACKGROUND

Only few data on the prevalence of DM in young patients with ST-elevation myocardial infarction (STEMI) exist. Aim of the present study was to analyse this prevalence, its association to other cardiovascular risk factors and its impact on severity of CAD. In a substudy, consecutive HbA1c measurements in each patient were evaluated.

METHODS

All patients ≤ 45 years old, admitted with STEMI to an overregional German Heart Centre and treated with primary coronary intervention between 2006 and 2019, entered analysis. Since 2015 HbA1c measurements were performed to detect unknown dysglycaemia.

RESULTS

Out of 776 young patients of the total cohort, 88 patients (11.4%) had a DM, while 688 (88.6%) did not. Diabetics were more likely to be obese (BMI ≥ 30 kg/m², OR 2.4, 95%CI 1.4-4.0, p < 0.01) and very obese (BMI ≥ 40 kg/m², OR 5.1, 95%CI 2.1-12.2, p < 0.01). In diabetics, a higher likelihood of subacute STEMI (OR 2.2, 95% CI 1.1-4.5, p < 0.05) and more advanced CAD (OR 1.6, 95% CI 1.0-2.6, p < 0.05) compared to non-diabetics was observed. 208 patients were included in the substudy with HbA1c measurements. Out of those, 26 patients (12%) had known DM, while 17 patients (8%) had newly diagnosed DM and 49 patients (24%) preDM. The combined prevalence of any type of dysglycaemia was 44%.

CONCLUSION

DM in young patients with STEMI was associated with (severe) obesity, a higher likelihood of subacute STEMI and more advanced CAD compared to non-diabetics. Measurement of HbA1c in every consecutive STEMI-patient increased the rate of detected dysglycaemias more than three times higher than in general population.

Does obesity mediate the relationship between diabetes and osteoporosis in Chinese elderly population?

OBJECTIVES

Diabetes mellitus (DM), osteoporosis (OP), and obesity (OB) are three complex diseases. OB is associated with both DM and OP, but it is unclear whether OB mediates association between DM and OP. The study aimed to investigate the potential mediation effects of OB on association between DM and bone mineral density (BMD) by the causal inference tests (CIT).

METHODS

A total of 5682 Chinese aged over 65 years were enrolled in an ongoing cohort: Osteoporosis Preventive Project (OPP). Obesity-related indexes, including body mass index (BMI), waist circumference, and waist circumference-hip circumference-ratio (WHR), and BMD at total hip (TH) and femur neck (FN) were measured.

RESULTS

Subjects with DM had significant greater values of age, weight, BMI, waist circumference, WHR, and BMD than non-DM subjects. BMD at TH and FN was significantly associated with DM (p < 0.05) with adjustment of age both in males and females. Further CIT showed that OB-related indexes (BMI, waist circumference, and WHR) are significantly mediators in the associations between DM and BMD in females, but not in males. Furthermore, the mediation effects of waist circumference were detected on DM and TH BMD in the females of normal-weight group.

CONCLUSIONS

Obesity-related indexes, especially waist circumference, serve as significant mediator(s) between DM and OP in Chinese female elderly. Diabetes increases BMD by increasing obesity-related indexes. The findings established the intermediate role of OB underlying the association between DM and OP in human population.

Obesity Management Education Needs Among General Internists: A Survey

Objective

The purpose of this study was to determine self-reported knowledge, attitudes, prior experience, and perceived needs for the management of overweight and obese patients within a General Internal Medicine Practice.

Patients and Methods

An emailed cross-sectional survey was sent between June 20, 2019 and September 12, 2019 to 194 healthcare workers (93 primary care providers (PCPs) and 101 nurses) which focused on management of patients with weight issues.

Results

In total, 80 of the eligible 194 participants completed the survey (nurses = 42, PCPs = 38). Up to 87% were white, 74.7% female (74.7%). Most of the responders were either in the age group of 30’s (30%) or 50’s (30%). Among the responders, 48.8% reported some type of specialty training in weight management since their medical training with lectures being the most common form of training (36%). When asked about their interest in either weight management training or strategies to initiate weight conversations, 79% of the respondents reported an interest in education on weight management or strategies to initiate weight conversations, while 65.8% indicated they would be interested in both topics.

Conclusion

Our study suggests that healthcare workers have a self-reported need for further training in management of overweight and obese patients, irrespective of previous training in this area.

Metabolic Aspects of Migraine: Association With Obesity and Diabetes Mellitus

Migraine is a disabling neurovascular disorder, characterized by moderate to severe unilateral headaches, nausea, photophobia, and/or phonophobia, with a higher prevalence in women than in men, which can drastically affect the quality of life of migraine patients. In addition, this chronic disorder is related with metabolic comorbidities associated with the patient's lifestyle, including obesity and diabetes mellitus (DM). Beyond the personal and socioeconomic impact caused by migraine, obesity and DM, it has been suggested that these metabolic disorders seem to be related to migraine since: (i) they are a risk factor for developing cardiovascular disorders or chronic diseases; (ii) they can be influenced by genetic and environmental risk factors; and (iii) while clinical and epidemiological studies suggest that obesity is a risk factor for migraine, DM (i.e., type 1 and type 2 DM) have been reported to be either a protective or a risk factor in migraine. On this basis, and given the high worldwide prevalence of migraine, obesity, and DM, this article provides a narrative review of the current literature related to the association between the etiology and pathophysiology of migraine and these metabolic disorders, considering lifestyle aspects, as well as the possible involvement of neurotransmitters, neuropeptides, and/or sex hormones. While a link between migraine and metabolic disorders has been suggested, many studies are contradictory and the mechanisms involved in this association are not yet sufficiently established. Therefore, further research should be focused on understanding the possible mechanisms involved.

Potential biomarker in serum for predicting susceptibility to type 2 diabetes mellitus: Free fatty acid 22:6

AIMS/INTRODUCTION

Type 2 diabetes mellitus is closely linked to increased levels of free fatty acids (FFAs) in obese individuals, although which FFA is most associated with type 2 diabetes mellitus is unclear. This study aimed to identify the specific FFAs that best predict the occurrence of type 2 diabetes mellitus in obese individuals, and assess their potential application value.

MATERIALS AND METHODS

Participants were divided into three groups: a normal weight group (n = 20), an obese group (n = 10) and a type 2 diabetes mellitus group (n = 10). FFAs in serum samples were determined by ultra-high-pressure liquid chromatography-mass spectrometry, and orthogonal partial least squares discriminant analysis models were used to study the FFA profile among the three groups.

RESULTS

Compared with the normal weight group, 14 FFAs (C8:0/10:0/14:0/16:1/18:1/20:2/ 20:3 /20:4/ 20:5/ 22:6/7:0/9:0/11:0 and C13:0) were significantly increased in the obese group, and nine FFAs (C14:0, C18:1, C20:1, C 18:2, C20:2, C20:3, C18:3, C20:5 and C22:6) were significantly increased in the type 2 diabetes mellitus group. Subsequently, the Venn diagram results showed that six FFAs (C14:0, C18:1, C20:2, C20:3, C20:5 and C22:6) were significantly increased in both the obese and type 2 diabetes mellitus groups. Among these six, C22:6 was finally identified as an independent risk factor for type 2 diabetes mellitus, and had a great potential to predict the susceptibility to type 2 diabetes mellitus (area under the curve 0.803).

CONCLUSIONS

C22:6 can be an independent risk factor for type 2 diabetes mellitus, and it has a great potential to predict the susceptibility to type 2 diabetes mellitus.

Snoring frequency and risk of type 2 diabetes mellitus: a prospective cohort study

OBJECTIVE

To evaluate the association between snoring frequency and type 2 diabetes mellitus (T2DM) according to age and gender in Chinese population.

DESIGN

A cohort study was performed in Suzhou site of the China Kadoorie Biobank. Residents who didn't suffer from T2DM at baseline survey (2004-2008) and in half a year after baseline were enrolled in this study and followed cause-specific morbidity until 31 December 2013. All participants were requested to complete a detailed questionnaire and undergo anthropometric measurements. Cox regression models were used to estimate HRs and 95% CIs for the snoring and T2DM association.

SETTING

Wuzhong district, Suzhou, China.

PARTICIPANTS

A total of 49 453 participants (men: 41.8%; mean age: 51.14±10.28 years) were enrolled in this study.

OUTCOME MEASURES

T2DM cases were defined as International Classification of Diseases 10th Revision code of E11 and were identified through disease registries and health insurance databases.

RESULTS

During a media of 7.18 years follow-up, 1120 T2DM cases were identified. Higher T2DM incidence was observed in participants with frequent and occasional snoring compared with those without (4.80 and 2.87 vs 2.39 per 1000 person-years). The multivariable-adjusted model found snoring was independently associated with T2DM (HR 1.28, 95% CI 1.20 to 1.38), both in men (HR 1.25, 95% CI 1.10 to 1.41) and women (HR 1.28, 95% CI 1.17 to 1.39). Moreover, a significant multiplicative interaction effect between snoring and age was detected on T2DM risk (p=0.015).

CONCLUSIONS

Snoring was independently associated with an increased risk of T2DM in Chinese population, both in men and women. Meanwhile, there was an interaction effect between snoring and age on T2DM risk.

Sesamol promotes browning of white adipocytes to ameliorate obesity by inducing mitochondrial biogenesis and inhibition mitophagy via β3-AR/PKA signaling pathway

Background

Obesity is defined as an imbalance between energy intake and expenditure, and it is a serious risk factor of non-communicable diseases. Recently many studies have shown that promoting browning of white adipose tissue (WAT) to increase energy consumption has a great therapeutic potential for obesity. Sesamol, a lignan from sesame oil, had shown potential beneficial functions on obesity treatment.

Objective

In this study, we used C57BL/6J mice and 3T3-L1 adipocytes to investigate the effects and the fundamental mechanisms of sesamol in enhancing the browning of white adipocytes to ameliorate obesity.

Methods

Sixteen-week-old C57BL/6J male mice were fed high-fat diet (HFD) for 8 weeks to establish the obesity models. Half of the obese mice were administered with sesamol (100 mg/kg body weight [b.w.]/day [d] by gavage for another 8 weeks. Triacylglycerol (TG) and total cholesterol assay kits were used to quantify serum TG and total cholesterol (TC). Oil red O staining was used to detect lipid droplet in vitro. Mito-Tracker Green was used to detect the mitochondrial content. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the levels of beige-specific genes. Immunoblotting was used to detect the proteins involved in beige adipocytes formation.

Results

Sesamol decreased the content of body fat and suppressed lipid accumulation in HFD-induced obese mice. In addition, sesamol significantly upregulated uncoupling protein-1 (UCP1) protein in adipose tissue. Further research found that sesamol also significantly activated the browning program in mature 3T3-L1 adipocytes, manifested by the increase in beige-specific genes and proteins. Moreover, sesamol greatly increased mitochondrial biogenesis, as proved by the upregulated protein levels of mitochondrial biogenesis, and the inhibition of the proteins associated with mitophagy. Furthermore, β3-adrenergic receptor (β3-AR), protein kinase A-C (PKA-C) and Phospho-protein kinase A (p-PKA) substrate were elevated by sesamol, and these effects were abolished by the pretreatment of antagonists β3-AR.

Conclusion

Sesamol promoted browning of white adipocytes by inducing mitochondrial biogenesis and inhibiting mitophagy through the β3-AR/PKA pathway. This preclinical data promised the potential to consider sesamol as a metabolic modulator of HFD-induced obesity.

Effect of SGLT inhibitors on weight and lipid metabolism at 24 weeks of treatment in patients with diabetes mellitus: A systematic review and network meta-analysis

BACKGROUND

The goals of improving quality of life and increasing longevity are receiving growing amounts of attention. Body weight and lipid metabolism are closely related to various complications of diabetes. The aim of this study was to rank SGLT inhibitors according to their efficacy with regard to weight and evaluate the effect of SGLT inhibitors on lipid metabolism at 24 weeks of treatment.

METHODS

The Web of Science, PubMed, Cochrane Library, Embase, and Clinical Trials databases were electronically searched to collect randomized controlled trials involving patients with type 2 diabetes mellitus through June 2020. Two researchers independently screened and evaluated the selected studies and extracted the outcome indexes. ADDIS 1.16.5 and STATA 16 software were used to perform the network meta-analysis and draw the plots.

RESULTS

Ultimately, 36 studies were selected and included in this study. We found that all SGLT inhibitors were effective at reducing weight; canagliflozin was the most effective. SGLT inhibitors and placebo were not associated with significantly different serum cholesterol levels. SGLT inhibitors lowered serum triglyceride levels and increased serum high-density and low-density lipoprotein cholesterol levels. SGLT inhibitors also reduced the level of alanine aminotransferase.

CONCLUSIONS

SGLT inhibitors can bring about weight loss in patients with T2DM and can also improve lipid metabolism. Therefore, patients with hyperlipidemia who have been unsuccessful at losing weight should consider taking SGLT inhibitors. In addition, SGLT inhibitors are hepatoprotective and appear to be safe for patients with mild to moderate liver dysfunction.

TRIAL REGISTRATION

CRD42020198516.

Level of and Related Factors to Diabetes Awareness among Diabetic Adults by Gender: Based on Data from the Korean National Health and Nutrition Examination Survey

PURPOSE

This study aimed to determine the level of awareness about diabetes mellitus (DM) and identify the associated factors among diabetic adults in Korea by sex, using data from most recent nationwide representative survey.

METHODS

Secondary data analysis was conducted using data obtained from the Korean National Health and Nutrition Examination Survey VII (2016-2018). In total, 2,026 participants (1,049 men, 977 women) aged ≥30 years with DM were included. Data were analyzed using a complex sample analysis considering the combined sampling weight for 3 years. Odds ratios and 95% confidence intervals were calculated using stepwise multiple logistic regression analysis to identify the association between DM awareness (DA) and sociodemographic and health-related factors.

RESULTS

Researchers observed that 60.2% of men and 68.4% of women had DA. DA levels in both men and women were higher in those who were older, less educated, had normal weight, had hypertension and/or dyslipidemia, and had a family history of DM than in their counterparts. Having undergone a health screening in the past 2 years was associated with DA levels in men, whereas glycated hemoglobin levels of 5.7-6.4% were associated with higher DA levels in women.

CONCLUSION

The level of DA is unsatisfactory. Although the DA level is slightly higher in women than in men, it needs to be improved regardless of gender. Most of the factors associated with DA levels are similar in both men and women. Nurses in the community setting should provide health education, conduct campaigns, and promote referral to medical services by targeting the high-risk groups with lower DA identified in this study.

Characterization of Mechanical Allodynia and Skin Innervation in a Mouse Model of Type-2 Diabetes Induced by Cafeteria-Style Diet and Low-Doses of Streptozotocin

Background: Painful distal symmetrical polyneuropathy (DPN) is a frequent complication of type-2 diabetes mellitus (T2DM) that commonly presents as neuropathic pain and loss of skin nerve fibers. However, there are limited therapies to effectively treat DPN and many of the current animal models of T2DM-induced DPN do not appear to mirror the human disease. Thus, we validated a DPN mouse model induced by a cafeteria-style diet plus low-doses of streptozotocin (STZ).

Methods: Female C57BL/6J mice were fed either standard (STD) diet or obesogenic cafeteria (CAF) diet for 32 weeks, starting at 8 weeks old. Eight weeks after starting diets, CAF or STD mice received either four low-doses of STZ or vehicle. Changes in body weight, blood glucose and insulin levels, as well as oral glucose- and insulin-tolerance tests (OGTT and ITT) were determined. The development of mechanical hypersensitivity of the hindpaws was determined using von Frey filaments. Moreover, the effect of the most common neuropathic pain drugs was evaluated on T2DM-induced mechanical allodynia. Finally, the density of PGP -9.5⁺ (a pan-neuronal marker) axons in the epidermis from the hindpaw glabrous skin was quantified.

Results: At 22–24 weeks after STZ injections, CAF + STZ mice had significantly higher glucose and insulin levels compared to CAF + VEH, STD + STZ, and STD + VEH mice, and developed glucose tolerance and insulin resistance. Skin mechanical sensitivity was detected as early as 12 weeks post-STZ injections and it was significantly attenuated by intraperitoneal acute treatment with amitriptyline, gabapentin, tramadol, duloxetine, or carbamazepine but not by diclofenac. The density of PGP-9.5⁺ nerve fibers was reduced in CAF + STZ mice compared to other groups.

Conclusion: This reverse translational study provides a painful DPN mouse model which may help in developing a better understanding of the factors that generate and maintain neuropathic pain and denervation of skin under T2DM and to identify mechanism-based new treatments.

Obesity and impairment of pancreatic β-cell function in early adulthood, independent of obesity age of onset: The Santiago Longitudinal Study

AIM

We investigated the relation of time of onset and length of obesity with biomarkers of β-cell function in early adulthood in an infancy cohort.

MATERIAL AND METHODS

In 1039 23-year-olds, body-mass index (BMI) was measured at multiple time-points from enrollment. BMI trajectories were interpolated with cubic polynomials. Fasting glucose, insulin and adiponectin were measured at 23 years. Homeostatic model assessment-insulin resistance (HOMA-IR), HOMA-S, HOMA-β, HOMA-adiponectin (AD) and disposition index (DI) were estimated. IR and non-alcoholic fatty liver (NAFL) were diagnosed. According to the BMI trajectory, five groups were defined: participants who were never obese (NOB); participants with obesity starting in adolescence and remained obese into adulthood (recent-onset obesity, ROB); participants who were obese in early childhood but transitioned to non-obesity as preadolescents (former obesity, FOB); participants who were obese in early childhood and remained obese into adulthood (persistent obesity, POB); participants with obesity starting in preadolescence and transitioned to non-obesity as adolescents (transient obesity; TOB).

RESULTS

Obesity was present in 47% of participants during at least one time-point. ROBs and POBs had higher insulin, HOMA-IR and HOMA-β, lower HOMA-S and DI, and higher prevalence of IR and NAFL at 23 years than NOBs, TOBs and FOBs. No differences were found in the β-cell functionality of NOBs, TOBs and FOBs.

CONCLUSIONS

Persistent and recent obesity are both related to IR, NAFL and a decline of β-cell function in emerging adulthood. Defeating obesity in childhood or adolescence allows reaching emerging adulthood with β-cell functioning similar to that of subjects who were NOB.

Evaluation of gingival and periodontal status in obese and non-obese type II diabetic patients - a cross sectional study

Objective

The aim of this study was to evaluate gingival and periodontal status in obese and non-obese type II Diabetic Patients.

Methods

The study population comprised of 75 subjects visiting the outpatient department of our institution, divided into three different groups, group 1 (obese diabetic), group 2 (non-obese diabetic), and group 3 (obese, non-diabetic). Diabetic status was assessed with HbA1c values and obesity status was assessed by body mass index (BMI) score greater than or equal to 30 kg/m². Gingival and periodontal status were assessed using the Gingival Index (GI) and Community Periodontal Index (CPI) respectively.

Results

The mean gingival index score in group 1, group 2, and group 3 were 1.58, 1.54, and 1.25, respectively. Gingival status was poor among obese and non-obese diabetic subjects (Groups 1 and 2) when compared with obese non-diabetic patients (Group 3). The periodontal status showed that periodontal pockets were increased in diabetic obese group (15.4%), followed by diabetic non obese (4.66%), and non-diabetic obese (2%) group respectively and loss of attachment was severe in diabetic obese group (60.7%), followed by diabetic non obese (45.9%) and non-diabetic obese (15.3%) respectively.

Conclusion

Gingival and periodontal status was poor in the obese diabetic group compared to non-obese diabetic and obese non diabetic group. Hence, the risk of gingivitis and periodontitis in obese diabetic patients should be addressed earlier to prevent further complications and achieve a good oral health status.

Tuina for diabetes with obesity: Protocol for a systematic review and meta-analysis

BACKGROUND

Obesity is an independent risk factor for the occurrence and development of diabetes. Patients with diabetes combined with obesity will face serious burdens such as increase in insulin resistance and difficulty in blood glucose control. As a safe, effective, economical, and simple intervention, Tuina is more acceptable to the public than drugs. The objective of this systematic evaluation and meta-analysis is to evaluate the efficacy and safety of Tuina for diabetes with obesity.

METHODS

We will search the following electronic databases: PubMed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure (CNKI), Sino Med, Wanfang, Chinese Clinical Trial Registry System, China Biomedical Literature Database (CBM). The time limit for retrieving studies is from establishment to November 2020 for each database. Randomized controlled clinical trials related to Tuina intervention on diabetes with obesity will be included. Data synthesis, sensitivity analysis, subgroup analysis as well as the assessment of bias risk will be conducted by using Stata V.13.0 and Review manager 5.3 software.

RESULTS

This study will provide a quantitative and standardized evaluation for the efficacy of Tuina therapy on diabetes with obesity.

CONCLUSION

This systematic review and meta-analysis will provide the high-quality evidence of whether Tuina is an effective intervention for diabetes with obesity.

REGISTRATION NUMBER

INPLASY2020110106.

Mindfulness Practice for Glycemic Control: Could it be a New Strategy for an Old Problem? A Systematic Review and Meta-Analysis

BACKGROUND

The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient's lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual's adherence. Therefore, equipping the patients with the necessary coping and self-care techniques may be an important step in managing diabetes.

OBJECTIVE

To evaluate the effect of interventions using established mindfulness-based protocols on glycemic control of individuals with T2DM.

METHODS

Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in English, Spanish and Portuguese languages.

STUDY SELECTION

Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected.

DATA EXTRACTION

Two authors independently assessed the risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence).

CONCLUSION

Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness have no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, large-scale trials are needed to evaluate the contribution of mindfulness to glycemic control in clinical practice. PROSPERO Registration ID: RD42020161940.

Effect of Metabolic Health and Obesity Phenotype on Risk of Diabetes Mellitus: A Population-Based Longitudinal Study

BACKGROUND

Epidemiologic evidence on body mass index (BMI)-metabolic status phenotypes and diabetes risk remains controversial, especially for metabolically healthy obesity (MHO). We aimed to examine the effect of metabolic health and obesity phenotype on diabetes risk in the Chinese population.

METHODS

A population-based cohort study was carried out. The baseline survey was conducted in 2017, with two follow-up visits in 2018 and 2020. Diabetes was defined based on the criteria of the World Health Organization. Robust generalized estimating equation models with a binary distribution using a log link and exchange structure were applied for the pooled analysis sample.

RESULTS

A total sample of 9623 observations was pooled for the longitudinal data analysis. The average follow-up time was 1.64 years per person and the overall incidence density of diabetes was 6.94% person-years. Decreased diabetes risk was found in metabolically healthy overweight phenotype (RR = 0.65; 95% CI = 0.47-0.90) and no significant associations were detected for the MHO individuals (RR = 0.99; 95% CI = 0.63-1.53) compared with those of metabolically healthy normal weight, in contrast to metabolically unhealthy normal weight (MU-NW) (RR = 1.81; 95% CI = 1.28-2.55), metabolically unhealthy overweight (MU-OW) (RR = 2.02; 95% CI = 1.57-2.61) and metabolically unhealthy obesity (MUO) (RR = 2.48; 95% CI = 1.89-3.26) phenotypes. Significant associations between BMI-metabolic status phenotypes and diabetes were found in both males and females.

CONCLUSION

The MUO phenotype needs to be accorded much more importance. MU-NW and MU-OW are also important component for targeted prevention. Our findings can be targeted for optimizing preventive strategies to mitigate the obviously increased prevalence of diabetes.

Targeting Orphan Nuclear Receptors NR4As for Energy Homeostasis and Diabetes

Orphan nuclear receptors are important members of the nuclear receptor family and may regulate cell proliferation, metabolism, differentiation, and apoptosis. NR4As, a subfamily of orphan nuclear receptors, have been reported to play key roles in carbohydrate and lipid metabolism and energy homeostasis. Popularity of obesity has resulted in a series of metabolic diseases such as diabetes and its complications. While imbalance of energy intake and expenditure is the main cause of obesity, the concrete mechanism of obesity has not been fully understood. It has been reported that NR4As have significant regulatory effects on energy homeostasis and diabetes and are expected to become new targets for discovering drugs for metabolic syndrome. A number of studies have demonstrated that abnormalities in metabolism induced by altered levels of NR4As may contribute to numerous diseases, such as chronic inflammation, tumorigenesis, diabetes and its complications, atherosclerosis, and other cardiovascular diseases. However, systematic reviews focusing on the roles of NR4As in mediating energy homeostasis and diabetes remain limited. Therefore, this article reviews the structure and regulation of NR4As and their critical function in energy homeostasis and diabetes, as well as small molecules that may regulate NR4As. Our work is aimed at providing valuable support for the research and development of drugs targeting NR4As for the treatment of obesity and related metabolic diseases.

Causal associations between urinary sodium with body mass, shape and composition: a Mendelian randomization study

Observational studies have found associations between urinary sodium (UNa) with obesity, body shape and composition; but the findings may be biased by residual confounding. The objective of this two-sample Mendelian randomization (MR) study was to analyze their causal associations in both sex-combined and sex-specific models. Genome-wide association studies of UNa, body mass index (BMI), BMI-adjusted waist-to-hip ratio (WHR), body fat (BF) percentage and estimated glomerular filtration rate (eGFR) were identified. We initially extracted fifty SNPs associated with UNa at significance level of 5 × 10^–8, but further removed those SNPs with potential horizontal pleiotropy. Univariable and multivariable MR with adjustment for eGFR were performed. Inverse-variance weighted MR was performed as the primary analysis, with MR-Egger methods as sensitivity analysis. The potential bidirectional association between BMI and UNa was investigated. All exposure and outcomes were continuous, and the effect measure was regression coefficients (beta) and their 95% confidence intervals (95% CI). The total sample size was up to 322 154. UNa was causally associated with increased BMI in both men [eGFR-adjusted beta 0.443 (0.163–0.724)] and women [0.594 (0.333–0.855)]. UNa caused BF percentage increase in men [0.622 (0.268–0.976)] and women [0.334 (0.007–0.662)]. UNa significantly elevated BMI-adjusted WHR in men [0.321 (0.094–0.548)], but not in women [0.170 (− 0.052 to 0.391)]. Additionally, we found that BMI causally increased UNa [0.043 (0.023–0.063)]. UNa increased BMI and BF percentage. Salt intake affects male body shape by increasing BMI-adjusted WHR, but showed no effects on female body shape. The bidirectional association between BMI and UNa suggested that salt reduction measures and weight reduction measures should be implemented simultaneously to break the vicious cycle and gain more health benefits.

Characterisation of gut microbiota of obesity and type 2 diabetes in a rodent model

Various studies have suggested that the gut microbiome interacts with the host and may have a significant role in the aetiology of obesity and Type 2 Diabetes (T2D). It was hypothesised that bacterial communities in obesity and T2D differ from control and compromise normal interactions between host and microbiota. Obesity and T2D were developed in rats by feeding a high-fat diet or a high-fat diet plus a single low-dose streptozotocin administration, respectively. The microbiome profiles and their metabolic potentials were established by metagenomic 16S rRNA sequencing and bioinformatics. Taxonomy and predicted metabolism-related genes in obesity and T2D were markedly different from controls and indeed from each other. Diversity was reduced in T2D but not in Obese rats. Factors likely to compromise host intestinal, barrier integrity were found in Obese and T2D rats including predicted, decreased bacterial butyrate production. Capacity to increase energy extraction via ABC-transporters and carbohydrate metabolism were enhanced in Obese and T2D rats. T2D was characterized by increased proinflammatory molecules. While obesity and T2D show distinct differences, results suggest that in both conditions Bacteroides and Blautia species were increased indicating a possible mechanistic link.

Development and Validation of a Novel Model for Predicting the 5-Year Risk of Type 2 Diabetes in Patients with Hypertension: A Retrospective Cohort Study

Background

Hypertension is now common in China. Patients with hypertension and type 2 diabetes are prone to severe cardiovascular complications and poor prognosis. Therefore, this study is aimed at establishing an effective risk prediction model to provide early prediction of the risk of new-onset diabetes for patients with a history of hypertension.

Methods

A LASSO regression model was used to select potentially relevant features. Univariate and multivariate Cox regression analyses were used to determine independent predictors. Based on the results of multivariate analysis, a nomogram of the 5-year incidence of T2D in patients with hypertension in mainland China was established. The discriminative capacity was assessed by Harrell's C-index, AUC value, calibration plot, and clinical utility.

Results

After random sampling, 1273 and 415 patients with hypertension were included in the derivation and validation cohorts, respectively. The prediction model included age, body mass index, FPG, and TC as predictors. In the derivation cohort, the AUC value and C-index of the prediction model are 0.878 (95% CI, 0.861-0.895) and 0.862 (95% CI, 0.830-0.894), respectively. In the validation cohort, the AUC value and C-index of the prediction model were 0.855 (95% CI, 0.836-0.874) and 0.841 (95% CI, 0.817-0.865), respectively. The calibration plots demonstrated good agreement between the estimated probability and the actual observation. Decision curve analysis shows that nomograms are clinically useful.

Conclusion

Our nomogram can be used as a simple, affordable, reasonable, and widely implemented tool to predict the 5-year T2D risk of hypertension patients in mainland China. This application helps timely intervention to reduce the incidence of T2D in patients with hypertension in mainland China.

PPARα mediates night neon light-induced weight gain: role of lipid homeostasis

Rationale: Light pollution leads to high risk of obesity but the underlying mechanism is not known except for the influence of altered circadian rhythm. Peroxisome proliferator-activated receptor α (PPARα) regulates lipid metabolism, but its role in circadian-related obesity is not clear. Methods: Wild-type (WT) and Ppara-null (KO) mice on a high-fat diet (HFD) were treated with neon light at night for 6 weeks. Body weights were recorded and diet consumption measured. The hypothalamus, liver, adipose and serum were collected for mechanism experimentation. Results: WT mice on a HFD and exposed to night neon light gained about 19% body weight more than the WT control mice without light exposure and KO control mice on a HFD and exposed to night neon light. The increase in adipose tissue weight and adipocyte size led to the differences in body weights. Biochemical analysis suggested increased hepatic lipid accumulated and increased transport of lipid from the liver to peripheral tissues in the WT mice that gained weight under neon light exposure. Unlike KO mice, the expression of genes involved in lipid metabolism and the circadian factor circadian locomotor output cycles kaput (CLOCK) in both liver and adipose tissues were elevated in WT mice under neon light exposure. Conclusions: PPARα mediated weight gain of HFD-treated mice exposed to night neon light. More lipids were synthesized in the liver and transported to peripheral tissue leading to adaptive metabolism and lipid deposition in the adipose tissue. These data revealed an important mechanism of obesity induced by artificial light pollution where PPARα was implicated.

Establishment of a Risk Prediction Model for Non-alcoholic Fatty Liver Disease in Type 2 Diabetes

INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is becoming more prevalent in patients with type 2 diabetes mellitus (T2DM) and can contribute to serious liver damage in this patient population. The aim of this study was to develop a risk nomogram for NAFLD in a Chinese population with T2DM.

METHODS

A questionnaire survey, physical examination and biochemical indicator testing were performed on 874 patients with T2DM, and the collected data were used to evaluate the risk to develop NAFLD in T2DM patients. The least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection by running cyclic coordinate descent with k-fold (tenfold in this case) cross-validation. Multivariable logistic regression analysis was applied to build a predictive model by introducing the predictors selected from the LASSO regression analysis. The nomogram was developed based on the selected variables visually. A calibration plot, receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to validate the model, with further assessment by external validation.

RESULTS

A total of nine predictors, namely sex, age, total cholesterol (TC), body mass index (BMI), waistline, diastolic blood pressure (DBP), serum uric acid (SUA), course of disease and high-density lipoprotein-cholesterol (HDL-C), were identified by LASSO regression analysis from a total of 24 variables studied. The model constructed using these nine predictors displayed medium prediction ability, with an area under the ROC of 0.848 in the training set and 0.809 in the validation set. The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 48 and 91%, which was found to be between 44 and 82% in the external validation.

CONCLUSION

Introducing sex, age, TC, BMI, waistline, DBP, SUA, course of disease and HDL-C into the risk nomogram increased its usefulness for predicting NAFLD risk in patients with T2DM.

Potential contribution of the gut microbiota to hypoglycemia after gastric bypass surgery

Obesity has become a global health problem. Lifestyle modification and medical treatment only appear to yield short-term weight loss. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it sustains weight reduction and results in the remission of obesity-associated comorbidities for obese individuals. However, patients who undergo this surgery may develop hypoglycemia. To date, the diagnosis is challenging and the prevalence of post-RYGB hypoglycemia (PRH) is unclear. RYGB alters the anatomy of the upper gastrointestinal tract and has a combined effect of caloric intake restriction and nutrient malabsorption. Nevertheless, the physiologic changes after RYGB are complex. Although hyperinsulinemia, incretin effects, dysfunction of β-cells and α-cells, and some other factors have been widely investigated and are reported to be possible mediators of PRH, the pathogenesis is still not completely understood. In light of the important role of the gut microbiome in metabolism, we hypothesized that the gut microbiome might also be a critical link between RYGB and hypoglycemia. In this review, we mainly highlight the current possible factors predisposing individuals to PRH, particularly related to the gut microbiota, which may yield significant insights into the intestinal regulation of glucose metabolic homeostasis and provide novel clues to improve the treatment of type 2 diabetes mellitus.

Drp1 mediates high glucose-induced mitochondrial dysfunction and epithelial-mesenchymal transition in endometrial cancer cells

This study aims to clarify the role and molecular mechanism of dynamin-related protein 1 (Drp1)-mediated mitochondrial homeostasis in high glucose (HG)-induced endometrial cancer (EC). Normal endometrium and tumor tissues of EC patients with normal and HG levels were collected, and Drp1 and p-Drp1 expression levels were detected by immunohistochemistry. Human EC cells were cultured with different glucose concentrations, and Drp1 and p-Drp1 expression levels were evaluated by Western blotting. Cell models of control and siDrp1 groups under normal and HG conditions were established, and subsequent functional experiments were conducted. Histology and in vitro experiments showed that the HG environment increased Drp1 activation, which could lead to mitochondrial dysfunction. Moreover, the imbalance of mitochondrial homeostasis mediated by Drp1 resulted in cell dysfunction, including altered glucose metabolism and increased epithelial-mesenchymal transition (EMT), migration and invasion. All these changes caused by HG could be partially alleviated by Drp1 knockdown. This study revealed that Drp1 was involved in the progression of EC associated with HG, and Drp1 might be a new potential therapeutic target for EC patients with diabetes.

Interplay Between Diabetes and Pancreatic Ductal Adenocarcinoma and Insulinoma: The Role of Aging, Genetic Factors, and Obesity

Epidemiologic analyses have shed light on an association between type 2 diabetes (T2D) and pancreatic ductal adenocarcinoma (PDAC). Recent data also suggest a potential relationship between T2D and insulinoma. Under rare circumstances, type 1 diabetes (T1D) can also be implicated in tumorigenesis. The biological mechanisms underlying such relationships are extremely complex. Some genetic factors contributing to the development of T2D are shared with pancreatic exocrine and endocrine tumors. Obesity and overweight can also contribute to the initiation and severity of T2D, while aging may influence both endocrine and exocrine tumors. Finally, pharmacological treatments of T2D may have an impact on PDAC. On the other hand, some treatments for insulinoma can trigger diabetes. In the present minireview, we discuss the cellular and molecular mechanisms that could explain these interactions. This analysis may help to define new potential therapeutic strategies.

Identification of Reactive Hypoglycemia with Different Basic BMI and Its Causes by Prolonged Oral Glucose Tolerance Test

PURPOSE

To identify the population susceptible to reactive hypoglycemia and explain the possible reasons for their susceptibility.

METHODS

Ninety-four patients were divided into normal weight, overweight and obese groups before a 75-gram prolonged oral glucose tolerance test (POGTT). The incidence of reactive hypoglycemia (blood glucose ≤3.1 mmol/L or 55 mg/dL at points of 0-4 hours) was compared among three groups, and blood glucose and insulin levels were monitored simultaneously from 0 - 4 hours to assess the level of insulin resistance and insulin sensitivity. Furthermore, the degree of insulin resistance among three groups and within each subgroup (whether hypoglycemia events occurred) was compared.

RESULTS

Among the three groups, the incidence of hypoglycemia was significantly different at 3 (P=0.033) and 4 hours (P=0.020). At 4 hours, the incidence of reactive hypoglycemia in the obese group was approximately 3 times that in the normal weight group. The insulin level in obese group at 4 hours was nearly 4 times higher than that in normal group, and the same result also exists in the same subgroup of different groups. In addition, the hypoglycemia subgroup of obese group had higher insulin level than non-hypoglycemia (P=0.000). The homeostasis model assessment of insulin resistance index increased with increasing BMI among the three groups (P=0.000), while the Matsuda index decreased (P=0.000). The comparison of the homeostasis model assessment of insulin resistance index between subgroups in each group showed that the P values were 0.021, 0.038 and 0.085, successively, and the P values for the Matsuda index were 0.019, 0.013 and 0.119, respectively.

CONCLUSION

Obese people has higher rate of reactive hypoglycemia than other groups in POGTT, in which insulin resistance may play an important role. But patients who are evaluated for reactive hypoglycemia need to be observed for at least 3 or 4 hours.

Development and Validation of a Nomogram to Predict Type 2 Diabetes Mellitus in Overweight and Obese Adults: A Prospective Cohort Study from 82938 Adults in China

BACKGROUND

The twin epidemic of overweight/obesity and type 2 diabetes mellitus (T2DM) is a major public health problem globally, especially in China. Overweight/obese adults commonly coexist with T2DM, which is closely related to adverse health outcomes. Therefore, this study aimed to develop risk nomogram of T2DM in Chinese adults with overweight/obesity.

METHODS

We used prospective cohort study data for 82938 individuals aged ≥20 years free of T2DM collected between 2010 and 2016 and divided them into a training (n = 58056) and a validation set (n = 24882). Using the least absolute shrinkage and selection operator (LASSO) regression model in training set, we identified optimized risk factors of T2DM, followed by the establishment of T2DM prediction nomogram. The discriminative ability, calibration, and clinical usefulness of nomogram were assessed. The results were assessed by internal validation in validation set.

RESULTS

Six independent risk factors of T2DM were identified and entered into the nomogram including age, body mass index, fasting plasma glucose, total cholesterol, triglycerides, and family history. The nomogram incorporating these six risk factors showed good discrimination regarding the training set, with a Harrell's concordance index (C-index) of 0.859 [95% confidence interval (CI): 0.850-0.868] and an area under the receiver operating characteristic curve of 0.862 (95% CI: 0.853-0.871). The calibration curves indicated well agreement between the probability as predicted by the nomogram and the actual probability. Decision curve analysis demonstrated that the prediction nomogram was clinically useful. The consistent of findings was confirmed using the validation set.

CONCLUSIONS

The nomogram showed accurate prediction for T2DM among Chinese population with overweight and obese and might aid in assessment risk of T2DM.

The impact of body weight and diabetes on new-onset atrial fibrillation: a nationwide population based study

Background

Being obese or underweight, and having diabetes are important risk factors for new-onset atrial fibrillation (AF). However, it is unclear whether there is any interaction between body weight and diabetes in regard to development of new-onset AF. We aimed to evaluate the role of body weight status and various stage of diabetes on new-onset AF.

Methods

This was a nationwide population based study using National Health Insurance Service (NHIS) data. A total of 9,797,418 patients who underwent national health check-ups were analyzed. Patients were classified as underweight [body mass index (BMI) < 18.5], normal reference group (18.5 ≤ BMI < 23.0), upper normal (23.0 ≤ BMI < 25.0), overweight (25.0 ≤ BMI < 30.0), or obese (BMI ≥ 30.0) based on BMI. Diabetes were categorized as non-diabetic, impaired fasting glucose (IFG), new-onset diabetes, diabetes < 5 years, and diabetes ≥ 5 years. Primary outcome end point was new-onset AF. New-onset AF was defined as one inpatient or two outpatient records of International Classification of Disease, Tenth Revision (ICD-10) codes in patients without prior AF diagnosis.

Results

During 80,130,161 patient*years follow-up, a total of 196,136 new-onset AF occurred. Obese [hazard ration (HR) = 1.327], overweight (HR = 1.123), upper normal (HR = 1.040), and underweight (HR = 1.055) patients showed significantly increased risk of new-onset AF compared to the normal reference group. Gradual escalation in the risk of new-onset AF was observed along with advancing diabetic stage. Body weight status and diabetes were independently associated with new-onset AF and at the same time, had synergistic effects on the risk of new-onset AF with obese diabetic patients having the highest risk (HR = 1.823).

Conclusions

Patients with obesity, overweight, underweight, and diabetes had significantly increased risk of new-onset AF. Body weight status and diabetes had synergistic effects on the risk of new-onset AF. The risk of new-onset AF increased gradually with advancing diabetic stage. This study suggests that maintaining optimal body weight and glucose homeostasis might prevent new-onset AF.

Current Knowledge of IL-6 Cytokine Family Members in Acute and Chronic Kidney Disease

Healthy kidneys are important for the efficient regulation of metabolism. However, there is an ever increasing population of patients suffering from both acute and chronic kidney diseases that disrupt this homeostasis. This review will explore the emerging roles that interleukin 6 (IL-6) cytokine family members play in the pathogenesis of kidney disease. The IL-6 family of cytokines are involved in a diverse range of physiological functions. In relation to kidney disease, their involvement is no less diverse. Evidence from both preclinical and clinical sources show that IL-6 cytokine family members can play either a deleterious or protective role in response to kidney disease. This appears to be dependent on the type of kidney disease in question or the specific cytokine. Current attempts to use or target IL-6 cytokine family members as therapies of kidney diseases will be highlighted throughout this review. Finally, the involvement of IL-6 cytokine family members in kidney disease will be presented in the context of three regularly overlapping conditions: obesity, hypertension and diabetes.